diff --git "a/data_train.csv" "b/data_train.csv" --- "a/data_train.csv" +++ "b/data_train.csv" @@ -1,76113 +1,3 @@ -,text -0,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ketanserin is -, with the following options: A: 5-HT,1B antagonist, B: 5-HT2 antagonist, C: 5-HT1A antagonist, D: 5-HT1P. antagonist - -### Response: -Ans. is 'b' i.e., 5-HT2 antagonist o Ketanserin and ritanserin are useful as antihypertensive agents. It is important to know that these drugs have additional a receptor blocking property and antihypertensive effect is due to a-blockade, not due to 5HT2A/2C blockade.SEROTONERGIC RECEPTORSo There are four families of 5-HT receptors -5HT1, 5HT2, 5HT3, 5HT4-7o All 5-HT receptors (except 5-HT3) are G protein coupled receptors. 5 HT3 is a ligand gated cation Na+, K+) channel - ionotropic receptor.1. 5HT1 (Five subtypes 5HT1A,B,D,E,F)o All types of 5-HT1 receptors inhibit adenylyl cyclase.o These receptors function primarily as autoreceptors in brain - inhibit 5-HT release or firing of 5-HT neurons.o The most important locations of 5HT1A receptor are raphe nuclei of brainstem and hippocampus.o Buspiron, ipsapirone, gepirone (antianxiety drugs) act as partial agonists on 5HT1A receptors.o 5HT1D regulates dopamenergic tone in substantia nigra basal ganglia.o 5TH1B/1D cause constriction of cranial blood vessels,o The antimigraine drug sumatriptan is a selective 5-HT1B/1D agonist.2. 5-HT2o Coupled to phospholipase lc' and function through IP3/DAGo 5 HT2A is the most widely expressed postjunctional 5-HT receptor.o 5HT 2A/2C receptor is responsible for most of the direct action of serotonine.o Important antagonists of these receptors are : -Ketanserin and ritanserin are useful as antihypertensive agents. It is important to know that these drugs have additional a receptor blocking property' and antihypertensive effect is due to a-blockade, not due to 5HT2A/2C blockade.Clozapine, resperidone are used as antipsychotics.Methylsergide is used in migraine.Cyproheptadine blocks 5HT2A, HI histaminic and muscarinic receptors. It increases appetite and can be used in children to promote weight gain.3. 5-HT3o It is the only 5-HT receptor which is a ligand gated cation Na+, K+ channel.o It mediates most of the indirect and reflex actions of 5-HT at:1. Area postrema and nucleus tractus solitarius in brain stem - nausea and vomiting.2. Nerve ending in myentric plexus - | peristalsis3. Somatic and autonomic nerve ending - pain, itch, coronaiy chemoreflex.o Stimulation of 5-HT3 receptor is responsible for vomiting induced by anticancer drugs.o 5-HT3 receptor antagonists (ondansetron, granisetron and tropisetron) are DOCs for chemotherapy induced vomiting.4. HT4o Present on mucosa, plexuses and smooth muscles of the gut - | intestinal secretion and peristalasis.o Cisapride, renzapride and tegaserod are selective 5-HT4 agonists - useful in gastroesophageal reflux disease.o Most direct actions of serotonin are mediated by 5 - HT2 receptors.o Most indirect and reflex actions of serotonin are mediated by 5-HT3 receptors. -### End" -1,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The advantages of cryosurgery over electrocau-terization are all except:, with the following options: A: Less discomfort to the patient, B: Postoperative bleeding is much less, C: Postoperative vaginal discharge is also much less, D: Cervical stenosis is extremely rare - -### Response: -After cryosurgery there will be profuse vaginal discharge for about 2–3 weeks -### End" -2,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a plasma expander similar to the albumin, has a molecular weight of 30,000 and causes less hypersensitivity reactions but should be used with caution?, with the following options: A: Hydroxy ethyl starch (HES), B: Dextran, C: Polygeline, D: Polypyrrolidone - -### Response: -Ans. c. Polygeline Polygeline is a plasma expander similar to the albumin, has a molecular weight of 30,000 and causes less hypersensitivity reactions but should be used with caution. Polygeline Polypeptide with average MW 30,000Q Exes oncotic pressure similar to albuminQ Not antigenic, hypersensitivity reactions are rareQ but should be watched for. Does not interfere with grouping and cross matching of bloodQ Remains stable for three years. It is not metabolized in the body; excreted slowly by the kidney. Expansion of plasma volume lasts for 12 hours. It is more expensive than dextran It can also be used for priming of hea-lung and dialysis machines -### End" -3,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a measure of stroke volume?, with the following options: A: Left ventricular end diastolic volume minus left ventricular end systolic volume, B: Ejection fraction times left ventricular end diastolic volume, C: Ejection fraction times cardiac output, D: Cardiac output/hea rate - -### Response: -Stroke vol is the volume of blood pumped from left ventricle per beat SV can be calculated by 1) CO =SV*HR 2)Ejection fraction= SV/ End diastolic. volume 3) SV= EDV-ESV of each ventricle -### End" -4,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Excessive secretion of ACTH causes:, with the following options: A: Cushing's syndrome, B: Addison's disease, C: Myxoedema, D: Thyrotoxicosis - -### Response: -Ans. A. Cushing's syndromeOverproduction of ACTH leads to Cushing's syndrome. It is characterized by hyper-pigmentation and increased production of adrenocorticosteroid. These symptoms lead to negative nitrogen balance, impaired glucose tolerance, hypertension, edema, muscle atrophy etc. -### End" -5,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of following statements are included in 2005 American Heart Association – a) Newborn CPR is applied from first hour after birth until the newborn leaves the hospitalb) Newborn CPR is applied from first hour after birth until first 24 hoursc) Child CPR guidelines for lay rescuer apply to children from 1 to 8 years of aged) Child CPR guidelines for healthcare providers apply to children from 1-8 years of agee) Hospital paediatric advanced life support guideline for paediatric patient extend age to 16–18 years, with the following options: A: acd, B: bde, C: ace, D: ade - -### Response: -Age delineation according to AHA guidelines for CPR and ECC - -Differences in the etiology of cardiac arrest between child and adult victims necessitate some differences in the recommended resuscitation sequence for infant and child victims compared with the sequence used for adult victims. Because there is no single anatomic or physiologic characteristic that distinguishes a ""child"" victim from an ""adult"" victim and no scientific evidence that identifies a precise age to initiate adult rather than child CPR techniques, the ECC scientists made a consensus decision for age delineation that is based largely on practical criteria and ease of teaching. -In these 2005 guidelines, the recommendations for newborn CPR apply to newborns in the first hours after birth until the newborn leaves the hospital. Infant CPR guidelines apply to victims less than approximately 1 year of age. -Child CPR guidelines for the lay rescuer apply to children about 1 to 8 years of age, and adult guidelines for the lay rescuer apply to victims about 8 years of age and older. To simplify learning for lay rescuers retraining in CPR and AED apropos the 2005 guidelines, the same age divisions for children are used in the 2005 guidelines as in the ECC guidelines 2000. -Child CPR guidelines for healthcare providers apply to victims from about 1 year of age to the onset of adolescence or puberty (about 12 to 14 years of age) as defined by the presence of secondary sex characteristics. Hospitals (particularly children's hospitals) or pediatric intensive care units may choose to extend the use of Pediatric Advanced Life Support (PALS) guidelines to pediatric advanced of all ages (generally up to about 16 to 18 years of age) rather than use onset of puberty for the application of ACLS versus PALS guidelines. -### End" -6,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preferred procedure for obtaining endometrial sample for histopathology is, with the following options: A: Dilatation and curettage, B: Dilatation and evacuation, C: Endometrial aspiration, D: Hysteroscopy - -### Response: -Endometrial aspiration should be the preferred procedure for obtaining endometrial sample for histopathology. If endometrium is thick on imaging, but where HPE is inadequate or atrophic, hysteroscopy should be performed to rule out polyps. Dilatation and curettage should not be the procedure of choice for endometrial assessment. Reference: Novak's gynaecology; 14th edition; Chapter 14; Benign Diseases of the Female Reproductive Tract -### End" -7,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a suspected case of death due to which of the following poison cadaveric rigidity lasts longer than usual?, with the following options: A: Lead, B: Arsenic, C: Mercury, D: Copper - -### Response: -Postmoem rigidity is prolonged in arsenic poisoning. Convulsions prior to death can cause prolongation of rigor mois, arsenic poison is found to cause convulsions resulting in prolongation of rigor mois. Ref: Forensic Medicine and Toxicology By John Dixon Mann, Page 453 -### End" -8,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aim of damage control laparotomy are:, with the following options: A: Arrest hemorrhage, B: Prevent Coagulopathy, C: Control contamination, D: All - -### Response: -Ans is A(Arrest hemorrhage), B(Prevent Coagulopathy) & C(Control contamination) -### End" -9,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Magistrate inquest not needed in: JIPMER 14, with the following options: A: Homicide, B: Exhumation, C: Police custody death, D: Dowry death - -### Response: -Ans. Homicide -### End" -10,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19 year young patient with sclerotic lesion at diaphysis. What is the MOST likely diagnosis?, with the following options: A: Osteoid osteoma, B: Ewings sarcoma, C: Osteoclastoma, D: Metastasis - -### Response: -This patient most likely has osteoid osteoma which is a benign bone forming tumor characterized by small size, limited growth potential and dispropoionate pain. It usually affects children and adolescents. It commonly involves diaphysis of long bones, paicularly in the proximal humerus. Patients usually presents with pain with nocturnal exacerbations. It is usually relieved with NSAIDS. On X ray it appears as dense coical sclerosis surrounding a radiolucent nidus. Ewing's sarcoma affects long bones such as femur, tibia or humerus in young and affects flat bones in young patients. In the long bones, tumor almost always affects the metaphysis or diaphysis. X ray shows onion peel appearance due to alternate layers of reactive new bone formation and the tumor tissue. Osteosarcoma is a highly malignant bone tumor, it affects metaphysis of long bones. Ref: Pathology and Genetics of Tumours of Soft Tissue and Bone edited by Christopher D. M. Fletcher, page 260. Sho Textbook of Surgery By Roy, page 387 -### End" -11,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Residual chlorine level after disaster like flood ?, with the following options: A: 0.7 mg/litre, B: 1.5 mg/litre, C: 2 mg/litre, D: 3 mg/litre - -### Response: -Ans. is 'a' i.e., 0.7 mg/litre Principles of chlorination Water should be clear and free from turbidity. Turbidity impedes efficient chlorination. The chlorine demand of the water should be estimated. It is the amount of chlorine that is needed to destroy bacteria and to oxidize all the organic matter and ammoniacal substances present in water. Chlorine demand of water is the difference between the amount of chlorine added to the water and the amount of residual chlorine remaining at the end of specific period of contact (usually 60 minutes) at a given temperature and pH of the water. The point at which the chlorine demand of the water is met is called break point chlorination. If fuher chlorine is added beyond break point, free chlorine begins to appear in water. The presence of free residual chlorine for a contact period of at least one hour is esential to kill bacteria and virus. The minimum recommended concentration of free chlorine is 0.5mg/1 for one hour. This free residual chlorine provides margin of safety against subsequent microbial contamination. The sum of the chlorine demand of the specific water plus the free residual chlorine of .5 mg/L constitutes the correct does of chlorine to be applied. It is woh noting here that recommended residual chlorine level for drinking water is 0.5 mg/ litre, while for swimming pool sanitation it is 1.0 mg/ litre and for water bodies & post disaster it is 0.7 mg/litre. -### End" -12,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following influenza is most deadly?, with the following options: A: H1N1, B: H2N2, C: H3N2, D: H3N8 - -### Response: -(A) H1N1 > Respiratory infection popularly known as SWINE FLU is caused by an influenza virus first recognized in spring 2009, near the end of the usual Northern Hemisphere flu season.> New virus, 2009 H1N1, spreads quickly and easily. A few months after the first cases were reported, rates of confirmed H1N1-related illness were increasing in almost all parts of the world. As a result, the World Health Organization declared the infection a global pandemic. That official designation remained in place for more than a year. -### End" -13,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bitemporal hemianopia can be due to:, with the following options: A: Third ventricle tumour, B: Meningioma of sella diaphragmatica, C: Calcarine coex infarction, D: Aneurysm of basilar aery - -### Response: -Ans. Meningioma of sella diaphragmatica -### End" -14,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Flask shaped hea is seen in -, with the following options: A: Ebstein anomaly, B: Pericardial effusion, C: TOF, D: TAPVC - -### Response: -Flask shaped hea / Pear shaped / Money shaped hea is seen in Pericardial effusion. Boot shaped / Coer-en-sabot hea is seen in TOF. Snowman hea / Figure of 8 appearance is seen in TAPVC. Pulmonary oligemia is an xray finding of Ebsteins anamoly. -### End" -15,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bilateral loss of ankle jerk and extensor plantar response is seen in:, with the following options: A: Amyotrophic lateral sclerosis, B: Freidrich's ataxia, C: Tabes dorsalis, D: Lead poisoning - -### Response: -Answer is B (Friedrich's ataxia): Absent deep tendon reflexes despite coicospinal tract involvement with an extensor plantar reflex is characteristic of Friedrich's ataxia. Disorder Pyramidal tract Posterior column Deep tendon Planter Associations involvement involvement reflexes Neurological Others Friedrich's ataxia Present Present Areflexia"" Extensor - Wide based - Cardiomyopathy (genetic) (Areflexia despite coicospinal involvement) Q ataxia - Nystagmus - Dysahria - Optic atrophy - Skeletal abnormality - Dysmetria - Diabetes mellitus SACD Present Present Exaggerated Extensor Spastic gait Low serum B12 (4, B12) usuallyQ (may be decreased increased or absent) (initially ataxic) megaloblastic anemia Tabes dorsalis Absent Absent AreflexiaQ Absent Argyll Atonic bladder (teiary syphilis) Robeson pupil -### End" -16,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least common quadrant of cancer breast, with the following options: A: Superior Outer, B: Inferior Outer, C: Sub areolar, D: Lower inner quadrant - -### Response: -Ans. (d) Lower Inner Quadrant* MC site - Upper outer (60%)* Central/areolar (12%)* Upper Inner (12%)* Lower Outer (10%)* Least Common site - Lower Inner (6%) -### End" -17,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following causes the opening of the eustachian tube, with the following options: A: Salpingopharyngeus, B: Levator veli palatini, C: Tensor veli palatini, D: None of the above - -### Response: -The medial fibres of tensor veli palatini are attached to the lateral lamina of the tube and when they contract they help to open the tube lumen. These fibres also called dilator tube muscles. -### End" -18,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Floating teeth is seen in:, with the following options: A: Hyperparathyroidism, B: Hypoparathyroidism, C: Rickets, D: Scurvy - -### Response: -Ans. Hyperparathyroidism -### End" -19,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thickness of lead apron is, with the following options: A: 0.25 mm, B: 0.3 mm, C: 0.4 mm, D: 0.5 mm - -### Response: -Thickness of lead apron is 0.5 mm. -### End" -20,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurolathyrism is due to ingestion of -, with the following options: A: Ergot alkaloid, B: Crotolaric seeds, C: Khesari Dal, D: Sanguinarine - -### Response: -Ans. is 'c' i.e., Khesari Dal DiseaseToxinAdulterantLathyrismBOAAKhesari Dal (Lathyrus sativus)Epidemic DropsySanguinarineArgemone mexicana (oil)Endemic AscitesPyrrolizidine alkaloidsCrotolaria seeds (,Jhunjhunia)AflatoxicosisAflatoxinAspergillus flavus/parasiticusErgotismClavine alkaloidsClaviceps fusiformis -### End" -21,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cusco's speculum is -, with the following options: A: Double bladed posterior vaginal speculum, B: Bivalve selfretaining vaginal speculum, C: Double bladed selfretaining posterior vaginal speculum, D: Bivalve double bladed vaginal speculum - -### Response: -Ans. is 'b' i.e., Bivalve self retaining vaginal speculumCusco's self-retaining bivalved speculum is a surgical instrument used for vaginal and cervical examinationIt limits the visualization of the vaginal walls.It is used to visualize the cervix and the vaginal fornixes for the local cause of APH.It is also used for minor procedures like pap smear and IUCD inseion.It is also used to detect the leakage of liquor from the cervical os in case of suspected PROM. -### End" -22,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which vessel causes Wallenburgs syndrome is:, with the following options: A: Pontine, B: Posterior Cerebral, C: Posterior inferior cerebellar aery, D: Veebral aery - -### Response: -Posterior inferior cerebellar aery -### End" -23,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An undifferentiated malignant tumour on immunohistochemical stain shows cytoplasmic positivity of most of the tumor cells for cytokeratin. The most probable tumor is:, with the following options: A: Sarcoma, B: Lymphoma, C: Carcinoma, D: Malignant Melanoma - -### Response: -. Carcinoma -### End" -24,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of emphysema is: March 2013, with the following options: A: Centriacinar, B: Panacinar, C: Paraseptal, D: Irregular - -### Response: -Ans. A i.e. Centriacinar Emphysema It is COPD. It is defined pathologically as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. It frequently occurs in association with chronic bronchitis. Patients have been classified as having COPD with either emphysema or chronic bronchitis predominance. The 3 described morphological types of emphysema are centriacinar, panacinar, and paraseptal. Centriacinar emphysema begins in the respiratory bronchioles and spreads peripherally. Also termed centrilobular emphysema, this form is associated with long-standing cigarette smoking and predominantly involves the upper half of the lungs. - Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs. Panacinar emphysema generally is observed in patients with homozygous alfal antitrypsin deficiency. In people who smoke, focal panacinar emphysema at the lung bases may accompany centriacinar emphysema. - Paraseptal emphysema, also known as distal acinar emphysema, preferentially involves the distal airway structures, alveolar ducts, and alveolar sacs. The process is localized around the septae of the lungs or pleura. Although airflow frequently is preserved, the apical bullae may lead to spontaneous pneumothorax. Giant bullae occasionally cause severe compression of adjacent lung tissue. -### End" -25,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malignant otitis externa affects which Cranial nerve:, with the following options: A: 7th, B: 8th, C: 9th, D: 10 - -### Response: -Ans. (a) 7thRef: Dhingra's ENT 6th edJ 52-53* Malignant otitis externa is an inflammatory condition caused by pseudomonas infection usually in elderly diabetic & those on immune-compromised drugs.* Facial nerve paralysis is common. -### End" -26,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child undergone bilateral adrenalectom, later he developed headache, visual field defect, Hyper pigmentation of skin,what is the most probable diagnosis?, with the following options: A: Pitutary adenoma, B: Allgrove syndrome, C: Wolman syndrome, D: Nelson syndrome - -### Response: -Nelsom syndrome :  -It is complication after bilateral adrenalectomy due to rapid enlargement of pre - existing ACTH producing adenoma with above clinical features. -### End" -27,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are the markers for malignant germ cell tumors of ovary except:, with the following options: A: CA-125, B: Alpha fetoprotein, C: HCG, D: LDH - -### Response: -- most germ cell tumors secrete some tumor marker. - endodermal sinus tumors secrete alpha fetoprotein. - human chorionic gonadotrophin is secreted by choriocarcinoma. - tumors markers like placental alkaline phosphatase and lactic dehydrogenase may be elevated in dysgerminoma. - CA-125 is tumor marker in epithelial ovarian cancer. Reference : textbook of gynaecology Sheila balakrishnan, 2nd edition, pg no: 282 <\p> -### End" -28,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One-year-old male child presented with poor urinary stream since birth. The investigation of choice for evaluation is –, with the following options: A: Voiding cystourethrography (VCUG), B: USG bladder, C: Intravenous urography, D: Uroflowmetry - -### Response: -Poor urinary stream since birth suggests urinary tract obstruction (usually intravesical). -Most common cause of urinary tract obstruction in a male child is → posterior urethral valve. -And the best diagnostic method for posterior urethral valve is voiding cystourethrogram. -### End" -29,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Doges Cap Sign is ?, with the following options: A: Air under Diaphragm, B: Air in Morrisons Pouch, C: Air on either side of Bowel Wall, D: Air under central tendon of Diaphgram - -### Response: -A) Air in Morrisons Pouch - Doges Cap Sign. B) Air on either side of Bowel Wall - Riglers Sign. C) Air under central tendon of Diaphgram - Cupola Sign. -### End" -30,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding furosemide true statement is, with the following options: A: Acute pulmonary edema is an indication, B: Acts on PCT, C: Mild diuresis, D: Given only by parenteral route - -### Response: -Furosemide possesses vasodilatory action which is responsible for quick relief in LVF and pulmonary edema.It can be used orally as well as parenterally -### End" -31,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about TGA –, with the following options: A: Cyanotic disease, B: Aorta anterior to pulmonary artery, C: VSD, D: All of these - -### Response: -In TGA aorta lies anterior and to the right of puhnonary artery. -In patients with TGA the oxygenated pulmonary venous blood recirculates in the lungs whereas deoxygenated systemic venous blood recirculates in the systemic circulation --> Pulmonary artery saturation is always higher than aortic saturation (opposite to normal person). -Because oxygenated blood is not available for systemic circulation, survival depends on the mixing available between the two circulation. -So, patients with TGA can be divided into : - - - -TGA with intact ventricular septum -TGA with VSD. - -i) TGA with intact septum - -The mixing of blood depends on atrial communication. -Most of the time atrial communication is a patent foramen ovale. -As patent foramen ovale is very small communication, mixing of oxygenated blood with deoxygenated blood is inadequate —> Patients are symptomatic and cyanotic at birth, and CHF may develop during first week. - -ii) TGA with VSD - -Presence of VSD of adequate size results in good mixing of blood. - -a Patients become symptomatic, at 4-8 weeks when fetal pulmonary vasculature regresses maximally —> CHF -develops at this time. - -The failing left ventricle and large pulmonary blood flow cause increase in left atrial pressure —> T back pressure Pulmonary venous hypertension and pulmonary plethora. -The presence of a large VSD equalizes the pressure in the two ventricles as well as in two great vessels. -Pulmonary artery carries large flow —) patients with TGA and large VSD develop pulmonary vascular obstructive disease (Eisenmenger physiology) early in life. -### End" -32,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secretors are those who?, with the following options: A: Secrete enzymes in blood, B: Secrete immunoglobulin in intestine, C: Secrete blood group antigen in sweat/saliva, D: Secrete hormones in response to stress - -### Response: -Ans. is'c'i.e., Secrete blood group antigen in sweat/saliva -### End" -33,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lilliputian hallucinations are seen in, with the following options: A: Alcohol withdrawal, B: Opioid withdrawal, C: LSD withdrawal, D: Cocaine withdrawal - -### Response: -Lilliputian hallucinations are the visual type where objects appear tiny than their usual size. delirium is a type of ORGANIC BRAIN SYNDROME it presents with clouding of consiousness the main cognitive function that is altered is attention impairment and disorientation the main hallucinations that presents in delirium is visual hallucinations the visual hallucinations sometimes presents lilliputian hallucinations, that is they can see small miniature animals and humans hitting them they have a phenomenon called as sun downing phenomenon, that is worsening of symptoms in the evening and night the delirium that is cahrecterstic of alcohol withdrawl is hyper active delirium it is also called as delirium tremens as it is assosiated with tremors. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 955 -### End" -34,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All muscles of the palate are supplied by pharyngeal plexus, EXCEPT?, with the following options: A: Tensor veli palatine, B: Palatoglossus, C: Palatopharyngeus, D: None of the above - -### Response: -With the exception of tensor veli palatini, which is supplied by the motor branch of the mandibular division of the trigeminal through the nerve to medial pterygoid, the muscles are supplied by the cranial pa of the accessory nerve the pharyngeal plexus. -### End" -35,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the most common cause of skeletal abnormality in a case of renal osteodystrophy?, with the following options: A: Impaired synthesis of Vitamin D3, B: Hypocalcemia, C: Hypercalcemia, D: Hyperphosphatemia - -### Response: -Renal osteodystrophy combines features of secondary hyperparathyroidism, rickets, osteomalacia, and osteoporosis. The primary retention of phosphate by abnormal kidneys results in hyperphosphatemia, which causes hypocalcemia, resulting in secondary hyperparathyroidism. Therefore, the spectrum of clinical and radiographic findings in renal osteodystrophy may be a manifestation of any of these disorders. The most common complication of renal osteodystrophy is fracture, which may be insufficiency fractures through osteomalacic bone or pathologic fractures through brown tumors or amyloid deposits. Dialysis patients may experience carpal tunnel syndrome, osteomyelitis, septic ahritis, and osteonecrosis. Renal transplant patients may experience osteonecrosis, tendinitis, tendon rupture, and fracture. -### End" -36,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Evidence not used in rape is, with the following options: A: Semen in vagina, B: Semen on clothes, C: Presence of smegma bacilli in vagina, D: Presence of smegma under prepuce - -### Response: -In the uncircumcised penis the presence of smegma under the prepuce and on the corona glandis rules out complete penetration because smegma will be rubbed off during intercourse. Smegma usually requires 24 hours to redeposit. Presence of smegma indicates that no sexual intercourse with full penetration is taken place within 24 hours but absence of smegma will not indicate intercourse. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 305 -### End" -37,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best index of contraceptive efficacy is, with the following options: A: Pearl index, B: Chandelers index, C: Quetlet index, D: Broca index - -### Response: -Pearl index is defined as the number of failures per 100 woman years of exposure (HWY) Failure rate per Hundred Women Years = Total accidental pregnancies X 1200/ Total months of exposure Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 510 -### End" -38,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurons of first order for visual sensations are:, with the following options: A: Rods and cones, B: Bipolar cells, C: Ganglion cells, D: None of the above - -### Response: -Ans. Bipolar cells -### End" -39,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of Unilateral Hypertranslucent hemithorax, with the following options: A: Pleural effusion, B: Pneumonectony, C: Poland's syndrome, D: Collapse - -### Response: -Poland's (U/L congenital absence of pectoral muscles) - thus hypertransluscency. -### End" -40,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60 year old lady comes with blood stained discharge from the nipple with family history of breast cancer. Next best step for her will be, with the following options: A: Ductoscopy, B: Nipple discharge cytology, C: Sono-mammogram, D: MRI - -### Response: -Ans. (d) MRI(Ref Schwart 10th edition Page 527)* Mammography - IOC for women >35 years* Mammography - IOC for Screening purpose* MRI- IOC for screening in High risk Women* Mammography - IOC for detecting Ductal carcinoma In-situ lesions* Mammography - IOC to detect Micro calcifications (Which is the only feature for DCIS)* USG - IOC for women <35 years* MRI - IOC for Implanted breasts* MRI - IOC for doing Breast Conservative surgery in Cancer breast* MRI - IOC for Scarred breast* PET scan - IOC for detecting local and distant recurrences -### End" -41,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 day - old infant developed icterus and two days later symptoms and signs of acute liver failure appeared. Child was found to be positive for Hbs Ag. The mother was also HBs Ag carrier. The mother's hepatitis B serological profile is likely to be ?, with the following options: A: HBs Ag positive only, B: HBs Ag and Hbe Ag positivity, C: HBsAg and anti - HBe antibody positivity, D: Mother infected with mutant HBV - -### Response: -Ans. is `b' i.e., HBs positive and Hbe Ag positive Perinatal transmission of HBV o Most impoant risk factor that determines perinatal transmission is HBe Ag. HBs Ag carrier mothers who are HBe Ag positive almost invariably (> 90%) transmit hepatitis B infection to their offspring, where as carrier mothers with anti HBe rarely (10 to 15%) infect their offspring. o Most common time of perinatal transmission is at the time of delivery. o Most of the infected neonates are asymptomatic carrier with increased chances of chronic hepatitis and hepatocellular carcinoma. -### End" -42,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an embryologic structure that contributes to the formation of the face, with the following options: A: Frontonasal prominence, B: Zygomatic prominence, C: Maxillary prominence, D: Mandibular prominence - -### Response: -The face is derived from the following structures that contributes to the formation of the face. The face is derived from the following structures around the stomatodeum (primitive mouth): Mandibular prominences and maxillary prominences of the first arch. Frontonasal prominence formed by the prominence of mesenchyme ventral to the brain vesicles. It also gives rise to medial and lateral nasal prominence. Structures contributing to the development of face Prominence Structure formed Frontonasal Forehead, bridge of the nose, also forms the medial and lateral nasal prominences Medial nasal Philtrum of the upper lip, crest of the nose, and tip of the nose Lateral nasal Alae of nose Maxillary Upper pa of cheeks, lateral poion of the upper lip Mandibular Lower pa of cheeks, chin, lower lip Ref: Inderbir Singh&;s Human Embryology 11th edition Pgno: 153 -### End" -43,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All cause viral hepatitis except -, with the following options: A: Measles, B: EBV, C: Rhinovirus, D: Reovirus - -### Response: -Ans. is 'c' i.e., Rhinovirus Impoant viruses causing hepatitis:? 1) Hepatotropic viruses : HAV, HBV, HCV, HD V, HEV. 2) Herpes viruses : CMV, EBV, HSV-1, VZV. 3) Flaviviruses : Yellow fever, dengue fever. 4) Filoviruses : Marburg virus, Ebola virus. 5) Occasinal causes Measles virus, adenovirus, Echoviruses, Coxsackieviruses, influenza virus, parvoviruses, reoviruses, mumps virus. -### End" -44,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Role of somatotropine in fat metabolism, with the following options: A: Antilipolytic, B: Lipolytic, C: Ketogenic, D: Glucogenic - -### Response: -Growth Hormone (GH) - i. It is also called somatotropin. It is a single polypeptide chain with 191 amino acids. GH is synthesized by acidophils (somatotropic cells) of anterior pituitary. ii. Plasma concentration of GH is less than 2 ng/ml during day time, with secretory peak appearing 3 hr after meals. Maximum level of GH is seen during deep sleep. For measurement of serum GH, the samples are collected during sleep and also during waking hours to assess the circadian rhythm. iii. GH secretion is regulated by the balance between GHRH and GHIH (somatostatin). The regulation of secretion is predominantly inhibitory. Hypoglycemia stimulates GH secretion, and hyperglycemia suppresses it. The hypothalamic growth hormone releasing hormone (GHRH) stimulates GH synthesis and release. Ghrelin, a peptide derived from stomach induces GHRH and directly stimulates the release of GH. Somatostatin synthesized in the hypothalamus inhibits the GH secretion. iv. The metabolic effect of GH is paly mediated by somatomedin, also known as insulin-like growth factor1 (IGF-1). The growth of long bones is stimulated by this factor. IGF-1, the peripheral target hormone of GH exes feedback inhibition. v. GH increases the uptake of amino acids by cells; enhances protein synthesis, and produces positive nitrogen balance . The anti-insulin effect of GH causes lipolysis and hyperglycemia. The overall effect of GH is to stimulate growth of soft tissues, cailage and bone. It is anabolic. vi. Excess secretion by GH secreting tumor, leads to gigantism in children and acromegaly in adults. REF:DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY, SIXTH EDITION, PG.NO.,530. -### End" -45,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Orexins play an impoant role in people with eating disorders. All of the following are orexins, EXCEPT:, with the following options: A: Leptin, B: Orexin-A, C: Hypocretin 1, D: Hypocretin 2 - -### Response: -Orexins (A and B) or Hypocretins (1 and 2): They are produced by neurons in the lateral hypothalamus perifornical area. Regulated by glucose, leptin, neuropeptide Y, and POMC neurons. They stimulate food intake. Leptin: It is produced in adipose tissue. Acts on neuropeptide Y, AgRP-containing neurons, and -MSH neurons in the arcuate nucleus of the hypothalamus to decrease food intake. Ref: Molina P.E. (2010). Chapter 10. Endocrine Integration of Energy & Electrolyte Balance. In P.E. Molina (Ed), Endocrine Physiology, 3e. -### End" -46,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stereocilia and kinocilium are present in, with the following options: A: Tongue, B: Inner ear, C: Nose, D: Eye - -### Response: -(B) Inner ear > A kinocilium is a special type of cilium on the apex of hair cells located in the sensory epithelium of the vertebrate inner ear. Stereocilia (or stereovilli) are apical modifications of the cell, which are distinct from cilia and microvilli, but closely related to the latter. They are found in three regions of the body: the ductus deferens, the epididymis and the inner ear. -### End" -47,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Release of histamine and leukotrienes from mast cells is prevented by:, with the following options: A: Zileuton, B: Nedocromil sodium, C: Zafirlukast, D: Fexofenadine - -### Response: -nedocromil and sod.cromoglycate- mast cell stabilizers Sodium cromoglycate (Cromolyn sod.) is a synthetic chromone derivative which inhibits degranulation of mast cells (as well as other inflammatory cells) by trigger stimuli. Release of mediators of asthma-like histamine, LTs, PAF, interleukins, etc. are restricted. Nedocromil sodium has propeies similar to those of cromolyn Sodium Pharmacology and pharmacotherapeutics Satoskar 24th page no. 586 ESSENTIALS OF MEDICAL PHARMACOLOGY 7th EDITION KD TRIPATHI PG NO.229 -### End" -48,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inheritence of ichthyosis vulgaris is :, with the following options: A: X linked dominant, B: X linked recessive, C: Autosomal dominant, D: Autosomal recessive - -### Response: -C i.e. Autosomal dominant -### End" -49,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fascia around nerve bundle of brachial plexus is derived from:, with the following options: A: Preveebral fascia, B: Clavipectoral fascia, C: Deep cervical fascia, D: Pectoral fascia - -### Response: -The preveebral fascia forms a tubular sheath around the veebral column and the preveebral muscles, which are attached to the veebral column. It,Attaches superiorly from the base of the skull and inferiorly to the endothoracic fascia in the thorax.Extends laterally as the axillary sheath, which surrounds the axillary vessels and brachial plexus of nerves to the upper limb.Contains, within its connective tissue fibers, the cervical sympathetic trunk and ganglia.Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 25. Overview of the Neck. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy. -### End" -50,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Into how many segments, the infant's gum pad is divided?, with the following options: A: Two in each quadrant, B: Three in each quadrant, C: Two in each jaw, D: Five in each quadrant - -### Response: -The Gum Pads  -The alveolar arches of an infant at the time of birth are called Gum Pads. These are greatly thickened oral mucous membrane of the gums, which soon become segmented, and each segment is a developing tooth site. They are pink in color and firm in consistency. -The pads get divided into a labio/buccal and a lingual portion which differentiates later. Transverse grooves separate the gum pads into 10 segments. The groove between the canine and the first molar region is called the lateral sulcus, which helps to judge the inter-arch relationship. -### End" -51,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epitheliod granuloma is characterstic of, with the following options: A: Sarcoidosis, B: Eosinohilia, C: T.B., D: Mycosis Fungoides - -### Response: -A i.e. Sarcoidosis -### End" -52,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recall bias is more common with, with the following options: A: Coho study, B: Randomized control trial, C: Cross sectional study, D: Case control study - -### Response: -When cases and controls are asked questions about their past history it may be more likely for the cases to recall the existence of ceain events or factors than the controls who are healthy. (refer pgno:73 park 23rd edition) -### End" -53,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Delayed pubey seen in -, with the following options: A: Chronic disease, B: Hypothyroidism, C: Turner's syndrome, D: All - -### Response: -Ans. is All Delayed pubey o Delayed pubey is defined as failure of development of signs of sexual development by the age of 14 years in boy and breast budding by 13 years of girls. o Etiology of Delayed Pubey : 1. Chronic systemic diseases : Gluten enteropathy, anorexia nervosa. 2. Constitutional delay in growth and pubeal development - most common cause. 3. Hypogonadotropic hypogonadism (Low FSH. LH). a) CNS causes : Congenital anomalies, intracranial tumors, inflammatory diseases, traumatic lesions of CNS : b)Primary gonadotropin deficiency : Hypopituitarism. c) Syndromes with gonadotropin deficiency : Kallmann, Prader-Willi; Laurence-Moon-Biedl-Bardet, Froehlich. d)Miscellaneous : Hypothyroidism, hyperprolactinemia. 4. Hypergonadotropic hypogonadism (high FSH, LH, Gonadal disorders) : a) Turner syndrome (45 XO), Noonan syndrome, Klinefelter syndrome (47 XXY). b) Anticancer therapy for neoplasms of gonads. c) Orchitis d) Vanishing testes syndrome. e) Testosterone biosynthetic defects. f) Infiltration and autoimmune disease of gonads. -### End" -54,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thyroid Ca not diagnosed by FNAC -, with the following options: A: Follicular, B: Medullary, C: Papillary, D: Anaplastic - -### Response: -Ans. is 'a' i.e., Follicular o The diagnosis of follicular carcinoma cannot be made by FNA.o FNAB is unable to distinguish benigs follicular lesions from follicular carcinoma. -### End" -55,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a content of adductor canal?, with the following options: A: Femoral artery, B: Femoral vein, C: Saphenous nerve, D: Nerve to vastus lateralis - -### Response: -Ans: D (Nerve to vatus lateralis) Ref: Grays Anatomy 40th EdExplanation:Adductor canal/subsartorial canal/hunter's canalLocated at the middle of the thighExtends from apex of the femoral triangle to the opening of the adductor magnusBoundaries:Roof - SartoriusFloor - Adductor longusLaterally - Vastus medialisContents:1. Femoral arteryFemoral veinSaphenous nerveNerve to vastus medialisOccasionally posterior division of obturator nerve -### End" -56,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A chronic alcoholic presents with regurgitation and retrosternal pain. Endoscopic biopsy confirms Barrett's oesophagus. What is most appropriate management in this case, with the following options: A: PPI, B: H. pylori treatment, C: Balloon dilatation, D: Endoscopic biopsy every 2 years - -### Response: -Patients who are found to have Barrett's oesophagus may be submitted to regular surveillance endoscopy with multiple biopsies in the hope of finding dysplasia or in situ cancer rather.Annual endoscopy has been widely practised, but two-year intervals are probably adequate, provided no dysplasia has been detected.High-dose PPI treatment or an antireflux operation, these endoscopic ablation methods can result in a neosquamous lining. But there is no evidence yet that any of these methods are reliable in eliminating cancer risk.Bailey and Love 26th edition pg: 1002 -### End" -57,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: FDA indications of inhaled NO is?, with the following options: A: Malignant hypeension, B: Pulmonary hypeension in newborn, C: Cyanotic CHD, D: None of the above - -### Response: -Ans. is 'b' i.e., Pulmonary hypeension in newborn According to Goodman Oilman ""Inhaled nitric oxide has been approved by FDA for use in newborns with persistent pulmonary hypeension and has become the first line therapy for this disease. In this disease state NO inhalation has been shown to reduce, significantly, the necessity for extracorporeal oxygenation"" -### End" -58,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following can be given as a single weight-based intravenous bolus over 10 seconds?, with the following options: A: Tissue plasminogen activator (tPA), B: Tenecteplase (TNK), C: Reteplase (rPA), D: Any of the above - -### Response: -.Tenecteplase is an enzyme used as a thrombolytic drug. Tenecteplase is a tissue plasminogen activator produced by recombinant DNA technology using an established mammalian cell line. Tenecteplase is a tissue plasminogen activator (tPA) produced by recombinant DNA technology using an established mammalian cell line (Chinese hamster ovary cells). Tenecteplase is a 527 amino acid glycoprotein developed by introducing the following modifications to the complementary DNA (cDNA) for natural human tPA: a substitution of threonine 103 with asparagine, and a substitution of asparagine 117 with glutamine, both within the kringle 1 domain, and a tetra-alanine substitution at amino acids 296-299 in the protease domain. Tenecteplase is a recombinant fibrin-specific plasminogen activator that is derived from native t-PA by modifications at three sites of the protein structure. It binds to the fibrin component of the thrombus (blood clot) and selectively conves thrombus-bound plasminogen to plasmin, which degrades the fibrin matrix of the thrombus. Tenecteplase has a higher fibrin specificity and greater resistance to inactivation by its endogenous inhibitor (PAI-1) compared to native t-PA. pharmacokinetics: Distribution: approximates plasma volume Metabolism: Primarily hepatic Half-life elimination: Biphasic: Initial: 20-24 minutes; Terminal: 90-130 minutes Excretion: Clearance: Plasma: 99-119 mL/minute Ref Robbins 9/e pg 234 -### End" -59,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Radial keratotomy is used as a treatment modality for –, with the following options: A: Small degree in myopia, B: Progressive non healing ulcer, C: High astigmatism, D: High hypermetropia - -### Response: -Radial keratotomy is used for low to moderate myopia (-2 to -6D). -### End" -60,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are causes of Antepaum hemorrhage (APH) except, with the following options: A: Placenta pre, B: Abruptio placenta, C: Circumvallate placenta, D: Battledore placenta - -### Response: -Causes of APH placenta prae abruptio placenta local causes like polyp,cancer cervix ,varicose veins and local trauma circumvallate placenta vasa prae unclassified or indeterminate haemorrhage (refer pgno:128 sheila textbook of obstetrics 2 nd edition) -### End" -61,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following indicators involve reproductive woman -, with the following options: A: Bih Rate, B: G.F.R, C: T.F.R, D: Maternal moality rate - -### Response: -Ref: Park 25th edition Pgno : 540 -### End" -62,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 22-year-old woman nursing her newborn develops a tender erythematous area around the nipple of her left breast. A thick, yellow fluid is observed to drain from an open fissure. Examination of this breast fluid under the light microscope will most likely reveal an abundance of which of the following inflammatory cells?, with the following options: A: B lymphocytes, B: Eosinophils, C: Mast cells, D: Neutrophils - -### Response: -The thick, yellow fluid draining from the breast fissure in this patient represents a purulent exudate. Purulent exudates and effusions are associated with pathologic conditions such as pyogenic bacterial infections, in which the predominant cell type is the segmented neutrophil (polymorphonuclear leukocyte). -Mast cells (choice C) are granulated cells that contain receptors for IgE on their cell surface. -B lymphocytes (choice A) and plasma cells are mediators of chronic inflammationDiagnosis: Acute mastitis -### End" -63,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IV fluid replacement in a trauma patient is determined by, with the following options: A: Urine output, B: Chest condition, C: CVP, D: BP - -### Response: -Adequacy of fluid replacement should be checked with hemodynamic stability and urine output. When very large fluid shifts are expected and the patient has compromised renal insufficiency it is necessary to monitor fluid status using central venous pressure(CVP). Manipal manual of surgery-Shenoy,4th edition,pg -### End" -64,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pathology of endometriosis is best explained by, with the following options: A: Coelemic metaplasia, B: Endometrial hyperplasia, C: Retrograde menstruation, D: Intraperitoneal immunologic deficit - -### Response: -Retrograde menstruation is the most acceptable theory -### End" -65,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following in the natural course of disease has no reversal of the shunt, with the following options: A: ASD, B: VSD, C: TOF, D: PDA - -### Response: -Ans. c. TOF Infants with acyanotic gradually become cyanotic as a result of worsening condition of the infundinular stenosis a.nd polycythemia Polycythemia develop secondary to cyanosis Hypoxic spells may develop in infants Growth retardation may be present if cyanosis is severe Brain abscess and cerebrovascular accidents rarely occur SABE is occasionally a complication Some patients, paicularly those with severe TOF develop AR Coagulopathy is a late complication of longstanding cyanosis Eisenmenger syndrome Eisenmenger syndrome was so named by Dr. Paul Wood after Dr. Victor Eisenmenger, who first described the condition in 1897. Congenital hea defects causing Eisenmenger syndrome Atrial septal defects Ventricular septal defects Patent ductus aeriosus More complex types of acyanotic hea disease -### End" -66,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which pathway can use propionic acid ?, with the following options: A: Glycolysis, B: Gluconeogenesis, C: Glycogenolysis, D: Glycogenesis - -### Response: -Fats cannot be conveed to carbohydrates because link reaction is irreversible. EXCEPTIONS are: 1. Glycerol breaks down products of triglycerides 2. Propionic acid can be conveed into carbohydrate Odd chain fatty acid can act as substrates of Gluconeogenesis, sincePropionyl CoA,the product of their oxidationcan enter TCA cycle through formation of Succinyl CoA (see fig), hence can contribute towards glucose production. -### End" -67,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ketone body formation without glycosuria is seen in -, with the following options: A: Diabetes mellitus, B: Diabetes insipidus, C: Starvation, D: Obesity - -### Response: -Ans. is 'c' i.e.. Starvation o Amongst the given options, DM and starvation are the causes of ketosisDiabetes Ketosis with hyperglycemia and glycosuriaProlonged starvation :- Ketosis with low or normal glucose and without glycosuria.o In diabetic Ketoacidosis:- (i) Positive Rothera's test (due to ketone bodies) (ii) Positive Benedict's test (due to presence of reducing sugar in urine)o In Starvation ketosis:- (i) Postive Rothera's test (due to ketone bodies), (ii) Negative Benedict's test (no sugar in urine) -### End" -68,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are pneumatic bone EXCEPT:, with the following options: A: Maxilla, B: Frontal, C: Mandible, D: Ethmoid - -### Response: -Ans. (c) MandibleRef: Gray's 38th ed./431* Pneumatic Bone: Some cranial bones have air filled cavities for making skull light weight, resonance of voice & air conditioning.* Maxilla, Mastoid, Ethmoid, Sphenoid & Frontal bones are pneumatic bones.Types of boneSesamoid bonesPneumatic bone (Mn: It has Maximum Spherical Front Mass)Membranous (Dermal) bone* Patella* Pisiform* Fabella* Ethmoid* Maxilla* Sphenoid* Frontal* Mastoid (temporal)* Skull vault bones* Facial bones -### End" -69,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Buprenorphine is:, with the following options: A: paial agonist at mu Receptor, B: Paial agonist at kappa Receptor, C: Full Agonist at mu Receptor, D: Full Agonist at kappa Receptor - -### Response: -Ref : Katzung 11/e p546 *Buprenorphine appears to be a paial agonist at mu Receptor and antagonist at kappa Receptor. -### End" -70,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Essential fatty acids, with the following options: A: Linoeic acid, B: Linolenic acid, C: Arachiconic acid Palmitic acid, D: Plamitic acid - -### Response: -ESSENTIAL FATTY ACIDSThree polyunsaturated fatty acids, linoleic acid, linolenic acid and arachidonic acid are called ""essential fatty acids"" (EFA). They cannot be synthesised in the body andmust be provided in the diet. Lack of EFA in the diet can produce growth retardation and other deficiency manifestation symptoms.Which EFA is Impoant?Linoleic acid is most impoant as, arachidonic acid can be synthesised from linoleic acid by a three-stage reaction by addition of acetyl-CoA. Pyridoxal phosphate is necessary for this conversion. Biologically arachidonic acid is very impoant as it is precursor from which prostaglandins and leukotrienes are synthesised in the body.Why EFA cannot be Synthesised?Introduction of additional double bonds in unsaturated fatty acid is limited to the area between - COOH group and the existing double bond and that it is not possible to introduce a double bond between the - CH3 group at the opposite end of the molecule and the first unsaturated linkage. This would explain body's inability to synthesise an EFA from oleic acid.Functions of EFA: (Biomedical Impoance)Structural elements of tissues: Polyunsaturated fatty acids occur in higher concentration in lipids associated with structural elements of tissues.Structural element of gonads: Lipids of gonads also contain a high concentration of polyunsaturated fatty acids, which suggests impoance of these compounds in reproductive function.Synthesis of prostaglandins and other compounds: Prostaglandins are synthesised from Arachidonic acid by cyclooxygenase enzyme system. Leucotrienes are conjugated trienes formed from arachidonic acid in leucocytes by the Lipoxygenase pathway.Structural element of mitochondrial membrane: A deficiency of EFA causes swelling of mitochondrial membrane and reduction in efficiency of oxidative phosphorylation. This may explain for increased heat production noted in EFA deficient animals.Serum level of cholesterol: Fats with high content of polyunsaturated fatty acids tends to lower serum level of cholesterol.Effect on clotting time: Prolongation of clotting time is noted in ingestion of fats rich in EFA.Effect on fibrinolytic activity: An increase in fibrinolytic activity follows the ingestion of fats rich in EFA.Role of EFA in fatty liver: Deficiency of EFA produces fatty liver.Role in vision: Docosahexaenoic acid (22:6n-3) is the most abundant polyenoic fatty acids present in retinal photoreceptor membranes. Docosahexaenoic acid is formed from dietary linolenic acid. It enhances the electrical response of the photoreceptors to illumination. Hence linolenic acid is necessary in the diet for optimal vision.Deficiency manifestations: A deficiency of EFA has not yet been unequivocally demonstrated in humans. In weaning animals, symptoms of EFA deficiency are readily produced. They are Cessation of growth.Skin lesions: Acanthosis (hyperophy of prickle cells) and hyperkeratosis (hyperophy of stratum corneum). Skin becomes abnormally permeable to water. Increased loss of water increases BMR.Abnormalities of pregnancy and lactation in adult females.Fatty liver accompanied by increased rates of fatty acids synthesis lessened resistance to stress.Kidney damage.CLINICAL ASPECTHuman deficiency: Some cases ofEczema like dermatitis,Degenerative changes in aerial wall andFatty liver in man may be due to EFA deficiency.There are also some repos that administration of EFA in such cases may produce:Some improvement of eczema in children kept on skimmed milk,Prevent fatty liver (some cases) andLowering of cholesterol levels.Infants and babies with low-fat diet develop typical skin lesions which have shown to be improved with EFA (linoleic acid).Fate of EFA: EFA undergoes b-oxidation after necessary isomerisation and epimerisation, like other unsaturated fatty acids.CLINICAL ASPECTAbnormal Metabolism of EFAAbnormal metabolism of EFA, which may be concerned with dietary insufficiency, has been noted in a number of disease like cystic fibrosis, hepatorenal syndrome, Crohn's disease, acrodermatitis enteropathica, Sjogren's syndrome, Cirrhosis and Reye's syndrome.Ref: M.N. Chatterjee - Textbook of Biochemistry, 8th edition, page no: 48-49 -### End" -71,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Daily Iodine requirement during pregnancy is, with the following options: A: 75mcg, B: 150mcg, C: 220mcg, D: 500mcg - -### Response: -Recommendation of the daily requirement of iodine during pregnancy is 220mcg and during lactation is 290mcg.(Ref: William's Obstetrics; 25th edition) -### End" -72,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following organism is the most common cause of acute meningitis in an AIDS patient?, with the following options: A: Streptococcus pneumoniae, B: Streptococcus agalactiae, C: Cryptococcus neoformans, D: Listeria monocytogenes - -### Response: -Oppounistic infections of the CNS generally occur in HIV infected patients with CD4 counts below 200. Most common organism that causes acute meningitis in an AIDS patients is Cyptococcus neoformans. Cryptococcus neoformans is an encapsulated budding yeast that is found worldwide in soil and on dried pigeon dung. Infections are acquired by inhalation. In the lung, the infection may remain localized, heal, or disseminate. Progressive lung disease and dissemination occur in cases of cellular immunodeficiency. Ref: Current Medical Diagnosis and Treatment, 2012, Chapter 36 -### End" -73,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is cell cycle phase specific?, with the following options: A: Ifosfamide, B: Bleomycin, C: Cisplatin, D: Chlorambucil - -### Response: -Ans. is 'b' i.e., Bleomycin Bleomycin is specific for G2 phase. o Alkylating agents (Ifosfamide, chlorambucil) and platinum compound (cisplatin) are cell cycle nonspecific. -### End" -74,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of ubiquitin, with the following options: A: Binding, B: Transpo, C: Degradation, D: Assembely - -### Response: -Ubiquitin plays a major role in protein destruction. (Ref: Textbook of physiology N Geetha 2nd edition page no.10) -### End" -75,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with abdominal injury presents to the emergency department with signs of signs of peritonitis and shock. Airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be, with the following options: A: FAST, B: Exploratory Laparotomy under general anesthesia, C: Insertion of abdominal drain followed by laparotomy, D: Laproscopy - -### Response: -Treatment for abdominal injury includes Emergency laparotomy. -Indications include  - -Frank haemoperitoneum -Significant diagnostic peritoneal lavage -Haemodynamically unstable patient -U/S or CT scan shows significant intra-abdominal injuries -### End" -76,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surfactant deficiency occurs in NOT RELATED, with the following options: A: Infant of diabetic mother, B: Meconium aspiration syndrome, C: Transient tachypnea of newborn, D: Bronchopulmonary dysplasia - -### Response: -. -### End" -77,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pompholyx affects?, with the following options: A: Flexors, B: Extensors, C: Palms and soles, D: Face - -### Response: -Ans. is 'c' i.e., Palms and soles Pompholyx (vesicular endogenous eczema/ dyshidrotic eczema)* It is a form of hands and feet eczema characterised by vesicles or bullae (blisters). It is sometimes subclassified as cheiropompholyx (hands) and pedopompholyx (feet).Predisposing factors* Females sex, palmoplantar hyperhidrosis, atopic eczema, tinea ('id* reaction)Clinical presentation* Presents as recurrent crops of deep-seated blisters on the palms and soles associated with intense itching and/ or a burning sensation. The blisters peel off and the skin then appears red, dry and has painful fissures (cracks). It can result in paronychia (nail fold swelling) and nail dystrophy with irregular pitting and ridges.* Secondary bacterial infection with Staphylococcus aureus and/or Streptococcus pyogenes is common in pompholyx, and results in pain, swelling and pustules on the hands and feet.TreatmentA. General measures -Wet dressings with dilute potassium permanganate, aluminium acetate or acetic acid, Cold packs, Soothing agents, antiperspirants at night, protective gloves, well-fitting footwearB. Medicines- Ultrapotent topical corticosteroid creams and ointments. Short courses of systemic corticosteroids, eg prednisone or prednisolone, for flare-ups. Other - Oral antistaphylococcal antibiotics, immune modulating medicines (severe cases). Alitretinoin is used for resistant chronic disease.C. Other options - Superficial radiotherapy, Botulinum toxin injections ,Phototherapy and photochemotherapy (PUVA) therapy -### End" -78,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of death in Klinefelter's syndrome is?, with the following options: A: Infections, B: Cardiovascular, C: Respiratory, D: suicide - -### Response: -ANSWER: (A) InfectionsREF: www.ncbi.nlm.nih .gov/pubmed/15292313 None of the text books mention it directly.On searching various studies, it was found that only two studies by far have been conducted to find increased mortality in klienfelter's syndrome, there for a larger cohort study was done where patients were followed for a long time.The results of study are complicated with statastical tools and stuff; therefore i took help of stasticians and simplified it.The most common cause of death was found to be infections > neurological diseases > lung and circulatory diseases > suicide -### End" -79,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Methionine is synthesised in human body from -, with the following options: A: Cysteine, B: Homocysteine, C: Cystine, D: Tryptophan - -### Response: -Ans. is 'b' i.e., Homocysteine* Homocysteine in the presence of methionine synthase and methyl B12, gets converted to methionine. -### End" -80,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ascaris lumbricoides causes deficiency of:, with the following options: A: Iron, B: Vitamin B 12, C: Folic acid, D: Vitamin A - -### Response: -Vitamin A -### End" -81,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Unconjugated hvperbilirubenemia is seen in all except, with the following options: A: Gilbert's syndrome, B: Dubin Johnson's syndrome, C: Criggle Najar syndrome, D: Neonatal physiological jaundice - -### Response: -(B) Dubin Johnson's syndrome# Common causes of raised bilirubin and urobilinogen> Raised conjugated bilirubin (bilirubinuria)> Hepatocellular disease and post-hepatic or cholestatic disease (intrahepatic and extrahepatic), including drug toxicity as well as pancreatic causes of obstructive jaundice.> Inherited defects in excretion - eg, Dubin-Johnson syndrome, Rotor's syndrome.> Raised unconjugated bilirubin (no bilirubinuria) Gilbert's syndrome Haemolysis Post viral hepatitis Mild chronic hepatitis Crigler-Najjar syndrome> PHYSIOLOGIC JAUNDICE (non-pathologic unconjugated hyperbilirubinemia):1. Term Infants: 50-60 % of all newborns are jaundiced in the first week of life. Total serum bilirubin peaks at age 3-5 d (later in Asian infants). Mean peak total serum bilirubin is 6 mg/dL (higher in Asian infants).2. Preterm Infants: Incidence of visible jaundice is much higher than in term infants. Peak is later (5-7d). Because of ? risk of bilibubin encephalopathy (see below), ""physiologic"" jaundice is more difficult to define and jaundice should be followed closely. -### End" -82,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Iron supplementation in a healthy term breast fed baby should be staed at the age of -, with the following options: A: 2 weeks, B: 4 weeks, C: 8 weeks, D: None - -### Response: -Ans. is NoneCorrect answer is 6 months. -### End" -83,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Singers Alkali denaturation test is done with :, with the following options: A: Maternal Hb, B: Fetal Hb, C: Amniotic fluid, D: Menstrual fluid - -### Response: -Ans. is b i.e. Fetal Hb Ref. Dutta Obs. 6/e, p 247-248: Williams Obs. 23/e, p 583, 584; Text book of Ohs. by Sheila Balakrishnan, p 167-168 Fetal hemoglobin can be distinguished from Adult hemoglobin by : Wright stain : On staining blood with wright stain if RBC's appear nucleateddeg the blood is of fetal origindeg. Singers alkali denaturation test : It is based on the fact that fetaldeg hemoglobin is more resistant to alkali denaturationdeg. Test -- Blood + Sodium hydroxide/ Potassium hydroxide -### End" -84,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Subendothelial electron dense deposits within the glomerulus are seen -, with the following options: A: MPGN type I, B: Crescentic glomerulonephritis, C: Dense deposit disease, D: IgA nephropathy - -### Response: -Repeated Question. -### End" -85,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the causative organism for Baholin's cyst?, with the following options: A: Candida, B: Anaerobes, C: Neisseria gonorrhoeae, D: Trichomonas - -### Response: -Ducts of Baholin's gland are lined with transitional epithelium and their obstruction secondary to inflammation may lead to the development of a Baholin's cyst or abscess. Infections are often polymicrobial; sexually transmitted Neisseria gonorrhoeae and C. trachomatis are often implicated. Abscesses usually present as acutely inflamed, exquisitely tender masses. Treatment consists of incision and drainage and placement of a Word catheter. Ref: Cain J., ElMasri W.M., Gregory T., Kohn E.C. (2010). Chapter 41. Gynecology. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e. -### End" -86,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Laryngeal cailage forming complete circle is ?, with the following options: A: Thyroid, B: Cricoid, C: Corniculate, D: Arytenoid - -### Response: -Ans. is 'b' i.e., CricoidCricoid cailage is the only cailage forming a complete ring, therefore is shaped like a ring.Laryngeal cailages Thyroid (unpaired)o It is the largest of all laryngeal cailages. It is 'V' shaped with right and left lamina. Both laminae (alae) meet anteriorly forming an angle of 90deg in males and 120deg in females and forms laryngeal prominence. Vocal cords are attached to the middle of thyroid angle. Upper border of thyroid cailage lies at C3-C4 junction (at upper border of C4). Thyroid cailage itself lies at C4-05 level.Cricoid (unpaired)It is the only cailage forming a complete ring, therefore is shaped like a ring. It aiculates with arytenoid cailage to form cricoarytenoid joint, a type of synol joint. It lies at the level of C6 veebra Epiglottis (unpaired)It is leaf-shaped elastic cailage (in adults). It is omega shaped in children. It forms the anterior wall of laryngeal inlet. It lies above glottis.Arytenoid cailage (paired)Each Arytenoid cailage is pyramidal in shape. Base aiculates with cricoid cailage, and apex suppos the corniculate cailage. A vocal process directed anteriorly and gives attachement to vocal cord. A muscular process directed laterally and gives attachment to intrinsic laryngeal muscles.Corniculate cailage (of Santorini) : PairedAiculates with apex of Arytenoid cailageCuneiform cailage (of Wrisberg) : PairedSituated in aryepiglottic fold in front of corniculate cailage. -### End" -87,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mode of inheritance of ichthyosis Vulgaris is:, with the following options: A: Autosomal dominant, B: Autosomal recessive, C: X-linked, D: Codominant gene - -### Response: -Ichthyosis Vulgaris: Autosomal dominant Filaggrin synthesis is defective. At bih, skin may appear normal Skin gradually becomes dry, rough and scaly, with most signs and symptoms appearing by the age of 5 The scale is white or grey, small, flaky or branny, and semi-adherent with turned-up edges Most pronounced on the extensor surfaces of arms and lower legs Hyperlinearity of palms and soles Associated with atopic dermatitis and keratosis pilaris Improvement with warm and sunny weather Mode of inheritance Ichtyosis Vulgaris- Autosomal dominant X linked ichtyosis- X linked recessive Lamellar ichtyosis- Autosomal recessive Harlequin ichtyosis- Autosomal recessive -### End" -88,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has just been admitted to hospital for observation. Based on patient's laboratory results. What is the patient's primary problem?Hematocrit 45%Hemoglobin 16g/dlPlatelets 50×109/L, with the following options: A: Hemochromatosis, B: Deep vein thrombosis, C: Hepatic vein thrombosis, D: Recurrent nose bleeds - -### Response: -Due to low platelet count of 50×109/L. There is recurrent nose bleeds - Normal platelet count = 1,50,000 - 4,00,000/ L -### End" -89,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During which of the following prenatal stages, are leukocytes not present in the developing embryo?, with the following options: A: Hepatic stage, B: Bone marrow stage, C: Mesoblastic stage, D: Splenic stage - -### Response: -Leukocytes are absent during the mesoblastic (yolk-cell) stage, but appear at approximately two months gestation in the liver and somewhat late in the spleen. The bone marrow first paicipates in hematopoiesis at approximately six months gestation and assumes an increasingly larger role thereafter. The liver and spleen cease to paicipate in hematopoiesis at about the time of bih, and this task is completely taken up by the red bone marrow. Ref: Kaushansky K. (2010). Chapter 16. Hematopoietic Stem Cells, Progenitors, and Cytokines. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e. -### End" -90,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 23 year old male patient complains that his face appears too long. Extra-oral examination reveals a retrognathic mandible, steep mandibular plane angle and a prominent antegonial notch. Which of the following statements regarding this patient's condition is false?, with the following options: A: Growth of mandible is more posteriorly, B: Growth of mandible is more anteriorly, C: Rotation is backward, D: Rotation can be given a positive sign - -### Response: -By convention, the rotation of either jaw is considered ""forward"" and given a negative sign if there is more growth posteriorly than anteriorly. The rotation is ""backward"" and given a positive direction if it lengthens, anterior dimensions more than posterior ones, bringing the chin downward and backward. -Contemporary orthodontics, William Proffit, 4th edition page 116 -### End" -91,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The presence of large quantities of un-reabsorbed solutes in the renal tubule causes an increase in urine volume is called:, with the following options: A: Osmotic diuresis, B: Osmotic natriuresis, C: Water intoxication, D: Water dieresis - -### Response: -Osmotic diuresis -### End" -92,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pavlov's experiment is an example of ?, with the following options: A: Operant conditioning, B: Classical conditioning, C: Learned helplessness, D: Modeling - -### Response: -Ans. is 'b' i.e., Classical conditioningClassical conditioningIn classical conditioning, the conditioned stimulus (which usually does not produce the response), when paired with unconditioned stimulus (stimulus which usually produces a response), directly produces a response.The typical example of classical conditioning is pavlov's experiment. Normally food produces salivation in dog, Therefore salivation in response to food is called unconditioned response and the stimulus, i.e., food is called unconditioned stimulus. Under normal circumstances, a dog does not salivate at the sound of a bell. However, if the sound of bell is paired consistently with presentation of food, the dog begans to salivate to the sound of bell even if the food is not presented. This learned response, i.e., salivation to a sound of bell without food, is called conditioned response and the stimulus (sound of a bell) is called conditioned stimulus.There is a reverse side to classical conditioning, called counter conditioning. This amounts to reducing the intensity of conditioned response (e.g., anxiety) by establishing an incompatible response (e.g., relaxation) to a conditioned stimulus (i.e., snake). So anxiety symptoms can be reduced when the stimuli to anxiety are presented in graded order and systemically paired with a relaxation response. This process of reciprocal inhibition is called systemic desensitization.Other behavioral therapies based on classical conditioning principle (counter conditioning) are exposure with response prevention and aversion therapy. -### End" -93,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most common cause of perforation of uterus in non-pregnant state?, with the following options: A: IUCD, B: Dilatation and curettage, C: Laparoscopy, D: Carcinoma Endometrium - -### Response: -In the non pregnant state,perforation of the uterus occurs usually during dilatation and curettage Dilatation and curettage procedure is a primary tool for diagnostic evaluation and treatment of abnormal uterine bleeding. Perforation of the uterus is common during a state of pregnancy or malignancy ( Soft Uterus) The atrophic uterus of post menopausal woman may also be perforated easily during D&C IUCD inseion also cause perforation, especially if done in a hurry. In case of a perforation: If the uterus is empty and not malignant, simple observation will suffice. However in complicated cases hysterectomy is done. Often abdominal viscera prolapse through the perforation and hence a laparotomy is done to repair the defect and bowel . -### End" -94,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Compounds with a large amount of carbohydrate & small amount of protein -, with the following options: A: Glycoprotein, B: Glycosaminoglycan, C: Proteoglycan, D: Glycocalyx - -### Response: -A large amount of carbohydrate small amount of protein → Proteoglycans. -A large amount of protein small amount of carbohydrate → Glycoproteins. -### End" -95,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lisengang rings are present in, with the following options: A: CEOT, B: OKC, C: CGCG, D: All of the above - -### Response: -Calcifying Epithelial Odontogenic Tumor (Pindborg tumor) is a rare, benign odontogenic lesion. This is rare benign tumor which was first described in 1955 by Dutch pathologist Or J J Pindborg. -### End" -96,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is the management of vulvar varices during pregnancy :, with the following options: A: Pressure, B: Cautery, C: Simple vulvectomy, D: Observation only - -### Response: -Varicosities (lower leg, vulva, rectum) may appear for the first time or aggravate during pregnancy usually in later months Its due to obstruction in the venous return by the pregnant uterus. Specific treatment is better to be avoided Usually disappears following delivery Ref . Dutta Obs 6/e p103 Williams Obs 23/e p 210-211 -### End" -97,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following comes under primordial prevention of myocardial infarction except, with the following options: A: Maintenance of normal body weight, B: Changes in the life style, C: Change in the nutritional health, D: Screening for hypeension - -### Response: -A novel approach to primary prevention of CHD is primordial prevention. It involves preventing the emergence and spread of CHD risk factors and lifestyles that have not yet appeared or become endemic. Ref: Park; 23rd ed; Pg 370 -### End" -98,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lambda phage which of the following is true ?, with the following options: A: It causes mad cow disease, B: Lysogenic to lytic conversion cannnot occur, C: Lysogenic form incorporates in host DNA & remain dormant, D: Lytic phase incorporates in host DNA, proliferate & causes rupture of cell - -### Response: -Ans. is 'c' i.e., lysogenic form incorporates in host DNA and remain dormant . Lambda phase is nothing else but prototype of bacteriophage. . It has already been explained in previous explaination that lysogenic form is incorporated into the host genome ( not in lytic phase). In lytic phase,there is replication of phage inside the bacteria that causes lysis of bacteria. . On exposure to ultraviolet light or other agents the lysogenic phase undergoes induction i.e., the phase DNA is excised from the host cell and it undergoes lytic cycle. -### End" -99,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these Is not an FDA approved indication for use of modafinil as an adjunct?, with the following options: A: Major depression and associated lethargy, B: Narcolepsy, C: Obstructive sleep apnea, D: Shift work disorder - -### Response: -Ref: KD Tripathi 7th edition Page no 487 Modafinil is a newer psychostimulant and it's approved indications are narcolepsy, sleep apnea syndrome and shift work syndrome. It is being evaluated as a drug to prevent relapse of cocaine dependence. It is not used for depression -### End" -100,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wreden's test is to demonstrate: MP 09; NEET 15, with the following options: A: Live bih, B: Insanity, C: Putrefaction, D: Assault - -### Response: -Ans. Live bih -### End" -101,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A pateint with cervix cancer is mised by a screeing test and later diagnosed with advanced disease. This time interval is called, with the following options: A: Lead time, B: Screening time, C: Serial interval, D: Generation time - -### Response: -.lead time is actually the advantage gained by screening.the priod between the diagnosis by early detection and diagnosis by other means.detection programmes should therfore concentrate on those conditions where the time lag between the disease&;s onset and its final critical point is sufficiently long to be suitable for population screening. ref:park&;s textbook,ed 22,pg no 128 -### End" -102,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serotonin, a mediator of inflammation in our body, is secreted /released by:, with the following options: A: Leukocytes, B: Endothelial cell, C: Mast cell, D: Platelet - -### Response: -Answer- D. PlateletSerotonin :It is found in the intestinal mucosa, brain tissue & platelets.Release of serotonin (and histamine) from platelets is stimulated when platelets aggregate after contact with collagen, thrombin, adenosine diphosphate (ADP), and antigen-antibody complexes. -### End" -103,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with abdominal mass. Biopsy showed a triphasic tumour with areas of small blue cells. Which of the following is a feature of this tumour?, with the following options: A: MYCN amplification, B: C-MYC overexpression, C: WT1 mutation, D: RB deletion - -### Response: -Small blue round tumour cells seen in- retinoblastoma, medulloblastoma, Ewing sarcoma, neuroblastoma, Wilms tumor, ALL Microscopically, Wilms tumors are characterized by recognizable attempts to recapitulate different stages of nephrogenesis. The classic triphasic combination of blastemal, stromal, and epithelial cell types is observed in the majority of Wilms tumours. Sheets of small blue cells with few distinctive features characterize the blastemal component. Epithelial differentiation is usually in the form of aboive tubules or glomeruli. Stromal cells are usually fibroblastic or myxoid in nature. Nephrogenic rests are putative precursor lesions of Wilms tumors and are seen in the renal parenchyma adjacent. WT1 protein is critical for normal renal and gonadal development. Wilms tumors demonstrate WT1 mutations. MYCN amplification - neuroblastoma C-MYC overexpression - Burkitt lymphoma RB deletion - retinoblastoma -### End" -104,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not seen in iron deficiency anemia?, with the following options: A: Hyper-segmented neutrophils, B: Microcytosis and hypochromia in red cells, C: Low serum ferritin, D: Commonest cause of anemia in India - -### Response: -- Hypersegmented neutrophils - is a feature of megaloblastic anemia - caused d/t Vit B12 / folic acid deficiency. - Remaining all features given in options are characteristic to Iron deficiency anemia -### End" -105,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MC type of ca vulva is:, with the following options: A: Squamous cell carcinoma, B: Melanoma, C: Adenocarcinoma, D: Adenosquamous carcinoma - -### Response: -Ans. is 'a' i.e., Squamous cell carcinoma * MC variety of vulvar cancer= Squamous cell carcinoma.* MC site= labia (majora and minora) followed by clitoris.* Risk factors for Ca vulva=HPV infection, cigarette smoking, lichen sclerosis, squamous hyperplasia, VIN.* Most patients are asymptomatic at the time of diagnosis. -### End" -106,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a component of APACHE score ?, with the following options: A: Serum Potassium, B: Serum Sodium, C: Serum Calcium, D: Creatinine - -### Response: -.APACHE II (Acute Physiology and Chronic Health Evaluation II) point score is calculated from a patient&;s age and 12 routine physiological measurements: PaO2 Temperature Mean aerial pressure pH aerial Hea rate Respiratory rate Serum Sodium Serum Potassium Creatinine Hematocrit White blood cell count Glasgow Coma Scale S.Ca is pa of Ransons criteria -### End" -107,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Norplant contains how many capsules of levonorgestrel:, with the following options: A: 4, B: 6, C: 8, D: 10 - -### Response: -Norplant contains a set of 6 capsules each containing 36mg levonorgestrel for subcutaneous implantation-placed subcutaneously in the medial aspect of upper arm (Ref.Essentials of medical pharmacology TD Tripathi 6th edition page no.323) -### End" -108,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congenital adrenal hyperplasia is associated with -, with the following options: A: Hypoglycemia, B: Hyponatremia, C: Hypokalemia, D: All - -### Response: -Ans. is 'a' i.e., Hypoglycemia, 'b' i.e., Hyponatremia, 'c' i.e., Hypokalamia o Also see previous explanations : ? o Depending into type of deficiency, congenital adrenal hyperplasia (CAH) may be divided into : ? 1. Salt retaining (17-a hydroxylase or 11-13 hydroxylase deficiency) Due to excessive mineralocoicoids there is --> i) Hypernatremia iii) Increased chloride ii) Hypokalemia iv) Hypeension 2. Salt losing (21 hydroxylase or 3-13 HSD) deficiency Due to mineralocoicoid deficiency threre is i) Hyponatremia iii) Hyperkalemia ii) Low chloride iv) Low BP dehydration o In all types of CAH, there is deficiency of glucocoicoid that results in hypoglycemia. -### End" -109,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Positive hepatojugular reflux is found in all of the following conditions except aEUR', with the following options: A: Tricuspid regurgitation, B: Right hea failure, C: Decreased after load, D: Increased capillary bed pressure - -### Response: -Associated with decreased afterload Hepatojugular reflux This is done by applying firm pressure with the palm of the hand to the right upper quadrant of the abdomen for 1030 seconds with the patients breathing quietly while the jugular vein is observed. In normal subjects (Negative hepatojugular reflux) - Jugular venous pressure rises only transiently with rapid return to the baseline. Positive hepatojugular reflux (Left ventricular,failureQ) - A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds. Explanation Pushing on the liver (or even midabdomen) for about 15 seconds increases the amount of blood returned to the right atrium and right ventricle (increased preload). Concurrently, there is increase in right ventricle afterload, owing to upward movement of the diaphragm which reduces intrathoracic volumes. (Pulmonary aery pressure is increased due to reduced intrathoracic volumes).(Leading to increased right ventricle afterload) In a normal person the jugular venous pressure would rise temporarily and then normalize quickly as the healthy right ventricle pumps out the additional blood i.e. it handles the increase in preload and afterload quite well. A dysfunctioning right ventricle however fails to accept this increase in preload and afterload and therefore there is persistent elevation of systemic venous pressure. The abdominojugular reflux is not specific to any disorder but rather is a reflection of the inability of the right ventricle to accept or reject the transiently increased venous return. ""Positive abdominojugular reflux is most commonly associated with left ventricular failure"". In the absence of left hea failure a positive abdominal jugular reflex sign should prompt consideration of :- Impaired right ventricular proload - A Decrease in right ventricular compliance. - A decrease in right ventricular systolic function or - An elevation in right ventricular afterload. Conditions associated with abdominojugular reflux ? Left ventricularfailtereo (MC) Right hea .failureQ Constrictive pericarditis() Right ventricular infarction() Restrictive cardiomyopathyg Note - Both pulmonary stenosis and tricuspid regurgitation cause right hea failure. -### End" -110,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In AIDs control programme. For treatment of STDs, blue colored pack is used for treatment of-, with the following options: A: Urethral discharge, B: Scrotal swelling, C: Genital ulcers, D: Ano-rectal discharge - -### Response: -Am. is 'c' i.e., Genital ulcersNACO centers providing ART (as of sept 2006)o The National AIDS control organization (NACO) has increased the numbers of centres providing ART from 54 to 91 centres with another 9 more centres also getting operational soon,o All the 91centres have specially appointed and trained doctors, counsellors and laboratory technicians to help initiate patients on ART and follow them regularly,o At these 91 centres medicines for treating 85000 patients have been made available.o The ART is a combination of three potent drugs, which is being given to the persons with advanced stage of AIDS.o Apart from providing free treatment, all the ART centres are providing counselling to the infected persons so that they maintain regularly of their medication.o NACO has branded the STI/RTI sendees as ""Suraksha clinic"" and has developed a communication strategy for generating demand for these services.o Pre-packed colour coded STI/RTI kits have been provided for free supply to all designated STI/RTI clinics.Kit 1 - Grey, for urethral discharge, ano-rectal discharge, cervicitis.Kit 2 - Green, for vaginitisKit 3 - White, for genital ulcersKit 4 - Blue, for genital ulcersKit 5 - Red, for genital ulcersKit 6 - Yellow, for lower abdominal painKit 7 - Black, for scortal swelling. -### End" -111,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At isoelectric pH protein, with the following options: A: Have Net charge 'O', B: Are positively charged, C: Are negatively charge, D: Don't migrate - -### Response: -Proteins are least soluble at their isoelectric pH . Significance of isoelectric proteind : The amonoacid composition will determine the isoelectric pH of protein . The alpha amino acids and carboxyl group are utilized for peptide bond formation, and hence are not ionizable.All other ionizable groups present in the protein will influence pl of the protein. At the isoelectric point,the number of anioins andcations present on the protein molecule will be equal and the net charge is zero. At the pl value,the proteins will not migrate in an electrical field.At the pl, solubility,buffering capacity and viscosity will be minimum; and precipatation will be maximum. On the acidic side of pl, the proteins are cations and on alkaline side, they are anions in nature. REFERENCE : DM VASUDEVAN TEXTBOOK SEVENTH EDITION ; PAGE NO :41 -### End" -112,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wiskott Aldrich syndrome is characterized by all Except:, with the following options: A: Thrombocytopenia, B: Autosomal recessive, C: Failure of aggregation of platelets in response to agonists, D: Eczema - -### Response: -Answer is B (Autosomal Recessive) Wiskot Aldrich syndrome is an X linked Recessive syndrome and not an autosonzal recessive syndrome. Wiskott Aldrish Syndrome is associated with an impaired platelet aggregation response. `Several platelet abnormalities have been repoed in Wiskott Aldrich syndrome including impaired aggregation responses' -### End" -113,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wickmann's straie seen in ?, with the following options: A: Lichen planus, B: Psoriasis, C: Dermatomyositis, D: Was - -### Response: -Ans. is 'a' i.e., Lichen planus -### End" -114,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Embryonic period is upto -, with the following options: A: 8 week, B: 10 week, C: 12 week, D: 6 week - -### Response: -Ans. is 'a' i.e., 8 week o Embryonic period = from fertilization to end of 8 week,o Fetal period = from 9 week on ward,o In prenatal period - following events are seen.Milestones of Prenatal DevelopmentWKDevelopmental events1.Fertilization and implantation: beginning of embryonic period2.Endoderm and ectoderm appear (bilaminar embryo)3.First missed menstrual period; mesoderm appears (trilaminar embryo); somites begin to form4.Neural folds fuse; folding of embryo into human-like shape; arm and leg buds appear; crowm-rump length 4-5 mm5.Lens placodes, primitive mouth, digital rays on hands6.Primitive nose, philtrum, primaty palate; crown-ramp length 21-23 mm7.Eyelids begin8.Ovaries and testes distinguishable9.Fetal period begins; crown-rump length 5 cm; weight 9 g10.External genitals distinguishable20.Usual lower limit of viability; weight 460 g; length 19 cm25Third trimester begins; weight 900 g; length 25 cm28Eyes open; fetus turns head down; weight 1,000 g38.Term -### End" -115,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After an accident a male patient had come for his routine evaluation. His RBCs showed Cabot's ring. What is the likely condition responsible?, with the following options: A: Acquired hemolytic anemia, B: Hemochromatosis, C: Thalassemia, D: After splenectomy - -### Response: -Cabot'srings are red cell inclusions consist of mitotic spindle remnants appearing as fine, threadlike filaments of bluish purple color in the shape of a single ring or a double ring (figure-eight shape). They stain red or reddish purple with Wright's stain and have no internal structure. These are arginine rich and acidophilic. Cabot's rings are present in anemia (severe, pernicious), lead poisoning, myelofibrosis, and myeloid metaplasia, but are typical of post splenectomy. Ref: Medical Laboratory Technology By Sood, 2005, Page 201 ; Wintrobe's Clinical Hematology, 11th Ed p. 22 Table 1.4 ; Laboratory Medicine Hematology 6th ed. CV Mosby Co., 1982, p. 488 -### End" -116,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Biochemical test in thiamine deficiency is:, with the following options: A: FIGLU test, B: Histidine test, C: Erythrocyte transketolase test, D: Ferric chloride test - -### Response: -Ans. C. Erythrocytes transketolase testa. In thiamine deficiency - the most reliable is the measurement of whole blood or Erythrocytes Transketolase activity.b. FIGLU test and Histidine test - Formimino-glutamate (FIGLU), a catabolite of histidine, transfers its formimino group to H4- to form N5 formimino-H4 folate. In folate deficiency FIGLU will accumulate after oral challenges with histidine.c. FeCl3 test: -i. In phenyl ketonuria - gives Emerald green, when tested with fresh urineii. In maple-syrup urine disease - gives navy blue colour when tested with urineiii. Also used to detect aceto-acetic acid in Gerhardt's test -### End" -117,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At the level of Arch of aoa, the relationship of left vagus nerve and left phrenic nerve?, with the following options: A: Phrenic nerve anterior, vagus nerve posterior, B: Phrenic nerve posterior, vagus nerve anterior, C: Both in same plane anteroposteriorly, D: Variable in relationship - -### Response: -Phrenic nerve anterior, vagus nerve posterior -### End" -118,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Problem of bias is maximum with, with the following options: A: Coho study, B: Case study, C: Case control study, D: Experimental study - -### Response: -Bias is any systemic error in the determination of the association between exposure and disease. The relative risk may increase or decrease as a result of the bias it reflects some type of no compatibility between the study and control groups. The possibility of bias must be considered when evaluating a possible cause and effect relationship. (refer pgno 73, park 23rd edition) -### End" -119,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a strategy used to increase the yield of protein produced in recombinant protein synthesis?, with the following options: A: Promoter induction, B: Genes for protease inhibitors, C: Translation initiation, D: Translation and transcription termination - -### Response: -B i.e. Genes for protease inhibitors Expression vector is a vector which synthesize/produce/express the protein coded by a gene introduced DNA recombination technology. So it is used to produce protein by genetic engineering and detect specific c-DNA molecules in library. Expression vectors are specially constructed so that they contain very active inducible promoters, proper in phase translation initiation codons, both transcription & translation termination signalsQ (to increase transcription & translation) and appropriate protein processing signals, if needed (to produce processed function protein). To enhance the final yield of protein product, some expression vectors even contain genes that code for protease inhibitorsQ. -### End" -120,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Route of administration of BCG for bladder cancer is:, with the following options: A: Oral, B: Subcutaneous, C: Intravenous, D: None of the above - -### Response: -(Ref: Goodman & Gilman 11/e p1422) Intravesical route is used for BCG in the treatment of bladder carcinoma. -### End" -121,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dicumarol interferes with-, with the following options: A: Vitamin K, B: Antithrombin, C: Platelets, D: Plasminogen - -### Response: -Ans. is 'a' i.e., Vitamin K o Dicumarol (an oral anticoagulant) acts by inhibiting Vitamin K dependent clotting factors. -### End" -122,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pulmonary lymph flow rate is, with the following options: A: 20 ml/hour, B: 40 ml/hour, C: 50 ml/hour, D: 60 ml/hour - -### Response: -Pulmonary lymph flow rate is 20 ml per hour Ref: guyton and hall textbook of medical physiology 12 edition -### End" -123,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Warthin Finkeldey giant cells are seen in?, with the following options: A: Tuberculosis, B: Sarcoidosis, C: Herpes, D: Measles - -### Response: -Ans. is 'd' i.e., Measles o Warthin-Finkeldey cell is a type of giant multinucleate cell found in hyperplastic lymph nodes early in the course of measles.Also found ino HIV-infectiono Kimura disease,o lymphoma and non-neoplastic lymph node disorders. -### End" -124,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: _______________ of Fluid is required to produce costophrenic angle bluting** on erect chest X-ray, in cases of pleural effusion:, with the following options: A: 100ml, B: 300ml, C: 500ml, D: 750ml - -### Response: -At least 100ml of fluid is required to detect by USG. -A minimum of 300ml is required to produce bluttening of costophrenic angle on erect chest X-ray. -About 500ml of effusion is required for detection on clinical examination. -### End" -125,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which aery is formed by joining of 2 veebral aeries?, with the following options: A: Basal aery, B: Middle cerebralaery, C: Posterior cerebral aery, D: Basilar aery - -### Response: -Basilar aery is formed by the union of two veebral aeries at the lower border of pons. Middle cerebral aery is a branch of internal carotid aery. Posterior cerebral aery is a branch of basilar aery. (Ref: Vishram Singh textbook of clinical neuroanatomy, second edition pg-174,176) -### End" -126,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prolactin levels are highest in which of the following?, with the following options: A: After 24 hrs of ovulation, B: After 24 hrs of paurition, C: After nipple stimulation, D: Just before paurition - -### Response: -Prolactin levels in maternal plasma increase markedly during normal pregnancy. Concentrations are usually 10 fold greater at term- about 150 ng/mL compared to non pregnant women. Paradoxically, plasma concentrations drop after delivery even in women who are breast feeding. During lactation, pulsatile bursts of prolactin are a response to suckling. The alveolar cells are the principal sites for production of milk. ""Although some secretory activity is evident during pregnancy and accelerated following delivery, milk secretion actually stas on 3rd or 4th postpaum day Probably, steroids -- estrogen and progesterone circulating during pregnancy make the breast tissues unresponsive to prolactin. When the estrogen and progesterone are withdrawn following delivery, prolactin begins its milk secretory activity in previously fully developed mammary glands. -### End" -127,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following statements regarding water reabsorption in the tubules is true?, with the following options: A: The bulk of water reabsorption occurs secondary to Na+ reabsorption, B: Majority of facultative reabsorption occurs in proximal tubule, C: Obligatory reabsorption is ADH dependent, D: 20% of water is always reabsorbed irrespective of water balance - -### Response: -Maximum of filtered water (60-70%) is reabsorbed in the proximal tubule, with or without Vasopressin. This is independent of the fluid and electrolyte status of the body and is caused by the osmotic gradient created by Na+ reabsorption. -Obligatory water reabsorption- (Independent of ADH)- 85% --        Proximal tubule- 60-70% --        Descending limb of loop of Henle- 15% -Facultative water reabsorption- (ADH dependent)- 15% -This depends on fluid and electrolyte status of the body --        Late distal tubule --        Cortical collecting duct -Medullary collecting duct -### End" -128,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PID does not include:, with the following options: A: Cervicitis, B: Endometritis, C: Peritonitis, D: Salpingitis - -### Response: -Ans: A (Cervicitis) Ref: Dutta Textbook of Gynecology 5th Ed pg 124Explanation:PELVIC INFLAMMATORY DISEASE (PID)Infection of upper genital tract involvingEndometriumFallopian tubesOvariesPelvic peritoneum and surrounding structuresCervicitis is not included in PIDRisk factorsMenstruating teenagersMultiple sexual partnersNo OCP useIUCD usageSTDsProtective factorsCondomsOCPsPregnancyMenopauseWomen whose partner has done vasectomyHusband is azoospermicCausative organismsNeisseria gonorrhoae Chlamydia trachomatisMycoplasma hominisSymptomsLower abdominal painFeverLassitudeExcessive vaginal bleedingPurulent vaginal dischargeDyspareuniaFitz-Hugh Curtis syndrome--Acute salpingitis with perihepatitis causes pain in right hypochondiiumInvestigationsDischarge sent for stain and cultureLeucocytosisLaparoscopy USGTreatmentDoxy 100 mg bd.Erythromycin 500 mg qid.Tetracycline 500 mg qid. Metronidazole 500 mg bd.Azithromycin Ism single dose. Ofloxacin 400 mg bd for 7 to 14 days.For N. gonorrhoea Ceftriaxone 250 mg deep IM single dose, Ciproflox 500 mg orally single dose. -### End" -129,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reactive depression is similar to:, with the following options: A: Dysthymia, B: Double depression, C: Adjustment disorder, D: Post-traumatic stress disorder - -### Response: -Reactive depression: * Type of non-endogenous depression It is depression secondary to external events leading to significant psychological stress. External events like - Breakup, job loss, death of a close relative or friend In ideal case, the depression would not have occured without the stress to which it is a reaction. It continues as long as the event is present, and it terminates with the reversal of the event (e.g., return of the lover) Self limiting condition It is similar to adjustment disorder. Adjustment disorder is a disorder characterized by mild depressive and anxiety features characterized following a significant life event. It lasts for a maximum duration of 6 months and mostly resolves spontaneously. -### End" -130,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A test has high false positive rate in a community.True is, with the following options: A: High specificity, B: High sensitivity, C: High prevalence, D: Low prevalence - -### Response: -Low prevalence Repeat form Nov 08 ""In a population with a low prevalence of a paicular disease, it is likely that most of the positive results in a screening program for that disease would be falsely positive.""- Epidemiology, biostatistics, and preventive medicine By James F. Jekel, David L. Katz, Joann G. Elmore 2/e p120 ""In a high-prevalence population, the absolute number of false-positives is small in comparison with the absolute numbers of true positives. In a low-prevalence population, the absolute number of false-positives is large in comparison with the absolute number of true positives."" -The basic science of oncology By Ian Tannock 4/e p486, 487 The no. of false positive varies inversely with the prevalence of disease in population. This means that when the same test is applied to two populations with differing prevalence; false positive cases would be more in the population with low prevalence and false positive cases would be low in the population with high prevalence. Also Note: Sensitivity and specificity are characteristic of a paicular test and do not depend on the prevalence of disease in the population being tested. The positive predictive value and the negative predictive value depend on characteristics of both the test (sensitivity and specificity) and the population being tested (prevalence of disease). The positive predictive value is directly propoional to the prevalence. The negative predictive value is inversely propoional to prevalence. As the prevalence of disease declines, the positive predictive value of the test declines and the negative predictive value increases. -### End" -131,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following types of reaction occur in glycolysis, except, with the following options: A: Hydration, B: Isomerisations, C: Phosphoryl transfer, D: Aldol cleavage - -### Response: -Step 1: Uptake and Phosphorylation of Glucose Glucose is phosphorylated to form glucose-6-phosphate. The reaction is catalysed by the specific enzyme glucokinase in liver cells and by non-specific enzyme hexokinase in liver and extrahepatic tissue. The enzyme splits the ATP into ADP, and the Pi is added to the glucose. Hexokinase is a key glycolytic enzyme. Hexokinase catalyses a regulatory step in glycolysis that is irreversible. Hexokinase, like many other kinases, requires Mg2+ for its activity. Step 2: Isomerization of Glucose-6-Phosphate to Fructose-6-Phosphate Glucose-6-phosphate is isomerised to fructose-6-phosphate by phosphohexose isomerase. This reaction involves an aldose-ketose isomerisastion catalysed by phosphohexose isomerase. There is opening of the glucopyranose ring of glucose-6-phosphate to a linear structure which then changes to the furanose ring structure of fructose-6-phosphate. Step 3: Phosphorylation of F-6-P to Fructose 1,6-Biphosphate Fructose-6-phosphate is fuher phosphorylated to fructose 1,6-bisphosphate. The enzyme is phosphofructokinase-1. It catalyses the transfer of a phosphate group from ATP to fructose-6-phosphate. The reaction is irreversible. One ATP is utilised for phosphorylation. Phosphofructokinase-1 is the key enzyme in glycolysis which regulates breakdown of glucose. Step 4: Cleavage of Fructose 1,6-Biphosphate The 6 carbon fructose-1,6-bisphosphate is cleaved into two 3 carbon units; one glyceraldehyde-3-phosphate (GAP) and another molecule of dihydroxyacetone phosphate (DHAP). The enzyme which catalyses the reaction is aldolase. Since the backward reaction is an aldol condensation, the enzyme is called aldolase. The reaction is reversible. Step 5: Interconversion of the Triose Phosphates GAP is on the direct pathway of glycolysis, whereas DHAP is not. Hence Triose-phosphate isomerase conves DHAP into GAP useful for generating ATP. Thus net result Is that glucose is now cleaved into 2 molecules of glyceraldehyde-3-phosphate. This reaction is rapid and reversible. Step 6: Oxidative phosphorylation of GAP to 1,3-Bisphosphoglycerate The first step in the payoff phase is the oxidation of glyceraldehyde 3-phosphate to 1,3-bisphosphoglycerate. This reaction is catalyzed by glyceraldehyde 3-phosphate dehydrogenase. It is the energy-yielding reaction. Reactions of this type in which an aldehyde group is oxidised to an acid are accompanied by the liberation of large amounts of potentially useful energy. During this reaction, NAD+ is reduced to NADH. This is a reversible reaction. Step 7: Conversion of 1,3-Biphosphoglycerate to 3-Phosphoglycerate The enzyme phosphoglycerate kinase transfers the high-energy phosphoryl group from the carboxyl group of 1,3-bisphosphoglycerate to ADP, forming ATP and 3-phosphoglycerate. This is a unique example where ATP can be produced at substrate level without paicipating in electron transpo chain. This type of reaction where ATP is formed at substrate level is called as Substrate level phosphorylation. Step 8: Conversion of 3-Phosphoglycerate to 2-Phosphoglycerate 3-phosphoglycerate is isomerized to 2-phosphoglycerate by shifting the phosphate group from 3rd to 2nd carbon atom. The enzyme is phosphoglucomutase. This is a readily reversible reaction. Mg2+ is essential for this reaction. Step 9: Dehydration of 2-Phosphoglycerate to Phosphoenolpyruvate 2-phosphoglycerate is conveed to phosphoenolpyruvate by the enzyme enolase. One water molecule is removed. A high energy phosphate bond is produced. The reaction is reversible. Enolase requires Mg++. Step 10: Conversion of Phosphoenol Pyruvate to Pyruvate Phosphoenolpyruvate (PEP) is dephosphorylated to pyruvate, by pyruvate kinase. First PEP is made into a transient intermediary of enol pyruvate; which is spontaneously isomerized into keto pyruvate, the stable form of pyruvate. One mole of ATP is generated during this reaction. This is again an example of substrate level phosphorylation. The pyruvate kinase is a key glycolytic enzyme. This step is irreversible. REF:DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY,EIGHTH EDITION,PG.NO.,129. -### End" -132,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cinnarizine used for motion sickness is a, with the following options: A: 5HT4 - antagonist, B: H2 - antagonist, C: Antihistamine, D: NK1 antagonist - -### Response: -Cinnarizine is an antihistamine with anticholinergic property given for motion sickness & also used in the treatment of vertigo. -### End" -133,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the World Health Organization (WHO) definition of osteoporosis?, with the following options: A: Bone mineral density less than 1 standard deviation below the mean of a young, healthy adult., B: Bone mineral density at least 2.5 standard deviations below the mean of a young, healthy adult., C: T score less than -2.5., D: (B) and (C). - -### Response: -Ans. D. (B) and (C).In 1994, the WHO introduced definitions for osteoporosis and osteopenia in terms of T score thresholds of -2.5 and -1 respectively. A T score of -2.5 means that the bone mineral density in the lumbar spine (L2-L4) is at least 2.5 standard deviations below the mean of a young (age 25-35), healthy female. A T score of more than -2.5 implies it is more positive and hence could represent either osteopenia or normal bone density. -### End" -134,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false about Calciphylaxis, with the following options: A: It is Calcific arteriopathy in chronic kidney disease, B: Livedo reticularis can be seen, C: Vascular Calcification is seen, D: Associated with hypoparathyroidism - -### Response: -Hyperparathyroidism , increased use of oral Calcium and warfarin treatment are risk factors. -### End" -135,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs are used for smoking cessation?, with the following options: A: Bupropion, B: Buspirone, C: Venlafaxine, D: Fluoxetine - -### Response: -Ans. (A) Bupropion(Ref: Harrison 16th/e p2575; Katzung 11th/e p521,1110)Drugs used for smoking cessation are:Nicotine (gum, patch, nasal inhaler, oral inhaler)BupropionClonidine (oral, patch)NortriptylineRimonabantVarenicillineAmfebutamoneMecamylamine -### End" -136,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Black piedra is caused by -, with the following options: A: Piedraia hortae, B: Trichosporon asahii, C: Trichosporon ovoides, D: Trichosporon inkin - -### Response: -Ans. is 'a' i.e., Piedraia hortae o Piedra is an asymptomatic superficial fungal infection of the hair shaft also known as trichomycosis nodu- laris. Black piedra is caused by Piedraia hortae, whereas white piedra is caused by pathogenic species of the Trichosporon genus, namely Trichosporon asahii, Trichosporon ovoides, Trichosporon inkin, Trichosporon mucoides, Trichosporon asteroides, and Trichosporon cutaneum. -### End" -137,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin E deficiency is associated with, with the following options: A: Ataxia, B: Cholestasis, C: Hyperkeratosis, D: Pseudotumour cerebri - -### Response: -Vitamin E deficiency causes axonal degeneration of the large myelinated axons results in posterior column & spino cerebellar symptoms -### End" -138,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45-year-old male presents to the emergency depament with 2 days of haemoptysis. He repos that he has been coughing up 1-3 tablespoons of blood each day. He does repo mild chest pain, low-grade fevers, and weight loss. He has had about 1 year of severe upper respiratory symptoms including frequent epistaxis and purulent discharge treated with several courses of antibiotics. His only medications are daily aspirin and lovastatin. On examination, he has normal vital signs, and upper airway is notable for saddle nose deformity and clear lungs. A CT scan of the chest shows multiple cavitating nodules, and urinalysis shows RBCs . Which of the following tests offers the highest diagnostic yield to make the appropriate diagnosis?, with the following options: A: Deep skin biopsy, B: Percutaneous kidney biopsy, C: Pulmonary angiogram, D: Surgical lung biopsy - -### Response: -The patient presents with classic symptoms for granulomatosis with polyangiitis. C/F: Vasculitis of 1. U= Epistaxis (Oral cavity Strawberry gingivitis) 2. L= Haemoptysis (Cavity formation in lungs) 3. Kidney = Haematuria The average age of diagnosis is 40 years. Male predominance. The diagnosis is made by demonstration of necrotizing granulomatous vasculitis on biopsy. Pulmonary tissue offers the highest yield. Biopsy of the upper airway usually shows the granulomatous inflammation but infrequently shows vasculitis. Renal biopsy may show the presence of pauci-immune glomerulonephritis. -### End" -139,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At equilibrium the concentrations of Cl- inside and outside a cell are 8 mmol/L and 120 mmol/L, respectively. The equilibrium potential for Cl- at 37oC is calculated to be (NOT RELATED), with the following options: A: +4.07 mV, B: -4.07 mV, C: +71.7 mV, D: -71.7 mV - -### Response: -Nernst equation Ei - Eo = 61/-1 x log10 120/8 = -61 x 1.176 = -71.7 mV inside the cell. Note that for Cl-, the value for z (valence) is -1 -### End" -140,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Communicability of disease is assessed by means of:, with the following options: A: Secondary attack rate, B: Generation time, C: Serial interval, D: Incubation period - -### Response: -Secondary attack rate -### End" -141,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding barret's oesophagus is :, with the following options: A: Benign course, B: Premalignant condition, C: Sq. metaplasia of lower oesophagus, D: Medical T/t is not useful - -### Response: -Ans is 'b' ie Premalignant condition As already explained Barrett's esophagus is an Intestinal metaplasia (not squamous metaplasia) which follows the metaplasia - dysplasia - cancer course (a Premalignant condition for adenocarcinoma of esophagus)About the medical t/t Though medical treatment does not revert back the metaplastic changes, it's given to treat the underlying reflux disorder and prevent further damage. CSDT, Bailey, Maingot's, all advice medical treatment for reflux esophagitis in cases of Barrett's esophagus. -### End" -142,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a specific protection method under primary level of prevention?, with the following options: A: Ribavirin to close contact meningitis patient, B: Health education about hand washing, C: Giving Pentavalent vaccination to children, D: Addition of iron with Wheat flour - -### Response: -Ans. (B) Health education about hand washing(Ref: Park Text book of PSM 25th ed; pg. 410)Hand washing is not a specific protection measure under primary prevention. All other options are protection measures against specific disease.Health education about hand washing is usually primordial prevention.Ribavirin to close contact meningitis patient comes under chemoprophylaxis and primary prevention.Giving Pentavalent vaccination to children: Primary preventionAddition of iron with Wheat flour: Specific protection and primary prevention -### End" -143,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What does the arrow point to in the fundus examination of a myopic patient?, with the following options: A: FosterFuchs spot, B: Lacquer cracks, C: Arlt line, D: Myopic crescent - -### Response: -Fundus findings in degenerative myopia:1A pale tessellated ('tigroid') appearance is due to diffuse attenuation of the RPE with visibility of large choroidal vessels.2Focal chorioretinal atrophy is characterized by the visibility of the larger choroidal vessels and eventually the sclera.3Anomalous optic nerve head which may appear unusually small, large or anomalous with a 'tilted' conformation. Peripapillary chorioretinal atrophy is very common, and in milder cases taking the form of a temporal crescent of thinned or absent RPE exposing the choroid and/or sclera.4'Lacquer cracks' are ruptures in the RPE-Bruch membrane-choriocapillaris complex characterized clinically by fine, irregular, yellow lines, often branching and crisscrossing at the posterior pole. They are present in around 5% of highly myopic eyes and can precede the development of CNV, retinal hemorrhages without CNV, and geographic atrophy. It is thought that the flaw in the RPE barrier constituted by the cracks provides a route through which choriocapillaris tissue can grow.5Lattice degeneration.6Subretinal 'coin' hemorrhages, which may be intermittent, may develop from lacquer cracks in the absence of CNV.7A Fuchs spot is a raised, circular, pigmented lesion at the macula developing after a subretinal hemorrhage has absorbed.8A staphyloma is an ectasia or bulging of the posterior sclera due to focal expansion and thinning. It occurs in about a third of eyes with pathological myopia, and is viually always peripapillary or involves the macula. Staphyloma development can be associated with macular hole formation.Ref: Kanski; 7th edition; Pg. 637 -### End" -144,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stone which is resistant to lithiotripsy, with the following options: A: Calcium oxalate, B: Triple phosphate stone, C: Cystine stone, D: Uric acid stone - -### Response: -lithiotripsy  is a medical procedure involving the physical destruction of hardened masses like kidney stones. -### End" -145,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are neurologic channelopathies, except?, with the following options: A: Hypokalemic periodic paralysis, B: Episodic ataxias, C: Familial hemiplegic migraine, D: Huntington's disease - -### Response: -Choice 1 and 3 are calcium channel defect. Choice 2 is potassium channel defect. Huntington' disease is a disorder of trinucleotide repeats due to Huntington gene on chromosome 4. -### End" -146,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Malnourished child from a poor socioeconomic status, residing in overcrowded and diy areas present with a nodule around the limbus with hyperemia of surrounding conjunctiva in his left eye. He is also observed to have axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis:, with the following options: A: Phlyctenular conjunctivitis, B: Foreign body granuloma, C: Vernal keratoconjunctivitis, D: Episcleritis - -### Response: -Ans. Phlyctenular conjunctivitis -### End" -147,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following areas are commonly involved sites in pelvic fracture except, with the following options: A: Pubic rami, B: Alae of ilium, C: Acetabulum, D: Ischial tuberosities - -### Response: -ref : maheswari 9th ed -### End" -148,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is the treatment of choice for a desmoids tumor?, with the following options: A: Surgery, B: Radiotherapy, C: Chemotherapy, D: Radiotherapy + Chemotherapy - -### Response: -Desmoid tumors are cytologically bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. Desmoid tumors are twice more common in females than in males. Primary surgery with negative surgical margins is the most successful primary treatment modality for desmoid tumors. Positive margins after surgery reflect a high risk for recurrence. Wide excision with a 2.5 cm margin is usually done. -### End" -149,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alcohol Dehydrogenase comes under which class of enzyme?, with the following options: A: Oxidoreductase, B: Dehydrogenase, C: Hydrolase, D: Oxidase - -### Response: -Ans. A. OxidoreductaseHere the question is asking about class of enzyme, hence answer oxidoreductase. Dehydrogenase is the subclass not class of enzyme. -### End" -150,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oaubain acts by inhibiting, with the following options: A: Adenyl cyclase, B: Ca+ chanells, C: H+K+ ATPase, D: Na+K+ATPase - -### Response: -Ouabain is a cardiac glycoside and in lower doses, can be used medically to treat hypotension and some arrhythmias. It acts by inhibiting the Na/K-ATPase, also known as the sodium-potassium ion pump Refer kDT 6/e p496 -### End" -151,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to ICD-10, which letter is used to denote mental illness?, with the following options: A: Q, B: B, C: G, D: F - -### Response: -Ref: International Classification of Diseases - Version 10 ICD-10. WHO documentExplanation:INTERNATIONAL CLASSIFICATION OF DISEASES (ICD)It is a system for coding all diseases of mankind.It also includes:o Signs and symptomso Abnormal findingso Social circumstanceso External causes of injury or distress.It is published by WHO (World Health Organization).The current version is 10th.Next version 11th is expected in 2015.It has 22 chapters (coded in Roman I to XXII).It also has codes as ""alpha-numericaC (i.e. alphabets and numbers).The alphabets A to Z are there but put in chapters as ''blocks"". For example, Chapter I contains A and B blocks.Mental health disorders are coded in Chapter V, F block.Each alphabet (block) has numbers in two digits which in turn followed by two decimal numbers.For example, moderate depressive episode with somatic syndrome is coded as F32.ll.Mental health disorders are coded from F00 to F99 in ten categories (F00-FO9, FIO-19. F20-29, F90-99).First organic conditions (F00-09), then substance use (F10-19) are coded and insist all of us to rule out these etiopathological factors first in any case of behavioral disturbance.Other classificatory systems are DSM (Diagnostic and Statistical Manual, Vth revision) and Chinese Classification of Mental Disorders (CCMD, 3rd edition).DSM is devised by APA ( American Psychiatric Association).In contrast to ICD. these classification systems are applicable for mental health problems ONLY (ICD codes all disorders).ICD system is used for medical insurance system in USA though DSM is used widely by clinicians. -### End" -152,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mass spectrometry is used for:, with the following options: A: Pulp vitality assessment., B: Protein and body fluid assessment., C: Pulpal blood flow assessment., D: Pulpal nerve stimulation assessment. - -### Response: -Mass Spectrometry (MS) is new chemical method used For - -Determination of the primary structure of proteins -Assessment of body fluid -Detection of post-translational modifications -### End" -153,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with burns presents to the emergency room. He was started on intravenous fluids. The best method to assess the adequacy of volume replacement is, with the following options: A: Pulse rate, B: Urine output, C: Systolic blood pressure, D: Central venous pressure - -### Response: -Answer: b) Urine output (Merck manual & Handbook of Evidence based critical care)Treatment of shock is directed at maintainingCVP of 8-12 mm HgMean arterial pressure of >65 mmHg (systolic pressure >90 mmHg)Cardiac index of 2-4 L/min/m2The urine output rate should be kept at >0.5 mL/kg per hourAdequate end-organ perfusion is best indicated by urine output of > 0.5 to 1 mL/kg/hHeart rate, mental status, and capillary refill may be affected by the underlying disease process and are less reliable markers.Because of compensatory vasoconstriction, mean arterial pressure (MAP) is only a rough guideline; organ hypoperfusion may be present despite apparently normal values.An elevated arterial blood lactate level reflects hypoperfusion; however, levels do not decline for several hours after successful resuscitation.HEMODYNAMIC SUPPORT IN SHOCKNS or RL (crystalloids) is the first choice for acute stage of resuscitationWhen fluid requirements are high, colloids (Dextran, gelatin, 5% albumin) are of usePacked RBC should be given at 10 mL/kg to maintain hematocrit at 30% or Hb 9 g/dLBolus of 20ml/Kg given rapidly over 5-10 mins; if no response - repeat bolusPatients who do not respond to rapid boluses of 40-60ml/Kg in the first hour are labeled as fluid refractory shock and inotrophic support (dopamine or dobutamine) should be givenUse insulin only if it is needed to maintain the blood glucose concentration below 150 mg/dLFirst line Vasopressor inAnaphylactic shock: EpinephrineSeptic shock, Cardiogenic shock, Vasodilatory shock: NorepinephrineRefractory shock: EpinephrineIf shock persists - catecholamine resistant shock - give Hydrocortisone if adrenal insufficiency is suspectedACTH stimulation test is not useful for detecting less profound degrees of corticosteroid deficiency in patients who are critically illVasodilators (nitroprusside, nitroglycerine) in children remaining hypodynamic with high SVR despite fluid and ionotropic supportChildren remaining normotensive with low output state and high SVR despite epinephrine and vasodilator - phosphodiesterase III inhibitors (Amrinone, Milrinone) are givenRecombinant activated protein C (aPC) - for severe sepsis or septic shock -### End" -154,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following is true about amoebic liver abscess except -, with the following options: A: It is common in the left lobe of the liver, B: CT and USG are helpful for diagnosis, C: Metronidazole is the mainstay of treatment, D: Entamoeba Histolytica is acquired through the faeco oral route - -### Response: -Amoebic Liver abscess Caused by Entamoeba histolytica whose cysts are acquired through the feco-oral route and their trophozoites reach the liver through poal venous system Like pyogenic abscess they are also common in . lobe of liver Clinical Picture The typical clinical picture is of a patient 20-40 yrs of age who has travelled to an endemic area, presents with fever, chills, anorexia, . upper quadrant pain. Although liver abscess results from an obligatory colonic infection, a recent history of diarrhoea is uncommon. Jaundice is rare. (c.f. in pyogenic abscess jaundice is seen in -25% of pts.) Liver function tests may show mild abnormalities, hyperbilirubinemia is uncommon CT > U/S are the mainstay of investigation. Diagnosis is confirmed by serological tests (enzyme immuno assay) for antiamoebic antibodies Cultures of amoebic abscess are usually negative Treatment Metronidazole is the mainstay of t/t and is curative in over 90% of patients, (other nitroimidazoles i.e. secnidazole, tinidazole, are also effective) Therapeutic needle aspiration is avoided. Done only when Pt. fails to respond to metronidazole High risk of rupture Abscess secondarily infected with pyogenic organism Complications may occur uncommonly; these are Rupture into the peritoneum, pleural cavity or pericardium Ref srb manual of surgery 5e Liver p596 -### End" -155,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pringle maneuver may be required for treatment of:, with the following options: A: Injury to fail of pancreas, B: Mesenteric ischemia, C: Bleeding esophageal varices, D: Liver laceration - -### Response: -Ans. (d) Liver Laceration* Pringle Maneuver is used to stop bleeding from liver during trauma as well as during surgery* It occludes the inflow totally - bleeding stops from Hepatic artery and portal vein.* Pringle maneuver can be tolerated by normal liver for 60 minutes and only for 30 minutes in Cirrhotic liver. -### End" -156,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Advantage of laparoscopic sterilization over mini-laparotomy sterilization is, with the following options: A: Less failure rate, B: Less blood loss, C: Very small scar, D: Easy procedure - -### Response: -Mini-laparotomy Vs Laparoscopic sterilization FeaturesMinilaparotomyLaparoscopic sterilizationAdvantages Safe, effective and convenient methodDone as outpatient procedureDone with minimal trainingDone in peripheral setting (PHCs and Camps)Used for mass sterilization for population controlDoes not need special training.Does not need special equipmentCan be performed during puerperium, after aboionCan be done for interval sterilizationEffective method of contraception (as effective as minilap).Very low complication rate.Can be done as outpatient procedure.Can be done in peripheral setting (PHCs and Camps).Very small scar.Postoperative pain and discomfo minimal.Daycare procedure (Patient can be discharged on the same day).Shoer convalescence.Highly reversible (when done with clips).Disadvantages High chances of wound and pelvic infectionsLonger duration and severity of postoperative painLonger convalescenceLonger incisional scarComplication rate is low, but it occurs, can be life-threatening.Costly equipment.Requires specially trained expes.(Refer: Shaw&;s Textbook of Gynaecology, 15th edition, pg no: 240) -### End" -157,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for bone metastasis in carcinoma of the breast in women is:, with the following options: A: Skull, B: Ribs, C: Spine, D: Pelvis - -### Response: -(C) Spine > It is by this route that skeletal metastases occur, although the initial spread may be via the lymphatic system. In order of frequency the lumbar vertebrae, femur, thoracic vertebrae, rib and skull are affected and these deposits are generally osteolytic.> Metastases may also commonly occur in the liver, lungs and brain and, occasionally, the adrenal glands and ovaries; they have, in fact, been described in most body sites. -### End" -158,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve damaged in radical mastoidectomy is -, with the following options: A: Facial, B: Cochlear, C: Vestibular, D: All - -### Response: -Complications of radical mastoidectomy - -Injury to facial nerve -Dislocation of incus -Injury to horizontal semicircular canal. The patient will have post-operative giddiness and nystagmus. -Injury to sigmoid sinus with profuse bleeding. -Injury to the dura of middle cranial fossa. -### End" -159,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5 year old female patient complains of deformed shape of legs. Patient is a strict vegetarian. Lab investigations reveal elevated levels of alkaline phosphatase. This patient is suffering from deficiency of a vitamin whose recommended dietary allowance is-, with the following options: A: 300IU, B: 400IU, C: 500IU, D: 600IU - -### Response: -Deficiency of vitamin D causes rickets in children and osteomalacia in adults. The weight bearing bones are bent to form bow-legs.  In rickets, the plasma level of calcitriol  is  decreased  and  alkaline phosphatase  activity  is  elevated. The daily requirement of vitamin D is 400IU or 10 mg of cholecalciferol. -Satyanarayana- Biochemistry, 3rd edition, pg-127 -### End" -160,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25–year old male gives a history of redness, pain and mild diminished vision in one eye for past 3 days. There is also a history of a low backache for the past one year. On examination, there is circumcorneal congestion, the cornea is clear apart from a few fine keratic precipitates on the corneal endothelium, there are 2+ cells in the anterior chamber and the intraocular pressure is within normal limits. The patient is most likely suffering from –, with the following options: A: Acute attack of angle closure glaucoma, B: HLA B–27 related anterior uveitis, C: JRA associated uveitis, D: Herpetic keratitis - -### Response: -Information in this question are :- - - -Age → 25 years -A low backache (most likely due to sacroiliitis) -Circumcorneal congestion, KPs, aqueous cells (2 + cells in anterior chamber) -Normal intraocular tension - - -The diagnosis is anterior uveitis. -A most common cause of anterior uveitis in young adults is HLA-B27 associated uveitis (ankylosing spondylitis). Low back pain (due to sacroiliitis) further supports the diagnosis. -### End" -161,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following inhalational agent sensitizes myocardium to catecholamine, with the following options: A: Sevoflurane, B: Isoflurane, C: Ether, D: Alothane - -### Response: -Some inhalational agent sensitize the hea to adrenaline -Arrhythmias can occur -therefore these agents are contraindicated in Pheochromocytoma and along with adrenalinHalothane has maximum propensityOther agents sensitizing the hea to adrenaline are Trilene, Cyclopropane, Chloroform, Enflurane(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 167 - 169) -### End" -162,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient is known to have calcium nephrocalcinosis for the post 10 years. All of the following dietary recommendations should be suggested, Except:, with the following options: A: Protein Restriction, B: Calcium Restriction, C: Calcium Restriction, D: All of the above - -### Response: -Answer is B (Calcium Restriction): Low protein, Low sodium and Normal Calcium diet is recommended for patients with calcium nephrolithiasis Dietry Intervention in patients with Calcium Nephrolithiasis Dietary intervention plays a cardinal role in the preventive treatment of calcium nephrolithiasis. Studies have shown that a low protein, low salt diet significantly reduces nephrolithiasis recurrence rates in patients with idiopathic hypercalciuria. Long term dietary compliance with a low protein, low salt diet has been shown to be superior to a low calcium diet in prevention of nephrolithiasis. A low calcium diet may increase the intestinal absorption of oxalate reducing the effectiveness of this therapy. Therefore low calcium diets are not recommended. Diets containing 700 to 800 mg of calcium are adequate for patients with idiopathic hypercalciuria. Low protein diets reduce purine intake, resulting in reduced systemic acid and uric acid loads. Low sodium diets reduce the amount of calcium in urine' - The Washington Manual Nephrology Subspecialty Consult' 2nd/245 -### End" -163,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Supports of uterus are all except, with the following options: A: Uterosacral ligaments, B: Mackenrodt's ligament, C: Broad ligament, D: Levatorani - -### Response: -Ans. C. Broad ligamentCLASSIFICATIONPrimary supportsa. Muscular or activei. Pelvic diaphragmii. Perineal bodyiii. Urogenital diaphragmb. Fibromuscular or mechanicali. Uterine axisii. Pub cervical ligamentiii. Transverse cervical ligamentiv. Uterosacral ligamentv. Round ligament of uterusSecondary supportsi. Broad ligamentsii. Uterovesical fold of peritoneumiii. Rectovaginal fold of peritoneum Broad Ligaments:These are folds of peritoneum which attach the uterus to the lateral pelvic wall, it has anterior and posterior surfaces and upper, lower, medial and lateral borders. It contains the following structures:Uterine tubei. Round lig. of uterusii. Lig. of ovaryiii. Uterine and ovarian plexus and nerve plexusiv. Epoophoron and paroophoronv. Lymphaticsvi. Connective tissue. -### End" -164,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AFP is elevated in, with the following options: A: HCC, B: Infant hemangioendothelioma, C: Amoebic liver abscess, D: Embryonic sarcoma - -### Response: -. -### End" -165,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common complication of intracapsular fracture neck of femur is, with the following options: A: Mal union, B: Osteoahritis, C: Non-Union, D: Shoening - -### Response: -C i.e. Nonunion -### End" -166,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following gas is commonly used in laparoscopic procedures?, with the following options: A: Air, B: Pure 02, C: N20, D: C02 - -### Response: -CO2 is used for insufflation during endoscopic procedures (e.g., laparoscopic surgery) because it is highly soluble and does not suppo combustion. Inadveent gas emboli thus are dissolved and eliminated more easily by the respiratory system. Ref: Patel P.M., Patel H.H., Roth D.M. (2011). Chapter 19. General Anesthetics and Therapeutic Gases. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -167,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rapid fluid resuscitation of the hypovolemic patient after abdominal trauma is significantly enhanced by which of the following?, with the following options: A: Placement of long 18-gauge subclavian vein catheters, B: Placement of percutaneous femoral vein catheters, C: Bilateral saphenous vein cutdowns, D: Placement of short, large-bore percutaneous peripheral intravenous catheters - -### Response: -Rapid fluid administration is often the key to successful trauma resuscitation. Some of the important factors affecting the rate of fluid resuscitation include the diameter of the intravenous tubing, the size and length of the venous cannulae, the fluid viscosity, and the site of administration. According to Poiseuille's law, flow is proportional to the fourth power of the radius of a catheter and inversely proportional to its length. Therefore, the shorter a catheter and the larger its diameter, the faster one can infuse a solution through it. Central venous placement alone does not assure rapid flow. Importantly, the diameter of the intravenous tubing employed may be the rate-determining factor in fluid delivery: blood-infusion tubing allows twice the flow of standard intravenous tubing and should be used when rapid fluid resuscitation is needed. Any patient who is suspected of having a major abdominal injury should immediately have at least two short, large-bore (16-gauge or larger) intravenous cannulae placed in peripheral veins. Longer, smaller catheters, such as standard 18-gauge central venous catheters, may take more time to place and will have lower flow rates. Once fluid resuscitation is under way, one may elect to place an 8- or 9-French pulmonary artery catheter-introducer via a central venous approach for further volume administration, as well as for measurement of central venous pressure or for Swan-Ganz catheter insertion. Lower-extremity venous cannulae, placed by saphenous vein cutdown or percutaneously into the femoral veins, are no longer advised as primary access for patients with abdominal trauma, since possible disruption of iliac veins or the inferior vena cava will render volume infusion ineffective. Studies have demonstrated that the flow rate of cold whole blood is roughly two-thirds that of whole blood at room temperature. Diluting and warming the blood by ""piggybacking"" it into infusion lines that are delivering crystalloid will decrease the blood's viscosity, enhance flow, and minimize hypothermia. -### End" -168,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common site of brain metastasis is, with the following options: A: Cerebrum, B: Cerebellum, C: Medulla oblongata, D: Pons - -### Response: -MC site of brain metastases (85%) CEREBRUM2nd MC site of brain metastases- CEREBELLUM LUNG, BREAST, MELANOMA (SKIN CANCER), COLON AND KIDNEY cancers commonly spread to the brain.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2460) -### End" -169,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gastrojejernostomy surgery belongs to, with the following options: A: Clean surgery, B: Contaminated surgery, C: Clean contaminated surgery, D: Dirty surgery - -### Response: -Clean contaminated surgery : - -Wound is exposed to not only skin but also GI tract / Respiratory tract / Urinary tract organism in controlled enviroment. -Hence Gastrojejunostomy surjery belongs to this category. -### End" -170,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not related to epidemiology ?, with the following options: A: Promotion of health, B: Identification of etiology of disease, C: To collect data of magnitude of health problem, D: To teach a medical student how to conduct safe delivery - -### Response: -Ans. is 'd' i.e., To teach a medical student how to conduct safe delivery According to the International Epidemiological Association (IEA), epidemiology has three main aims : a) To describe the distribution and magnitude of health and disease problems in human populations. b) To identify aetiological factors (risk factors) in the pathogenesis of disease; and c) To provide the data essential to the planning, implementation and evaluation of services for the prevention, control and treatment of disease and to the setting up of priorities among those services. In order to fulfil these aims, three rather different classes of epidemiological studies may be mentioned : descriptive studies, analytical studies, and experimental or intervention studies. The ultimate aim of epidemiology is to lead to effective action : a) To eliminate or reduce the health problem or its consequences; and b) To promote the health and well-being of society as a whole. -### End" -171,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following actions of aspirin is manifested at the lowest dose?, with the following options: A: Analgesic, B: Antipyretic, C: Anti-inflammatory, D: Antiplatelet aggregatory - -### Response: -Aspirin can produce dose dependent effects. Antiplatelet action is seen at lowest doses (40-325 mg). Anti-inflammatory action require the highest doses. -### End" -172,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shoest acting local anaesthetic, with the following options: A: Procaine, B: Xylocaine, C: Bupivacaine, D: Chloroprocaine - -### Response: -. -### End" -173,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During USG, fetal abdominal circumference is measured at the level of:, with the following options: A: Stomach and umbilical vein, perpendicular to spine, B: Kidneys, C: Stomach parallel to spine, D: Liver and spleen - -### Response: -Ans. is a, i.e Stomach and umbilical vein, perpendicular to the spineRef. Williams 24/e, p 198The abdominal circumference is measured at a transverse plane (i.e. plane perpendicular to fetal spine) at the level of stomach and conference of the umbilical vein with the portal sinus.It is an indicator of fetal growth, hence is an indicator of IUGR/macrosomia in fetus.Note: Biparietal diameter: is measured in transthalamic view at the level of thalamic and cavut septum pellucidum (CSP), from the outer edge of the skull to inner edge of the distal skull. -### End" -174,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of rubeosis iridis, with the following options: A: Tumor, B: CRAO, C: Radiation retinopathy, D: Diabetic retinopathy - -### Response: -it develops following retinal ischemia which is a common feature of: -●proliferative diabetic retinopathy -●central retinal vein occlusion -●sickle cell retinopathy -●Eale's disease -### End" -175,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 26 year old female underwent hysterosalpingogram for the investigation of infeility. She has a previous history of tuberculosis. If she had developed genital tuberculosis, which genital organ will be affected commonly?, with the following options: A: Cervix, B: Ovary, C: Fallopian tube, D: Vagina - -### Response: -The primary focus of genital tuberculosis is the fallopian tubes (90% of the times), which are almost always affected bilaterally but not symmetrically. The tubes are thickened and show a rough external surface with adhesions. As tuberculosis heals, the entire tube becomes encased in heavy connective scar tissue and the lumen develops a beaded, rigid pipe stem appearance. The obstruction of the tube most frequently occurs in the region of transition between the isthmus and the ampulla. -### End" -176,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arrange following structures as pierced by spinal needle during spinal block (from outside to inside) i) Interspinous ligaments ii) Ligamentum flavum iii) Supra spinous ligament iv) Epidural space, with the following options: A: (i), (ii), (iii), (iv), B: (ii), (iv), (i), (iii), C: (iii), (i), (ii), (iv), D: (ii), (iii), (i), (iv) - -### Response: -Structures as pierced by spinal needle during spinal block (from outside to inside): iii)Supra spinous ligament i) Interspinous ligaments ii) Ligamentum flavum iv) Epidural space -### End" -177,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following represents the clinical presentation of a patient with critical lower limb ischemia?, with the following options: A: Intermittent Claudication, B: Intermittent Claudication and gangrene, C: Rest pain and ischemic ulcers, D: Intermittent claudication and ischemic ulcers - -### Response: -Patient with critical limb ischemia has insufficient perfusion to sustain limb at rest, if left untreated such patients require amputation in 6 months. They experience pain at rest, ulcers and ischemic gangrene. Rest pain is exacerbated when lying supine and is improved by dangling the feet. Narcotics can also relieve the pain. Ref: Noninvasive Cardiovascular Imaging: A Multimodality Approach By Mario J. Garcia, Page 123; Schwaz's Principles of Surgery, 9th Edition, Chapter 23 -### End" -178,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An investigator finds out that 5 independent factors influence the occurrence of a disease. Comparison of multiple factors that are responsible for the disease can be assessed by, with the following options: A: Multiple logistic regression, B: Multiple linear regression, C: Chi-square test, D: ANOVA - -### Response: -• ANOVA: Analysis of Variance is a parametric test used for polyotomous independent variable -• Chi-square test: Is non-parametric test used for testing association between 2 or more qualitative variables -• Multiple linear regression: Is used if the target variables are dimensional having multiple possible values (e.g. blood pressure, serum cholesterol, body temperature) -• Multiple logistic regression: Is used if the target variables are binary having only two possible values (e.g. hypertension, smoking, geriatric age group) -### End" -179,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about diffuse axonal injuries except:, with the following options: A: Injuries to axons by shearing force, B: Most common location is lobar white matter at the junction of grey and white matter, C: Associated with raised ICT in all the cases, D: MRI is investigation of choice - -### Response: -DIFFUSE AXONAL INJURIES (DAI) - DAI represents the presence of widespread axonal damage (white matter)in both hemispheres secondary to serve head injury. - Results from application of severe acceleration/ deceleration or angular strain to the brain (injuries to axons by shering force) - MC location: Lobar white matter at the junction of grey and white matter>Corpus callosum> Brain stem - Loss of conscciousness is a common finding - DAI: MC cause of post-traumatic vegetative state - Raised ICT may or may not be associated - MRI is IOC for DAI(better than CT scan). -### End" -180,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40 year old male presented with sudden onset of severe chest pain radiating to the left upper arm. ECG was suggestive of myocardial infarction. Investigations revealed poor blood supply to the anterior 2/3rd of the interventricular septuum. Which of the following blood vessels is most likely to be blocked, with the following options: A: Right coronary aery, B: Left coronary aery, C: Posterior interventricular aery, D: Marginal aery - -### Response: -The anterior 2/3rd of the interventricular septum is supplied by the left coronary aery. The right coronary aery distribution supplies Right atrium Right Ventricle ( except a small region to the right of the anterior interventricular groove ) A variable paof the diaphragmatic aspect of the left ventricle. Posteroinferior 1/3rd of the interventricular septum. Pa of the left atrium. The conduction system as far as the proximal pas of the right and left crura. The left coronary aery distribution supplies Left atrium Left ventricle A narrow strip of the right ventricle. The anterior 2/3rd of the interventricular septum Ref: Gray&;s Anatomy 41st edition Pgno: 1019 -### End" -181,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Feature(s) of Taenia capitis is/are all except:, with the following options: A: May presents as a boggy swelling, B: Most commonly occurs in elderly, C: May present as black dot, D: Caused by trichophyton & microsporum but not by epidermophyton - -### Response: -Ans: B (Most...) ""ScutuluirrThe characteristic lesion of favus, appearing as a yellow saucershaped crust made up ofhyphae and spores.""- dictionary.thefreedictionary.comTINEA CAPITIS AND TINEA BARBAE iVeena khanna3rd/244T.capitis - caused by microsporum any species & Trichophyton most species- Ananthanarayan 8^/606Tinea capitis is dermatophytosis or ringworm of the scalp and hair.Age: invariably a child3 Pattern are recognized: Non-inflammatory( broken hair present zls gray/black dot), inf]ammatory(kerion-pnesenf as a boggy swelling with multiple discharging sinus) & Favi/s(cause cicatrical alopecia)As the hair grows out of the follicle, the hyphae of microsporum species produce a chain of spores that form a sheath around the hair shaft (ectothrix). These spores impart a greenish to silvery fluorescence when the hairs are examined under Wood's light (365 nm).In contrast, T tonsurans, the chief cause of *black dot"" tinea capitis, produces spores within the hair shaft (endothrix). These hairs do not fluoresce; they are weakened and typically break easily at the follicular opening. In prepubescent children, epidemic tinea capitis is usually self-limiting.Zoophilic species may induce a severe combined inflammatory and hypersensitivity reaction called a kerion.Another manifestation of tinea capitis is favus, an acute inflammatory infection of the hair follicle caused by T schoenleinii, which leads to the formation of scutula (crusts) around the follicle. In favic hairs, the hyphae do not form spores but can be found within the hair shaft.Table :Some Clinical Features of Dermatophyte InfectionSkin DiseaseLocation of LesionsClinicalFungiTinea corporis (ringworm)Nonhairy, smooth skin.Circular patches with advancing red, vesiculated border and central scaling. Pruritic.T rubrum, E floccosumTinea pedis1 (athlete's foot)Interdigital spaces on feet of persons wearing shoes.Acute: itching, red vesicular. Chronic: itching, scaling, fissures.T rubrum, T mentagrophytes, E floccosumTinea cruris (jock itch)Groin.Erythematous scaling lesion in intertriginous area. PruriticT rubrum, T mentagrophytes, E floccosumTinea capitisScalp hair. Endothrix: fungus inside hair shaft. Ectothrix: fungus on surface of hair.Circular bald patches with short hair stubs or broken hair within hair follicles. Kerion rare. Microsporum- infected hairs fluoresce.Tmentagrophytes, M canisTinea barbaeBeard hair.Edematous, erythematous lesion.T mentagrophytesTinea unguium (onychomycosis)Nail.Nails thickened or crumbling distally; discolored; lusterless.Usually associated with tinea pedis.T rubrum, T mentagrophytes, E floccosumDermatophytid (id reaction)Usually sides and flexor aspects of fingers. Palm. Any site on body.Pruritic vesicular to bullous lesions. Most commonly associated with tinea pedis.No fungi present in lesion.May become secondarily infected with bacteria. -### End" -182,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 64-year-old man develops increasing dysphagia over many months. A barium swallow is performed. What is the most likely cause of his clinical presentation?, with the following options: A: Carcinoma of the esophagus, B: Achalasia, C: Sliding hiatal hernia, D: Paraoesophageal hernia - -### Response: -The appearance of unexplained dysphagia in adults requires urgent evaluation. Esophageal carcinoma is particularly prevalent in certain parts of Africa and Asia, but the incidence is increasing in Western countries. In achalasia there is initially a greater tolerance for solids over liquids. In carcinoma, dysphagia for solids is noted initially, and later there is difficulty in swallowing liquids as well. Esophagoscopy is required in the workup of dysphagia. It is imperative to rule out an underlying carcinoma. -### End" -183,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Specific gravity of CSF is?, with the following options: A: 1.003 - 1.008, B: 1.006 - 1.009, C: 1.001 - 1.003, D: 1.010 - 1.013 - -### Response: -1.006 -- 1.009 REF: Ganong's 22"" ed p. 613 Specific gravity of CSF is 1.006 -- 1.009 -### End" -184,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40 yr. old male patient presented with chronic history of breathlessness and intermittent jaundice. He denies any smoking and alcohol abuse. Lung and liver specimens revealed the following findings respectively Which of the following pooled plasma human concentrates have been approved for the above condition: -, with the following options: A: Prolastin, B: Aralast, C: Zamaira, D: All of the above - -### Response: -The lung specimen reveals diffusive panacinar emphysema. The liver biopsy shows PAS positive diastase resistant deposits. Both the above clues point towards option C. Human plasma concentrates approved are: - A. Prolastin B. Aralast C. Zamaira -### End" -185,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for Mycoplasma pneumoniae is :, with the following options: A: Penicillin, B: Tetracycline, C: Cefuroxime, D: Erythromycin - -### Response: -Answer is D (Erythromycin): -### End" -186,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Effective leprosy control programme may be indicated bn all of the following except ?, with the following options: A: Increasing number of children affected, B: Decreased grade 2 disability, C: Low MDR resistant, multibacillary cases, D: High new case detection rate - -### Response: -Ans. is 'a' i.e. Increasing number of children affected' FNaluation of programme: here are two main types of indicators in leprosy control a) Operational indicators These are related to case-finding, treatment, relapses & disabilities for e.g. o Relapse rate - One of the best indicators of the efficacy of drug regimen o Case detection ratio - No. of cases registered / no. of cases estimated. o Propoion of children among newly detected cases. o Propoion of multibacillary cases on regular treatment during the year. o Propoion of female cases among newly detected cases. o Treatment completion/cure rate. o Propoion of new cases presenting with grade 2 disability/impairment at the time of diagnosis. o Propoion of treatment defaulters. o Propoion of patients who develop new/additional disability during MDT. b) Epidemiological indicators: To assess the impact of the actions taken with regard to the problem reduction. o Incidence rate - most sensitive index of transmission of disease. Only index for measuring the effectiveness of the measure taken i.e. reduction of transmission. o Prevalence - This provides a measure of case load & is useful in planning of the treatment services. High new case detection rate comes under operational indicators which shows that the Leprosy Control Programme is effective in detecting new cases from the already pool of leprosy cases. Thus these new cases could be treated to reduce fuher transmission of disease. -### End" -187,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ascaris lumbricoides is:, with the following options: A: Ascaris lumbricoides is:, B: Cestode, C: Protozoa, D: Trematode - -### Response: -Nematode -### End" -188,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following testicular carcinoma is not germ cell tumor -, with the following options: A: Embryonal cell carcinoma, B: Teratoma, C: Choriocarcinoma, D: Gonadoblastoma - -### Response: -Ans. is 'd' i.e., Gonadoblastoma -### End" -189,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: any behaviour that is assosiated with aversive response is not repeated in future, what is the line of therapy, with the following options: A: mentalization therapy, B: behavioural therapy, C: activity sheduling, D: interpersonal therapy - -### Response: -Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845 -### End" -190,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infection with colitis is caused by -, with the following options: A: Enterobius vermicularis, B: Trichuris trichura, C: Strongyliodes, D: Clonorchis - -### Response: -STRONGYLOIDES The clinical disease may be classified as cutaneous, pulmonary and intestinal. The overwhelming severe disease seen in the immunocompromised is known as hyperinfection. Cutaneous There may be a dermatitis, with erythema and itching at the site of penetration of the filariform larvae, paicularly when large numbers of larvae enter the skin. In those sensitised by prior infection, there may be an allergic response. This may prevent circulation in the blood of the larvae, which may instead migrate in skin, leading to a form of creeping eruption or larva migrans. Pulmonary During escape of the larvae from the pulmonary capillaries into the alveoli, small haemorrhages occur, along with cellular infiltration into alveoli and bronchioles. Larvae may be found in the sputum. Intestinal The symptoms may resemble those of peptic ulcer or of malabsorption syndrome. Mucus diarrhoea is often present. In heavy infection, the mucosa may be honeycombed with the worm and there may be extensive sloughing, causing dysenteric stools. Hyperinfection In debilitated individuals, and paicularly in those with cellular immune defects, extensive internal reinfection takes place, leading to enormous numbers of adult worms in the intestines and lungs, and larvae in various tissues and organs. This is known as hyperinfection. Severe malnutrition, lepromatous leprosy, lymphoreticular malignancies, AIDS, immunosuppressive drugs and other situations in which cellmediated immunity is defective, predispose to this condition. Hyperinfection is an impoant hazard of steroid therapy and other instances of prolonged immunosuppression as in tansplant patients. Manifestations depend on the sites affected. Brain abscess, meningitis and peritonitis are major fatal complications. TEXTBOOK OF MEDICAL PARASITOLOGY;CKJ PANIKER;6TH EDITION;PAGE NO 173 -### End" -191,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neuroparalytic keratitis is associated with paralysis of which cranial nerve?, with the following options: A: 3rd, B: 4th, C: 6th, D: 7th - -### Response: -Ans. d (Seventh cranial nerve palsy). (Ref. Parson, Diseases of eye, 18th ed., 154; Basak, Ophthalmology, 2nd/298)Herpes simplex keratitis (HSV 1)Neuro- ophthalmological keratitisNeuroparalytic KeratitisMarginal keratitisPhlecty-nular keratitisInterstitial keratitisMooren's ulcer- Primary herpetic kertitis- Dendritic geographical (inadvertent use of steroids)- Disciform (treatment is steroids)- Punctate- numular- Optic neuritis- Cranial nerve palsy (3, 4 and 6th nerves)- Affects cornea, but 3rd cranial nerve palsy is most common cause.Due to paralysis of motor nerve that closes eyelids and is usually a sequel to facial palsy.Catarrhal ulcerCaused by Staph.- Endogenous toxin induced keratitis- TB protein, staph, strepto, intestinal parasites- Fascicular ulcer- Ring ulcer- Pannus- Treatment: topical steroids'Groundglass' appearance- Salmon patch of Hutchinson- KP nodules- Etiology: Congenital syphilis, TB (Hutchison triad) and Cogan's syndrome.Chronic serpiginous ulcer.Treated with steroids -### End" -192,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hutchinson's rule is related to ?, with the following options: A: Herpes simplex keratitis, B: Mycotic keratitis, C: Herpes zoster ophthalmicus, D: None - -### Response: -Ans. is 'c' i.e., Herpes zoster ophthalmicus Hutchinson's rule : - In herpes zoster ophthalmicus, involvement of the tip of nose, supplied by external nasal nerve (a terminal branch of nasociliary nerve), signifies increase risk of ocular involvement (uveitis). -### End" -193,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Radiofrequency ablation is done for :, with the following options: A: Ventricular tachycardia, B: PSVT, C: WPW, D: Atrial tachycardia - -### Response: -Answer is C (WPW) `Ablation of bypass tract offers a permanent cure of supraventricular tachycardias. The advent of radiofrequency catheter ablation has viually eliminated the need for surgery.' -### End" -194,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Podophyllum resin is indicated in the treatment of –, with the following options: A: Psoriasis, B: Pemphigus, C: Condyloma acuminata, D: Condylomata lata - -### Response: -Podophylin is used in anogenital wart (condyloma accuminata). -### End" -195,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The cycle of malaria parasite is in sequence of ? 1) Exoerythrocytic stage 2) Gametocytic stage 3) Erythrocytic stage 4) Sporogony, with the following options: A: 1,2,3,4, B: 1,3,2,4, C: 1,4,2,3, D: 4, 3, 2 - -### Response: -Ans. is 'b' i.e., 1, 3, 2, 4 -### End" -196,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The professional antigen presenting cells are, with the following options: A: Endothelial cells, B: Dendritic cells, C: T cells, D: B cells - -### Response: -Professional APC Express MHC class II molecules Dendritic cells Immature dendritic cells (Langerhans cells) Macrophages B cells Non - professional APC Do not express MHC class II molecules Stimulated by cytokines like IFN Fibroblasts Thymic epithelial cells Thyroid epithelial cells Glial cells Pancreatic beta cells Endothelial cells -### End" -197,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DNA transfer in bacteria via phage is:, with the following options: A: Conjugation, B: Transduction, C: Transformation, D: Translation - -### Response: -Ref: Textbook of Microbiology by Surinder Kumar, P 93 Microbiology by Ananthanarayan and Paniker, 8th ed., pg. 60Some bacteria also transfer genetic material between cells via following ways:* Transduction: Transfer of genetic material from one bacterium to another by a bacteriophage is known as transduction# Most widespread mechanism of gene transfer among prokaryotes* Transformation: Transfer of genetic material through the agency of free DNA* Conjugation: DNA is transferred through direct cell contact. Gram negative anerobes like E. Coli, Bacteroides, Porphyromonas, and Fusobacterium use this method of gene transfer* Bacteriophages are viruses that parasitize bacteria* Most bacteriophages carry their genetic information (the phage genome) as a length of double-stranded DNA coiled up inside a protein coat.* Lysogenic conversion: Phage DNA integrated in bacterial chromosome as prophase - replicated stably as part of host cell chromosome - transferred to daughter cell.# In other words: ""This process by which the prophage DNA confers genetic information to a bacterium is called lysogenic or phage conversion.""# NOTE: In transduction, phage acts only as a vehicle carrying bacterial genes from one cell to another but in lysogenic conversion the phage DNA itself is the new genetic element. -### End" -198,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not used in pasteurization ?, with the following options: A: Phosphatase test, B: Methylene blue test, C: Coliform count, D: Standard plate count - -### Response: -Ans. is 'b' i.e., Methylene blue test -### End" -199,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common nephrotic syndrome in elderly patients, with the following options: A: Minimal change GN, B: Membranous GN, C: IgA nephropathy, D: None of the above - -### Response: -Ans. b (Membranous GN) (Ref H-17th/1791)# MEMBRANOUS GN accounts for approx 30% of cases of nephrotic syndrome in adults with peak incidence between 30-50 yrs age.# It is rare in childhood and by far the most common cause of nephrotic syndrome in the elderly# In 25-30% of cases, MGN is secondary to malignancy (solid tumors of the breast, lung, colon), infection (hepatitis B, malaria, schistosomiasis), or rheumatologic disorders like lupus or rarely rheumatoid arthritis.# Male to female ratio of 2:1.MEMBRANOUS GLOMERULONEPHRITISA. Primary/idiopathic membranous glomerulonephritisB. Secondary membranous glomerulonephritis1. Infection: Hepatitis B and C, syphilis, malaria, schistosomiasis, leprosy, filariasis2. Cancer: Breast, colon, lung, stomach, kidney, esophagus, neuroblastoma3. Drugs: gold, mercury, penicillamine, nonsteroidal anti-inflammatory agents, probenecid4. Autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis, primary biliary cirrhosis, dermatitis herpetiformis, bullous pemphigoid, myasthenia gravis, Sjogren's syndrome, Hashimoto's thyroiditis5. Other systemic diseases: Fanconi's syndrome, sickle cell anemia, diabetes, Crohn's disease, sarcoidosis, Guillain- Barre syndrome, Weber-Christian disease, angiofollicular lymph node hyperplasia# Uniform thickening of the BM along the peripheral capillary loops is seen by light microscopy on renal biopsy.# Immunofluorescence demonstrates diffuse granular deposits of IgG and C3, and electron microscopy typically reveals electron-dense subepithelial deposits.# Eighty percent of patients with MGN present with nephrotic syndrome and nonselective proteinuria. Microscopic hematuria is seen in up to 50% of patients. Spontaneous remissions occur in 20-33% of patients and often occur late in the course after years of nephrotic syndrome. One-third of patients continue to have relapsing nephrotic syndrome.# Although thrombotic complications are a feature of all nephrotic syndromes, MGN has the highest reported incidences of renal vein thrombosis, pulmonary embolism, and deep vein thrombosis.# Rx: In addition to the Rx of edema, dyslipidemia, and hypertension, inhibition of the renin-angiotensin system is recommended.Recommendations based on small clinical studies are to treat with steroids and cyclophosphamide, chlorambucil, or cyclosporine.Additional Educational Points# The renal lesions most commonly seen, in order of decreasing frequency, are cryoglobulinemic glomerulonephritis, MGN, and Type I MPGN.# All cases with borderline lepromatous and lepromatous types of leprosy have various forms of glomerulonephritis. Most common is focal glomerulonephritis followed by mesangioproliferative glomerulonephritis or renal amyloidosis. -### End" -200,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young girl has consumed barium carbonate with suicidal intent. She complains of generalized muscle weakness. The most likely electrolyte is:, with the following options: A: Hyponatremia, B: Hypocalcemia, C: Hypokalemia, D: Hypomagnesemia - -### Response: -Barium may shift extracellular potassium intracellularly, resulting in extracellular hypokalemia, which is believed to mediate barium-induced paralysis and muscle weakness. So hypokalemia is thesingle best answer of choice Ref: Medical Toxicology-Richard C. Da, Pages 1403-04; The Essentials of Forensic Medicine and Toxicology By Dr.K.S. Narayan R. -### End" -201,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thickening of axon leads to -, with the following options: A: Increased speed of conduction, B: Decreased speed of conduction, C: Increased absolute refractory period, D: Unmyelination - -### Response: -Ans. is 'a' i.e., Increased speed of conduction o Thickness of nerve fiber (Axon) has linear relation with velocity (speed) of conduction.Factors affecting nerve conduction (Propagation of APIo There are many factors that affect the nerve conduction. Propagation of action potential (nerve conduction) is favoured byQ:-Low axoplasmic resistance (Ri)QLow external longitudinal resistance (Ro)High membrane resistance (Rm)QLow membrane capacitance (Cm) QHigh space constantHigh time constantThick (large) nerve - Linear relation with conduction QMyelination of nerv e Q -### End" -202,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epithelium of ""Trigone of bladder"" is derived from, with the following options: A: Vesicourethral Canal, B: Mesoderm, C: Splanchnopleuric Mesoderm, D: Urachus - -### Response: -The urinary bladder is derived from the cranial pa of the vesicourethral canal (endoderm).The epithelium of the trigone is derived from absorbed mesonephric ducts (mesoderm)Reference: Inderbir Singh Embryology; 10th edition; Page no: 292 -### End" -203,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of Wernicke's,encephalopathy:, with the following options: A: Global confusion, B: Opthalmoplegia, C: Ataxia, D: Aphasia - -### Response: -Ans.(d) AphasiaRef: Harrison 19th ed. / 2724The classic triad of symptoms found in Wernicke's encepha- lopathy is:* Global Confusion* Ophthalmo-plegia (Most commonly affecting the lateral rectus muscle).* AtaxiaFor diagnosis: Thiamine can be measured using an erythrocyte transketolase activity assay or by activation by measurement of in vitro thiamine diphosphate levels. -### End" -204,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In tubercular meningitis what is not seen?, with the following options: A: Low sugar, B: Lymphocytic pleocytosis, C: High protein, D: Opening pressure is low - -### Response: -ANSWER: (D) Opening pressure is lowREF: Chandrasoma Taylor 3rd ed p. 915CSF changes in meningitisCSF parametersBacterial meningitisTB meningitisViral meningitisOpening pressureRaisedRaisedRaisedGross appearanceTurbidClear (may clot)ClearProtein (normal - 20-50 mg/dl)HighVery highSlightly highGlucose (40-70mg/dl)Very lowLowLowChloride (116-122 micro gram/dl)LowVery lowNormalCells > 5/microliterNeutrophilsPleocytosisLymphocytosis -### End" -205,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Perioperative respiratory failure is, with the following options: A: Type I respiratory failure, B: Type II respiratory failure, C: Type III respiratory failure, D: Type IV respiratory failure - -### Response: -TYPE III RESPIRATORY FAILUREThis form of respiratory failure results from lung atelectasis. Because atelectasis occurs so commonly in the perioperative period, this form is also called perioperative respiratory failure. After general anaesthesia, decreases in functional residual capacity lead to the collapse of dependent lung units. Such atelectasis can be treated by frequent changes in position, chest physiotherapy, upright positioning, and control of incisional and/or abdominal pain.Noninvasive positive-pressure ventilation may also be used to reverse regional atelectasis.Harrison 19e pg:1732 -### End" -206,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On MRI, the differential diagnosis of spinal cord edema is:, with the following options: A: Myelodysplasia, B: Myelomalacia, C: Myeloschisis, D: Cord tumors - -### Response: -Myelomalacia is a increased T2w signal in the spinal cord where the spinal cord is atrophic with gliosis producing small and bright appearence of spinal cord -### End" -207,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are used to assess the mid-upper arm circumference except?, with the following options: A: Bangle test, B: Shakir tape method, C: Quac stick, D: Harpenden calliper - -### Response: -Harpenden calliper is used to measure skinfold thickness which is an indication of subcutaneous fat. The other three are used to measure the mid-upper arm circumference. The Shakir tape is used to measure mid-upper arm circumference. It has three coloured zones corresponding to various levels of wasting * In bangle test, a bangle with an internal diameter of 4 cm is passed above the elbow. In severe malnutrition, it can be passed above the elbow, in normal children it cannot. * QUACK stick - Quaker arm circumference measuringstick. It is a measure of expected Mid-arm circumference that would be expected for a given height -### End" -208,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal Axis of the hea is best described as being between:, with the following options: A: -30 to + 110, B: +30 to - 110, C: -30 to - 110, D: +90 to + 110 - -### Response: -Cardiac Axis Normal Cardiac Axis Normal cardiac axis flow down and towards the left lower aspect of the hea between - 30 and +110 Left Axis Detion Cardiac axis flow is upward and toward the left upper half of the hea between -30 and -90 Right Axis Detion Cardiac axis flow is downward and toward the right pa of the hea between +90 and +/-180 Extreme Right Axis Detion When flow of cardiac axis is upward and to the right between +/-180 and -90 -### End" -209,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of hypernatremia except, with the following options: A: Convulsions, B: Elevated intracranial tension, C: Periodic paralysis, D: Doughy skin - -### Response: -Ans. is 'c' i.e., Periodic paralysis Periodic paralysis, is seen in hyponatermia Clinical features of Hypernatremia :? Most patients with hypernatremia are dehydrated and have the typical signs and symptoms of dehydration. Hypernatremia even without dehydration causes central nervous system symptoms that tend to parallel the degree of sodium elevation and the acuity of the increase. Patients are irritable, restless weak and lethargic Some have high pitched cry and hyperpnea. Ale patient are very thirsty. Hypernatremia causes fever although many patients have underlying process that contributes to the fever Except for dehydration, there is no clear direct effect of hypernatremia on other organs or tissues except the brain. Complication of hypernatremia :? Brain hemorrhage is the most devastating consequence of hypernatremia. As the extracellular osmolarity increases water moves out of brain cells, resulting in decrease in brain volume. This can result in tearing of intra cerebral veins and bridging vessels as the brain moves away from the skull and the meninges. Patient may have subarachnoid, subdural and parenchymal hemorrhage. Seizure and coma are possible sequale of the hemorrhage even though seizures are more common during t/t. Thrombotic complications are common in severe hypernatremic dehydration and include stroke, dural sinus thrombosis, peripheral thrombosis and renal vein thrombosis. The intracranial tension can be increased due to hemorrhage -### End" -210,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atherosclerosis is due to, with the following options: A: HDL receptor defect, B: Apo protein E deficiency, C: Decreased LDL activity, D: Decreased lipoprotein lipase - -### Response: -Atherosclerosis is a slowly progressive disease of large to medium-sized muscular aeries and large elastic aeries characterised by elevated focal intimal fibrofattyPlaques. Principal larger vessels affected are the abdominal aoa, descending thoracic aoa, internal carotid aeries and medium to smaller sized vessels affected are popliteal aeries, coronary aeries, and circle of Willis in brain. The atheroma may be preceded by fatty streaks that are intimal collection of lipid-laden macrophages and smooth muscle cells, occurring in persons as young as one year of age.The disease typically manifests in later life as the vessel lumen is compromised, predisposing to thrombosis and the underlying media is thinned, predisposing to aneurysm formation. It is the number one killer disease, 50 per cent of all deaths in the USA are attributed to atherosclerosis and half of theseare due to acute myocardial infarctions. The remainder include cerebrovascular accidents (""stroke""), aneurysm rupture, mesenteric occlusion and gangrene of theextremities. Etiological Factors Major risk factors in CHD have been discussed earlier. Risk of developing atherosclerosis increases with age, a positive family history, cigarette smoking, diabetes mellitus, hypeension, and hypercholesterolemia. The risk is correlated with elevated LDL and inversely related to the HDL level. Hereditary defects, e.g. familial hypercholesterolemia involving the LDL receptor or the LDL apoproteins cause elevated LDL, hypercholesterolemia andaccelerated atherosclerosis. Lesser influences on the risk of atherosclerosis include sedentary, or high-stress lifestyle, obesity and oral contraceptives.Ref: M.N. Chatterjee - Textbook of Biochemistry, 8th edition, page no: 454 - 456 -### End" -211,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A multigravida at 35 weeks' gestation had the following finding on ultrasound. The following can be the causes except:, with the following options: A: Diabetes, B: Posterior urethral valve, C: Rh alloimmunization, D: Anencephaly - -### Response: -Ans. B. Posterior urethral valvePolyhydramnios is diagnosed when the AFI >24cm or the single deepest pocket measures >8cm.Causes of polyhydramnios:a. MC cause of mild polyhydramnios = idiopathicb. Multifetal pregnancyc. Maternal diabetesd. Cleft lip/palate (GIT anomalies >NTD)e. Esophageal atresia/duodenal atresiaf. Anencephalyg. Chorangioma of placentah. Hydrops fetalis (Rh alloimmunization)i. TORCHj. Trisomyk. sacrococcygeal teratoma -### End" -212,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60 year male is brought by his wife. He thinks that he had committed sins all through his life. He is very much depressed and has considered committing suicide but has not thought about going for it. He had also attached sessions with a spiritual guru. He is not convinced by his wife that he has lead a pious life. He does not want to hear anything on the contrary. How will you treat him ?, with the following options: A: Antipsychotic + Antidepressant, B: Antidepressant with cognitive behavioural therapy, C: Guidance & recounselling with guru + Antidepressant, D: Anti depressant alone - -### Response: -The patient in question is presenting with features of depression and delusional guilt suggesting a diagnosis of depressive disorder with psychotic features. Such patients should be managed with a combination of Antipsychotics and antidepressants. -### End" -213,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In spinal anaesthesia the needle pierced upto, with the following options: A: Subdural space, B: Extradural space, C: Epidural space, D: Subrachnoid space - -### Response: -Ans. d (Subarachnoid space). (Ref. Harrisons, Medicine, 18th/735)SPINAL ANESTHESIA# The term ""spinal anesthesia"" was coined in 1885 by Leonard Corning.Technique of spinal anesthesia:# In spinal anaesthesia the spinal needle is pierced upto subarachnoid space where the anaesthetic agent is injected to produce the anaesthesia.# The selected level should be below LI in an adult and L3 in a child to avoid needle trauma to the spinal cord. As an anatomic landmark, the L3-L4 interspace is located at the line intersecting the top of the iliac crests. Either a midline or paramedian approach can be used.# The anatomic layers passed through include skin, subcutaneous structures, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, and arachnoid membrane.# Once the needle tip is believed to be in the subarachnoid space, the stylet is removed to see if CSF appears at the needle hub. With small diameter needles (26 to 29 gauge) this generally requires 5 to 10 seconds, but may require >1 minute in some patients. Gentle aspiration may speed the appearance of CSF. If CSF does not appear, the needle orifice may be obstructed by a nerve root and rotating the needle 90 degrees may result in CSF flow. Alternatively, the needle orifice may not be completely in the subarachnoid space and advancing an additional 1 to 2 mm may result in brisk CSF flow. This is particularly true of pencil-point needles, which have their orifice on the side of the needle shaft proximal to the needle tip.# Finally, failure to obtain CSF suggests that the needle orifice is not in the subarachnoid space and the needle should be reinserted.# Common complications include hypotension, bradycardia, increased sensitivity to sedative medications, nausea and vomiting (possibly secondary to hypotension), postdural puncture headache, nerve injury, total spinal, and hematoma/abscess formation at the site of puncture.# Total spinal anesthesia results from local anesthetic depression of the cervical spinal cord and brain stem. Signs and symptoms include dysphonia, dyspnea, upper extremity weakness, loss of consciousness, pupillary dilation, hypotension, bradycardia, and cardiopulmonary arrest. Eaily recognition is the key to management. Treatment includes securing the airway, mechanical ventilation, volume infusion, and pressor support.# Absolute contraindications include local infection at the puncture site, bacteremia, severe hypovolemia, coagulopathy, severe stenotic valvular disease, infection at the site of the procedure, and intracranial hypertension. Relative contraindications include progressive degenerative (demyelinating) neurologic disease (multiple sclerosis), low back pain, and sepsis.# Intrathecal opioids:- Opioids produce intense visceral analgesia and may prolong sensory blockade without affecting motor or sympathetic function.- Fentanyl and sufentanil have a rapid onset of action and an effective duration greater than 6 hours.- Morphine lasts 6-24 hours.- Side effects include respiratory depression (which may occur late with hydrophilic agents), nausea, vomiting, pruritus, and urinary retention. -### End" -214,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apex of the heart is formed by -, with the following options: A: Left atrium, B: Left atrium + left ventricle, C: Left ventricle, D: Right ventricle + left ventricle - -### Response: -Ans. is 'c' i.e., Left ventricle o The heart has following borders and surfacesA) Bordersi) Right border:- Formed by right atrium.ii) Left border (obtuse margin):- Formed mainly by left ventricle and partly by left auricle (in its upper most part).iii) Inferior border (acute margin):- Formed mainly by right ventricle and partly by left ventricle near apex.iv) Upper border:- Mainly by left atrium and partly by right atrium where SVC enters.v) Apex:- Formed by left ventricle.B) Surfacesi) Anterior (sternocostal) surface:- Formed mostly by right ventricle (major) and right auricle and partly by left ventricle and left auricle.ii) Inferior (diaphragmatic) surface:- It is formed by left ventricle (left 2/3) and right ventricle (right 1/3). It is traversed by posterior interventricular groove (PIV) containing PIV branch of RCA.iii) Base (posterior surface) :- Formed mainly by left atrium and partly by right atrium. It is separated from T5 to T8 vertebrae by pericardium, oblique pericardial sinus, esophagus and descending thoracic aorta.iv) Right surface:- Mainly by right atrium.v) Left surface :- Mainly by left ventricle and partly by left auricle. -### End" -215,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Cock-up"" splint is used in treatment of, with the following options: A: Ulnar nerve palsy, B: Radial nerve palsy, C: Median nerve palsy, D: Sciatic nerve palsy - -### Response: -Ans. b (Radial nerve palsy) (Ref. Maheshwari orthopedics 3rd ed., p 59; Table 10.6.)RADIAL NERVE PALSY# This is a common injury after a humerus and if there is no prospect of return of function, then transfers of flexor tendons to the extensor side will stabilise the wrist and allow extension of the fingers.# The classic transfer is the Robert Jones.# Pronator teres is inserted into extensor radialis iongus to restore wrist extension.# Flexor carpi ulnaris is inserted into extensor digitorum to restore finger extension.# Palmaris iongus when present is inserted into extensor potlicis Iongus to restore thumb extension.# Splintage: cock-up splintSome important splints used in orthopedic practiseSplints and castsClinical useCock-up splintShoulder abduction splintKnuckle-bender splintFoot-drop splintRadial nerve palsy (Extensors of the wrist and MP joints paralysed)Axillary nerve (Deltoid paralysis)Ulnar nerve palsy (Lumbricals paralysis)Sciatic nerve or common peroneal nerve palsy Cylinder/tubular castFracture patellaHanging castFracture humerusPatellar tendon bearing castFracture tibiaMinerva castCervical spine fractureTrunk Buckle castScoliosisRisser's castScoliosisAluminium splintImmobilization of fingerThomas splintFracture femurBohler Braun splintFracture femurToe rising splintFoot dropKnuckle bender splintUlnar nerve palsyDennis Brown splintCTEVSome important splits and casts used in orthopedic practiseDunlop tractionFracture elbowGallow's tractionFracture femur - shaft (below 2 years)Bryant's tractionFracture femur - shaft (below 2 years)Russell's tractionTrochanteric fracturePerkin's tractionFracture shaft femur in adults -### End" -216,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of breech presentation is, with the following options: A: Prematurity, B: Contracted pelvis, C: Oligohydramnios, D: Placenta pre - -### Response: -Causes of breech presentation : Prematurity - Most common cause Undue mobility of the fetus Fetal abnormality Favorable adaptation Ref: Dutta Obs 9e pg 352. -### End" -217,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ACE inhibitor when used for long time in hypeension patient cause, with the following options: A: Rightward shift in Renal pressure natriuresis curve, B: Reduction in filtration fraction, C: Significant increase in hea rate, D: No change in the compliance of large aeries - -### Response: -Refer Goodman and Gilman 10e p804 Angiotensin 2 shifts the renal pressure natriuresis curve to the right side and helps to adjust the sodium levels in the body according to dietary intake of the sodium( more excretion from more intake and less excretion from less excretion from less intake ACE inhibitors block the action of angiotensin 11 and cause leftward shift of renal pressure natriuresis curve show that if the sodium intake is decreased much more natriuresis occur ACE inhibitors can increase the renal blood flow without increasing GFR and thus result in reduction of filtration fraction -### End" -218,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The ideal treatment of bilateral idiopathic clubfoot in a newborn is -, with the following options: A: Manipulation by mother, B: Manipulation and Dennis Brown splint, C: Manipulation and casts, D: Surgical release - -### Response: -Bilateral idiopathic clubfoot is managed by manipulation & applying cast I.e the surgeon manipulates the foot after sedating the child .The foot is then held in corrected position with plaster casts. There are two philosophies of treatment of clubfoot - * Kite&;s & * ponsetti&;s * kite&;s philosophy- begin at age of 1 month .deformities are corrected sequentially .Adduction deformity is corrected first followed by inversion deformity then equinus deformity . Then a below - knee plaster cast us usually sufficient . the cast is changed every 2 weeks , & continued until it is possible to overcorrect all deformities .once this happens foot is kept in corrected position by maintenance device. *ponsetti philosophy - the calcaneo- cuboid - navicular complex is internally rotated under plantarflexed talus , hence the deformity can be corrected back under talus by gradually stretching the tight structures . This is done by putting thumb pressure under talus .By doing so the calcaneo- cuboid- navicular complex is externally rotated under the talar head .treatment is staed within 1st week of life .cavus aspect of deformity is corrected first ,followed by adduction ,then varus & lastly equinus .after each correction above knee pop is applied , which is changed every 5-7 days .Possible to correct all components within 6weeks.Equinus deformity is often under corrected , can be treated by percutaneous tenotomy of tendoachilles . REF:Essential ohopedics, Maheshwari ,9th edition, pg.no.214 -### End" -219,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HTLV-1 causes which of the following?, with the following options: A: Tropical spastic paraparesis, B: Familial medeterranian fever, C: Cutaneous T cell lymphoma, D: burkitts lymphoma - -### Response: -HTLV1 causes tropical spastic paraparesis&adult T cell leukemia REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.567 -### End" -220,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient's relative gives a history of tattoo, however it was not found during autopsy. What should be dissected to find it:, with the following options: A: Lymph node, B: Skin, C: Spleen, D: Kidney - -### Response: -Tattoo Marks Faint or disappeared tattoo marks can be made out on histological study of the regional lymph nodesQ. In Decomposed bodies,they are made visible by treating the area with 3 %hydrogen peroxideQ. -### End" -221,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 55-year-old woman is diagnosed with invasive cervical carcinoma by cone biopsy. Pelvic examination and rectal examination reveal the parametrium is free of disease but upper part of vagina is involved with tumor .IVP and sigmoidoscopy are negative but CT S can of abdomen and pelvis shows grossly enlarged pelvic and para aortic nodes. Thus patient is classified as stage., with the following options: A: IIa, B: IIb, C: IIIa, D: IIIb - -### Response: -Now here — in this patient -On examination — Parametrium is not involved and upper part of vagina is involved so stage will be IIa — clinically. -Remember cervical cancer is still staged clinically by using investigations recommended by FIGO. -CT scan results, while clinically useful are not useful to stage the disease. -No matter whatever finding are reported on CT scan it does not after the staging so Answer remains is Stage 11a. -### End" -222,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the dosage of retinol palmitate for early stages of xerophthalmia: September 2011, with the following options: A: 90 mg orally on two successive days, B: 100 mg orally on two successive days, C: 110 mg orally on two successive days, D: 120 mg orally on two successive days - -### Response: -Ans. C: 110 mg orally on two successive days Nearly all of the early stages of xerophthalmia can be reversed by administration of a massive dose (2,00,000 IU or 110 mg of retinol palmitate) orally on 2 successive days Xerophthalmia/ Dry eyes Condition in which the eye fails to produce tears. Xerophthalmia caused by a severe vitamin A deficiency is described by pathologic dryness of the conjunctiva and * cornea. The conjunctiva becomes dry, thick and wrinkled. If untreated, it can lead to corneal ulceration and ultimately to blindness as a result of corneal damage. Xerophthalmia is a term that usually implies a destructive dryness of the conjunctival epithelium due to dietary vitamin A deficiency -- a rare condition in developed countries, but still causing much damage in developing countries. Other forms of dry eye are associated with aging, poor lid closure, scarring from previous injury, or autoimmune diseases such as rheumatoid ahritis and SjOgren's syndrome, and these can all cause chronic conjunctivitis. Radioiodine therapy can also induce xerophthalmia, often transiently Xerophthalmia from hypovitaminosis A is specifically due to lack of the hormone-like vitamin A metabolite retinoic acid Treatment can occur in two ways: treating symptoms and treating the deficiency. Treatment of symptoms usually includes use of aificial tears in the form of eye drops, increasing the humidity of the environment with humidifiers, and wearing wrap around glasses when outdoors. Treatment of the deficiency can be accomplished with a Vitamin A or multivitamin supplement or by eating foods rich in Vitamin A. Treatment with supplements and/or diet can be successful until the disease progresses as far as corneal ulceration, at which point only an extreme surgery can offer a chance of returning sight. -### End" -223,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an example of Trinucleotide repeat mutation?, with the following options: A: Huntington's chorea, B: Fragile-X-syndrome, C: Friedreich ataxia, D: All of the above - -### Response: -Polyglutamine Disorders Huntington Disease (HD) Spinobulbar Muscular Atrophy (SBMA) Spinocerebellar Ataxias (SCA types 1, 2, 3, 6, 7, and 17) Dentatorubro-Pallidoluysian Atrophy (DRPLA) Non-polyglutamine Disorders Fragile X Syndrome (FRAXA) Fragile XE Mental Retardation (FRAXE) Friedreich Ataxia (FRDA) Myotonic Dystrophy (DM, not MD) Spinocerebellar Ataxias (SCA types 8, and 12) Ref-D.M.Vasudevan 7/e p509 -### End" -224,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Streptococcus is classified based on, with the following options: A: M protein, B: Cultural characteristics, C: Bile solubility, D: Cell wall carbohydrate - -### Response: -Hemolytic streptococci were classified by Lancefield serologically into groups based on the nature of a carbohydrate (C) antigen on the cell wall. These are known as Lancefield groups, twenty of which have been identified so far and named A-V (without I and J). Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 211 -### End" -225,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When fetus is in attitude of flexion, presentation is :, with the following options: A: Veex, B: Brow, C: Cephalic, D: Face - -### Response: -The pa of the fetus which occupies the lower pole of the uterus is called the presentation of the fetus In an attitude of flexion the presention is Cephalic Ref: Dutta Obs 9e pg 69. -### End" -226,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Broad casts seen in cases of -, with the following options: A: Advanced renal failure, B: Hypotention, C: Severe hydronephrosis, D: Renal pappilary necrosis - -### Response: -Ans. is 'a' i.e., Advanced renal failure Casts* Urinary casts are formed only in the distal convoluted tubuleQ (DCT) or the collecting ductR (distal nephron).* The proximal convoluted tubule and loop of henle are not the locations for cast formation.* Casts are formed through the solidification of materials in the tubules of nephrons.* Later the material is flushed out of the kidney upon the production of more urine leaving a small solidified microscopic cylinder that can also contain what ever other materials that might be within the tubules of the kidneys at the time of cast formation.* The microscopic detection of various types of casts can often be helpful diagnostic tool in the study of various types of renal diseases.Urinary casts and their characteristic featuresHvaline casts* These are the most common type of casts and they can be found in normal urine samples.* They consists almost entirely of Tamm Horsfall protein.* Zero-to Two hyaline casts per low power field is considered normal.* Increased numbers of Hyaline casts can occur with exercise, heat exposure, dehydration, fever, congestive heart failure and diuretic.Renal tubular epithelial cell casts* These casts results when the epithelial cells of the renal tubules are being excreted along with the casts.* These are rarer casts, can in theory indicate a serious situation involving the possible breaking down of the lining of the renal tubules themselves.* Renal tubular epithelial casts are most suggestive of tubular injury as in acute tubular necrosis.* They are also found in other disorders including eclampsia, heavy metal poisoning, ethyleneglycol intoxication (most of these cases lead to acute tubular necrosis).Granular casts* These casts are fairly common and occur in both pathological and non pathological condition.* Granular casts can result either from the breakdown of cellular casts to a point where the cells that once were within them are no longer distinguishable or they can result from the inclusion of aggregates of plasma proteins, fibrinogen or immune complexes within the cast upon formation.* They can be further divided into coarse granular casts and fine granular casts.* Fine granular casts can appear in non pathological conditions such as vigorous exercise, but the presence of coarse granular cast is abnormal and presents in wide variety of clinical diseases.* They are common in renal parenchymal disease.Broad casts* These casts originate from dilated chronically damaged tubules or the collecting ducts therefore thev are called renal failure casts.* These are formed in collecting duct as a result of urinary stasis.* Broad casts are two to six times the size of other types of casts.* Broad casts or renal failure casts are usually seen in patients with advanced renal failure.Waxv casts* Waxy casts are cylinders of smooth highly refractive material.* Waxy aists are seen in final stages of degeneration of fine granular casts. Since the granules need time to degrade, this implies nephron obstruction.* Waxy casts are seen in chronic renal diseases associated with renal failure seen in diabetic nephropathy, malignant hypertension, glomerulonephritis. -### End" -227,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraceptive method of choice in lactating mothers is, with the following options: A: Barrier method, B: Progesterone only pills, C: Oral contraceptive pills, D: Lactational amenorrhea - -### Response: -Progesterone only pills or mini pill Pills that contain very low doses of progestin, do not contain estrogen, and so can be used throughout the period of breastfeeding.These pills work primarily by thickening cervical mucus, disrupting the menstrual cycle, and preventing the ovulation.Reference: Mudaliar and Menon&;s clicks obstetrics,12th edition, page no:452 -### End" -228,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are mediators of acute inflammation except -, with the following options: A: Angiotensin, B: Prostaglandin E2, C: Kallikrein, D: C 3a - -### Response: -. Angiotensin -### End" -229,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding Anti-mullerian hormone true is all except, with the following options: A: It causes regression of ipsilateral paramesonephric duct., B: Controls rapid gubernacular growth necessary for transabdominal descent of testis., C: AMH levels in women reflect ovarian follicle reserve., D: AMH is secreted by Leydig cells. - -### Response: -AMH is secreted by sertoli cells. -### End" -230,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Frequency for trans vaginal USG for obstetric purpose, with the following options: A: 3 - 5 MHz, B: 5 -7.5 MHz, C: 7.5 - 20 MHz, D: > 20 MHz - -### Response: -Transabdominal USG - 3 - 5 MHz. -Trans vaginal USG - 5 - 7.5 MHz. -### End" -231,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Energy is required in which transport process, across cell membrane -, with the following options: A: Osmosis, B: Facilitated diffusion, C: Active transport, D: Simple diffusion - -### Response: -Ans. is kc' i.e.. Active transport Types of transport across cell membrane Carrier protein involvedEnergy requiredConcentration gradientSimple diffusionNoNoAlong (Down hill)Osmosis (Diffusion of H30)NoNoAlong (Down hill)Facilitated diffusionYesNoAlong (Down hill)Active transportYesYesAgainst (Uphill)ExocytosisNoYesN/A (not applicable)Endocytosis# Pinocytosis & PhagocytosisNoYesN/A# Receptor mediated endocytosisYesYesN/A -### End" -232,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maintenance level of Mixed Venous Oxygen Saturation in shock must be, with the following options: A: < 40%, B: 40-50%, C: 50-70%, D: >70%. - -### Response: -Mixed Venous Oxygen Saturation: - * This is a measure of oxygen returning to hea from body after delivery and extraction by tissues. * Normal Value- 50-70% * In cardiogenic shock and Hypovolemic shock, the tissues takes up more oxygen and hence value is low < 50% * In Septic and Distributive shock , the tissues takes up less oxygen and hence more oxygenated blood returns to hea and hence value is high > 70% Ref:- Surgery Sixer 3rd Edition; Pg num:- 8 -### End" -233,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A baby with flat face, low set ears, micrognathia has limb deformities . and bilateral renal agenesis . There is antenatal history of oligohydromnios . The baby died of pulmonary hypoplasia what is the most probable diagnosis?, with the following options: A: Polycystic Kidney disease, B: Prune belly syndrome, C: Potter syndrome, D: Multicystic dysplastic kidney - -### Response: -Potter syndrome : -potter facies : Flat face, flat nose, low set ears, receding chin. Bilateral renal agenesis. Most common cause of death in pulmonary hypoplasia. -### End" -234,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Iceberg phenomonon is shown by -, with the following options: A: Rabies, B: Measles, C: Tetanus, D: Influenza - -### Response: -Ans. is 'd' i.e., Influenza Icebarg of diseaseo Disease in a community may be compared with an iceberg. The floating tip of the iceberg represents what the physian sees in the community, i.e. clinical cases (Diagnosed case, symptomatic case or clinically apparent case).o The vast submerged portion of the iceberg represents the hidden mass of disease, i.e. latent, inapparent, presymptomatic and undiagnosed cases and carriers in the communityo The ""waterline"" represents the demarcation between apparent and inapparent disease.o Epidemiologist is concerned with Hidden portion of iceberg whereas clinician is concerned with tip of icebergo Screening is done for Hidden portion of iceberg whereas diagnosis is done for tip of icebergo Iceberg phenomenon of disease is not shown by rabies, tetanus and measles.o The clinician concerned only with the tip of iceberg, i.e symptomatic cases that are seen in clinical treatment, this can result in inaccurate view of the nature and causes of a disease results because the minority of the cases are studied (hidden cases submerged portion of ice berg is not studied) - Clinician's Fallacy.o Important diseases with a great deal of subclinical cases (and thus showing iceberg phenomenon) are : Rubella. Polio. Mumps, Japanese encephalitis. Influenza, diphtheria, Hepatitis A, and Hepatitis B. -### End" -235,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least common cause of clubbing is:, with the following options: A: Adenocarcinoma, B: Squamous cell cancer, C: Small cell cancer, D: Mesothelioma - -### Response: -Lung cancer is the most common cause of clubbing . Most common with adenocarcinoma and is least common with small cell lung cancer. -### End" -236,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following changes does not occur in malignant hypeension :, with the following options: A: Peticheal Haemorrhages on coical surface, B: Fibrinoid necrosis of aerioles, C: Intimal concentric thickening, D: Hyaline aeriosclerosis - -### Response: -Answer is D (Hyaline Aeriosclerosis) : Hyaline aeriosclerosis is a feature of Benign Nephrosclerosis associated with benign phase of Hypeension. It is not a ,feature of Malignant Hypeension. -### End" -237,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fixative agent for PAP smear is which of the following?, with the following options: A: Normal saline, B: 95% ethanol, C: Formalin, D: Air drying - -### Response: -PAP smear is an impoant screening test which is used to diagnose cervical dysplasia or cervical carcinoma in females. We use Ether and 95% ethyl alcohol solution in the ratio 1:1 as fixative for the purpose of PAP smear. Best screening test to pick up cervical cancer in the early stage - (Visual Inspection of Cervix with Acetic acid) -### End" -238,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amino acid derived hormone are all except:, with the following options: A: Adrenal medullary hormone., B: Thyroid hormone., C: FSH., D: None. - -### Response: -Steroid hormones (derivatives of cholesterol) - Eg: Corticosteroids and sex hormones -Derivatives of amino acid tyrosine - Eg: Thyroid & adrenal medullary hormones -Protein hormones – - -i) Glycoproteins - Eg: TSH, LH, FSH -ii) Polypeptides - Eg: Growth hormone, ACTH, Insulin, Prolactin -### End" -239,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Highest cholesterol content is seen in -, with the following options: A: LDL, B: VLDL, C: Chylomicrons, D: IDL - -### Response: -Ans. is 'a' i.e., LDL o Maximum triglyceride contento Maximum exogenous triglyceride o Maximum endogenous triglycerideo Maximum cholesterol content----ChylomicronsChylomicronsVLDLLDL -### End" -240,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are examples of microvascular causes of acute kidney injury, EXCEPT:, with the following options: A: Antiphospholipid antibody syndrome, B: Radiation nephritis, C: Thrombotic thrombocytopenic purpura, D: Renal vein thrombosis - -### Response: -Microvascular causes of AKI are Thrombotic microangiopathies Antiphospholipid antibody syndrome Radiation nephritis Malignant nephrosclerosis Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP-HUS) Scleroderma Atheroembolic disease Large vessel diseases associated with AKI include Renal aery dissection Thromboembolism Thrombosis Renal vein compression or thrombosis Ref: Harrison, E-18, P-2296. -### End" -241,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are contents of occipital triangle except, with the following options: A: Greta auricular nerve, B: Suprascapular nerve, C: Lesser occipital nerve, D: Occipital aery - -### Response: -Ref BDC volume3,6th edition pg 87 CONTENTS OF OCCIPITAL TRIANGLE NERVES: Spinal accessory nerve Four cutaneous branches of cervical plexus; lesser occipital, great auricular,anterior cutaneous nerve of neck,suprascapular Muscular branches; two small branches to the levator scapulae, two small branches to the trapezius,nerve to rhomboids C5, C6 roots of brachial plexus VESSELS: Transverse cervical aery and vein Occipital aery LYMPH NODES: Supraclavicular nodes Occipital nodes NOTES: Suprascapular nerve is present in subclan triangle. -### End" -242,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient presenting with joint pain and mild fever. NSAIDs prescribed by the doctor. Developed pigmentation after 1 week on the tip of the nose. What may be the condition?, with the following options: A: Melasma, B: Dengue, C: Chikungunya, D: Fixed drug eruption - -### Response: -Ans. (c) ChikungunyaRef: Illustrated Synopsis of Dermatology and SexuallyTransmitted Diseases by Neena Khanna 4th Ed; Page No- 284* Melasma is most commonly occurs in female with peak incidence 30-50 years. In Melasma brown macular lesions with scalloped margins are seen on the cheeks and nose. So it is ruled out.. Melasma1. sites of predilection of melasma2 (1) Melasma; (2) Sites of predilection of Melasma* As the patient has previous history of taking drugs so fixed drug eruption may the answer but In fixed drug eruption; lesions recur at the same site, each time the drug is taken,usually 8-16 h after the intake of drug and the lesions are seen in genitalis and lips. So it is ruled out.* In this case the rash presents in tipoff the nose with chicks and chick signs are marked. So it is case of Chikungunya.Chikungunya Virus* Chikungunya is mosquito-borne viral disease first described during an outbreak in southern Tanzania.* It is a RNA virus that belongs to the Alphavirus genus of the family Togoviridae.* Vector is Aedes aegypti.* No animal reservoir.* Clinical Features:# Typical biphasic fever# Crippling joint pain with maculopapular rash# Conjunctivitis# Lymphadenopathy.* Investigation:# IgM antibody levels are highest 3 to 5 weeks after the onset of illness and persist for about 2 months.# IgM/IgG ELISA in paired sea# RTPCR* Treatment:# No vaccine is available# No specific antiviral drugs# Supportive measures like antipyretics, analgesics and fluids. -### End" -243,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60 yrs old male comes to casualty with acute retention of urine since 12 hrs. On examination there was distended bladder. His wife gives a history of taking some drug by the patient since 2 days as he is suffering from depression. The most likely drug is:, with the following options: A: CPZ, B: Amitriptyline, C: Haloperidol, D: Pimozide - -### Response: -Anticholinergic effects of tricyclic antidepressants (TCAs) are most common. These effects result in dry mouth, constipation, urinary retention, blurred vision, and confusion. They are more common with teiary amine TCAs such as amitriptyline and imipramine than with the secondary amine TCAs desipramine and noriptyline. The potent alpha blocking propey of TCAs often results in ohostatic hypotension. H1 antagonism by the TCAs is associated with weight gain and sedation. The TCAs are class 1A antiarrhythmic agents and are arrhythmogenic at higher doses. Sexual effects are common, paicularly with highly serotonergic TCAs such as clomipramine. The TCAs have a prominent discontinuation syndrome characterized by cholinergic rebound and flulike symptoms. Ref: DeBattista C. (2012). Chapter 30. Antidepressant Agents. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e. -### End" -244,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are psychedelic drugs except?, with the following options: A: Lysergic acid diethylamide, B: Phencyclidine, C: Cocaine, D: Mescaline - -### Response: -Hallucinogens (Psychotomimetics, psychedelics, psychotogens) are drugs which alter mood, behaviour, thought and perception in a manner similar to that seen in psychosis. These are as: Lysergic acid diethylamide (LSD) Psilocybin Harmine Bufotenin Mescaline (Phenyl alkyl amines) Phencyclidine Lysergic acid amide -### End" -245,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Evan's syndome refers to presence of which of the following hematologic changes?, with the following options: A: Autoimmune thrombocytopenia in autoimmune hemolytic anemia, B: DIC in autoimmune hemolytic anemia, C: Thrombocytopenia in hairy cell leukemia, D: Thrombocytosis in autoimmune hemolytic anemia - -### Response: -Some cases of autoimmune hemolytic anemia can be associated with autoimmune thrombocytopenia, known as Evan's syndrome. Ref: Harrison's principles of internal medicine, 18th edition, Page 881. -### End" -246,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dimpling in carcinoma is due to:, with the following options: A: Edema, B: Contraction of Cooper's ligaments, C: Subdermal lymphangitis, D: Scarring - -### Response: -Dimpling: Small depression over skin of breast due to infiltration of ligament of Cooper by carcinoma Puckering: Small fold or wrinkle of skin over the breast due to infiltration of ligament of Cooper by carcinoma Cancer en-cuirasse: Infiltration of breast skin & chest wall with multiple nodules & ulceration by the carcinoma -### End" -247,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30 year old female with a 15 year history of asthma presents to the emergency room with left elbow pain. Physical examination reveals tenderness and swelling over the olecranon process. An x-ray of the left arm reveals a fracture. Her medications include oral prednisone and albuterol aerosol. By which of the following mechanisms might coicosteroids have contributed to her fracture?, with the following options: A: Decreased osteoblastic bone formation only, B: Decreased osteoblastic bone formation and osteoclastic bone resorption, C: Increased osteoclastic bone resorption only, D: Increased osteoclastic bone resorption and decreased osteoblastic bone formation - -### Response: -Coicosteroids inhibit the proliferation and function of osteoblasts, which are modified mesenchymal cells. These agents stimulate osteoclasts to differentiate from bone marrow macrophages and also stimulate their activity.The net effect is maximal bone loss with increased resorption and decreased formation. Ref: Funder J.W. (2011). Chapter 42. ACTH, Adrenal Steroids, and Pharmacology of the Adrenal Coex. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -248,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recurrent dislocation is least common in, with the following options: A: Shoulder, B: Knee, C: Patella, D: None - -### Response: -B i.e. Knee * Recurrent dislocation is most common in shoulder jointQ, accounting for nearly 50% of all dislocations.* Anterior shoulder dislocation of subcoracoid typeQ (> anterior subclavicular type) is most common type of shoulder dislocation. -### End" -249,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old male athlete is admitted to the emergency department after a bad landing in the pole vault. Radiographic examination of his hand reveals a fractured carpal bone in the floor of the anatomic snuffbox. Which bone has most likely been fractured?, with the following options: A: Triquetral, B: Scaphoid, C: Capitate, D: Hamate - -### Response: -(b) Source: GAS 752-754; GA 392, 394, 422 The anatomic snuffbox is formed by the tendons of the extensor pollicis brevis, the abductor pollicis longus, and the extensor pollicis longus. The floor is formed by the scaphoid bone, and it is here that one can palpate for a possible fractured scaphoid. -### End" -250,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Putrefaction process is delayed by :, with the following options: A: Peritonitis, B: Ansarca, C: Carbolic acid, D: Sepsis - -### Response: -Carbolic acid delays the process of putrefaction. -Peritonitis, ansarca, sepsis enhances the process of putrefaction. -### End" -251,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Autophagic vacuoles fuse with -, with the following options: A: Golgi complex, B: ER, C: Lysosome, D: Mitocondria - -### Response: -Ans. is 'c' i.e., Lysosome o Autophagy is the process by which cells sequester and degrade their own cytoplasmic organelles,o During the process, autophagic vacuole is formed, which is a bilayer vacule containing unnecessary or dysfunctional organelle.o Autophagic vacule fuses with lysosome to form autophagosome (autophagolysosome).o Then, hydrolytic enzymes of lysosome degrade the organelle of autophagic vacuole. -### End" -252,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is ovoviviparous?, with the following options: A: Strongyloides, B: Trichinella, C: Enterobius, D: Ascaris - -### Response: -Nematodes that lay eggs from which larvae immediately hatch out. So bih of larvae instead of eggs are called viviparous. Strongyloides stercoralis is ovoviviparous. -### End" -253,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The first neuromuscular blocker-, with the following options: A: Succinylcholine, B: d-tubocurare, C: Atracurium, D: Doxacurium - -### Response: -The first agent to be used was d-tubocurare the purified and standardized product of plant chondrodendron tomentosum. -### End" -254,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Condylomata latae are seen in, with the following options: A: Congential syphilis, B: Primary syphilis, C: Secondary syphilis, D: Teiary syphilis - -### Response: -C i.e. Secondary Syphilis -### End" -255,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Abortion stick used in criminal abortion causes abortion by the mechanism of -, with the following options: A: Uterine contraction, B: Stimulation of uterine nerves, C: Uterine infection & necrosis, D: Placental separation - -### Response: -Abortion stick used in criminal abortion causes abortion by uterine contraction. -### End" -256,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 55yr old male patient with his HTN on ACE inhibitors and has CABG four years back is scheduled for hernia surgery He has good effo tolerance which of the following pre-op investigations are ordered, with the following options: A: Routine preop evaluation + Routine preop evaluation, B: Routine preop +clinical+stress testing, C: Routine preop + clinical +angiography to look for potency, D: Routine preop + clinical exam +V/Q scan - -### Response: -ref : willey 10th ed -### End" -257,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bell clapper testis predisposes to:, with the following options: A: Torsion testis, B: Varicocele, C: Cancer of testis, D: Hydrocele - -### Response: -Testicular torsion is a condition in which testicle twists in such a way that the blood supply is compromised. Abnormalities which lead to torsion of the testis: 1. High investment of tunica vaginalis causing the testis to hang within the tunica like a clapper in the bell bilaterally. 2. Inversion of the testis. 3. Separation of the epididymis from the pedicle that connects the testis. -### End" -258,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a branch of posterior cord of Brachial plexus-, with the following options: A: Thoracodorsal, B: Radial, C: Ulnar, D: Axillary - -### Response: -Ans. C. UlnarBranches of brachial plexus-a. Musculocutaneous nerve branchThe musculocutaneous nerve is a mixed nerve containing sensory and motor axons. The musculocutaneous nerve is derived from the lateral cord. The musculocutaneous nerve leaves the brachial plexus sheath high in the axilla at the level of the lower border of the teres major muscle and passes into the coracobrachialis muscle. It innervates the muscles in the flexor compartment of the arm and carries sensation from the lateral (radial) side of the forearm.b. Ulnar nerve branchThe ulnar nerve is derived from the medial cord. Motor innervation is mainly to intrinsic muscles of the hand. Sensory innervation is to the medial (ulnar) 1.5 digits (little finger, half of the ring finger).c. Median nerve branchThe median nerve is derived from the lateral and medial cords. Motor innervation is to most flexor muscles in the forearm and intrinsic muscles of the thumb (thenar muscles). Sensory innervation is to the lateral (radial) 3.5 digits (thumb, index and middle fingers, half of the ring finger).d. Axillary nerve branchThe axillary nerve is derived from the posterior cord. The axillary nerve leaves the brachial plexus at the lower border of the subscapularis muscle and continues along the inferior and posterior surface of the axillary artery as the radial nerve. The axillary nerve serves as motor innervation to the deltoid and teres minor muscles. These act at the glenohumeral joint. Sensory innervation is from the skin just below the point of the shoulder. The axillary nerve continues as the superior lateral brachial cutaneous nerve of the arm.e. Radial nerve branchThe radial nerve is also derived from the posterior cord. The radial nerve continues along the posterior and inferior surface of the axillary artery and innervates the extensor muscles of the elbow, wrist, and fingers. Sensory innervation is from the skin on the dorsum of the hand on the radial side.f. Additional branchesIn addition to the 5 terminal branches described above, numerous preterminal or collateral branches leave the plexus at various points along its length.g. Dorsal scapular nerveThe dorsal scapular nerve is derived from the C5 root just after its exit from the intervertebral foramen. It serves as the motor nerve to the rhomboids major and minor musclesh. Long thoracic nerveThe long thoracic nerve is derived from C5 ,C6 , and C7 roots immediately after their emergence from the intervertebral foramina. The long thoracic nerve crosses the first rib and then descends through the axilla behind the major branches of the plexus. It innervates the serratus anterior muscle.i. Phrenic nerveThe phrenic nerve arises from C3 ,C4 , and C5 root levels, although chiefly from the C4 nerve root. It crosses the anterior scalene from lateral to medial and extends into the thorax between the subclavian vein and artery.j. Subclavius muscle nerveThe nerve to the subclavius muscle is a small filament that arises from the upper trunk. It descends to the subclavius muscle in front of the subclavian artery and the lower trunk of the plexus.k. Suprascapular nerveThe suprascapular nerve arises from the upper trunk formed by the union of the fifth and sixth cervical nerves. It innervates the supraspinatus muscles and infraspinatus muscles. It runs laterally beneath the trapezius and the omohyoideus and enters the supraspinatus fossa through the suprascapular notch, below the superior transverse scapular ligament; it then passes beneath the supraspinatus and curves around the lateral border of the spine of the scapula to the infraspinatus fossa.l. Lateral pectoral nerveThe lateral pectoral nerve arises from the lateral cord of the brachial plexus, from the fifth, sixth, and seventh cervical nerves. It passes across the axillary artery and vein, pierces the coracoclavicular fascia, and is distributed to the deep surface of the pectoralis major. It sends a filament to join the medial anterior thoracic and forms with it a loop in front of the first part of the axillary artery. This nerve innervates the clavicular head of the pectoralis major muscle.m. Medial pectoral nerveThe medial pectoral nerve arises from the medial cord from the eighth cervical and first thoracic nerve. It passes behind the first part of the axillary artery, curves forward between the axillary artery and vein, and unites in front of the artery with a filament from the lateral nerve. It then enters the deep surface of the pectoralis minor, where it divides into a number of branches, which supply the muscle. Several branches of the medial pectoral nerve pierce the muscle and end in the pectoralis major, which supply the muscle.The medial and lateral pectoral nerve often join together to act as a single nerve innervating the pectoralis major and minor muscles.n. Thoracodorsal nerveThe thoracodorsal nerve arises from the posterior cord (C6 to 8) between the subscapular nerves. It accompanies the subscapular artery along the posterior axillary wall and supplies latissimus dorsi, reaching its distal border.o. Medial brachial cutaneous nerveThe medial brachial cutaneous nerve is the smallest branch of the brachial plexus; arising from the medial cord, it receives its fibers from the eighth cervical and first thoracic nerves. It passes through the axilla, at first lying behind and then medial to the axillary vein, and communicates with the intercostobrachial nerve.The medial brachial cutaneous nerve descends along the medial side of the brachial artery to the middle of the arm, where it pierces the deep fascia, and is distributed to the skin of the back of the lower third of the arm, extending as far as the elbow, where some filaments are lost in the skin in front of the medial epicondyle, and others over the olecranon. It communicates with the ulnar branch of the medial antebrachial cutaneous nerve. The medial brachial cutaneous nerve carries sensation from the lower medial portion of the arm.p. Medial antebrachial cutaneous nerveThe medial antebrachial cutaneous arises from the medial cord of the brachial plexus. It derives its fibers from the eighth cervical and first thoracic nerves and at its commencement is medial to the axillary artery. It gives off near the axilla a filament that pierces the fascia and supplies the integument covering the biceps brachii, nearly as far as the elbow. The nerve then runs down the ulnar side of the arm medial to the brachial artery, pierces the deep fascia with the basilic vein, about the middle of the arm, and divides into a volar and an ulnar branch. -### End" -259,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: BRCA1 gene is located on which chromosome?, with the following options: A: Chromosome 13, B: Chromosome 19, C: Chromosome 21, D: Chromosome 17 - -### Response: -The BRCA2 gene is located on chromosome 13 and encodes over 3000 amino acids. It appears that BRCA2 plays an important role in male breast cancer. -• The human BRCA1 gene is located on the long (q) arm of chromosome 17 -### End" -260,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In retinal sealing/retinopexy, what is used?, with the following options: A: Sulphur hexafluoride, B: Carbon monooxide, C: Nitrous oxide, D: S02 - -### Response: -The gases commonly employed for tamponading the retina are sulphur hexafluoride (SF6) or perfluoropropane (C3F8). These are injected after sealing the breaks with cryopaxy. The gas bubble remains in contact with the tear for 5-7 days and are absorbed later. Ref: Parson's 22 nd edition page no. 335 -### End" -261,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Red flag sign in child development if not attained ?, with the following options: A: Vocalization at 2 months, B: Walking at 12 months, C: Single word at 12 months, D: Standing alone at 16 month - -### Response: -Ans. is 'd' i.e., Standing alone at l6 month Red flag sign of child developmentMilestoneAgeNo visual fixation or following by2 monthsNo vocalisation6 monthsNot siting without suppo9-10 monthsNot standing alone16 monthsNot walking alone18 monthsNot single word18 monthsLack of imaginative play3 years -### End" -262,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The energy for muscle contraction is supplied by the enzymatic hydrolysis of ATP by ATPase present in:, with the following options: A: Heavy meromyosin, B: Light meromyosin, C: Tropomyosin, D: Troponin - -### Response: -The energy for muscle contraction is supplied by the enzymatic hydrolysis of ATP by ATPase present in heavy meromyosin. Two strands of heavy meromyosin are found in each myosin head - one of which is folded over as a protein mass. Light meromyosin is also found in myosin but is not involved in splitting ATP. Troponin and tropomyosin are located on the actin filament. Ref: Murray R.K. (2011). Chapter 49. Muscle & the Cytoskeleton. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. -### End" -263,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coffee bean nuclei are seen in all of the following Except, with the following options: A: Granulosa cell tumor, B: Follicular carcinoma thyroid, C: Brenner tumor, D: Langerhan's cell histiocytosis - -### Response: -A nucleus with longitudinal groove gives it a coffee bean nuclei appearance and is seen characteristically inPapillary carcinoma thyroidBrenner tumorGranulosa cell tumorLangerhan's cell histiocytosis -### End" -264,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bone marrow in Amyloid Lightchain Amyloidosis shows which of the following features?, with the following options: A: Bone marrow plasmacytosis, B: Granulomatous reaction, C: Fibrosis, D: Giant cell formation - -### Response: -Amyloid light chain (AL) protein is derived from plasma cells. All patients with AL amyloidosis have increased plasma cells in their bone marrow presumably accounting for the production of precursors of AL protein. Ref: Pathologic Basis of Disease, Robbins, 6th Edition, Page 253; 7th Edition, Page 261 -### End" -265,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dawn phenomenon refers to-, with the following options: A: Early morning hyperglycemia, B: Early morning hypolgycemia, C: Hypoglycemia followed by hyperglycemia, D: High insulin levels - -### Response: -Question repeated The dawn phenomenon, sometimes called the dawn effect, is an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugar (glucose) relevant to people with diabetes. It is different from chronic Somogyi rebound in that dawn phenomenon is not associated with nocturnal hypoglycemia. The dawn phenomenon can be managed in many patients by avoiding carbohydrate intake at bedtime, adjusting the dosage of medication or insulin, switching to a different medication, or by using an insulin pump to administer extra insulin during early-morning hours. In most of the cases, there is no need to change insulin dosing of patients who encounter the dawn phenomenon. -### End" -266,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Indication for surgery in a case of adrenal incidentaloma -, with the following options: A: Size > 5 cm, B: Bilateral adrenal metastasis, C: Functional tumor, D: All of the above - -### Response: -According to CSDT nonfunctioning adrenal tumors larger than 5 cm in diameter should be removed because of the high risk of malignancy. -### End" -267,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Restriction fragment length polymorphism uses the technique of: UP 10; NIMHANS 11, with the following options: A: Southern blotting, B: Nohern blotting, C: Western blotting, D: Eastern blotting - -### Response: -Ans. Southern blotting -### End" -268,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which drug is not acetylated?, with the following options: A: INH, B: Dapsone, C: Hydralazine, D: Metoclopropamide - -### Response: -Ans. is 'd' i.e. Metoclopramide Acetylation is a phase II metabolic reactionPhase II reactions serves to attach a conjugate to the drug molecule. After the phase II reactions all drugs becomes water soluble, so that they can be readily eliminated from the body.Phase II reactions includesGlucuronidationAcetylationMethylationSulfationGlycine conjugation AcetylationDrugs having amino or hydrazine resides are conjugated with the help of acetyl coenzyme A. Examples are :S - Sulfonamides (Dapsone)H- Hydralazine I - Isoniazid P-PASAcetylation is a genetically mediated condition.Multiple genes control the acetyl transferases and the rate of acetylation shows genetic polymorphism -### End" -269,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs of choice for MRSA in skin-soft tissue infections and serious infections are:, with the following options: A: Vancomycin, Teicoplanin, B: Clindamycin, Vancomycin, C: Vancomycin, Linezolid, D: Dicloxacillin, Vancomycin - -### Response: -Ans. B. Clindamycin, VancomycinMRSA mild infection - Clindamycin, MRSA serious infection - Vancomycin, empirical therapy - Vancomycin -### End" -270,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mite transmits -, with the following options: A: Scrub typhus, B: Trench fever, C: Endemic typhus, D: Epidemic typhus - -### Response: -Ans. is 'a' i.e., Scrub typhus -### End" -271,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pauci immune glomerulonephritis is seen in ?, with the following options: A: After transplant in Alpos, B: Microscopic polyangitis, C: Henoch-schonlein nephritis, D: Lupus - -### Response: -Ans. is 'b' i.e., Microscopic polyangitis -### End" -272,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bone not present at bih-, with the following options: A: Malleus, B: Incus, C: Stapes, D: Petrous temporal - -### Response: -D i.e. Petrous temporal -### End" -273,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is not a cause for ""Restrictive cardiomyopathy"" -, with the following options: A: Alcohol, B: Hemochromatosis, C: Amyloidosis, D: Sarcoidosis - -### Response: -Ref: Harrison&;s 19th E: pg: 1566. Most common cause of restrictive cardiomyopathy is amylodosis. The least common of the physiologic triad of cardiomyopathies is restrictive cardiomyopathy, which is dominated by abnormal diastolic function, often with mildly decreased contractility and ejection fraction (usually >30-50%). Other causes : hemochromatosis, hyper and hypothyroidism, pheochromocytoma, nutritional deficiencies., sarcoidosis. -### End" -274,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In fracture surgical neck of humerus, the following nerve injury is common:, with the following options: A: Axillary, B: Radial, C: Ulnar, D: Median - -### Response: -A i.e. Axillary -### End" -275,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A destitute woman is admitted to the hospital with altered sensorium and dehydration; urine analysis shows mild proteinuria and no sugar; what other test would be desirable, with the following options: A: Fouchet, B: Rothera, C: Hays, D: Benedicts - -### Response: -Rothera - -The women are presenting with altered sensorium and dehydration, which may be the presenting features of ketoacidosis. She has already been tested for urine sugar (rules out diabetic ketoacidosis) and protein. -The important investigation missed out in this patient is ketone bodies in urine, which is important to reach the diagnosis of starvation ketosis. Ketone bodies are tested by Rothera's test. -About other options -### End" -276,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ash leaf macules are characteristic of, with the following options: A: Von Recklinghausen disease, B: Bournviller disease, C: Von Hipple -Lindau disease, D: Sturge - Weber syndrome - -### Response: -Ash leaf macules are hypopigmental off - white coloured macules 1 - 3 cm in zise.It is seen is tuberous sclerosis (also known as Bournville's disease). -### End" -277,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phenylketonuria is due to the deficiency of:, with the following options: A: Phenylalanine, B: Phenylalanine hydroxylase (PAH), C: Phenylene, D: All of these - -### Response: -(B) Phenylalanine hydroxylase (PAH)[?]PHENYLKETONURIAoClassical is HyperPhenylaminemia. Other can be due to defective biopterin cofactoroBiosynthesis-GTP cyclohydrolase I-6-pyruvoyl-tetrahydropterin synthase - Dihydropterin reductase.[?]Biology of PhenylketonuriaoPhenylketonuria or PKU is the inability of the body to Metabolize pheynlamine.oPhenylaline builds to toxic levels in the tissues, particularly damaging the nervous systemoPKU is a chronic disease, but it is possible to greatly reduce the probability of further damage by following a strict low-protein dietoPKU is autosomal recessive and carried on chromosome 1 2[?]Symptoms: Often have lighter skin, hair, and eyes than brothers or sisters without the disease.oOther symptoms include:-Eczema-Recurrent vomiting-Jerking movements in arms and legs-Tremors & Mood disorders, MicrocephalyoA birth defect that causes an amino acid called phenylalanine to build up in the body.oPKU is an autosomal recessive metabolic genetic disorder.oPKU is characterized by homozygous or compound heterozygousmutations in the gene for the hepatic enzyme phenylalanine hydroxylase (PAH), rendering it nonfunctional.oThis enzyme is necessary to metabolize the amino acid phenylalanine (Phe) to the amino acid tyrosine (Tyr). When PAH activity is reduced, phenylalanine accumulates and is converted into phenylpyruvate (phenyl ketone), which can be detected in the urine.oPAH gene is located on chromosome 12 in the bands 12q22-q24.1.oMore than 400 disease-causing mutations have been found in the PAH gene.INBORN ERRORS OF AMINO ACID METABOLISMS DISORDERSDisorderEnzyme Deficiency*. PhenylketonuriaPhenylalanine hydroxylase*. AlkptonuriaHomogentistate 1, 2- Dioxygenase complex*. Homocystenuria Type IDefect in cofactor binding site of cystathionine synthase*. Homocysteinuria Type IIMethylene THF Reductase Decrease*. Cysteinuria Type ICystathionine synthase*. CystathioninuriaCystathionase*. Tyrosinemia Type ICystathionine synthase*. Tyrosinemia Type IITyrosine Aminotransferase*. Tyrosinemia Type IIIPara-hydroxyphenylpyruvate dioxygenase*. AlbinismTyrosinase -### End" -278,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following operations are done in case of otosclerosis:, with the following options: A: Stapedectomy, B: Fenestration, C: Stapedotomy, D: All - -### Response: -Role of surgery in a case of otosclerosisSurgeryformsthe mainstay of management in a case of otosclerosis(Surgery of choice)|Stapedectoy / stapedotmy(surgery oh choice) Lempes fenestration procedure|Fenestration of the lateral semicircular canal is done. It is reserved for cases where footplate cannot be mobilized during stapedectomy(Outdated nowadays) Stapes mobilization|It is done in those cases only in wbichthere is paial ankylosis of footplate of stapes althoughreankylosis tends to develop a although reankylosis tends to develop -### End" -279,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Honey comb lung appearance is seen in, with the following options: A: Consolidation, B: Alveolar cell carcinoma, C: Scleroderma, D: Pulmonary edema - -### Response: -Honey comb lung -Histiocytosis-x, scleroderma, Rheumatoid arthritis, ILD, TB. -### End" -280,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Frame shift mutation causes -, with the following options: A: Transversion, B: Transition, C: Termination of protein synthesis, D: Alteration of whole reading sequence - -### Response: -Ans. is 'd' i.e., Alteration of whole reading sequenceMutationso A mutation is apermanant change in the DMA.o Mutations that affect germ cells (sperm or ovum) are transmitted to progeny and may give rise to inherited disease.o Mutations that affect somatic cells are not transmitted to progeny but are important in the genesis of cancers and congenital malformations,o Mutations may be classified into three categories -l.Gene mutationsThe vast majority of mutations associated with hereditary disease are gene mutationsThese may of different types depending whether it involves complete gene or single base -(a) Point mutationo A single nucleotide base is substituted by a different base.o When a pyrimidine base is substituted by other pyrimidine base or a purine base is substituted by other purine - Transition.o When a purine is substituded by a pyrimidine or vice-versa - Transversion,o This may alter the code in a triplet of bases, i.e. in codon and leads to replacement of one aminoacid by another in the gene product.o Because these mutations alter the meaning of the genetic code, they are often termed missense mutation.o Example is sickle mutation in which CTC codon in b-chain of hemoglobin that codes for glutamic acid is changed to CAC codon that codes for valine,o Another type of point mutation is nonsense mutation in which a point mutation may change an amino acid codon to a stop codon.o Example is b-thalassemia in which CAG codon in b-chain of hemoglobin that code for glutamin is changed to stop codon UAG after point mutation.(b) Deletion and insertionso Deletion or insertion of one or two base lead to alterations in the reading frame of the DNA strand - frame shift mutation.o If the number of base pairs invoved is three or a multiple of three framshift does not occur (because codon is triplet), instead an abnormal protein missing one or more amino acids is synthesized.(c) Trinucleotide repeat mutationo Normally a codon is triplet ie trinucleotide.o In this type of mutation a codon, ie trinucleotide sequence undergoes amplification and the same codon is repeated continuously so many times in the chain,o For example in fragile X-syndrome. CGG codon is repeated 250-4000 times, ie. there are 250-4000 tandem repeates of CGG.Chnomosome mutationo Result from rearrangement of genetic material that give rise to visible structural changes in the chromosome.Genome mutationo Involves loss or gain of whole chromosome, e.g. monosomy - Turner syndrome, trisomy - Down syndrome. -### End" -281,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a Cluster B personality disorder?, with the following options: A: Schiziod personality disorder, B: Narcissistic personality disorder, C: Dependant personality disorder, D: Anantastic personality disorder - -### Response: -Narcissistic personality disorder is a cluster B personality disorder. -Schiziod personality disorder is a cluster A personality disorder. -Dependant & Anankastic personality disorders are cluster C personality disorder. -### End" -282,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2 year old child without fever develops bone pain, vomiting and features of increased intracranial pressure following excessive medication. The drug most likely to be responsible for this is –, with the following options: A: Vitamin A, B: Phenothiazine, C: Phenytoin, D: Vitamin D - -### Response: -It is a case of pseudotumor cerebri. -### End" -283,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NARY is a -, with the following options: A: Lipid storage disorder, B: Glycogen storage disorder, C: Mitochondrial disorder, D: Lysosomal storage disorder - -### Response: -Ans is 'c' i.e., Mitochondria! disorder Clinical Syndromes of Mitochondrial Diseases Primary Features Chronic progressive external o External ophthalmoplegia ophthalmoplegia (CPEO) o Bilateral ptosis o PEO onset before age 20 years o Pigmentary retinopathy o One of the following CSF protein greater than I g/L, cerebellar ataxia, hea block o Sideroblastic anemia of childhood o Panytopenia o Exocrine pancreatic failure o Hypotonia in the first year of life o Feeding and respiratory difficulties o Subacute relapsing encephalopathy o Cerebellar and brain-stem signs o Infantile onset o Late-childhood or adult-onset peripheral neuropathy o Ataxia o Pigmentary retinopathy o Stroke-like episodes before age 40 years o Seizures and/or dementia o Ragged-red fibers and/or lactic acidosis o Myoclonus o Seizures o Cerebellar ataxia o Myopathy o Subacute painless bilateral visual failure o Males: females-- 4:1 o Median age of onset 24 years Bilateral deafness Myopathy Dysphagia Diabetes mellitus Hypoparathyroidism Dementia Renal tubular defects Fatal form may be associated with a cardiomyopathy and/or the Toni-Fanconi-Debre syndrome Basal ganglia lucencies Maternal history of neurologic disease of Leigh syndroms Basal ganglia lucencies Abnormal electroretinogram Sensorimotor neuropathy 0 Diabetes mellitus 0 Cardiomyopathy (initially hyperophic; later dilated) 0 Bilateral deafness 0 Pigmentary retinopathy 0 Cerebellar ataxia Dementia Optic atrophy Bilateral deafness Peripheral neuropathy Spasticity Multiple lipomata Dystonia Cardiac pre-excitation syndromes -### End" -284,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The basic pathology of Barrett's esophagus is -, with the following options: A: Metaplasia of columnar cells to squamous cells, B: Metaplasia of squamous cells to columnar cells, C: Dysplasia of esophageal epithelium, D: Cardiac sphincter pressure disturbances - -### Response: -Ans. is 'b' i.e., Metaplasia of squamous cells to columnar cells Barrett's esophaguso Is metaplastic change of distal esophageal mucosa from normal squamous epithelium to columnar epithelium, in response to chronic gastro-esophageal reflux.o The junction between squamous esophageal mucosa and gastric mucosa moves proximally.o Three types of columnar epithelium have been described in Barrett's esophagus:i) Intestinal type - the most common typeii) The junctional type andiii) The gastric fundic typeo Barrett's esophagus is a premalignant condition for adenocarcinoma esophaguso ""The definition of Barrett's esophagus (BE) has evolved considerably over the past decade. Traditionally, BE was identified by the presence of columnar mucosa extending at least 3 cm into the esophagus. It is now recognized that the specialized intestinal type epithelium found in the Barrett's mucosa is the only tissue predisposed to malignant degeneration. Consequently, the diagnosis of BE is presently made given any length of endoscopically indentifiable columnar mucosa that proves on biopsy to show intestinal metaplasia."" - Schwartz 9/e p831 (8/e, p868)Also remembero The hallmark of intestinal metaplasia is the presence of intestinal goblet cells. -### End" -285,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one is not true regarding pseudocyst of pancreas -, with the following options: A: Epigastric mass, B: Increase level of amylase, C: Cystogastrostomy is the ideal T/t, D: Percutaneus aspiration is the T/t - -### Response: -Ans is 'd' ie Percutaneous aspiration is the t/t Percutaneous aspiration is preferred only in cases of infected cyst and abcesses, other wise internal drainage is the t/t of choice. Epigastric mass is the main symptom of pseudocyst. Increased level of amylase is usually elevated with pancreatic pseudocysts. -### End" -286,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: National Family Health Survey has successfully completed -, with the following options: A: One round, B: Two rounds, C: Three rounds, D: Four rounds - -### Response: -The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India. Three rounds of the survey have been conducted since the first survey in 1992-93. The survey provides state and national information for India on feility, infant and child moality, the practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services. Each successive round of the NFHS has had two specific goals: a) to provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes, and b) to provide information on impoant emerging health and family welfare issues. The Ministry of Health and Family Welfare (MOHFW), Government of India, designated the International Institute for Population Sciences(IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey. IIPS collaborated with a number of Field Organizations (FO) for survey implementation. Each FO was responsible for conducting survey activities in one or more states covered by the NFHS. Technical assistance for the NFHS was provided mainly by ORC Macro (USA) and other organizations on specific issues. The funding for different rounds of NFHS has been provided by USAID, DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MOHFW, GOI Ref: GOI -### End" -287,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Essential criteria for TOF includes all, EXCEPT:, with the following options: A: Valvular stenosis, B: Infundibular stenosis, C: Over riding of aoa, D: RVH - -### Response: -ToF is the most common cyanotic congenital hea malformation and one of the first complex lesions to be successfully repaired. ToF occurs in 7% to 10% of children with CHD. The four characteristic findings in ToF are (1) a malaligned VSD, (2) RV outflow or pulmonary valve or aery stenosis or atresia, (3) a dextroposed overriding aoa, and (4) RV hyperophy. Valvular stenosis is not a essential criteria for TOF. Ref: Aboulhosn J.A., Child J.S. (2011). Chapter 84. Congenital Hea Disease in Adults. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e. -### End" -288,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common extra articular manifestation of Ankylosing spondylitis is, with the following options: A: Anterior uveitis, B: Inflammatory bowel disease, C: Gallstones, D: Heart block - -### Response: -(A) Anterior uveitis # Most common extra articular manifestation is ACUTE ANTERIOR UVEITIS, which occurs in 40% of patients and can antedate the spondylitis. Attacks are typically unilateral, causing pain, photophobia, & increased lacrimation. These tend to recur, often in opposite eye. Up to 60% of patients have inflammation in the colon or ileum. This is usually asymptomatic, but in 5 to 10% of patients with AS, frank IBD will develop. Aortic insufficiency, sometimes producing symptoms of congestive heart failure, occurs in a few percent of patients, occasionally early in the course of the spinal disease but usually after prolonged disease. Third-degree heart block may occur alone or together with aortic insufficiency. Gall stones are not a prominent feature. Mortality attributable to AS is largely the result of spinal trauma, aortic insufficiency, respiratory failure, amyloid nephropathy, or complications of therapy such as upper gastrointestinal hemorrhage. -### End" -289,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about umbilical aery Doppler is, with the following options: A: Changes in the flow velocity waveforms of umbilical aery may be impoant in the management of high-risk pregnancies, B: Absence of end-diastolic flow is normal at term, C: Maternal smoking decreases SID ratio, D: Increased diastolic flow indicates worse prognosis - -### Response: -Ans. Absence of end-diastolic flow is normal at term -### End" -290,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which drug is not metabolised by acetylation?, with the following options: A: INH, B: Dapsone, C: Hydralazine, D: Metoclopramide - -### Response: -Acetylation is a phase II metabolic reaction. Drugs metabolized by acetylation are Sulfonamides, Hydralazine, Isoniazid, Procainamide. Individuals who are slow acetylators are predisposed to drug-induced autoimmune disorders. Ref: K.D.T 6th Ed Page 25 -### End" -291,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In marasmus, which of the following is not seen?, with the following options: A: Edema, B: Voracious appetite, C: Hepatomegaly not seen, D: Child is active - -### Response: -Edema is a feature of Kwashiorkor, not seen in marasmus. Kwashiorkor Marasmus Edema Present absent appetite poor Voracious appetite CNS involvement apathy Active child Hepatomegaly seen Not seen Skin and hair changes More common Less common -### End" -292,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a posterior mediastinal tumor :, with the following options: A: Neurofibroma, B: Lymphoma, C: Thymoma, D: Gastroenteric cyst - -### Response: -Ans is 'c' ie Thymoma Mediastinum- is situated b/w the lungs in the center of the thorax.It is divided into 3 compartmentsAnterior or Anterosuperior it lies in front of the anterior pericardium & tracheaMiddle mediastinum or Visceral compartment it lies within the pericardial cavity including the tracheaPosterior mediastinum or paravertebral sulci it lies posterior to the post pericardium & tracheaLocations of the common Mediastinal MassesAnterior mediastinumMiddle MediastinumPost. MediastinumThymoma (most common in Ant med.)LymphomaGerm cell tumorsMesenchymal tumorsThyroid & parathyroid massesThymic cystCysts (MC in Mid. Med.)pleuropericardialbronchogenicenterogenousneuroentericVascular masses (aneurysm)Lymph node enlargement (including lymphoma)Mesenchymal tumorsPheochromocytomaMC tumor in middle Mediastinum- LymphomaNeurogenic tumors (MC overall)MeningoceleGastroenteric cystMesenchymal tumorsPheochromocytomaLymphoma -### End" -293,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 26-year-oldman, Raju met with an accident & is brought to emergency. The person accompanying him informed that a truck run over the patient. CXR reveals an air fluid level in left lung &nasogastric tube got coiled upward into left chest. Which of the following is the next best step in management of this patient?, with the following options: A: Placement of a chest tube on left side, B: Thoracotomy, C: Diagnostic peritoneal lavage, D: Laparotomy - -### Response: -This is likely a case of acute diaphragmatic rupture and should be treated with immediate laparotomy. Etiology of diaphragmatic rupture: 1. Penetrating trauma 2. Blunt trauma - Comprehensive force applied to pelvis or abdomen Clinical features: Most injuries are Silent Patients presents with S/S of injury of associated organs Late complication of diaphragmatic injury -Herniation Most common organ herniated - Stomach > colon > Small intestine Investigations VATS (Video assisted Thoracoscopy) Laparoscopy & evaluate the other abdominal organs Treatment: Operative repair in all cases BergquistTraid: Rib fracture Spine or Pelvic fracture Traumatic rupture of diaphragm -### End" -294,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Area 4 of the coex corresponds to:, with the following options: A: Primary motor area, B: Primary sensory area, C: Visual coex, D: None of the above - -### Response: -The primary motor coex (MI) corresponds to the precentral gyrus (area 4). It is the area of coex with the lowest threshold for eliciting contralateral muscle contraction by electrical stimulation. Ref: Gray's anatomy 40th edition, Chapter 21. -### End" -295,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about sulfonylureas is -, with the following options: A: Chlorpropamide is 2nd generation agent, B: Most common side effect is hypoglycemia, C: Effective even after pancreactomy, D: Safe in pregnancy - -### Response: -Ans. is 'b' i.e., Most common side effect is hypoglycemiao Sulfonylureas are -1. First generation Tolbutamide, chlorpropamide.2. Second generation Glibenclamide (Glyburide), glipizide, gliclazide, glimpride.Sulfonylureas act byo Sulfonylurease provoke a brisk release of insulin from pancreas. They act on the so called ""Sulfonylurea receptors"" (SUR1) on pancreatic b-cell membrane - cause depolarization by reducing conductance of ATP sensitive K+ channels. This enhances influx of Ca+2 - degranulation. They do not cause hypoglycemia in pancreatectomized animals and type 1 diabetes (Presence of at least 30% of functional b-cells in essential for their action). A minor action reducing glucagon secretion by increasing insulin and somatostatin release has been demonstratedo Extrahepatic action# On chronic administration they sensitize the target cells (especially the liver) to the action of insulin.# On chronic administration their action on pancrease (to release insuline) declines due to down regulation of sulfonylurea receptors.# But glycemic control is maintained due to extrahepatic action.# Glimepiride exerts beneficial effects with regard to ischemic preconditioning.Sulfonyloreas cause following adverse effectso Hypoglycemia# This is commonest side effect.# More common in elderly, liver and kidney disease.# Chlorpropamide is a frequent culprit due to its long action due to its long action.# Tolbutamide carries lowest risk due to its low potency and short duration of action.# Lower incidence is also reported with glipizide, glibenclamide, glimepiride.o Hypersensitivity# Rashes, photosensitivity, purpura, transient leukopenia, rarely agranulocytosiso Adverse effects specific to particular drug# Cholorpropamide causes cholestasis, dilutional hyponatremia, intolerance to alcohol (disulfiram like reaction). Chlorpropamide causes dilutional hyponatremia by sensitising the kidney to ADH action.# Tolbutamide reduces iodine uptake by thyroid.o Sulfonylureas are not safe during pregnancy - change over to insulin. Sulfonylureas are secreted in milk - should not be given to nursing mothers. Gliclazide has an antiplatelet effect. -### End" -296,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common cause of pulmonary embolism is, with the following options: A: Amniotic fluid embolism, B: Calf vein thrombi, C: Pelvic vein thrombosis, D: Cardio thoracic surgery - -### Response: -About half of the patient with pelvic vein thrombosis or proximal leg deep vein thrombosis have pulmonary thromboembolism. Isolated calf vein thrombosis pose a lower risk of pulmonary embolism. The majority of pulmonary emboli arise from the propagation of lower limb deep vein thrombosis (p. 186). Rare causes include septic emboli (from endocarditis affecting the tricuspid or pulmonary valves), tumour (especially choriocarcinoma), fat following fracture of long bones such as the femur, air, and amniotic fluid, which may enter the mother's circulation following delivery. Ref Davidson edition23rd pg 620 -### End" -297,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding hemobilia, with the following options: A: Triad of jaundice, pain, Melena, B: MC cause : rupture of poal vein into biliary system, C: MR angiography is the IOC, D: None of the above - -### Response: -Clinical features of Hemobilia Characterised by Quinck's triad (Sandblom's triad) : GI hemorrhage +biliary colic +jaundice Presentation: Melena (90 %), hemetemesis (60%), biliary colic (70%), and jaundice (60%). Tendency for delayed presentation (upto weeks) and recurrent brisk but limited bleeding over months and even years Ref : Sabiston 20th edition Pgno :1472-1474 -### End" -298,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Schizophrenia is characterized by -, with the following options: A: Formed through disorder, B: Hallucination, C: Delusion, D: All - -### Response: -This one is different from both the previous one. Here the examiner has not asked about the characteristic feature of schizophrenia. Schizophrenia is characterized by all symptoms which have been explained earlier. So, -Schizophrenia is a disorder of → thought, perception, mood & volition. -Hallmark of schizophrenia→ Thought disorders. -Characteristic features of schizophrenia → Delusions, hallucinations, disorganized speech and behavior, negative symptoms. -Schizophrenia is characterized by → All previously explained symptoms. -### End" -299,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infection of CNS spreads in inner ear through, with the following options: A: Cochlear aqueduct, B: Endolymphatic sac, C: Vestibular aqueduct, D: Hyle fissure - -### Response: -Ans. A Cochlear aqueductAs we know that cochlear aqueduct (Aqueduct of Cochlea) is a connection between scala tympani (containing perilymph) and the subarachnoid space (containing CSF). On occassions, paicularly in young children, the Cochlear aqueduct is large and open.Infection can spread to the inner ear from the infected CSF or vice versa, the cochlear aqueduct resulting in severe profound hearing loss (meningitic labyrinthitis). -### End" -300,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40 years males presented with painful vesicular lesion in the forehead extending to the eyelids. Diagnosis is, with the following options: A: Herpes simplex, B: Herpes-Zoster, C: Coxschiae infection, D: Molluscum contagiosum - -### Response: -(Herpes- Zoster) (52-Roxburg's 17th) (1182- CMDT-08)* Herpes simplex - manifest as acute gingivo-stomalitis, herpes labialis**, balanitis, vulvo-vaginitis, proctitis or kerato conjunctivitis* Intraepidermal vesicles around the mouth and lip (Type I) on the genitalia (Type II)* Herpes Zoster (Shingles) - Involvement of the branches of trigeminal ganglion, with lesions in the distribution of the maxillary, mandibular or ophthalmic sensory nerves as is involvement of dermatomes of the cervical and thoracic regions* H. Zoster affecting the opthalmic branch of the trigeminal nerve involving the right side of the forehead and eye and corneal ulcerations (.Hutchinson's sign)* The eruption consists of grouped tense vesicles or even bullae surrounded by a zone of erythema characteristically limited to a singe neural segment and is strictly unilateralMolluscum Contagiosum - transmitted by skin to skin contact* Typical lesion is a pink - coloured or skin coloured umbilicatedpapule** containing a greyish central plug, face and genital regions are commonly involved* A live attenuated VZV vaccine helps prevent herpes Zoster in persons 60 years and older -### End" -301,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rough endoplasmic reticulum is site of synthesis for, with the following options: A: Protein, B: Cholesterol, C: Carbohydrate, D: Fat - -### Response: -Ans. is 'a' i.e. Protein Rough endoplasmic reticulum is concerned withProtein synthesis*Initial folding of the polypeptide chains with the formation of disulfide bondsSmooth endoplasmic reticulum is concerned withSteroid synthesis*Detoxification processesAs sarcoplasmic reticulum plays important role in skeletal and cardiac muscle contraction * -### End" -302,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DNA restriction fragments are separated by, with the following options: A: Paper chromatography, B: Agarose gel electrophoresis, C: Thin-layer chromatography, D: Ultracentrifugation - -### Response: -Typically, a DNA molecule is digested with restriction enzymes, and the agarose gel electrophoresis is used as a diagnostic tool to visualize the fragments. An electric current is used to move the DNA molecules across an agarose gel, which is a polysaccharide matrix that functions as a so of sieve. Ref-D.M.Vasudevan 7/e p479 -### End" -303,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Intranuclear inclusions"" in oligodendrocytes are seen in, with the following options: A: Creutzfeldt Jacob disease, B: Polio, C: Japanese encephalitis, D: Progressive multiple encephalopathy - -### Response: -progressive multifocal leukoencephalopathy, JC virus-infected oligodendroglia display 2 distinct patterns of intranuclear viral inclusions: full inclusions in which progeny virions are present throughout enlarged nuclei and dot-shaped inclusions in which virions are clustered in subnuclear domains termed ""promyelocytic leukemia nuclear bodies"" (PML-NBs) Surrounding the demyelinated areas, the oligodendrocytes are enlarged and contain intranuclear inclusionbodies filled with papovavirus paicles, often forming pseudocrystalline arrays Ref ganong's review of medical physiology 25e -### End" -304,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Artery not supplying Kisselbacks plexus is-, with the following options: A: Anterior ethmoidal artery, B: Greater Palatine artery, C: Sphenopalatine artery, D: Ascending pharyngeal artery - -### Response: -Ans. is 'd' i.e., Ascending pharyngeal artery * Kiesselbach's plexus, which lies in KiesselbaclTs area or Little's area, is a region in the anteroinferior part of the nasal septum where four arteries anastomose to form a vascular plexus. The arteries arei) Anterior ethmoidal artery (branch of the ophthalmic artery)ii) Sphenopalatine artery (terminal branch of the maxillary artery)iii) Greater palatine artery (from the maxillary artery)iv) Septal branch of the superior labial artery (from the facial artery) -### End" -305,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are new markers for Acute Kidney Injury (AKI) except:, with the following options: A: Plasma IL 18, B: Urinary IL 18, C: Plasma NGAL, D: Urinary NGAL - -### Response: -Marker of AKI: Urinary 1) KIM- 1 - Kidney injury molecule-1 Plasma & Urinary 2) NGAL - Neutrophil gratinate associated lipocalin Urinary 3) IL - 18 | Tissue protected effected in proximal tubule -### End" -306,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bonds in cellulose that make it resistant to digestion is:, with the following options: A: b1-4, B: a1-6, C: b1-6, D: a1-6 - -### Response: -Cellulose is the chief constituent of plant cell walls. It is insoluble and consists of b-D -glucopyranose units linked by b,1-4 bonds to form long, straight chains strengthened by cross-linking hydrogen bonds. Mammals lack any enzyme that hydrolyzes the b1 -4 bonds, and so cannot digest cellulose. Ref: Harper 28th edition, chapter 14. -### End" -307,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coenzyme, in an enzymatic reaction usually functions to :, with the following options: A: Activate the substrate, B: Increase the active sites of apoenzyme, C: Enhance the specificity of aponzyme, D: Accept one of the cleavage products - -### Response: -Coenzymes act either a donar or an acceptor of group. They serve as recyclable shuttles - or group transfer agents - that transpo many substrates from their point of generation to their point of utilization. -### End" -308,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non caseating granuloma is characteristically seen in, with the following options: A: Syphilis, B: Sarcoidosis, C: TB, D: Histoplasmosis - -### Response: -ref Robbins 8/e p701 ,9/e p98 NONCASEATING GRANULOMA Sarcoidosis is characterized bynoncaseating granulomas. These are different than the caseating granulomasproduced by other diseases, especially tuberculosis. Caseous necrosis is destruction of cells which are conveed to amorphous greyish debris located centrally ingranulomas. -### End" -309,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is not a sign of increased ICT:, with the following options: A: Erosion of dorsum sella, B: Sutural diastases, C: Ballooning of sella, D: copper-beaten appearance - -### Response: -Ballooning of sella Ballooning of sella is seen in intrasellar neoplasm or empty sella syndrome The radiological signs of raised ICT on plain x-ray depend on the age of the patient and the duration of the elevated ICT. The radiological sign of raised ICT on plain x-rays are: a. Suture diastasis: - Seen only in infants and children - Suture diastasis is the first and most prominent sign of raised ICT in infants and children. b.Increased convolutional markings (Copper beaten appearance) - seen in children - Copper beaten appearance was attributed to raised ICT in past, but recent books say, it has little diagnostic impoance. It may also be seen in normal children. c. Erosion of dorsum sellae - Erosion of the dorsum sellae is the cardinal sign of raised ICT in adults - Frank erosion of sella may also be seen in local tumors. d.J-shaped sella - Direct pressure on the sella by tile an'erior end of an enlarged third ventricle in chronic hydrocephalus may give rise to a J-shaped sella. e. Pineal displacement - Pineal displacement is an impoant sign in adults, but not in infants and children as pineal gland is rarely calcified in infants and children. - In standard PA view of skull, the pineal gland lies within 3 mm of the midline. - Any lateral displacement of pineal gland more than 3 mm strongly suggests presence of intracranial tumor. -### End" -310,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During shock which organ is spared from vasoconstriction?, with the following options: A: Skin, B: Hea, C: Kidney, D: Liver - -### Response: -During shock vasoconstriction is generalized, sparing only the vessels of the brain and hea.A widespread reflex venoconstriction also helps maintain the filling pressure of the heaIn the kidneys, both afferent and efferent aerioles are constrictedRef: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:516 -### End" -311,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of Nicotine withdrawal?, with the following options: A: Depression, B: Headache, C: Tachycardia, D: Anxiety - -### Response: -In nicotine withdrawal there is bradycardia not tachycardia. The most common symptoms of nicotine withdrawal are impaired concentration, irritability, tension, disturbed sleep or drowsiness, intense longing for a cigarette/nicotine, headaches, and an increased appetite leading to weight gain. -### End" -312,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug used for post-operative shivering -, with the following options: A: Atropine, B: Pethidine, C: Thiopenone, D: Suxamethonium - -### Response: -Ans. is 'b' i.e., Pethidine Post-anaesthesia shivering (PAS)o Post anaesthesia (post operative) shivering occurs in 40% of patients recovering from general anaesthesia,o Some time it is preceded by central hypothermia and peripheral vasoconstriction, indicating that it is a thermoregulatory mechanism.o Pethidine is most effective drug for treatment of PAS.o Other drugs used are -clonidine, doxapram, ketanserin, alfentonil, butorphanol, chlorpromazine. -### End" -313,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: |A 65-year-old male complains of severe back pain and inability to move his left lower limb. Radiographic studies demonstrate the compression of nerve elements at the intervertebral foramen between vertebrae L5 and S1. Which structure is most likely responsible for this space-occupying lesion?, with the following options: A: Anulus fibrosus, B: Nucleus pulposus, C: Posterior longitudinal ligament, D: Anterior longitudinal ligament - -### Response: -Compression of nerves at the intervertebral foramen indicates a disk herniation. A disk herniation is characterized by protrusion of the nucleus pulposus from the anulus fibrosus posterolaterally into the spinal canal or intervertebral foramen. The ligaments may be affected by the herniation but are not responsible for the compression of the spinal nerve roots. -### End" -314,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Jones fracture is fracture of -, with the following options: A: Metatarsal, B: Metacarpal, C: Proximal phalynx, D: Distal phalynx - -### Response: -Ans. is 'a' i.e., Metatarsal Fracture of the base of 5th metatarsal (Jones* fracture)* This is a fracture at the base of the 5th metatarsal, caused by the pull exerted by the tendon of the peroneus brevis muscle inserted on it.* Clinically, there is pain, swelling and tenderness at the outer border of the foot, most marked at the base of the 5th metatarsal.* Diagnosis is easily confirmed on X-ray.* Treatment is by a below-knee walking plaster cast for 3 weeks. -### End" -315,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which screening test is not done in pregnant women?, with the following options: A: VDRL, B: Hep A, C: Hep B, D: Hep D - -### Response: -Ans: b (Hep A) Ref: Dutta, 6th ed, p. 99Routine investigations done during antenatal checkup1. Blood grouping. VDRL, RBS( only in selected cases)2. Urine routine-- protein, sugar and pus cells.3. Cervical cytology in selected cases.Special investigations in pregnancy1. Serological tests for rubella. Hep B and HIV (with consent).2. MSAFP or triple test for mothers at risk.3. USG - first trimester scan and anomaly scan at 20 wks.Though Hep D is also not mentioned, it can be taken as a part of Hep B virus because Hep D does not occur alone. It is always associated with Hep B. So the best answer here is Hep A- which is not transmitted by blood. -### End" -316,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 45 years male, blood sample gives purple-brown colour in Ehrich&;s solution, the substance is, with the following options: A: Urobilinogen, B: Conjugated bilirubin, C: Unconjugated biliburin, D: Haemosedrin - -### Response: -Bilinogens(UBG and SBG) react with Ehrlich solution to form red/brown color. Ehrlich&;s aldehyde reagent(para dimethylamino benzaldehyde) don&;t react with any other forms of bilirubin or hemosiderinRef: Textbook of biochemistry for medical students, seventh edition, page no: 279 -### End" -317,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3 year old girl is brought to the casualty by her mother. She has multiple bruises on her body. On X-ray 3 fractures at different stage of healing are seen. Excessive callus formation is also noted. The father is repoed to be an alcoholic. Mother claims that the baby had fallen off the stairs. What is the likely diagnosis?, with the following options: A: Scurvy, B: Rickets, C: Osteopetrosis, D: Child abuse - -### Response: -The above given is a classical description of battered baby syndrome or child abuse. Here the child as sustained injuries as a result of physical abuse from an adult parent or caregiver. The presence of injuries at various stages of healing proves the long term nature of the problem and that it is a non-accidental injury. -### End" -318,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 year old lady complains dysphagia, Raynaud's phenomenon, sclerodactyly. Investigations show antinuclear antibody. The likely diagnosis is ?, with the following options: A: Systemic lupus erythematosis, B: Systemic sclerosis, C: Mixed connective tissue disorder, D: Rheumatoid ahritis - -### Response: -Ans. is 'b' i.e., Systemic sclerosiso Dysphagia, Raynaud's phenomenon, sclerodactyly in 35 years old lady suggest the diagnosis of systemic sclerosis (see above explanations).I think option 'b' needs some explanation here.Mixed connective tissue diseaseo Patients having the co-existence of features suggestive of SLE, polymyositis, Rheumatoid ahritis and systemic sclerosis. -### End" -319,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 17-year-old boy is admitted to the hospital after a road traffic accident. Per abdomen examination is normal. After adequate resuscitation, his pulse rate is 80/min and BP is 110/70 mm Hg. Abdominal CT reveals 1 cm deep laceration in the left lobe of the liver extending from the done more than half way through the parenchyma. Appropriate management at this time would be:, with the following options: A: Conservative treatment, B: Abdominal exploration and packing of hepatic wounds, C: Abdominal exploration and ligation of left hepatic aery, D: Left hepatectomy - -### Response: -Classification of liver injury (Moore) Grade Types Operative or CT Scan findings I Hematoma Laceration Subcapsular, <10% of surface area Capsular tear, < 1 cm in parenchymal death II Hematoma laceration Subcapsular, 10-50% of surface area Intraparenchymal, <10 cm in diameter 1-3 cm in parenchymal depth, <10 cm in length III Hematoma laceration Subcapsular, >50% of surface area or expanding; rupture subcapsular or parenchymal hematoma Intraparenchymal, hematoma > 10 cm or expanding > 3 cm in parenchymal depth IV Laceration Parenchymal disruption involving 25-75% of the hepatic lobe or 1-3 couinauds segments in a single lobe V Laceration vascular Parenchymal disruption involving >75% of the hepatic lobe or > 3 Coulnauds segments in a single lobe Juxta hepatic venous injuries, i.e retro hepatic vena cava / central major hepatic veins VI Vascular Hepatic avulsion -### End" -320,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adenoma carcinoma sequence was prototypically observed in which carcinoma, with the following options: A: Colon, B: Gastric, C: Salivary gland, D: Lacrimalgland - -### Response: -Adenoma of colon has high malignant potential. Potentiality increases with size. If size of adenoma is >2cm there is 30-50% chance of developing carcinoma. If it is 1-2cm then there is 10% chance of developing carcinoma, and if it is less than 1cm then there is 1-5% chance of carcinoma. Reference : SRB's Manual of Surgery, 6th Edition, page no = 890. -### End" -321,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When doctor is charged with serious professional misconduct, the action will be taken by, with the following options: A: MCI, B: State medical council, C: Cou, D: CBI - -### Response: -State Medical Council sends a warning notice to a doctor if he or she is found guilty of any of the following these conditions Adultery Aboion Association with unqualified persons in professional matters Adveising Addiction Alcohol Ref: K.S. Narayan Reddy's Synopsis of Forensic Medicine & Toxicology, 29th edition,Page 15 & 17. -### End" -322,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature or propey of a virus?, with the following options: A: Heat labile, B: Antibiotic resistant, C: May contain both DNA and RNA, D: Forms extra cellular infectious paicle - -### Response: -Virus contains either RNA or DNA, not both, it is surrounded by a capsid composed of small protein units called capsomeres. Other specific propeies of viruses are : inability to replicate on their own, inability to divide by binarry fission, mitosis or meiosis, lack of genes and enzymes needed for energy production, depend on ribosomes, enzymes and metabolites of host cell for protein and nucleic acid production. -### End" -323,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An infant of a mother with type I. Diabetes has a PCV of 68%. On day 3 of life, he suddenly manifests gross hematuria and a flank mass on the left. Most likely diagnosis is:, with the following options: A: Meconium plug, B: Neuroblastoma, C: Renal venous thrombosis, D: Ureteropelvic junction obstruction - -### Response: -Renal venous thrombosis in the newborn period commonly presents with gross hematoria and a flank mass. Infants of diabetic mothers by viue of polycythemia are at slightly increased risk for this condition. A meconium plug may cause abdominal distention, but probably would not cause a discrete flank mass and would not lead to gross hematuria. A neuroblastoma would not produce hematuria nor grow so fast as to suddenly produce a flank mass. A ureteropelvic junction obstruction is usually not associated with hematuria and should have been palpable at the time of bih. An adrenal hemorrhage may present as a sizeable mass but would not be associated with gross hematuria. -### End" -324,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epidural analgesia is suitable for, with the following options: A: Rib fracture, B: Lower abdominal Surgery, C: Thoracotomy, D: All of the above - -### Response: -Epidural is very suitable as independent anaesthesia technique and as accompanying technique with general anaesthesia. thoracic epidural for Thoracic surgery , rib fracture Lumbar Epidural for upper and lower abdominal surgeries. -### End" -325,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is nor a feature of irritable bowel syndrome?, with the following options: A: Abdominal pain, B: Constipation, C: Rectal bleeding, D: Bloating - -### Response: -Answer is C (Rectal Bleeding) Irritable Bowel syndrome is characteristically not associated with rectal bleeding. Evidence of blood in stool should raise an alarm that a process other than IBS is operating and should prompt fuher investigations. Abdominal pain, abnormal stool formation (hard/constipation or loose/ watery stool), and Bloating or feeling abdominal distension are characteristic features of Irritable Bowel Syndrome. Symptoms that cumulatively suppo the diagnosis of Irritable Bowel Syndrome: Abnormal stool frequencyQ (fbr research Imposes., ""abnormal- defined as > 3 bowel movements/week) Abnormal stool formations (lumpy/hard or loose/watery stool) Abnormal stool habitsQ (straining, urgency, or feeling of incomplete evacuation) Passage al mucusQ Bloating or feeling of abdominal distention The diagnosis of a functional bowel disorder always presumes the absence of a structural or biochemical explanation for the symptoms. Dagnostic criteria for Irritable Bowel Syndrome 1. Recurrent abdominal pain or discomfo at least 3 days per month in the last 3 months associated with two or more of the follow ing I. Improvement with defecation 2. Onset associated with a change in frequency of sioole 3. Onset associated with a change in form (appearance) of stoolQ. Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis. Discomfo means an uncomfoable sensation not described as pain. In pathophvsiologv research and clinical trails, a pain/discomfo frequency of at least 2 days a week during screening evaluation is required for subject eligibility. -### End" -326,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 52 year female pt. presents with symptoms of pheochromocytoma. She also has a thyroid carcinoma. Her thyroid Ca is of which type -, with the following options: A: Anaplastic, B: Medullary, C: Follicular, D: Papillary - -### Response: -Pt. is having MEN syndrome type II. -MEN syndrome is associated with medullary Ca of thyroid. -MTC with MEN syndrome present at a younger age and are multicentric and bilateral. -These patients with familial MTC can be recognized early by identifying RET proto-oncogene mutation and death can be prevented from thyroid carcinoma by performing prophylactic thyroidectomy. -Schwartz writes - ""Total thyroidectomy is indicated in RET mutation carriers once the mutation is confirmed. The procedure should be performed before age 6 years in MEN 2A patients. Central neck dissection can be avoided in children who are RET positive and calcitonin negative with a normal ultrasound examination. When the calcitonin is increased or the ultrasound suggests a thyroid cancer, a prophylactic central neck dissection is indicated."" -### End" -327,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Salivary gland tumor is most common in which Salivary Gland?, with the following options: A: Sublingual gland, B: Submandibular gland, C: Minor salivary gland, D: Parotid gland - -### Response: -Ans. (d) Parotid GlandRef: Bailey and Love 27th edition Page 783Incidence of Salivary Gland Tumors:TypeLocationIncidenceMalignancy Percentage of the tumors seenMajorParotidCommon10-20%SubmandibularUncommon50%SublingualVery rare85%MinorUpper aerodigestive tractRare90% -### End" -328,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not used as emergency contraceptive?, with the following options: A: Danazol, B: Levonorgestrel, C: Mifepristone, D: IUCD - -### Response: -Isoxazole derivative of 17 - alpha ethinyl testosterone propeies Causes atrophy of endometrium It is strictly antigonadotropin but acts as an androgen agonist Mode of action Acting on the hypothalamo - pituitary - gonadal axis - depression of frequency of GnRh pulses - suppression of pituitary FSH and LH surge. There is however no change in the basal gonadotropin level Indication of danazol Endometriosis DUB Symptomatic fibroid Precocious pubey -### End" -329,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common malignant bone tumor is:, with the following options: A: Ewing's sarcoma, B: Osteosarcoma, C: Metastasis, D: Chondrosarcoma - -### Response: -Ans: c (Metastasis) Ref: Maheswari, 3rd ed, p. 224Metastatic tumors are the most common malignant tumors of the bone followed by primary bone tumors.Most common sites from which mets arise are:Lungs--in malesBreast-- in femalesProstateThyroidFrequently asked questions regarding bone tumorsMost common malignancy of bone-SecondariesMost common primary malignant bone tumour-Multiple myelomaMost common primary malignant tumour of long bones-OsteosarcomaMost common true benign tumour of bone-Osteoid osteomaCommonest benign tumour of bone-OsteochondromaHormone dependent bone tumour-fibrous dysplasiaMost common symptom of secondaries-pain -### End" -330,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a small child diagnosed with H. influenza meningitis, what investigation must be done before discharging him from the hospital?, with the following options: A: BERA, B: MBI, C: CT scan, D: X ray skull - -### Response: -Ans. (a) BERARef: OP Ghai 8th ed./619; OskisPediatrics: Principles & Practice by Julia A. McMillan -### End" -331,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of nephrotic syndrome in paediatric age group is, with the following options: A: Minimal change disease, B: Membranous glomerulonephritis, C: Malarial infection, D: Mesangioproliferative glomerulonephritis - -### Response: -Ans. a (Minimal change disease). Refer to Q. No.49 of Pathology section of same paper.Minimal-Change Disease (Lipoid Nephrosis)# This relatively benign disorder is the most frequent cause of the nephrotic syndrome in children.# It is characterized by glomeruli that have a normal appearance by light microscopy but show diffuse effacement of podocyte foot processes when viewed with the electron microscope.# Although it may develop at any age, this condition is most common between ages 1 and 7 years.# When the changes in the podocytes reverse (e.g., in response to corticosteroids), the proteinuria remits. -### End" -332,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following forms the Passavant&;s ridge?, with the following options: A: Palatoglossus, B: Salpingopharyngeus, C: Palatopharyngeus, D: Hyoglossus - -### Response: -Some of the upper fibres of the palatopharyngeus pass circularly deep to the mucous membrane of the pharynx,and form a sphincter internal to the superior constrictor.These fibres constitute passavant's muscle which on contraction raises a ridge called the Passavant's Ridge. REF.BDC VOL.3,FIFTH EDITION -### End" -333,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Insulin storage in the body requires which ion?, with the following options: A: Cu, B: Zn, C: Mo, D: Se - -### Response: -Zinc is involved in the insulin packaging, secretion, and signaling Zinc in pancreatic beta cells binds to several insulin molecules, six to be exact, forming an insulin hexamer for storage.Ref: DM Vasudevan, 7th edition, page no: 319 -### End" -334,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in ARDS, except :, with the following options: A: Pulmonary edema, B: Decreased tidal volume, C: Hypercapnia, D: Decreased compliance - -### Response: -Answer is C (Hypercapnia): ARDS results in Type I Respiratory failure and is characterized by normal or low PaCO2 (Hypocapnia) and not Hypercapnia (see previous explanation on types of respiratory failure). ARDS (Acute Respiratory distress syndrome) ARDS is an acute form of lung injury characterized by: Increased permeability of alveolar capillary membrane. Diffuse alveolar damage. Accumulation of proteinaceous pulmonary edema (non cardiogenic pulmonary edema Q) -### End" -335,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The power to summon persons by a police officer comes under which section of CRPC, with the following options: A: 39, B: 175, C: 357, D: 416 - -### Response: -Section Deals with 39 Duty to give information 53 examination of accused by a medical at the request of medical professor 53A examination of person accused of rape by medical practitioner 54 examination of arrested person by medical practitioner by request of arrested person 61-69 summons 161 the police has the power to examine witness 162 oral statements made to the police and recorded by police should not be signed 175 power to summons by a police officer Reference :the essentials of Forensic Medicine and toxicology page number 55 -### End" -336,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renal vein thrombosis is most commonly found in :, with the following options: A: Focal glomenilosclerosis, B: Membranous GN, C: Minimal change GN, D: Acute pyelonephritis - -### Response: -Nephrotic syndrome accompanying membranous glomerulopathy and certain carcinomas are the most common cause of RVT. -Remember : - -Most common cause of RVT in adult —› Nephrotic syndrome due to membranous glomerulonephritis. -Most common cause of RVT in children —› K nephrotic syndrome due to minimal change disease. -Most common cause of RVT in newborns and infants ---> Asphyxia, dehydration, shock and sepsis. -### End" -337,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aaron's sign is seen in:, with the following options: A: Chronic appendicitis, B: Hiatus hernia, C: Mediastinum emphysema, D: Acute appendicitis - -### Response: -Abdominal Examination Signs Sign Description Diagnosis Aaron Sign Pain or pressure in epigastrium or anterior chest with persistent firm pressure applied to McBurney's point. Acute appendicitis Bassler Sign Sharp pain created by compressing appendix between abdominal wall and iliacus Chronic appendicitis Blumberg's Sign Transient abdominal wall rebound tenderness Peritoneal inflammation Carnett's Sign Loss of abdominal tenderness when abdominal wall muscles are contracted Intra-abdominal source of abdominal pain Claybrook Sign Accentuation of breath and cardiac sounds through abdominal wall Ruptured abdominal viscus Mannkopf's Sign Increased pulse when painful abdomen palpated Absent if malingering Ten Horn Sign Pain caused by gentle traction of right testicle Acute appendicitis -### End" -338,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A highway truck driver has profuse rhinorrhea and sneezing. Which of the following drugs would you prescribe him?, with the following options: A: Cetrizine, B: Pheniramine, C: Promethazine, D: Dimenhydrinate - -### Response: -As the patient in the question is a truck driver, antihistamine which is best suitable for him is cetrizine. Cetirizine is a second generation antihistamine with least sedation. Promethazine and Dimenhydrinate are highly sedative and Pheniramine is moderately sedative preparations of H1 antihistamine which is not preferred for a truck driver as it causes sedation while driving. Ref: Essentials of Medical Pharmacology By K D Tripathi, 5th Edition, Pages 141-2 -### End" -339,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Highly selective proteinuria is seen in, with the following options: A: Minimal change, B: Mesangial proliferative nephritis, C: Membranous glomerulonephritis, D: Focal glomerulosclerosis - -### Response: -Loss of glomerular basement membrane (GBM) polyanion has been proposed as a cause of the selective proteinuria in minimal change nephrotic syndrome (MCNS).The exact role of charge selectivity in the pathogenesis of nephrotic proteinuria remains controversial Proteinuria that is more than 85% albumin is selective proteinuria. Nonselective proteinuria, being a glomerular leakage of all plasma proteins, would not involve changes in glomerular net charge but rather a generalized defect in permeability Ref Harrison20th edition pg 287 -### End" -340,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a child, non – functioning kidney is best diagnosed by :, with the following options: A: Ultras onography, B: IVU, C: DTPA renogram, D: Creatinine clearance - -### Response: -The most convenient method of estimation of renal function is by isotope renography. -Two types of isotope renography is there : - -1) Renogram, DTPA scan or MAG3 : - -DTPA and MAG3 are rapidly excreted by the kidney and are therefore used as radiopharmaceutical agents for dynamic scan. -This scan is preferred for the information : - -i) About the blood flow of kidney. -ii) How well each kidney is functioning. -iii) It there is any obstruction to urine output. -2) DMSA scan : - -DMSA is concentrated in the renal parenchyma for a time and is therefore used as static scan. -This scan is preferred to lood at structure of kidney, i.e. size, shape and position. -### End" -341,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Management of retinoblastoma:, with the following options: A: Enucleation, B: Chemotherapy, C: Radiotherapy, D: All - -### Response: -A i.e. Enucleation; B i.e. Chemotherapy; C i.e. Radiotherapy -### End" -342,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hormones decreased in PCOD, with the following options: A: Androgens, B: Progesterone, C: Estrone, D: Insulin - -### Response: -In PCOD, Progesterone is decreased due to anovulation. -### End" -343,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has a congenital deficiency in factor XIII (fibrin-stabilizing factor). What would analysis of his blood reveal?, with the following options: A: Prolonged prothrombin time, B: Prolonged whole blood clotting time, C: Prolonged paial thromboplastin time, D: Easily breakable clot - -### Response: -Fibrin monomers polymerize to form a clot. Creation of a strong clot requires the presence of fibrin stabilizing factor that is released from platelets within the clot. The other clotting tests determine the activation of extrinsic and intrinsic pathways or number of platelets. -### End" -344,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lateral medullary syndrome (Wallenberg syndrome) is characterized by all, Except :, with the following options: A: Giddiness, B: Dysphagia, C: Crossed hemianaesthesia, D: Homer's syndrome is rare - -### Response: -Answer is D (Horner's syndrome is rare): Horner's syndrome forms pa of the constellation of manifestations seen in lateral medullary syndrome or Wallenberg syndrome. It is produced as a result of infUrction of the descending sympathetic tract. Ipsilateral Homer's syndrome -### End" -345,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common extranodal site for non-hodkin&;s lymphoma is -, with the following options: A: Stomach, B: Brain, C: Intestines, D: Tonsils - -### Response: -Extranodal marginal zone B cell lymphoma of MALT type also called as MALTOMA comprises about 8% of NHLs.In this most frequent is gastric lymphoma of MALT type. Reference : Harsh Mohan textbook of pathology, 7th edition.Pg no.357 -### End" -346,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding Fanconi anemia, the wrong statement is:, with the following options: A: Autosomal dominant, B: Bone marrow show pancytopenia, C: Usually aplastic anemia, D: It is due to defective DNA repair - -### Response: -Fanconi's anemia is an autosomal recessive disease Characterized:- Progressive pancytopenia Increased risk of malignancy (solid tumors and AML) Congenital developmental anomalies like sho stature, cafe au lait spots, abnormalities affecting thumb, radius and genitourinary tract. Fanconi's anemia is associated with BRCA gene. -### End" -347,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ethambutol should be used very cautiously in child-hood tuberculosis due to which of its side effect?, with the following options: A: Ocular toxicity, B: Renal damage, C: Hepatotoxicity, D: Neurotoxicity - -### Response: -Ethambutol (E) Ethambutol is selectively tuberculostatic and clinically as active as S. Fast multiplying bacilli are more susceptible as are many atypical mycobacteria. Added to the triple drug regimen ofRHZ it has been found to hasten the rate of sputum conversion and to prevent development of resistance Patient acceptability of E is very good and side effects are few. Loss of visual acuity I colour vision. field defects due to optic neuritis is the most impoant dose and duration of therapy dependent toxicity. Because young children ma,be unable to repo early visual impairment, it should not be used below 6 years of age. With early recognition and stoppage of therapy, visual toxicity is largely reversible. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:742,743 -### End" -348,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bacillus anthracis is unique to other bacteria. It is the only bacteria to possess which of the following, with the following options: A: A polypeptide capsule, B: A polysaccharide capsule, C: An exotoxin, D: An endotoxin - -### Response: -Virulent forms of B. anthracis, the causative agent of anthrax, are more likely to be surrounded by a capsule. This capsule is a polypeptide, composed of a polymer of glutamic acid, and is a unique feature of B. anthracis. Lipopolysaccharides (LPS/endotoxin) are unique to gram-negative bacteria (B. anthracis is a gram-positive rod). In addition, whereas B. anthracis is associated with both teichoic acid (cell wall) and a potent exotoxin, these are not unique features of this bacterium. Other gram-positives (i.e., staphylococci) release exotoxins and have teichoic acid in their cell walls. -### End" -349,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding peptic ulcer disease:, with the following options: A: Posteriorly perforated ulcers are always managed conservatively, B: Anterior ulcers bleed more commonly Increased acid production is prerequisite for gastric ulcer, C: Anti-H. pylori drugs must be included in the treatment regimen, D: H. pylori is known to increase the incidence of gastric malignancy - -### Response: -Ans is 'd' (H. pylori is known to increase the incidence of gastric malignancy) Surgery is almost always indicated for perforated ulcers, although occasionally nonsurgical treatment can be used in stable patients without peritonitis, and in whom radiologic studies document a sealed perforation. Though increased acid production is associated with duodenal ulcers, its not so with gastric ulcers. Gastric ulcers type I and type IV are associated with decreased acid secretion. (Gastric type II and type III are associated with acid hypersecretion) Anti-H.pylori drugs are included in those pts. of peptic ulcer ds. who test positive for H. pylori. -### End" -350,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non-invasive prenatal screening (NIPS) is paicularly useful in the modern era of diagnosis in clinical genetics. Which of the following statements is not true regarding this test?, with the following options: A: Useful in screening for aneuploidies, B: Evaluates maternal blood for abnormalities, C: HIgh positive predictive value, D: Positive test need confirmation by invasive testing - -### Response: -Non-invasive prenatal screening (NIPS) has a high negative predictive value. NIPS: Useful in screening high-risk pregnancies for aneuploidies Done after 10 weeks of gestation Evaluates maternal blood for screening Positive tests need confirmation by invasive testing (like amniocentesis, Chorionic villous sampling) Ref: Ghai essential pediatrics 9th edition Pgno: 643 -### End" -351,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 1 mm change in Length of the eyeball, leads to the change in dioptor power of eye by, with the following options: A: 1 D, B: 2.5 D, C: 5D, D: 6D - -### Response: -(3D): (3-Khurana 5th edition; 1-Nema 6th/ed)The axial length (AL) is the distance between the anterior surface of the cornea and the fovea and usually measured by A-scan ultrasonography or optical coherence biometry. The AL is the most important factor in IOL calculation: A 1-mm error in AL measurement results in a refractive error of approximately 2.35 D in an average eye.Axial length of the eyeThe distance between the anterior and posterior poles of the eye. In vivo, it is measured either by ultrasonography or by partial coherence interferometry (PCI). These measurements represent the distance between the anterior pole and Bruch's membrane. (In young eyes in which there is a refractive index difference at the retina-vitreous interface ultrasonography measures the distance between the anterior pole and the anterior surface of the retina.) The axial length of the eye at birth is approximately 17 mm and reaches approximately 24 mm in adulthood. It is typically longer than 24 mm in myopes and shorter than 24 mm in hyperopes. Each mm of change in axial length of the eye corresponds to approximately 2.5 D* At birth, the eyeball measures antero posteriorly about 17.5 mm and reaches 24 mm in adults. The horizontal and vertical diameter of the eye ball are 23.5 and 23 mm respectively* The optic nerve leaves the eyeball 3 mm medial to the posterior pole and passes along the axis of the orbit, therefore, the axes of the eye ball and the orbit do not coincide but make an angle between them -### End" -352,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true statement about spinal cord except, with the following options: A: Coccygeal ligament is investing layer of dura over filum terminale, B: Dural sac ends at S2 veebra, C: Cords ends at lower border of L1, D: Filum terminate extends up to coccyx - -### Response: -Final terminal is the pia connecting conus medullaris to coccyx. Below the end of Dural sac at S2, dura encloses this filum and attaches to coccyx as coccygeal ligament.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 53) -### End" -353,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Virchow's triad includes all of the following except, with the following options: A: Venous stasis, B: Endothelial injury to veins, C: Blood Hypercoagulability, D: Venous thrombosis - -### Response: -(D) Venous thrombosis # Virchow's triad refers to three primary influences that predispose to thrombus formation.> This triad should be the cornerstone for the assessment of risk factors for deep venous thrombosis. This includes Endothelial injury Stasis or turbulence of blood flow Blood hypercoagulability> These factors may act independently or they may combine to cause thrombus formation.> Note that endothelial integrity is the single most important factor. Injury to endotlielial cells can affect local blood flow or coagula bility# Some important Points on DVT: Homan's sign - Caif tenderness on forced ankle dorsiflexion. Phlegmasia alba do lens - Painful white leg Phlegmasia cerulea dolens - Painful blue leg Moses Sign - Calf tenderness on direct pressure on the calf. Pratt's Sign - Calf tenderness on squeezing the calf from the sides.> Duplex ultasound is the diagnostic modality of choice in deep vein thrombosis. -### End" -354,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phantom limb phenomenon is explained by, with the following options: A: Law of projection, B: Webers law, C: Fechner's law of degeneration, D: Pascals law - -### Response: -The sensory fibres are experimentally stimulated anywhere in their course to the coex, the conscious sensation produced is referred to the loaction of the receptor. This principle is called the law of projection. Due to this, after amputation of a limb, sometimes patient complains of intense pain in the absent limb (phantom limb). These sensations are produced due to irritation of the damaged nociceptive and proprioceptive afferents at the stump of amputated limb. The sensations are evoked are projected to the area where receptors are used to be located. Ref: guyton and hall textbook of medical physiology 12 edition page number: 671,672,673 -### End" -355,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A coin is struck at 25 cm from incisor in the esophagus, this place coincides with-, with the following options: A: Cricopharyngeal junction, B: Bronchial bifurcation, C: Aortic arch, D: Oesophago-gastric junction - -### Response: -Esophagus shows three normal constriction which are narrower portions of esophagus and foreign body can be held there. -These constrictions are : - - - -At pharyngo-esophageal junction (C6) - 15 cm from the upper incisors. -At crossing of arch of aorta and left main bronchus (T4) - 25 cm from upper incisors. -Where it pierces the diaphragm (T10) - 40 cm from upper incisors. -### End" -356,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: SAFE strategy is recommended for-, with the following options: A: Glaucoma, B: Cataract, C: Trachoma, D: Diabetic retinopathy - -### Response: -Ans. is 'c' i.e., Trachoma o SAFE strategy developed by the WHO is the key to the treatment of trachoma. This consists of Surgery (S) on the lids. Antibiotics to treat the community pool of infection (A), Facial cleanliness (F) ; and Environmental changes (E). Blindness From Trachoma Can Be Stopped At FourDifferent points: SAFES - Surgical correction for trichiasis. It is a simple operation that can turn out lashes which are scratching the cornea, patients can be operated on in a local dispensary or health center, or other community space if properly prepared.The surgical procedure can be performed by those who have had surgical training : eye doctors, eye nurses or eye care assistants.A - Antibiotic treatment of people with active trachoma infection.Regular detection and treatment of people with active trachoma is important. The recommended treatment is as follows:o Wash the face and clean the eyeso Apply tetracycline 1% ointment to both eyes two times daily for six weekso The ointment is sticky and may blur the vision for a few moments. This will only last a few moments. If possible, treat all the children in the family.F - Clean FacesFamilies and individuals can do something to protect themselves from infection by increasing the number of times a child washes his/her face. Regular face washing removes discharge so that flies are not attracted to faces. It does not require great quantities of water : one liter of water can wash up to 30 faces.E - Environmental Improvemento This question is a repeat from NEET 2012-13, All India & AIIMS. -### End" -357,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ulnar nerve injury at wrist involves following except :, with the following options: A: Palmar interossei, B: Opponems pollicis, C: Dorsal interossei, D: Adductor pollicis - -### Response: -B. i.e. Oppenens polices Ulnar nerve in hand supply-3rd & 4""1 lumbricals, interossei (pabnar & dorsal), adductor pollicis & hypothenar musclesQ. -### End" -358,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atracurium is excreted by -, with the following options: A: Renal excretion, B: Hepatic elimination, C: Nonenzymatic degradation, D: All of the above - -### Response: -Ans. is 'c' i.e., Nonenzymatic degradation o The unique feature of atracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofmann elimination) in addition to that by alkaline ester hydrolysis.o Consequently, its duration of action is not altered in patients with hepatic/renal insufficiency or hyperdynamic circulation - Preferred muscle relaxant for such patients as well as for neonates and the elderly.o Atracurium is metabolized to laudanosine that is responsible for seizures,o It can cause histamine release Hypotension & bronchoconstriction. -### End" -359,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of chronic pancreatitis is:-, with the following options: A: Alcohol, B: Gall stones, C: Trauma, D: Smoking - -### Response: -Most common cause of chronic pancreatitis is alcohol -### End" -360,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The greater petrosal nerve is formed from -, with the following options: A: Geniculate ganglion, B: Plexus around ICA, C: Plexus around middle meningeal artery, D: None of the above - -### Response: -Ans-A -### End" -361,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common fetal response to acute hypoxia is?, with the following options: A: Tachycardia, B: Tachypnea, C: Bradycardia, D: Arrhythmia - -### Response: -Ans. is 'c' i.e., Bradycardia The initial response of the normal fetus to acute hypoxia or asphyxia is bradycardia results from chemoreceptor stimulation of vagal nerve. -### End" -362,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hormonal abnormalities in men and post menopausal women suffering from rheumatoid ahritis include the following except, with the following options: A: Decreased testosterone, B: Decreased luteinizing hormone, C: Decreased dehydroepiandrosterone, D: Decreased thyroid autoantibodies - -### Response: -Answer- D. Decreased thyroid autoantibodiesMen and postmenopausal women with RA have lower mean serum testosterone, luteinizing hormone (LH) and dehydroepiandrosterone (DHEA) levels than control populations. -### End" -363,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brain damage in phenylketonuria is due to accumulation of-, with the following options: A: Tyrosine, B: Phenylalanine, C: Tryptophan, D: None - -### Response: -Ans. is 'b' i.e., Phenylalanine ""The primary symptom of untreated phenylketonuria (i.e. mental retardation) is the result of consuming foods that contain phenylalanine, which is toxic to brain tissue ""Phenviaketonuriao It is an autosomal recessive disorder due to deficiency of phenylalanine hydroxylase.o As a result phenylalanine is not metabolized by hydroxylase, and metabolism is shifted to alternative pathvway and there is increased concentration of phenylalanine, phenylpyruvate, phenylacetate and phenyl-lactate.o Because phenylalanine is not converted into tyrosine, tyrosine becomes art essential amino acid.o Classical phenylketonuria is due to deficiency ofphenylalanine hydroxylase. Milder form may be caused by deficiency of dihydrobiopterin reductase that produces tetrahydrobiopterin, a cofactor for phenylalanine hydroxylase.Clinical presentationo The babies are normal at birth but may present with vomiting. Gradually mental retrardation and growth retardation develop. Baby has light complexion with blue iris. Other features are microcephaly, rash, hypertonia, seizures, exaggerated tendon reflex, wide spaced teeth, enamel hypoplasia and hyperactivity.o There is musty or mousy odour of urine and other body secretions due to presence of phenylketones.o Pregnant females with increased pheynlalanine (maternal phenylketonuria) may cause mental retardation, microcephaly, growth retardation and CHDs in babies.Diagnosiso Elevated phenylalanine levelso Elevated blood tyrosine levelo Presence of urinary metabolites of phenylalanineo Guthrie's Test - It detects the presence of phenylalanine in serumo FeCl3 - It detects the presence of phenylalanine in urine. FeCl3 is added to patients urine. If it contains phenylalanine, it will turn green.o 2-4 Dinitrophenol hydrazine - gives yellow precipitate with old urine.Treatmento Administration of low phenylalanine is the mainstay of treatment (but phenylalanine should not be completely restricted as it is necessary for growth). Tetrahydrobiopterin can be used in milder form. -### End" -364,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female presents with ductal ca in situ of breast with diffuse microcalcifications on mammography. She also gives family history of breast ca. What is best possible management, with the following options: A: Breast conservative surgery, B: Simple mastectomy, C: Modified radical mastectomy, D: Radiotherapy - -### Response: -.* Total (simple) mastectomy: Along with the tumour, entire breast, areola, nipple, skin over the breast, including axillary tail are removed. There is no axillary dissection. Often the patient is subjected to radiotherapy later (External) to axilla. * Conservative breast surgeries: Tumour is removed with a rim of 1 cm of normal tissue. It may be a. Wide excision. b. Quadrantectomy as pa of therapy -- QUA (VERONESI): Entire segment of the involved breast is removed along with axillary dissection (done through a separate incision in the axilla, level I and II removal) and radiotherapy. There is a higher rate of local recurrence after conservative QUA therapy especially in younger patient and in high grade tumours. ref:SRB&;s manual of surgery,ed 3,pg no 484 -### End" -365,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Esophageal atresia may occur as a part of VACTER group of anomalies. What does 'TE' stand for?, with the following options: A: Tetralogy of Fallot, B: Thoracic empyema, C: Tracheo-esophageal fistula, D: Talipes equinovarus - -### Response: -c. Tracheo-esophageal fistula(Ref: Nelson's 20/e p 1783, Ghai 8/e p 173)VACTERL association (also called VATER association) refers to the non-random co-occurrence of birth defects including Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula and/or Esophageal atresia, Renal and Radial anomalies and Limb defects. -### End" -366,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 56 year old chronic smoker, mass in bronchus resected. What is the possible marker-, with the following options: A: Cytokeratin, B: Vimentin, C: Epithelial membrane Cadherin, D: Leukocyte - -### Response: -Ref:Harrison&;s principle of internal medicine ,18 th edition, page no. 739 The diagnosis of lung cancer most often rests on the morphologic or cytologic features correlated with clinical and radiologic findings. Immunohistochemistry may be used to verify neuroendocrine differentiation within a tumour, with markers such as neuron specific enolase (NSE),CD56 or neural cell adhesion molecule (NCAM), synaptophysin, chromograin, and Leu7.Cytokeratin 7 and 20 used in combination can help narrow the differential diagnosis; Non-Small Cell Lung Cancer , Small Cell Lung -### End" -367,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False rejection of a true null hypothesis is due to?, with the following options: A: Type II error, B: Type I error, C: Beta error, D: Error of second kind - -### Response: -Ans. is 'b' i.e., Type I error Statistical errors Statistical errors are used to describe possible errors made in statistical decision. Before reading about the types of error you must know null hypothesis because these tests are related to null hypothesis. Null hypothesis says - Any kind of difference or significance you see in a set of data is due to chance and not significant that means there is no variation (difference) exists between variables. Null hypothesis testing (e.g., in Chisquare test) is used to make a decision about whether : - i) The data contradict the null hypothesis - That means there is true difference (which is significant) between variables and it is not due to chance. Or ii) The data approve the null hypothesis There is no difference between variables and the difference you see is due to chance. Now see types of error :? There are two basic type of statistical errors : ? Type I error Type II error Type I error It is also known as an error of first kind or a-error or false positive. This type of error rejects null hypothesis when it is true - False rejection of null hypothesis. That means in real there is no difference (as null hypothesis says) but we observe a difference (by rejecting the null hypotesis due to error). In very simple words ""we observe a difference when it is not true"" - false positive. One of the simplest example of this would be if a test shows that a women is pregnant when in reality she is not, i.e., she is false positive for pregnancy. Probability of type-I error is given by 'P-value' (probability of declaring a significant difference when actually it is not present). Significance (a) level is the maximum tolerable probability of type I error. Significance (a) level is fixed in advance and calculation of P value (probability of type I error) can be less than, equal to or greater than the significance (a) level. If the probability of type I error (P -value) is less than significance (a) level, the results are declared statistically significant. Therefore, to declare the results statistical significant, type I error (a-level) should be kept to minimum . Type I error is more serious that type II error. Type II error It is also known as an error or second kind or A-error or false negative. This type of error accept/fail to reject the null hypothesis when it is false False acceptance of null hypothesis. That means we fail to observe a difference when in truth there is one - False negative. An example of this would be if a test shows that a woman is not pregnant when in reality she is i.e., she is false negative. -### End" -368,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sign of antemortal hanging is?, with the following options: A: Dribbling of saliva, B: Ligature mark, C: Fracture of hyoid bone, D: Seminal emission - -### Response: -ANSWER: (A) Dribbling of salivaREF: Parikh 6th edition page 3.44 Antemortem hangingPostmortem hangingMotiveUsually suicidal (Homicidal only in Lynching)HomicidalLigature markWell developed with parchment like base and is yellow or brownNot well developedSalivaDribbling of saliva presentAbsentInjuriesNo other injuries seenOther injuries causing death seenSigns of asphyxiaPresentAbsentCircumstantialevidenceClosed room No signs of struggleSigns of struggle presentDrag marks on bodyMaybe seenNot seenSuicide noteMay or may not be presentNever presentRope fibresMay be seen in the handsNot seen -### End" -369,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement about Bradykinin is true?, with the following options: A: Causes pain, B: Causes bronchodilation, C: Causes vasoconstriction, D: Decreases vascular permeability - -### Response: -Bradykinin increases vascular permeability, causes contraction of smooth muscles (bronchoconstriction), dilatation of blood vessels and pain. Ref: Urinary Tract By Karl-Erik Andersson, Page 413; Peptidergic G Protein-coupled Receptors: From Basic Research to Clinical Applications By Pierangelo Geppetti, Page 100; The New Angiotherapy By Tai-Ping D. Fan, Elise C. Kohn, Page 94; Robbin's Illustrated Pathology, 7th Edition, Pages 65, 74, 75 -### End" -370,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False regarding delirium tremens ?, with the following options: A: Tremors, B: Opthalmoplegia, C: Visual hallucination, D: Clouding of consciousness - -### Response: -Ans. is 'b' i.e., Ophthalmoplegia Delirium tremens Delirium tremens is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant alcohol abstinence. This is an acute organic brain syndrome (delirium) with characteristic features of delirium. Clouding of consciousness with disorientation in time and place. Poor attention span and distractability. Visual (and also auditory) hallucination, and illusion. Tactile hallucination of insect crawling under the skin (formication) may also occur. Marked autonomic disturbances with tachycardia, sweating, hypeension, mydriasis, coarse tremers. Insomnia, psychomotor agitation, ataxia, anxiety. Benzodiazepines are the drugs of choice for delirium tremens. Chlordiazepoxide is the agent of choice with diazepam as an alternative. -### End" -371,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DOC in allergic bronchopulmonary aspergillosis ABPA:, with the following options: A: Prednisolone, B: IV Amphotercin B, C: IV Phenramine maleate, D: Fluconazole - -### Response: -Ans: a (Prednisolone) Ref: Harrison, 16th ed, p. 1189; 17th ed, p. 1260, Table (197-2)Drug of choice for ABPA is prednisolone. (According to new recommendadation 17th ed, Harrison,Table 197-2 drug of choice is ITRACONAZOLE)Treatment of aspergillus infectionFungus ball of the lung - Surgical resectionABPA- short course of Glucocorticoids (prednisolone)Invasive Aspergillosis-voriconazole, liposomal or conventional amphotercin BMajor diagnostic criteria for ABPA:Secondary diagnostic criteria1. Clinical history of asthma1. History of brownish plugs in sputum2. Pulmonary infiltrates (transient or fixed)2. Culture of A. fumigatus from sputum3. Peripheral eosinophilia (> 1000/uL)3. Late skin reactivity to aspergillus antigen4. Immediate skin reactivity to aspergillus antigen.4. Elevated IgE (and IgG) class antibodies specific for A. fumigatus.5. Serum precipitates to A. fumigatus6. Elevated serum IgE levels.7. Central / proximal bronchiectasis(In recent papers lot of questions are asked regarding the antimicrobial of choice. Therefore we have listed some of the important ones.)Gonococcal infection- CeftriaxoneClostridium- Penicillin (IV) + ClindamycinDiphtheria- ErythromycinListeria- IV Ampicillin or PenicillinKlebsiella- CarbepenemCampylobacter- ErythromycinYersenia pestis- StreptomycinPertussis- ErythromycinBrucella- StreptomycinChlamydia- AzithromycinMycoplasma- Erythromycin -### End" -372,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reflux Nephropathy with protenuria in the nephrotic range may be seen in patients with :, with the following options: A: Membranous glomerulonephritis, B: Focal segmental Glomerulosclerosis, C: Nodular glomerulosclerosis, D: Crescenteric glomerulonephritis - -### Response: -Answer is B (Focal segmental Glomerulosclerosis): Focal segmental glomerulosclerosis may develop following acquired loss of nephrons from reflux nephropathy. Proteinuria is nonselective in most cases and may be in subnephrotic range (nephritic range < 3.0 g/24h) or nephrotic range. - Harrison Association of Reflux Nephropathy and protein aria suggests an irreversible glomerular lesion most commonly focal segmental glomerulosclerosis : Medline -### End" -373,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In ACLS which drug can be given following ventricular fibrillation after cardiac arrest other than epinephrine?, with the following options: A: Amiodarone, B: Dopamine, C: Adenosine, D: Atropine - -### Response: -V-Fib or VF is the most common rhythm that occurs immediately after cardiac arrest. In this rhythm, the hea beats with rapid, erratic electrical impulses. Treatment: * Shock / Defibrillation: every 2 minutes in a single one shock, successive, shockable increments * 200 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * 300 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * 360 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * Drugs : * Give Epinephrine 1mg of a 1:10,000 solu,on every 3 to 5 minutes * Give either: * Amiodarone : 300mg first dose / 150mg second dose at 3 to 5 minutes increments. Lidocaine: First dose: 1mg/kg or 1.5 mg/kg. Can repeat it at half the original dose up to a total of 3 mg/kg REF : BAILEY AND LOVE 27TH ED -### End" -374,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Taste sensation from anterior 2/3rd of tongue are carried by, with the following options: A: Glossopharyngeal, B: Chordatympani, C: Trigeminal, D: Greater auricular - -### Response: -TASTE SENSATION FROM ANTERIOR TWO-THIRDS OF TONGUE IS CARRIED BY CHORDA TYMPANI. CHORDA TYMPANI IS THE NERVE OF TASTE EXCEPT VALLAA PAPILLAE. REFER BDC 6 TH EDITION VOLUME 3 PAGE NO: 268 REFER FIG 17.8 -### End" -375,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Concentration of H+ ion is 10-9. What is the pH of the solution?, with the following options: A: 9, B: 13, C: 4, D: 7 - -### Response: -Ref: Vasudevan DM, Sreekumari S. Text book of BIOCHEMISTRY, 6th Edn. Page No: 339,Explanation:pH is defined as the negative logarithm of hydrogen ion concentration (moles/L)pH = -Log10 In this problem, H+ Concentration is 1X109 Moles/LpH = -log 10pH = 9Similarly pka = -logl0 Where Ka is dissociation constant. M/L M/LpHpOHInference1 X10 -131 X 10 1113Strong acid1 X 10 -10c1 X 10 -4410Acid1 X 10 -71 X 10 -777Neutral1 X 10 -41 X 10 -10104Alkali1 X 10 -11 X 10 -13131Strong alkali -### End" -376,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which pox wont grow in egg, animal cells:, with the following options: A: Cow pox, B: Vaccinia, C: Variola, D: Molluscum - -### Response: -Ans. d. Molluscum -### End" -377,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true of water shed infarcts except, with the following options: A: Seen at junction of major cerebral aeries, B: Seen at sub ganglionic White matter, C: Cerebral vasospasm may cause it, D: Associated With hypoxic ischemic encephatopathy - -### Response: -Harrison's principles of internal medicine. *Occur at distal territories between the major cerebral aeries and can cause cognitive deficits,visual agnosia and weakness that is greater in proximal than in distal muscle groups. watershed stroke is defined as a brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral aeries. The actual blood stream blockage/restriction site can be located far away from the infarcts. Watershed locations are those border-zone regions in the brain supplied by the major cerebral aeries where blood supply is decreased. Watershed strokes are a concern because they comprise approximately 10% of all ischemic stroke casesThe watershed zones themselves are paicularly susceptible to infarction from global ischemia as the distal nature of the vasculature predisposes these areas to be most sensitive to profound hypoperfusion Ref Harrison20th edition pg 2234 -### End" -378,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The primary role of chaperones is to help in, with the following options: A: Protein synthesis, B: Protein degradation, C: Protein denaturation, D: Protein folding - -### Response: -Proteins must fold to achieve their functional form. Folding can be spontaneous or facilitated by chaperones. Proteins that are defective (for example misfolded) or destined for rapid turnover are marked for destruction by the attachment of chains of a small, highly conserved protein called ubiquitin. Ubiquitinated proteins are rapidly degraded by a cytosolic complex known as the proteasome. Reference: Lippincotts illustrated reviews of Biochemistry Sixth edition: page no; 807 -### End" -379,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady with 36-week pregnancy with previous C section comes with low BP, tachycardia and on USG fluid present in peritoneum. What is diagnosis and next management, with the following options: A: Uterine scar rupture with Laparotomy, B: Impending dehiscence and Laparoscopy, C: Ectopic pregnancy and aboion, D: Abruptio and C-section - -### Response: -Above history points towards diagnosis of Uterine scar rupture Signs and symptom of rupture: Maternal Tachycardia Maternal hypotension Dead baby or severe fetal distress Uterine contour is lost Sudden stoppage of uterine contraction Hemoperitoneum P/V: loss of station Mx: Emergency laparotomy -### End" -380,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: It is true regarding the normal microbial flora present on the skin and mucous membranes that ?, with the following options: A: It cannot be eradicated by antimicrobial agents, B: It is absent in the stomach due to the acidic pH, C: It establishes in the body only after the neonatal period, D: The flora in the small bronchi is similar to that of the trachea - -### Response: -Ans is 'a' i.e., It cannot be eradicated by antimicrobial agents . The normal microbial flora are more or less constant for each species and are broadly divided into residents and transients. The former constitute a constant population which cannot be completely removed permanently. - Ananthanarayan 7'''/e 599 . Because of low pH of stomach, it is viually sterile except soon after eating - Ananthanarayan 71/4 601 . With in 4-24 hours of bih an intestinal flora is established - Ananthanarayan r/e 600 . In the pharynx and trachea, flora is similar to that of mouth, while smaller bronchi and alveoli are normally sterile - Ananthanarayan 7th/e 600 -### End" -381,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common organs involved in the wagners granulomatosis are, with the following options: A: Skin and nose, B: Lung and kidney, C: Hea and kidney, D: Kidney and nervous system - -### Response: -Refer robbins 9/e p511 Granulomatosis with polyangiitis (formerly called Wegener's) is a rare disease of unceain cause that can affect people of all ages. It is characterized by inflammation in various tissues, including blood vessels (vasculitis), but primarily pas of the respiratory tract and the kidneys. The areas most commonly affected by GPA include the sinuses, lungs, and kidneys, but any site can be affected -### End" -382,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding fibromuscular dysplasia are all except -, with the following options: A: Medium size vessels, B: OCPs predispose, C: Aneurysm may occur, D: Irregular hyperplasia - -### Response: -Ans. is 'b' i.e., OCPs predispose Fibromuscular dysplasia It is focal irregular thickening of the walls of medium and large muscular aeries, including renal, carotid, splanchnic, and veebral vessels. Segments of vessel wall are focally thickened by a combination of irregular medial and intimal hyperplasia and fibrosis, causing luminal stenosis. In renal vessels, it may cause renovascular hypeension. Aneurysm may develop in the vessel segment with attenuated media, and can rupture in some cases. There is no association with use of oral contraceptives or sex hormone abnormalities. -### End" -383,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 20 year old male come to casuality with head injury. Examination reveals normal counsciousness, clinically normal and blood in the tympanic membrane, most likely cause is, with the following options: A: Extradural haemorrhage, B: Subdural haemorrhage, C: Intraventricular haemorrhage, D: Complete basilar fracture - -### Response: -(Complete basilar fracture) (595 - 99- B & L 24th) (302-Baily & Love 25th)Extradural haemorrhage - Common in younger age group* Usually from haemorrhage of middle meningeal artery* **Lucid interval is characteristic* Surgery without delay is essentialSubdural haematoma - most common intracranial mass lesions resulting from head trauma* *Develop from tom bridging veins or cortical lacerations* More severe poorer out come* **CT - concave hyperdense collectionsBase of skull fractures|||Anterior Cranial Fossa FractureMiddle Cranial Fossa Fracture* Sub conjunctival haematoma* CSF rhinorrhoea* Carotico-cavemous fistula* Periorbital haematoma or ""raccoon eyes""* CSF otorrhoea or rhinorrhoea* Haemotympanum ** Ossicular disruption* ""Battle sign"" (brushing behind the ear)* VII and VIII cranial nerve palsies -### End" -384,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The receptor through which M-tropic HIV strains bind -, with the following options: A: CCR5, B: CXCR4, C: CXCR5, D: Any of the above - -### Response: -HIV-1 most commonly uses the chemokine receptors CCR5 and/or CXCR4 as co-receptors to enter target immunological cells. Option 1: Macrophage (M-tropic) strains of HIV-1, or non-syncitia-inducing strains (NSI) use the beta-chemokine receptor CCR5 for entry and are thus able to replicate in macrophages and CD4+ T-cells. These strains are now called R5 viruses. Option 2: T-cell line (T-tropic) isolates or syncytium-inducing (SI) strains replicate in primary CD4+ T-cells as well as in macrophages and use the alpha-chemokine receptor, CXCR4, for entry. Option 3: CXCR5 in B-cell and tumor cell responses: expressed in Burkitt Lymphoma and Intraocular Lymphoma. -### End" -385,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cilastatin is given along with, with the following options: A: Imipenem, B: Amoxycillin, C: Erythromycin, D: Ampicillin - -### Response: -. -### End" -386,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement is not true regarding NK cells, with the following options: A: NK cells have CD markers 16, 56, B: They mediate antibody dependent cell mediated cytotoxicity, C: They are MHC I restricted, D: Reduced expression of MHC Class I moleules favours cytotoxicity of NK cells. - -### Response: -NK cells are not MHC restricted. -### End" -387,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are the posterior relations of kidney except:, with the following options: A: Psoas Major, B: Quadratus Lumborum, C: Sympathetic chain, D: Ilioinguinal Nerve - -### Response: -Ans. C. Sympathetic chainThe posterior relations of two kidneys are:a. Four muscles: Diaphragm, quadratus lumborum, psoas major, and transversus abdominis.b. Three nerves: Subcostal (T12 , iliohypogastric (L1 ), and ilioinguinal (L1 ). The subcostal nerve is accompanied by the subcostal vessels.c. One or two ribs: The right kidney is related to the 12th rib whereas the left kidney is related to the 11th and 12th ribs. -### End" -388,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a small child diagnosed with H.influenza meningitis, what investigation must be done before discharging him from the hospital ?, with the following options: A: BERA, B: MBI, C: CT scan, D: X-ray skull - -### Response: -Clinical description : Bacterial meningitis is characterized by acute onset of fever (usually > 38.5 degC rectal or 38.0 degC axillary), headache and one of the following signs: neck stiffness, altered consciousness or other meningeal signs. Hib, meningococcal meningitis and pneumococcal meningitis cannot be differentiated on clinical grounds alone Laboratory criteria for diagnosis Bacterial meningitis can be confirmed by three methods. (1) Culture method: isolation of a bacterial pathogen from a normally sterile clinical specimen such as CSF or blood. (2) Antigen detection methods: identification of a bacterial antigen in normally sterile fluids (i.e. CSF or blood) by such methods as latex agglutination or counterimmunoelectrophoresis (CIE). (3) Gram stain results Case classification Suspected: Any person with sudden onset of fever (> 38.5 degC rectal or 38.0 degC axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal sign Probable: A suspected case with CSF examination showing at least one of the following: - turbid appearance; - leukocytosis (> 100 cells/mm3); - leukocytosis (10-100 cells/ mm3) AND either an elevated protein (> 100 mg/dl) or decreased glucose (< 40) Confirmed: A case that is laboratory-confirmed by growing (i.e. culturing) or identifying (i.e. by Gram stain or antigen detection methods) a bacterial pathogen (Hib, pneumococcus or meningococcus) in the CSF or from the blood in a child with a clinical syndrome consistent with bacterial meningitis. Acute bacterial meningitis (ABM) constitutes 1.5% of all admissions in the pediatric ward with a mean case fatality of 16%. Sensorineural hearing loss (SNHL) is the most common neuropsychological sequel of ABM. It occurs in as many as 30% of patients with pneumococcal meningitis, 10% with meningococcal meningitis and 5-20% with Haemophilus influenzae type &;b&; meningitis.The effect of SNHL on language is well-recognized and therefore early detection is mandatory. However, hearing assessment is difficult in infants and young children. Brainstem evoked response audiometry (BERA) can help to assess hearing in this population. BERA is a helpful tool for screening of SNHL, especially in the young children and infants in whom other conventional methods may not be of much use. There is significantly increased risk of developing SNHL if the CSF has increased cells, paicularly polymorphs and proteins. Reference: GHAI Essential pediatrics, 8th edition -### End" -389,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following cervical joint helps a person to look towards the right or left?, with the following options: A: Atlanto-occipital joint, B: Atlanto-axial joint, C: C2-C3 joint, D: C3-C4 joint - -### Response: -The atlantoaxial joint allows the greatest degree of motion among all the joints of the neck. It allows the head to flex and extend about 10 degrees, and also allows more than 60 degree of rotation in the horizontal plane. Thereby permitting a person to look to the right or left. Ref: Atlas of Interventional Pain Management By Steven D. Waldman, 3rd edition, Page 7 ; Understanding Joints: A Practical Guide to Their Structure and Function By Bernard Kingston, Page 36 ; Clinical Anatomy by Region's by Richard's Snell, Page 862, 858 -### End" -390,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is example of hyaline cailage?, with the following options: A: Epiglottis, B: Tip of nose, C: Apex of arytenoid cailage, D: Pinna - -### Response: -Hyaline cailage is seen at tip of nose ; lateral wall of nose and nasal septum Inderbir Singh&;s textbook of human Histology Seventh edition Pg no 82 -### End" -391,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about anatomy of the cerebellum?, with the following options: A: Globose cells are present in the roof, B: Vermis is present in the midline, C: Flocculonodular lobe is concerned with smoothening and co-ordination of movements, D: Dentate nucleus is the medial most nucleus - -### Response: -Ans. is 'b' i.e., Vermis is present in the midline.(Ref: Ganong 23d/e p. 255)'The vermis is a midline structure that connects the two cerebellar hemispheres.'Dentate nucleus is the lateral most nucleus.''Spinocerebellum and not flocculonodular lobe is concerned with smoothing and coordination of movements''Globose cells are a pa of deep cerebellar nuclei and are present deep inside the substance of cerebellum. -### End" -392,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not transmitted by fish -, with the following options: A: Paragonimus westermanii, B: Clonorchis sinensis, C: Diphyllobothrium latum, D: Schistosoma japonicum - -### Response: -definitive host-man and domestic animals Intermediate snail host-Oncomelania sp. (refer pgno:117 baveja 3 rd edition) -### End" -393,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is safest to be used in asthmatic patients –, with the following options: A: Nitrazepam, B: Phenobarbitone, C: Chloral hydrate, D: All hypnotics are safe - -### Response: -Safe in asthma → Propofol, etomidate, ketamine, vecuronium, rocuronium, Pancuronium, Halothane, Sevoflurane, Desflurane, Isoflurane, Pethidine, Fentanyl, Alfentanil, Benzodiazepines (Nitrazepam). -### End" -394,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Break bone fever"" is:, with the following options: A: Rheumatic fever, B: Dengue fever, C: Rat-bite fever, D: Relapsing fever - -### Response: -(Dengue fever): Ref: 111, 1164-H (1230-H17th)DENGUE FEVER: - Caused by (4 - serotype) Aedes - aegpti (flavi virus)* Headache, musculoskeletal pain (""break bone fever""): leukopenia occasionally biphasic ( ""saddleback"") fever* Macular rash on the first day, as well as adenopathy, palatal vesicles and scleral injection* Epistaxis and scattered petectiae are often noted in uncomplicated dengue, and preexisting GI lesion may bleed during the acute illness* Leucopenia, thrombocytopenia and increased aminotransferase -### End" -395,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 14 year old boy presents with chronic diarrhea. Duodenal biopsy shows villous atrophy. Anti endomysial antibodies and IgA TTG antibodies are positive. What is the treatment of choice?, with the following options: A: Gluten free diet, B: Antibiotics, C: Loperamide, D: 5-ASA - -### Response: -Chronic diarrhea, villous atrophy of duodenal biopsy, anti-endomysial antibodies and IgA TTG antibodies are features of coeliac sprue. Management of coeliac sprue includes life long gluten free diet and correcting deficiencies of iron, folate and calcium. Ref: Davidson's principles and practice of Medicine, 20th Edition, Chapter 22, Page 894-896; Harrison's Principles of Internal Medicine, 16th Edition, Page 1772 -### End" -396,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which gas is most commonly used in laparoscopy:, with the following options: A: O2, B: CO2, C: N2O, D: N2 - -### Response: -Ans. is 'b' CO2 -### End" -397,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The procedure shown below is used in all of the following illnesses except:, with the following options: A: Catatonic SZ, B: Treatment-resistant major depressive disorder, C: Severe Mania, D: Dissociative Disorder - -### Response: -Ans:D.) Dissociative Disorder.Electroconvulsive therapy is shown in the image.ECT It is used with informed consent in treatment-resistant major depressive disorder, treatment-resistant catatonia, or prolonged or severe mania, and in conditions where ""there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by stupor, marked psycho-motor retardation, depressive delusions or hallucinations, or life-threatening physical exhaustion associated with mania) -### End" -398,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Calcium in human milk is (mg/100gm) -, with the following options: A: 200, B: 100, C: 70, D: 28 - -### Response: -Ans. is 'd' i.e., 28 Cow's milkHuman milkLactose (g)4.47.4Proteins (g)3.21.1Fat (g)4.13.4Calcium (mg)12028Iron (mg)0.21.0Water (g)8788Energy (Kcal)6765 -### End" -399,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following in high doses can cause convulsions ?, with the following options: A: Penicillin, B: Aminoglycosides, C: Erythromycin, D: All - -### Response: -Ans. is 'a' i.e., Penicillin Drugs causing seizures o Lactam antibiotics o Local anaesthetics o Quinolones o Cyclosporine o Acyclovir & Ganciclovir o OKT3 o Isoniazid o Tacrolimus o Meperidine o Interferons o Tramadol o Antidepressants o Antipsychotics o Lithium o Theophylline o Alcohol withdrawl o Barbiturate withdrawl o Benzodiazepine withdrawl -### End" -400,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During fetal life development of testis takes place in relation with:, with the following options: A: Intraperitoneal near ventral wall, B: Anterior abdominal wall, C: Retroperitoneal near dorsal wall, D: All - -### Response: -C i.e. Retroperitoneal Near dorsal wall -### End" -401,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following exclusively involve neurons:, with the following options: A: Spinocerebellar ataxia, B: Supranuclear palsy, C: Corticobasilar degeneration, D: Multiple system atrophy - -### Response: -Ans. is 'a' i.e. Spinocerebellar ataxia -### End" -402,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Component of PQLI -, with the following options: A: Neonatal moality rate, B: Infant moality rate, C: Perinatal moality rate, D: None of the above - -### Response: -PQLI- Physical Quality of Life Index is one index to measure quality of life.It consolidates 3 indicators -infant moality rate -life expectancy at age one -literacy For each component score 0 to 100 given.The composite index is calculated by averaging three indicators,giving equal weight to each.Resulting PQLI is also scaled 0 to 100. Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 17 -### End" -403,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A key gluconeogenic amino acid is:, with the following options: A: Alanine, B: Serine, C: Valine, D: Tyrosine - -### Response: -Alanine is a key gluconeogenic amino acid. The rate of hepatic gluconeogenesis from alanine is far higher than from all other amino acids. The capacity of the liver for gluconeogenesis from alanine does not reach saturation until the alanine concentration reaches 20 to 30 times its normal physiologic level. -Ref: Harper’s illustrated biochemistry. 30th edition page no: 289 -### End" -404,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Effective dose in radiation at 1 m is 4 Gy; at 4 m it will be:, with the following options: A: 0.25, B: 0.5, C: 2, D: 4 - -### Response: -Intensity of an X-ray beam is inversely proportional to the square of the distance between the source and the point of measure. When the distance from the focal spot is doubled, the intensity of the beam decreases to one quarter. -### End" -405,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a cause of consecutive optic atrophy:, with the following options: A: Retinitis pigmentosa(RP), B: CRAO, C: Pathological Myopia, D: Retrobulbar neuritis - -### Response: -Retrobulbar neuritis is considered as Primary optic atrophy. -### End" -406,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dissociative fugue is: Maharashtra 08, with the following options: A: Person has sudden onset of paralysis, B: Person is fearful of a specified object, C: Person has multiple identities, D: Person flees from an immediate life situation - -### Response: -Ans. Person flees from an immediate life situation -### End" -407,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Continuous cell culture of bacteria, with the following options: A: U tube, B: Craige tube, C: Chemostat device, D: Agar dilution method - -### Response: -Ans. is 'c' i.e., Chemostat device Bacterial cultures can be maintained in a state of exponentional growth over long periods of time using a system of continuous culture. Continuous culture, in a device called chemostat, can be used to maintain a bacterial population at a constant density, a situation that is, in many ways, more similar to bacterial growth in natural environments. In a chemostat microbial cells are grown at a steady state where cell biomass production, substrates and products concentrations remains constant, and growth occurs at a constant rate. These features make a chemostat unique and powerful tool for biological and physiological research. -### End" -408,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Second injury in an explosion is due to -, with the following options: A: Due to flying debris, B: Due to blast wind, C: Due to shock wave, D: Due to complication - -### Response: -Ans. is 'a' i.e., Due to flying debriso Primary injuryo Secondary injuryo Tertiary injuryo Quaternary injury- due to shock wrave.- due to flying debris.- due to blast wind.- due to complicating factors (complications). -### End" -409,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Monoprotic acid are -, with the following options: A: Formic acid, B: Acetic acid, C: Nitric acid, D: All of these - -### Response: -Monapratic acids (HA) can donate 1 proton (H+) per molecule. Examples are hydrochloric acid (HCl), nitric acid (HNO3), formic acid, acetic acid, lactic acid and benzoic acid. -Polyprotic acids can donate more than one protons (H+) per molecules. These can be divided into :- - -(i) Diprotic acid (H2A) :- These can donate upto 2 protons (RE) per molecule. Examples are carbonic acid, sulphuric acid, succinic acid and glutaric acid. -(iii) Triprotic acid (H3A) :- These can donate upto 3 protons (H+) per molecule. Examples are phosphoric acid and citric acid. -### End" -410,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triad of exophthalmos, bone lesions, and diabetes insipidus is a feature of, with the following options: A: Hand-schuller christian disease, B: Craniofacial dysostosis, C: Mickulicz syndrome, D: Letterer - sieve disease - -### Response: -HSCD is associated with multifocal langerhans cell histiocytosis. -Triad: - -Exophthalmos -Lytic bone lesions -Diabetes insipidus. -### End" -411,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sternocleidomastoid is supplied by all of the following aeries, EXCEPT:, with the following options: A: Occipital, B: Posterior auricular, C: Thyrocervical trunk, D: Superior thyroid - -### Response: -The sternocleidomastoid muscle derives its blood supply from three separate sources: Superior-occipital aeryCentral-superior thyroid aeryInferior- thyrocervical trunkRef: Gray's anatomy: the anatomical basis of clinical practice by Henry Gray, Susan Standring, Harold Ellis, 2005, Page 536. -### End" -412,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AFP surveillance registry indicator is ?, with the following options: A: Number of AFP cases repoed, B: Number of wild polio-virus positive cases, C: Number of non-polio AFP < 5 years, D: Number of non-polio AFP < 15 years - -### Response: -Ans. is 'a' i.e., Number of AFP cases repoed The number of AFP cases repoed each year is used as an indicator of a country's ability to detect polio, even in countries where the disease no longer occurs. Polio surveillance It is the most impoant pa of whole polio eradication intiative. It has two components:? Acute flaccid paralysis (AFP) surveillance Acute flaccid paralysis is defined as acute onset (< 4 weeks) of flaccid paralysis (reduced tone) without other obvious cause in children WHO recommends the immediate repoing and investigation of every case of AFP in children less than 15 years. -### End" -413,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about anterior shoulder dislocation -, with the following options: A: It is most common type of shoulder dislocation, B: It is most commonly subclavicular, C: Patient keeps his arm in saluting position, D: Injury to brachial plexus may occur - -### Response: -Answer- A. It is most common type of shoulder dislocationMost common type of shoulder dislocation is anterior dislocation (subcoracoid being most common).Patient keeps his arm by the side ofthebodyin apositionofabduction anileernalrotation -### End" -414,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common presentation of organ damage in Diabetes mellitus is, with the following options: A: Retinal changes, B: Microalbuminuria, C: Autonomic neuropathy, D: Coronary artery disease - -### Response: -(A) Retinal changes # CHRONIC SYMPTOMS OF DIABETES are due to vascular damage from persistent hyperglycemia.> Vascular damage leads to end-organ damage.> Other conditions associated with diabetes, such as hypertension, dyslipidemia (as well as smoking) accelerate the development of vascular damage and the chronic complications of diabetes, which are the following:# Microvascular complications are a significant cause of morbidity. Persistent hyperglycemia is the major cause for the microvascular complications which are highly specific for diabetes. Retinopathy with potential loss of vision Nephropathy leading to kidney failure Peripheral neuropathy leading to pain, foot ulcers, and limb amputation Autonomic neuropathy causing gastrointestinal, genitourinary, cardiovascular symptoms and sexual dysfunction# Macrovascular complications are the main cause of mortality.> Although persistent hyperglycemia may contribute to macrovascular complications, it is the associated conditions (hypertension, dyslipidemia, smoking) that account for most of the burden of the macrovascular complications. Coronary heart disease which is the major cause of death for patients with diabetes Peripheral vascular disease Cerebrovascular disease> Diabetic retinopathy may be the most common microvascular complication of diabetes. The risk of developing diabetic retinopathy or other microvascular complications of diabetes depends on both the duration and the severity of hyperglycemia. Development of diabetic retinopathy in patients with type 2 diabetes was found to be related to both severity of hyperglycemia and presence of hypertension.> Diabetic nephropathy is the leading cause of renal failure. It is defined by proteinuria > 500 mg in 24 hours in the setting of diabetes, but this is preceded by lower degrees of proteinuria, or ""microalbuminuria."" Microalbuminuria is albumin excretion of 30-299 mg/24 hours. Without intervention, diabetic patients with microalbuminuria typically progress to proteinuria and overt diabetic nephropathy. This progression occurs in both type 1 and type 2 diabetes. -### End" -415,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most Common extranodal site of Lymphoma in HIV is?, with the following options: A: CNS, B: GIT, C: Retroperitoneum, D: Mediastinum - -### Response: -Ans. (a) CNS(Ref: Harrison 18th/pg Chapter 189)Lymphoma in HIV90% of lymphomas in HIV are B cell in phenotype; more than half contain EBV DNA.Immunoblastic lymphomas account for 60% of the cases of lymphoma in patients with AIDS.Primary CNS lymphoma accounts for 20% of the cases of lymphoma in patients with HIV infection.Most common extranodal site involved in Lymphoma in HIV is the CNS, which is involved in one-third of all patients with lymphoma. -### End" -416,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about cushing's syndrome is -, with the following options: A: Adrenomedullary hyperplasia in association wift MEN syndrome is common cause, B: Bronchial &Mediastinal carcinoid causes wishing syndrome, C: It is diagnosed by hypokalemia in association wifo increased adrenal secretion, D: It is often fatal due to its coronary and cerebrovascular accidents - -### Response: -most of the cases are associated with oat cell type of bronchogenic carcinoma or with carcinoid tumor of thymus, pancreas, ovary, medullary carcinoma of thyroid, bronchial adenoma( Harrison 17 pg 2255) -### End" -417,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cerebellar hemangioblastoma and retinal tumors are seen in:, with the following options: A: Von Hippel Lindau syndrome, B: Neurofibromatosis type 1, C: Tuberous sclerosis, D: Neurofibromatosis type 2 - -### Response: -Ref: Chapter 28. CNS. page - 1343: Robbins and Cot ran Pathologic Basis of Disease: 8th editionExplanation:The Von Hippel Lindau gene (VHL) is tumor suppressor gene located on Chromosome 3p25-p26 and down-regulates expression of vascular endothelial growth factor; hence its dysregulation is associated with hemangioblastomas and retinal tumors.The neurofibromatosis type 1 (Chr. 17) is associated with:Optic nerve gliomasLisch nodules (pigmented nodules of the iris)Cafe au lait spots (cutaneous hyperpig- mented macules)Neurofibromatosis type 2 (Chr. 22) is associated with:8th nerve schwannomasMultiple meningiomasGliomasEpendymoma of spinal cordTuberous sclerosis complex: It is associated with:Cortical tubersSubependymal nodulesSubependymal giant cell astrocytomasRenal angiomyolipomasRetinal glial hamartomasPulmonary lymphangioleiomyomatosisCardiac rhabdomyomasShagreen patches (cutaneous leathery thickenings)Ash-leaf patches (hypopigmented areas)Subungual fibromas -### End" -418,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The role of plasmids in conjugation was first described by Lederberg and Tatum (1946) in which bacteria?, with the following options: A: H. influenza, B: Pseudomonas, C: Escherichia coli, D: M. Tuberculosis - -### Response: -Bacterial conjugation was first described by Lederberg and Tatum (1946) in a strain of E.coli called K12 (carried a conjugative plasmid F) The F factor: The F plasmid, also called F factor, is a transfer factor that contains the genetic information, essential for controlling mating process of the bacteria during conjugation. The F plasmid of Escherichia coli is the prototype for feility plasmids in Gram-negative bacteria. Strains of E. coli with F+ plasmid are called as donors, whereas plasmid are F- behave as recipients. -### End" -419,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A rickshaw ran over the thighs of a child. The tyre marks of the vehicle can be seen on the child's thighs. These marks are an example of:, with the following options: A: Imprint bruise, B: Patterned bruise, C: Imprint abrasion, D: Ectopic bruise - -### Response: -A patterned contusion is one in which the size and shape mirror a poion of the object which caused it. In this case a tryre mark is seen on the child's thigh so it is a case of patterned bruise. Ref: K.S.N.Reddy 29th Ed Page 166 -### End" -420,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A male, 55 years old is brought to the clinic in unconscious condition. The patient is a Type 2 diabetic since 15 years. General examination reveals RBS levels 268 mg/dl. Blood and Urine samples confirm the presence of ketone bodies. Which of the following substances found raised in this patient blood is volatilized by lungs?, with the following options: A: β-hydroxybutyrate, B: Acetoacetate, C: Acetone, D: Glycerol 3- phosphate - -### Response: -In most cases, ketonemia is due to increased production of ketone bodies by the liver rather than to a deficiency in their utilization by extrahepatic tissues. While acetoacetate and d(−)-3-hydroxybutyrate are readily oxidized by extrahepatic tissues, acetone is difficult to oxidize in vivo and to a large extent is volatilized in the lungs. -A clear understanding of the biochemical basis and pathophysiology of DKA is essential for its efficient treatment. -The cardinal biochemical features are: - -Hyperketonaemia (≥  3.0 mmol/L) or ketonuria (more than 2+ on standard urine sticks) -Hyperglycaemia (blood glucose  ≥ 11 mmol/L, (approximately 200 mg/dL)) -Metabolic acidosis (venous bicarbonate < 15 mmol/L and/or venous pH < 7.3 (H+ > 50 nmol/L)). - -Reference: HARPERS ILLUSTRATED BIOCHEMISTRY30th ed Page no 231; Davidson, page no 735 -### End" -421,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of meningococcal epidemic?, with the following options: A: A, B: C, C: Y, D: W-135 - -### Response: -Ans. is 'a' i.e., A Meningococcal meningitis (cerebrospinal fever) It is an acute communicable disease caused by N. meningitidis. Out of 13 serogroups, group A, B and C are most impoant. Group A is associated with epidemics and group C mostly with localized outbreaks, while group B causes both epidemics and outbreaks. Group 29-E, W-135 and Y also frequently cause meningitis. Reservoir - Human nasopharynx is the only reservoir Source of infection - carriers are the most impoant source of infection, not the clinical cases. Age group - Children between 3 months to 5 years. Outbreaks of meningococcal meningitis occur more frequently in the dry and cold months of the year. Period of communicability - until meningococci are no longer present in discharges from nose and throat. Cases rapidly lose their infectiousness within 24 hours of specific treatment. Meningococcal meningitis is a very fatal disease. In untreated cases moality is 80%. The disease is fatal in 5-10% of cases even with prompt antimicrobial treatment in good health care facility. -### End" -422,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are used for the treatment of Pulmonary hypeension except, with the following options: A: Endothelin receptor antagonist, B: Phosphodiesterase inhibitors, C: Calcium channel blockers, D: Beta blockers - -### Response: -Refer kDT 6/e p 297 Vasodilators are used for the treatment of Pulmonary hypeension. Treatments include: endothelin receptor antagonists - such as bosentan, ambrisentan and macitentan phosphodiesterase 5 inhibitors - sildenafil and tadalafil prostaglandins - epoprostenol, iloprost and treprostinil soluble guanylate cyclase stimulators - such as riociguat calcium channel blockers - nifedipine, diltiazem, nicardipine and amlodipine -### End" -423,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about unfractionated heparin are true except:-, with the following options: A: It is a powerful anticoagulant only in vivo, B: Protamine sulfate is the antidote, C: It should not be given by intramuscular route, D: It acts by inhibiting factor IIa and Xa - -### Response: -Heparin Warfarin 1. Route of administration parenteral (IV, SC) Oral 2. Onset of action Rapid Delayed (1-3 days) 3. Activity In vitro and in vivo In vivo only 4. MOA Activates Antihrombin III | Activation of II, VII, IX, X 5 Monitoring by aPTT PT 6. Antagonist Protamine sulphate Vit. K1 (Phytonadione) 7. Placental barrier Does not cross placenta Fetal warfarin syndrome 8. Use To initiate therapy For maintenance -### End" -424,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 36-year-old woman with a history of obstructive sleep apnea is admitted with acute shoness of breath, cough with greenish sputum, and fever. On physical examination, she is febrile and has decreased breath sounds generally and diffuse bilateral rhonchi. ABGs: pH 7.32; PCO2 47 mm Hg; PO2 65 mm Hg with O2 saturation 87%.The patient improves initially but has a respiratory arrest as she is being moved to the ICU, requiring emergency endotracheal intubation. While a CXR is ordered, it is noted that she has absent breath sounds on the left side. CXR shows, with the following options: A: Left pneumothorax, B: Pneumomediastinum with esophageal rupture, C: Left pleural effusion, D: Atelectasis - -### Response: -The chest radiograph shows a homogeneous opacity occupying the left hemithorax with no air bronchograms. The left hea border and left diaphragm are not seen, consistent with left lung atelectasis. The right upper zone parahilar area is also paially opacified, suggesting paial right upper lobe atelectasis. An endotracheal tube is seen extending down to the right intermediate bronchus. This patient was admitted with symptoms of pneumonia with hypoxemia and respiratory acidosis. Initial treatment should include controlled oxygen therapy, antibiotics, and aerosolized bronchodilator therapy. IV theophylline is not considered standard practice and is not a first-line drug for bronchospasm. During CPR and resuscitation, traumatic pneumothorax and pneumomediastinum can occur. The CXR shows left-sided atelectasis with the endotracheal tube placed distally in the right intermediate bronchus. Correct positioning of the tube above the carina should be the first step in this case. -### End" -425,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The pattern for the metallic framework of a removable partial denture is fabricated from:, with the following options: A: Inlay wax type-II, B: Boxing wax, C: Modeling wax, D: Casting wax - -### Response: -Dental waxes can also be classified in one of three types, pattern wax (inlay, casting, and baseplate types), processing wax (boxing, utility, and sticky types), and impression wax (bite registration and correction types).  -Casting wax is used for partial denture frameworks and other metal frameworks. -Ref: Phillip’s 12th edition page 195. -### End" -426,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are true of Mendelson's syndrome –, with the following options: A: Critical volume of aspirate is 50 mls, B: Critical pH of gastric aspirate is 1.5, C: Onset of symptoms generally occurs within 30 minutes, D: Steroids have been shown to improve outcome - -### Response: -Symptoms of Mendelson's syndrome generally occurs within 30 minutes of aspiration. -Critical pH is 2.5 and critical volume is 25 ml. -Use of corticosteroid is generally not recommended. -### End" -427,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Centre of air pollution control by WHO ?, with the following options: A: Hyderabad, B: Bombay, C: Nagpur, D: Kanpur - -### Response: -Ans. is 'c' i.e., Nagpur -### End" -428,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Knowledge of the segmental cutaneous innervation of the skin of the lower extremity is important in determining the level of intervertebral disc disease. Thus, S1 nerve root irritation will result in pain located along the -, with the following options: A: Anterior aspect of the thigh, B: Medial aspect of the thigh, C: Anteromedial aspect of the leg, D: Lateral side of the foot - -### Response: -S1 nerve root impairment results in - -Weak plantar flexion -Weak eversion of the foot -Depressed ankle jerk -Sensory loss along lateral border of foot -### End" -429,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Discoloration of the skin, mucosa and nails is sideeffect of, with the following options: A: Zidovudine, B: Lamivudine, C: Stavudine, D: Enfuviide - -### Response: -.When nail discoloration is due to zidovudine, patients are usually able to repo if the discoloration preceded or coincided with the initiation of therapy. Another unusual side effect of zidovudine noted by some is a grayish-black discoloration of the tongue. Azidothymidine-induced nail pigmentation Ref Robbins 9/e pg 789 -### End" -430,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with following findings. what will be the media used to diagnose this condition?, with the following options: A: Loffler's serum slope, B: Lowenstein Johnson, C: Karry Blair, D: Chocolate agar - -### Response: -The image shows grey membrane on the tonsil extending to anterior pillar that is suggestive ofdiphtherial infection. Loeffler's serum slope: Enriched medium frequently used for the growth ofC. diphtheriae. Bacteria produce a luxuriant growth in 6-8 hours at 37degC. Does not suppo the growth of streptococci pneumococci. -### End" -431,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudoexotropia is associated with:, with the following options: A: Prominent epicanthal fold, B: Positive angle kappa, C: Negative angle kappa, D: None of the above - -### Response: -Ans. Positive angle kappa -### End" -432,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following strategies are effective in preventing mother to child transmission of IV, except -, with the following options: A: Zidovudine to mother & baby, B: Vaginal cleansing before delivery, C: Stopping breast feeding, D: Elective caesarean section - -### Response: -Methods to prevent vertical transmission -a) Antiretroviral prophylaxis- - -Vertical transmission can be prevented substantially by giving antiretroviral therapy to mother and early prophylaxis to newborn. - -b) Caesarean delivery - - -Elective caesarean section reduces the risk of transmission by 50% in women with or without ZDV treatment. - -c) Breast feeding - - -Because breast milk can carry the virus, breastfeeding by HIV infected mothers is contraindicated. -However, Dutta/obs writes - - -""In the developing world, where alternative forms of infant nutrition are not safe, the minor risk associated with breastfeeding may be accepted. Mother is counselled as regards the risk and benefits. She is helped to make an informed choice."" -### End" -433,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Percentage of Blasts in AML, with the following options: A: 8%, B: 15%, C: 20%, D: 25% - -### Response: -Ans.(c) 20%Ref: Nelson 18th ed. ch. 495* The characteristic feature of AML is that >20% of bone marrow cells on bone marrow aspiration or biopsy touch preparations constitute a fairly homogeneous population of blast cells, with features similar to those that characterize early differentiation states of the myeloid-monocyte-megakaryocyte series of blood cells. The most common classification of the subtypes of AML is the FAB system.French-American-British (FAB) Classification of Acute Myelogenous LeukemiaSUBTYPECOMMON NAMEMlAcute myeloblastic leukemia without maturationM2Acute myeloblastic leukemia with maturationM3Acute promyeloblastic leukemiaM4Acute myelomonocytic leukemiaM5Acute monocytic leukemiaM6ErythroleukemiaM7Acute megakaryocytic leukemia -### End" -434,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ADAMTS deficiency is seen in -, with the following options: A: Essential thrombocythemia, B: ITP, C: Thrombotic thrombocytopenic purpura, D: CLL - -### Response: -Answer- C. Thrombotic thrombocytopenic purpuraPatients with TTP are deficient in an enzyme called ADAMTS (This enzyme is ako known as vWF metalloprotease). -### End" -435,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Poal vein is formed by union of which of the following veins?, with the following options: A: Superior mesenteric vein & Splenic vein, B: Superior mesenteric vein & inferior mesenteric vein, C: Inferior mesenteric vein & Splenic vein, D: inferior mesenteric vein & Hepatic vein - -### Response: -Poal vein is formed by the union of Superior mesenteric vein (SMV) and splenic vein posterior to the neck of pancreas. The inferior mesenteric vein drains into the splenic vein. The hepatic poal vein pass posterior to the first pa of duodenum, in the free edge of lesser omentum. At the poa hepatis, it divides into right and left branches supplying the right and left lobes of the liver. Within the sinusoids of the liver, hepatic poal blood and oxygenated blood from the hepatic aery mix together and come into contact with the hepatocytes, where metabolites such as products of digestion are exchanged. Blood from the sinusoids empties into hepatic veins draining the liver and in turn drain into IVC, and blood is returned to hea. -### End" -436,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The extrinsic pathway of clotting is activated by, with the following options: A: Release of tissue thromboplastin, B: Conversion of fibrinogen into fibrin, C: Formation of prothrombin, D: Release of calcium - -### Response: -The extrinsic system is triggered by the release of tissue thromboplastin, a protein–phospholipid mixture that activates factor VII. -### End" -437,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve related to anatomical snuff box ?, with the following options: A: Ulnar, B: Median, C: Superficial branch of radial, D: Axillary - -### Response: -ANATOMICAL SNUFF BOX is a triangular depression on the lateral side of the wrist. BOUNDARIES: ANTERIOR-Tendons of abductor pollicis longus and extensor pollicis brevis. POSTERIOR: Tendon of extensor pollicis longus Limited above by Styloid process of the radius. FLOOR: Scaphoid and Trapezium. CONTENTS: Superficial branch of radial nerve radial aery cephalic vein Ref - BD Chaurasia 7th edition Page no: 136 -### End" -438,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50year old with history of jaundice in the past has presented with RUQ abdominal pain. Examination and investigations reveals chronic calculous cholecystitis. The liver function tests are within normal limits and on ultrasound examination, the common bile ducts is not dilated. Which of the following will be the procedure of choice in her, with the following options: A: Laparoscopic cholecystectomy, B: Open choledocholithotomy with CBD exploration, C: ERCP + choledocholithotomy followed by laparoscopic cholecystectomy, D: Laparoscopic Cholecystectomy followed by ERCP +choledocholithotomy - -### Response: -In the given question, there was an episode of jaundice, but at present, LFT is normal and CBD is not dilated. The best option is laparoscopic cholecystectomy only Management of CBD stones associated with GB stones Pre-operatively detected stones Experienced laparoscopic surgeon - Cholecystectomy and choledochotony in same suiting Inexperienced laparoscopic surgeon - pre-op ERCP with stone removal and laparoscopic cholecystectomy later Unsuspected stones found at the time of cholecystectomy Experienced Laparoscopic surgeon - Laparoscopic CBD exploration and stone retrieval through the cystic duct. Laparoscopic choledochotomy and stone extraction Inexperienced laparoscopic surgeon - Conve to open procedure and remove CBD stones. Complete the cholecystectomy and refer the patient for ERCP. Conversion to an open procedure is preferred over ERCP because the success rate of ERCP is not 100% Ref: Sabiston 20th edition Pgno :1496 -### End" -439,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renal biopsy is indicated in all the following conditions except:, with the following options: A: CRF with normal size kidney, B: Size<60%, C: Glomerular disease in adults, D: Asymptomatic proteinuria - -### Response: -(B) Size<60%# Renal biopsy is used to establish the nature and extent of renal disease in order to judge the prognosis and need for treatment.# Indications:> Acute renal failure that is not adequately explained> CRF with normal-sized kidneys> Nephrotic Syndrome or glomerular proteinuria in adults.> Nephrotic Syndrome in children that has atypical features or is not responding to treatment> Isolated haematuria with ""renal"" characteristics or associated abnormalities.> Asymptomatic proteinuria (> 1 gm/day)# Contraindications:> Coagulation disordered or thrombocytopenia> Uncontrolled hypertension Kidneys < 60% predicted size Solitary kidney (except transplants)> Infections - perinephritic abscess, pyonephrosis etc.> Cystic disease - Hydronephrosis, polycystic disease of kidneys or large solitary cyst.> Hypernephroma -### End" -440,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Modified radical mastoidectomy is indicated in all except -, with the following options: A: Safe CSOM, B: Unsafe CSOM with attticoantra! disease, C: Coalescent mastoiditis, D: Limited mastoid pathology - -### Response: -Ans- A in safe tympanoplasty is done -### End" -441,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A girl has primary amenorrhea with normal ovaries, absent internal genitalia but normal external genitalia. Most probable diagnosis?, with the following options: A: Mayer-Rokitansky-Kuster-Hausers- syndrome, B: Turner's syndrome, C: Noonan's, D: Androgen insensitivity syndrome - -### Response: -Mayer Rokitansky Kuster Hauser's syndrome : karyotype is 46,XX Normal secondary sexual charecteristics Functional ovaries Normal hormonal profile Associated with skeletal and renal anomalies Management involves creation of a functional vagina for coital purposes and can become biological mother by surrogacy. SHAW'S TEXTBOOK OF GYNAECOLOGY,Pg no:286,15th edition -### End" -442,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Changes occuring in vessels in Raynauds disease are all except -, with the following options: A: Asphyxia, B: Recovery, C: Hyperfusion, D: Syncope - -### Response: -Ans. is 'c' i.e., Hyperperfusion Three stages are observed with exposure to cold or emotional disturbances. These are -Stages of local syncope - On cold exposure - digital arterioles go in spasm and blood flow decreases, pallor or blanching is observed (Stage of blanching).Stage of local asphyxia - With gradual warming there is slow relaxation of arterioleso Slowly flowing blood becomes easily deoxygenated - the part becomes dusky or cyanosed (Stages of dusky anoxia).C) Stage of recovery -o Attack passes off - arterioles are fully relaxed - oxygenated blood returns into dilated capillaries - fingers becomes red and swollen (Stage of red engorgement). -### End" -443,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute coronary syndrome includes all except-, with the following options: A: STEMI, B: NSTEMI, C: Stable angina, D: Unstable angina - -### Response: -Ref: R. Alagappan Manual for Medicine 4th Edition pg no:179 This syndrome includes unstable angina, and non-ST elevation myocardial infarction (NSTEMI). ACS is a spectrum of disease characterised by either one of the following: 1. New-onset angina 2. Angina at rest 3. Progression of angina of increasing frequency or severity 4. Angina in response to lower levels of exeion. ACS most often represents acute atherosclerotic plaque rupture with exposure of thrombogenic sub-endothelial matrix. Thrombus formation, which may be episodic in nature and it is the mechanism by which it interferes with coronary blood flow -### End" -444,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Edrophonium test is diagnostic of, with the following options: A: Myasthenia gravis, B: Lambert Eaton syndrome, C: Ammyotropic lateral sclerosis, D: All - -### Response: -Ans. a (Myasthenia gravis). (Ref. Harrison, Internal Medicine, 16th ed., 2519)Test for diagnosis of MGCommentsAcetyl Choline Esterase/Tensilon/EdrophoniumTest# Most commonly used rapid test.# Highly probable diagnosis if unequivocally positive.# False positive in ammyotropic lateral sclerosis and placebo reactorsAnti-Ach receptor ab assay# 85% positivity in generalized myasthenia gravis.# 50% positivity in ocular myasthenia gravis.# Definitive diagnosis if positive.Repetitive nerve stimulation test# Highly probable.Single fiber EMG# Confirmatory but non-specific -### End" -445,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased oxygen delivery during prematurity causes all the following EXCEPT:, with the following options: A: Vasoconstriction, B: Vasodilation, C: Vaso obliteration, D: Neovascularisation - -### Response: -Ans. (b) VasodilationRef.:: Nelson's 18th edCh: 97.2 style=""font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"">. gov/pubmed/12030843Supplemental oxygen in premature infants leads to the development of bronchopulmonary dysplasia.The Pathogenesis Involves* Vasoconstriction in the retina is an early response to oxygen that can lead to Vaso-obliteration.* Neovascularization* FibrosisOxygen causes tissue injury through the formation of reactive oxygen intermediates and peroxidation of membrane lipids. -### End" -446,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A middle aged man presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep and appetite for two months. There was no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no family history of psychiatric illness. Routine investigations including haemogram, renal function tests, liver function tests electrocadiogram did not reveal any abnormality. This patient should be treated with -, with the following options: A: Haloperidol, B: Sertraline, C: Alprazolam, D: Olanzapine - -### Response: -This patient has (for 2 months) - -i) Lack of interest                   -ii) Low mood  - iii) Loss of energy / fatigue (lethargy)      -iv) Decreased sleep  -v) Decreased appetite           - -Diagnosis is major depression → Antidepressant should be given. Amongst the given options only sertaline is antidepressant. -### End" -447,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Point prevalence studies tend to over estimate the occurence of which of the following diseases?, with the following options: A: Diseases with a high incidence, B: Disease with a long duration, C: Disease with a high moality, D: Diseases with a sho duration - -### Response: -.point prevalence of a disease is defined as the number of all current cases old and new of a disease at one point of time.point prevalence can be made specific for age,sex,and other relevant factors or attributes. prevalence studies are mainly employed in the study of those diseases which have a longer duration of action. ref:park&;s textbook,ed 22,pg no 59 -### End" -448,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least amount of co2 is in, with the following options: A: Anatomical dead space-end inspiration phase, B: Anatomical dead space-end expiration phase, C: Alveoli-end inspiration phase, D: Alveoli-end expiration phase - -### Response: -Ans. (a) Anatomical dead space-end inspiration phase(Ref: Ganong, 25th ed/p.630)Anatomical dead space containing atmospheric air at the end of inspiration will have the least amount of CO2 - because atmospheric air has negligible CO2 Anatomical dead space-end expiration phase: Here alveolar gas rich in CO2 occupies the Anatomical dead space dead space areaAlveolar air contains a mixture of O2 from the inspired air and CO2 which is continuously added to it to exhale out -### End" -449,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of fulminant diabetes is?, with the following options: A: Viruses, B: Diabetic Ketoacidosis, C: Non-ketotic hyperosmolar coma, D: Autoimmunity - -### Response: -Bcz of virus - coxackie B, Mumps, Rubella Type IDM - insulinopenia Leading causes - 1) Autoimmunity 2) Fulminant DM | 3) Bronze DM - Hemochromatosis -### End" -450,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a sign of pulmonary hydatidosis, with the following options: A: Waterlily sign, B: Rising sun sign, C: Meniscus sign, D: Drooping lilly sign - -### Response: -Drooping lilly sign is seen in neuroblastoma and duplication of ureter Duplication of ureter: Drooping lilly sign on IVP(Nonvisualized upper pole of a duplex system displaces the lower pole down, looking like a drooped down lilly flower on IVP Chracteristic signs of pulmonary hydatidosis Meniscus sign Double arc sign Moon sign Waterlily sign Crescent sign Ref: Wolfgang 2nd edition Pg no : 309 -### End" -451,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about multipotential connective tissue cells is:, with the following options: A: These are most radiosensitive, B: These are most radioresistant, C: They have intermediate sensitivity, D: None of the above - -### Response: -Multipotent connective tissue cells: - -These cells have intermediate sensitivity. -These cells divide when there is a demand for more cells. - -Eg: Endothelial cells, fibroblasts, mesenchymal cells. -### End" -452,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum refractive power is due to the, with the following options: A: Anterior surface of lens, B: Posterior surface of lens, C: Anterior surface of cornea, D: Posterior surface of cornea - -### Response: -Ans. Anterior surface of cornea -### End" -453,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A new born is noted to have a large head and sho limbs. On fuher examination, sho broad fingers, a small face, and low-normal length are noted. The trunk appears long and narrow. to confirm the diagnosis you should -, with the following options: A: Order an ophthalmologic examination, B: Obtain skeletal radiographs, C: Order chromosome analysis, D: Examine the parents - -### Response: -Ans. is 'b' i.e., Obtain skeletal radiographs o In case of dispropoionate limbs and trunk, arrange for skeletal X-rays. -### End" -454,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Expressed emotionally is related to which of the following illnesses?, with the following options: A: Depression, B: Schizophrenia, C: Mania, D: Somatoform disorder - -### Response: -""Expressed emotions"" is a term which is used to describe ceain attitudes of family members of patients with Schizophrenia, which have an impact on the illness itself. Family inveions are done in psychosocial treatment of schizophrenia. These attitudes includes over involvement (excessive and pathological involvement with the patient), hostility (hostile attitude towards the patient), passing critical comments (making negative comments about the patient), etc. -### End" -455,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice in type I lepra reaction with severe neuritis is:, with the following options: A: Systemic steroid, B: Clofazimine, C: Thalidomide, D: Chloroquine - -### Response: -Therapy for Reactions Type 1 lepra reactions are best treated with glucocoicoids (e.g., prednisone, initially at doses of 40-60 mg/d). As the inflammation subsides, the glucocoicoid dose can be tapered, but steroid therapy must be continued for at least 6 months Type 2 Lepra reaction: If ENL is mild (i.e., without fever or other organ involvement), it may be treated with antipyretics alone. In cases with many skin lesions, fever, malaise, and other tissue involvement, brief courses (1-2 weeks) of glucocoicoids are effective. If, despite two courses of glucocoicoid therapy ENL appears to be recurring and persisting, treatment with thalidomide should be initiated -### End" -456,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tip of tongue drains into -, with the following options: A: Occipital lymph node, B: Submental lymph node, C: Deep cervical lymph nodes, D: Tonsillar lymph nodes - -### Response: -Tip of the tongue drains into submental nodes, anterior 2/3 drains into submandibular nodes, and posterior 1/3 into jugulodigastric nodes. -Finally, all lymphatics drain into juguloomohyoid nodes, also known as lymph nodes of the tongue. -### End" -457,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following central controllers of appetite does not decrease the appetite?, with the following options: A: CART, B: GRP-1, C: Melanin concentrating hormone (MCH), D: MSH-alpha - -### Response: -Answer: c) Melanin concentrating hormone (MCH)Decrease Feeding (Anorexigenic)Increase Feeding (Orexigenic)a-Melanocyte-stimulating hormone (a-MSH)Neuropeptide Y (NPY)LeptinAgouti-related protein (AGRP)SerotoninMelanin-concentrating hormone (MCH)NorepinephrineOrexins A and B (Hypocretins)Corticotropin-releasing hormoneEndorphinsInsulinGalanin (GAL)Cholecystokinin (CCK)Amino acids (GABA)Glucagon-like peptide (GLP)CortisolCocaine- and amphetamine-regulated transcript (CART)GhrelinPeptide YY (PYY)Endocannabinoids -### End" -458,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding alcoholic gaze nystagmus, which one of the following is false, with the following options: A: It appears at blood alcohol levels of 50 - 100 mg %, B: Horizontal gaze nystagmus is pathognomic of alcohol intoxication, C: Positional alcohol nystagmus I occurs 30 minutes after ingestion, D: Positional alcohol nystagmus II occurs 5 - 6 hours after ingestion - -### Response: -Alcoholic gaze nystagmus - It appears at blood alcohol levels of 50 - 100 mg % - Positional alcohol nystagmus I occurs 30 minutes after ingestion - Positional alcohol nystagmus II occurs 5 - 6 hours after ingestion - Horizontal gaze nystagmus is not pathognomic of alcohol intoxication, can occur in pathological conditions, ingestion of sedatives and transquillizers -### End" -459,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: While seeing a colour chart a colour blind male has decreased vision for red light colour which appear very light than that of other colours. Which of the following is the likely anomaly in him?, with the following options: A: Protanomaly, B: Dutanomaly, C: Tritanomaly, D: Butanomaly - -### Response: -(A) Protanomaly > Prefixes ""Prot = red, Deuter = green & Tri = blue refer to defects cone system, respectively Suffixes anomaly = colour weakness; anopia = colour blindness> Individuals with normal colour vision and those with Protanomaly (red colour weakness), deuteranomaly (green colour weakness), and tritanomaly (blue colour weakness) are called Trichomates --i.e. they have all three cones, system but one is weak.> Dichromates: only two cone system present, E.g. Protanopia = red cone absent; Deuteranopia = green cone absent Tritanopia = Blue cone absent. -### End" -460,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most sensitive test for acute fetal distress :, with the following options: A: Fresh meconium on induction of labour, B: Loss of beat to beat variation of hea beat, C: Increased fetal movements, D: Type 1 dips in second stage - -### Response: -Loss of beat to beat variation of hea beat -### End" -461,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following condition respond well with Clonidine?, with the following options: A: Opiate withdrawal, B: Attention-deficit/hyperactivity disorder, C: Tourette's disorder, D: All of the above - -### Response: -Ans. D. All of the aboveClinically, clonidine has been useful and effective in a series of medical and psychiatric conditions. Among them are Tourette's disorder, other tic disorders, opiate withdrawal, nicotine withdrawal, autism spectrum disorders, posttraumatic stress disorder (PTSD), and other anxiety disorders. Clonidine was synthesized in the early 1960s and was found to produce vasoconstriction mediated by -receptors. Clonidine is well absorbed after oral administration, and its bioavailability is nearly 100 percent. -### End" -462,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ototoxicity and nephrotoxicity may be the side effect of: March 2012, with the following options: A: Vancomycin, B: Azithromycin, C: Clindamycin, D: Penicillin - -### Response: -Ans: A i.e. Vancomycin Drugs and side-effects Vancomycin can cause plasma concentration dependent nerve deafness which may be permanent. Kidney damage is also dose related. Side-effects of azithromycin are mild gastric upset, abdominal pain (less than erythromycin), headache and dizziness Side effects of clindamycin are rashes, uicaria, abdominal pain, but the major problem is diarrhoea and pseudomembranous colitis due to Cl. Difficile superinfection which is potentially fatal. Adverse effects of penicillin include local irritancy and direct toxicity, hypersensitivity, superinfections and JarischHerxheimer reaction (in syphilitic patient) -### End" -463,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Respiratory rate in a 2 month old, to label it tachypnea is –, with the following options: A: 40, B: 50, C: 60, D: 70 - -### Response: -Tach nea - - -< 2 months --->             60 or more RR/min -2-12 months —>          50 or more RR/min -12-60 months -3      40 or more RR/min -### End" -464,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 8 year old boy presents with boggy swelling and easily pluckable hair, Diagnosis is –, with the following options: A: Tinea capitis, B: Alopecia areata, C: Tuberculorid leprosy, D: Pityriasis alba - -### Response: -Boggy swelling with easily pluckable hair suggests the diagnosis of keroin type of Tinea capitis. -### End" -465,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a vehicle accident, the musculocutaneous nerve was completely severed, but still the person was able to weekly flex the elbow joint. All of the following muscles are responsible for this flexion, EXCEPT?, with the following options: A: Brachioradialis, B: Flexor carpi radialis, C: Ulnar head of Pronator teres, D: Flexor carpi ulnaris - -### Response: -Muscles involved in elbow flexion are biceps brachii/biceps, brachialis, brachioradialis, extensor carpi radialis longus/ long radial extensor, pronator teres, palmaris longus, flexor carpi radialis and flexor carpi ulnaris.Pronator teres has two heads a humeral and an ulnar head. The ulnar head arises from the medial border of coronoid process of ulna. And both the heads get united and the combined muscle passes obliquely across the proximal forearm for inseion into lateral surface of radius. This muscle is primarily involved in the rapid pronation movements of the forearm. -### End" -466,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Peau d' orange is due to -, with the following options: A: Secondary infection, B: Blockage of subdermal lymphatics, C: Invasion of skin with malignant cells, D: Aerial obstruction - -### Response: -Peaud's orange is produced due to obstruction of superficial lymph vessels by cancer cells. This causes edema of the skin giving rise to an appearance like that of the skin of an orange (Peau'd orange appearance) Ref - Srb's manual of surgery 5e p534 -### End" -467,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fetal blood is separated from syncytiotrophoblast with all the following except :, with the following options: A: Fetal blood capillary membrane, B: Mesenchyme of intervillous blood space, C: Cytotrophoblast, D: Decidua parietalis - -### Response: -The decidua over the anembryonic pole is the decidua capsularis.As the chorionic cavity becomes larger, the decidua capsularis is streched and degenerates .The chorion leave now comes into close contact with the uterine wall on the opposite side,resulting in the formation of the decidua parietalis. For more information refer page no 59,60 and also fig.5,18 ,of textbook of obsteics,sheila balakrishnan,2 nd edition. layers of placental barrier from maternal to fetal side includes: maternal blood -### End" -498,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most common site for hymen tear following intercourse, with the following options: A: Posterolaterally, B: Anteromedially, C: Posteromedially, D: Anterolaterally - -### Response: -Tears usually occur at 4 or 8 clock position. (at posterolateral location). -### End" -499,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following statements are true with respect to glycogen except, with the following options: A: Principle storage of carbohydrate in the human body is glycogen, B: Liver and muscle are the main sites of glycogen storage, C: Produced by glycogenesis, D: Insulin stimulates glycogenolysis - -### Response: -Insulin inhibits glycogenolysis by oring the inactivation of glycogen phosphorylase and inhibiting glucose-6-phosphatase. The net effect of all these three mechanisms, blood glucose level is lowered.Ref: DM Vasudevan, 7th edition, page no: 321 -### End" -500,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The best surgical treatment for chronic maxillary sinusitis is:, with the following options: A: Repeated antral washout, B: Fiberoptic endoscopic sinus surgery, C: Caldwell-Luc's operation, D: Horgan's operation - -### Response: -CHRONIC MAXILLARY SINUSITIS 1. Antral puncture and irrigation. Sinus cavity is irrigated with a cannula passed through the inferior meatus. Removal of pus and exudates helps the sinus mucosa to reve to normal. 2. Intranasal antrostomy. It is indicated if sinus irrigations fail to resolve infection. A window is created in the inferior meatus to provide aeration to the sinus and its free drainage. 3. Caldwell-Luc operation. In this operation, antrum is entered through its anterior wall by a sublabial incision. All irreversible diseases are removed and a window is created between the antrum and inferior meatus. Ref: Dhingra 7e pg 219 -### End" -501,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Giant's rollover test for PIH is done at-(Orrisa R), with the following options: A: 22-24 weeks, B: 28-32 weeks, C: 24-26 weeks, D: 32-34 weeks - -### Response: -Ans-BNote-THE ROLL-OVER TEST Between the 28th and 32nd week of pregnancy, the woman lies quietly on her left side for about 5 minutes. A blood pressure cuff is applied to the right arm and the blood pressure is taken. After releasing the valve and expelling all air from the blood pressure cuff bladder, the cuff is left loosely in place on the arm. The woman then rolls over on her back and the blood pressure is taken again immediately. If the bottom number (diastolic pressure) is elevated 20 points between the first and the second readings, this is said to demonstrate a contracted blood volume and indicate a risk of developing metabolic toxemia. The test is positive in many normal pregnancies and even in the nonpregnant person. Again, this test has been discredited and should not be used. -### End" -502,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False -ve hydrostatic test in live born fetus is for-, with the following options: A: Atelectasis, B: Meconium aspiration, C: Emphysema, D: Putrefaction - -### Response: -Hydrostatic (Raygat's) test is false negative in atelectasis and diseases like acute pulmonary edema, pneumonia and congenital syphilis etc. -### End" -503,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from :, with the following options: A: Korsakoff's psychosis, B: Wernicke encephalopathy, C: DeClerambault syndrome, D: Delirium tremens - -### Response: -Confusion, nystagmus, ataxia and 6th cranial nerve weakness in an alcohol dependent patient suggest the diagnosis of Wernicke's encephalopathy. -### End" -504,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zonular cataract, with the following options: A: Riders not seen, B: Developmental cataract, C: Acquired cataract, D: After complication - -### Response: -i.e. (Developmental cataract): (265-Parson 21st) (172-Khurana 4th)ZONULAR OR LAMELLAR CATARACT - refers to the developmental cataract in which the opacity occupies a discrete zone in the lensMost common types of congenital cataract presenting with visual impaiment*** Usually bilateral* Lineal opacities like spikes of a wheel (called riders) may run outwards towards the equator- Other most common types of developmental cataract- Punctate cataract- Fusiform cataract- Nuclear cataract- Coronary cataract- Anterior capsular (polar) cataract- Posterior capsular (polar) cataract -### End" -505,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non-functional enzymes are all except:, with the following options: A: Alkaline phosphatase, B: Acid phosphatase, C: Lipoprotein lipase, D: Gamma glutamyl transpeptidase - -### Response: -Ans. is 'c' i.e. Lipoprotein lipase Plasma enzymes can be classified into functional and non-functional plasma enzymes. Functional plasma enzymesNon-functional plasma enzymesFunctionHas known physiological functionHas no known physiological functionCone, in plasmaNormally present in plasma in higher conc.in comparison to tissues.Normally, present in plasma in very low cone, in comparison to tissues.SubstrateTheir substrates are always present in bloodTheir substrates are absent from the bloodSite of synthesisMajority synthesized and secreted by liverDifferent organs e.g. Liver, heart, muscles etc.These non-funtional plasma enzymes arise from:Cell damage or necrosis with the release of enzymes into the blood e.g. blood cells, liver cells in viral hepatitis, myocardial cells in infarctionObstruction of normal pathway e.g. obstruction of bile ducts alkaline phosphatase.Clinical importance of Non-functional plasma enzymes- Measurement of non-functional plasma enzymes is important for:diagnosis of diseaseprognosis of diseasePrinciple non-functional plasma enzymes used in clinical diagnosisSerum EnzymesDiagnostic useAmylase and lipase enzymesAcute pancreatitisAminotransferasesAspartate aminotransferase(AST or SGOT)Alanine aminotransferase (ALT or SGPT)Myocardial infarction Viral hepatitisAcid PhosphataseProstate cancerAlkaline phosphataseObstructive liver diseases, bone diseases and hyperparathyroidismCreatine kinaseMuscle disorders and Myocardial infarctionCeruloplasminWilson's diseaseGamma-glutamyl transpeptidaseLiver diseasesLactate dehydrogenaseMyocardial infarctionLipoproteinlipase is a functional enzyme that hydrolyzes lipids in lipoproteins, such as those found in chylomicrons and very low-density lipoproteins (VLDL), into free fatty acids and glycerol molecule. -### End" -506,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the follow ing is an example of heterophile antibody test-, with the following options: A: Widal test, B: Weil-Felix reaction, C: Rose-wraler test, D: Blood grouping & cross matching - -### Response: -Ans. is 'b' i.e., Weil-Felix reaction Ref: Ananthanarayan 9th/ep. 109 &- 8th/e p. 108; Immunology Lachmann 4th/ ep. 1534. 1535]Heterophilic agglutination reactiono Some organisms of different class or species share closely related antigens.o When serum containing agglutinin (antibody) of one organism gives agglutination reaction with antigen of other organism, it is called heterophilic agglutination test.Examples areo Streptococcus M.G agglutination test for primary atypical pneumonia,o Weil - Felix reaction for typhus fever.o Paul Bunnell test for IMN. -### End" -507,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Openings of the tube of bronchoscope are known as:, with the following options: A: Holes, B: Apeures, C: Vents, D: Any of the above - -### Response: -Bronchoscope is similar to esophagoscope, but has openings at the distal pa of the tube, called Vents which help in aeration of the side bronchi. -### End" -508,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following immunohistochemical markers would be expected to be positive in biopsies of Ewings Sarcoma?, with the following options: A: CD3, B: CD21, C: Myogenin, D: S-100 - -### Response: -S-100 protein and neuron-specific enolase, both of which are markers for tumors with neuroendocrine differentiation, are usually positive in Ewing sarcoma. The tumor also usually contains glycogen, which can be helpful in the distinction with other ""small blue cell tumors"" (including lymphomas, neuroblastoma, and Wilms tumor) of childhood. GOOD TO KNOW: CD3 is a T cell marker. CD21 is a B-cell marker. Myogenin is a marker for rhabdomyosarcoma. Ewing sarcoma: It typically involves the diaphyseal region of long bones and also has an affinity for flat bones. The plain radiograph may show a characteristic ""onion peel"" periosteal reaction with a generous soft tissue mass, which is better demonstrated by CT or MRI. The presence of p30/32, the product of the mic-2 gene (which maps to the pseudoautosomal region of the X and Y chromosomes) is a cell-surface marker for Ewing's sarcoma (and other members of the Ewing's family of tumors, sometimes called PNETs. Ref: Patel S.R., Benjamin R.S. (2012). Chapter 98. Soft Tissue and Bone Sarcomas and Bone Metastases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -509,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Birbeck granules in the cytoplasm are seen in ?, with the following options: A: Mast cells, B: Langerhan's cells, C: Thrombocytes, D: Myelocytes - -### Response: -Ans. is 'b' i.e., Langerhan's cells -### End" -510,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true about macular function test is:, with the following options: A: Two-point discrimination, B: Maddox rod, C: Laser interferometry, D: Retinogram - -### Response: -Ans.Retinogram -### End" -511,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vaginal delivery is allowed in all except, with the following options: A: Monochorionic monoamniotic twins, B: First twin cephalic and second breech, C: Extended breech, D: Mento anterior - -### Response: -Ans. Is a i.e. Monochorinoic monoamniotic twins In face presentation the best presentation is mento anterior, especially left mento anterior and delivery is possible. In twins, the chances of vaginal delivery are high if the first twin or presenting twin is cephalic. Extended beech is the commonest breech presentation and is also the best possible presentation for a normal vaginal delivery in breech. In Monochorionic monoamniotic presentations the twins share a single amniotic sac and placate so there is almost a 50% incidence of cord accidents and that is one reason which even prompts to do a preterm cesarean to many practioners to avoid a sudden fetal cord entrapment and fetal death. ""A situation requiring cesarean delivery in twin pregnancy is a monoamniotic placentation. The fetal moality in these pregnancies is greater than 50% and the overwhelming cause is cord accidents such as cord prolapse or entaglement."" Also Know: Indications for elective cesarean section in Twin pregnancy First twin presenting as non veex (breech or transverse) or both the fetuses non veex. Collision of both the heads at brim preventing engagement of either head. Monoamniotic twins. Chronic Twin-Twin Transfusion Syndrome. Conjoined twins at term. Severe IUGR of one or both fetus. Previous cesarean section. In discordant twin - weight of smaller twin < 1500 gm. Obstetric factors necessitating cesarean section like contracted pelvis, placenta pre, severe preeclampsia, cord prolapse of first baby. Note : There is no valid reason to perform LSCS in all cases of second twins for non cephalic presentation. -### End" -512,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rate of induction of the anaesthesia is increased by all of the following except, with the following options: A: agents with low blood gas solubility, B: high Cardiac Output, C: Second gas effect, D: high alveolar ventilation - -### Response: -High cardiac output causes fast uptake of potent inhalational agent from alveoli thus slow speed of induction. rest all options maintain alveolar concentration . -### End" -513,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these amino acids does not have asymmetric carbon atom?, with the following options: A: Valine, B: Glycine, C: Alanine, D: Tryosine - -### Response: -Glycine is the simplest amino acid with no optical activity. -### End" -514,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about inferior vena cava - -a) Passes through diaphragm at level of D10 vertebra -b) Rt. Suprarenal artery directly drains to it. -c) It lies anterior to the renal vein. -d) It forms the posterior wall of the epiploic foramen -e) It is related to psoas muscle, with the following options: A: abc, B: bce, C: de, D: d only - -### Response: -Inferior vena cava passes diaphragm at the level of T8. -Inferior vena cava does not receive blood from an artery. -Epiploic foramen lies anterior to the inferior vena cava. -### End" -515,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Azygos vein drains into:, with the following options: A: Left brachiocephalic vein, B: Inferior vena cava, C: Superior vena cava, D: Right brachiocephalic vein - -### Response: -The azygos vein ends by joining the posterior aspect of the superior vena cavaThe Azygos VeinThe azygos vein connects the superior and inferior venae cavae, either directly by joining the IVC or indirectly by the hemiazygos and accessory hemiazygos veins.The azygos vein drains blood from the posterior walls of the thorax and abdomen.It ascends in the posterior mediastinum, passing close to the right QA des of the bodies of the inferior eight thoracic veebrae (T4-T12).It is covered anteriorly by the oesophagus as it passes posterior to the root of the right lung.It then arches over the superior aspect of this root to join the SVC.In addition to the posterior intercostal veins, the azygos vein communicates with the veebral venous plexuses.This vein also receives the mediastinal, oesophageal, and bronchial veins. -### End" -516,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which organ is the primary site of hematopoiesis in the fetus before mid-pregnancy?, with the following options: A: Bone, B: Liver, C: Spleen, D: Lung - -### Response: -Ans. B. LiverFetal Hematopoiesisi. Begins in the yolk sac (2 -8 weeks) - progenitor cells migrate from the yolk sac to the liver at 5-8 weeks' gestationii. Only terminal differentiation of red cells occurs in the yolk saciii. Liver active from 5-8 weeks' gestation - mainly red cells. Spleen also involved before 20 weeksiv. Begins in the medullary cavity of the clavicle at about 10-12 weeks and in the medullary cavity of long of bones at 20 weeksv. gestationvi. Some lymphocytes are produced in lymph nodesvii. At term, all red cell production is in bones unless there is a reason for increased hematopoiesis -### End" -517,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following conditions are associated with the development of Necrotizing papillitis, EXCEPT:, with the following options: A: Diabetes mellitus, B: Sickle cell disease, C: Analgesic nephropathy, D: Tuberculous pyelonephritis - -### Response: -Common causes of papillary necrosis are diabetes mellitus, analgesic nephropathy, sickle cell disease and urinary tract obstruction. Diabetes mellitus is the most common cause of renal papillary necrosis. Analgesic nephropathy is associated with the use of more than 1 kg analgesics. Ref: Radiology Illustrated: Uroradiology By Seung Hyup Kim, 2nd Edition, Pages 471-2 -### End" -518,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the minimal cut off age for employment of children under the Factory Act?, with the following options: A: 12 years, B: 14 years, C: 15 years, D: 18 years - -### Response: -The Factory Act prohibits the employment of children below 14 years and declares 15 to 18 years as belonging to the adolescent group. Adolescents require fitness ceificate prior to employment in a job. Ref: Park 21st edition page: 756. -### End" -519,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vaccines that must be given before age of two years according to IAP are all of the following EXCEPT?, with the following options: A: Varicella vaccine, B: MMR vaccine, C: Conjugated typhoid vaccine, D: Pneumococcal polysaccharide vaccine - -### Response: -Vaccine Recommended age of vaccination (1st dose) a. Varicella vaccine 15 months b. MMR vaccine 9 months c. Conjugated typhoid vaccine 9 months d. Pneumococcal polysaccharide vaccine Beyond 2 yrs age - As polysaccharides stimulate B-cells independent of T-cells, the pneumococcal polysaccharide is poorly immunogenic at <2yrs age & immunological memory is low - Hence, it is recommended beyond 2yrs of age. -### End" -520,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Russel bodies are seen in:, with the following options: A: Lymphocytes, B: Neutrophils, C: Macrophages, D: None of the above - -### Response: -None of the above -### End" -521,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of electromagnetic radiation, constant parameter is:, with the following options: A: Intensity, B: Wave length, C: Frequency, D: Velocity - -### Response: -Ans: d (Velocity) Ref:Resnick and Halliday Fundamentals of General physicsElectromagnetic radiation is the spectrum of waves propagated through space or matter by the oscillation of electric field and a magnetic field at right angle to one another.Waves travel perpendicular to both electric and magnetic field.They have a constant velocity of 3 x 10s m/s in vacuum.Remember the formula E= me2 where c is the constant velocity.Electromagnetic waves include radio waves, heat waves, light waves, UV waves, X-rays, gamma raysNote:X rays are produced from orbital electrons where as gamma rays are produced from the nucleus of an atomSource of radiation that cause heat cataract -infra red radiationPrinciple used in radiotherapy -ionization of moleculeFunctional basis of ionizing radiation -excitation of electrons from orbitIn therapeutic x rays - Compton effectIn diagnostic x-rays - photoelectric effectIn accidental x-ray work * pair productionDevices used in radiotherapyLinear accelerator- used to accelerate electrons and produce x-ray beamCyclotron- produces neutrons and photonsMicrotron- an electron accelerator, combines principles of linear accelerator and cyclotronBetatron- device for accelerating electrons used for production of electron beam for RT and an x-ray beamTypes of therapy:Superficial therapy - treated with x-rays produced at a energy ranging from 50- 150 kvOrthovoltage or deep therapy - treated with x-rays ranging from 150- 500 kvSuper voltage therapy - x-ray therapy in the range of 500 - 1000 kvOxygen enhancement ratio is maximum with neutrons -### End" -522,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Long term complication of live kidney donors are, with the following options: A: Hypeension, B: HPV Infection, C: Renal Carcinoma, D: Pyelonephritis - -### Response: -Answer- A. HypeensionHypeentionCardiovascular risksPreoteinuriaEnd stage renal disease -### End" -523,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To prevent veical transmission of HIV in a child of pregnant mother, used is:, with the following options: A: Zidovudine for mother (36 weeks) and child (6 weeks), B: Zidovudine for 6 months to mother and 6 weeks to child, C: Zidovudine for 6 Weeks, D: Avoid zidovidine - -### Response: -Zidovudine for mother (36 weeks) and child (6 weeks) -### End" -524,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Group B Nerve fibers are situated in:, with the following options: A: Muscle spindles, B: Fibers carrying pain sensation, C: Preganglionic autonomic fibers, D: Post ganglionic autonomic fibers. - -### Response: -Ans. is 'c' is Preganglionic autonomic fibres Nerve fiber types in mammalian nerve:Fiber Type AFunctionFiber Diameter (mm)Conduction Velocity (m/s)alphaProprioception; somatic motor*12-20(Max.)* 70-120betaTouch, pressure*5-1230-70gammaMotor to muscle spindles*3-615-30deltaPain, cold, touch*2-512-30BPreganglionic autonomic*<33-15C Dorsal rootPain, temperature, some mechanoreceptor, reflex responses0.4-1.20.5-2Sympathetic*Postganglionic sympathetic0.3-1.30.7-2.3* A and B fibres are myelinated; C fibres are unmyelinated. -### End" -525,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true about mucinous cystadenoma pancreasaEUR', with the following options: A: Microcystic adenoma, B: Lined by columnar epithelium, C: Pre malignant, D: Focus of ovarian stroma in it - -### Response: -Microcystic adenoma [Ref. Robbin's Pathology 8/e p899; Schwaz 9/e p1232) Mutinous cystadenoma are macrocystic adenomas. Serous cystadenomas are microcystic adenomas. Cystic neoplasm of Pancreas Cystic neoplasms are of the following types: Common types? a. Serous cystadenomas (approx. 25-30% of all cystic neoplasms) b. Mucinous cystadenomas and cystadenocarcinomas (appro. 40-50% of all cystic neoplasms) Uncommon types? c. intraductal papillary mucinous tumor (approx.10% of all cystic neoplasms) d. solid pseudopapillary neoplasm (about 5-10% of all cystic neoplasms) Serous cystadenomas Serous cystadenomas are benign tumors without malignant potential. (Serous cystadenocarcinoma has been repoed very rarely (<1%) They have a spongy appearance, composed of multiple small cysts (microcystic). May contain central stellate fibrotic scar that may calcify (sunburst calcification) and it is highly specific and considered to be viually pathognomonic of serous cystadenoma. The cyst is lined by simple cuboidal epithelium. They do not produce mucin These lesions thus contain thin serous fluid that does not stain positive for mucin and is low in CEA (<200 ng/mL). Common in females (F:M ratio is 2:1), usually in 7th decade of life. Common in the head/ uncinate process region.(50% in the head/uncinate process, and 50% in the neck, body, or tail) Serous cystadenomas do not have malignant potential, hence operated only when symptomatic. Mucionous cystic neoplasms (cystadenoma and cystadenocarcinoma) Mucinous cystic neoplasms (MCNs) encompass a spectrum ranging from benign but potentially malignant (i.e. cystadenomas) to carcinoma with a very aggressive behavior (i.e. cystadenocarcinomas); suggesting a gradual malignant transformation. MCNs are composed of large thick-walled, septate cysts (macrocystic) with no connection to the ductal system. (difference .from 1PMN there tumor is connected to the ductal system) The cysts are lined by tall columnar epithelium that fills the cyst with viscous mucin. MCNs are characterised by the presence of ovarian-type stroma which is a key pathologic feature distinguishing these lesions. This stroma is not only morphologically similar to that of the ovarian coex, but also expresses oestrogen and progesterone receptors that are detectable by immunohistochemistry Females are much more commonly affected than males (ratio 9:1), with mean age of 50 years. MCNs predominantly involve the body and tail of the pancreas. High CEA levels in the fluid (>200 ng/mL) may suggest malignant transformation. Resection is the treatment of choice for MCNs as the best way to distinguish the entirely benign form (mucinous cystadenoma) from its malignant counterpa (mucinous cystadenocarcinoma) is pathologic assessment after complete surgical removal. Because most MCNs are located in the body and tail of the pancreas, distal pancreatectomy is the most common treatment. IPMNs IPMNs are similar to MCNs in that they are cystic tumors that secrete mucin. The epithelial lining of the cyst is by tall columnar mucin producing cells that frequently forms papillary projections. Two major differences from MCNs is: - IPMNs extensively involve the main pancreatic ducts or the major side branches (or both); whereas MCNs do not connect to the pancreatic duct system. - IPMNs lack the 'ovarian' stroma seen in MCNs. Mucin production by cells leads to intraductal mucin accumulation and subsequent cystic dilation. This mucin production may be so great that mucin can be seen extruding from the ampulla of Vater. On ERCP, mucin can be seen extruding from the ampulla of Vater, a so-called fish-eye lesion, that is viually diagnostic of IPMN Like MCNs IPMNs can range from benign (IPMN adenomas) to malignant (IPMN carcinomas) In contrast to mucinous cystic neoplasms, IPMNs arise more frequently in men than in women, and they involve the head of the pancreas more often than the tail. Age group: seventh to eighth decade of life Surgery is the treatment of choice. Solid- Pseudopapillary tumor Solid-pseudopapillary tumors are rare and typically occur in young women These are well encapsulated, typically large lesions (>10 cm), and may occur anywhere within the pancreas. -### End" -526,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Peaud' orange develops due to, with the following options: A: Vascular obstruction, B: Lymphatic obstruction, C: Local spread, D: Endocrinal abnormality - -### Response: -(Lymphatic obstruction) (837-LB) (839-B & L 25th)Phenomena resulting from lymphatic obstruction In advanced breast cancer(i) Peaud's orange (ii) Cancer-en-cuirasse (iii) LymphangiosarcomaPeaud' orange - is due to cutaneous lymphatic oedema, where the infiltrate skin is fethered by the sweat ducts, it cannot swell leading to an appearance like orange skin. Occasionally the same phenomenon is seen over a chronic abscess -### End" -527,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 17-year-old female underwent Fine Needle Aspiration cytology (FNAC) for a lump in the breast which was non-tender, firm and mobile. Which of the following features would suggest finding of a benign breast disease?, with the following options: A: Dyscohesive ductal epithelial cells without cellular fragments, B: Tightly arranged ductal epithelial cells with dyscohesive bare nuclei, C: Stromal predominance with spindle cells, D: Polymorphism with single or arranged ductal epithelial cells - -### Response: -Ans. b. Tightly arranged ductal epithelial cells with dyscohesive bare nuclei Non-tender, firm and mobile breast lump in a female of age 17 years is suggestive of fibroadenoma, in which tightly arranged ductal epithelial cells with dyscohesive bare nuclei are seen on FNAC. (AIIMS May 2013 repeat) Fibroadenoma: Diagnostic findings on needle biopsy consist of: Abundant stromal cells which appear as bare bipolar nuclei Sheets of fairly uniform-size epithelial cells that are typically arranged in either an antler like pattern or a honeycomb pattern. Foam cells and apocrine cells may also be seen, although these are less diagnostic features. Fibroadenoma MC benign tumor of female breastQ MC age group: 15-30 yearsQ Known as breast mouseQ Etiology: Increased sensitivity of focal areas of breast tissue to estrogenQ Pathology: Encapsulated spherical lesion, composed of fibrous and glandular tissueQ Arise from interlobular stroma, stromal cells can be monoclonal or polyclonal Types of Fibroadenoma Pericanalicular Intracanalicular Hard Soft Due to proliferation of connective tissue inside the elastic lamina Due to proliferation of connective tissue outside the elastic lamina Clinical Features: Painless, slowly growing solitary mobile lump in the breast (Breast mouser) Diagnosis: Characteristic popcorn calcificationQon mammography IOC is FNACQ Diagnostic findings on needle biopsy consist of Abundant stromal cells which appear as bare bipolar nuclei Sheets of fairly uniform-size epithelial cells that are typically arranged in either an antler like pattern or a honeycomb pattern. Foam cells and apocrine cells may also be seen, although these are less diagnostic features. Treatment: No treatmentdeg is necessary when diagnosis is confirmed. Excision biopsy is the treatment of choice for suspicious lesionQand for cosmetic indications. -### End" -528,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of genital tuberculosis is?, with the following options: A: Fallopian tubes, B: Uterus, C: Ovary, D: Fimbriae - -### Response: -ANSWER: (A) Fallopian tubesREF: Shaw 14th edition p. 139""Most common site od genital tuberculosis id fallopian tube""Genital Tuberculosis:Secondary to focus anywhere elseMost common route of spread- HematogenousMost common route of transmission to endometrium - retrograde spreadMost common site - fallopian tubeMost common symptom- infertility -### End" -529,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most recommended film among the following is:, with the following options: A: C film, B: E film, C: D film, D: U film - -### Response: -The types of film used most often in the United States are Ultra-speed (group D) and INSIGHT (high end of the E speed range with manual processing and F with automatic processing conditions). INSIGHT film is preferred because it requires approximately half the exposure time and thus half the radiation dose of Ultra-speed film.  -Multiple studies have found that E/F-speed film is preferred because it has the same useful density range, latitude, contrast, and image quality as D-speed films and can be used in routine intraoral radiographic examinations without sacrifice of diagnostic information. -The current F speed film require about 75% less exposure of E speed film and only 40% of D speed film. -White and Pharoah's Oral  Radiology Principles and Interpretation 8th edition -### End" -530,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 34-year-old woman has a routine Pap smear for the first time. The results indicate that dysplastic cells are present, consistent with a high-grade squamous intraepithelial lesion (HSIL), also called cervical intraepithelial neoplasia (CIN) III. She is referred to a gynecologist, who performs colposcopy and takes multiple cervical biopsy specimens that all show CIN III. The conization of the cervix shows a focus of micro invasion at the squamocolumnar junction. Based on these findings, what is the next most likely step in treating this patient?, with the following options: A: Bone scan for metastatic lesions, B: Course of radiation therapy, C: No further therapy, D: Pelvic exenteration - -### Response: -Micro invasive squamous cell carcinomas of the cervix are stage I lesions that have a survival rate similar to that of in situ lesions. Such minimal invasiveness does not warrant more aggressive therapies. The likelihood of metastasis or recurrence is minimal. -### End" -531,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: String sign in angiography is suggestive of:, with the following options: A: Aerial dissection, B: Aoa aneurysm, C: Stroke, D: None of the above - -### Response: -Traditional angiography remains the basis of diagnosis and characterization of aerial dissection. Angiographic abnormalities include stenosis of the true lumen, or ""string-sign,"" visible intimal flaps, and the appearance of contrast in the false lumen. Four-vessel cerebral angiography should be performed when suspicion of dissection exists. Ref: Schwaz's principle of surgery 9th edition, chapter 42. -### End" -532,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about ulcerative colitis, with the following options: A: Continuous inflammation, B: Leadpipe appearance, C: String sign is seen, D: Crypt abscesses are typical - -### Response: -String sign is seen in chron's disease. -### End" -533,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: SIADH- all are features except -, with the following options: A: Decreased sodium, maintaining the concentrating ability of the urine osmolality (> 100 mOsm), B: Normal sodium balance maintained indicating excess urinary sodium is due to efficient sodium intake, C: Hypouricemia, D: Low blood pressure due to volume depletion - -### Response: -The serum sodium concentration is normally regulated by - - -The balance of water intake. -Renal excretion of sodium and -ADH mediated water conservation by distal renal tubule. - -These processes are mediated by - - -Stimulation of thirst -Secretion of ADH -Feedback mechanisms of the renin angiotensin aldosterone system and variation of renal handling of filtered sodium. - -Disorders in any one of the these components of sodium balance can result in sodium imbalance. -Action of ADH - -ADH is secreted by the posterior pituitary gland. -Its effect in kidney is mediated by the vasopressin. (V2 receptors) on the basolateral surface of the principal cells of the collecting duct. -The key action of ADH in the kidney is increasing the permeability of water. It allows water to be reabsorbed from the medullary interstitium thus enhancing water reabsorption. - -In SIADH the A.D.H. level is inappropriately elevated - -The inappropriately elevated level of vasopressin enhances the reabsorption of water thereby leading to. -Production of concentrated urine. - Inability to excrete water and consequently - Hyponatremia  - -​​Clinical features of SIADH -- Hyponatremie (sodium < 135 mEq/L) -- Inappropriately elevated urine osmolality (> 150 mosm/kg) -- Excessive urine sodium excretion ( Na > 30 mEq/L) -- Decreased serum osmolality- (< 280 mosm/kg) -These findings occur in -- Absence of diuretic therapy -- In the presence of euvulemia without edema -- In the setting of otherwise normal cardiac, renal, adrenal, hepatic and thyroid function. -Remember, -. The key to pathophysiological signs, symptoms and eventual treatment of SIADH is an understanding that the hyponatremia is a result of excess water and not a sodium deficiency. -Laboratory features of SIADH -  - -Hyponatremia (sodium < 135 mEq/L) -B.U.1V. and serum uric acide tends to fallQ because of plasma dilution and increased excretion of nitrogenous products. -Serum potassium and Bicarbonate levels are normal in SIADH (hypokalemia and metabolic acidosis suggests, diuretic therapy or vomiting) -Low serum osmolality. - -​Remember, -These characteristic features of SIADH - -There is increase in urinary concentration of sodium in the presence of hyponatremia. -There is increase in urine osmolarity in the presence of with decrease in serum osmolarity. -### End" -534,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Barrier method is: JIPMER 13, with the following options: A: Oral contraceptive pill, B: Intrauterine devices, C: Spermicidal, D: Tubectomy - -### Response: -Ans. Spermicidal -### End" -535,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fibroma belongs to ?, with the following options: A: Germ cell tumor, B: Sex cord stromal tumor, C: Surface epithelial stromal tumors, D: Metastatic tumors from non ovarian primary - -### Response: -Ans. is 'b' i.e., Sex cord stromal tumor -### End" -536,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At the altitude of 6500 meters, the atmospheric pressure is 347 Hg. What is the inspired PO2?, with the following options: A: 73 mmHg, B: 63 mmHg, C: 53 mmHg, D: 83 mmHg - -### Response: -PO2 of the inspired air is 21 percent of ihe total barometric (atmospheric) pressure. Hence, (21/100) 347 = 72.87. Decreased ambient oxygen pressure results in hypoxemia. This is most commonly seen at high altitude or in nonobstructive asphyxia. The A-a O2 gradient is normal, and hypoxemia improves with supplemental oxygen. Ref: Sarko J., Stapczynski J.S. (2011). Chapter 65. Respiratory Distress. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. -### End" -537,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 1% silver nitrate is used for:, with the following options: A: Ophthalmia neonatorum, B: Sympathetic ophthalmitis, C: Inclusion conjunctivitis, D: Pharyngoconjunctival fever - -### Response: -Ans. A. Ophthalmia neonatorum1% silver nitrate (crede's method) is used for Ophthalmia neonatorum acquired during birth caused by Neisseria gonorrhea in mother's vagina -### End" -538,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The secretory component of immunoglobulin molecule is -, with the following options: A: Formed by epithelial cells of lining mucosa, B: Formed by plasma cell, C: Formed by epithelial cell and plasma cell, D: Secreted by bone marrow - -### Response: -The secretory component is a component of immunoglobulin A (IgA). Secretory component is a proteolytic cleavage product of the polymeric immunoglobulin receptor which remains associated with dimeric IgA in sero-mucus secretions. Polymeric IgA binds to the polymeric immunoglobulin receptor on the basolateral surface of epithelial cells and is taken up into the cell transcytosis. Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:97 -### End" -539,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following tactile receptors respond to the vibration sense of 30 - 800 Hz?, with the following options: A: Pacinian corpuscles, B: Ruffini ending, C: Merkel's disk, D: Meissner's corpuscles - -### Response: -Ans. A. Pacinian corpuscles. (Ref. Guyton Physiology 11th/pg. 587; Ganong 23rd/pg. 121-127, 746)Guyton Physiology 11th/pg. 587.........""Detection of Vibration: All tactile receptors are involved in detection of vibration, although different receptors detect different frequencies of vibration. Pacinian corpuscles can detect signal vibrations from 30 to 800 cycles per second because they respond extremely rapidly to minute and rapid deformations of the tissues, and they also transmit their signals over type Ab nerve fibers, which can transmit as many as 1000 impulses per second. Low-frequency vibrations from 2 up to 80 cycles per second, in contrast, stimulate other tactile receptors, especially Meissner's corpuscles, which are less rapidly adapting than pacinian corpuscles"". The Ruffini ending is a tonic receptor that produces a train of action potentials proportional to the intensity of pressure applied to the skin.Free nerve endings:# found everywhere in the skin and in many other tissues# Can detect touch and pressure.# For instance, even light contact with the cornea of the eye, which contains no other type of nerve ending besides free nerve endings, can nevertheless elicit touch and pressure sensations.Meissner fs corpuscle:# It is a touch receptor with great sensitivity is the Meissner's corpuscle# It is an elongated encapsulated nerve ending of a large (type Ab) myelinated sensory nerve fiber.# Present in the nonhairy parts of the skin and are particularly abundant in the finger- tips, lips, and other areas of the skin where one's ability to discern spatial locations of touch sensations is highly developed.# Meissner's corpuscles adapt in a fraction of a second after they are stimulated, which means that they are particularly sensitive to movement of objects over the surface of the skin as well as to low- frequency vibration.Merkel's discs:# Merkel's discs are often grouped together in a receptor organ called the Iggo dome receptor, which projects upward against the underside of the epithelium of the skin. This causes the epithelium at this point to protrude outward, thus creating a dome and constituting an extremely sensitive receptor.# Also note that the entire group of Merkel's discs is innervated by a single large myelinated nerve fiber (type Ab).# These receptors, along with the Meissner's corpuscles, play extremely important roles in localizing touch sensations to specific surface areas of the body and in determining the texture of what is felt.Hair end-organ:# Slight movement of any hair on the body stimulates a nerve fiber entwining its base. Thus, each hair and its basal nerve fiber, called the hair end-organ, are also a touch receptor.# This receptor adapts readily and, like Meissner's corpuscles, detects mainly- (a) movement of objects on the surface of the body or- (b) initial contact with the body.Ruffini's end-organs:# Located in the deeper layers of the skin and also in still deeper internal tissues are many Ruffini's end-organs, which are multibranched, encapsulated endings.# These endings adapt very slowly and, therefore, are important for signaling continuous states of deformation of the tissues, such as heavy prolonged touch and pressure signals.# They are also found in joint capsules and help to signal the degree of joint rotation.Pacinian corpuscles:# lie both immediately beneath the skin and deep in the fascial tissues of the body.# They are stimulated only by rapid local compression of the tissues because they adapt in a few hundredths of a second.# Therefore, they are particularly important for detecting tissue vibration or other rapid changes in the mechanical state of the tissues. -### End" -540,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following markers is specific for Gastro intestinal stromal tumors (GIST)?, with the following options: A: CD 117, B: CD 34, C: CD 23, D: S-100 - -### Response: -CD 117 is most specific marker for Gastrolintestinal stromal tumor, than CD 34. GIST has a universal expression of CD117. It can also be present in fibroblastic and endothelail tumors. Ref: M. Wasif Saif (2010), Chapter ""Gastrointestinal Stromal Tumors"", In the book, ""Gastrointestinal Malignancies"", Volume 1, Issue 1, USA, Page 152; Robbin's Basic Pathology, 7th Edition, Page 826; Oncology: An Evidence Based Approach, (2006), Pages 413-14; Sternberg's-Diagnostic Surgical Pathology, 4th Edition, Page 1590 -### End" -541,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A woman is said to be have menorrhagia if the menstrual blood loss is MORE than:, with the following options: A: 20 ml, B: 40 ml, C: 60 ml, D: 80 ml - -### Response: -Menorrhagia is defined as loss more than 80 ml of blood per cycle and frequently producing anemia. Predictors of menorrhagia includes bleeding resulting in iron deficiency anemia or a need of transfusion, passage of clots more than 1 inch diameter and changing pad or tampon more than hourly. Normal menstrual bleeding last for an average of 5 days with a mean blood loss of 40 ml. Menorrhagia is defined as bleeding between periods. Polymenorrhea is defined as bleeding that occurs more often than every 21 days. Oligomenorrhea is defined as bleeding that occur less frequently than every 35 days. Ref: Konkle B. (2012). Chapter 58. Bleeding and Thrombosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -542,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oxyhaemoglobin Dissociation Curve is shifted to the right in the following condition, with the following options: A: Acidosis, B: Increased 2-3 DPG level, C: Hyperthermia, D: All the above - -### Response: -(D) All the above # Major factors involved in dissociation curve are:pH - increase, results in shift to the left. Decrease, results in shift to the right.Temperature - increase, results in shift to the right. Decrease, results in shift to the leftpCO2 - increase results in shift to the right. Decrease results in shift to the left.2,3-DPG - increase results in shift to the right, decrease results in shift to the left.OXYHAEMOGLOBIN DISSOCIATION CURVE Shift to LEFT(increase in O2 affinity)Shift to RIGHT(decrease in O2 affinity)> Fall in> Rise in |p50 | P50 |PCO2 | PCO2 | Temperature | Temperature> Decrease in> Increase in | Temperature | Temperature | Red cell 2,3-DPG | Red cell 2,3-DPG | Adenosine diphosphate | Adenosine diphosphate | Adenosine triphosphate | Adenosine triphosphate | Inorganic phosphates | Inorganic phosphates | Fetal blood> Anaemia> Residence at high altitude > Rise in> Fall in | pH | pH | Red cell carboxyHb | Methaemoglobin -### End" -543,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A round cell having fine nuclear chromatin, prominent nucleoli and fine azurophilic granule. The cell is:, with the following options: A: Myeloblast, B: Lymphoblast, C: Monoblast, D: None - -### Response: -The myeloblast (precursor of the granulocytes) varies considerably in size (10-18 μm in diameter), having a large round to oval nucleus nearly filling the cell, has fine nuclear chromatin and contains 2-5 well-defined pale nucleoli. The thin rim of cytoplasm is deeply basophilic and devoid of granules. -The myeloblasts of acute myeloid leukemia may, however, show the presence of rod-like cytoplasmic inclusions called Auer’s rods which represent abnormal derivatives of primary azurophilic granules. -### End" -544,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Polychromatic lusture is seen in :, with the following options: A: Complicated cataract, B: Diabetes mellitus, C: Post radiation cataract, D: Congenital cataract - -### Response: -A i.e. Complicated cataract Complicated cataract (i.e. cataract secondary to some intraocular disease) may be - Anterior coical Q in anterior segmental lesions as glaucoma, acute iritis, or, - Posterior coical Q in posterior segmental lesions as uveitis, RD, pigmentary retinal dystrophy. The second type of complicated cataract presents with posterior coical bread crumb appearance/ polychromatic lusture or rainbow cataract Q Complicated cataract occurs secondary intraocular disease e.g. Inflammatory conditions as uveitis. Degenerative conditions as retinitis pigmentosa, high myopia etc. Intraocular tumors Retinal detachment, Glaucoma etc. -### End" -545,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Calcareous degeneration occurs most commonly in which type of fibroids :, with the following options: A: Submucous, B: Subserous, C: Interstitial, D: Cervical - -### Response: -Ans. is b i.e. Subserous Ref. Dutta Gynae 4/e, p 256 Calcareous degeneration usually involves the subserous fibroids with small peduncle or myomas of postmenopausal women. It is usually preceded by fatty degeneration. There is precipitate of calcium carbonate or calcium phosphate within the tumour, when whole of the tumour is conveed into a calcified mass it is termed as 'womb stone'. Also Know : Most common type of fibroid * Interstitial (Intramural) To sta with all fibroids are * Interstitial (Intramural) Most common fibroid to undergo malignant change * Interstitial (Intramural ) Most common fibroid to cause Retention of urine * Anterior cervical fibroid & central cervical fibroid Torsion is most common in * Large pedunculated subserous fibroid Fibroid causing pseudo Meig's syndrome * Subserous fibroid Most common symptom of fibroid * Menorrhagia Inversion is seen in * Fundal fibroid M/C symptom of fundal fibroid * Menorrhagia Fibroid with maximum symptoms * Submucous fibroid. Wandering or parasitic fibroid * Subserous fibroid. Lantern on dome of St. Paul * Cervical fibroid. Pseudo cervical fibroid * Fibroid polyp. Most common fibroid to undergo calcerous degeneration * Subserous fibroid -### End" -546,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apixaban is:, with the following options: A: Antithrombin inhibitor, B: Direct Xa inhibitor, C: Platelet activator, D: Clotting Factor XII - -### Response: -Ref. KDT. Page. 617 -Apixaban is an oral, direct, and highly selective factor Xa (FXa) inhibitor (of both free and prothrombinase-bound FXa independently of antithrombin III) for the prevention and treatment of thromboembolic diseases - -Apixaban prolongs clotting tests such as prothrombin time (PT), INR, and activated partial thromboplastin time (aptt) -Apixaban is absorbed in the stomach and small intestine -87% plasma protein bound. -Apixaban mainly undergoes o-demethylation and hydroxylation to metabolites -Grapefruit juice may increase apixaban serum concentration. -St. John's wort will likely decrease apixaban serum concentration -### End" -547,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inhibition of platelet aggregation by -, with the following options: A: ADP, B: Thromboxane A2, C: Thrombin, D: Bradykinin - -### Response: -Ans. is 'd' i.e., Bradykinin Platelet aggregationAggregating factorPreventing aggregatng factoro ADPo Epinephrineo VWFo ThrombospondinoTXA2o Serotonino Fibrinogeno Collegeno Immune complexo Thrombin.oPGI2o EndochelinoNOo Bradykinin. -### End" -548,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following traditional medicines is effective in the treatment of hea failure, with the following options: A: Terminalia Arjuna, B: Neem bark extract, C: St. John's wo, D: Gingkoba biloba - -### Response: -Ans. a. Terminalia Arjuna Terminalia Arjuna (An ayurvedic cardioprotective botanical) Although many Ayurvedic plants have shown to help coronary aery disease, Arjuna (Terminalia Arjuna) by far seems to be the best plant for hea health. Terminalia arjuna is a traditional ayurvedic plant containing tannins, triterpenoid saponins (arjungenin, arjunglucosides), flavonoids (arjunon, arjonolone), phytosterols, oligomeric proanthocyanidins (OPC's), calcium, magnesium, zinc, and copper. -### End" -549,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding progressive supranuclear palsy except, with the following options: A: Tremors, B: Unsteadiness, C: Dysahria, D: Gaze palsy - -### Response: -Progressive supranuclear palsy presents with symmetrical parkinsonism, cognitive impairement, early falls and bulbar involvement. The charecteristic eye movement disorder, with up and down gaze. There will be dysahria, but not tremors. Reference : Harrison20th edition pg 2456 -### End" -550,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hormone replacement therapy is contraindicated in-, with the following options: A: Atherosclerosis, B: Thromboembolism, C: Osteoporosis, D: Gall stones - -### Response: -Ans. is 'b' i.e., Thromboembolism Contraincations of hormone replacement therapyo Pregnancy and breast feeding,o Undiagnose vaginal bleeding.o Recent angina or MI.o Venous thromboembolic diseaio Breast cancer,o Active liver disease,o Endometrial cancer,o Uncontrolled hypertension. -### End" -551,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 34 year old housewife reports a three month history of feeling low, lack of interest in activities, lethargy, multiple body-aches, ideas of worthlessness, decreased appetite and disturbed sleep with early morning awakening. She is likely to benefit from -, with the following options: A: Anti-psychotics, B: Anti-depressants, C: Anxiolytics, D: Hypno-sedatives - -### Response: -This patient has (for 3 months) - - -Depressed mood (feeling low)        -Lack of interest     -Loss of energy / fatigue (lethargy) -Ideas of worthlessness -Disturbed sleep (insomnia / hypersomnia)        -Decreased appetite - - -As more than 5 symptoms are present for more than 2 weeks, Diagnosis is major depression Antidepressant should be given. -### End" -552,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscle is inserted into the floor of the intertubercular sulcus of the humerus?, with the following options: A: Latissimus dorsi, B: Teres major, C: Pectoralis major, D: Deltoid - -### Response: -Ans. is 'a' i.e., Latissimus dorsi o The shaft of humerus is cylindrical in the upper half and triangular on cross-section in the lower half. The upper part has intertnbercular sulcus {bicipital groove) anteriorly. Bicipital groove contains long head of biceps w ith its synovial sheath and an ascending branch of anterior circumflex humeral artery. Middle third of posterior surface of shaft of the humerus has a spiral groove {radial groove) which contains radial nerve and profunda brachi vessels.o Attachment to shafts are -Insertions of pectoralis major (on lateral lip of bicipital groove), latissimus dorsi (on floor of bicipital groove), teres major (on deltoid tuberosity) and coracobrachialis (medially on mid shaft).Origin of brachialis (anterior surface); Lateral and medial head of triceps (posterior surface); pronater teres (from medial supracondylar ridge); brachioradialis (from lateral supracondylar ridge) and ECRL (from lateral supracondylar ridge). -### End" -553,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In hyperkalemia with bradycardia treatment is: -, with the following options: A: Calcium gluconate, B: Steroid, C: Salbutamol, D: K+ resin - -### Response: -The treatment for hyperkalemia can be thought of in 3 distinct steps. First, antagonize the effects of hyperkalemia at the cellular level (membrane stabilization). Second, decrease serum potassium levels by promoting the influx of potassium into cells throughout the body.(insulin,beta2 agonist) Third, remove potassium from the body.(k+resins) In cells with calcium-dependent action potentials, such as SA and atrioventricular nodal cells, and in cells in which the sodium current is depressed, an increase in extracellular calcium concentration will increase the magnitude of the calcium inward current and the Vmax by increasing the electrochemical gradient across the myocyte. This would be expected to speed impulse propagation in such tissues, reversing the myocyte depression seen with severe hyperkalemia. The effects of intravenous calcium occur within 1 to 3 minutes but last for only 30 to 60 minutes. Therefore, fuher, more definitive treatment is needed to lower serum potassium levels. Calcium gluconate is the preferred preparation of intravenous calcium. The dose should be 10 mL of a 10% calcium gluconate solution infused over 2 to 3 minutes. -### End" -554,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Longest acting statin is, with the following options: A: Simvastatin, B: Pravastatin, C: Rosuvastatin, D: Lovastatin - -### Response: -Among statins, shoest acting is simvastatin and longest acting is rosuvastatinRef: KD Tripathi 7thed.Pg: 637 -### End" -555,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common uterine malignancy, with the following options: A: Leiomyosarcoma of uterus, B: Endometroid adeno carcinoma, C: Serous Uterine carcinoma, D: Clear cell carcinoma - -### Response: -75 to 80 % of endometrial tumors are type1, which are endometroid adenocarcinomas. -### End" -556,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The best possible intervention for acute myocardial infarction is -, with the following options: A: Streptokinase, B: Streptokinase and aspirin, C: Early primary coronary intervention, D: Streptokinase and heparin - -### Response: -Ref : harrisons-manual-of-medicine-16th-edition pg no: 622-624 TREATMENT Initial Therapy Initial goals are to: (1) quickly identify if patient is candidate for reperfusion therapy, (2) relieve pain, and (3) prevent/treat arrhythmias and mechanical complications. * Aspirin should be administered immediately (162-325 mg chewed at presentation, then 162-325 mg PO qd), unless pt is aspirin-intolerant. * Perform targeted history, exam, and ECG to identify STEMI (1 mmST elevation in two contiguous leads or new LBBB) and appropriateness of reperfusion therapy , which reduces infarct size, LV dysfunction, and moality. * Primary PCI is generally more effective than fibrinolysis and is preferred at experienced centers capable of performing procedure rapidly , especially when diagnosis is in doubt, cardiogenic shock is present, bleeding risk is increased, or if symptoms have been present for 3 h. * Proceed with IV fibrinolysis if PCI is not available or if logistics would delay PCI 1 h longer than fibrinolysis could be initiated (Fig. 123-1). Dooo- needle time should be  30 min for maximum benefit. Ensure absence of contraindications before administering fibrinolytic agent. Those treated within 1-3 h benefit most; can still be useful up to 12 h if chest pain is persistent or ST remains elevated in leads that have not developed new Q waves. Complications include bleeding, reperfusion arrhythmias, and, in case of streptokinase (SK), allergic reactions. Heparin should be initiated with fibrinolytic agents other than SK ; maintain aPTTT at 1.5-2.0 control (50-70 s). * If chest pain or ST elevation persists 90 min after fibrinolysis, consider referral for rescue PCI. Later coronary angiography after fibrinolysis generally reserved for pts with recurrent angina or positive stress test. The initial management of NSTEMI (non-Q MI) is different . In paicular, fibrinolytic therapy should not be Additional Standard Treatment (Whether or not reperfusion therapy is undeaken): * Hospitalize in CCU with continuous ECG monitoring. * IV line for emergency arrhythmia treatment. * Pain control: (1) Morphine sulfate 2-4 mg IV q5-10min until pain is relieved or side effects develop ; (2) nitroglycerin 0.3 mg SL if systolic bp  100 mmHg; for refractory pain: IV nitroglycerin (begin at 10 g/min, titrate upward to maximum of 200 g/min, monitoring bp closely); do not administer nitrates within 24 h of sildenafil or within 48 h of tadalafil (used for erectile dysfunction); (3) -adrenergic antagonists * Oxygen 2-4 L/min by nasal cannula (maintain O2 saturation  90%). * Mild sedation (e.g., diazepam 5 mg PO qid). * Soft diet and stool softeners (e.g., docusate sodium 100-200 mg/d). * -Adrenergic blockers reduce myocardial O2 consumption, limit infarct size, and reduce moality. Especially useful in pts with hypeension, tachycardia, or persistent ischemic pain; contraindications include active CHF, systolic bp  95 mmHg, hea rate  50 beats/min, AV block,or history of bronchospasm. Administer IV (e.g., metoprolol 5 mg q5-10min to total dose of 15 mg), followed by PO regimen (e.g., metoprolol 25-100 mg bid). * Anticoagulation/antiplatelet agents: Pts who receive fibrinolytic therapy are begun on heparin and aspirin as indicated above. In absence of fibrinolytic therapy, administer aspirin, 160-325 mg qd, and low-dose heparin (5000 U SC q12h for DVT prevention). Full-dose IV heparin (PTT 2 control) or low-molecular-weight heparin (e.g., enoxaparin 1 mg/kg SC q12h) followed by oral anticoagulants is recommended for pts with severe CHF, presence of ventricular thrombus by echocardiogram, or large dyskinetic region in anterior MI. Oral anticoagulants are continued for 3 to 6 months, then replaced by aspirin. * ACE inhibitors reduce moality in pts following acute MI and should be prescribed within 24 h of hospitalization for pts with STEMI--e.g., captopril (6.25 mg PO test dose) advanced to 50 mg PO tid. ACE inhibitors should be continued indefinitely after discharge in pts with CHF or those with asymptomatic LV dysfunction ; if ACE inhibitor intolerant, use angiotensin receptor blocker (e.g., valsaan or candesaan). * Serum magnesium level should be measured and repleted if necessary to reduce risk of arrhythmias. -### End" -557,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about rheumatic fever/ rheumatic heart disease except -, with the following options: A: Mitral stenosis is evident in the early stage of the disease, B: Mitral valve is most commonly affected, C: Presence of antischkow cells is pathognomic, D: MacCallum plaques are commonly seen in left atrium - -### Response: -Ans. is 'a' i.e., Mitral stenosis is evident in the early stage of the disease Rheumatic fever/ Rheumatic heart disease* Rheumatic fever (RF) is an acute, immunologically mediated, multisystem inflammatory disease classically occurring a few weeks after an episode of group A streptococcal pharyngitis; occasionally, RF can follow streptococcal infections at other sites, such as the skin.* Acute rheumatic carditis is a common manifestation of active RF and may progress over time to chronic rheumatic heart disease (RHD), mainly manifesting as valvular abnormalities. RHD is characterized principally by deforming fibrotic valvular disease, particularly involving the mitral valve.* Distinctive lesions occur in the heart, called Aschoffbodies, consisting of foci of T lymphocytes, occasional plasma cells, and plump activated macrophages called Anitschkow cells (pathognomonic for RF). These macrophages have abundant cytoplasm and central round-to-ovoid nuclei (occasionally binucleate) in which the chromatin condenses into a central, slender, wavy ribbon (hence the designation ""caterpillar cells"").* During acute RF, diffuse inflammation and Aschoff bodies may be found in any of the three layers of the heart, resulting in pericarditis, myocarditis, or endocarditis (pancarditis).* Inflammation of the endocardium and the left-sided valves typically results in fibrinoid necrosis within the cusps or tendinous cords. Overlying these necrotic foci and along the lines of closure are small (1 to 2 mm) vegetations, called verrucae.* Subendocardial lesions, perhaps exacerbated by regurgitant jets, can induce irregular thickenings called MacCallum plaques, usually in the left atrium.* The cardinal anatomic changes of the mitral valve in chronic RHD are leaflet thickening, commissural fusion and short- ening, and thickening and fusion of the tendinous cords. In chronic disease the mitral valve is virtually always involved.* The mitral valve is affected in isolation in roughly two thirds of RHD, and along with the aortic valve in another 25% of cases. Tricuspid valve involvement is infrequent, and the pulmonary valve is only rarely affected.* Up to 60% of patients with ARF progress to RHD.* Valvular damage is the hallmark of rheumatic carditis. The mitral valve is almost always affected, sometimes together with the aortic valve; isolated aortic valve involvement is rare.* Early valvular damage leads to regurgitation. Over ensuing years, usually as a result of recurrent episodes, leaflet thickening, scarring, calcification, and valvular stenosis may develop.* Therefore the characteristic manifestation of carditis in previously unaffected individuals is mitral regurgitation, sometimes accompanied by aortic regurgitation.* Myocardial inflammation may affect electrical conduction pathways, leading to P-R interval prolongation (first- degree AV block or rarely higher-level block) and softening of the first heart sound. -### End" -558,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In child survival and safe motherhood programme which is not advised as a provision in conduct of delivery -, with the following options: A: Clean room, B: Clean tie, C: Clean perineum, D: Clean cord - -### Response: -Ans. is 'c' i.e., Clean perineum -### End" -559,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following test is not used for dignosis of leprosy-, with the following options: A: Lepromin test, B: slit skin smear, C: Fine needle aspiration cytology, D: skin biopsy - -### Response: -Lepromatous test it is not a diagnostic test but a prognostic test. it helps in the classification of leprosy. antigens used for skin testing: mitsuda lepromin, Dharmendra leprominmanifests as biphasic reaction: early Fernandez (48-72hrs)and late mitsuda reaction (3-4weeks)Represents Cmi towards antigen. Erythema and induration more than 5mm indicates positive and good delayed hypersensitivity. lepromin test positive: tuberculoid, borderline tuberculoid leprosy lepromin test negative in lepromatous leprosy, borderline lepromatous leprosyand mid borderline leprosy iadvl textbook of dermatologypage 2060 -### End" -560,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oxidative capacity is high in which type of skeletal muscle fiber, with the following options: A: Type I fiber, B: Type IIA fiber, C: Type IIB fiber, D: All of the above - -### Response: -Oxidative capacity is high in type I fiber (slow-oxidative), moderate in type IIA (fast-oxidative-glycolytic), low in Type IIB fiber (fast-glycolytic).Reference: Ganong's review of Medical Physiology,25th ed, p 108 -### End" -561,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nicoladoni sign is positive in a young patient with an aeriovenous fistula. This sign is also known as:, with the following options: A: Murray sign, B: Frei sign, C: Darrier sign, D: Branham sign - -### Response: -Nicoladoni-Branham sign: Compression of a large aeriovenous fistula may cause reflex slowing of the hea rate. Duplex ultrasonography may detect an aeriovenous fistula, especially one that affects the femoral aery and vein at the site of catheter access. Computed tomographic and conventional angiography can confirm the diagnosis. Ref: Creager M.A., Loscalzo J. (2012). Chapter 249. Vascular Diseases of the Extremities. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -562,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ezetimibe acts on ?, with the following options: A: LPL, B: PPAR, C: NPC ILI, D: HMG-CoA reductase inhibitor - -### Response: -Ans. is 'c' i.e., NPC1LI -### End" -563,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement regarding Gastrochisis is TRUE?, with the following options: A: Herniation occur through umbilical cord, B: Herniation from right of umbilical cord from obliteration of right umbilical vein, C: Covered with amniotic sac, D: Associated with multiple anomalies - -### Response: -Gastrochisis is an abdominal wall defect located at the junction of the umbilicus and normal skin and is almost right of the umbilicus. It is a congenital anomaly characterized by a defect in the anterior abdominal wall through which the intestinal contents protrude freely. There is no overlying sac and the size of the defect is much small (less than 4cm). If the intestine appears normal that suggests that rupture had occurred late in pregnancy. If the intestine appear thickened, edematous, discoloured and covered with exudate it indicates a long standing process. Ref:Schwaz's Principles of Surgery, 9e chapter 39. -### End" -564,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of cholangiocarcinoma?, with the following options: A: Distal biliary duct, B: Hilum, C: Intrahepatic duct, D: Multifocal - -### Response: -Most common site for cholangiocarcinoma is perihilar region(65%).Distal pa of duct constitutes 25% &Intrahepatic pa constitutes around 10%. Reference:SRB's manual of surgery,5th edition,page no:661. -### End" -565,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Microvesicular type of fatty liver is Seen in the following except, with the following options: A: Acute fatty liver of pregnancy, B: Alcoholic liver disease, C: Reye's syndrome, D: Phosphorus intoxication - -### Response: -Fatty liver disease means you have extra fat in your liver. You might hear your doctor call it hepatic steatosis. Heavy drinking makes you more likely to get it. Over time, too much alcohol leads to a buildup of fat inside your liver cells. This makes it harder for your liver to work. But you can get fatty liver disease even if you don't drink a lot of alcohol Refer robbins 9/e -### End" -566,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child with recurrent mouth ulcer which usually begin as a round yellowish elevated spot surrounded by a red halo and heals within 7-10 days:, with the following options: A: Gingivitis, B: Aphthous ulcers, C: Malignancy, D: Herpetic ulcer - -### Response: -Ans.: (b) Aphthous ulcersRef.: Harrison's 19th ed. /239* Apthous ulcers are also called as canker sores/apthous stomatitis and present as round ulcer with yellowish base and surrounded by a red halo.# The usual sites are oral mucosa on the insides of lips , cheeks or below the tongue.# Most of apthous ulcers are <5mm in size and heal within 1-2 weeks.# Painless recurrent apthous ulcers are seen in SLE# Painful recurrent apthous ulcers in oral cavity and genitilia is seen are in Behcet disease -### End" -567,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DOC for chemoprophylaxis of plague ?, with the following options: A: Streptomycin, B: Erythromycin, C: Tetracycline, D: Vancomycin - -### Response: -Ans. is 'c' i.e., Tetracycline -### End" -568,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Consent from guardian/husband for MTP is required in, with the following options: A: Female is below 28 years of age, B: Female is below 23 years of age, C: Female is below 17 years of age, D: Unmaried Female - -### Response: -The written consent of the guardian is necessary before performing aboion in women under 18 years of age and in lunatics even if they are older than 18 years Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 506 -### End" -569,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following shows that pulmonary circulation differs from systemic circulation?, with the following options: A: Pulmonary vasodilation in hypoxia, B: Pulmonary vasoconstriction in hypoxia, C: Decreased blood volume during systole, D: Increased basal vasoconstrictor tone - -### Response: -The vasoconstrictor response of the pulmonary circulation to low oxygen tension is exact opposite of response of systemic aerioles. The opposite effect in pulmonary vessels occurs in order to distribute the blood flow to better ventilated area and be more effective. This vasoconstriction occurs because of presence of potassium gated channel in pulmonary vessels. Ref: Barst R.J., Rubin L.J. (2011). Chapter 71. Pulmonary Hypeension. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e. -### End" -570,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kamla, age 48 yrs, presents with unilateral mild axial proptosis. There is no redness or pain. Investigation of choice is:, with the following options: A: T3&T4 measurements to rule out thyrotoxicosis, B: CT scan to rule out meningioma, C: Doppler to rule out hemangioma, D: USG to rule out orbital pseudotumor - -### Response: -All of the above conditions can cause proptosis. But, Graves' ophthalmopathy is the most common cause of unilateral or bilateral proptosis in adults or children. Orbital inflammation and engorgement of the extraocular muscles, paicularly the medial rectus and the inferior rectus, account for the protrusion of the globe. The accompanying upper eyelid retraction, manifesting as dispropoionately greater exposure of sclera superiorly than inferiorly, and lid lag, manifesting as impaired descent of the upper eyelid on downward gaze, distinguishes it from other causes of proptosis. Ref: Sullivan J.H. (2011). Chapter 13. Orbit. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. -### End" -571,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is derived from the Wolffian duct?, with the following options: A: Appendix of testis, B: Uterus, C: Appendix of epididymis, D: Prostate - -### Response: -An appendix of the epididymis is a developmental remnant of the mesonephric duct (Wolffian duct) which can be found in the head of the epididymis. In the female, in the absence of testosterone, the Wolffian duct regresses. However, inclusions may persist resulting in the epoophoron and Skene's glands. Where a remnant exists lateral to the wall of the vagina a Ganer's duct or Ganer's cyst may form. In males, the Wolffian duct develops into the rete testis, the efferent ducts, the epididymis, the ductus deferens and the seminal vesicles. The prostate is formed separately from the urogenital sinus. In both the male and the female the Wolffian duct develops into the trigone of the urinary bladder. Ref: Gray's 39e/p-1289 -### End" -572,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest site of fracture in Base of Skull?, with the following options: A: Anterior Cranial fossa, B: Middle cranial fossa, C: Posterior cranial fossa, D: Lateral cranial fossa - -### Response: -The common sites of fracture in the skull are:(a) The parietal area of the vault.(b) The middle cranial fossa of the base. This fossa is weakened by numerous foramina and canals.The facial bones commonly fractured are: (a) The nasal bone and (b) the mandible.Some clinical features of petrous temporal bone fractureBattle signCSF otorrheaotorrhagia -### End" -573,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Based on the type of life cycle, zoonoses are classified into all of the following except -, with the following options: A: Cyclo-zoonoses, B: Meta-zoonoses, C: Anthropozoonoses, D: Sporozoonoses - -### Response: -Ans. is 'c' i.e., Anthropozoonoses Classification of zoonoses 1) Based on direction of transmission : (i) Anthropozoonoses, (ii) Zoonthroponoses, and (iii) Amphixenoses 2) Based on type of life cycle : (i) Direct zoonoses, (ii) Cyclo-zoonoses, (iii) Meta-zoonoses, and (iv) Sporozoonoses. -### End" -574,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Saline infusion sonography is also called?, with the following options: A: Sonohysterography, B: Sonosalpingography, C: Hysterosalpingography, D: None of the above - -### Response: -Ans. is 'a' i.e.,SonohysterographySaline Infusion SonographyIt is also called Sonohysteorgraphy.In this procedure sterile saline is instilled into the uterine cavity before ultrasound evaluation for more precise visualization of the endometrial structures.It is often used as second step in the evaluation of abnormal uterine bleeding.It is paicularly useful when ultrasonography suggests a focal lesion, when endometrial biopsy is nondiagnostic, or when abnormal bleeding persists despite normal initial work up. -### End" -575,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Head gear causes, with the following options: A: Bucco lingual movement of maxillary molars, B: Mesio distal movement of maxillary molars, C: Intrusion of molars, D: All of the above - -### Response: -Headgears are the most commonly used oral orthopedic appliances. -They are indicated in patients with excessive horizontal growth of maxilla. They are used to distalize the maxillary dentition along with maxilla. -### End" -576,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person w anders in public places by removing his clothes it is called -, with the following options: A: Voyeurism, B: Frotterurism, C: Exhibitionism, D: Unidinism - -### Response: -Ans. is 'c' i.e., Exhibitionism o Exhibitionism is willful and intentional exposure of genitalia in public place to obtain sexual pleasure,o Frotteurism : is contact with another person in order to obtain sexual gratification. Sexual gratification by rubbing private parts against a female body in crowd. It is punishable under Section 2901.P. C., with fine upto Rs 200.o Unidinism: is sexual pleasure is obtained by witnessing the act of urination by some one of same or opposite sex.o Voyeurism = scotophilia^ peeping tom: sexual gratification is obtained by looking at the sexual organs of other persons, watching the act of sexual intercourse, or witnessing undressing by a women. -### End" -577,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antonie van Leeuwenhoek is associated with?, with the following options: A: Telescope, B: Microscope, C: Stains, D: Immunization - -### Response: -ANSWER: (B) MicroscopeREF: Ananthnarayan page 8Known as ""Father of Microbiology "", and considered to be the first microbiologist. He is best known for his work on the improvement of the microscope and for his contributions towards the establishment of microbiology. Using his handcrafted microscopes, he was the first to observe and describe single-celled organisms, which he originally referred to as animalcules, and which we now refer to as microorganisms. He was also the first to record microscopic observations of muscle fibers, bacteria, spermatozoa, and blood flow in capillaries (small blood vessels) -### End" -578,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The gene responsible for folic acid transpo is situated on:, with the following options: A: Chromosome 10, B: Chromosome 5, C: X Chromosome, D: Chromosome 21 - -### Response: -. Chromosome 21 -### End" -579,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the preferred route of access for total parenteral nutrition in a patient who requires the same for <14 days and there is otherwise no indication for use of central catheter?, with the following options: A: Internal jugular vein, B: External jugular vein, C: Periphaeral vein, D: PICC line - -### Response: -Ans. is 'c' i.e., Peripheral vein * Following are the recommendations of the route of access for total parental nutrition :Route of access1.8.8In hospital, parenteral nutrition can be given via a dedicated peripherally inserted central catheter as an alternative to a dedicated centrally placed central venous catheter. A free dedicated lumen in a multilumen centrally placed catheter may also be used.1.8.9Administration of parenteral nutrition via a peripheral venous catheter should be considered for patients who are likely to need short-term parenteral nutrition (less than 14 days) who have no need for central access for other reasons. Care should be taken in catheter choice, and in attention to pH, tonicity and long-term compatibility of the parenteral nutrition formulations in order to avoid administration or stability problems.1.8.10Tunnelling subclavian lines is recommended for long-term use (more that 30 days).1.8.11Catheters do not have to be tunnelled for short-term use (less than 30 days). -### End" -580,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All aeries involved in anastomosis around scapula except, with the following options: A: Circumflex scapular, B: Suprascapular, C: Infrascapular, D: Tansverse cervical - -### Response: -ANASTOMOSIS AROUND SCAPULA: Anastomosis occurs in the three fossae, subscapular, supraspinatus, and infraspinatus. It is formed by Suprascapular aery, a branch of the thyrocervical trunk Deep branch of the transverse cervical aery, another branch of the thyrocervical trunk Circumflex scapular aery, a branch of the subscapular aery which arises from the 3rd pa of the axillary aery. Note that this is an anastomosis between branches of the first pa of the subclan aery and branches of the third pa of axillar. ANASTOMOSIS AROUND THE ACROMIAN PROCESS: the acromial branch of the thoracoacromial aery. the acromial branch of the suprascapular aery. the acromial branch of the posterior circumflex humeral aery. REF: BD Chaurasia 7th edition Page no: 76. -### End" -581,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mental health programme was started in –, with the following options: A: 1982, B: 1987, C: 1990, D: 1995 - -### Response: -The Government of India has launched the National Mental Health Programme (NMHP) in 1982. Also know - - -Mental health act was started in 1987. -### End" -582,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Call exner bodies are seen in:, with the following options: A: Granulosa cell tumor, B: Yolk sac, C: Dysgerminoma, D: Embryonal carcinoma - -### Response: -Ans: (a) Granulosa cell tumorBerek and Novak's Gynecology, 14th editionWHO classification of ovarian tumoursCommon epithelial tumorsSex cord (gonadal stroma) tumorsGerm cell tumors*. Serous tumors*. Mucinous tumors*. Endometrioid tumors*. Clear cell (mesonephroid tumors)*. Brenner tumors (Transitional cell tumor)*. Mixed epithelial tumors*. Undifferentiated carcinoma*. Unclassified epithelial tumors*. Granulose-stromal cell tumors, theca cell tumors*. Androblastomas: Sertoli-Leydig cell tumors*. Gynandroblastomas*. UnclassifiedGonadoblastoma*. Pure*. Mixed with dysgerminoma or other germ cell tumors.*. Dysgerminoma*. Endodermal sinus tumors (yolk sac tumour)*. Embryonal carcinoma*. Polyembryoma*. Choriocarcinoma*. Teratoma*. Mixed formsLipid (lipoid) cell tumorsSoft tissue tumors not specific to ovaryUnclassified tumorsFamilial ovarian cancers: HNPCC (LYNCH-2), BRCA1 and BRCA2NOTE:Ovarian cancers are the most common cause of death among all gynecological malignancies.Ovarian cyst adeno carcinoma is most common malignant tumor of ovary (33-50% of epithelial cancers)Most common benign tumour of ovary: Dermoid cystMost common benign epithelial tumor: Serous cystadenomaLargest benign ovarian tumor: Mucinous cyst adenomaMost common ovarian tumour in <20 years of age group - germ cell tumourMost common germ cell tumour (GCT): Mature teratomaMost common malignant germ cell tumour (GCT): DysgerminomaOvarian tumor whose incidence is increased during pregnancy: Dermoid cystMost common ovarian tumor to undergo torsion in pregnancy: Dermoid cystMost common ovarian tumour to involve opposite side: Granulosa cell tumourSerous cyst adenoma is overall most common tumour of ovary.Of all the malignant tumors, 90% are epithelial in orgin, 80% are in primary in the ovary and 20% secondary from breasts, gastrointestinal tract and colon.Mucinous cyst becomes malignant in 5% but papillary cystadenoma becomes malignant in 50% if left untreated.Most common ovarian tumor associated with pseudomyxoma peritoni: Mucinous cystadeno Ca.Most common ovarian tumor associated with hyperthyroidism: Germ cell tumour with struma ovarii (struma ovarii is a teratoma with thyroid tissue).Ovarian tumors with calcification:Cystic teratoma / dermoid cyst (bone + teeth)GonadoblastomaFibromaTorsion of ovarian cyst in the most common complication and seen in teratoma/dermoid cyst most commonly.Tumors with lymphocytic infiltration: DysgerminomaOvarian serous tumors, both low- and high-grade, have a propensity to spread to the peritoneal surfaces and omentum and are commonly associated with the presence of ascites.Meig s syndrome: Combination of ovarian Fibroma + Ascites + right sided hemothoraxPseudo Meig's syndrome: Brenner's tumor, Granulosa Cell tumor, ThecomaRisk factorsProtective factors*. Repeated ovulation*. Old age*. Nullipara*. Early menarche, late menopause*. White race*. Late marriage, infertility*. Perineal exposure to talc*. OC pills*. Pregnancy*. Breastfeeding*. Chronic anovulation*. Bilateral salpingo oophorectomy*. Tubal sterilization*. HysterectomyAge Group:Malignant epithelial tumors40-60 yearsBenign cystic teratoma10-20 yearsDysgerminoma<20 yearsEndodermal sinus tumour15-20 yearsGranulose cell tumourPost-menopausalSertoli leydig cell20-30 yearsThecomaPost-menopausalGERM CELL TUMOURSAccount for 15-20% of all ovarian tumors.95% are benign cystic teratoma, also called as dermoids.Below the age of 20 years, 60% of the tumors are of germ cell origin.<10 years: 85% belong to this group and are malignant.Tumour markers of ovarian cancer:CA-125:>35U/ml indicates malignant and residual ovarian tumour. It is also raised in abdominal tuberculosis and endometriosis.CEA: >5 mg/dl seen in Mucinous ovarian tumour.Endodermal sinus tumors produce AFP.a fetoprotein and alpha-1-antitrypsin: Endodermal sinus tumorAFP and HCG: Embryonal carcinomaHCG: ChoriocarcinomaDysgerminomas and other germinomas: No markers, but secrete LDH Krukenberg's TumourPrimary site: Stomach (70%), large intestine (15%) and breast (6%), spread by retrograde lymphatics.Characteristic features: Signet ring cellsInvolvement of ovary by: Retrograde lymphatics.Always bilateral with smooth surface, slightly bossy and freely mobile over the pelvis.Maintains the shape of ovary and has a peculiar solid waxy consistency.No tendency of adhesion and no infiltration of nearby tissues.Ovarian Tumours and Their Specific FeaturesSchiller Duval bodies - Endodermal sinus tumourSignet ring cells - Krukenberg's tumourCoffee bean cells/Call Exner bodies - Granulosa cell tumourSertoli and Leydig cells - ArrhenoblastomaPsammoma bodies - Papillary Serous CystadenomaRokitansky's protuberance - Dermoid cyst (Mature teratoma)Hobnail cells - Clear cell Ca (mesonephroid Ca)Reinke's crystal - Hilus cell tumourWalthard cell nest - Brenner tumour -### End" -583,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these antihypeensives do not have any central action?, with the following options: A: Propranolol, B: Methyl dopa, C: Minoxidil, D: Nitroprusside - -### Response: -prpranolol is a beta blocker,methyldopa is a alpha agonist, minocidil is a potassium channel blocker and notroprusside is a nitrate all are used in treatment of hypeension. REF KD Tripathi 8th ed. -### End" -584,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The fascia seperating rectum from coccyx is called, with the following options: A: Scarpa's fascia, B: Waldeyer's fascia, C: Denonvillier's fascia, D: Colle's fascia - -### Response: -The lower third of the rectum is separated by a fascial condensation - Denonvilliers' fascia - from the prostate/vagina in front, and behind by another fascial layer - Waldeyer's fascia - from the coccyx and lower two sacral veebrae (Table 68.1). These fascial layers are surgically impoant as they are a barrier to malignant invasion . Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1219 -### End" -585,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The layer of the cornea once destroyed does not regenerate is:, with the following options: A: Epithelium, B: Bowman's membrane, C: Descemet's membrane, D: All of the above - -### Response: -Ans. Bowman's membrane -### End" -586,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyper alodosteronism causes All except, with the following options: A: Hypernatremia, B: Hypokalamia, C: Metabolic acidosis, D: Hypeension - -### Response: -Refer CMDT 2010/1056 Alodosterone causes retention of Na+ and water band removal of K+ and H+ Therefore excess of alodosterone may result in Hypernatremia, hypeension and hypokalamia and metabolic alkalosis -### End" -587,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mesalamine is used in:, with the following options: A: Ulcerative colitis, B: Diabetes, C: Erectile dysfunction, D: Tinea corporis - -### Response: -Ref: Katzung 11th p.I087Explanation:Mesalamine is an aminosalicylate used in the treatment of inflammatory bowel diseasesDrugs that contain 5-aminosalicylic acid (5-ASA) have been used successfully for decades in the treatment of inflammatory bowel diseases. 5- ASA differs from salicylic acid only by the addition of an amino group at the 5 (meta) position.Aminosalicylates are believed to work topically (not systemically) in areas of diseased gastrointestinal mucosa. Up to 80% of unformulated, aqueous 5-ASA is absorbed from the small intestine and does not reach the distal small bowel or colon in appreciable quantities.To overcome the rapid absorption of 5-ASA from the proximal small intestine, a number of formulations have been designed to deliver 5- ASA to various distal segments of the small bowel or the colon. These include sulfasalazine, olsalazine, balsalazide, and various forms of mesalamine.Pentasa is a mesalamine formulation that contains timed-release microgranules that release 5-ASA throughout the small intestineAsacol has 5-ASA coated in a pH-sensitive resin that dissolves at pH 7 (the pH of the distal ileum and proximal colon).Lialda also uses a pH-dependent resin that encases a multimatrix core.On dissolution of the pH-sensitive resin in the colon, water slowly penetrates its hydrophilic and lipophilic core. leading to slow release of mesalamine throughout the colon. -### End" -588,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Compared to high molecular weight heparin following is true about low molecular weight heparin ?, with the following options: A: Monitoring is not needed for low molecular weight heparin, B: Daily two subcutaneous doses are essential, C: They are easily filtered at the glomerulus, D: They do not interact with plasma proteins - -### Response: -Ans. is 'b' i.e., Daily two subcutaneous doses are essential Advantages of LMWH Longer, more consistent and predictable response --> Single daily dose is sufficient by subcutaneous route. o Lower risk of osteoporosis and HIT syndrome. Bleeding chances are less : LMW heparins have a different anticoagulant profile. They selectively inhibit factor Xa with little effect on antithrombin and coagulation in general. They act only by inducing conformational change in AT III. They appear to have lesser antiplatelet action. As a result they have a small effect on a PTT and whole blood clotting time. Since a PTT/clotting times are not prolonged (much) laboratory monitoring is not needed, and the incidence of haemorrhagic complication is less. They are easily filtered from glomerular capillaries because of there smaller molecular weight. LMW heparins do not interact with plasma proteins. -### End" -589,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The common cause of bilateral internuclear ophthalmoplegia is:, with the following options: A: Multiple sclerosis, B: Lead toxicity, C: Diphtheria, D: Diabetes mellitus - -### Response: -Ans. Multiple sclerosis -### End" -590,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are the hallmarks of nephrotic syndrome in children except ___________, with the following options: A: Severe proteinuria >2 gm/m2/day, B: Hypoalbuminemia < 2.5 g/dL, C: Gross hematuria, D: Edema - -### Response: -NEPHROTIC SYNDROME:- Characterised by massive proteinuria, hypoalbuminemua and edema, hyperlipidemia is often associated. Some patients show hematuria and hypeension. Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl). The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin angiotensin aldosterone axis and ADH secretion that enhances sodium and water retention. Hypoalbuminemia also induces hepatic synthesis of beta lipoproteins resulting in hypercholesterolemia. Main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy. Steroid sensitive nephrotic syndrome:- MCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non specific obliteration of epithelial foot processes. Immunofluorescence studies shows deposits of occassional mesangial IgM. Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia impa a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated. Low serum calcium level. Steroid resistant nephrotic stndrome:- Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and wilms tumor(WT1) genes. Reference: GHAI essential Paediatrics -### End" -591,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which joint is most commonly affected in pseudogout, with the following options: A: Knee joint, B: Hip joint, C: MP joint great toe, D: MP joint thumb - -### Response: -Pseudogout commonly involves the larger joints Knee joint is Most commonly involved Other sites are wrist, elbow, shoulder ankle Involvement of small joints is uncommon Refer Harrison 20th/e p 2167 maheswari 9th ed -### End" -592,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inguinal ligament is formed due to:, with the following options: A: External oblique aponeurosis, B: Transversus abdominis, C: Internal oblique aponeurosis, D: Inguinal muscle - -### Response: -Ans. A External oblique aponeurosis# Inguinal ligament is a fibrous, thickened, folded margin of the external oblique aponeurosis.# It extends from anterior superior iliac spine to pubic tubercle. -### End" -593,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The lens can be dislocated in all except -, with the following options: A: Homocystinuria, B: Marfan’s syndrome, C: Trauma, D: Wilson’sdisease - -### Response: -Ectopia lentis - -Ectopia lentis is defined as displacement or malposition of the crystalline lens of the eye. -The lens is considered dislocated (luxated) when it lies completely outside the lens patellar fossa. -The lens is described as subluxated when it is partially displaced but contained within the lens space. Causes are -### End" -594,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of torse de pointes:, with the following options: A: Propranolol, B: Calcium channel blocker, C: MgSO4, D: Lignocaine - -### Response: -Ans. C. MgSO4 Torse de pointe blocks the out potassium and inward calcium channel due to which there is prolongation of QT interval. Drug causing this are thiazides, ondansetron, sotalol. Drug of choice to terminate this magnesium sulfate. -### End" -595,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: X-rays are modified, with the following options: A: Protons, B: Electrons, C: Neutrons, D: Positrons - -### Response: -X rays are the modified electrons from cathode striking the anode both are made up of tungsten which has a high melting point and low vapourisation pressure -### End" -596,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Basic amino acids are, with the following options: A: Lysine and Arginine, B: Serine and cystein, C: Phenylalanine and Tyrosine, D: Aspartic acid and Glutamic acid - -### Response: -(Lysine and Arginine) (47- U.Satyanarayan 3rd)Classification of Amino acids1.Amino acid with aliphatic side chains - Glycine, Alanine, valine, leucine and Isoleucine2.Hydroxyl group containing amino acids- Serine, threonine and tyrosine3.Sulfur containing amino acids - cysteine, methionine4.Acidic ami noacids - Aspartic acid, glutamic acid5.Basic amino acids - Lysine, arginine, histidine6.Aromatic amino acids - Phenyl alanine, tyrosine and tryptophan7.Imino acids - Proline -### End" -597,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dohle bodies can be seen in which of the following?, with the following options: A: Plasma cell myeloma, B: Sepsis, C: Chronic granulomatous disease, D: Rheumatoid ahritis - -### Response: -In sepsis or severe inflammatory disorders (e.g., Kawasaki disease), leukocytosis is often accompanied by morphologic changes in neutrophils, such as toxic granulations, Dohle bodies, and cytoplasmic vacuoles Toxic granules are coarser and darker than normal neutrophilic granules, represent abnormal azurophilic (primary) granules Dohle bodies are patches of dilated endoplasmic reticulum that appear as sky-blue cytoplasmic ""puddles."" -### End" -598,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following anticancer drugs act on G2 phase except:, with the following options: A: Paclitaxel, B: Etoposide, C: Irinotecan, D: Bleomycin - -### Response: -Ans. (A) Paclitaxel(Ref: Katzung 13th/e p921)Paclitaxel is a taxane that act on mitotic spindle. Drugs acting on mitotic spindle act on M phase of cell cycle.Phase of cell cycleDrugs actingG1EtoposideSAntimetabolitesG2BleomycinEtoposideIrinoctecanTopotecanMVinca alkaloidsTaxanes -### End" -599,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady undergoes radical hysterectomy for stage Ib ca cervix. It was found that cancer extends to lower part of body of uterus and upper part of cervix Next step of management will be:, with the following options: A: Chemotherapy, B: Radiotherapy, C: Chemoradiation, D: Follow up - -### Response: -Postoperatively it was found that carcinoma extends to the lower part of uterus. Now this is a trap because uterine extension has no significance in cancer cervix and does not change the staging. -### End" -600,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wagner and Grossman theory is related to, with the following options: A: Palatal palsy, B: Vocal cord palsy, C: Facial palsy, D: Hypoglossal palsy - -### Response: -Wagner and Grossman hypothesis which states that cricothyroid muscle which receives innervation from superior laryngeal nerve keeps the cord in paramedian position due to its adductor function. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 7, page - 338 -### End" -601,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme defect in Classic Phenylketonuria, with the following options: A: Phenylalanine hydroxylase, B: Dihydrobiopterin reductase, C: Fumarylacetoacetate hydrolase, D: Homogentisate oxidase - -### Response: -Hyperphenylalaninemias arise from defects in phenylalanine hydroxylase (type I, classic phenylketonuria (PKU), frequency 1 in 10,000 bihs), in dihydrobiopterin reductase (types II and III), or in dihydrobiopterin biosynthesis (types IV and V).Ref: Harper&;s Biochemistry; 30th edition; Chapter 29 Catabolism of the Carbon Skeletons of Amino Acids -### End" -602,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Formication is seen, with the following options: A: Cannabis, B: Cocaine, C: Opioids, D: Ecstasy - -### Response: -Formication - also know as magnan phenomenon or cocaine bugs it is tactile type of hallucination seen in cocaine intoxication Jet black pigmentation - also seen in cocaine Flashback phenomenon / run amok / amotivational syndrome - seen in cannabis Flu like syndrome (water from everywhere - lacrimation, sweating, rhinorrhea and diarrhea) seen in opioids withdrawal -### End" -603,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about fouh hea sound 'S4'?, with the following options: A: Can be heard by the unaided ear, B: Frequency is greater than 20 Hz, C: Heard during ventricular filling phase, D: Heard during ventricular ejection phase - -### Response: -Precordial vibrations resulting from atrial contraction are normally neither palpable nor audible. Under pathologic conditions, forceful atrial contraction generates a low-frequency sound (S4) just before the first hea sound (S1).S4 is also termed the atrial diastolic gallop or the presystolic gallop.Atrial contraction must be present for the production of S4. It is absent in atrial fibrillation.The S4 follows the onset of the P wave of the ECG by approximately70 ms.S 4 has a very low frequency--usually 20 cycles/sec or less. (Guyton and Hall)Audibility of the S4 depends not only on its intensity and frequency but also on its separation from S1. A loud S1 also can mask the audibility of a preceding softer S4.The S4 is best heard at the apex impulse with the patient turned in the left lateral position. It varies considerably with respiration, usually being heard best during expiration.Both the intensity and timing of the S4 are closely related to the end-diastolic volume of the ventricle.Audible fouh hea sounds are usually accompanied by a palpable presystolic apical impulse in the absence of obesity, emphysema, and so foh.The S4 generated by a forceful right atrial contraction is usually heard best at the lower left sternal border. Unlike the left-sided S4, it tends to be accentuated with inspiration. It is also accompanied by prominent 'a waves' in the JVP.An audible S4 with a palpable presystolic impulse is common in patients with ischemic hea disease during an acute episode of angina and in the early phases of transmural MI.In patients with LV an aneurysm or idiopathic or ischemic cardiomyopathy, abnormal fouh hea sounds are commonly present and are often associated with an S3, producing a quadruple rhythm.Ref: Hurst's The Hea 13/e p288, Guyton & Hall's Textbook of Medical Physiology 12/e p266 -### End" -604,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neostigmine can reverse the effect of muscle relaxants in all of the below conditions except, with the following options: A: Blockade by Non Depolarizing muscle relaxants, B: Phase 1 block by Depolarizing muscle relaxants, C: Phase 2 block by Depolarizing muscle relaxants, D: All of the above - -### Response: -Neostigmine is an anticholinesterase used to reverse effects of muscle relaxants in all of the above conditions except for Phase 1 block by depolarizing muscle relaxants. -### End" -605,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secondary action of Inferior oblique, with the following options: A: Intortion, B: Extortion, C: Elevation, D: Depression - -### Response: -Inferior oblique -1o - Extortion -2o - Elevation -3o - Abduction. -### End" -606,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Age of marriage age for women: Gujarat 10, with the following options: A: 16 years, B: 17 years, C: 18 years, D: 21 years - -### Response: -Ans. 18 years Prohibition of Child Marriage Act(2006), and it came into effect on 1 November 2007; states that a girl in India can't marry before the age of 18, and a boy before 21. -### End" -607,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Short acting non deipolarizing blocker -, with the following options: A: Rocurorium, B: Suxamethonium, C: Mivacurium, D: Pancuronium - -### Response: -Ans. is 'c' i.e., Mivacurium SKELETAL MUSCLE RELAXANTSo Skeletal muscle relaxants are drugs that act peripherally at neuromuscular junction/muscle fibre itself or centrally in the cerebrospinal axis to reduce muscle tone.o The neuromuscular blocking agents are used primarily in conjuction with general anaesthetics to provide muscle relaxation for surgery', while centrally acting muscle relaxants are used mainly for painful muscle spasms and spastic neurological conditions.Muscle relaxantsPeripherally actingCentrally acting o Mephenesin congenersNeuromuscular blocking agentsDirectly acting agents# Chlorzoxazone o Dantrolene sodium#ChlormezanoneNondepolarizing (competitive) blockersDepolarizing blockers# Diazepama)Long acting - d. tubocurarine, Pancuronium,o SuccinyIcholineo GABA derivativesDoxacurium, Pipecuroniumo Decamethonium# Baclofenb) Intermediate - Vecuronium, Atracurium o Central a2 - agonistactingcisatracurium, Rocuronium, Rapacuronium# Tizanidinec) Short acting - MivacuriumCompetitive (nondepolarizing) blockers are of two types1. Benzytisoquinolone derivativeso This includes -d-TC, doxacurium, atracurium, cisatracurium, mivacurium, metocurine.o These drugs have tendency to release histamine and to block autonomic ganglion.2. Amminio steroid derivativeso This include pancuronium, rocuronium, vecuronium, pipecuronium, rapacuronium.These drugs do not block autonomic ganglia and have minimal histamine releasing property'. -### End" -608,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organism lacking cell wall:, with the following options: A: Bacillus, B: Actinomycetes, C: Chlamydiae, D: Mycoplasma - -### Response: -Ans: d (Mycoplasma) Ref: Ananthanarayanan, 7th ed, p. 395Mycoplasma are a group of bacteria that are devoid of cell walls and so highly pleomorphic with no size and shape.The cells are bounded by a soft trilaminar unit membrane containing sterols.Cell wall: Between capsule & cytoplasmic membrane-CELL WALL COMPONENTS Gram positiveGram negativePeptidoglycanPeptidoglycanTeichoic acidLipoproteinPolysaccharideLipopolysaccharide Peptidoglycan (mucopeptide or murien)Formed ofN acetyl glucosamine and N acetyl muramic acid.In Gram positive around 40 sheets while inGram negative only 1-2 are present.It provides tensile strength.LipopolysacchrideHas endotoxic activity; released only when cells are lysed.LipoproteinMost abundant part of Gram negative cell wallTeichoic acidMajor antigenic determinantPolymer of ribitol or glycerol -### End" -609,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: WHO guidelines for minimal sperm count is:September 2007, with the following options: A: 10 million/ ml, B: 20 million/ml, C: 50 million/ ml, D: 60 million/ ml - -### Response: -Ans. B: 20 million/mlAccording to WHO guidelines, minimum sperm values of normal sperm areVolume: 2 mlConcentration:20 million/ mlMotility: 50%Normal morphology: 30% -### End" -610,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Compament syndrome is treated by, with the following options: A: Fasciotomy, B: Bicarbonate, C: Chloride rich fluid, D: Early aggressive fluid - -### Response: -A i.e. Fasciotomy -### End" -611,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Natural method of horizontal gene transfer among bacteria includes -, with the following options: A: Electroporation, B: Transduction, C: Transformation, D: Conjugation - -### Response: -TRANSDUCTION: the trannsfer of a poion of the DNA from one bacterium to another by a abactriophage is known as transduction . bacteriophages are viruses that parasitise the bacteria and consist of a nucleic acid core and a protein coat. a phage paicle may have its core beside its own nucleic acid a segment of hostDNA . when this paicle infects another bacterium DNA transfer is effected and the recepient cells acquire new characteristic coded by the donor DNA. it appers to be the most widespread mechanism of gene transfer among prokaryotes and provides an excellent tool for the genetic mapping of bacteria . it has been propsed as a method of genetic engineering in the treatment of some inborn errors of metabolism. REF:Ananthanarayan and Panicker's Textbook ofMicrobiology 8thEdition pg no:63 -### End" -612,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In tissue, Coccidioides immitis produces:, with the following options: A: Spherules and endospores, B: Encapsulated yeast cells, C: Fine, delicate hyphae, D: Coarse, septate hyphae - -### Response: -Ans. is 'a' i.e., Spherules and endospores(Ref: Ananthanarayan, 8th/e, p. 611, 612; Harrison, 18th/e, p. 1643, 17th/e, p. 1244)C. imitis reproduces in host tissue by forming small endospores within mature spherules. -### End" -613,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5 days old, full term male infant was severely cyanotic at bih. PEE was administered initially and later balloon atrial septostomy was done which showed improvement in oxygenation. Most likely diagnosis:, with the following options: A: Tetralogy of Fallot, B: Transposition of great vessels, C: Truncus aeriosus, D: Tricuspid atresia - -### Response: -Transposition of great vessels Transposition of great aeries with an intact ventricular septum is also referred to a simple TGA or isolated TGA. * Cyanosis and tachypnea are most often recognized within hours or day one of life, hypoxemia is severe but hea failure is less common. * Transposition of great aeries with VSD - cyanosis can generally recognized within the { 'l month of life, but it may remain diagnosed in some infants for several months. Treatment - Infusion of prostaglandin E2 should be initiated immediately to maintain patency of the ductus aeriosus and improve oxygenation * Infant who remain severely hypoxic or acidotic despite prostaglandin infusion should undergo Rashkind-halloon atrial septostomy Aerial switch (Jantene) procedure is the surgical treatment of choice for neonates with d-TGA and intact ventricular septum and is usually performed within the 1-2 week of life. Truncus Aeriosus (TA) a single aerial trunk :runcus aeriosus) arises from the hea and supplies the systemic pulmonary and coronary circulation. A VSD is always present Clinical picture - In the immediate newborn period, signs of hea failure are usually absent, a murmur and minimal cyanosis are the initial signs. As a conotruneal lesion, T A is often associated with a deletion of chromosome 22q 11 (DiGeorge syndrome) and associated endocrine immunologic, facial and pulmonary abnormalities Treatment - surgery is indicated usually in the 12 weeks of life Older patients -* Hea -lung transplantation is the only options. -### End" -614,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not abrasion?, with the following options: A: Graze, B: Scratches, C: Impact, D: Avulsion - -### Response: -Ans. is d i.e., Avulsion Types of abrasion are : ? 1) Scratches (linear abrasion) : It is an abrasion with legnth but no significant width produced by a sharp object e.g., pin, needles, knife, thorn and nail etc. Point scratch is a very superficial incision produced by a sharp or pointed object not sharp enough to incise but pointed enough to produce scratch. 2) Grazes (Sliding abrasion/scraping abrasion/grinding abrasion) : It is the most common type of abrasion, produced when a broad surface of skin slides against rough surface, e.g., during vehicular accidents. Injury is due to friction. The surface of injury show irregular parallel lines, i.e., furrows or grooves. A violent lateral graze, due to rubbing of skin (as in dragging) is known as brush burn (Gravel rash). Friction burn (Scuff or brush abrasion) occur due to tangential contact with a smooth surface or when the skin is covered by clothing. It is an extensive superficial, reddened excoriated area without bleeding and with little or no linear mark. 3) Pressure abrasions (crushing or friction abrasions) : Though it is called friction abrasion, it results from pressure of the object on the body with no or little friction (it is a misnomer). It is caused by crushing of superficial epidermis due to inward directed movement of object at around 90deg to skin. Example are ligature marks in hanging/strangulation, teeth bites and nail marks. 4) Impact abrasion (Imprint or contact abrasion) : It is caused by impact (but not pressure) with a rough object, when the force is applied at or near 90deg to skin surface. It is depressed below surface unless associated with contusion (bruise). -### End" -615,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The parasympathetic nervous system has central connections with the brain through all of the following cranial nerves, except?, with the following options: A: III, B: VII, C: X, D: V - -### Response: -The cranial nerves containing preganglionic general visceral efferent components of the parasympathetic system are the oculomotor, facial, glossopharyngeal, and vagus or III, VII, IX, and X, respectively. -### End" -616,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic of chronic eczema is, with the following options: A: Erythema, B: Induration, C: Lichenification, D: Edema - -### Response: -In chronic eczematous conditions, lichenification (cutaneous hyperophy and accentuation of normal skin markings) may alter the characteristic appearance of eczema.Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 71 Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders; Page no: 344 -### End" -617,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young female presented with lacy linear lesions on buccal mucosa since a month with elongation of nail fold beyond the nail bed. What is the diagnosis -, with the following options: A: Psoriasis, B: Geographic tongue, C: Lichen planus, D: Candidiasis - -### Response: -As per the clinical picture, features such as forward growth of nail fold beyond nailbed ( pterygium) and lacy linear lesions on tongue points towards lichen planus. LICHEN PLANUS:-Inflammatory T cell mediated auto immune disorder affecting skin, hair,nails and mucous membranes.Four Ps- purple , polygonal and pruritic papule. Nail finding:-thinning , longitudinal ridging, and distal splitting of nail plate. Pterygium/ forward growth of the proximal nailfold with adherence to the proximal nail plate is a classic sign. Mucosal lichen planus:-Reticular pattern.- Lacy white pattern on buccal mucosa- whitish streaks IADVL textbook of dermatology page 1074 -### End" -618,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The single most common feature in Aphasic patients is, with the following options: A: Agraphia, B: Alexia, C: Anomia, D: Apraxia - -### Response: -(C) Anomia # Clinical Examination of Language should include the assessment of naming, spontaneous speech, comprehension, repetition, reading, and writing.> A deficit of naming (anomia) is the single most common finding in aphasic patients.# Anomic Aphasia:> Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy; and Alzheimer's disease.# Pure Alexia without Agraphia:> This is the visual equivalent of pure word deafness.> The lesions (usually a combination of damage to the left occipital cortex and to a posterior sector of the corpus callosum- -the splenium) interrupt the flow of visual input into the language network. -### End" -619,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about deep palmar arch ?, with the following options: A: Main contribution is by ulnar aery, B: Lie superficial to lumbricals, C: Gives three perforating branches, D: Gives four palmar metacarpal aeries - -### Response: -Deep palmar archIt lies across the base of metacarpal bones. It is formed mainly by radial aery and completed by deep branch of ulnar aery. Its branches are :-Three palmar metacarpal aeries on the II, III and IV palmar interossei muscles to join the digital branches of superficial palmar arch.Three perforating aeries :- Anastomose with dorsal metacarpal aeries.Recurrent branches :- Supply carpal bones and join palmar carpal arch.The deep palmar arch lies deep to the oblique head of adductor pollicis, long flexor tendon and lumbrical muscles and passes across the base of metacarpal and interossei. -### End" -620,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child knows his/her sex by the age of?, with the following options: A: 2 years, B: 3 years, C: 4 years, D: 5 years - -### Response: -O.P. Ghai 7th ed, page 30 -### End" -621,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epidemic typhus cause and vector is, with the following options: A: R. prowazki and louse, B: R. typhi and mite, C: R. conori and tick, D: R. akari and mite - -### Response: -Epidemic Typhus Is a type of rickettsial disease of typhus group : Recrudence form of Epidemic typhus : Brill Zinsser Disease Was the 'most formidable rickettsial disease in past' Causative agent: R.prowazekii Vector : Louse (p.capitis,p.corporis) Mode of Transmission: (Not by Louse bite) Scratching and inoculation with infected louse faeces Crushing infected louse on body Inhalation of infected louse faeces or dust Clinical picture : Prolonged febrile illness, Vasculitis Drug of choice : Tetracycline Under International Health Regulations (IHRs), ""Louse borne typhus is a disease under surveillance"" Ref: Park 25th edition Pgno : 316 -### End" -622,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19 - year - old boy suffering from chronic Schizophrenia is put on haloperidol at the dose of 20 mg/day. A week after the initiation of medication the patient shows restlessness, fidgetiness, irritability and cannot sit still at one place. The most appropriate treatment strategy is:, with the following options: A: Increase in the dose of haloperidol, B: Addition of anticholinergic drug, C: Addition of beta blocker, D: Adding another antipsychotic drug - -### Response: -The history here is suggestive of akathisia AKATHASIA It is a subjectively unpleasant state of inner restlessness where there is a strong desire to move Signs and symptoms: foot stamping when seated constantly crossing/uncrossing legs rocking from foot to foot constantly pacing up and down Prevalence: Higher prevalence with typical antipsychotics Among atypical antipsychotics, most prevalent withAripiprazole Treatment: Beta blockers like propranolol (DOC) Anticholinergics and benzodiazepines can also be used -### End" -623,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In how many flaps is fetal skull opened during autopsy?, with the following options: A: 2, B: 3, C: 4, D: 5 - -### Response: -Ans. is 'c' i.e., 4 In infants and fetuses, before skull ossification and suture closure is complete, the fontanelles can be separated and the skull opened in 4 flaps, in a ""butterfly"" manner.In newborn infants in whom sagittal sinus trauma or developmental abnormalities are suspected, the following alternative cranial opening preserves the critical anatomy.To preserve the superior sagittal sinus, dura is incised at lateral angles of the anterior fontanelle parallel to and approximately 1 cm lateral on both sides of the midline, preserving the superior sagittal sinus in between.Each of these incisions is continued anteriorly and posteriorly (into frontal and occipital bones) and laterally (into the parietal bones) to create two large bone flaps, each on a ""hinge"" of uncut parietal bone inferiorly.In adults, the saw line is made in slightly V - shaped direction - to remove the skull cap. -### End" -624,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient had injury to right leg by road traffic accident and his leg was amputated. This is ?, with the following options: A: Disease, B: Disability, C: Impairment, D: Handicap - -### Response: -Ans. is 'c' i.e., Impairment Any loss of anatomical structure (e.g. loss of leg in this question) is called as impairment. According to WHO definitions, Disease: Any abnormal condition of an individual that impairs function Impairment: Any loss or abnormality of psychological, physiological or anatomical structure or function Disability: (Because of impairment,) any restriction or inability to perform an activity in a range considered normal for a human being Handicap: A disadvantage for a given individual, resulting from an impairment/disability, that limits/prevents fulfillment of a role considered normal (depending on age, sex, social, cultural factors) for that individual For example, Event Classification Interpretation Accident Disease Impairs function of a person Loss of foot Impairment Loss of anatomical structure in the form of foot Cannot Walk Disability Walking is a normal routine daily activity of a human being Unemployed Handicap Loses out his job because he cannot walk, so cannot fulfill his role in the society, i.e, earning for his family members -### End" -625,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vaccine that can be safely given during pregnancy are the following except-, with the following options: A: Tetanus, B: Influena, C: Rubella, D: Pneumpcoccus - -### Response: -.vaccines containing live attenuated strains of viruses such as rubella are not administered during pregnancy duto the immunocompromised statesref:parks textbook,ed22,pg 122 -### End" -626,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The fastest acting schizontocidal drug among the following is:, with the following options: A: Aemether, B: Mefloquine, C: Chloroquine, D: Proguanil - -### Response: -Aemisinin derivatives like dihydroaemisinin, aeether and aemether etc. are fastest acting antimalarial drugs. -### End" -627,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is False about Red Cross emblem-, with the following options: A: It came into existence in 1863 in Geneva meet, B: The veical and horizontal lines are of equal lengths, C: It is used by members of UNO, D: Use of red cross symbol without permission of government of India is a punishable offence in India - -### Response: -Ans. is `c' i.e., It is used by members of UNO Emblems of lin ernational Red Cross and Red Crescent Mo. merit o Emblems simply means symbols. o The emblems (symbols) of International Red Cross and Red Crescent Movement are to be placed on Armed Forces Medical Services (humanitarian & medical vehicles, and buildings) to protect them from military attack on the battlefield. o There are four such emblems :? 1. The Red cross The Red cross on white background was the original protection symbol declared at the 1864 Geneva convention. There is an unofficial agreement within the Red Cross and Red Crescent Movement that the shape of the cross should be a cross made up of 5 squares. (Horizontal and veical lines are equal). However, regardless of shape. any Red Cross on white background should be valid and must be recognized as a protection symbol in conflict. o Of the 186 national societies which are currently recognized by ICRC, 152 are using the Red Cross as their official organization emblem. 2. Red crescent Red crescent on white background is used by 33 of the 186 recognized societies world wide. 3. Red crystal (the third protocol emblem) o On 22 June 2006 the ICRC announced that the International Red Cross and Red Crescent Movement adopted the Red Crystal as additional emblem for use by the National societies. 4. Red Lion and Sun No longer in use o All these emblems (symbols) are under the Geneva conventions. kuthorimi users of emblems 3 The authorized users of emblems are ? 1) The armed forces medical services, their personnel units, installations and means of transpo. ii) !CRC (International cornmitte of Red Cross) iii) I FRC (International Federation of Red Cross & Red Crescent Socies) iv) National Red Cross Society. v) First Aid centers that offer totally free medical assistance & are authorized by National Red Cross / Red Crescent Society. Misuse of emblems o Misuse of emblems is prohibited under the 4 Geneva Conventions of 1949. o Under the Indian Law (Geneva conventions Act, 1962), the abuse of the emblems is a pubishable offence. The punishment is a fine of Rs. 500, besides the provision for forfeiture of the goods or vehicles on which the emblem has been used without authorization. -### End" -628,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child with an abdominal mass diagnosed of having Wilms tumour. The child may have all of the following features associated with Wilms tumour, EXCEPT:, with the following options: A: Aniridia, B: Hemihyperophy, C: Hypeension, D: Bilateral polycystic kidney - -### Response: -Horseshoe kidney is associated with Wilms tumor not bilateral polycystic kidney. In a few children, Wilms tumor occurs in the setting of associated malformations or syndromes, including, Aniridia Hemihyperophy Genitourinary malformations Cryptorchidism Hypospadias Gonadal dysgenesis Pseudohermaphroditism Horseshoe kidney Beck-with-Wiedemann syndrome Denys-Drash syndrome WAGR syndrome (Wilms tumor, aniridia, ambiguous genitalia, mental retardation) Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e. -### End" -629,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heart failure with preserved ejection firaction-, with the following options: A: Dilated cardiomyopathy, B: Restrictive cardiomyopathy, C: MI, D: Hypertension - -### Response: -Ans. is 'b' i.e., Restrictive cardiomyopathy o Diastolic heart failure (DHF) is a clinical syndrome in which patients have:Symptoms and signs of heart failure (HF)Normal or near normal left ventricular (L Vi ejection fraction (EF)Normal or near normal L V volume,, and evidence of diastolic dysfunction (e.g., abnormal pattern ofL Vfilling and elected filling pressures).o By contrast, systolic heart failure (SHE) is characterized by increased L V volume and reduced EF.o Among all patients with HF, as many as half have a normal or near normal LVEF.o This condition has been termed ""heart failure with normal ejection fraction "" (HFNEF) or""heart failure with preserved ejection fraction "" (HF-PEFEtiologies of Heart FailureDepressed Ejection Fraction (<40%)o Coronary artery diseaseMyocardial infarctionaMyocardial ischemiaaoChronic pressure overloadHypertensionaObstructive valvular diseaseao Chronic volume overloadRegurgitant valvular diseaseIntracardiac- (left-to-right) shuntingExtracardiac shuntingo Nonischemic dilated cardiomyopathyFamilial/genetic, disordersInfiltrative disorders3o Toxic/drug induced damageMetabolic disorder3Viralo Chagas diseaseo Disorders of rate and rhythmChronic tachyarrhythmiasChronic tachyarrhythmiasPreserved Ejection Fraction (>40-50%)o Pathologic hypertrophy# Primary (hypertrophic cardiomyopathies)o Agingo Restrictive cardiomyopathy# Infiltrative disorders (amyloidosis sarcoiodosis)o Fibrosiso Endomyocardial disordersPulmonary Heart DiseaseCor pulmonalePulmonary vascular disorders High-Output States# Metabolic disordersThyrotoxicosisNutritional disorders (beriberi)o Excessive blood-flow requirementsSystemic arteriovenous shuntingChronic anemia -### End" -630,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apple–jelly nodules are seen in –, with the following options: A: Lupus vulgaris, B: DLE, C: Lichen planus, D: Psoriasis - -### Response: -""Apple jelly nodules"" : - Characterized by yellow-brown nodules with tiny darker granules. On probing, the nodules are soft jelly-like seen in cutaneous TB infection Lupus vulgaris. -### End" -631,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true for yellow fever EXCEPT, with the following options: A: Caused by vector aedes, B: Incubation period of 3-6 days, C: One attack gives life long immunity, D: Validity of vaccination certification begins immediately after vaccination - -### Response: -Ans. (d) Validity of vaccination certification begins immediately after vaccinationRef : K. Park 23rd ed. /121, 283 -### End" -632,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are characteristic features of treatment of iron deficiency anemia with oral iron supplements, except:, with the following options: A: If 200-300 mg elemental iron is consumed, about 50 mg is absorbed, B: The propoion of iron absorbed reduces as hemoglobin improves, C: The reticulocyte count should begin to increase in two weeks and peak in 4 weeks --this suggests good response to treatment, D: The treatment should be discontinued immediately once hemoglobin normalizes to prevent side effects of iron. - -### Response: -A total of200mg given daily in three divided doses produces the maximal haemopoietic response. Iron therapy should be continued for 3-6 months after the correction of deficiency in order to replenish the iron stores. From medical pharmacology padmaja 4th edition page 328 and essential of medical pharmacology K D Tripati 7th edition page no 603 -### End" -633,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are adverse effects of aminoglycosides except:, with the following options: A: Nephrotoxicity, B: Ototoxicity, C: Neuromuscular blockade, D: Cholestatic jaundice - -### Response: -Cholestatic jaundice is seen with usage of Erythromycin (a macrolide) not aminoglycosides. -### End" -634,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cervical hostility is tested by following except :, with the following options: A: Spinbarkeit, B: Post coital test, C: Miller kuzrole test, D: Keller test - -### Response: -Ans. is d i.e. Keller test As explained in question no 15, Post coital test and Miller kurzrok test can detect cervical hostility as noted by rotatory/shaky movement of the sperm in post coital test, or < 3 cm of penetration of cervical mucus in 30 minutes in miller kurzrok test. Spinbarkeit is basically a test for assessing ovulation :At the time of ovulation, the cervical mucus is thin and so profuse that the patient may notice a clear discharge, (called Normal ovulatory cascade). This ovulatory mucus has the propey of great elasticity and will withstand stretching up to a distance of over 10 cm. This phenomenon is called SPINBARKEIT, or thread test for oestrogen activity. Under the influence of progesterone after ovulation mucus becomes thick and opaque and breaks on stretching i.e. hostile for sperms Therefore, indirectly Spinbarkeit test can also detect cervical hostility. -### End" -635,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A girl presented with severe hyperkalemia and peaked T waves on ECC. Most rapid way to decrease serum potassium level:, with the following options: A: Calcium gluconate IV, B: Oral resins, C: Insulin + glucose, D: Sodium bicarbonate - -### Response: -Ans. c. Insulin + glucose Administering insulin and glucose are the most rapid way to decrease serum potassium level.""Intravenous insulin is the fastest way to lower serum potassium levels.""""Intravenous calcium gluconate is the first drug to he administered in a patient with hyperkalemia having ECG abnormalities. It stabilizes the myocardium immediately. It acts within minutes and is characterized by improvement in ECG appearance. ""Complaints of muscle weakness, nausea, vomiting and fatigue and ECG showing tall peaked T waves, prolonged PR interval, wide QRS and absent P wave is suggestive of Hyperkalemia, Beta-agonists are used in the management of hyperkalemia, not the beta-blockers.ECG changesHypokalemiaHyperkalemia* ST depressionQ* Flattened or inverted T waveQ* Prominent U waveQ* Prolonged PR intervalQ* Rarely S-A blockEarly* Increased T wave amplitudeQ* Peaked T wavesQLater (with severe degrees of hyperkalemia)* Prolonged PR intervalQ* Prolonged QRS durationQ* AV conduction delayQ* Loss of P wavesQ* Sine wave patternQ* Ventricular fibrillation or asystoleQHyperkalemiaHyperkalemia is defined as plasma K+ conc. > 5.0 mmol/L, but every case of Hyperkalemia doesn't require treatment.The management strategy of Hyperkalemia depends upon:Plasma K+ concentrationAssociated muscular weaknessChanges on ECGTreatment of Hyperkalemia is required in following cases:Serum K+ >5 along with ECG manifestation of HyperkalemiaSerum K+ >6 (even when ECG manifestation are not present)In Hyperkalemia the treatment is directed atMinimizing membrane depolarizationRedistribution of potassium (shifting of K+ back into cells)Increased excretion of potassium* Administration of calcium in the form of calcium gluconate, decreases membrane excitabilityQ* Calcium directly reverses the effect of potassium on the cardiac conduction systemQ* Administering insulin and glucose* Alkali therapy with I.V. NaHCO3Q* Beta2 adrenergic agonistQ* (When administered parenterally or in nebulized form, beta2 adrenergic agonist promote cellular uptake of K+)Q* Cation exchange resinQ (Sodium polystyrene sulfonate)* Diuretics (Enhance K+ excretion)Q* Hemodialysis (Most effective and rapid way of lowering plasma K+ conc.)Q -### End" -636,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following changes occur in urinary system in pregnancy except :, with the following options: A: Increased GFR, B: Increased RBF, C: Hyperophy of bladder musculature, D: Increased activity of ureters - -### Response: -URINARY SYSTEM: Kidney--There is dilatation of the ureter, renal pelvis and the calyces. The kidneys enlarge in length by 1 cm. RBF is increased by 50-75%, maximum by the 16 weeks and is maintained until 34 weeks. Thereafter it falls by 25%. Glomerular filtration rate (GFR) is increased by 50% all throughout pregnancy. Increased GFR causes reduction in maternal plasma levels of creatinine, blood urea nitrogen (BUN) and uric acid. Renal tubules fail to reabsorb glucose, uric acid, amino acids, water soluble vitamins and other substances completely. Ureter: Ureters become atonic due to high progesterone level. Dilatation of the ureter above the pelvic brim with stasis is marked on the right side specially in primigravidae. It is due to dextrorotation of the uterus pressing the right ureter against the pelvic brim and also due to pressure by the right ovarian vein which crosses the right ureter at right angle. The stasis is marked between 20-24 weeks. There is marked hyperophy of the muscle and the sheath of the ureter specially the pelvic pa probably due to estrogen. There is elongation, kinking and outward displacement of the ureters. Bladder: There is marked congestion with hyper-trophy of the muscles and elastic tissues of the wall. In late pregnancy, the bladder mucosa becomes edematous due to venous and lymphatic obstruction especially in primigravidae following early engagement. Increased frequency of micturition is noticed at 6-8 weeks of pregnancy which subsides after 12 weeks. It may be due to resetting of osmoregulation causing increased water intake and polyuria. In late pregnancy, frequency of micturition once more reappears due to pressure on the bladder as the presenting pa descends down the pelvis. Stress incontinence may be observed in late pregnancy due to urethral sphincter weakness. Reference: Dutta's Textbook of Obstetrics 7th edition page 54 -### End" -637,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hallucinogen is considered as angel dust?, with the following options: A: LSD, B: Phencyclidine, C: Heroin, D: Mescaline - -### Response: -PCP works primarily as an NMDA receptor antagonist Sma name for phencyclidine is angel dust which is a hallucinogen Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 330-336 -### End" -638,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which drug of anaesthetics causes hallucination –, with the following options: A: Ketamine, B: Trilene, C: Halothane, D: Trichloroethylene - -### Response: -Ketamine causes emergence reaction (emergence delirium) and hallucination. -### End" -639,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tentative cut is indicative of -, with the following options: A: Homicide, B: Accidental, C: Suicidal, D: Fall from height - -### Response: -Hesitation cuts (Tentative cuts or trial cuts) are characteristic features off suicidal attempt. -### End" -640,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a 6-year-old child with burns involving the whole of head and trunk, estimated body surface area of burns is:, with the following options: A: 44%, B: 52%, C: 55%, D: 58% - -### Response: -Ans. (a) 44%6 year old child:Apply Berkow formula:* Head and Trunk =13% for head +13% for anterior trunk +13% for posterior trunk +2% neck* Total =41% - nearby answer =40% -### End" -641,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Myasthenia gravis is most commonly associated with which of the following?, with the following options: A: Thymoma, B: Thymic carcinoma, C: Thymic hyperplasia, D: Lymphoma - -### Response: -Myasthenia gravis Autoimmune disease with fluctuating muscle weakness that is caused by autoantibodies that target the neuromuscular junction. About 85% of patients have autoantibodies against post-synaptic ACh receptors, while most of the remaining patients have antibodies against the sarcolemmal protein muscle-specific receptor tyrosine kinase. C/F: - Ptosis or diplopia (Weakness in extraocular muscle) There is a strong association between pathogenic anti-ACh receptor autoantibodies and thymic abnormalities. Approximately 10% of patients with myasthenia gravis have a thymoma, a tumour of thymic epithelial cells. An additional 30% of patients (and paicularly young patients) have a different thymic abnormality called thymic hyperplasia. Acetylcholinesterase inhibitors that increase the half-life of ACh are the first line of treatment. -### End" -642,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First clinical feature of cerebello-pontine angle tumor is ?, with the following options: A: Reduced lacrimation, B: Loss of corneal reflex, C: Hoarseness of voice, D: Exaggerated tendon reflexes - -### Response: -Answer- B. Loss of corneal reflexAbsent corneal reflex is the earliest sign of cerebellopontine (CP) angle tumors like acoustic neuroma. -### End" -643,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What disappears first in post mortem rigidity -, with the following options: A: Eyelids, B: Neck, C: Lower limbs, D: Upper limbs - -### Response: -Rigor mortis passes off in same order in which it has appeared. Thus upper eyelid is the first voluntary muscles, from which it disappears. -### End" -644,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest complication of CSOM is, with the following options: A: Subperiosteal abscess, B: Mastoiditis, C: Brain abscess, D: Meningitis - -### Response: -50% of brain abscesses in adults and 25% in children are otogenic in origin. In adults, an abscess usually follows CSOM with cholesteatoma. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 90) -### End" -645,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 54-year-old woman with rheumatoid arthritis presents with a 2-year history of dry eyes and dry mouth. Physical examination confirms xerostomia (dry mouth) and xerophthalmia (dry eyes) and reveals enlarged lacrimal glands bilaterally. Histologic examination of the lacrimal glands would likely show an infiltrate of which of the following inflammatory cell types?, with the following options: A: Fibroblasts, B: Lymphocytes, C: Macrophages, D: Mast cells - -### Response: -This patient has Sjogren (sicca) syndrome, an autoimmune disease characterized by an intense lymphocytic infiltration of the salivary and lacrimal glands. Patients develop xerostomia and xerophthalmia. The other choices are not characteristic of autoimmune disease.Diagnosis: Sjogren syndrome -### End" -646,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Eustachian tube -, with the following options: A: Length is 36 mm in adults and 1.6 mm to 3 mm in children, B: Higher elastin content in adults, C: Ventilatory function of ear better developed in infants, D: More horizontal in adults - -### Response: -“Eustachian tube serves to ventilate the middle ear and exchange nasopharyngeal air in the middle ear. In children, ET is relatively narrow. It is prone to obstructionQ when mucosa swell in response to infection or allergic challenge and it results in middle ear effusion” -### End" -647,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A boy complained of unprovoked bite by a local dog in the community. The dog was later caught by the local animal authorities and appeared to the healthy. The most appropriate course of action would be:, with the following options: A: Give post-exposure prophylaxis to the bitten person with cell-culture derived vaccine, B: Withhold vaccination, keep the dog under observation for ten days for signs of rabies, C: Test the dog for rabies antibodies, D: Immediately carry out euthanasia of the dog - -### Response: -The boy should be treated irrespective of the condition of the dog with PEP including vaccination and local wound treatment, Immunoglobulins may be used in Category 3 bite. The dog should be observed for 10 days, and if the dog remains healthy throughout the period, PEP may be discontinued. However, PEP should NOT be withheld. -### End" -648,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In disaster management all are true except-, with the following options: A: Mitigation before a disaster strikes, B: Response in pre-disaster phase, C: Yellow color is for medium priority, D: Gastroenteritis is commonest infection after disaster - -### Response: -Disaster management -Management sequence of a sudden-onset disaster is as follows:- -a) Risk reduction phase before a disaster strikes -It includes:- - -Mitigation: Measures designed either to prevent hazards from causing emergency or to lessen the likely effect of emergencies. -Preparedness: To ensure that appropriate systems, procedures and resources are in place to provide prompt effective assistance to disaster victims. - -b) Disaster Impact - -Most injuries are sustained during the impact, and thus greatest need for emergency care occurs in first few hours. - -The management can be divided into - -Search, rescue and first aid: Most immediate help comes from uninjured survivors. -Field care: As many injured patients come simultaneously, emergency services should be proper in terms of priorty and numbers of facilities. -Triage: Triage consists of classifying the injured on the basis of severity of injuries and the likely hood of their survival with prompt medical intervention. - -The most common triage classification system used internationally is four colour code system -i) Red → High priority treatment or transfer -ii) Yellow → Medium priority -iii) Green → Ambulatory patients -iv) Black → Dead or moribund patients -4. Tagging : All patients should be identified with tags. -5. Identification of dead : Proper respect to dead is of great importance. -c) Recovery phase after disaster  -It includes :- -Response : Response starts with disaster impact and extends in recovery phase. -Rheabilitation and reconstruction : These should lead to restoration of pre-disaster condition - -The ‘control room’ is nodal center in terms of disaster management. -The diseases common after a disaster are: Gastroenteritis (most common), acute respiratory infections (pneumonia), leptospirosis, rabies, equine encephalitis and rickettsiosis. -### End" -649,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding somatization disorder except:, with the following options: A: Maintain sick role, B: 4-Pain symptoms, C: 1-Sexual symptom, D: 1-Pseudo neurological symptom - -### Response: -Ans:A-Maintain sick roleSomatic symptom disorder (SSD formerly known as ""somatization disorder"" or ""somatoform disorder"") is a form of mental illness that causes one or more bodily symptoms, including pain.The symptoms may or may not be traceable to a physical cause including general medical conditions, other mental illnesses, or substance abuse. But regardless, they cause excessive and dispropoionate levels of distress.The symptoms can involve one or more different organs and body systems, such as:PainNeurologic problemsGastrointestinal complaintsSexual symptomsMany people who have SSD will also have an anxiety disorder.People with SSD are not faking their symptoms. The distress they experience from pain and other problems they experience are real, regardless of whether or not a physical explanation can be found. And the distress from symptoms significantly affects daily functioning. -### End" -650,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aerial supply to middle l/3rd of vagina is by ?, with the following options: A: Internal pudendal aery, B: Uterine aery, C: Inferior vesical aery, D: Middle rectal aery - -### Response: -Ans. is 'c' i.e., Inferior vesical aeryAerial supply of vaginaVaginal branch of internal iliac (main supply)Cervicovaginal branch of uterine aery (in upper pa).Middle rectal and internal pudendal aeries (in lower pa).Inferiorvesical aery (in middle 3rd). -### End" -651,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for pregnancy induced hypertension is:, with the following options: A: Methyl dopa, B: Atenolol, C: Nitroprusside, D: Enalapril - -### Response: -Ans. (A) Methyl dopa(Ref: Goodman Gilman 12th/e p773, 774; Katzung 12th/e p176)Alpha methyl dopa is drug of choice for pregnancy induced hypertension. However, these days labetalol is preferred for this indication. -### End" -652,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When there is no other source of glucose, liver and muscle glycogen would be exhausted after, with the following options: A: 12 hours, B: 18 hours, C: 24 hours, D: 36 hours - -### Response: -Were there no other source of glucose, liver and muscle glycogen would be exhausted after about 18 hours of fasting. As fasting becomes more prolonged, so an increasing amount of the amino acids released as a result of protein catabolism is utilized in the liver and kidneys for gluconeogenesis. Reference: Harper; 30th edition; Chapter 14; Page no: 149 -### End" -653,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transition from G2 to M phase of the ceil cycle is controlled by, with the following options: A: Retinoblastoma gene product, B: p53 protein, C: CyclinE, D: CyclinB - -### Response: -. CyclinB -### End" -654,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Frieberg's disease involve -, with the following options: A: Tibial tuberosity, B: Calcaneal tuberosity, C: 2nd metatarsal, D: 5th metarasal - -### Response: -*Frieberg's disease is osteochondritis of 2nd metatarsal head. Ref: Appley's 9th/e p.723 -### End" -655,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disc edema is not seen in:, with the following options: A: Retro bulbar neuritis, B: Papillitis, C: Papilledema, D: Optic nerve glioma - -### Response: -Retro bulbar neuritis REF: Neuro-ophthalmology: the practical guide, By Leonard A. Levin page 101 Optic Disc Edema: Possible diagnostic consideration of appearance of optic disc edema is to determine whether the disc edema is pathological or just the disc itself is congenitally elevated (Pseudopapilledema). A reliable indicator of Pseudopapilledema is the presence of anomalous vessels on the disc. Now if disc is truly swollen then its turn to decide, it is due to increased ICT (papilledema) or any other cause of disc edema. Unilateral Visual Increased Anomalous Broad category Examples or Bilateral function ICT vessels Generally bilateral Normal No Yes Pseudopapilledema Pseudopapilledema (aka-Optic Disc Drusen- congenital & asymptomatic) Bilateral Normal Yes No Papilledema Papilledema Either Normal No No Disc edema with preserved vision Diabetic papillopathy Aerial hypeension Papillophlebitis Either Abnormal No No Disc edema with abnormal vision Optic neuritis (Papillitis) Neuroretinitis Optic nerve tumors Optic nerve glioma Optic nerve sheath meningioma Anterior ischemic optic neuropathy -### End" -656,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The given instrument is used for harvesting the graft from healthy area in split skin thickness graft. What is this called?, with the following options: A: Humby knife, B: Silvers knife, C: Dermatome, D: Catlin amputating knife - -### Response: -Ans. A. Humby knife* This is a ""Humby"" skin-grafting knife, formerly owned by Sir Edward ""Weary""Dunlop, and made in 1950s.Silver's knifeBrown dermatome -### End" -657,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to disabilities ACT 1995. Seventh disability is usually refferred to as ?, with the following options: A: Neurological abnormality, B: Mental illness, C: Substance abuse, D: Disability due to road traffic accident - -### Response: -Mental illness According to disabilities act 1995, the disabilities are:- i) Blindness ii) Low vision iii) Leprosy cured iv) Hearing impairment v) Locomotor disability vi) Mental retardation vii) Mental illness -### End" -658,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sprinter gets its immediate energy from -, with the following options: A: Glycogen, B: Fatty acid, C: Creatine phosphate, D: None - -### Response: -Ans. is 'c' i.e., Creatine phosphate Source of energy for muscular activityo The immediate source of energy for all muscle contraction is ATP, followed immediately by creatine phosphate6. In stemous exercise ATP store is sufficient only for 1-2 seconds and creatine phosphate for another 5-7 seconds. Thus, energy rich phosphagen stores (ATP and creatine phosphate) permit severe muscle contraction for 8-10 seconds only. After this, energy is obtained from the metabolism of stored glycogen or from circulating glucose and free fatty acids, depending upon the availability- of oxygen. Energy source during in exercise can be summarized by : -Short burst of intense activity (e.g., 100 meter sprint or weight lifting) : - All energy comes from ATP and creatine phosphateQ. Breakdown of these compound is an anaerobic processesQ.Little longer intense exercise (e.g., 200 m eter sprint or 100 meter swim): - Besides ATP and creatine phosphate, glycogen is metabolised by anerobic6 glycolytic pathways to provide a ready source of energy. So, muscle work is anaerobic.in) Longer duration exercise (e.g., jogging, marathan run) : - The muscle w ork is aerobic and energy comes from aerobic utilization of glucose and free fatty acids. More glucose is utilized at the initial stage, but as the exercise is prolonged, free fatty acids become the predominant fuelQ. -### End" -659,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fever & hemorrhagic rash are seen in ail except:, with the following options: A: Dengu fever, B: Lassa fever, C: Rift Valley fever, D: Sand fly fever - -### Response: -Ans: D (Sand,.) [Ref: Ananthanarayan 8th/514.518-19; Harrison 18th/l50,1629; Medical microbiology by Greenwood 16 th /4961The viral HF syndrome is a constellation of findings based on vascular instability and decreased vascular integrity. An assault, direct or indirect, on the microvasculature leads to increased permeability and (particularly when platelet function is decreased) to actual disruption and local hemorrhage""Dengue (breakbone fever) Q is a mosquito-borne infection caused by a flavivirus that is characterized by fever, severe headache, muscle and joint pain, nausea and vomiting, eye pain, and rash""-Harrison 18th/1632""Lassa fever: The disease is characterized by very high fever, mouth ulcers, severe muscle aches, skin rash with hemorrhages, pneumonia, and heart and kidney damage""- Harrison 18th/1628Viral hemorrhagic feverArboviruses and arenavirusesPetechial rash Residence in or travel to endemic areas or other virus exposureTriad of fever, shock, hemorrhage from mucosa or gastrointestinal tractTable (Harrison 18th/1629): Viral Hemorrhagic Fever (HF) Syndromes and Their DistributionDiseaseIncubation Period, DaysCase-Infection RatioCase-Fatality Rate, %Geographic RangeTarget PopulationLasso fever-5-16Mild infections probably common15West AfricaAll ages, both sexesRift Valley fever2-5~1:100a~50Sub-Saharan Africa, Madagascar. EgyptAll ages, both sexes; more often diagnosed in men; preexisting liver disease may predisposeCrimean-Congo HF3-12>1:515-30Africa, Middle East, Turkey, Balkans, southern region of former Soviet Union, western ChinaAll ages, both sexes: men more exposed in some settingsYellow fever3-61:2-1:2020Africa, South AmericaAh ages, both sexes; adults more exposed in jungle setting; preexisting flavivirus immunity may cross-protectDengue HF/dengue shock syndrome2-7Nonimmune, 1:10,000; heterologous immune, 1:100<1 with supportive treatmentTropics and subtropics worldwidePredominantly children: previous heterologous dengue infection predisposes to HF -### End" -660,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vascular sign of narath is seen in-, with the following options: A: Dislocation of hip, B: Dislocation of knee, C: Dislocation of elbow, D: Dislocation of shoulder - -### Response: -Vascular sign of Narath *Normally femoral pulse is felt in the groin against head of the femur. *In posterior dislocation of hip the vessels fall back unsuppoed, so femoral aerial pulsation, which isn't felt against the head of the femur will be feeble or even, may not be palpable. Ref: Textbook of Ohopaedics by kotwal p.25 -### End" -661,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Balthazar scoring system is used for?, with the following options: A: Acute Pancreatitis, B: Acute Appendicitis, C: Acute Cholecystitis, D: Cholangitis - -### Response: -ANSWER: (A) Acute PancreatitisREF: REF: Schwartz 9th ed chapter 33, Sabiston 18th ed chapter 55, The Washington Manual of Critical Care by Marin Kollef page 418See ""ASSESSMENT OF SEVERITY OF PANCREATITIS"" in Surgery 2012 Session 2 -### End" -662,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: EDD ( Expected Date of Delivery) is calculated by:, with the following options: A: Young's rule, B: Naegele's formula, C: Cardiff Formula, D: Hadlock Formula - -### Response: -Expected date of delivery is calculated by - Naegele's formula From the 1st day of last menstrual cycle - 9 months + 7 days -### End" -663,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Greenstick/ Nightstick fractures are seen in -, with the following options: A: Children, B: Elderly, C: Young adults, D: Common in all age groups - -### Response: -Ans. is 'a' i.e., Children Greenstick fractureso A greenstick fracture is an incomplete transverse fracture pattern seen in childreno Greenstick fractures occur when an injuring force applied to a bone exceeds the limits of elasticity of the bone. This results in the bone's bending to the point of bony disruption and fracture on the side opposite to the applied forceo However, a green-stick fracture is an incomplete fracture, in which the compressed cortex and periosteum remain intact.o Greenstick fractures of radius-ulna are common fractures in children and often result from a fall on a outstretched hands. -### End" -664,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best time for hearing assessment in an infant -, with the following options: A: 1st month of life, B: 3-6 months, C: 6-9 months, D: 9-12 months - -### Response: -Ans. is 'a' i.e., 1st month of lifeo The American Academy of Pediatrics (AAP), Joint Committee on Infant hearing (2007), has recommended that all newborn infants be screened for hearing impairment either as neonate or before 1 month of age and that those infants who fail newborn screening have an audiologic examination to varifv hearing loss before age of 3 months. -### End" -665,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The maximum number of death in children occur in following age group -, with the following options: A: 2-5 years, B: 1-2 years, C: first 7 days, D: 6 months - 12 months - -### Response: -Ans. is 'c' i.e., First 7 days -### End" -666,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Russel bodies are seen in, with the following options: A: Lymphocytes, B: Monocytes, C: Macrophages, D: Plasma cells - -### Response: -*Multiple myeloma is plasma cells disorder. These plasma cells may have intracytoplasmic inclusion called as Russel bodies and intranuclear inclusions called as Dutcher bodies. -### End" -667,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most severe form of Ehler Danlos syndrome is, with the following options: A: Type 1, B: Type 8, C: Type 4, D: Type 2 - -### Response: -Ehlers danlos syndrome *A genetic defect in the synthesis of fibrillar collagen*Of all the types, type IV (vascular type) is the most severe form as it involves internal organs*Common type - Type VI (kyphoscoliosis type) caused due to a defect in lysyl hydroxylase*Type VII - defect in type 1 collagen*Type IV - Defect in type 3 collagen*Type I and II - Defect in type 5 collagen ( Ref: Robbins 8/e p146) -### End" -668,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 32-year-old man presents with abdominal pain. On examination, he is noted to have pigmented spots in the buccal region. He is diagnosed to have Peutz-Jeghers syndrome, which also results in what? SELECT ONE., with the following options: A: Optic neuroma, B: Constricted pupil, C: Cerebellar dysfunction, D: Hamartomatous polyps in the small intestine - -### Response: -In Peutz-Jegher syndrome, pigmented melanin spots are found in the buccal and perineal region. The lesions are flat and greenish black in the buccal region and remain after puberty. Pigmentation is found inside the mouth, nostrils, palms, and feet. Usually at about 20-30 years of age, hamartomatous polyps are found in the small intestine, but other parts of the alimentary tract may also be involved. Adenocarcinoma develops in 23% of patients. -### End" -669,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: pH of polycarboxylate liquid is:, with the following options: A: 5, B: 7, C: 8, D: 1.7 - -### Response: -Biocompatibility -Pulpal response is classified as mild. Despite the initial acidic nature of polycarboxylate cement, the pH of the liquid is 1.0-1.07 and that of freshly mixed cement is 3.0-4.0. After 24 hours, pH of the cement is 5.0-6.0. -They are less irritant than zinc phosphate cement because: - -The liquid is rapidly neutralized by the powder. The pH of polycarboxylate cement rises more rapidly than that of zinc phosphate. -Penetration of polyacrylic acid into the dentinal tubules is less because of its higher molecular weight and larger size. The histological reactions are similar to zinc oxide eugenol cements but more reparative dentine is observed with polycarboxylate. - -Ref: Manappalil P;97 -### End" -670,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common chromosomal defect is:, with the following options: A: Down's, B: Turner, C: Edward, D: Patau - -### Response: -Ans: a (Downs) Ref: Robbins, 7th ed, p. 175Down's syndrome is the most common of the chromosome disorders and a major cause of mental retardation.Cytogenetic abnormalityNon disjunction (MC) = 95%Translocation (robertsonian) = 4 %Mosaicism = 1%Increased maternal age is the main risk factor .Translocation carriers carry high recurrence risk.Clinical features:Cardiac - endocardial cushion defect (MC)HypotoniaGIT - duodenal atresia, TEF, IHPS, Hirschprung disease, annular pancreasMental retardationShort statureMusculoskeletal system - atlantoaxial dislocationMicrocephaly/ brachycephalyRespiratory - recurrent aspiration pneumoniaOpen AFEndocrine - primary gonadal defect, hypothyroidismOblique palpebral fissureHaematopoietic - increased ALL and AMLBmshfield spot. But AML has a betterprognosis than normal individualsDepressed nasal bridgesLow set earsCNS alzhiemers in patients older than 40 yearsShort neck Simian crease,clinodactyly Sandal gap between 1st and 2nd toes Kennedy crease -### End" -671,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Botulism is a disease of: -, with the following options: A: Neural transmission caused by the toxin of the bacterium Clostridium botulinum, B: Muscular transmission caused by the toxin of the bacterium Clostridium botulinum, C: Neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum, D: Non neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum - -### Response: -Neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum leads to botulism. C. botulinum produces powerful neurotoxin 'botulinum toxin'(BT). Botulinum toxin is absorbed from the gut, enters the blood circulation, and binds to receptors of presynaptic membranes of motor neurons of PNS and cranial nerves. The toxin does not cross the blood brain barrier or affect the central nervous system. Botulinum toxins act by blocking the release of acetylcholine at synapses and neuromuscular junction- resulting in lack of muscle contraction and flaccid paralysis. C/F - Flaccid ,symmetrical cranial nerve palsy -blurred vision, loss of pupilary reflexes. Symmetrical flaccid descending motor paralysis - Quadriparesis. -### End" -672,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are cestodes EXCEPT, with the following options: A: Treponema pallidum, B: Echinococcus, C: Taenia solium, D: Taenia saginata - -### Response: -Ref: Harrisons 19th ed. pg. 1146; table 245e1* Cestodes are helminthes. Example of cestodes:CestodesIntermediate hostDefinitive hostTaenia soliumPigManTaenia saginataBeefManEchinococcus granulosusMan, camels and sheepDogEchinococcus multilocularisRodents and humansFoxes, dogs and catsH. nanaManManD. latumCyclops, fresh water fishManNote: Treponema pallidum is a spirochete -### End" -673,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of red infarction? September 2010, with the following options: A: Venous occlusion, B: Occurs in organs having dual circulation, C: Occurs in solid organs, D: Occurs in previously congested tissues - -### Response: -Ans. C: Occurs in solid organsRed infarctions (hemorrhagic infarcts), generally affect the lungs or other loose organs (testis, ovary, small intestines). The occlusion consists more of red blood cells and fibrin strands.Characteristics of red infarcts include: occlusion of a vein; loose tissues that allow blood to collect in the infarcted zone; tissues with a dual circulatory system (lung, small intestines); tissues previously congested from sluggish venous outflow; and reperfusion (injury) of previously ischemic tissue that is associated with reperfusion-related diseases such as - Myocardial infarction, stroke (cerebral infarction), shock-resuscitation, replantation surgery, frostbite, burns and organ transplantation. -### End" -674,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute corneal hydrops is seen in: September 2009, with the following options: A: Cornael dystrophy, B: Anterior staphyloma, C: Interstitial keaitis, D: Keratoconus - -### Response: -Ans. D: KeratoconusCorneal hydrops is an uncommon complication seen in patients with keratoconus.It is characterized by significant corneal edema resulting from a spontaneous rupture in Descemet's membrane.Clinical findings include dense stromal and epithelial edema with corneal protrusion, possible conjunctival hyperemia and irregular epithelium secondary to microcystic edema.The location and area of the involved cornea is variable -### End" -675,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 24 year old man gets married with 14 year old female. Having sex with her will be considered rape because :, with the following options: A: No consent taken from wife, B: Wife age < 14 year, C: Wife age < 15 year, D: Wife age < 17 year - -### Response: -C i.e. Wife age < 15 years -### End" -676,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gamma waves of REM sleep in sleep cycle are associated with -, with the following options: A: Intense attention, B: Subconscious thinking, C: Deep subconscious thinking, D: Deep sleep - -### Response: -Ans is 'a' i.e. Intense attention ""Beta and gamma waves (20-80Hz) occur spontaneously during REM sleep and waking and are evoked by intense attention, conditioned responses, tasks requiring fine movements and sensory stimuli."" - The Neuroscience of Sleep, p.24 EEG rhythms (Berger's rhythm) and sleep wake cycle 1) Alpha rhythm: - In adult humans who are awake but at rest with mind wandering and the eye closed, a-rhythm is prominent. It is a regular rhythm with a frequency of 8-13 Hz and amplitude of 50-100 m V. It is most marked in parietal and occipital lobe. It is associated with decreased level of attention, i.e., person is awake but has decreased attention (relaxed) - Person is thinking but with decreased attention (subconscious thinking). 2) Beta rhythm:- When attention is focused on something, the alpha rhythm is replaced by Beta rhythm. It is an irregular 13-30 Hz low voltage activity. It is most evident on frontal lobe and occurs when patient is fully awake and alert. Therefore this replacement of beta rhythm for alpha rhythm is called arousal or alerting response or alpha block. This phenomenon can be produced by any form of sensor stimulation or mental concentration such as solving arithmetic problems. Person is thinking with a maximum concentration - Conscious thinking. 3) Theta rhythm:- When person with alpha rhythm becomes slightly more relaxed (as occurs when there is transition from wakefullness to sleep, i.e., stage 1 of NREM), alpha rhythm is replaced by theta rhythm. Thinking is present but with even less attentiveness than which was present in alpha rhythm stage (Deep subcsoncious thinking). Two types of theta rhythm have been described:- i) Hippocampal (occurs in mammals other than men, i.e., cat dogs, etc). ii) Cortical (occurs in men). 4) Delta rhythm:- It is present when the person is in deep sleep (NREM stage 3 & 4) and there is no thinking. -### End" -677,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antenatal suppo is not delivered by, with the following options: A: Anganwadi worker, B: Female Health worker, C: Health supervisor female, D: Traditional bih Attendant - -### Response: -The special category of &;maternal and child health worker&; at peripheral level is gradually being phased out. A wide range of workers is now considered necessary for maternal and child health work. They include1) Professionals: Specialists2) Field workers: Multi-purpose workers, Health guides, Dais (traditional bih attendants), balsevikas, Anganwadi workers, ASHA3) Members of women organisations.Park23rd edition pg: 556 -### End" -678,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Schedule-3 of MCI includes -, with the following options: A: MBBS degree of indian universities, B: DNB degree, C: Diploma of CPS, D: MBBS degree of foreign universities - -### Response: -Ans. is 'c' i.e., Diploma of CPS Schedules of MCI Acto MCI was established in 1934 and MCI act was revised in 1956,1964,1993,1999, and 2002. The schedules of MCI includes list of medical degrees recognized by MCI :-Schedule 1Includes list of recognised degrees awarded by Indian universities7^(tm)5 ll) and also DNB awardedby National Board of Examination, New Delhi.Schedule 2 Includes list of recognized medical degrees awarded by foreign universities^7^.Schedule 3 Includes list of medical qualifications awarded by Indian or foreign boards or societies, but are notincluded in schedule 1 or 2. It has two partsPart I: Includes list of recognized degrees other than MBBS awarded by Indian Societies and Boards, e.g LMPand diploma of CPS.Part II: Includes list of recognized degrees other than MBBS awarded by Foreign Societies and Boards. -### End" -679,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primordial prevention is done in population -, with the following options: A: With risk factors, B: Without risk factors, C: Whole population with low prevalence of disease, D: Population with disease - -### Response: -In primordial prevention, action is taken prior to emergence of risk factor, i.e. action is taken in population which has not developed risk factor. -### End" -680,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most important prognostic factor in carcinoma breast is:, with the following options: A: Size of tumour, B: Skin involvement, C: Involvement of muscles, D: Axillary gland involvement - -### Response: -Ans: d (Axillary gland involvement)Ref: Patho Robbins, 7th ed, p. 1146 & 6th ed, p. 115, Schwartz surgery, 7th ed, p. 558, Bailey & Love, 24th ed, p. 839 & 23rd ed, p. 765 -### End" -681,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is seen in this patient of Grave disease?, with the following options: A: Chemosis, B: Kocher sign, C: Von Graefe sign, D: Stellwag sign - -### Response: -Ans. B. Kocher signFollowing Eye signs are seen in all cases of hyperthyroid.a. Wide staring appearance (Kocher Sign)b. Upper Lid retraction (Dalrymple sign),c. lid lag with down gaze (Von Graefe sign).d. Decreased blinking (Stellwag sign)(All these features are due to sympathetic over stimulation causing levator palpebrae superioris contraction.)Following Eye signs are seen only in Grave disease.a. Chemosis'b. Exophthalmosc. Corneal ulcerationd. Ophthalmoplegiae. Papilledemaf. Diplopia (diplopia results, typically when patient looks up and laterally)(PROPTOSIS occur due to GLYCOSAMINOGLUCAN deposit) -### End" -682,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following actions are caused by 2-4-diinitrophenol?, with the following options: A: Inhibition of ATP synthase, B: Inhibition of electron transpo, C: Uncoupling of oxidation and phosphorylation, D: Accumulation of ATP - -### Response: -2,4-dinitrophenol and valinomycin are two uncouplers which inhibit oxidative phosphorylation. 2,4-dinitrophenol is a potent uncoupler even in low concentrations by dissolving itself in the bi-lipid core of the inner cell membrane. Ref: Harper's Illustrated Biochemistry 27th/107; Biochemistry 3E By S C Rastogi, 2010, Page 224. -### End" -683,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following are indications of TURP for BHP? 1. Prostatism 2.Acute retention of urine 3. Haematuria 4.Complications like hydronephrosis, with the following options: A: 1,2 and 3, B: 2,3 and 4, C: 1,2 and 4, D: 1,2,3 and 4 - -### Response: -Indications for surgery in BPH Prostatism (frequncy,urgency,dysuria) Acute rention of urine Chronic retention of urine with residue more than 200ml Haematuria Complications like hydroureter , hydronephrosis , stone formation , bladder changes etc ref- srb's manual of surgery 5e p 1045 -### End" -684,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In classic Barret's, the length of columnar epithelium in distal oesophagus is, with the following options: A: >1cm, B: >2cm, C: >3cm, D: >4cm - -### Response: -Classic Barrett's (>= 3cm columnar epithelium);Sho-segment Barrett's (<3 cm of columnar epithelium);Cardia metaplasia (intestinal metaplasia at the oesophagogastric junction without any macroscopic change at endoscopy).The relative risk of cancer rises with increasing length of abnormal mucosa. -### End" -685,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secondary osteosarcoma are associated with, with the following options: A: Paget's disease, B: Osteogenesis imperfecta, C: Melhoreostosis, D: Ankylosing spondilitis - -### Response: -Answer- A. Paget's diseaseCauses of secondary osteosarcomaPagets DiseaseFibrous dysplasiaEnchondromatosisHereditary multiple exostosisRadiationChronicosteomyelitisBone infarction -### End" -686,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female married to a normal male but her father had vitamin D resistant rickets. So what are the chances that her childrens will be colour blind:March 2013, with the following options: A: 0%, B: 50%, C: 75%, D: 100% - -### Response: -Ans. B i.e. 50%X-linked dominant are transmitted by an affected heterozygous female to half her sons and half her daughters and by an affected male parent to all his daughters but none of his sons, if the female parent is unaffected. -### End" -687,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common organism causing meningitis in a 1 year old child, with the following options: A: Streptococcus pneumoniae, B: H. influenza, C: Listeria, D: Neisseria meningitidIs - -### Response: -Streptococcus pneumonia is the most common organism causes meningitis even in the 1 year old child. Reference: GHAI Essential pediatrics, 8th edition -### End" -688,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A bodybuilder starts eating raw egg for protein. He used develop fatigue on moderate exercise. The doctor prescribes a vitamin. Which enzyme is deficient in him?, with the following options: A: Glucose 6 Phosphatase, B: Pyruvate Carboxylase, C: PEPCK, D: Glycogen Phosphorylase - -### Response: -Ans. (b) Pyruvate CarboxylaseRef: Harpers Biochemistry 30th Ed; Page No- 560* Raw egg contains Avidin, it is antagonist of Biotin.* Eating raw egg is harmful because of Avidin present in raw egg inhibit biotin.* Affinity of Avidin to Biotin is stronger than most of the Antigen antibody reaction.* So doctor only prescribe Biotin.* ELISA test and Labeling of DNA test are used.* Why do u need biotin? Because biotin is the mother of all carboxylation reaction.* Only one carboxylase given in options, so option B will be the best answer.Note* Streptavidin is also biotin antagonist. It is purified from Streptomyces Avidin. Bind 4 molecule of biotin.Coenzyme role of BiotinBiotin dependent carboxylation reaction* Pyruvate carboxylase: pyruvate (3C)- oxaloacetate (4C)* Acetyl-CoA carboxylase: acetyl-CoA (2C)- malonyl-CoA (3C)* Propionyl-CoA carboxylase: propionyl-CoA(3C)- methylmalonyl-CoA(4C)* Methyl Crotonyl CoA Carboxylase.Biotin Independent carboxylation reaction* Malic enzyme (Pyruvate to Malate)* Carbamoyl phosphate Synthetases -I & II* Gamma Carboxylation (Vitamin K dependent)* Addition of CO2 tC6 in purine ring (AIR Carboxylase)Extra MileCoenzyme Role of Vitamin B complex Thiamine* Pyruvate dehydrogenase (links glycolysis to TCA cycle)* a-ketoglutarate dehydrogenase (TCA cycle)* Transketolase (HMP shunt)* Branched-chain ketoacid dehydrogenaseRiboflavin* Component of flavins FAD and FMN, used as cofactors in redox reactions, eg, the succinate dehydrogenase reaction in the TCA cycleNiacin* NAD+ linked Enzymes# Lactate dehydrogenase# Pyruvate dehydrogenase# a-ketoglutarate dehydrogenase# Isocitrate dehydrogenase# Malate dehydrogenase# Glutamate dehydrogenase# Glyceraldehyde 3 phosphate dehydrogenase* NADPH generating reaction# Glucose 6 phosphate dehydrogenase in HMP shunt pathway# 6 phospho Gluconate Dehydrogenase in HMP shunt pathway# Malic enzyme (NADP Malate Dehydrogenase) -### End" -689,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Angle between nasal septum and lower border of upper lateral cailage is ____, with the following options: A: 40 0, B: 60 0, C: 500, D: 15 0 - -### Response: -- Angle between the nasal septum and lower border of upper lateral cailage is generally > 10-15deg The internal nasal valve, in normal development, is thenarrowest poion of the nasal cavity and is bounded bythe septum medially, caudal edge of the upper lateral cailage and head of the inferior turbinate laterally and nasalfloor inferiorly. The apex of the internalnasal valve is approximately 10-15 degrees in Caucasiansand wider in non-Caucasian populations. -### End" -690,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following conditions produce a seborrheic dermatitis like lesions in an infant?, with the following options: A: Langerhan cell histiocytosis, B: Juvenile xanthogranuloma, C: Multicentric histiocytosis, D: Erdheim Chester disease - -### Response: -All the above mentioned optionscare disorders of histiocytes. In langerhan cell histiocytosis, bone, lymph node and skin are the most frequently affected sytems. The most characteristic presentation is with scalp involvement. which is erythematous with greasy scales, looking very like seborrheic dermatitis. S100 Paraffin, peanut agglutinin, Placental alkaline phosphatase are the common used immunological markers. -### End" -691,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not an indication of thoracotomy -, with the following options: A: Massive pneumothorax, B: Pulmonary contusion, C: Bleeding more than 200m1/hr. in thoracotomy tube, D: Oesophageal rupture - -### Response: -Indications of thoracotomy after chest trauma - -Cardiac arrest (resuscitative thoracotomy) -Massive hemothorax (drainage of more than 1500 ml of blood when a chest tube is first inserted or continuous haemorrhage of more than 200 ml/hr for more than 3 consecutive hours). -Brisk bleeding (> 100 ml/15 min) -Penetrating injuries of the anterior chest with cardiac tamponade. -Large open wounds of the thoracic cage. -Rupture of the bronchus, aorta, esophagus or diaphragm. - -A non-emergent indication of thoracotomy - -Empyema not resolved with tube thoracostomy -Clotted hemothorax -Lung abcess -Thoracic duct injuries -Tracheoesophageal fistulas -Chronic sequelae of vascular injuries (pseudo aneurysms & AV fistulas) - - -Such an exhaustive list is prepared by mixing all the three books. (Shwartz, Sabiston, Bailey) -### End" -692,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which egg does not float in a saturated solution of saline ?, with the following options: A: Ankylostoma eggs, B: Trichuris eggs, C: Unfeilized egg of Ascaris, D: Feilized egg of Ascaris - -### Response: -Helminth eggs floating in saturated salt solution: Hell FATE Hell-Helminth,H.nana F-Feilised eggs of Ascaris A-Ancylostoma duodenale T-Trichuris trichiura E-Enterobius vermicularis -### End" -693,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cholecysto-venacaval line seperates which of the following ?, with the following options: A: Gallbladder and IVC, B: Poa hepatis and IVC, C: Caudate lobe and quadrangular lobe, D: Right and left lobe of liver - -### Response: -Cholecysto-venacaval line (cantlie line) seperates right and left lobe of the liver. Cantlie line is an imaginary line that divides the liver into two planes. It extends from the midpoint of the gallbladder fossa at the inferior margin of the liver back to the midpoint of the IVC and contains the middle hepatic vein. Ref: Gray&;s Anatomy 41st edition Pgno: 1162 -### End" -694,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient diagnosed with HIV and Tuberculosis. How to sta ATT and c-A.R.T, with the following options: A: Sta ATT first, B: Sta cA first, C: Sta both simultaneously, D: Sta cA only - -### Response: -Ans. is 'a' i.e., Sta ATT first In a case when HIV and TB are diagnosed together ATT should be staed first. ATT staed first, because of IRIS (Immune Reconstitution Inflammatory syndrome). If A staed first, it may improve CD4 cells at first, but later a previously acquired infection (TB, Herpes), responds with an overshelming inflammatory response that paradoxically makes the symptom of infection worse. Therefore, staing of ATT-2 weeks before A, have shown to decrease the incidence of IRIS. -### End" -695,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements related to gastric injury is not true?, with the following options: A: Mostly related to penetrating trauma, B: Treatment is simple debridement and suturing, C: Blood in stomach is always related to gastric injury, D: Heals well and fast - -### Response: -Ans. (c) Blood in stomach is always related to gastric injuryRef: Sabiston 19/e p461-462* Blood in stomach may come from esophageal injury, or from bleeding periampullary lesion can regurgitate, peptic ulcers etc.* MC mechanism of stomach injury is Penetrating injury -### End" -696,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscle originates from tibia, fibula and interosseous membrane?, with the following options: A: Popliteus, B: Flexor digitorum longus, C: Flexor hellus longus, D: Tibialis posterior - -### Response: -TIBIALIS POSTERIOR:Origin: upper two-thirds of lateral pa of posterior surface of tibia below the soleal line.Posterior surface of fibula in front of medial crest Posterior surface of interosseous membrane.Popliteus: arises from lateral surface of lateral condyle of femur.origin is intracapsular.lateral meniscus of knee joint.Flexor digitorum longus: uppercut two third of medial pa of posterior surface of tibia below soleal line.Flexor hallucis longus: posterior surface of fibula and interosseous membrane.{Reference: BDC 6E pg no.106} -### End" -697,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A severely ill patient was maintained on an infusional anaesthetic agent. On the 2nd day he staed detiorating. The probable culprit may be, with the following options: A: Etiomidate, B: Propofol, C: Opioid, D: Barbiturate - -### Response: -A i.e. Etomidate; B i.e. Propofol Increased infection and moality in a group of patients sedated with etomidate infusion in an ICU was associated with low coisol levelsQ and is attributed to etomidate induced supression of adrenal coisal synthesisQ. Etomidate is a dose dependent but reversible inhibitor of 11 - hydroxylase in the adrenal coex and is more potent than metyrapone. This enzyme is required for both mineralocoicoid and coicosteroid production. Minor adrenocoical supressive effects (i.e. impaired response to ACTH) follow induction doses or sho infusion doses. Propofol is not recommended for sedation of critically ill pediatric patients in ICU. The drug has been associated with higher moality d/t propofol infusion syndrome. Its essential features are metabolic acidosis, multiple organ failure, hemodynamic instability, hepatomegaly, and rhabdomyolysis. Very rarely, it may occur in adults, and in patients undergoing long term propofol infusion (> 48 hours) for sedation at high doses (>5 mg/ kg/ hr). -### End" -698,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The pharmacokinetics of Paroxetine include its ability to be easily absorbed after oral administration in healthy volunteers even after food is ingested. Which of the following is TRUE?, with the following options: A: Main poion of the medication resides in system circulation, B: Little of the medication is absorbed into the tissues, C: Less than 1% of the drug is in systemic circulation owing to extensive distribution in body tissues., D: Less than 25% is eliminated by the kidneys - -### Response: -The major poion of paroxetine is distributed into the tissues and less than 1% if in systemic circulation while 64% if eliminated by the kidneys and 36% in the feces. The primary effect is believed to be on brain neurons because of its qualities as a selective serotonin reuptake inhibitor (SSRI). Ref: Pollock B.G., Semla T.P., Forsyth C.E. (2009). Chapter 63. Psychoactive Drug Therapy. In J.B. Halter, J.G. Ouslander, M.E. Tinetti, S. Studenski, K.P. High, S. Asthana (Eds), Hazzard's Geriatric Medicine and Gerontology, 6e. -### End" -699,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the follow ing are risk factors for carcinoma gall bladder, except -, with the following options: A: Typhoid carriers, B: Adenomatous gall bladder polyps, C: Choledochal cysts, D: Oral contraceptives - -### Response: -Ans. is 'd' i.e., Oral contraceptives No risk of Ca G.B. has been noted with the use of oral contraceptiveso Risk factors for Ca Gall bladder are :i) Gall stonesApproximately 90% of patients with Ca GB have gall stonesSize of the stone has a direct relationship with development of carcinoma, the risk is ten times more for larger stones (3 cm in diameter) than for stones less than 1 cm in diameterThe risk is higher with symptomatic than asymptomatic stones.ii) Adenomatous gall bladder polyps (particularly polyps larger than 10 mm)Calcified (porcelain) gall bladderCholeduochal cystEstrogensAnomalous pancreaticobiliary duct junctionExposure to carcinogens (azotoulene, nitrosamine)Typhoid carriersSclerosing cholangitisCholecystoenteric fistula Ulcerative colitis o ASI Surgery mentions two other risk factorsChemicals used in rubber industryUse of adulerated mustard cooking oil in India -### End" -700,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clotting factor common to extrinsic and intrinsic pathway is:, with the following options: A: Factor II, B: Factor III, C: Factor V, D: Factor VII - -### Response: -Tissue factor initiates the extrinsic pathway, whereas contact of Factor XII and platelets with collagen in the vascular wall initiates the intrinsic pathway. -An especially important difference between the extrinsic  and  intrinsic  pathways is that the extrinsic  pathway can be explosive; once initiated, its speed of completion to the final clot is limited only by the amount of tissue factor released from the traumatized tissues and by the quantities of Factors X, VII,  and V in the blood. With severe tissue trauma, clotting can occur in as little as 15 seconds. The intrinsic pathway is much slower to proceed, usually requiring 1 to 6 minutes to cause clotting.  -Clotting factor common to extrinsic and intrinsic pathway is Factor V. -### End" -701,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a debranching enzyme:, with the following options: A: Glycogen synthetase, B: Glucose-6-phosphatase, C: Amylo alpha-1,6-glucosidase, D: Amylo (1,4)-(1,6) trans glycosylase - -### Response: -Debranching enzyme is a Bifunctional enzyme with two activities Glucan transferase Amylo a-1,6-glucosidase breaks the alpha (1-6) glycosidic bond present at the branch point of glycogen in glycogen breakdown. Other Options: Glycogen synthetase transfer glucose from UDP-glucose to glycogenin. Glycogen branching enzyme (also known as amylo-a(1,4)-a(1,6) trans glycosylase) make glycogen branches by transferring the end of the chain onto an earlier pa a-1,6 glycosidic bond. Glucose-6-phosphatase dephosphorylates glucose-6-phosphate to free glucose. -### End" -702,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The primary form of coisol in the plasma is, with the following options: A: Bound to albumin, B: Bound to transthyretin, C: Free in solution, D: Bound to coicosteroid-binding globulin (CBG) - -### Response: -The majority of coisol is bound to a specific carrier protein, coicosteroid binding globulin (CBG), while smaller amounts are bound nonspecifically to albumin. Few, if any, coisol receptors would be expected in the plasma and transthyretin binds primarily thyroxine.Ref: Guyton; 13th edition -### End" -703,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MRI finding of Schizophrenia FALSE is, with the following options: A: Increased ventricular volume, B: Cortical thickening, C: Reduced volume of temporal lobe, D: Reduced volume of hippocampal lobe - -### Response: -(B) Cortical thickening# MRI studies utilizing modern cortical surface reconstruction techniques have shown widespread reduction in cerebral cortical thickness (i.e., ""cortical thinning"") in frontal and temporal regions.> Whole brain and hippocampal volume are reduced and that ventricular volume is increased in patients with a first psychotic episoderelative to healthy controls.> Most schizophrenia studies have found average reduced volume of the left medial temporal lobe and left superior temporal gyrus, and half of studies have revealed deficits in certain areas of the frontal gyrus, parahippocampal gyrus and temporal gyrus. -### End" -704,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most commonly lesioned nerve in intracranial aneurysms is, with the following options: A: Optic, B: Oculomotor, C: Trochlear, D: Abducent - -### Response: -Intracranial aneurysm may involve oculomotor, abducent and optic nerve in descending order Trochlear nerve is involvement is higher in head trauma. Ref: Gray's 39e/p-227 -### End" -705,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Features of right side carcinoma colon are -I. Obstruction -II. Altered bowel habit -III. Anemia -IV. Melena, with the following options: A: 1 only, B: 1 and 2, C: 3 and 4, D: 2, 3 and 4 - -### Response: -Right sided Ca. Bleeds ( melena) causing anemia. -### End" -706,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is activated for nuclear fragmentation in apoptosis -, with the following options: A: Caspases, B: Apaf - 1, C: Oxygen free radicals, D: All - -### Response: -Caspases and endonuclease cause chromatin fragmentation in apoptosis. They are inactive, so first they should be activated. Cytochrome &;c&; binds with Apaf-1 and this complex activates caspases. Caspases cause fragmentation of chromatin and also activate endonuclease. About option &;b&; Though Apaf-1 helps in activation of caspases, it has no role in chromatin framentation and It does not have two seprate forms active or inactive. It just forms complex with cytochrome &;C&; to activate caspases. REF: ROBBINS pathology 10th edition -### End" -707,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Radical neck dissection involves all except, with the following options: A: Sternocleidomastoid muscle, B: Internal jugular vein, C: Vagus nerve, D: Spinal accessory nerve - -### Response: -Vagus nerve is not removed in Radical Neck Dissection. Structures removed in Radical Neck Dissection: Level I-V Lymph nodes, Sternocleidomastoid, Internal Jugular Vein, Spinal Accessory Nerve, Submandibular salivary gland, Tail of parotid and Omohyoid muscle. Ref: Textbook of ENT, Dhingra; 6th edition; Pg no: 388 ref img -### End" -708,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Laparoscopic sterilization is not recommended during the period of:, with the following options: A: Immediate post-paum, B: Interval, C: Post menstrual, D: Post first trimester M.T.P - -### Response: -- Laparoscopy is not advisable for postpaum patients for 6 weeks following delivery- Hence, option-1 is answer - However, it can be done as a concurrent procedure to MTP. - Haemoglobin should not be less than 8. - It is recommended that the patient be kept in hospital for a minimum of 48 hours after the operation. -### End" -709,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of Blockade of 2nd pa of axillary aery blood supply to upper limb is maintained by which anastomosis -, with the following options: A: Dorsal scapular anastomosis, B: Ventral scapular anastomosis, C: Circle of Willis, D: Anastomosis around internal thoracic aery - -### Response: -Ans. is'a'i.e., Dorsal scapular anastomosis(Ref: Clinical anatomy 3d/e p. 756)Dorsal Scapular Anastomosis:This anastomosis occurs connects the 1st pa of subclan aery to the third pa of axillary aery providing an alternate route of flow of blood in case of occlusion anywhere within the subclan and axillary aery. -### End" -710,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mammography was performed in 45 year old female for screening of breast cancer. The finding is suggestive of, with the following options: A: Benign lesion, B: Malignant lesion, C: Indeterminate, D: No opinion can be given - -### Response: -Mammography Soft tissue radiographs are taken by placing the breast in direct contact with ultrasensitive film and exposing it to low-voltage, high-amperage x-rays. The dose of radiation is approximately 0.1 cGy and, therefore, mammography is a very safe investigation. The sensitivity of this investigation increases with age as the breast becomes less dense. In total, 5% of breast cancers are missed by population-based mammographic screening programmes; even in retrospect, such carcinomas are not apparent. Thus, a normal mammogram does not exclude the presence of carcinoma. Digital mammography is being introduced, which allows manipulation of the images and computer-aided diagnosis. Tomo-mammography is also being assessed as a more sensitive diagnostic modality. Ultrasound Ref: Sabiston 20th edition Pgno : 861 -### End" -711,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45-years-old multipara presents with dysmenorrhea and menorrhagia. Uterus is symmetrically enlarged upto 14 weeks. What is the probable diagnosis?, with the following options: A: Intramural fibroid, B: Adenomyosis, C: Endometrial hyperplasia, D: Pelvic inflammatory disease - -### Response: -AdenomyosisCommon in women above 40 years.Often co-exists with fibroid, endometriosis and endometrial cancer.Uterus is symmetrically enlarged to not more than 14 weeks size.Histology - Islands of endometrial glands surrounded by stroma seen in the myometrial tissue beyond the endomyometrial junction.The distance between basal endometrium and the endometrial gland should be > 2.5 mm.Common complaint--Menorrhagia and progressive dysmenorrhoea.Clinical examination reveals symmetrical enlargement of uterus and tender uterus.Treatment is localized excision, hysterectomy.Medical treatment includes danazol, GnRH, Mirena IUCD.(Refer: Shaw&;s Textbook of Gynaecology, 15th edition, pg no: 407, 475) -### End" -712,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maastrichat classification category 3 stands for DCD donor of:, with the following options: A: Brought dead patient, B: Cardiac arrest during brain dead, C: Awaiting cardiac death after withdrawal of supports, D: Cardiac arrest and unsuccessful resuscitation in hospital - -### Response: -Ref. Sabiston Textbook of Surgery. Pg. 877 -  -MAASTRICHAAT CLASSIFICATION OF NHBD -Category 1 : Dead on arrival at hospital -Category 2 : Death with unsuccessful resuscitation . -Category 3 : Awaiting cardiac death . -Category 4 : Cardiac arrest while brain dead . -### End" -713,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aflatoxin is produced by -, with the following options: A: Aspergillus flavus, B: Aspergillus famigatus, C: Calviceps purpura, D: Argemone mexicana - -### Response: -Ans. is 'a' i.e., Aspergillus flavus -### End" -714,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most common cause of “reversible” dementia in geriatric population?, with the following options: A: Depression, B: Normal Pressure Hydrocephalus, C: Hypothyroidism, D: Vit B12 deficiency - -### Response: -Depression -(ref : pg 189 Clinical Practice guidelines JK Trivedi) -### End" -715,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Allopurinol is used in treatment of:, with the following options: A: Rheumatoid arthritis, B: Psoriatic arthritis, C: Gouty arthritis, D: Poly sero arthritis - -### Response: -Ans. is 'c' i.e., Gouty arthritis* Allopurinol is a hypoxanthine analogue which was synthesized as a purine anti metabolite.* Allopurinol is xanthine oxidase inhibitor.* Uses:# Allopurinol is the first choice drug for chronic gout. It can be used for both over producers as well as under excretors of uric acid.# With long term allopurinol therapy, tophi gradually disappear and nephropathy is halted and even reversed.* Allopurinol is contraindicated in acute gout because a sudden decrease in urate levels may precipitate re - crystallization in the joints.* Other uses# Allopurinol may be used in some cases of kala azar or leishmaniasis but efficacy is doubtful. -### End" -716,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient approaches you with multiple infected bite wounds to the shoulder. There are also a few scratch marks on his back. He confess you that he has raped a woman a few weeks ago but has asked you to keep it a secret. He warns you that he would sue you for breach of professional secrecy if you inform anyone. What is the appropriate response in this scenario?, with the following options: A: Treat the patient and keep the information a secret, B: Refused to treat the patient and inform the police, C: Treat the patient and inform the police immediately, D: Treat the patient and inform the police after his wounds have healed - -### Response: -As per section 3a, CrPC and section 176 IPC the doctor is duty bound to repo such matters (crimes) to the nearest magistrate or police. Failing to do so intentionally is punishable by imprisonment as per section 202 of IPC. Since an infected bite wound can sepsis and death. Its essential to treat the wounds in this case. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page - 28,29 -### End" -717,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement is false: March 2007, with the following options: A: Granulomatous inflammation is found in Crohn's disease., B: Perianal lesions are common in Crohn's disease, C: Stricture involving the colon is found in ulcerative colitis, D: Fistula formation is common in Crohn's disease. - -### Response: -Ans. C: Stricture involving the colon is found in ulcerative colitisCrohn's disease/regional enteritis) is an autoimmune disease, which can affect any pa of the gastrointestinal tract from mouth to anus (terminal ileum is the area most commonly affected).Anal lesions are also commonThe disease is characterized by areas of inflammation with areas of normal lining between in a symptom known as skip lesions.Microscopy of Crohn's disease show focal areas of chronic inflammation involving all layers of the intestinal walls.There are non-caseating granulomas, but these are found in only 60% of patients.The main gastrointestinal symptoms are:Abdominal pain may be the initial symptom of Crohn's disease. It is often accompanied by diarrhea, especially in those who have had surgery. The diarrhea may or may not be bloody.The nature of the diarrhea in Crohn's disease depends on the pa of the small intestine or colon that is involved. Ileitis typically results in large-volume watery feces. Colitis may result in a smaller volume of feces of higher frequency.Visible bleeding in the feces is less common in Crohn's disease than in ulcerative colitis, but may be seen in the setting of Crohn's colitis.Although the association is greater in the context of ulcerative colitis, Crohn's disease may also be associated with primary sclerosing cholangitisPerianal discomfo may also be prominent in Crohn's disease. Itchiness or pain around the anus may be suggestive of inflammation, fistulization or abscess around the anal area or anal fissure.Crohn's disease is associated with a type of rheumatologic disease known as seronegative spondyloahropathy. This group of diseases is characterized by inflammation of one or more joints (ahritis) or muscle inseions (enthesitis). Common complications of inflammation include scarring that can produce intestinal blockage (obstruction) and deep ulcers penetrating through the bowel wall that can create pus-filled pockets of infection (abscesses) or abnormal connecting channels between the intestine and other organs (fistulas).When the large intestine is affected extensively by Crohn's disease, rectal bleeding commonly occurs.After many years, the risk of colon cancer (cancer of the large intestine) is greatly increased.About one third of people who develop Crohn's disease have problems around the anus, especially fistulas and cracks (fissures) in the lining of the mucus membrane of the anus.Crohn's disease may lead to complications in other pas of the body. These complications include gallstones, inadequate absorption of nutrients, urinary tract infections, kidney stones, and deposits of the protein amyloid in several organs (amyloidosis).A colonoscopy is the best test for making the diagnosis of Crohn's disease as it allows direct visualization of the colon and the terminal ileum, identifying the pattern of disease involvement. Finding a patchy distribution of disease, with involvement of the colon or ileum but not the rectum, is suggestive of Crohn's disease, as are other endoscopic stigmata. The most common disease that mimics the symptoms of Crohn's disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms.It is impoant to differentiate these diseases, since the course of the diseases and treatments may be different. -### End" -718,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the is the most common cause of delayed urinary tract obstructive symptoms after TURP, with the following options: A: Stricture of the Navicular fossa, B: Stricture of the membranous urethra, C: Stricture of the bulb of urethra, D: Bladder neck stenosis - -### Response: -Complications of TURP Bleeding, urethral stricture or bladder neck contracture, perforation of the prostate capsule with extravasation, and if severe, TUR syndrome Late complications Bladder neck stenosis (4%) > Urethral stricture (3.6%) Bladder neck stenosis is seen more often with small (<30 gm) fibrotic prostate Bladder neck contracture Occasionally, a dense fibrotic stenosis of the bladder neck occurs following overaggressive resection of a small prostate. It may be due to the overuse of coagulating diathermy. Trans- urethral incision of the scar tissue is necessary using laser or diathermy. Ref: Bailey and love 27th edition Pgno :1467 -### End" -719,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are malignancies caused by Epstein Barr (EB) virus, EXCEPT:, with the following options: A: Hodgkin's disease, B: Non-Hodgkin's lymphoma, C: Nasopharyngeal carcinoma, D: Multiple myeloma - -### Response: -EBV can cause both malignant and nonmalignant diseases. Multiple myeloma is not associated with EBV infection. Non malignant diseases caused by EBV virus are Infectious mononucleosis, oral hairy leukoplakia, and X linked lymphoproliferative syndrome. Malignancies caused by EBV includes Burkitt's lymphoma, Hodgkins disease, Post transplant lymphoma, Tcell lymphoma, Nasopharyngeal carcinoma, Gastric carcinoma and Leiomyosarcoma. Ref: Sequelae and Long-Term Consequences of Infectious Diseases By Pina M. Fratamico, Page 352-3 ; Oral Microbiology At a Glance By Richard J. Lamon, Page 69 -### End" -720,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zero order kinetics is shown by which drug -, with the following options: A: Digoxin, B: Theophylline, C: Phenobarbitane, D: Etomidate - -### Response: -Ans. is 'b' i.e., Theophylline 1 o Drugs showing zero/pseudo-zero order kinetics :# Phenytoin# Tolbutamide# Theophylline# Warfarin# Alcohol# Salicylates (Aspirin) -### End" -721,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Greenstick fracture is -, with the following options: A: Incomplete transverse fracture pattern in children, B: Complete transverse fracture pattern in children, C: Incomplete spiral fracture pattern in children, D: Complete spiral fracture pattern in children - -### Response: -Ans. is 'a' i.e., Incomplete transverse fracture pattern in children * A greenstick fracture is an incomplete transverse fracture pattern seen in children.* Greenstick fractures occur when an injuring force applied to a bone exceeds the limits of elasticity of the bone.* This results in the bone's bending to the point of bony disruption and fracture on the side opposite to the applied force.* However, a green-stick fracture is an incomplete fracture, in which the compressed cortex and periosteum remain intact.* Greenstick fractures of radius-ulna are common fractures in children and often result from a fall on a outstretched hands. -### End" -722,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DNA replication and transcription occurs in which direction -, with the following options: A: 51-31, B: 5l-51, C: 31 -51, D: 31 -31 - -### Response: -Ans. is 'a' i.e., 51 - 31 Elongation in DNA synthesiso Once the RNA primer has been synthesized at each of the replicating forks, a DNA polymerase III initiates the synthesis of new DNA strand by adding deoxyribonucleotides to the 31 end of RNA primer. Thus, both new strands are synthesized always in 51- 31 direction. Both the DNA strands are synthesized simultaneously, but in opposite direction.o During synthesis of RNA primer and synthesis of DNA strands, the nucleotides are added according to the sequence of base in the template strand, i.e. 'base pairing rule'. For example, an adenine nucleotide would enter at a thymine nucleotide.Elongation in transcriptiono The process of elongation proceeds after the formation of the first phosphodiester bond. After formation of approximately 10 phosphadiester bonds of new RNA, sigma (a) factor dissociates from the core enzyme. RNA polymerase utilize ribnucleotide triphosphate (ATP, GTP, CTP and UTP) for the formation of RNA.o RNA synthesis occurs in 51-3' direction (similar to DNA synthesis), i.e. genetic information is read in 31-51direction on template DNA and complementary base sequence is synthesized in 51-31 direction for RNA strand.o The selection of nucleotide is according to base-pairing rule, (e.g. U opposite to A and G opposite to C)o The process of elongation continues until a termiantion point is reached. -### End" -723,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Good prognosis factors of ALL are all except, with the following options: A: Hyperdipoidy, B: WBC count < 50000, C: Age > 10 years, D: T (12:21) translocation - -### Response: -Hyperdiploidy with chromosome number more than 50 is associated with good prognosis for ALL.Ceain chromosomal abnormalities like t(12;21) are also associated with good prognosis.Age > 10 years is a bad prognostic factor,the age group of 2-10 years have ourable outcome. WBC count less than 50,000/mm3 is also associated with good prognosis. Reference:Essential pediatrics-Ghai,8th edition,page no:600,601. -### End" -724,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of action of oxybutynin is:-, with the following options: A: Cholinergic muscarinic receptor agonist, B: Cholinergic muscarinic receptor antagonist, C: Cholinergic nicotinic receptor antagonist, D: Cholinergic nicotinic receptor agonist - -### Response: -Oxybutynin is an anticholinergic drug used in overactive bladder. It acts by blocking M3 muscarinic receptors. It has maximum risk of causing dry mouth and other anti-cholinergic adverse effects. -### End" -725,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aschoffs nodules are seen in:, with the following options: A: Subacute bacterial endocarditis, B: Libman sacks endocarditis, C: Rheumatic carditis, D: Non bacterial thrombotic endocarditis - -### Response: -Aschoffs bodies are characteristic focal inflammatory lesion of acute rheumatic fever found in any of the three layers of the hea. (ref Robbins 7th/593,9/e558) -### End" -726,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement regarding base excision repair is ?, with the following options: A: Used only for the bases which are deaminated, B: Uses enzyme called as DNA glycosylase which generate abasic suger site, C: Removes about 10 – 15 nucleotide, D: Recognizes a bulk lesion - -### Response: -- This is the first step of base excision repair. Bases modified by deamination, methylation, or by other chemical modification are removed by this kind of repair system. -### End" -727,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Memory T cell can be identified using the following marker, with the following options: A: CD45RA, B: CD45RB, C: CD45RC, D: CD45RO - -### Response: -. -### End" -728,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In ICDS the requirement in pregnant females is ?, with the following options: A: 300 cal, 15 gm protein, B: 300 cal , 25 gm protein, C: 500 cal, 15 gm protein, D: None - -### Response: -Ans. is 'None' o According to 21st/e of Park, answer of this question is none as 600 calories and 18-20 grams of protein are recommended for pregnant and nursing women. Kishori Shakti Yojna (KSY) o KSY is rename of 'Adolescent Girl's scheme' under ICDS. Its aims are - To improve the nutritional and health status of adolescent girls To promote self development, awareness of health, hyiegene nutrition and family life and child care. o KSY covers 6118 ICDS projects. -### End" -729,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an indication ofcotrimoxazole aEUR', with the following options: A: >Lower UTI, B: >Prostatitis, C: >Chancroid, D: >Typhoid - -### Response: -Chancroid Corimoxazole in Typhoid Initially cotrimoxazole was an effective alternative to chloramphenicol. However, in many areas resistant S. typhi have appeared and now it is seldom used. Cotrimoxazole in chancroid Corimoxazole for 7 days is a 3rd choice inexpensive alternative to ceftriaxone, erythromycin or iprofloxacin. Cotrimoxazole It is a combination of sulfonamide (sulfamethoxazole) and trime- thoprim in the ratio of 1 :5. Cotrimoxazole was claimed to be more effective than either of its components individually in treating bacterial infections. Because of its associated greater incidence of adverse effects including allergic responses its widespread use has been restricted in many countries to very specific circumstances where its improved efficacy is demonstracted. Uses of Cotrimoxazole Upper and lower respiratory tract infections - Exacerbations of chronic bronchitis - For otitis media and sinusitis. - It should never be used for streptococcal pharyngitis. Urinary tract infections -Uncomplicated cystitis in non pregnant women. Especially valuable for chronic and recurrent cases. - Prostatitis (cotrimoxazole is concentrated in goodamounts in prostate) Pneumocystic carinii pneumonia -Drug of choice next to pentamidine for the treatment and prophylaxis of pneumonias caused by Pneumocystic Jirovecci (commonly seen in imtnunocompromised patients including those suffering from HIV/AIDS). Other conditions where cotrimoxazole finds its use. -Listeria monocytogens infections - Meliodosis - Shigellosis - Traveller's diarrhoeas (E. coli, Campylobacter, Shigella, Y. enterocolitica) - Prophylaxis of cerebral toxoplasmosis - Whipple's disease - Salmonella (typhoid) initially it was responsive but now resistant strains have emerged. - Chancroid According to K.D.T. - Cotrimoxaxole can be used in both chancroid and typhoid. According to Harrison (18/e) Cotrimoxazole is used in Typhoid but it is not used in chancroid. Antiobiotic therapy in typhoid Empirical Ceftriaxone Azithromycin Fully susceptible Ciprofloxacin Amoxicillin Chloramphenicol Cotritnoxazole Multidrug resistant Ciprofloxacin Ceftriaxonl Azithromycin Nalidixic acid resistant Ceftriaxone Azithromycin High dose ciprofloxacin Treatment of chancroid Ciprofloxacin Ceftriaxone Azithromycin -### End" -730,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the recommended dose of steroids for attaining fetal lung maturity?, with the following options: A: Inj Betamethasone 12 mg for 2 doses 12 hours apart, B: Inj Betamethasone 12 mg for 2 doses 24 hours apart, C: Inj Dexamethasone 6 mg for 4 doses 24 hours apart, D: Inj Dexamethasone 12 mg for 2 doses 12 hours apart - -### Response: -b. Inj Betamethasone 12mg for 2 doses 24 hours apart(Ref: Nelson's 20/e p 852)Inj Betamethasone 12mg IM 2 doses, 24 hrs apart or Inj Dexamethasone 6mg IM every 12 hrs for 4 doses can be used -### End" -731,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cicatrising alopecia with perifollicular blue-gray patches is most commonly associated with:, with the following options: A: Pitting of nails, B: Whitish lesions in the buccal mucosa, C: Ahritis, D: Discoid plaques in the face - -### Response: -Cicatrising alopecia with perifollicular blue-gray patches is likely to be associated with whitish lesions in buccal mucosa which is characteristic of Lichen planus. Ref: Cicatricial Alopecia: An approach to diagnosis and management, By Vera Price, Paradi Mirmirani, Page 1-5. -### End" -732,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To test the association between risk factor and disease, which of the following is the wakest study design -, with the following options: A: Case-control study, B: Ecological study, C: Coho study, D: Cross-sectional study - -### Response: -Ans. is 'b' i.e., Ecological study To test the association between risk factor and diseaseo Most reliable, overall --> systematic review and meta-analysis of RCTso Most reliable individual study --> Randomized controlled trial.o Most reliable observational analytic study Coho studyo Least reliable study and least reliable observational analytic study --> Ecological study. -### End" -733,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the first sign of pubey in girls?, with the following options: A: Pubarche, B: Thelarche, C: Menarche, D: Growth spu - -### Response: -Adolescence: Stage of transmission from childhood to adulthood. During this stage, there will be an appearance of sexual characters with changes in cognition and psychology. Adolescence refers to this entire process, pubey refers to the physical aspect. Age 10-19 year is considered as a period of adolescence and pubey marks the early half of adolescence. Pubey in girls stas with breast development( thelarche) anytime between 8-13 years. This is followed by an appearance of pubic hair ( pubarche) and subsequently menstruation ( menarche), occurring at an average of 12.6 years. Menarche occurs after 2-21/2 years of thelarche. In boys, the earliest change is an increase in testicular size( testicular volume reaching 4 ml) and this occurs between 9-14 years. This is followed by an appearance of pubic hair and lengthening of the penis. Spermarche( sperm production) stas during mid-adolescence. Laryngeal growth, manifesting as cracking of voice, begins in boys in mid-pubey, deepening of voice is complete by end of pubey. During pubey, boys gain 20-30 cm and girls 16-28 cm of height. Peak growth velocity in girls occurs before attainment of menarche. Boys have their peak growth in later stages of pubey. Reference: GHAI Essential pediatrics, 8th edition -### End" -734,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NOT a content of Jugular Foramen, with the following options: A: Hypoglossal nerve, B: Glossopharyngeal nerve, C: Occipital arteries, D: Sigmoidal sinus - -### Response: -(A) Hypoglossal nerve# JUGULAR FORAMEN may be subdivided into three compartments, each with their own contents.> Anterior compartment transmits the inferior petrosal sinus.> Intermediate transmits the glossopharyngeal, vagus, and accessory nerves ( cranial nerves number IX, X, and XI respectively).> Posterior transmits the sigmoid sinus (becoming the internal jugular vein) and some meningeal branches from the occipital and ascending pharyngeal arteries. -### End" -735,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nail pitting is caused by all except -, with the following options: A: Lichen planus, B: Psoriasis, C: Alopecia areata, D: Pityriasis Rosacea - -### Response: -Nail involvement is common in alopecia areata, paicularly in severe forms. Pitting is the most common finding, but other abnormalities such as trachyonychia have been repoed. Nail plate pitting tends to be more shallow and regularly spaced than in psori-atic nail pitting Nail pitting is often a sign of another condition that can include: psoriasis, which causes skin inflammation. reactive ahritis or inflammation caused by an infection elsewhere. alopecia areata, which causes temporary bald patches on the scalp. Ref Harrison20th edition pg 1278 -### End" -736,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the most probable cause of this condition?, with the following options: A: Chronic lymphedema, B: Chronic aerial blockage, C: Chronic venous blockage, D: Chronic venous insufficiency - -### Response: -In the given image :- Buffalo hump, squaring of toes :- chronic lymphedema Unlike other types of oedema,lymphedema characteristically involves the foot.The contour of the ankle is lost through infilling of the submalleolar depressions,a ""buffalo hump"" forms on the dorsum of the foot,the toes appear""square"" because of confinement of footwear and the skin on the dorsum of the toes cannot be pinched because of subcutaneous fibrosis(Stemmer's sign) -### End" -737,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Floating water-lily sign is feature of:, with the following options: A: Lung Hydatid, B: Bronchial adenoma, C: Lung abscess, D: Aspergilloma - -### Response: -C i.e. Pulmonary Hamaoma Calcification type Condition associated Pop corn calcification Pulmonary hamaomaQ, mediastinal lymph nodes of acute histoplasmosis. Egg shell (peripheral) calcification SilicosisQ, SarcoidosisQ Rice grain calcification CysticercosisQ Tram track (Rail road) calcification Struge Weber syndromeQ Basal ganglion calcification Hyper parathyroidism Cardiac calcification Carcinoid syndrome Pericardial calcification Constructive pericarditis Not calcify Hydatid cyst in lungQ -### End" -738,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A normal MCV would be expected in a patient with which one of the following conditions?, with the following options: A: Resection of the terminal ileum, B: b-thalassemia minor, C: 2 days post-acute bleed, D: Chronic bleeding duodenal ulcer - -### Response: -A patient who is 2 days post-acute bleed will have a normal MCV because the bone marrow has not had enough time to release reticulocytes into the peripheral blood. Reticulocytes are larger than a mature RBC and could potentially increase the MCV. The other choices in the question are conditions associated with either an increase or decrease in the MCV. A pregnant woman not taking vitamin supplements will very likely develop folate deficiency because she has only a 3-4 month supply of the vitamin in her liver. A patient with resection of the terminal ileum will develop vitamin B deficiency, since the terminal ileum has receptors for the vitamin B factor complex for reabsorption. The patient with b- thalassemia minor as well as the patient with a chronic bleeding peptic ulcer will have a microcytic anemia, the former from a decrease in globin-chain synthesis, and the latter secondary to iron deficiency. -### End" -739,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurofibromomatosis I is, with the following options: A: AD, B: AR, C: X linked recessive, D: X linked dominant - -### Response: -Autosomal Dominant Inheritance Familial hypercholesterolemia Marfan syndrome Ehlers-Danlos syndrome Hereditary spherocytosis Neurofibromatosis, type 1 Adult polycystic kidney disease Autosomal Recessive Inheritance Cystic fibrosis Phenylketonuria Tay-Sachs disease Severe combined immunodeficiency a- and b-Thalassemias Sickle cell anemia X-linked Recessive Inheritance Hemophilia A Duchenne/Becker muscular dystrophy Fragile X syndrome (Robbins Basic Pathology,9th edition,pg no. 219) -### End" -740,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Appendix of testis is remnant of ?, with the following options: A: Mesonephric duct, B: Mesonephric tubules, C: Wolffian duct, D: Mullerian duct - -### Response: -Mullerian duct -### End" -741,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lower esophageal sphincter lies at what distance from the incisor teeth?, with the following options: A: 15cm, B: 25cm, C: 40cm, D: 50cm - -### Response: -Ans. is 'c' i.e., 40cm * 2nd constriction is at T4 level where arch of aorta crosses esophagus.Esophageal constrictionsNumberDistance from incisorBony levelAnatomical landmark1st15 cm (6 inches)C6At its beginning (pharyngo-esophageal junction)2nd22.5 cm (9 inches)T4Crossing of aortic arch3rd27.5 cm (11 inches)T6Crossing of left main bronchus4th37.5 - 40 cm (15-16 inches)T10Piercing diaphragm (at lower esophageal sphmotor) -### End" -742,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Obstruction of IVC leads to, with the following options: A: Dilatation of thoracoepigastric veins, B: Caput medusae, C: Hemorrhoids, D: Esophageal varices - -### Response: -. -### End" -743,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Duplication of GIT most commonly involves?, with the following options: A: Esophagus, B: Stomach, C: Duodenum, D: Ileum - -### Response: -Answer is 'd' i.e. Ileum ""The term duplication actually is a misnomer, since approximately 75% are enteric cysts & not true duplication. The remainder are true tubular duplications that are intimately attached to the adjacent poion of the G.I.T, possesses a gastrointestinal type of mucosal lining & may or may not communicate with the visceral lumen. Duplications occur on the mesenteric side of the intestine between the leaves of the mesentery & are most often found in the Ileum. Cystic lesions may present with symptoms of obstruction from extrinsic compression. Communicating tubular duplication often are lined by gastric mucosa, which may ulcerate and present with gastrointestinal hemorrhage or perforation. In addition, cancers have been repoed to arise in the mucosal lining of these duplications. Treatment is surgical resection. Small tubular duplications and all cysts are excised along with overlying normal intestine; intestinal continuity is restored by end-to-end anastomosis"" - Schwaz -### End" -744,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A women at 8 months of pregnancy complains of abdominal pain and slight vaginal bleed. On examination the uterus is tender with size more than expected for dates with absent fetal hea sounds. The diagnosis, with the following options: A: Hydramnios, B: Concealed haemorrhage, C: Active labour, D: Uterine rupture - -### Response: -This is a case of abruption with concealed retroplacental bleed which makes the uterus tender and also increase the uterine height. Please note that there may be some amount of vaginal bleeding in concealed hemorrhage as well. The uterine tenderness is also because of bruising of the uterine surface. With abruption the fetal hea sounds are often not heard due to the taut abdominal wall and hypeonic uterus, even when the fetus is alive. If the fetal hea rate is normal, the best management here is to induce labour, -### End" -745,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Crystalline Lens is derived from (JIPMER May 2019), with the following options: A: Surface ectoderm, B: Neuroectoderm, C: Mesoderm, D: Endoderm - -### Response: -- Eye ball have contribution from several structures - Neural plate ectoderm forms Neural tube form - CNS which have diencephalon pa of brain aExtension of diencephalon (optic sulcus) into eyeball form retina (optic cup) & optic nerve (optic stalk) - Neural plate ectoderm also forms - epithelium of ciliary body & iris muscle - Muscles of Iris - Sphincter pupillae, dilator pupillae - Eye ball have some contribution from surface ectoderm as well which gives Surface epithelium of cornea (1st layer) Eye lens - Most of derivatives in eyeball come from neural crest cells which gives Secondary mesoderm of eyeball - Forms sclera, choroid, ciliary body & Iris (not epithelium) - All other layers of cornea except 1st layer develops from N.C.C -### End" -746,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In acute inflammation, excessive fluid seepage occurs due to increased permeability of?, with the following options: A: Venules, B: Capillaries, C: Arterioles, D: Arterioles and capillaries - -### Response: -Postcapillary venules are an important point of interchange between the Lumen of the vessels and the surrounding tissue. Moreover, both vascular leakage and Leukocyte exudation occur preferentially in venules in many types of inflammation. -Increased vascular permeability is the hallmark of acute inflammation. -### End" -747,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 5 yr old male had fever and cervical lymphadenopathy. Histopathologic examination of cervical lymph nodes shows:, with the following options: A: Caseating granuloma, B: Non caseating granuloma, C: Stellate granuloma, D: Fat necrosis - -### Response: -Ans. (a) Caseating granulomaCaseating granuloma typical granuloma resulting from infection with Mycobacterium tuberculosis showing central area of caseous necrosis, activated epithelioid macrophages, giant cells, and a peripheral accumulation of lymphocytes.. We can also see langhans giant cell at 3, 0 clock position in image -### End" -748,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 57-year- old lady came with chief complaints of fatigue. On fuher questioning, she reveals that she has gained 5 kg weight in one month. She has been taking L-thyroxine for hypothyroidism since 10 years and fairly controlled. Recently she was staed on an anti-arrhythmic drug for treatment of his cardiac condition. The symptoms staed after sta of this drug. Most likely anti-arrhythmic drug she was prescribed is?, with the following options: A: Lignocaine, B: Amiodarone, C: Procainamide, D: Verapamil - -### Response: -The patient is already a case of hypothyroidism stabilized on thyroxine. Amiodarone is an antiarrhythmic drug with side effects on the thyroid gland and thyroid hormones. It inhibits peripheral conversion of T4 to T3. It contains iodine and can inhibit the formation of thyroid hormones. Most likely Amiodarone would have resulted in loss of control over the hypothyroidism. Procainamide, lidocaine and verapamil are also anti-arrhythmics but have no role on thyroid. -### End" -749,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurological complications of meningitis include all of the following, except:, with the following options: A: Seizures., B: Increased intra-cranial pressure., C: Cerebral hamartoma., D: Subdural effusions. - -### Response: -Ans. is 'c' i.e. Cerebral hamartoma Cerebral hamartoma is a benign, neoplastic condition and is not associated with meningitis.Complications of MeningitisHydrocephalusCranial nerve involvementSeizuresSubdural effusionsSubdural empyemaCerebral herniation d/t increased ICT. -### End" -750,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HLA Complex in human is located on chromosome?, with the following options: A: Chromosome 5, B: Chromosome 6, C: Chromosome 7, D: Chromosome 8 - -### Response: -Harshmohan textbook of pathology 7th edition. *HLA or MHC are located on sho arm of chromosome 6. -### End" -751,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false regarding point source single exposure epidemic?, with the following options: A: Often explosive, B: Is caused by infectious agents only, C: Cases develop within incubation period only, D: Rapid rise and fall of epidemic curve occurs - -### Response: -Point source single epidemic is commonly caused by infectious agent but not always. The example of non infectious agents being involved include Bhopal gas tragedy, Chernobyl tragedy etc. Ref: Park, 21st Edition, Pages 60, 61. -### End" -752,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is of the following is not a content of inguinal canal?, with the following options: A: Spermatic cord, B: Round ligament, C: Ilioinguinal nerve, D: Pudendal nerve - -### Response: -Contents of inguinal canal: Spermatic cord- in males Round ligament- in females Ilioinguinal nerve Genital branch of genitofemoral nerve -### End" -753,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Probenecid interacts with ?, with the following options: A: Streptomycin, B: Ampicillin, C: Vancomycin, D: Erythromycin - -### Response: -Ans. is 'b' i.e., Ampicillin Interactions of probenecid Probenecid inhibits urinary excretion of penicillins, cephalosporins, methotrexate, sulfonamides and indomethacin. It inhibits biliary excretion of rifampicin. Salicylates block uricosuric action of probenecid. Probenecid inhibits tubular secretion of nitrofurantoin. Pyrazinamide and ethambutol may interfere with uricosuric action of probenecid. Note : Ampicillin is a penicillin. -### End" -754,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of neonatal hyperbilirubinemia ?, with the following options: A: Inefficient ervthropoiesis, B: RBC hemoglobin, C: Immature liver enzyme, D: All of above - -### Response: -Ans. is 'd' i.e., All of aboveAvery -textbook of neonatology (P.1536/ed 6th)o 75% of daily billirubin production in Neonats came from normal destruction of circulating RBC.o 25% comes from other factor like.Ineffective erythropoiesisDestruction of immature RBCo Immature UDPGT activity in foetal liver especially preterm baby. -### End" -755,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about oxytocin are all except -, with the following options: A: Synthesized by paraventricular nucleus of hypothalamus, B: Secreted by posterior pituitary, C: Causes uterine contraction of body, D: Causes contraction of lower segment - -### Response: -Ans. is 'd' i.e., Causes contraction of lower segmentOxytocino Oxytocin is a nonapeptide, synthesized predominantly in the paraventricular nucleus of the hypothalamus along with its binding protein neurophysin II. Oxytocin has following physiological actions : -Uterus : - It increases the force and frequency of uterine contraction. Estrogens sensitize the uterus to oxytocin, while progestins decrease the sensitivity. The increased contractility is restricted to the fundus and body, lower segment is not contracted, may even be relaxed at term.Breast: - Oxytocin contracts myoepithelium of mammary alveoli and forces milk into bigger sinusuids - Milk ejection or milk letdown reflex.o Oxytocin secretion is inhibited by sympathetic discharge and circulating catecholamines, by pain and enkephalins, by emotional stress, especially fear, and by alcohol. -### End" -756,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presented with scarring alopecia, thinned nails, hyperpigmented macular lesions over the trunk and oral mucosa. Diagnosis is:, with the following options: A: Psoriasis, B: Leprosy, C: Lichen planus, D: Pemphigus - -### Response: -Scarring alopecia is found in LP and Leprosy both. But oral mucosal involvement and thinning of nails or the diagnosis of LP. -### End" -757,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Migraine prophylaxis includes:, with the following options: A: Verapamil, B: Valproate, C: Amitryptiline, D: All of the above - -### Response: -Trick: Very Volatile Pharma Agent For Migraine Prophylaxis -V  →  Verapamil -V  →  Valproate -P  →  Pizotifen -A  →  Amitryptiline -F  →  Flunarizine -M  →  Methylsergide -P  →  Propranolol -### End" -758,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best treatment of refractory peri-anal fistula in crohn's disease:-, with the following options: A: Fistulectomy, B: Infliximab, C: Olasalizine, D: Mesalamine - -### Response: -Infliximab is effective in CD patients with refractory perianal and enterocutaneous fistulas, with 68% response rate (50% reduction in fistula drainage) and a 50% complete remission rate. Reinfusion, typically every 8 weeks, is necessary to continue therapeutic benefits in many patients. -### End" -759,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Satellite lesions in eye is caused by, with the following options: A: Herpes zoster, B: Herpes simplex, C: Aspergillosis, D: Trachoma - -### Response: -C i.e. Aspergillosis -### End" -760,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hemmorhagic fever is not caused by -, with the following options: A: Yellow fever, B: KFD, C: Japanese encephalitis, D: Dengue fever - -### Response: -kyasanur foerst disease a hemorrhagic fever found in karnataka. It is arboviral disease. A new arbo virus genetically related to RSSE isolated ANANTHANARYANAN TEXT BOOK OF MICROBIOLOGY 9EDITION PGNO.524 -### End" -761,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not given in the treatment cyanotic spells in a patient of TOF?, with the following options: A: Phenylephrine, B: Propranolol, C: Calcium chloride, D: Sodium bicarbonate - -### Response: -Calcium chloride is not used . Propanolol,sodium bicarbonate, phenylephrine are given for cyanotic spells Ghai essential of pediatrics, eighth edition ,p.no:412,table 15.13 -### End" -762,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paranoid Psychosis with cocaine is seen due to-, with the following options: A: Tolerance, B: Withdrawl, C: Reverse Tolerance, D: Intoxication - -### Response: -Paranoid Psychosis is typically a feature of chronic intoxication with cocaine and is related to the prolonged duration of use, high dose, and the individual user's sensitivity to the substance. -### End" -763,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following may be seen as severity of mitral stenosis increases Except, with the following options: A: Pulsatile liver, B: Atrial fibrillation, C: Opening snap delayed from S2, D: Length of murmur is prolonged - -### Response: -Answer is C (Opening snap delayed from S2) The interval between opening snap and S2 is shoened (reduced) as severity of mitral stenosis increases. 'The opening snap generally follows the sound of Aoic valve closure (A2, S2) by 0.5 - 0.12 seconds. The time interval between S2 and OS varies inversely with the severity of MS'- Features suggesting severe M.S. Proximity of S2-OS gap Longer Duration of mid -diastolic murmur' Atrial Fibrillation may be seen in severe Mitral stenosis Mitral stenosis and mitral regurgitation are common causes of Left atrial enlargement which predisposes to AF. The probability of AF increases as severily of MS increases. The irregularly irregular pulse of AF usually means severe mitral stenosis except in elderly patients when AF can occur with mild mitral stenosis' - 'Clinical Methods in cardiology' by Raju (Orient Blackswan) 2003/201 Pulsatile liver may be seen in severe Mitral Stenosis Enlarged Pulsatile Liver is essentially a feature of Tricuspid Regurgitation. Patients with severe MS have pulmonary hypeension that may cause Tricuspid Regurgitation and result in a pulsatile liver. -### End" -764,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Change seen in mitochondria due to aging is?, with the following options: A: Decrease in size & increase in number, B: Decrease in number & increase in size, C: Decrease in size and number both, D: Increase in size and number both - -### Response: -Ans. is 'c' i.e., Decrease in size and number both Morphological changes associated with agingCellular changesDecrease in cell size and numberDecreased in size and number of mitochondria Detachment of ribosomes from ERIncreased number of phagolysosomal vacuolesDefective DNA repairNon-enzymatic glycosylation ofprotienConnective tissue changesThere is loss of elasticity (wrinkling of skin| BP due to decreased elasticity of artery)Ground glass substance changes (cataract)Cartilage and bone changes (osteoarthritis, osteoporosis)Decreased immunityDecreased T cells, B cells, plasma cells and antibodies -### End" -765,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Products of uronic acid pathway in human beings are all EXCEPT:, with the following options: A: Vitamin C, B: Pentoses, C: NADH, D: Glucuronic acid - -### Response: -Humans cannot synthesize vitamin C due to deficiency of enzyme, L-Gulonolactone Oxidase Uronic acid pathway in humans -### End" -766,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest pre-malignant condition of oral cancer is, with the following options: A: Leukoplakia, B: Aphthous ulcer, C: Lichen planus, D: Erythro-leukoplakia - -### Response: -Leukoplakia is the most common (~ 85%) of the premalignant lesions of the oral cavity. -### End" -767,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child is brought by mother with HO massive hematemesis with HO drug intake previously with NSAIDS and on Rx. Associated with moderate splenomegaly diagnosis is –, with the following options: A: Oesophageal varices, B: Duodenal ulcer, C: Drug induced gastritis, D: Peptic ulcer - -### Response: -Clues in this question are - - -1) H/0 massive hematemasis                                    -2) Splenomegaly - -Amongst the given options, splenomegaly will be seen only in esophageal varices due to portal hypertension. -### End" -768,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most specific marker for myeloid series is, with the following options: A: CD 34, B: CD 45, C: CD 99, D: CD 117 - -### Response: -The markers for myeloid series are CD13, CD33, CD 11b, CD15, CD117 and cMPO. c MPO is the most lineage specific marker amongst these. Regarding other options, CD 34 - Myeloid and lymphoid blasts, stem cells, CD 45 - Leukocyte common antigen (nonerythroid hematopoietic cells), CD 99 - Ewing's sarcoma/primitive neuroectodermal cells. -### End" -769,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following blocks replication without getting involved in the DNA strand?, with the following options: A: Cytarabine, B: Nalidixic acid, C: Carbamazepine, D: 5-Fluorouracil - -### Response: -Nalidixic acid: It is active against gram-negative bacteria, especially coliforms: E. coli, Proteus, Klebsiella, Enterobacter, Shigella but not Pseudomonas. It acts by inhibiting bacterial DNA gyrase and is bactericidal. Resistance to nalidixic acid develops rather rapidly. Nalidixic acid is absorbed orally, highly plasma protein bound and paly metabolized in liver: one of the metabolites is active. It is excreted in urine with a plasma tllz -8 hrs. Concentration of the free drug in plasma and most tissues attained with the usual doses is nontherapeutic for systemic infections (MIC values for most susceptible bacteria just approach the &;break-point&; concentration). However, high concentration attained in urine (20-50 times that in plasma) is lethal to the common urinary pathogens. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:687 -### End" -770,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dalen fuchs nodule is a pathognomic feature of which of the following condition ?, with the following options: A: Sympathetic opthalmitis, B: Sarcoidosis, C: Tuberculosis, D: Retinitis pigmentosa - -### Response: -Dalen fuchs nodule refers tocollections of epithelial cells lying between Bruch membrane and the retinal pigment epithelium in sympathetic ophthalmitis. -### End" -771,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a patient of mesothelioma, one often finds ?, with the following options: A: Hypoglycaemia, B: An association with asbestosis, C: Haemorrhagic pleural effusion, D: All of the above - -### Response: -Ans. is `d' i.e., All of the above -### End" -772,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non blanchable erythema of skin is classified as which stage of decubitus ulcer?, with the following options: A: Stage I, B: Stage II, C: Stage III, D: Stage IV - -### Response: -The four stages of pressure ulcer formation are as follows: Stage I, nonblanchable erythema of intact skin; Stage II, paial-thickness skin loss involving epidermis or dermis, or both; Stage III, full-thickness skin loss, but not through the fascia; and Stage IV, full-thickness skin loss with extensive involvement of muscle and bone. Ref: Schwaz's principle of surgery 9th edition, chapter 9. -### End" -773,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Radiocontrast is contraindicated in all except -, with the following options: A: Renal failure, B: Patient on metformin, C: Dehydration, D: Obesity - -### Response: -Impoant risk factors for contrast induced nephropathy (CIN) : Renal failure Diabetes Hypeension Dehydration Patient on metformin Hyperuricemia -### End" -774,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs which increase GABA level in brains-, with the following options: A: Diazepam, B: Phenobarbitone, C: Sodium valproate, D: Carbamazepine - -### Response: -Ans. is 'c' i.e., Sodium valproate GABA level is increased by Valproate and vigabatrine --> by inhibiting GABA transaminase Gabapentin --> by increasing synaptic vesicle release of GABA. -### End" -775,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Methimazole differ from propylthiouracil in all except-, with the following options: A: Is secreated into milk, B: Has more volume of distribution, C: More protein bound, D: All - -### Response: -Ans. is 'c' i.e., More protein bound -### End" -776,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Germ tube test is done for, with the following options: A: Candida albicans, B: Candida tropicalis, C: Candida glabrata, D: Candida kefyr - -### Response: -Germ tube test / Reynold braude phenomenon - specific test for Candida albicans Colonies are mixed with human or sheep serum & incubated for 2 hours . Wet mount preparation is examined under microscope. Germ tubes are formed , describe as long tube like projections extending from yeast cells. -### End" -777,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are the reasons for pain in Sub-Mucosal fibroid, EXCEPT ?, with the following options: A: Torsion, B: Large size, C: Sarcomatous change, D: Degeneration - -### Response: -Pain due to torsion is see with pedunculated subserosal fibroid Torsion is not characteristic of a Sub Mucosalfibroid Pain in sub mucosal fibroid is due to: Fibroid degeneration Large size Sarcomatous change -### End" -778,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about imipenem is most accurate?, with the following options: A: The drug has a narrow spectrum of antibacterial action, B: It is used in fixed dose combination with sulbactum, C: In renal dysfunction, dosage reductions are necessary to avoid seizures, D: Imipenem is active against methicillin-resistant staphylococci - -### Response: -Carbapenems are synthetic b-lactam antibiotics Imipenem, meropenem, doripenem and eapenem are the drugs of this group currently available. Imipenem : Effective against : Gm +ve, Gm -ve including pseudomonas and anaerobic. Dehydropeptidase by kidney metabolises imipenem rapidly. Cilastatin is a dehydropetidase inhibitor, which must be given along with imipenem for desired action. Side effect : Seizure -### End" -779,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skin smear is negative in which leprosy, with the following options: A: Indeterminate, B: Neuritic, C: Lepromatous, D: Borderline - -### Response: -B i.e. Neuritic Leprosy Type Slit Smear & Infectivity Neuritic NegativeQ Tuberculoid - AFB may be found from margin - Not infective usually Borderline - AFB may be found - Infective Lepromatous - Teeming with AFB - Infective Indeterminate - Slit smear & lepromin test is +- Country Most common type of leprosy India, Africa TT (Polar tuberculoid)Q Southeast Asia BT (Borderline tuber culoid) Mexico, Caribbea Lepromatous (LL>BL) -### End" -780,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 15 year old boy had 10–12 partial complex seizures per day inspite of adequate 4 drugs antiepileptic regime. He had a history of repeated high-grade fever in childhood. MRI for epilepsy protocol revealed normal brain scan. What should be the best noninvasive strategy to make a definite diagnosis so that he can be prepared to undergo epilepsy surgery –, with the following options: A: Interictal scalp EEG, B: Video EEG, C: Interictal 18F–FDg PET., D: Video EEG with Ictal 99m Tc – HMPAO Brain SPECT - -### Response: -If localization of epileptic focus is unrevealed on MRI, Ictal SPECT with HMPAO is the most practical and best method. Addition of video EEG further helps in localization of epileptic foci. -### End" -781,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: T-cell mature in:(1991), with the following options: A: Peyer's patches, B: Lymph node, C: Thymus, D: Bursa of fabricius - -### Response: -Ans: c (Thymus)Ref: Ananthanarayan Micro, 7th ed, p. 123 & 6th ed, p. 117, 115; Fig. 15.4 -### End" -782,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sternocleidomastoid is supplied by all of the following aeries except, with the following options: A: Occipital, B: Posterior auricular, C: Thyrocervical trunk, D: Superior thyroid - -### Response: -Superior thyroid aery is a branch of ECA, inferior thyroid aery is a branch of thyrocervical trunk of subclan aery Ref: Gray's40e/262 -### End" -783,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rupture of sclera in ocular contusion is seen most commonly in:, with the following options: A: Superonasal quadrant, B: Superotemporal quadrant, C: Inferonasal quadrant, D: Inferotemporal quadrant - -### Response: -Ans. Superonasal quadrant -### End" -784,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true about sabin vaccine?, with the following options: A: Three doses are given in primary immunization, B: The doses are given at 4-6 weeks interval, C: Given intramuscularly, D: Contains all the 3 strains - -### Response: -

The primary course of immunisation consists of 4 inoculations. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:206. <\p> -### End" -785,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neologism is seen in:, with the following options: A: Depression, B: Schizophrenia, C: Mania, D: Dysphasia - -### Response: -Neologisms - creates new own words, seen in Schizophrenia. Neologisms may be new words that are constructed by the patient or ordinary words that are used in a new way. Neologisms may be mannerisms or stereotypies - in patients with catatonia Is a result of formal thought disorder, words are fused together in the same way as concepts are blended with one another. -### End" -786,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Effect of environment on genes is called?, with the following options: A: Positive Eugenics, B: Negative Eugenics, C: Euthenics, D: Enthenics - -### Response: -Ans. is 'c' i.e., Euthenics Eugenics Science which aims to improve the genetic endoment of human population. o That is improving the quality of the human species or a human population by genetic manipulation. o Eugenis may be : 1. Negative Discouraging reproduction by persons having genetic defect or presumed to have inheritable undesirable traits this includes aboions, sterilization & other methods family planing. 2. Postive Eugenics -> Encouraging reproduction presumed to have inheritable desirable trait. For example, in vitro-feilization, cloning, egg transplantation etc. Euthenick Euthenics deal with human improvement through altering the external environment (environmental manipulation). It includes education, prevention and removal of contagious disease and parasites, education regarding home economics, sanitation and housing. -### End" -787,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following organs is enlarged?, with the following options: A: Colon, B: Ovary, C: Stomach, D: Spleen - -### Response: -Answer C. StomachMassive dilation of the stomach with distal gas is most consistent with gastric outlet obstruction. -### End" -788,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood Tellurite media is used for: March 2013, with the following options: A: Mycobacterium tuberculosis, B: Corynebacterium diphtheriae, C: Mycoplasma pneumoniae, D: Yersinia pestis - -### Response: -Ans. B i.e. Corynebacterium diphtheriae Identification of C. diphtheriae A Gram stain is performed to show gram-positive, highly pleomorphic organisms with no paicular arrangement. Special stains like Albes's stain and Ponder's stain are used to demonstrate the metachromatic granules formed in the polar regions. The granules are called as polar granules, Babes Ernst Granules, Volutin, etc. An enrichment medium, such as Loffler's medium, is used to preferentially grow C. diptheriae. After that, use a differential plate known as tellurite agar, which allows all Corynebacteria (including C. diphtheriae) to reduce tellurite to metallic tellurium. The tellurite reduction is colormetrically indicated by brown colonies for most Cornyebacteria species or by a black halo around the C. diphtheriae colonies. -### End" -789,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minimum time of diagnosis for manic illness: DNB 10; AIIMS 14, with the following options: A: 1 week, B: 1 month, C: 1 year, D: 2 years - -### Response: -Ans. 1 week -### End" -790,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Compound microscope was invented by: September 2004, with the following options: A: Louis Pasteur, B: Hippocrates, C: Robe Hooke, D: Leeuwenhoek - -### Response: -Ans. C i.e. Robe Hook -### End" -791,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organs involved in calcium homeostasis are all except, with the following options: A: Lungs, B: Kidneys, C: Skin, D: Intestines - -### Response: -Answer: a) Lungs.CALCIUM METABOLISM* Total body calcium-lkilogram of which 99% is in bones.* Normal serum calcium: 5mEq/L or 2.5mmol/L or simply 9-10.5 mg/dl.* Normal dietary requirement: 0.5 to lg.Types of calcium:* Ionized calcium (4.5mg/dl) is responsible for many functions such as muscular contraction, coagulation etc...* Maximum calcium absorption occurs in duodenum & proximal jejunum, facilitated by gastric acidDiffusibie/ultra filterable (5.5mg/dl)Non-diffusible/protein bound (4.5mg/dl)Ionized calcium (4.5mg/dl)Albumin bound(4mg/dl)Complexed with other minerals (0.5mg/dl)Globulin bound(0.5mg/dl)* Absorption 'fed by-Acidic pH, hypocalcaemia, proteins* Absorption >ped by Achlorhydria, phosphates, oxalates, alkalis, hypercalcemia.PARATHYROID HORMONESynthesized by principal/ chief cells of parathyroid gland.* In bone, PTH receptors are located on osteoblasts but not on osteoclasts.* Initially and briefly, PTH causes an increase in bone formation by a direct action on osteoblasts. (This brief action is the basis for the usefulness of intermittent PTH administration in the treatment of osteoporosis)* In a second, long-lasting action on osteoclasts, PTH causes an increase in bone resorption.* This second action on osteoclasts is indirect & mediated by cytokines released from osteoblasts.* Thus, osteoblasts, are required for the bone-resorbing action of PTH on osteoclastsSYNTHESIS OF VITAMIN-D* 1, 25-dihydroxyvitamin D rapidly induces absorption of Ca++ by the duodenum (transcaltachia)CALCITONIN* The Para follicular cells (C cells) of the thyroid gland secrete Calcitonin.* Its secretion is increased by hypercalcemia, hypergastrinemia, and b adrenergic agonists* Salmon Calcitonin: produced by ultimo bronchial bodies, is more effective than Calcitonin.* Receptors for calcitonin are found in bones and the kidneys.* Calcitonin lowers circulating calcium and phosphate levels.* It exerts its calcium-lowering effect by inhibiting bone resorption.* This action is direct, and calcitonin inhibits the activity of Osteoclasts in vitro.* It also increases Ca2+ excretion in the urine.FEATURESPTHVITAMIN-DCALCITONINStimulus for release|sb serum ca2+| serum ca2+| serum P| PTH| serum ca2+Receptor locationOsteoblastOsteoblastOsteoclast Action on: Bone| resorption| resorption| resorptionKidney| P reabsorption| ca2+ reabsorption (in distal tubule)| P reabsorption| ca2+ reabsorption Intestine| ca2+ absorption (by activation of vit-D)| P absorption| ca2+ absorption Overall effect on: Serum calcium|| Serum phosphorus|| Other hormones involved in calcium metabolism:* Gluco corticoid excess: 4/ serum ca2 and leads to osteoporosis.* Growth hormone: ^ urinary ca2+ excretion* Oestrogens & testosterone - Prevent osteoporosis. -### End" -792,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most characteristic feature of acute inflammation:, with the following options: A: Vasoconstriction, B: Vascular stasis, C: Vasodilatation and increased vascular permeability, D: Margination of leucocytes - -### Response: -The main vascular reactions of acute inflammation are increased blood flow secondary to vasodilation and increased vascular permeability, both designed to bring blood cells and proteins to sites of infection or injury.Changes in Vascular Caliber and FlowAfter transient vasoconstriction (lasting only for seconds), aeriolar vasodilation occursThe microvasculature becomes more permeable, and protein-rich fluid moves into the extravascular tissuesAs stasis develops, leukocytes (principally neutrophils) begin to accumulate along the vascular endothelial surface--a process called marginationIncreased Vascular PermeabilitySeveral mechanisms may contribute to increased vascular permeability in acute inflammatory reactions areEndothelial cell contraction leading to intercellular gaps in postcapillary venules is the most common cause of increased vascular permeability.Endothelial injury results in vascular leakage by causing endothelial cell necrosis and detachmentIncreased transcytosis of proteins by way of an intracellular vesicular pathway augments venular permeabilityLeakage from new blood vessels.( Robbins Basic Pathology, 9th edition, page 33 ) -### End" -793,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A newborn infant refuses breast milk since the 2nd day of bih, vomits on force-feeding but accepts glucose-water, develops diarrhea on the third day, by 5th day she is jaundiced with liver enlargement and eyes show signs of cataract. Urinary reducing sugar was positive but blood glucose estimated by glucose oxidation method was found low. The most likely cause is deficiency of :, with the following options: A: Galactose-1-phosphate uridyl transferase., B: Beta galactosidase, C: Glucose-6-phosphatase, D: Galactokinase - -### Response: -A i.e. Galactose-l-phosphate uridyl transferase -### End" -794,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following murmurs increase with Valsalva maneuver?, with the following options: A: MR, B: VSD, C: AS, D: Hyperophic cardiomyopathy - -### Response: -Hyperophic cardiomyopathy is defined as left ventricular hyperophy that develops in the absence of causative hemodynamic factors, such as hypeension, aoic valve disease, or systemic infiltrative or storage diseases. Patients may be diagnosed after undergoing evaluations triggered by the abnormal physical findings (murmur) or symptoms of exeional dyspnea, angina, or syncope. Alternatively, diagnosis may follow evaluations prompted by the detection of disease in family members.The systolic ejection murmur of left ventricular outflow tract obstruction is harsh and late peaking and can be enhanced by bedside maneuvers that diminish ventricular volume and transiently worsen obstruction, such as standing from a squatting position or the Valsalva maneuver.Ref: Harrison; 19th edition; Page no: 1569 -### End" -795,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acetazolamide is administered to a glaucoma patient. Given that this drug inhibits carbonic anhydrase in the renal proximal tubule, which of the following substances will be excreted at a lower rate?, with the following options: A: Na+, B: H2O, C: HCO3-, D: NH4 - -### Response: -The primary effect of carbonic anhydrase inhibitors such as acetazolamide is to inhibit both H+ secretion and NaHCO3 reabsorption, making the urine alkaline. NH4+ excretion is reduced as a result of the diminished H+ secretion. Carbonic anhydrase inhibitors restrict H+ secretion by inhibiting the intracellular hydration of CO2, a primary source of intracellular H+. The decline in H+ secretion inhibits the Na+-H+ exchange at the luminal membrane of the proximal tubule, which is the primary site of NaHCO3 diuresis. Carbonic anhydrase inhibitors also block the dehydration of H2CO3 formed in the tubular lumen. Chronic doses of such drugs can lead to hyperchloremic acidosis (metabolic acidosis). Ref: McNamara J.O. (2011). Chapter 21. Pharmacotherapy of the Epilepsies. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -796,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Herpes simplex infection can lead to?, with the following options: A: Frontal lobe infarction, B: Parietal lobe infarction, C: Temporal lobe involvement, D: Occipital neuralgia - -### Response: -Ans. is 'c' i.e., Temporal lobe involvement Pathology of Herpex simplex encephalitis:o Herpes simplex infection has a prediliction for the involvement of Temporal lobe.o The lesions in HSV encephalitis are intense hemorrhagic necrosis of the inferior and medial temporal lobe and the mediorbital part of frontal lobes.o The temporal lobe lesions are usually b/L but not symmetrical.o The distribution of the lesion is so characteristic that the diagnosis can be made by gross inspection or by their location and appearance on imaging studies.o In the acute stages of the disease, intranuclear eosinophilic inclusions are found in neurons and glial cells in addition to the usual microscopic abnormalities of acute encephalitis and hemorrhagic necrosis.C.S.F examination# Increased C.S.F pressure# Pleocytosis, cells are mostly lymphocytes# Red cells sometimes numbering in thousands and xantho chromia are found refecting the hemorrhagic nature of the brain lesions.# Protein content is increased in most cases.# Slight reduction of glucose.o Herpes simplex encephalitis is characterized bv ""focal neurological symptoms""o Over 90% patients will have one of the following symptoms offocal neurological deficit, plus fever -# Focal cranial nerve deficits# Hemiparesis# Dysphasia# Aphasia# Ataxia# Focal seizure# Altered mentation and level of consciousnesso Most common area involved in herpes simplex encephalitis is ""Temporal lobe""# Temporal lobe abnormalities on brain imaging are considered strong evidence for herpes simplex encephalitis.# Temporal lobe lesions are predominantly unilateral.# Most sensitive and specific investigation for HSV-1 encephalitic is MRI# In contrast, cranial CT scans have only 50% sensitivity and that too early in the disease.EEG findings in HSV-jencephalitis# Focal electroencephalogram (EEG) findings occur in >80% of cases typically showing prominent intermittent high amplitude slow waves (delta and theta slowing) and occasionally continuous ""periodic lateralized epileptiform discharges "". -### End" -797,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thrombotic event is seen in all of following except:, with the following options: A: Paroxysmal nocturnal hemoglobinuria, B: Disseminated intravascular coagulation, C: Idiopathic thrombocytopenic purpura, D: Heparin induced thrombocytopenia - -### Response: -*PNH is seen due to PIGA gene defect - Pancytopenia Altered function of platelets - | risk of thrombosis Especially in cerebral & hepatic veins - | Moality *DIC is thrombo-hemorrhagic disorder *Heparin-induced thrombocytopenia has ab produced against platelet factor 4. Also associated with | risk of thrombosis *In ITP, Immune dysfunction characterized by ab formation against Platelet antigen. - Pt sequestration Coombs +ve, Hemolytic anemia -| platelet count - Bleeding -### End" -798,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is most active against both dormant & non-dormant bacilli -, with the following options: A: Pyrazinamide, B: Rifampicin, C: Streptomycin, D: INH - -### Response: -Ans. is 'b' i.e., Rifampin Isoniazid is bacteriostatic for resting bacilli, but is bactericidal for rapidly dividing microorganisms. o The bactericidal action of rifampicin covers all subpopulations of TB bacilli. -### End" -799,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eugene Bleuler's four 'A' of schizophrenia are all EXCEPT, with the following options: A: Autism, B: Affect, C: Anhedonia, D: Association - -### Response: -Ans. c (Anhedonia) (Ref: Psychiatry by Niraj Ahuja 5th/pg. 55)SCHIZOPHRENIA# It commonly begins in late adolescence, has an insidious (and less commonly acute) onset, and, classically, a poor outcome, progressing from social withdrawal and perceptual distortions to a state of chronic delusions and hallucinations.# Patients may present with positive symptoms (such as conceptual disorganization, delusions, or hallucinations) or negative symptoms (loss of function, anhedonia, decreased emotional expression, impaired concentration, and diminished social engagement) and must have at least two of these for a 1-month period and continuous signs for at least 6 months to meet formal diagnostic criteria.# ""Negative"" symptoms predominate in one-third of the schizophrenic population and are associated with a poor long- term outcome and a poor response to drug treatment.# Eugen Bleuler's fundamental symptoms of schizophrenia (4 A's)deg:- Ambivalence (marked inability to decide for or against)- Autism (Withdrawal into self)- Affect blunting (Disturbance of affect)- Association disturbances (loosening of association, thought disorder)# The four main subtypes of schizophrenia are catatonic, paranoid, disorganized, and residual.Catatonic-type:# Patients whose clinical presentation is dominated by profound changes in motor activity, negativism, and echolalia or echopraxia.- Paranoid-type:# Patients who have a prominent preoccupation with a specific delusional system and who otherwise do not qualify as having disorganized-type disease.- Disorganized-type:# Characterized by disorganized speech and behavior are accompanied by a superficial or silly affect.- Residual-type:# Negative symptomatology exists in the absence of delusions, hallucinations, or motor disturbance.# The term schizophreniform disorder describes patients who meet the symptom requirements but not the duration requirements for schizophrenia, and schizoaffective disorder is used for those who manifest symptoms of schizophrenia and independent periods of mood disturbance.Q -### End" -800,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is associated with suicide risk?, with the following options: A: Noradrenaline, B: Serotonin, C: GABA, D: Dopamine - -### Response: -Ans. B SerotoninLow concentrations of 5-hydroxyindoleacetic acid (5-HIAA- metabolite of serotonin) in CSF associated with higher suicide risk -### End" -801,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Failure rate of male condom is:, with the following options: A: 0.50%, B: 2-18%, C: 2-4%, D: 18-28% - -### Response: -Condoms are barrier method of contraception. Total condom failure rates (breakage and slippage rate combined) can range from 2 to 18 % Contraceptive efficacy of the male condom is enhanced appreciably by areservoir tip and by the addition of a spermicide. Such agents, as well asthose used for lubrication, should be water-based because oil-based productsdegrade latex condoms and diaphragms. -### End" -802,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A forceps rotation of 30deg from left occiput anterior (LOA) to occiput anterior (OA) with extraction of fetus from +2station is described as which type of forceps delivery?, with the following options: A: High forceps, B: Mid forceps, C: Low forceps, D: Outlet forceps - -### Response: -Presence of fetal head at +2station indicate low forceps delivery. High forceps -head not engaged Mid cavity forceps-head engaged, presenting pa above +2station Low forceps -head at +2or below it but not at reached pelvic flow Outlet-head at or on perineum. Ref: Datta Obs 9e pg 533, table 37.2 -### End" -803,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of action of vancomycin is, with the following options: A: Inhibit protein synthesis, B: Inhibit cell wall synthesis, C: Inhibiting bacterial DNA replication, D: Inhibit DNA dependent RNA synthesis - -### Response: -(Inhibit - Cell wall synthesis) (732-KDT6th)VANCOMYCIN - bactericidal and acts by interfering with cell wall synthesis, inhibits the release of peptido glycah units from their site of assembly on cell membrane phospholipids. Thus these residues are not available for cross linking to form the cell wall* Clindemycin, Spectinomycin - inhibits protein synthesis* Nalidixic acid - acts by inhibiting bacterial DNA replication* Rifampicin - inhibits DNA dependent RNA synthesis -### End" -804,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not included in armamentarium of tests for malabsorption syndrome:, with the following options: A: D - Xylose, B: 14 C triolein breath test, C: 13 C trioctanoin breath test, D: 13 C triclosan breath test - -### Response: -Test Characterstics D- xylose test Sugar malabsorption and tests jejunal damage or proximal enteropathy 14 C triolein test Fat malabsorption picked up by radiocarbon being tagged to the triglycerides 13 C trioactanoin Fat malabsorption due to pancreatic exocrine insufficiency SeHCAT ( 23-seleno - 25- homo tauro -cholic acid) (selenium homocholic acid taurine) To diagnose bile acid malabsorption Hydrogen breath test For sugar malabsorption as unabsorbed sugar is degraded by bacteria. 13 C acetate breath tests For stomach emptying -### End" -805,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug used for atrial fibrillation and atrial flutter is, with the following options: A: Verapamil, B: Digitalis, C: Quinidine, D: Diphenylhydantoin - -### Response: -For AF, digoxin can be used- it decreases ventricular rate in AF Verapamil decreases conduction velocity and increases the refractory period of the AV node and so used in PSVT. REF.Essentials of Pharmacology KD Tripathi 8th ed. -### End" -806,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Charcot's triad, with the following options: A: Fever, abdominal pain, jaundice, B: Fever, vomiting, jaundice, C: Fever, jaundice, abdominal distension, D: Fever, diarrhoea, jaundice - -### Response: -Charcot's triad is seen in cholangitis It is characterized by Abdominal pain Jaundice Fever Reynold's pentad Charcot's triad Altered mental status. Shock (hypotension) Ref: Sabiston 20th edition Pgno :1507 -### End" -807,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following causes 'Euvolvemic hyponatremia*?, with the following options: A: Nephrotic syndrome, B: SIADH, C: Diarrhea, D: Vomiting - -### Response: -Ref: Nelson's Textbook of Pediatrics 18th edition: page no.275 & Harrison's 18th editionExplanation:Refer previous question's explanation. -### End" -808,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of Cataract, with the following options: A: Infrared, B: Microwaves, C: UV rays, D: All - -### Response: -A, C > B i.e. Infrared, UV rays > Microwaves -### End" -809,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood when stored at 4degC can be kept for-, with the following options: A: 7 days, B: 14 days, C: 21 days, D: 28 days - -### Response: -Typically, blood storage at 4 degrees C is sho term, which ranges from a few days to a few weeks. However, long-term storage usually involves blood being frozen, with a resultant loss in DNA yield. Refer robbins 9/e -### End" -810,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following terms is associated with cocaine, with the following options: A: Reefer, B: Smack, C: Speedball, D: Ecstacy - -### Response: -Reefer - CANNABIS Smack - HEROIN Speedball - COCAINE AND HEROIN Ecstacy - MDMA -### End" -811,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following feature of airways can make babies enable breathing while suckling breast milk?, with the following options: A: Sho, wide tongue, B: Small pharynx, C: Higher position of larynx, D: Small soft palate - -### Response: -Paediatric larynx: Infant's larynx is positioned high in the neck opposite C3 or C4 (vocal cord level ) at rest and reaches C1 or C2 during swallowing. This high position allows the epiglottis to meet soft palate and make a nasopharyngeal channel for nasal breathing during suckling. The milk feed passes separately over the dorsum of tongue and the side of epiglottis, thus allowing breathing and feeding to go on simultaneously. Ref: Diseases of Ear, Nose and Throat by PL Dhingra, 4th edition, Page 262. -### End" -812,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following has both endocrine and exocrine functions?, with the following options: A: Pancreas, B: Thyroid, C: Spleen, D: Kidney - -### Response: -Ans: a (Pancreas)Pancreas has both exocrine and endocrine functions.There are 4 distinct types of pancreatic cells in human.A cells (alpha) - GlucagonB cells (beta) - InsulinD cells (delta) - SomatostatinF cells - Pancreatic polypeptide D1 cells - VIPEndocrine pancreas secretes hormones -glucagon, insulin and somatosta-tin. Exocrine pancreas secretes digestive enzymes like trypsin, chymot-rypsin.Site and mechanism of hormone action:-Mechanism and siteHormoneAt nuclear receptorThyroid ormonesAt cytoplasmic receptorsSteroidal hormones eg:- Glucocorticoids, Mineralocortyicoids, Estrogen, Progestins.At cytoplasmic receptorsa) Direct transmembrane activation of tyrosine protein kinase -InsulinPhosphorylation cascade b) Through IP3/DAG generationVasopressin, oxytocinc) Through alteration of intracellular cAMP concentration - alteration of protein kinase A activityAdrenaline, glucagon, TSH,LH, FSH, PTHACTH, Calcitonin -### End" -813,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are used in heroin poisoning EXCEPT:, with the following options: A: Cloni di ne, B: Buprenorphine, C: Pentazocine, D: Haloperidol - -### Response: -D i.e. Haloperidol -### End" -814,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A five year old boy presents with precocious puberty and a blood pressure of 130/80 mmHg. Estimation of which of the following will help in diagnosis -, with the following options: A: | 17 hydroxy-progesterone, B: | Cortisol, C: | Aldosterone, D: Renin - -### Response: -Ans- A. Ref- Nelson Textbook Of Pediatrics Vol. 1 20th ed Biochemical diagnostic studies show elevated levels of serum 17-OHP, the substrate for the defective 21-hydroxylase enzyme activity. -### End" -815,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After radical mastectomy there was injury to the long thoracic nerve. The integrity of the nerve can be tested at the bedside by asking the patient to:-, with the following options: A: Shrug the shoulders, B: Raise the arm above the head on the affected side, C: Touch the opposite shoulder, D: Lift a heavy object from the ground - -### Response: -Nerve Muscle Movement long thoracic nerve serratus anterior overhead abduction. spinal accessory nerve trapezius Shrugging of shoulder Lateral and medial pectoral nerves Pectoralis major touching the opposite shoulder. -### End" -816,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thyroid gland is stimulated by which hormone during pregnancy ?, with the following options: A: Prolactin, B: HCG, C: Human placental lactogen, D: ACTH - -### Response: -Ans. is 'b' i.e., HCGThe endocrine system undergoes notewohy changes during pregnancy.The pituitary, thyroid and parathyroid glands appear enlarged.The enlargement of thyroid gland occurs under the influence of hCGs pituitary thyrotropin (TSH) and human chorionic thyrotropin from placenta. This results in an increase in thyroxine which stimulates metabolic activity in mother and fetus.Increased parathyroid hormone stimulates liberation of calcium ion from maternal bones for fetal use.Increased output of ACTH from pituitary stimulates secretion of :-Glucocoicoids : It mobilizes amino acids for protein synthesis in fetal tissues.Aldosterone : Promotes fluid retention in pregnancy. -### End" -817,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 58 year old male alcoholic with chronic pancreatitis develops a palpable abdominal mass. Ultrasound reveals a 9 cm cystic lesion adjacent to the pancreas. An impoant complication that might occur if this cyst ruptured would be?, with the following options: A: Anaphylactic shock, B: Carcinomatosis, C: Disseminated infection, D: Intestinal hemorrhage - -### Response: -The patient most likely has a pancreatic pseudocyst, which is a complication of pancreatitis. Pancreatic pseudocyst is not a true cyst; it is lined by granulation tissue and collagen. It contains pancreatic juices and lysed blood, so rupture would spill the active digestive enzymes onto the adjacent viscera, paicularly the stomach, small intestine, and transverse colon. Digestive action produces potentially severe gastrointestinal hemorrhage. Anaphylactic shock results from massive activation of the IgE-mediated branch of the immune system. Pancreatic secretions do not elicit an IgE response. The classic abdominal cyst that ruptures, producing anaphylactic shock, is a hydatid cyst. Carcinomatosis is widespread serosal spread of a carcinoma, typically due to tumor spillage into a body cavity. Although this may occur with pancreatic mucinous cystadenocarcinoma, this disease is far less likely to occur than is pancreatic pseudocyst in a patient with chronic pancreatitis. Pancreatic pseudocyst is not an infective disease. Although septic abscesses do occur in the abdomen, and may even complicate a pancreatic pseudocyst, the danger of rupture is more associated with tissue destruction by pancreatic enzymes than with infection. Ref: Fisher W.E., Anderson D.K., Bell R.H., Saluja A.K., Brunicardi F.C. (2010). Chapter 33. Pancreas. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e. -### End" -818,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disorders of phagocytosis are all, except:, with the following options: A: Job's syndrome, B: Chediak-Higashi syndrome, C: Myeloperoxidase deficiency, D: Wiskott-Aldrich syndrome - -### Response: -Ans. (d) Wiskott-Aldrich syndrome Ref. Anantlumarayan 9/e, p 172 Disorders of phagocytosis Chronic granulomatous disease Myeloperoxidase deficiency Chediak-Higashi syndrome Leukocyte G6PD deficiency Job's syndrome Tuftsin deficiency Lazy leukocyte syndrome Hyper-IgE syndrome Actin binding protein deficiency Shwachman's disease -### End" -819,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 16 year old athlete boy was diagnosed with an isolated avulsion fracture of the lesser tubercle of the humerus. It is caused by the forceful contraction of which of the following muscles ?, with the following options: A: Teres minor, B: Subscapularis, C: Supraspinatus, D: Infraspinatus - -### Response: -The subscapularis muscle is inseed on the lesser tubercle of the humerus. Forceful contraction of subscapularis muscle to resist the abduction and external rotation of the shoulder may cause an isolated avulsion fracture of lesser trochanter. Ref : Gray's Anatomy The Anatomical Basics of Clinical Practice 41e pg 806. -### End" -820,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about streptococcus except :, with the following options: A: M-protein is responsible for production of mucoid colonies, B: M- protein is responsible for virulence, C: Mucoid colonies are virulent, D: No resistance to penicillin has been reported - -### Response: -“Mucoid colonies are due to production of capsule of hyaluronic acid not due to M protein.” -Harrison 17/e, p 882 -Growth characteristic of Strep. pyogenes : - -On blood agar virulent stains forms matt or mucoid colonies while avirulent form glossy colonies. -M, T, R are proteins found on outer part of cell wall and forms the basis of Griffith classification. - -– M protein - Acts as virulence factor and antibody against it are protective. -– T and R protein - No relation to virulence - -Streptococci (Except enterococci) are usually susceptible to penicillin so option “d” is not completely wrong. As option “a” is completely wrong, that would be the answer. -### End" -821,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All can be seen as Post-Diarrhoea complications except:, with the following options: A: HUS, B: Nephritic syndrome, C: Reactive ahritis, D: Guillain Barre syndrome - -### Response: -Complications of Chronic diarrhea * Lactase deficiency * Small-bowel bacterial overgrowth * Malabsorption syndromes (tropical and celiac sprue) * Initial presentation or exacerbation of inflammatory bowel disease * Irritable bowel syndrome * Reactive ahritis (formerly known as Reiter's syndrome) * Hemolytic-uremic syndrome (hemolytic anemia, thrombocytopenia, and renal failure) * Guillain-Barre syndrome -### End" -822,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a nonsedative anxiolytic, with the following options: A: Buspirone, B: Hydroxyzine, C: Chlorpromazine, D: Alprazolam - -### Response: -Buspirone:- It is the first azapirone, a new class of antianxiety drugs. Buspirone * Does not produce significant sedation or cognitive/functional impairment. * Does not interact with BZD receptor or modify GABAergic transmission. * Does not produce tolerance or physical depen dence. * Does not suppress BZD or barbiturate with- drawal syndrome. * Has no muscle relaxant or anticonvulsant activity. Buspirone relieves mild-to-moderate genera lized anxiety, but is ineffective in severe cases. mechanism of anxiolytic action:- It is dependent on its selective paial agonistic action on 5-HT1A receptors. By stimulating presynaptic 5-HT1A autoreceptors, it reduces the activity of dorsal raphe serotonergic neurones. Ref:-kd tripathi; pg num:-466,467 -### End" -823,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements are false regarding plague, except, with the following options: A: Live attenuated vaccine are used, B: Septicemic Plague is highly infectious, C: Vaccine is not used to control epidemic of pneumonic plague, D: Most impoant measure to control epidemic is rodent control - -### Response: -Vaccine is not effective in pneumonic plague. -### End" -824,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which antidiabetic drug is used both for type I& II DM -, with the following options: A: Sulphonylureas, B: Metformin, C: Acarbose, D: Pramlinitide - -### Response: -Ans. is d i.e., Pramlinitide Pramlinide is the only approved drug, beside insulin, to be used in both type-I and type-2 DM. Pramilinitide This is a synthetic amylin analogue (Amylin is a polypeptide produced by pancreatic (3-cells which reduces glucagon secretion from a-cells and delays gastric emptying). Pramlintide attenuates postprandial hyperglycemia and exes a centrally mediate anorectic action. It is given by subcutaneous route and is used in both Type 1 and Type 2 DM. -### End" -825,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The optimum length of screw for fixation of plates in mandible:, with the following options: A: 3 mm, B: 4 mm, C: 5 mm, D: 6 mm - -### Response: -Usually the thickness of buccal cortex is around 3.5 mm. A 4 mm length screw is adequate for proper screw-bone contact. -### End" -826,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In chronic diabetics the value of TG and VLDL are more because, with the following options: A: Increased in activity of hepatic lipase, B: Increase in peripheral function of LDL receptors, C: Increased activity of lipoprotein lipase and decreased activity of hormone sensitive lipase, D: Increased activity of hormone sensitive lipase and decreased lipoprotein lipase activity - -### Response: -Insulin Activates Lipoprotein lipase Inhibits Hormone sensitive lipase (HSL) In diabetic condition opposite will occur, i.e. Increased activity of hormone sensitive lipase and decreased lipoprotein lipase activity. Increased activity of hormone sensitive lipase Catabolic activity of Fatty acid in Blood -### End" -827,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Monozygotic twins do not have same?, with the following options: A: Fingerprints, B: Genetic make up, C: Facial appearance, D: Stature - -### Response: -Ans. is 'a' i.e., Fingerprints Monozygotic twins are a result of the division of the single feilized egg into two embryos. Thus, they have exactly identical DNA, except for the generally undetectable micromutations that begin as soon as the cell stas dividing. Fingerprints of the identical twins sta their development from the same DNA so they show considerable genetic similarity. However identical twins are situated in different pas of the womb during development, so each fetus encounters slightly different intrauterine forces than their siblings. As a result fingerprints of the identical twins have different microdetails which can be used for identification purposes. -### End" -828,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'Hand and Foot' syndrome can be caused by :, with the following options: A: Cisplatin, B: Vincristine, C: Capecitabine, D: Mitomycin-C - -### Response: -5-FU, capecitabine and liposomal doxorubicin can cause hand and foot syndrome. Generally, this disease affects infants and children. Adults with immunodeficiency can also be affected. -### End" -829,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pancreatitis may be produced by which of the following drugs?, with the following options: A: Colchicine, B: L- asparagine, C: Ciprofloxacin, D: Nalidixic acid - -### Response: -Exposure to ceain drugs is the third most common frequent cause of pancreatitis after gallstones and alcohol. Drugs associated with pancreatitis: Definitive cause 5- Aminosalicylate 6- Mercaptopurine Azathioprine Cytosine arabinoside Dideoxyinosine Diuretics Estrogens Furosemide Metronidazole Pentamidine Tetracycline Thiazide Trimethoprim - sulphamethoxazole Valproic acid Probable cause Acetaminophen a- Methyl- DOPA Isoniazid L- asparagine Phenformin Procainamide Sulindac Ref: Sabiston 18/e, Page 1595 -### End" -830,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A newborn with respiratory distess was noted to have marked nasal flaring, audible grunting, minimal intercostal chest retarction. The respiratory rate was 30/min. The Silverman score of this child would be?, with the following options: A: 1, B: 2, C: 3, D: 6 - -### Response: -. -### End" -831,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bisphosphonates act by -, with the following options: A: Increasing the osteoid formation, B: Increasing the mineralization of osteoid, C: Decreasing the osteoclast mediated resorption of bone, D: Decreasing the parathyroid hormone secretion - -### Response: -Ans. is 'c' Decreasing the osteoclast mediated resorption of bone The clinical utility of biosphosphonates resides in their ability to inhibit bone resorption. The mechanism by which the entire resorptive effects occur is not completely known but it is thought that the biphosphonate becomes incorporated into bone matrix and is imbibed by osteoclasts during resorption. The osteoclast is then incapaciated and resorption decreases. Goodman & Gillman 1666. -### End" -832,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The school health surveys are quite useful in early detection of mainly:, with the following options: A: Refractive errors, B: Amblyopia, C: Colour vision defects, D: All of the above - -### Response: -Ans. All of the above -### End" -833,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phlycten is due to -, with the following options: A: Exogenous allergy, B: Endogeneous allergy, C: Viral keratitis, D: Fungal keratitis - -### Response: -Phlyctenular conjunctivitis - Endogenous allergy It is believed to be a delayed hypersensitivity (Type IV cell mediated) response to endogenous microbial proteins. Causative allergens are :- (i) Staphylococcus proteins (most common); (ii) Tuberculous proteins and (iii) Proteins of Moraxells axenfeld bacillus and ceain parasistes. Vernal keratoconjunctivitis - Exogneous allergy Reference : AK khurana 7th edition -### End" -834,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atropine poisoning causes all, except, with the following options: A: Dilated pupil, B: Excitement, C: Excessive salivation, D: Hot skin - -### Response: -Ans. (C) Excessive salivation(Ref: KDT 8th/e p132)Atropine is an anticholinergic drug. Its toxicity causes:Dry mouth (and not excessive salivation)Hot skinDilated pupil and photophobiaExcitementFlushing of skinHypotension - cardiovascular collapseConvulsions and coma -### End" -835,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following Thiazide diuretic is active if the GFR is 30-40 mm Hg, with the following options: A: Metolazone, B: Benzthiazide, C: Chlorothiazide, D: Chlohalidone - -### Response: -Although most thiazide diuretics lose their effectiveness in renal failure, metolazone remains active even when the glomerular filtration rate (GFR) is below 30-40 mL/min (moderate renal failure). This gives it a considerable advantage over other thiazide diuretics, since renal and hea failure often coexist and contribute to fluid retention(Refer: K. D. Tripathi&;s Essentials of Medical Pharmacology, 7th edition, pg no: 583) -### End" -836,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adrenal hyperplasia due to 21 hydroxylase deficiency is treated with low dose:, with the following options: A: Androgen, B: Estrogen, C: Cortisone, D: Anti androgen - -### Response: -Ans: cRef: Pedia ghai, 6th ed, p. 497, Nelson, 17th ed, p. 1912 -### End" -837,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MC cause of secondary PPH is:, with the following options: A: Atonic uterus, B: Retained placenta, C: latrogenic injury, D: Medical diseases - -### Response: -Retained placenta -### End" -838,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Montgomery tube used in ENT procedure is a:, with the following options: A: Double barrel tub, B: Lobster tail tube, C: Airway tube, D: Silicone tube - -### Response: -Montgomery tracheal tube is designed to give the surgeon a complete program for creating a secondary airway-from initial incision through long-term tracheostomy care. It is a tracheal cannula system used in place of tracheostomy tubes. The system provides long-term access to the tracheal airway in situations that require an aificial airway or where access is needed for pulmonary hygiene. It is so designed that the thin inner flange of the cannula is shaped to fit snugly against the contour of the inner anterior tracheal wall. No tube projects into the tracheal lumen. All tracheal cannulas are made of flexible implant grade silicone to assure patient comfo and safety while reducing complications. -### End" -839,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 20 years old nulliparous women is an oral contraceptives pills. She is currently diagnosed as having pulmonary tuberculosis. Which antituberculous drug decreases the effect of OCPs?, with the following options: A: INH, B: Pyrazinamide, C: Ethambutol, D: Rifampicin - -### Response: -Because rifampin potently induces CYPs 1A2, 2C9, 2C19, and 3A4, its administration results in a decreased t1/2 for a number of compounds, including: HIV protease and non-nucleoside reverse transcriptase inhibitors Digitoxin Digoxin Quinidine Disopyramide Mexiletine Tocainide Ketoconazole Propranolol Metoprolol Clofibrate Verapamil Methadone Cyclosporine Coicosteroids Coumarin anticoagulants Theophylline Barbiturates Oral contraceptives Halothane Fluconazole Sulfonylureas It leads to therapeutic failure of these agents, with potentially catastrophic consequences. Ref: Gumbo T. (2011). Chapter 56. Chemotherapy of Tuberculosis, Mycobacterium Avium Complex Disease, and Leprosy. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -840,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about tail wagging of bullet:, with the following options: A: Bullet rotates end-to-end during its path, B: Minor damage to tissues, C: Seen when the bullet leaves the muzzle at the beginning of its flight, D: Seen when the bullet loses its velocity near the termination of its flight - -### Response: -Yawning bullet:- Detion between the long axis of the bullet and axis of the path of the bullet Tumbling bullet:- Bullet rotates end-to-end during its path Tail wobble or Tail wagging:- It occurs for few microseconds after the bullet leaves the muzzle May cause great damage -### End" -841,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prokaryote is -, with the following options: A: Bacteria, B: Mycoplasma, C: Blue green algae, D: All - -### Response: -Ans. is 'a' i.e., Bacteria; 'b' i.e., Mycoplasma; 'c' i.e., Blue green algae -### End" -842,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of shoulder dislocation is: March 2011, with the following options: A: Posterior, B: Anterior, C: Inferior, D: Superior - -### Response: -Ans. B: Anterior Shoulder joint is the commonest joint in the body to dislocate Anterior shoulder dislocation is much more common than posterior dislocation Shoulder dislocation: MC joint to dislocate in body: Shoulder MC type of shoulder dislocation: Subcoracoid/ inferior Rarest type of shoulder dislocation: Posterior Posterior type of shoulder dislocation is associated with: Epileptic fits Banka's lesion is related with avulsion of glenoidal labrum Hill Sach's lesion is found on humeral head Test for dislocation of shoulder joint: - Duga's test, - Hamilton ruler test, - Callaways test Kocher's manouevre is done to reduce a dislocated shoulder -### End" -843,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best prognosis in nerve injury, with the following options: A: Neuropraxia, B: Axonotemesis, C: Neurotemesis, D: Complete transaction - -### Response: -Neurapraxia is a disorder of the peripheral nervous system in which there is a temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of six to eight weeks before full recovery.Ref: Ganong&;s review of medical physiology 23rd edition -### End" -844,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: H1N1 influenza prophylaxis, with the following options: A: Oseltamivir, B: Zanamivir, C: Amantadine, D: Rimantadine - -### Response: -Ans. a. OseltamivirRef: Goodman Gilman 12th E/P1114Drug of Choice for Treatment of InfluenzaInfluenza A and BOseltamivir resistant influenza A and BOral Oseltamivir 75 mg BD for 5 daysInhalational Zanamivir 75 mg OD for 7 daysDrug of Choice for Prophylaxis of InfluenzaInfluenza A and BOseltamivir resistant influenza A and BOral Oseltamivir 10 mg BD 5 daysInhalational Zanamivir 10 mg OD 7 days -### End" -845,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudo tumour cerebri is caused by all except:, with the following options: A: Hypervitaminosis A, B: Outdated tetracycline, C: Nalidixic acid, D: Digoxin - -### Response: -Ans: d (Digoxin) Ref: Nelson, 17th ed, p. 2048 & OP Ghai, 6th ed, p. 530Pseudo tumour cerebri is a clinical syndrome that mimics brain tumours and is characterized by increased intra cranial pressure with a normal cerebrospinal fluid cell count and protein content and normal ventricular size, anatomy and positionCAUSES OF PSEUDOTUMOUR CEREBRIMetabolic disoders * Galactosemia* Hypoparathyroidism* Pseudohypoparathyroidism* Hypophosphatasia* Prolonged corticosteroid therapy or too rapid corticosteroid withdrawal* Growth hormone treatment* Refeeding of a significantly malnourished child* Hypervitaminosis A* Vitamin A deficiency* Addison's disease* Obesity* Menarche* Oral contraceptive pills* PregnancyInfectionsHaemetological disorders* Roseola infantum* Chronic otitis media* Mastoiditis* Guillain Barre syndrome* Polycythaemia* Hemolytic anaemia* Iron deficiency anaemia* Wiskott Aldrich syndromeDrugs * Nalidixic acid* Outdated tetracyclins* Nitrofurantoin* Isotretinoin Obstruction of intracranial drainage by venous thrombosisHead injuryObstruction of superior venacava. -### End" -846,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Bone within a Bone"" appearance is seen in:, with the following options: A: Osteogenesis imperfecta, B: Osteopetrosis, C: Scurvy, D: Rickets - -### Response: -Osteopetrosis -### End" -847,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with blunt abdominal trauma presented to casualty with BP 90/60 mm Hg & pulse rate 124. The investigation to be done in this patient Is?, with the following options: A: CT abdomen, B: MR1 abdomen, C: DPL, D: FAST - -### Response: -ANSWER: (D) FASTREF: Bailey and love 25th edition page 143-144As the above mentioned patient is in shock with history of blunt abdomen trauma, the first investigation to be done should be FAST.""Ultrasound has an evolving role in the assessment of acutely traumatised patients. The main current roles of ultrasound include the assessment of intraperitoneal fluid and haemopericardium (focused assessment with sonography for trauma, FAST), the evaluation of pneumothoraces in supine patients and in guiding intervention""FAST ultrasound is a limited examination directed to look for intraperitoneal fluid or pericardial injury as a marker of underlying injury. This avoids the invasiveness of diagnostic peritoneal lavage. In the presence of free intraperitoneal fluid and an unstable patient, the ultrasound allows the trauma surgeon to explore the abdomen as a cause of blood loss. In the presence of fluid and a haemodynamically stable individual, further assessment by way of CT can be performed. Occasionally, a second ultrasound scan may show free fluid in the presence of an initially negative FAST scan. -### End" -848,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Modern IOL is made up of –a) Acrylic acidb) PMMAc) PMLd) Silicone) Glass, with the following options: A: abc, B: abd, C: bc, D: bde - -### Response: -IOL are made of (i) PMIVIA (rigid IOL); (ii) Silicon, acrylic, hydrogel, collamer (foldable IOL). -### End" -849,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a poxvirus-, with the following options: A: Vaccinia virus, B: Molluscum contagiosum, C: Tanapox virus, D: Coxsackie virus - -### Response: -Ans. is 'd' i.e., Coxsackie virus o Poxviruses are the largest viruses with largest genome. o Poxviridae has been classified into two subfamilies -i) Chordopoxvirinae: Poxviruses of vertebrates.ii) Entomopoxvirinae: Poxviruses of insects which do not infect vertebrates, o Chordopoxvirinae are classified into six genera or subgroups -i) Orthopoxvirus: These are mammalian poxviruses that tend to cause generalized infection with rash. Exmples are variola (smallpox virus), vaccinia, cowpox, monnkeypox, rabbitpox, buffalopox, camelpox, mousepox.ii) Parapoxvirus: Viruses of ungulates that may occasionally infact human, eg. Orf (contagious pustular dermatitis) and paravaccinia (milker's node, bovine pupular stomatitis).iii) Copripoxvirus: Viruses of goat and sheeps, eg. sheep-pox, goatpox, lumpy skin disease.iv) Leporipox virus: Viruses of of leporids (rabbits, hares, squirrels), e.g. myxoma and fibromas.v) Avipoxvirus: Virus of birds, eg. fowlpox, turkeypox, pigeonpox, canarypox.vi) Suipoxvirus: Virus of swine, eg. swinepox. -### End" -850,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an alkaloid, with the following options: A: Morphine, B: Neostigmine, C: Emetine, D: Atropine - -### Response: -Neostigmine, sold under the brand name Prostigmin among others, is a medication used to treat myasthenia gravis, Ogilvie syndrome, and urinary retention without the presence of a blockage. It is also used together with atropine to end the effects of neuromuscular blocking medication of the non-depolarizing type. Refer 7/105 -### End" -851,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following increases the susceptibility to coronary aery disease?, with the following options: A: Nephrotic syndrome, B: Von willebrand disease, C: Type V hyperlipoproteinemia, D: Systemic lupus erythematosus - -### Response: -Patients with nephrotic syndrome develop hyperlipidemia and hypercholesterolemia, secondary to increased hepatic synthesis of lipoproteins and decreased clearance of lipoproteins from the circulation. Hyperlipidemia in these patients also cause systemic atherosclerosis. Marked reduction of HDL receptor protein expression also contribute to increased atherosclerosis. All of these, acts as predisposing factors for the development of coronary aery disease. Ref: Heptinstall's Pathology of The Kidney, Volume 1 By J. Charles Jennette, Page 132; Therapy of Renal Diseases and Related Disorders By Wadi N. Suki, 2nd Edition, Chapter 321; Current Medical Diagnosis and Treatment, 2012, Chapter 22. -### End" -852,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Red velvety appearance of stomach mucosa is seen in the poisoning of:, with the following options: A: Lead, B: Arsenic, C: Copper, D: Mercury - -### Response: -Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 29th edition, 2010, Page 452Explanation:""Arsenic Poisoning: The lesions are mainly found in the stomach. The mucosa is swollen, oedematous and red either generally or in patches; especially in the pyloric region. There may be lines of redness running along the wails or curved lines of submucous haemorrhages. The stomach mucosa resembles red velvet."" (Ref: KS Narayan Reddy)ARSENIC POISONINGInterferes with cellular respiration by combining with the sulphvdryl groups of mitochondrial enzymes.Affects pyruvate oxidase and phosphatases. Clinical FeaturesSweet metallic taste.Burning colicky abdominal pain.Purging.Tenesmus.Stools are bloody dark coloured, foul smelling.Stools become colourless and odourless in late stages (Rice watery stool).Garlicky odour of breath and faeces.Other FeaturesFatty liver.Nephritis.Increased vascular permeability.Ventricular tachycardia.Ventricular fibrillation.Peripheral neuropathy - Stocking glove distribution.Fatal dose: 0.1 - 0.2 Arsenic trioxide.Fatal period: 1 - 2 days.TreatmentEmetics are not recommended.Stomach wash with warm water and milk.Freshly prepared hydrated ferric oxide: Converts toxic arsenic to nontoxic ferric oxide.BAL.Penicillamine.DMSA.Castor oil or magnesium sulphate decreases intestinal absorption.Postmortem Appearance:Raindrop type of skin pigmentation.Aldrich Mees lines in nails.Red velvety stomach mucosa.COPPER POISONINGAsa metal is not poisonous.Copper compounds are powerful inhibitors ofenzymes.Poisonous compounds:o Copper sulphate (Blue vitriol) o Copper subacetate (Verdigris).Clinical FeaturesMetallic taste.T Salivation.Blue vomitusDiarrhea.Uremia, hematuria.Acidosis.Hemoglobinuria.Jaundice.Pancreatitis.Altered sensorium.Weakness.Coma.Fatal Dose:Copper sulphate-30 grams.Copper subacetate-15 grams.Fatal Period: 1-3 days.TreatmentStomach wash with 1% potassium ferrocyanide.Hemodialysis useful in early stages.Castor oil removes copper from intestine.Chelation with penicillamine/EDTA/BAL.Postmortem AppearanceGastric mucosa and stomach contents: Bluish or greenish.Other CharacteristicsChronic poisoning: Chalcosis - Presence of copper deposits in tissues.MERCURY POISONINGAcid metallic taste.Hoarse voice.Greyish white coating of tongue.B lood- stai ned stool.Circulatory collapse.Necrosis of jaw.Membranous.Colitis.Proximal renal tubular necrosis.o Acrodyniat Aero-Limbs Odynia-Pain) is seen in mercury poisoning (aka Pink's Disease ). It is characterized by pain, swelling and parasthesia of limbso Mimimata disease--Contamination of fish with mercury, at a place called Minimate Bay in Japan.o Chronic Poisoning (Hydrargyrism): The symptoms are salivation, sore mouth and throat, fine tremors of the tongue, hands, arms, anemia.o Shaking palsy is associated with Hg poisoning. Mercurial tremors are also called hatter's shakes or glass blower's shake or Danbury tremors.o Mercurial erethism is seen in persons working with mercury in mirror manufacturing firms. Erethism is characterized by shyness, timidity, irritability, loss of confidence, mental depression, loss of memory and insomnia (Psychological symptoms).o Mercuria lentis is a peculiar eye change due to brownish deposit of mercury through the cornea on the anterior lens capsule (Brown- Malt Reflex). It is bilateral and has no effect on visual acuity. -### End" -853,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oliguria causing drug is-, with the following options: A: Acyclovir, B: Diazepam, C: Aspirin, D: Montelukast - -### Response: -Ans. is 'a' i.e., Acyclovir Drugs Causing Oliguriao Drugs causing decreased renal perfusion - diuretics.o Drugs causing nephrotoxicity - aminoglycosides and chemotherapeutic agents,o Urine retention - adrenergic and anticholinergic drugs.o Urinary obstruction associated with precipitation of urinary crystals - sulfonamides and acyclovir. -### End" -854,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are varients of Acne, EXCEPT:, with the following options: A: Acne conglobata, B: Acne agminata, C: Acne fulminans, D: Pomade acne - -### Response: -Acne agminata also known as lupus miliaris disseminatus faciei or facial idiopathic granulomatous with regressive evolution is a disorder of unceain etiology. Ref: Rook Textbook of Dermatology, 8th Edition, Page 38.37. -### End" -855,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surface antigen of E coli acting as virulence factors are:-, with the following options: A: LPS O Antigen, B: Capsular K antigen, C: Fimbriae, D: All of the above - -### Response: -Virulence factors of E. coli: Surface antigens Toxins Somatic or O ag- Lipopolysaccharide (LPS), most impoant virulence factor & responsible for endotoxic activities LT (heat labile toxin) - - | cAMP so causes excessive secretion of Na/Cl/H2O from within to outside the cell = secretory diarrhea Flagellar or H Ag- Makes the bacteria motile. ST (heat stable toxin)- - | cGMP so fluid accumulation in gut = Diarrhea Capsular or K Ag- It is a polysaccharide capsular Ag, inhibits the phagocytosis. Verocytotoxin or Shiga like toxin - - It inhibits the protein synthesis by binding to 28S subunit of 60S ribosome = Cell death Fimbrial antigen (Pilus) - helps in attachment & colonization. -### End" -856,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A type of teiary waste water treatment process is -, with the following options: A: Reverse osmosis, B: Sedimentation, C: Both, D: Neither - -### Response: -Sewage treatment Primary treatment : Physical treatment to remove solids (from the liquid) Secondary treatment : Bilogical treatment brought about by aerobic and anaerobic bacteria Teiary treatment : Improving fuher the quality of effluent (advanced waste treatment process), sludge (stabilisation and dewatering), assist sedimentation and sludge treatment (chemical treatment by the addition of coagulants) Ref: Park 25th edition Pgno : 800 -### End" -857,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following muscle cause hip extension and knee flexion ?, with the following options: A: Semitendinosus, B: Gastrosoleus, C: Psoas major, D: Tensor Fascia lata - -### Response: -Ans. is'a' i.e.. SemitendinosusSemitendinosus is hamstring muscle.Causes flexion at knee & extension at hip. -### End" -858,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Capitate bone aiculates with all EXCEPT, with the following options: A: Second metacarpal, B: Lunate, C: Trapezium, D: Scaphoid - -### Response: -The capitate bone is the largest of the carpal bones in the human hand, and occupies the center of the wrist. It aiculates with trapezoid (not trapezium) bone. -### End" -859,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are side effects of phenytoin, EXCEPT, with the following options: A: Ataxia, B: Hypoglycemia, C: Hirsutism, D: Gum hypertrophy - -### Response: -(B) Hypoglycemia # Dosage and Adverse Effects of Commonly Used Antiepileptic Drugs# Phenytoin (diphenylhydantoin) Principal Uses -- Tonic-clonic (grand mal); Focal-onset Typical Dose; Dose Interval-- 300-400 mg/d (3-6 mg/kg, adult; 4-8 mg/kg, child); qd-bid Half-Life -- 24 h (wide variation, dose dependent) Therapeutic Range -- 10-20 pg/mL Adverse Effects/Neurologic -- Dizziness Diplopia Ataxia Incoordination Confusion Adverse Effects/Systemic -- Gum hyperplasia Lymphadenopathy Hirsutism Osteomalacia Facial coarsening Skin rash Adverse interactions -- Level increased by isoniazid, sulfonamides, fluoxetine Level decreased by enzyme inducing drugs Altered folate metabolism -### End" -860,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Teuton giant cells are seen in:, with the following options: A: Sarcoidosis, B: Tuberculosis, C: Foreign body granuloma, D: Xanthoma - -### Response: -Touton giant cells - -These giant cells are seen in lesions with high lipid content such as fat necrosis, xanthoma, and xanthogranulomas. -They are also found in dermatofibroma. -They are formed by the fusion of epithelioid cells (macrophages) and contain a ring of nuclei surrounded by a foamy cytoplasm. -### End" -861,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True negative means -, with the following options: A: Sensitivity, B: Specificity, C: Positive predictive value, D: Negative predictive value - -### Response: -.true negative means specificity.it is defined as the ability of a test to identify correctly those who do not have the disease that is true negatives. ref:park&;s textbook,22nd edition,pg no 112 -### End" -862,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which carpal bone fracture causes median nerve involvement?, with the following options: A: Scaphoid, B: Lunate, C: Trapezium, D: Trapeziod - -### Response: -A palmar pole fracture of lunate may cause carpal tunnel syndrome and median nerve compression. -### End" -863,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organ of Rosenmuller is a remnant of -, with the following options: A: Endodermal sinus, B: Mullerian duct, C: Mesonephric tubule, D: Paramesonephric duct - -### Response: -Remnant of mesonephric tubule is known as an organ of Rosenmuller/ Epophoron. -### End" -864,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is seen in high attitude climbers:, with the following options: A: Hyperventilation, B: Hyperventilation, C: Pulmonary edema, D: All - -### Response: -A i.e. Hyperventilation, (B) i.e. Decreased Pa CO2 (C) pulmonary edema -### End" -865,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CTL inducing vaccines, recombinant adeno-associated virus vaccine and modified vaccinia Ankara are being developed for:-, with the following options: A: Tuberculosis, B: Leprosy, C: Malaria, D: HIV/AIDS - -### Response: -CTL inducing vaccines, recombinant adeno-associated virus vaccine and modified vaccinia Ankara are being developed for HIV/AIDS. Since 1987, more than 30 HIV candidate vaccines have been tested in clinical trials phases I/II: some of them are: AIDS VAX; only vaccine in phase III trials. Cytotoxic T-Lymphocytes inducing vaccine. Recombinant adeno-associated virus vaccine. Modified vaccine Ankara vaccine. Subunit vaccine. -### End" -866,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The appropriate term used for describing the condition when the palatal cusps of the maxillary posterior teeth are placed buccal to the buccal cusps of mandibular posterior teeth:, with the following options: A: Buccal non-occlusion, B: Lingual non-occlusion, C: Scissor bite, D: Both 1 and 3 - -### Response: -Buccal non-occlusion: Here the maxillary teeth palatal cusp of the occlusion are placed buccal to the buccal cusp of the mandibular posterior teeth. The condition is also known as scissors bite. -### End" -867,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infectious mononucleosis, a viral disorder that can be debilitating, is characterized by which of the following statements?, with the following options: A: It is most prevalent in children less than 14 years old, B: It is caused by a rhabdovirus, C: The causative pathogen is an Epstein-Barr virus, D: Affected persons respond to treatment with the production of heterophil antibodies - -### Response: -All of Koch's postulates have been verified for the relationship between infectious mononucleosis and Epstein-Barr virus, a herpesvirus. However, the relationship between this virus and Burkitt's lymphoma, sarcoid, and systemic lupus erythematosus (SLE) is less clear. Infectious mononucleosis is most common in young adults (14 to 18 years of age) and is very rare in young children. There is no specific treatment. Heterophil antibody titer is helpful in diagnosis, but is not expressed as a function of clinical recovery. -### End" -868,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A sho statured boy with rhizomelic limbs and brachydactyly is a feature of, with the following options: A: Achondroplasia, B: Laron dwarfism, C: Hypothyroidism, D: Morquio disease - -### Response: -Features of Achondroplasia Ref image - Researchgate.net -### End" -869,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are features of musculocutaneous nerve injury at axilla except, with the following options: A: Loss of flexion of shoulder, B: Weak elbow flexion, C: Weak forearm supination, D: Loss of sensation on radial side of forearm - -### Response: -Loss of flexion of shoulder* Flexion at shoulder is done by major muscles like pectoralis major, anterior fibres of deltoid, which are intact here. Musculocutaneous nerve (MCN)originates from the lateral cord of the brachial plexus of nerves. It pierces the coracobrachialis muscle and gives off branches to the muscle, as well as to brachialis and biceps brachii, the chief flexors at elbow joint. Coraco-brachialis is a flexor at shoulder joint Biceps brachii is a powerful supinator, hence supination is weakened. MCN terminates as the lateral cutaneous nerve of the forearm. -### End" -870,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The zinc oxide-eugenol impression pastes harden by:, with the following options: A: Chemical reaction, B: Cold, C: Heat, D: Pressure - -### Response: -Key Concept:  ZnO Eugenol impression paste hardens by chemical reaction. -### End" -871,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding malignant melanoma all the following are true EXCEPT, with the following options: A: Vertical depth of invasion is a prognostic indicator, B: Occurs in actinic damaged skin, C: Lentigo maligna is a type of malignant melanoma, D: May shows spontaneous regression - -### Response: -Ans) d (May shows spontaneous regression) Ref: Sabistons textbook of surgery 18th editionRisk factors1. Solar ultraviolet (UV) radiation - actinic damaged skin2. Severe bums in childhood3. Fair complexion4. Dysplastic nevus (DN) syndrome5. Xeroderma pigmentosum6. History of nonmelanoma skin cancer (NMSC)7. Family history of melanoma.Precursor Lesions and Risk Factors1. Congenital nevi2. DNs3. Spitz neviHistologic types of Cutaneous MelanomaSuperficial spreading melanoma - most commonLentigomalignaAcral lentiginous melanomaNodular melanomaPrognostic factors1. LN involvement (Most important)2. Breslows thickness (Major determinant in the absence of nodal disease) -### End" -872,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following has autosomal inheritance?, with the following options: A: Hemophilia, B: Marfan syndrome, C: CHD, D: Gout - -### Response: -Ans. is 'b' i.e., Marfan syndrome Marfan syndrome is an autosomal disorder (autosomal dominant). o Hemophilia is X-linked recessive. o CHD and gout have multifactorial inheritence. -### End" -873,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 69-year-old woman is taking large amounts of aspirin for osteoarthritis, and now complains of ringing in her ears and nausea.For the above patient with new symptoms, select the most likely acid base disorder., with the following options: A: metabolic acidosis, B: metabolic alkalosis, C: respiratory acidosis, D: respiratory alkalosis - -### Response: -Chronic salicylate use can cause respiratory alkalosis. Severe salicylate toxicity results in an anion gap metabolic acidosis such as during an overdose. During acute hyperventilation, plasma bicarbonate concentrations fall by approximately 3 mEq/L when the arterial pressure of CO2 falls to about 25 mm Hg. Acute respiratory alkalosis can be caused by anxiety, central nervous system (CNS) disorders, drugs, or fever. Chronic respiratory alkalosis occurs in pregnancy and liver disease as well. -### End" -874,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are oncogenic viruses except:, with the following options: A: Hepatitis C, B: Ebstein Barr virus, C: Human Metapneumovirus, D: Papillomavirus - -### Response: -Ans: C (Human Metapneumovirus) Ref: Robbins and Cotran 'Pathologic Basis of Disease 8th Edition. Elsevier. 201. Pg 313.Explanation:Oncogenic RNA VirusesHuman T-Cell Leukemia Virus Type 1 - T-cell leukemia/lymphomaHepatitis C Virus - Hepatocellular Carcinoma Oncogenic DNA VirusesHuman Papillomavirus.Types 1. 2. 4 & 7 - Benign Squamous Papillomas ( Warts)Types 16 & 18 - squamous cell Ca of the cervix and anogenital areaHuman herpes virus 8 - Kaposi SarcomaEpstein-Barr VirusThe African form of Burkitt lymphoma;B-cell lymphomas in immunosuppressed individualsA subset of Hodgkin lymphoma;Nasopharyngeal carcinomaGastric carcinomas and rare forms ofT cell lymphomas andNatural killer (NK) cell lymphomas.Hepatitis B Virus - Hepatocellular CarcinomaMerkel cell polyomavirus - Merkel Cell CarcinomaOncogenic BacteriaHelicobacter pylori - gastric adenocarcinomas and gastric lymphomas -### End" -875,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hutchinsons secondaries In skull are due to tumors in, with the following options: A: Lung, B: Breast, C: Adrenal, D: Liver - -### Response: -Adrenal neuroblastomas are malig8nant neoplasms arising from sympathetic neuroblsts in Medulla of adrenal gland Neuroblastoma is a cancer that develops from immature nerve cells found in several areas of the body.Neuroblastoma most commonly arises in and around the adrenalglands, which have similar origins to nerve cells and sit atop the kidneys. -### End" -876,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Association of deafness & nephritis is seen in, with the following options: A: Pickwickian syndrome, B: Alpo's syndrome, C: Fabry's disease, D: Lawrence Moon Biedl syndrome - -### Response: -Answer is B (Alpo's syndrome): Alpo's syndrome is an inherited disorder characterized by hereditary nephritis, sensorineural deafness and ocular abnormalities paicularly lenticonus. -### End" -877,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stimulation of horizontal semicircular canal causes nystagmus in which directions -, with the following options: A: Vertical, B: Horizontal, C: Rotary, D: Any of thethree - -### Response: -Ans. is 'b' i.e., Horizontalo The cupulae of the semicircular canals are stimulated by movement of endolymphatic fluid and each canal causes the nystagmus in its own planeStimulation of horizontal SCC - Horizontal nystagmus.Stimulation of superior SCC - Rotary nystagmus.Stimulation of vertical SCC - Vertical nystagmus -### End" -878,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dystrophic calcification is seen in ?, with the following options: A: Milk alkali syndrome, B: Atheromatous plaque, C: Hyperparathyroidism, D: Vitamin A intoxication - -### Response: -Ans. is 'b' i.e., Atheromatous plaqueDystrophic calcification o When pathological calcification takes place in dead, dying or degenerated tissue, it is called dystrophic calcification. o Calcium metabolism is not altered and serum calcium level is normal.Dystrophic calcification in dead tissues1.In caseous necrosis of tuberculosis(most common which may be in lymph nodes)2.Chronic abscess in liquifactive necrosis3.Fungal granuloma4.Infarct5.Thrombi6.Haematomas7.Dead parasites-Cystecercosis/Toxoplasma Hydatid/Schistosoma8.In fat necrosis of breast & other tissuesDystrophic calcification in degenerated tissuesAtheromatous plagueMonkeberg's sclerosisPsommama bodiesDens old scarsSenile degenrated changes such as in costal cailage, tracheal, bronchial rings, Pineal gland in brain.Hea valves damaged by rheumatic fever.How does calcification occurs in these site with normal serum calcium ?o Calcification of dead and dying cells and tissues is a common finding in human pathologic conditions. o Denatured proteins in dead or irreversible damaged tissues preferentially bind phosphate ions. o Phosphate ions react with calcium ions to form a precipitate or calcium phosphate.o Thus, necrotic tissue serves as a calcium sink. -### End" -879,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 27-year-old woman occasionally uses calcium carbonate (Turns) for ""heartburn"" symptoms after a large meal.For the above patient with an acid-peptic disorder, select the mechanism of action of the prescribed medication., with the following options: A: neutralizes gastric acid, B: works by binding to cysteine, C: inhibits gastrin release, D: irreversible H1-receptor blockade - -### Response: -Although doctors seldom prescribe antacids because of the availability of superior medications, patients still use them extensively. As well as neutralizing acid, calcium carbonate enhances secretion in the stomach. The release of CO2 from bicarbonate can result in belching, nausea, and abdominal distension. Belching can exacerbate gastroesophageal reflex. -### End" -880,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aery piercing the oblique popliteal ligament of knee -, with the following options: A: Superior genicular, B: Inferior genicular, C: Middle genicular, D: Popliteal - -### Response: -Middle genicular Oblique popliteal ligament is an expansion from the tendon of semimembranosus attachment to intercondylar line of femur. It is closely related to popliteal aery and is pierced by middle genicular vessels and nerve and the terminal pa of the posterior division of the obturator nerve. -### End" -881,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Protein estimation test is confused with, with the following options: A: Phosphates, B: Nitrates, C: Sulphates, D: Bile salts - -### Response: -On heating the urine, turbidity arises if proteins are present. -However, turbidity also arises if phosphates or carbonates are present in urine. This can leads to confusion. -Addition of few drops of acetic acid dissolves the turbidity due to phosphates or carbonates, whereas turbidity due to proteins remains persistent. -### End" -882,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young male presented with abdominal pain for the past 2 years. He also complains of weakness in his hands. His hemoblobin level was 8 gm/dL. The most likely diagnosis:, with the following options: A: Lead poisoning, B: Duodenal ulcer, C: Carcinoma stomach, D: Adenomatous polyposis coli - -### Response: -Ans. a. Lead poisoning (Ref: Parikh 6/e p9.22; Reddy 33/e p544, 31st/e p506-508)The most likely diagnosis in a young male who presented with abdominal pain for the past 2 years with complains of weakness in his hands and hemoblobin level of 8 gm/dL is lead poisoning.Lead poisoningMetallic lead and all its salts are poisonous.Principal toxic salts of Lead* Lead acetateQ (Saturn salt or sugar of lead)* Lead carbonateQ (safeda)* Lead chromateQ* Lead tetra oxide (red lead, vermillion, sindur)* Lead mono oxide (litharge)* Lead sulphide (Least toxic)At cellular level lead interacts with sulfhydryl groups and interferes in action of enzymes essential for heme synthesis, thus for hemoglobin and cytochrome production. It causes hemolysisQ.Fatal dose:Lead acetate: 20 gm; Lead carbonate: 40 gmFatal period: 1-2 daysSigns and symptoms of Lead PoisoningAcute PoisoningChronic Lead Poisoning (Plumbism, saturnism)* Astringent or metallic taste* Dry throat and thirst* Abdominal painQ, nausea and vomiting, sometimes diarrhea.* Peripheral circulatory collapseQ* Headache, weakness, insomnia, paresthesia, depression, coma and death.* Cerebellar ataxia is common in children in acute lead poisoningQ* Facial pallor Earliest and most consistent signQ* Weakness* Punctate basophilic or basophilic stipplingQ* Lead line (Burtonian lines in gums)Q* Colic (Dry belly ache)Q and constipation is late symptomQ* Sterility in males and females.* Wrist drop and foot dropQ* Vasoconstriction leads to hypertension and arteriolar degenerationQ* Lead encephalopathyQDiagnosis:Porphyrinuria (mainly due to coproporphyrin III inhibition)Stood testsUrine tests* >200 punctate basophilia stippling cells /mm3 is diagnosticQ* Zinc protoporphyrin and free erythrocyte protoporphyrin > 50mg/100mlQ* Increased lead and aminolaevulinic acid (>25mg/100ml)Q* Increased coproporphyrin (CPU) levels. In nonexposed person it is <150mg /literQ* Aminolaevulinic acid > 5mg* Presence of 0.25mg lead/liter is diagnosticQX-ray: Radiopaque matter in GI tract (ingested < 48 hours): Radio-opaque bands /lines at metaphysis of long bones in childrenQTreatment:Gastric lavage with 1% solution of sodium or magnesium sulphateQChelating agent: BAL, DMSAMost effective antidote: Calcium Disodium VersenateQIntravenous calcium chloride causes deposition of lead in skeleton from bloodQ.Peritoneal or hemodialysis.Symptomatic treatmentChronic Lead Poisoning presents with ""New-A B C D E F""New* Neuropathy (leading to weakness, wrist drop) and NephropathyQ (Late feature)A* Anemia with punctate basophilia (i.e. basophilic stippling)Q (Early feature)B* Burtonian or blue stippled lead line on gumsQC* Colic (abdominal pain) and ConstipationQD* Dry belly ache i.e. diarrhea is very rareQ* Dyspepsia. Drop of wrist etc due to neuropathyQE* EncephalopathyQ, EosinophiliaF* Facial pallorQ (earliest sign) -### End" -883,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Benzodiazepine acts through which receptor:, with the following options: A: Chloride, B: GABA, C: NMDA, D: b adrenergic - -### Response: -Ans: b (GABA) Ref: KDT, 6th ed, p. 395BZDs act by enhancing presynaptic/postsynaptic inhibition through a BZD receptor which is an integral part of the GABAA receptor-Cl- channel complex.They have GABA facilitatory action and no GABA mimetic action i.e. the BZD's increase the frequency of Cl channel opening induced by sub maximal concentrations of GABA and enhance GABA binding to GABAA receptor but they do not themselves increase Cl- conductance.Flumazenil is a competitive antagonist at BZD siteCarboline b - is an inverse agonist at BZD siteBicuculline - Competitive antagonist at GABAA receptorMuscimol - acts as agonist at GABAA site.Drugs active at the benzodiazepine receptor may be divided into four categories based on their elimination half-lives:(1) Ultra short acting: Midazolam(2) Short acting (t]/2 <6 hours): Triazolam, the nonbenzodiazepine zolpidem (t1/2 =2 hours) and zopiclone (t1/2 = 5-6 hours).(3) Intermediate-acting (t1/2 = 6-24 hours): Estazolam and temazepam.(4) long-acting (t1/2 >24 hours):Flurazepam, diazepam, and quazepam.Flurazepam has the longest half life of 50-100 hrs. -### End" -884,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rituximab is used for treatment of -, with the following options: A: RA, B: Crohn's disease, C: Non-Hodgkinscc lymphoma, D: Colorectal carcinoma - -### Response: -Ans. is 'c' i.e., Non-Hodgkins lymphoma -### End" -885,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metabolic alkalosis is seen in-, with the following options: A: Primary mineralocoicoid excess, B: Deficiency of mineralocoicoid, C: Decreased acid excretion, D: Decreased base excretion - -### Response: -Mineralocoicoid excess increases net acid excretion and may result in metabolic alkalosis, which may be worsened by associated K+ deficiency. ECFV expansion from salt retention causes hypeension. The kaliuresis persists because of mineralocoicoid excess and distal Na+ absorption causing enhanced K+ excretion, continued K+ depletion with polydipsia, inability to concentrate the urine, and polyuria. -### End" -886,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about bell's palsy is/are -a) Most common cause of facial palsyb) Associated with tinnitus & vertigoc) Crocodile tears & synkinesisd) No role of steroids, with the following options: A: a, B: bc, C: ad, D: ac - -### Response: -Bell's palsy is the most common cause of facial palsy. -Synkinesis and crocodile tear are sequelae of Bell's palsy. -### End" -887,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the setting of G-proteins which of the following is considered a third messenger :, with the following options: A: cAMP., B: Calcium., C: CO., D: NO. - -### Response: -Calcium is considered as a third messenger. -### End" -888,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is long acting glucocarticoid-, with the following options: A: Hydrocartisone, B: Prednisolone, C: Cortisol, D: Dexamethasone - -### Response: -Ans. is 'd' i.e., Dexamethasone o Short acting glucocorticoids (t 1/2 : 8-12 hrs.) : Cortisol, hydrocortisone.o Intermediate acting glucocorticoids (t 1/2 : 12-36 hrs.) : Prednisolone, methylprednisolone, triamcinoloneo Long acting glucocorticoids (t 1/2 : 36-54 hrs.) : Dexamethasone ,betamethasone. -### End" -889,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pyridoxine is involved in, with the following options: A: Carboxylation, B: Trans-sulfuration, C: Oxidation-reduction, D: Transketolation - -### Response: -Pyridoxine is involved in trans-sulfuration.Sulfur-Containing Amino Acids PLP plays an impoant role in methionine and cysteine metabolism. a.Homocysteine + Serine - Cystathionine. (Enzyme Cystathionine synthase) b.Cystathionine - Homoserine + Cysteine (Enzyme Cystathionase) Both these reactions require PLP. Here transfer of sulphur group occurs.Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 396 -### End" -890,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of death in criminal abortion is?, with the following options: A: Hemorrhage, B: Sepsis, C: Air embolism, D: Perforation - -### Response: -ANSWER: (B) SepsisREF: Forensic Medicine and Toxicology By R.N.Karmakar page 230, Textbook of Forensic Medicine and Toxicology, Krishan Vij 5th ed fig 26.2The most common complication from illegal abortion is retained product of conception; the most frequent cause of death is infection and sepsis.NATURAL VS CRIMINAL ABORTION Natural abortionCriminal abortionCauseSpontaneousInducedPrecipitating factorMaternal or fetal diseaseUnwanted pregnancyEvidence of genital violenceAbsentPresentForeign body from genitalsAbsentMay be presentToxic effect of drugAbsentMay be presentFetal injuryAbsentRarely present -### End" -891,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Staphylococcus differes from streptococcus by -, with the following options: A: Coagulase test, B: Catalase test, C: Phasphatase, D: Gram negative - -### Response: -Ans. is 'b' i.e., Catalase test * Coagulase test is used to differentiate the different species of staphylococci (staph aureus, staph, epidermidis).* Catalase test is used to differentiate staphylococci from streptococci. -### End" -892,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A middle aged man complains of upper abdominal pain after a heavy meal. There is tenderness in the upper abdomen and on X-ray, widening of the mediastinum is seen with pneumo-mediastinum. What is the diagnosis?, with the following options: A: Spontaneous perforation of the esophagus, B: Perforated peptic ulcer, C: Foreign body in esophagus, D: Rupture of emphysematous bulla - -### Response: -Above clinical scenario is suggestive of diagnosis of spontaneous perforation of the esophagus. Aka BOERHAAVE Syndrome - Caused by Forceful vomiting Repeated vomiting - Clinical features - Characterized byMackler's triad Thoracic Pain Vomiting Cervical subcutaneous emphysema Investigation - On CXR - Hydropneumothorax - IOC for Dx - Water soluble contrast esophagogram (Gastrograffin > Hypaque) -### End" -893,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60-year-old retired banker complains of feeling dizzy with palpitations and breathlessness. His BP becomes un-recordable while ECG is being recorded. What should be the first step in the management of this patient?, with the following options: A: IV Amiodarone 150mg, B: IV Lasix 40mg, C: Cardioversion, D: IV lignocaine - -### Response: -ECG shows broad complex QRS tachycardia diagnostic of Ventricular tachycardia (MONOMORPHIC). Since the BP of the patient is crashing-Pt unstable - Rx- Cardioversion-DC Shock -### End" -894,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nephrogenic diabetes insipidus is caused by all of the following except: March 2008, with the following options: A: Toxicity of lithium, B: Amyloidosis, C: Hypocalcemia, D: Hypokalemia - -### Response: -Ans. C: Hypocalcemia Nephrogenic diabetes insipidus is characterized by a decrease in the ability to concentrate urine due to a resistance to ADH action in the kidney. The 24 hour urine volume is more than 50 mL/kg body weight and the osmolarity is less than 300 mosmol/ L. Nephrogenic diabetes insipidus can be observed in: Drugs: - Lithium toxicity - Demeclocycline - Methoxyflurane - Amphotericin B Metabolic Hypercalcemia, - Hypokalemia, iii. Infiltration: - Amyloidosis Tubulointerstitial diseas Rarely, diabetes insipidus may be hereditary -### End" -895,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lallo 40 years has recently staed writing books. But the matter in this book could not be understood by anybody since it contained words which were never there in any dictionary and the theme was very disjoint. Now adays he has become very shy and self absorbed. When he addresses people he speaks about metaphilosophical ideas. What is likely diagnosis, with the following options: A: Mania, B: Schizophrenia, C: A genius writer, D: Delusional disorder - -### Response: -B i.e. Schizophrenia -### End" -896,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A disease has 3 time more incidence in females as compared to males, with same prevalence in both males and females. TRUE statement is - AIIMS 99, with the following options: A: Increase fatality in women, B: More survival in women, C: Better prognosis in men, D: Less fatality in man - -### Response: -ref: Park&;s 23rd edition pg 61 Here, incidence in females is 3times that of males. So, we expect such an increase in prevalence of that same disease in females. But, it is given, prevalence in males and females are the same. This means that the affected females donot survive as much as the affected males. This shows that disease has increased fatality in females. note: Prognosis depends on prevalence. As prevaleance is same, prognosis is also same in both. Incidence reflects the causal factors -### End" -897,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Landmark which is immune to surface deposition and resorption:, with the following options: A: Xi point and Eva point, B: Point A and Point B, C: Porion and Basion, D: Pogonion and Gnathion - -### Response: -Arcial growth of mandible: - -Proposed by Ricketts. -The advantage was that the arc of growth can be constructed for every individual depending on the length of the core of the mandible. -In order to locate the central core, which is immune to surface deposition and resorption, he introduced 2 landmarks - Xi point and Eva point on the mandibular ramus. -Xi Point: Represents geometric centre of ramus. -Eva point: In dried mandible, the stress lines run on the medial aspect parallel to the external oblique ridge and ascend up the ramus. The stress lines fork into two at a  particular point that was named as Eva point. - -Ref: Shreedhar Premkumar 1st edition P:199 -### End" -898,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood in urine in a patient in labour, with history of previous LSCS, diagnosis is:aEUR', with the following options: A: Impending scar rupture, B: Urethral injury, C: Obstructed labour, D: Cystitis - -### Response: -Obstructed labour /Ref. Dutta 6th/c p 405] -### End" -899,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Color of oxygen cylinder is:, with the following options: A: Black with white color, B: Blue with white color, C: Yellow with white color, D: White - -### Response: -ANSWER: (A) Black with white colorREF: Fundamentals of Anesthesia, Tim Smith Colin Pinnock Ted Lin, 3rd Ed, p830SubstanceColour codingCylinderShoulderOxygenblackwhiteNitrous oxideblueblueEntonox gasblueWhite/blueAirblackWhite/blackCarbon dioxidegreygrey -### End" -900,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Indication of caesarean section after previous caesarean section is?, with the following options: A: Hypertension, B: Type 1 placenta previa, C: CPD, D: Multigravida - -### Response: -ANSWER: (C) CPDREF: Dutta 6th ed page 589See previous question for explanation -### End" -901,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with a prosthetic hea valve develops endocarditis eight months after Valve replacement. Most likely organisms responsible is, with the following options: A: Staphylococcus aureus, B: Streptococcus Viridians, C: Salmonella faecalis, D: HACEK Group - -### Response: -Ref Harrison 19 th ed pg 816 Prosthetic valve endocarditis (PVE) arising within 2 months of valve surgery is generally nosocomial, the result of intraoperative contami- nation of the prosthesis or a bacteremic postoperative complication. This nosocomial origin is reflected in the primary microbial causes: S. aureus, CoNS, facultative gram-negative bacilli, diphtheroids, and fungi. The poals of entry and organisms causing cases beginning >12 months after surgery are similar to those in community-acquired NVE. PVE due to CoNS that presents 2-12 months after surgery often represents delayed-onset nosocomial infection. Regardless of the time of onset after surgery, at least 68-85% of CoNS strains that cause PVE are resistant to methicillin. -### End" -902,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serum enzyme used for MI, with the following options: A: CK, B: Alkaline phophatase, C: Acid phosphatase, D: Lipase - -### Response: -The enzymes routinely measured in the clinical laboratory for the purpose of diagnosing and monitoring myocardial infarction include creatine kinase (CK), aspaate aminotransferase (sGOT or AST), and lactate dehydrogenase (LDH). -### End" -903,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for extra-pelvic endometriosis, with the following options: A: Rectum, B: Sigmoid colon, C: Duodenum, D: Jejunum - -### Response: -Most common site for extra-pelvic endometriosis is gastro-intestinal system i.e., sigmoid colon> Rectum. -### End" -904,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady with abdominal mass was investigated. She was found to have bilateral ovarian masses with smooth surface. On microscopy they revealed cells with signet ring shapes. Diagnosis is-, with the following options: A: Dysgerminoma, B: Krukenberg tumour, C: Primary Adenocarcinoma of the ovaries, D: Epithelial ovarian tumour - -### Response: -Ans. is 'b' i.e., Krukenberg tumour Krukenberg Tumor* Accounts for 30-40% of metastatic CAs to the ovary.* Arises in the ovarian stroma and has characteristic mucin-filled signet ring cells.* The primary is most frequently located in the stomach and less commonly in the colon, breast, or biliary tract. Rarely, the cervix and bladder may be the primary site.* They are usually bilateral and discovered when the primary is well advanced and hence survival is very poor.* Treatment of primary carcinoma does not revert to Krukenberg tumor.* The ovaries are enlarged and have a smooth surface.* The shape of the ovary is maintained.* There is no tendency of adhesion and the capsule remains intact.* Cut surface shows waxy consistency with cystic spaces due to degeneration. -### End" -905,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which amongst the following antimicrobials exhibits a long post antibiotic effect -, with the following options: A: Quinolones, B: Macrolides, C: Beta-lactams, D: Oxazolidinones - -### Response: -Ans. is 'a' i.e., Quinoones o Post-antibiotic effect is seen with quinolones (fluoroquinolones) and aminoglycosides. -### End" -906,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alvarado scoring in appendicitis includes all expect:, with the following options: A: Migratory right iliac fossa pain, B: Nausea, C: Elevated temperature, D: Leucopenia - -### Response: -Alvarado (MANTRELS) scores Manifestation Score Symptoms Migratory RIF pain Anorexia Nausea and vomiting 1 1 1 Signs Tenderness (RIF) Rebound tenderness Elevated temperature 2 1 1 Laboratory Leuocytosis Shift to left 2 1 Total 10 Scores Prediction 9-10 Appendicitis is ceain 7-8 High likelihood of appendicitis 5-6 Equivocal 1-4 Appendicitis can be ruled out -### End" -907,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fluid used in hypovolemic shock-, with the following options: A: RL, B: DNS, C: Blood, D: 5%Dextose - -### Response: -Initial resuscitation requires rapid reexpansion of the circulating intravascular blood volume along with interventions to control ongoing losses. In accordance with Starling's law, stroke volume and cardiac output rise with the increase in preload. After resuscitation, the compliance of the ventricles.may remain reduced due to increased interstitial fluid in the myocardium. Therefore, elevated filling pressures are frequently required to maintain adequate ventricular performance. Volume resuscitation is initiated with the rapid infusion of either isotonic saline (although care must be taken to avoid hyperchloremic acidosis from loss of bicarbonate buffering capacity and replacement with excess chloride) or a balanced salt solution such as Ringer's lactate (being cognizant of the presence of potassium and potential renal dysfunction) through large-bore intravenous lines. Data, paicularly on severe traumatic brain injury (TBI), regarding benefits of small volumes of hypeonicsaline that more rapidly restore blood pressure are variable, but tend to show improved survival thought to be linked to immunomodulation. No distinct benefit from the use of colloid has been demonstrated, and in trauma patients it is associated with a higher moality, paicularly in patients with TBI. The infusion of 2-3 L of salt solution over 20-30 min should restore normal hemodynamic parameters. ref:harrison's principles of internal medicine,ed 18,pg no 2221 -### End" -908,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prostaglandin used in the treatment of peptic ulcer is, with the following options: A: Carboprost, B: Misoprostol, C: Dinoprost, D: Latanoprost - -### Response: -Ans) b (Misoprosotol) Kef: KDT 6th ed p. 629Misoprostol is the prostaglandin analogue used in the treatment of peptic ulcer.DRUGS USED IN PEPTIC ULCER1) H2 antagonists-ranitidine, cimetidine, famotidine roxatidine and nizatidine.Nizatidine has little first-pass metabolism and a bioavailability of al-most 100%. Famotidine is the most potent among them.2) Proton pump inhibitors (PPIs)- omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole. They are the most effective drugs in GERD.3) Mucosal protective agents-sucralfate, colloidal bismuth compounds4) Prostaglandin analogs-misoprostol5) Antacids6) Anticholinergics-Pirenzipine, propantheline7) Anti-H.pylori drugs -Amoxicillin, clarothromycin, metronidazole, tinidazole, tetracycline. -### End" -909,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 17-year-old female presents with a pruritic rash around the wrist. Seen in, with the following options: A: Herpes simplex, B: Shingles, C: Contact dermatitis, D: Seborrheic dermatitis - -### Response: -Contact dermatitis causes pruritic plaques or vesicles localized to an area of contact. In this case, a bracelet or wristband would be the inciting agent. Dermatitis may have vesicles with weeping lesions. The process is related to direct irritation of the skin from a chemical or physical irritant. It may also be immune-mediated Zoster would be painful and occur in a dermatomal distribution. Herpes simplex produces grouped vesicles, but they are painful and also unlikely to occur around the wrist. Seborrheic dermatitis presents as red, scaly lesions over a circular area with lesions developing in the nasolabial folds, scalp, and retroauricular areas. Ref Harrison 20th edition pg 1245 -### End" -910,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 53 year old male who is a heavy alcoholic presents with 12 hour history of sharp central abdominal pain and vomiting. He prefers to sit up rather than lying fiat as pain increases on lying down. O/E he has mild jaundice. Temp - 38. 3deg C. Pulse 132/min BP 118/82 mm Hg. There is periumbilical discoloration and maximum tenderness in epigastrium. Diagnosis, with the following options: A: Acute pancreatitis, B: Pyelonephritis, C: Acute viral hepatitis, D: Perforated duodenal ulcer - -### Response: -Ans. (a) Acute pancreatitisRef: Sabiston page 1525/20th edition* History of pain reduced on sitting with leaning forward is typical pancreatic pain.* Periumbilical discoloration = Cullen's signAll these favor more of acute pancreatitis -### End" -911,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Optimal /effective duration of short course therapy for pulmonary TB is:, with the following options: A: 6 months, B: 9 months, C: 12 months, D: 18 months - -### Response: -Ans: a (6 months) Ref: Park, 19th ed, p. 157Short course regimes of 6 months duration are highly effective, of low toxicity and well tolerated.These potent regimes are based on a initial intensive phase with four drugs--INH, rifampicin,Pyrizinamide, supplemented by either streptomycin or ethambutol for a period of 2 months, followed by 2 drugs in continuation phase.The treatment must be fully supervised and monitored mainly by bacteriological examination. -### End" -912,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person suffers from B27 associated reactive ahritis, urethritis and conjunctivitis. Which is most likely organism involved in this case?, with the following options: A: Borrelia burgdorferi, B: Ureaplasma urealyticum, C: Beta-hemolytic streptococci, D: Streptococcus bovis - -### Response: -Agents responsible for Reiter's syndrome: Salmonella enteritidis S. typhimurium S. heidelberg Yersinia enterocolitica Y. pseudotuberculosis Campylobacter fetus Shigella flexneri Genitourinary pathogens (such as Chlamydia or Ureaplasma urealyticum) Ref: Suurmond D. (2009). Section 14. The Skin in Immune, Autoimmune, and Rheumatic Disorders. In D. Suurmond (Ed), Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e. -### End" -913,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following conditions are associated with molar pregnancy except :, with the following options: A: Pregnancy induced hypeension, B: Thyrotoxicosis, C: Gestational diabetes, D: Hyperemesis gravidarum - -### Response: -Gestational diabetes -### End" -914,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following drug is aromatase inhibitor:, with the following options: A: Raloxifine, B: Tamoxifen, C: Leuprolide, D: Letrozole - -### Response: -Ans. D. Letrozoleletrozole, anastrozole are aromatase inhibitor which is enzyme responsible for estrogen synthesis, this drug is indicated in estrogen receptor positive breast cancer resistant to tamoxifen. It can also be given precocious puberty. -### End" -915,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deep branch of ulnar nerve innervates, with the following options: A: I and II lumbricals, B: Palmaris brevis, C: Dorsal interossei, D: Opponens pollicis - -### Response: -There are twenty muscles in hands of which all are supplied by the ulnar nerve Except the following five muscles which are supplied by median nerve: 1 Abductor pollicis brevis 2. Flexor pollicis brevis (also often receives additional supply from the deep branch of ulnar nerve) 3. Opponens pollicis 4. First lumbrical 5. Second lumbrical Note: Palmaris Brevis is supplied by the superficial branch of the ulnar nerve. All interossei are supplied by the deep branch of ulnar nerve. -### End" -916,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 8 year old male patient complains of food lodgement with a history of previous restoration of the same tooth. Intra-oral examination reveals fractured Class II amalgam restoration with mandibular molar. Which of the following is not responsible for the fracture of restoration?, with the following options: A: Poor cavity design resulting in an insufficient bulk of material across the isthmus can lead to failure of even a high-strength alloy, B: Avoiding moisture contamination of amalgam, C: Non-compliance of the child with instructions to refrain from biting down hard on the freshly placed amalgam, D: Thin edges of restoration - -### Response: -Moisture contamination of an amalgam restoration can promote failure. If zinc is present in the alloy, it will react with water, and hydrogen gas will be formed. As this gas builds up within the amalgam, a significant delayed expansion  can  occur  and  may  cause  protrusion  of  the amalgam  from  the  cavity  preparation,  which  enhances the possibility of fracture at the margins. If the restoration is improperly finished by the dentist, a thin ledge of amalgam may be left that extends slightly over the enamel at the margins. These thin edges of such a brittle material cannot support the forces of mastication. In time they fracture, leaving an opening at the margins. Poor cavity design resulting in an insufficient bulk of material across the isthmus can lead to failure of even a high-strength alloy. -Unlike a resin matrix composite, amalgam gains strength slowly over the first 24 hours. Premature loading can result in minute fractures that are not apparent for weeks or even months. The use of a rapid-setting amalgam with a high 1-hour compressive  strength  should  be  considered  during  the treatment  of  a  pediatric  patient,  in  whom  compliance with instructions to refrain from biting down hard on the freshly placed amalgam is in question. -### End" -917,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Respiratory rhythm nucleus-, with the following options: A: Pneumotaxic centre, B: Dorsal group of nucleus, C: Apneustic centre, D: Pre-Botzinger Complex - -### Response: -Ans. is 'd' i.e., Pre-Botzinger Complex Important facts about the regulation of respiration o Medullary respiratory group of neurons are - i) Dorsal respiratory group (DRG) - Concerned with inspiration ii) Ventral respiratory group (VRG) - Mainly concerned with Forceful expiration, but also shows some activity during inspiration. iii) Pre - Botzinger complex: - Responsible for generation of respiratory rhythm. o Pontine respiratory centers are - i) Pneumotaxic center - The primary function is to limit inspiration, i.e., to control the switch off point of inspiratory ramp and control of inspiratory depth. ii) Apneustic center - Excites inspiratory center to prolong inspiration. -### End" -918,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IgE receptors are present on, with the following options: A: Mast cells, B: NK cells, C: B cells, D: Histiocytes - -### Response: -Ref Robbins 9/e p201 Type 1 hypersensitivity is a rapid immunological reaction occuring in a previously sensitized individual that is triggered by the binding of an antigen to IgE antibody on the surface of mast cells -### End" -919,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Xerostomia is seen in all except ?, with the following options: A: Sjogren syndrome, B: RA, C: Sarcoidosis, D: Midline granuloma - -### Response: -Ans. is 'd' i.e., Midline granuloma -### End" -920,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for the treatment of acute gout in patients in whom NSAIDs are contraindicated is?, with the following options: A: Colchicine, B: Allopurinol, C: Xyloric acid, D: Paracetamol - -### Response: -Ans. is 'a' i.e., Colchicine Treatment of Gout 1) Acute gout NSAIDs are the drugs of choice Colchicine is the fastest acting drug. However it is reserved for the patients in which NSAIDs are contraindicated, because colchicine can cause gastrointestinal disturbances. If neither NSAIDs nor colchicin are tolerated, oral prednisolone is used. Allopurinol and uricosuric drugs (sulfinpyrazone, probenacid) are not effective in acute gout because they will not relieve symptoms as they don't have anti-inflammatory propey. 2) Chronic gout Allopurinal is the drug of choice. Other drugs are sulfinpyrazone and probenacid. -### End" -921,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30 year old lady presents with features of malabsorption and iron deficiency anaemia. Duodenal biopsy shows complete villous atrophy. Which of the following antibodies is likely to be present :, with the following options: A: Antiendomysial antibodies, B: Anti-goblet cell antibodies, C: Anti-saccharomyces cerevisae antibodies, D: Antineutrophil cytoplasmic antibodies - -### Response: -Answer is A (Antiendomysial antibodies): Evidence of Malabsorption together with charachteristic histopathological changes on small intestinal biopsy in the form of complete villous atrophy suggests the diagnosis of celiac spree / disease. Antibody studies are frequently used to identify patients with celiac disease. 'The antiendomysial antibody has 90 to 95% sensitivity and 90 to 95% specificity' in the detection of celiac disease. -### End" -922,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25 year old university student had a fight with the neighboring boy. On the next day while out, he staed feeling that two men in police uniform were observing this movements. When he reached home in the evening he was frightened. He expressed that police was after him and would arrest him. His symptoms represent:, with the following options: A: Delusion of persecution, B: Ideas of reference, C: Passivity, D: Thought inseion - -### Response: -A i.e. Delusion of persecution -### End" -923,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The efferent fiber bundle of the substantia nigra transmits dopamine to one of the following areas:, with the following options: A: Thalamus, B: Corpus striatum, C: Tegmentum of pons, D: Tectum of midbrain - -### Response: -B i.e. Corpus striatum -### End" -924,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about vasa pre except:, with the following options: A: Incidence is 1:2000 deliveries, B: Fetal moality rate of 10% with undiagnosed case, C: Associated with low lying placenta, D: Cesarean section is indicated - -### Response: -Vasa pre - It is a condition in which the fetal blood vessels unsuppoed by either umblical cord or placental tissue,Overlies the internal os and is vulnerable to rupture when suppoing membrane rupture. Bleeding in case of vasa pre is of fetal origin and not maternal origin. Fetal moality is often more than 50% It is rare condition and occurs in 1 in 2000 - 3000 deliveries Vasa pre can be associated with - Velamentous cord inseion - Bilobed placenta - Succenturiate lobed placenta - Placenta pre /low lying placenta in second trimester (option 'c' is correct) Management- In a diagnosed case of vasa pre elective cesarean section should be done or emergency LSCS should Be done if it is diagnosed intrapaum. -### End" -925,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fastest acting nondepolarizing neuromuscular blocker-, with the following options: A: Rocuronium, B: Pancuronium, C: Succinylcholine, D: Mivacurium - -### Response: -Rocuronium has onset of action at 1mg/kg 90 seconds Rocuroniumis the muscle relaxant of choice for day-care surgery. intermediate-acting muscle relaxant with a rapid onset (90 s). Rapacuronium has onset of action 75 secs but it is not in clinical use. Rest all nondepolarising neuromuscular blocker has onset of action - 3-5 minutes -### End" -926,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ESPS is due to, with the following options: A: K+ influx, B: Na+ efflux, C: Na+ influx, D: Ca++ influx - -### Response: -Ans. (c) Na+ efflux(Ref: Ganong, 25th ed/p.122)Excitatory Post Synaptic Potentials (EPSP)#Produced if the neurotransmitter released at the synapse is excitatory#The excitatory transmitter opens mainly Na+ ion channels producing depolarization -### End" -927,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After taking some drug for acute attack of migraine a patient develop nausea and vomiting he also develop tingling and numbness in the tip of the finger that also turn blue. which of the following is most likely drug implicated in the cause the above finding, with the following options: A: Dihydroergotamine, B: Sumatriptan, C: Aspirin, D: Butarphanol - -### Response: -This is a classical sign of ergot induced vasoconstriction dihydroergotamine can be used for acute attack of migraine and can result in such symptoms. due to their vasoconstriction potential Ergot alkaloids are contraindicated in a patient with peripheral vascular disease this may lead to development of gangrene. Refer katzung 11/e p289 -### End" -928,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infantile propoion in adult is seen in, with the following options: A: Morquio's disease, B: Achondroplasia, C: Hypothyroidism, D: Malnutrition - -### Response: -Normal body propoion in adults Height = arm span Upper segment= lower segment Normal body propoion in infants is Height ( length)> arm span Upper segment> Lower segment. Infantile propoion means increased upper to lower segment ratio. Seen in conditions like Achondroplasia and hypothyroidism. Reverse infantile propoion means increased lower segment. Seen in Eunuchoidism, Marfans syndrome, Homocystinuria, Klinefelter's syndrome. Ref: Nelson's 20th edition, Pg- 3371. -### End" -929,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Monteggia fracture is: (D. REPEAT 2012), with the following options: A: of proximal 1 /3rd ulna w ith dislocation of radioulnar joint, B: of distal 1 /3rd of ulna with dislocation of radioulnarJoint, C: of atlas, D: of distal l/3rd of radius with dislocation of radioulnar joint - -### Response: -Ref: Aples's Svstem of Orthopaedics and Fractures, 9th edition, Pages 770 and 773Explanation:MONTEGGIA FRACTUREThe injury described by Monteggia in the early nineteenth century (without the benefit of X-rays!).Fracture of shaft of the proximal third of ulna associated with dislocation of the proximal radio-ulnar joint.The radio-capitellar joint is dislocated.Recently, the definition has been extended to embrace almost any fracture of the ulna associated with dislocation of the radio- capitellar joint, including trans-olecranon fractures with dislocation of proximal radioulnar joint (Hume fracture).If the ulnar shaft fracture is angulated with the apex anterior (the most common type) then the radial head is displaced anteriorly, if the fracture apex is posterior, the radial dislocation is posterior, and if the fracture apex is lateral then the radial head will he laterally displaced.In children, the ulnar injury may he an incomplete fracture (greenstick or plastic deformation of the shaft).Fractures of the distal third of radius with dislocation of the ulnar head from the distal radio-ulnar joint was described by Galeazzi in 1934 and named after him. It is commoner than Monteggia fracture dislocation.Note* Monteggia fracture - Fracture proximal one- third of ulna with dislocation of radial head* Galleazzi fracture - Fracture distal one-third of radius with disruption of the distal radioulnar joint -### End" -930,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NK cells express, with the following options: A: CD 15;CD55, B: CD 16; CD 56, C: CD16;CD 57, D: CD21;CD66 - -### Response: -Ref Robbins 8/e p188 ;9/e p192 NK cells (belonging to the group of innate lymphoid cells) are defined as large granular lymphocytes (LGL) and constitute the third kind of cells differentiated from the common lymphoid progenitor-generating B and T lymphocytes. NK cells are known to differentiate and mature in the bone marrow, lymph nodes, spleen, tonsils, and thymus, where they then enter into the circulation. NK cells differ from natural killer T cells (NKTs) phenotypically, by origin and by respective effector functions; often, NKT cell activity promotes NK cell activity by secreting interferon gamma. In contrast to NKT cells, NK cells do not express T-cell antigen receptors(TCR) or pan T marker CD3 or surface -### End" -931,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal diurnal variation of intraocular pressure is:, with the following options: A: 0-2 mm of Hg, B: 2-3 mm of Hg, C: 3-6 mm of Hg, D: 6-8 mm of Hg - -### Response: -Ans. 3-6 mm of Hg -### End" -932,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which enzyme level is tested in thiamine deficiency?, with the following options: A: PDH, B: Pyruvate kinase, C: Transketolase, D: Kinase - -### Response: -Thiamine (vitamin B1) Deficiency It is assessed by Erythrocyte transketolase activity. Thiamine (Vitamin B1) is the marker for transketolase enzyme -which is involved in HMP pathway (in RBCs) Activity of Transketolase is measured (not the quantity). -### End" -933,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a component of JVP?, with the following options: A: A wave bigger than V wave, B: C wave is called as Dicrotic notch, C: X wave is seen ventricular systole, D: Y descent in ventricular diastole - -### Response: -Ans. B C wave is called as dicrotic notchRef: Ganong, 25th ed. pg. 542A waveAtrial systoleC waveBulge of tricuspid valve into right atrium during isovolumetric contractionX descentAtrial relaxationV waveBeginning of isovolumetric relaxationV descentVentricular relaxationDicrotic Notch is seen in Pulse recording. -### End" -934,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 42-year-old woman is admitted to the hospital with injury to the upper (superior) trunk of the brachial plexus. The diagnosis is Erb-Duchenne palsy. Which of the following conditions is expected to be present during physical examination?, with the following options: A: Winged scapula, B: Inability to laterally rotate the arm, C: Paralysis of intrinsic muscles of the hand, D: Paresthesia in the medial aspect of the arm - -### Response: -Injury to the superior trunk of the brachial plexus can damage nerve fibers going to the suprascapular, axillary, and musculocutaneous nerves. Damage to the suprascapular and axillary nerves causes impaired abduction and lateral rotation of the arm. Damage to the musculocutaneous nerve causes impaired flexion of the forearm. A winged scapula would be caused by damage to the long thoracic nerve. The long thoracic nerve is formed from spinal cord levels C5, C6, and C7, so the serratus anterior muscle would be weakened from the damage to C5 and C6, but the muscle would not be completely paralyzed. The intrinsic muscles of the hand are innervated by the ulnar nerve, which would most likely remain intact. Paraesthesia in the medial aspect of the arm would be caused by damage to the medial brachial cutaneous nerve (C8-T1; inferior trunk). Loss of sensation on the dorsum of the hand would be caused by damage to either the ulnar or radial nerves (C6 to T1). -### End" -935,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lymphangitis is caused by :, with the following options: A: Staphylococcus, B: Streptococci, C: Pneumococii, D: Neisseria - -### Response: -Ans. is 'b' i.e. Streptococci ""Lymphangitis & lymphadenitis are common manifestation of a bacterial infection that is usually caused by hemolytic streptococci or staphylococci. "" - CMDTBy our conventional rule of ""First come first served"" streptococci is our best option -### End" -936,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Over a holiday weekend, more than 100 adults at a resort hotel develop a diarrheal illness marked by voluminous, watery stools more than 10 times per day. They also report headaches, abdominal cramping pain, and myalgias. On physical examination, they have manifestations of dehydration and mild fever. Laboratory studies of stool samples show no increase in leukocytes or fat and no RBCs. Their illness lasts just 1 to 3 days and resolves with no sequelae. Which of the following infectious agents is the most likely cause of their illness?, with the following options: A: Cytomegalovirus, B: Clostridium botulinum, C: Norovirus, D: Staphylococcus aureus - -### Response: -Norovirus outbreaks result from contamination of food or water, most often in venues where multiple persons congregate. Was it the resort pool? Noroviruses, as well as the Giardia parasite, are resistant to chlorination. Was it the buffet? Salads, shellfish, and meats are often implicated. Voluminous diarrhea suggests small intestinal involvement. The lack of leukocytes makes bacterial infection less likely. Cytomegalovirus infections are more likely in immunocompromised persons. Botulism leads to paralysis from a neurotoxin. Staphylococcal food poisoning tends to be abrupt in onset and of short duration. Strongyloidiasis tends to persist for months to years. Cholera produces a life-threatening fluid loss. -### End" -937,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sanitary toilets can decrease incidence of all except, with the following options: A: Diarrhoea, B: Poliomyelitis, C: Malaria, D: Cholera - -### Response: -Diarrhea, Poliomyelitis, and cholera are transmitted by faeco-oral route Malaria is a vector-borne disease transmitted by Anopheles mosquito. Hence sanitary toilets and hand washing practices cannot prevent Malaria. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 831 -### End" -938,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following culture medium is made by adding Agar:, with the following options: A: Solid medium, B: Liquid medium, C: Selective medium, D: Transport medium - -### Response: -Ans. (a) Solid mediumRef: Microbiology by Ananthanarayan and Paniker 8th ed. / 39-40GROWING BACTERIAL CULTURES IN LIQUIDNUTRIENT BROTH* Nutrient broth is a liquid bacterial growth medium made of powdered beef extract and short chains of amino acids that have been dissolved in water.* Liquid medium is convenient to use for growing bacteria in test tubes, and can reveal information about the oxygen requirements of bacteria growing within.* Bacteria that require oxygen will grow close to the water s surface, and bacteria that cannot tolerate the presence of oxygen will grow at the bottom of the test tube.B GROWING BACTERIAL CULTURES ON SOUP MEDIA* Broth media can be made solid by adding agar, a gel like polysaccharide extracted from red algae.* Broth with about 1.5% agar added will be liquid when heated, but solid at room temperature, making it easy to pour into a vessel, such as a Petri dish or test tube when hot.* The solution then becomes solid once cooled. -### End" -939,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: cutaneous maculopapulary rash of the head and neck preceded by small ulcers in the buccal mucosa would suggest which of the following?, with the following options: A: Primary herpes simplex infection, B: Rubeola, C: Varicella, D: Primary syphilis - -### Response: -The maculopapulary rash of rubeola (measles) is preceded by the herald sign of Koplick’s spots (punctate ulcers of the buccal mucosa) -### End" -940,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dental local anesthetics containing 2% lignocaine with adrenaline 1 : 80000: -A) In any dosage are contraindicated in patients with heart disease -B) May cause tachycardia -C) Can produce allergic reactions, in which lignocaine is usually responsible -D) Or even prilocaine with felypressin should not be used in the pregnant patient because of the oxytocic effects of adrenaline or felypressin. -E) Cause hypertensive reactions in patients on tricyclic antidepressants, with the following options: A: Option B is true and ACDE are false, B: Option A true and BCDE are false, C: Option C is true and ABDE are false, D: Option D is true and ABCE are false - -### Response: -Adrenaline may cause tachycardia. -### End" -941,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Systoiic thrill in left 2nd or 3rd intercostal space is heard in which of the following conditions ?, with the following options: A: Sub pulmonic VSD, B: TOF, C: Ebstein's anomaly, D: Pulmonary stenosis - -### Response: -Pulmonary stenosis produces Ejection systolic murmur. It stas after S1, peaks at mid-systole and ends before S2. Best heard in pulmonary area. Ref: Harrison&;s 20th edition pg 1445 -### End" -942,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is a bullet shaped virus?, with the following options: A: Rabies virus, B: CoxsackieA, C: Coxsackie B, D: Polio virus - -### Response: -Ans. (a) Rabies virus -### End" -943,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady presented with creamy white vaginal discharge with fishy odour, the drug of choice is:, with the following options: A: Doxycycline, B: Ofloxacine, C: Clindamycin, D: Metronidazole - -### Response: -Symptoms are suggestive of trichomoniasis -Metronidazole 200mg by mouth 3 times a day for 7 days prescribed for both partners, and adviced to abstain from intercourse or use condomduring therapy. -It is best taken after meals otherwise nausea and vomiting can occur -### End" -944,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cystic medial necrosis responsible for aoic dilatation and rupture is seen in -, with the following options: A: Syphilitic aneurysm, B: Takayasu aeritis, C: Atherosclerosis, D: Marfan syndrome - -### Response: -Ans. is 'd' Marfan syndromeo Cystic medial necrosis is the degenerative disease of media of the aoa.o It characterized by degeneration of collagen and elastic fibers in tunica media of aoa, and also the loss of medial cells that are replaced by multiple cleft of mucoid material.It characteristically affects the proximal aoer, results in circumferential weakness and dilatation which results in the development offusiform aneurysm involving the ascending aoa and sinus of vulsalva.o Cystic medial necrosis is a pathological substrate for aoic dissection.Diseases causing cystic medial necrosis o Marfan syndromeo Ehler-Danlus syndrome (type IV)o Congenital bicuspid aoic valveo Familial thoracic aoic aneurysm syndrome o Pregnancy -### End" -945,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in Henoch schonlein purpura except -, with the following options: A: Thrombocytopenia, B: Glomerulonephritis, C: Ahralgia, D: Abdominal pain - -### Response: -Ans. is 'a' i.e., Thrombocytopenia Clinical manifestations of H.S. Purpura Constitutional symptoms --> Fever, fatigue, malaise, Anorexia, weight loss Skin The hallmark of this disease is rash begining as pinkish maculopapules that initially blanch on pressure and progress to petechiae or purpura which are characterized by clinically as palpable purpura. o Purpura usually occurs on dependent areas of the body such as buttocks. Joints o Ahralgia or ahritis of large joints that involves primarily the joint of lower exterimities, i.e. knee & ankle. Migratory pattern of joint involvement occurs. Gastrointestinal tract o Abdominal pain and GI bleeding Diarrhoea (with or without visible blood) or hematemesis. o Intussusception may occur. Kidney o Almost always appear after the development of skin manifestations. o The characteristic of kidney involvement is microscopic heamaturia due to glomerulonephritis. o Non-nephrotic range proteinura. o There is deposition of IgA in the mesangium. Others --> Rarely CNS and pulmonary involvement may occur. -### End" -946,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Familial hypercholesterolemia there is, with the following options: A: LDL receptor, B: Apo protein A, C: Apo protein C, D: Lipoprotein lipase - -### Response: -A i.e. LDL receptor -### End" -947,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An antibiotic not acting on tubulin is ?, with the following options: A: Bleomycin, B: Colchicine, C: Paclitaxel, D: Vincristine - -### Response: -Ans. is 'a' i.e., Bleomycin Bleomycin (an anticancer antibiotic) does not act on tubulin. -### End" -948,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acanthosis nigricans is seen in:, with the following options: A: GIT cancer, B: Hypothyroidism, C: Diabetes, D: All of the above - -### Response: -Ans. d. All of the aboveMost common association of acanthosis nigricans is obesity -### End" -949,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What will be the BMI of a male whose weight is 89 kg and height is 172cm -, with the following options: A: 27, B: 30, C: 33, D: 36 - -### Response: -BMI = weight in kg/ height in metre square = 89/1.72/1.72 =30.08. Ref-Park&;s textbook of Preventive and Social Medicine 24th edition. . -### End" -950,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is Eaton agent?, with the following options: A: Mycoplasma, B: H.influenza, C: Klebsiella, D: Chlamydia - -### Response: -Ref: Ananthnarayan R. Paniker CKJ. Textbook of Microbiology. 8th Edition. Hyderabad: Universities Press: 2009. Pg. 389.Explanation:Mycoplasma pneumoniae causes primary atypical pneumoniaEaton (1944) was the first to isolate the causative agent of the disease in hamsters and cotton rats.He was able to transmit the infection later to chick embryos by amniotic inoculation.Because it was filterable, it was considered to be a virus (Eaton agent), but was subsequently shown to be a mycoplasma and named M pneumoniae. -### End" -951,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hormones are raised in Praderwilli syndrome, with the following options: A: Growth Hormone (GH), B: Leutinizing Hormone (LH), C: Follicile Stimulating Hormone (FSH), D: Ghrelin - -### Response: -Prader-Willi syndrome (PWS) is a disorder caused by a deletion or disruption of genes in the proximal arm of chromosome 15 or by maternal disomy in the proximal arm of chromosome 15. Commonly associated characteristics of this disorder include diminished fetal activity, , , hypogonadotropic hypogonadism, strabismus, and small hands and feet. Reference: GHAI Essential pediatrics, 8th edition -### End" -952,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fogo selvagem is a type of:, with the following options: A: Pemphigus vulgaris, B: Pemghigus vegetans, C: Pemphigus foliaceus, D: Bullous pemphigoid - -### Response: -Endemic pemphigus foliaceus common in rural pas of South America, paicularly ceain states of Brazil is known as fogo selvagem (wild fire) caused by bite of black fly. Ref: Rook's textbook of dermatology, 8th edition, Pg 40.13 -### End" -953,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To test the association between risk factors and disease, which of the following is the weakest study design?, with the following options: A: Case control study, B: Ecological study, C: Coho study, D: Cross-sectional study - -### Response: -Ecological studies, as they donot take into consideration individual data of exposure & diseases, have poorest evidence of determining association. Hence they are considered as weak studies. These are done at point of time & commonly used in nutritional surveys. Order from strong to weak study determining association:Randomized Control Trial > Retrospective Coho Study > Prospective Coho Study > Case control study > Cross sectional study > Ecological study. -### End" -954,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Longest extra ocular muscle:, with the following options: A: Superior oblique, B: Inferior oblique, C: Superior rectus, D: Lateral rectus - -### Response: -Ans: a (Superior oblique)Ref: Khurana anatomy and physiology. 2nd ed. pg. 287Superior oblique muscle arises from body of sphenoid and moves forward to reach the trochlea which is a cartilagenous pulley attached to the frontal bone. It then turns posterolaterally to get inserted on to the sclera.Superior oblique is the longest and thinnest extra ocular muscle. Length of its direct part is 40 mm and reflected tendon is 19.5mm, total length being 59.5 mm.Actions of extraocular musclesMuscleprimarysecondarytertiaryMRAdduction LRAbduction SRElevationIntorsionAdductionIRDepressionExtorsionAdductionSOIntorsionDepressionAbduction10ExtorsionElevationAbductionAlso remember:The first muscle to be affected in thyroid ophthalmopathy- inferior rectusThe last muscle to be affected in retrobulbar block -superior oblique All superiors are intorters. So inferiors are extorters All recti are adductors. So obliques are abductors -### End" -955,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Extrinsic system of coagulation is checked by:March 2010, with the following options: A: aPTT, B: PT, C: BT, D: PTT - -### Response: -Ans. B: PTBleeding Time (Normal:1-6 min.) is for checking the number of platelets. It is prolonged by lack of platelets. Clotting time (Normal:6-10 min.) varies widely depending upon the method employed, so discarded nowadays. Instead measurements of clotting factors are being done.aPTT/PTT is employed for assessing intrinsic system.Prothrombin time (Normal:12 sec.) gives an good indication of concentration of prothrombin in the blood. Extrinsic pathway is assessed. -### End" -956,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraception with increased risk of actinomycosis -, with the following options: A: OCPs, B: Condom, C: IUCD, D: Vaginal - -### Response: -Ans. is 'c' i.e., IUCD o Actinomycosis may occur by use of IUCD.Side effects and complications of lUDs1. Bleeding - Most common2. Pain - Second major side effect3. Pelvic infection - PID4. Uterine perforation5. Pregnancy6. Ectopic pregnancy7. Expulsion8. Mortality' - extremely rare -### End" -957,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 26-year-old nulliparous female with third degree uterine prolapse but no cystocele and no rectocele is best treated by:, with the following options: A: Abdominal sling surgery, B: Le fort colpocleisis, C: Fothergills repair, D: Amputation of cervix - -### Response: -Ans. is a, i.e. Abdominal sling surgeryBest surgery for prolapse when a female wants to conceive in future is - Abdominal sling surgery. -### End" -958,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: C.S.F. is required to be preserved in :, with the following options: A: Alcoholic poisoning, B: Arsenic poisoning, C: Copper poisoning, D: Organophosphorous poisoning - -### Response: -A i.e. Alcoholic poisoning -### End" -959,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Indicator for the outbreak of Plague epidemic is, with the following options: A: Rat burrow index, B: Total flea, C: Specific flea index, D: Cheopis index - -### Response: -Cheopis index: It is an average no of X.cheopis per rat. It is a specific flea index. If this index is more than 1, it is regarded as indicative of potential explosiveness of the situation, should a plague outbreak occur -### End" -960,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: TSH secreted from the pituitary gland is under control by, with the following options: A: TRH and T3, T4, B: Releasing factors same as those of cortisol, C: Releasing factors bypass neurohypophysis to act on the anterior pituitary, D: TRH only - -### Response: -(A) TRH and T3, T4 -### End" -961,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35yr old female who was an Occasional drinker complained of Severe Pruritis that becomes more bothersome in evening. On examination, patient was noted to have icteric sclera. Lab tests revealed anti-mitochondrial antibodies. What is the possible diagnosis?, with the following options: A: Primary sclerosing cholangitis, B: Xanthogranulomatous cholecystitis, C: Primary biliary cirrhosis, D: Alcoholic cirrhosis - -### Response: -PBC- primary biliary cirrhosis Autoimmune disorder M/C in females Pathology Progressive destruction of intrahepatic bile ducts only Diagnostic appearance - florid duct lesion with lymphocytic infiltration and granulomatous inflammation Clinical features Pruritis precedes jaundiceQ Pruritis and fatigue - characteristic symptoms Diagnosis Anti-mitochondrial Ab - Can confirm diagnosis Investigation of choice - Biopsy Treatment Liver transplantation (severe pruritus & fatigue are indications for LT) -### End" -962,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not an antero-superior mediastinal mass, with the following options: A: Extra adrenal pheochromocytoma, B: Thymoma, C: Branchial cyst, D: Teratoma - -### Response: -Anterosuperior Compament The anterosuperior compament of the mediastinum borders the undersurface of the sternum ventrally, the pericardium dorsally, and the visceral pleura laterally (at the apposition of the pleura and pericardium). Tumors of the anterior mediastinum includethymomas, teratoma or germ cell tumors, a spectrum of lympho- mas including Hodgkin disease, and thyroid goiter. In most cases, tissue (core biopsy) is required for diagnosis; fine-needle aspirate is usually inadequate. Thymomas are usually the most frequently occurring neoplasm of the anterior mediastinum, and lymphomas are second. Germ cell neoplasms include benign and malignant teratomas, choriocarcinoma, seminoma, and embryonal cell neoplasm. Teratomas frequently occur in young adults. The gonads are the most common primary site, followed by the mediastinum. Most germ cell neoplasms are benign, but 20% are malignant. Malignant teratomas may produce high serum levels of a-fetoprotein (AFP) and carcinoembryonic antigen. Endocrine disease of the thyroid and parathyroid may occur in the anterior mediastinum as a result of their anatomic position in adults (substernal goiter) or embryologic development. Carcinoid tumors may be foundwithin the thymus. Primary carcinomas of the mediastinum are often unresectable and respond poorly to treatment. Ref: Sabiston 20th edition Pgno: 1608 -### End" -963,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If 10 women use IUCD for 10 years and assuming the failure rate of IUCD at 2/HWY, the number of expected accidental pregnancies would be-, with the following options: A: 1, B: 2, C: 5, D: 20 - -### Response: -- Given PI=2 ; Time =10 x 12 =120 months ; No. of women = 10 - Number of expected accidental pregnancies = Pearl Index X Time X No. of women / 1200 = 2 x 120 x 10 / 1200 = 2 -### End" -964,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement regarding the procedure shown below is:, with the following options: A: Used to treat high grade CIN, B: Uses freeze thaw freeze technique, C: Destroys dysplastic epithelium upto a depth of 5mm, D: It is an OPD procedure - -### Response: -Ans. A. Used to treat high grade CINa. The figure is showing a cryoprobe on the cervix while cryotherapy is being performed.b. It is an ablative procedure used for persistent CIN1. (cervical intraepithelial neoplasia)c. Useful for lesions involving the ectocervix onlyd. It is an OPD procedure and can be done under usual analgesics.e. It works by crystallization of the intracellular water and destroys the dysplastic epithelium upto a depth of 5mmf. It uses cold gas carbon dioxide or nitrous oxide at -22 degree Celsius.g. It works by freeze - thaw - freeze technique and a successful procedure should lead to a formation of an ice ball of 5 to 10mm as shown in this figure.h. The procedure can cause mild pain. It leads to persistent watery discharge. Cervical stenosis and incompetence following the procedure is rare. -### End" -965,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The normal value of P50 on the oxyhaemoglobin dissociation curve in an adult is, with the following options: A: 1.8 kPa, B: 2.7 kPa, C: 3.6 kPa, D: 4.5 kPa - -### Response: -Adult Hb- 50% saturation at PO2 of 26mmHg. -1mmHg= 0.133 KPa -26mmHg= 0.133 X 26 = 3.45 -### End" -966,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about vasomotor centre (VMC) is true?, with the following options: A: Independent of coiCohypothalamic inputs, B: Influenced by baroceptor signals but not by chemoreceptors, C: Acts along with the cardiovagal centre (CVC) to maintain blood pressure, D: Essentially silent in sleep - -### Response: -The vasomotor center (VMC) is a poion of the medulla oblongata that, together with the cardiovascular center and respiratory center, regulates blood pressure and other homeostatic processes Ref: guyton and hall textbook of medical physiology 12 edition page number:201,202,203 -### End" -967,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incubation period of plasmodium vivax is:, with the following options: A: 5 - 7 days, B: 7 - 10 days, C: 10 - 14 days, D: 15 - 30 days - -### Response: -10 - 14 days -### End" -968,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not involve nerve damage -, with the following options: A: Guillian Barre syndrome, B: Erb's paralysis, C: Volkmann's paralysis, D: Neurotmesis - -### Response: -Volkmann's ischemic contracture is also called Volkmann's ischemic paralysis. -In Volkmann's ischemic contracture nerves (median & ulnar) are involved. -But the contracture is due to necrosis and fibrosis as results of ischemia. -### End" -969,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Bernoulli's theorem"" explains:, with the following options: A: Nasal polyp, B: Thyroglossal cyst, C: Zenker's diverticulum, D: Laryngomalacia - -### Response: -(a) Nasal polyp(Ref. Scott Brown, 6th ed., 4/10/2)Thyroglossal cyst and laryngomalacia are the congenital malformations.Zenker's diverticulum occurs due to neuromuscular incoordination. -### End" -970,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All have incubatory carriers, except-, with the following options: A: Tetanus, B: Measles, C: Whooping cough, D: Polio - -### Response: -Tetanus is not transmitted from person to person; it has NO period of communicability. Delayed infections(up to several months later) are due to dormant spores in the wound. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 339, 340 -### End" -971,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client, indicates that the nurse’s teaching has been successful?, with the following options: A: 4-6 small meals of low-carbohydrate foods daily, B: High-fat, high-carbohydrate meals, C: Low-fat, high-carbohydrate meals, D: High-fat, low protein meals - -### Response: -For the client with cholecystitis, fat intake should be reduced. -The calories from fat should be substituted with carbohydrates. -Reducing carbohydrate intake would be contraindicated. Any diet high in fat may lead to another attack of cholecystitis. -### End" -972,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute phase reactants are all except-, with the following options: A: C-reactive protein, B: Haptaglobulin, C: Endothelin, D: Fibrinogen - -### Response: -Endothelin is a vasoconstrictive mediator released in response to endothelial dysfunction. Basic Pathology, Robbins. Page no.: 484 -### End" -973,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood gas paition coefficient of anaesthetic agent tells about, with the following options: A: Solubility in blood, B: Potency of agent, C: Time lag of induction of anaesthesia, D: All of the above - -### Response: -Time lag of induction of anaesthesia Blood gas solubility (blood gas paition coefficient) is the best indicator for induction and recovery. Agent with less blood gas solubility will have fast induction and recovery while agents with less blood gas solubility will have slow induction Ref Katzung 12th ed. -### End" -974,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metastasis to liver is UNCOMMON with malignancy of: March2013, with the following options: A: Colon, B: Lung, C: Breast, D: Prostate - -### Response: -Ans. D i.e. ProstateAlthough the most common primary sources producing hepatic metastases are those of the colon, breast, lung, and pancreas, any cancer in any site of the body may spread to the liver, including leukemias, melanomas, and lymphomas -### End" -975,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prostaglandins are produced by ?, with the following options: A: Neutrophils, B: Endothelium, C: Macrophages, D: All of the above - -### Response: -Ans. is 'd' i.e., All of the above -### End" -976,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic pathological finding in carcinoid of hea-, with the following options: A: Fibrous endocordial thickening of right ventricle andtricuspid valve, B: Collagen deposition in wall of right ventricle and tricuspid valve, C: Interstitial fibrous thickening of right ventricle and pulmonic valve, D: Mononuclear inflammatory infiltrate in the wall of right atrium - -### Response: -The carcinoid syndrome results from bioactive compounds such as serotonin released by carcinoid tumors (; systemic manifestations include flushing, diarrhea, dermatitis, and bronchoconstriction. Carcinoid hea disease refers to the cardiac manifestation caused by the bioactive systemic syndrome develops. Cardiac lesions typically do not occur until there is a massive hepatic metastatic burden, since the liver normally catabolizes circulating mediators before they can affect the hea. Classically, endocardium and valves of the right hea are primarily affected since they are the first cardiac tissues bathed by the mediators released by gastrointestinal carcinoid tumors. (Robbins basic pathology,9th edition,pg no.395) -### End" -977,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Creatinine is synthesized from, with the following options: A: Glycine, Arginine and Methionine, B: Glycine and Methionine, C: Ornithine and Glycine, D: Thymine and Ornithine - -### Response: -Creatine & CreatinineCreatinine is formed in muscle from creatine phosphate by irreversible, nonenzymatic dehydration, and loss of phosphate. Since the 24-hour urinary excretion of creatinine is propoionate to muscle mass, it provides a measure of whether a complete 24-hour urine specimen has been collected. Glycine, arginine, and methionine all paicipate in creatine biosynthesis. Synthesis of creatine is completed by methylation of guanidinoacetate by S-adenosylmethionine.Ref: Harper&;s Biochemistry; 30th edition; Chapter 30; Conversion of Amino Acids to Specialized Products -### End" -978,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ST elevation and hyperacute T waves in precordeal leads VI to V6 and in lead aVL indicates:, with the following options: A: Anterolateral wall MI, B: Posterior wall MI, C: Inferior MI, D: Lateral wall MI - -### Response: -Answer is A (Anterolateral wall MI) Acute transmural Anterolateral wall ischaemia is associated with changes in one or more of the precordial leads (V1 through V6)and in leads I and aVL -### End" -979,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for diagnosing lung sequestration is: March 2009, with the following options: A: X-ray chest-PA view, B: Plain CT scan-chest, C: Angiography, D: MRI - -### Response: -Ans. C: Angiography A pulmonary sequestration, also known as a bronchopulmonary sequestration or a cystic lung lesion, is a medical condition where a piece of tissue that develops into lung tissue is not attached to the pulmonary blood supply and does not communicate with the other lung tissue. Often it gets its blood supply from the thoracic aoa. This condition is normally detected in children and is generally held to be congenital in nature. The treatment for this is a segmentectomy a thoracotomy. More and more, these lesions are diagnosed by prenatal ultrasound. Symptoms can vary greatly, but they include a persistent dry cough. Sequestrations can be identified in-utero an abnormal aery on ultrasound. The gold standard for diagnosis is pulmonary angiography, but it being a very invasive procedure is getting replaced by CT Scan with a contrasting fluid, as the investigation of choice. -### End" -980,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The main source of menstrual blood during menstruation is:, with the following options: A: Aerial, B: Venous, C: Both, D: Cavernous - -### Response: -Menstrual bleeding is from both systems, but aerial bleeding is appreciably greater than venous. Endometrial bleeding appears to follow rupture of an aeriole of a coiled aery, with consequent hematoma formation. With a hematoma, the superficial endometrium is distended and ruptures. Hemorrhage stops with aeriolar constriction. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 3. Implantation, Embryogenesis, and Placental Development. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. -### End" -981,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sudden painful diminition of vision in -Anterior Uveitis is due to, with the following options: A: Blood in Anterior chamber, B: Cells in Anterior chamber, C: Edema of Cornea, D: Ciliary muscle spasm - -### Response: -Due to ciliary muscle spasm, convexity of lens increases leading to blurred vision and pain due to spasm. -### End" -982,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which ofthe following drugs is used for Irritable Bowel Syndrome of the constipating type-, with the following options: A: Lubiprostone, B: Cholestyramine, C: Alosetron, D: Rifaximin - -### Response: -Management of IBS The most impoant steps are to make a positive diagnosis and reassure the patient. Many people are concerned that they have developed cancer. A cycle of anxiety leading to colonic symptoms, which fuher heighten anxiety, can be broken by explaining that symptoms are not due to a serious underlying disease but instead are the result of behavioural, psychosocial, physiological and luminal factors. In individuals who fail to respond to reassurance, treatment is traditionally tailored to the predominant symptoms. Dietary management is effective for many patients. Up to 20% may benefit from a wheat-free diet, some may respond to lactose exclusion, and excess intake of caffeine or aificial sweeteners, such as sorbitol, should be addressed. A more restrictive, 'low-FODMAP' diet, supervised by a dietitian, with gradual re-introduction of different food groups, may help some patients, as may a trial of a gluten-free diet. Probiotics, in capsule form, can be effective if taken for several months, although the optimum combination of bacterial strains and dose have yet to be clarified. Patients with intractable symptoms sometimes benefit from several months of therapy with a tricyclic antidepressant, such as amitriptyline or imipramine (10-25 mg orally at night). Side-effects include dry mouth and drowsiness but these are usually mild and the drug is generally well tolerated, although patients with features of somatisation tolerate the drug poorly and lower doses should be used. It may act by reducing visceral sensation and by altering gastrointestinal motility. Anxiety and affective disorders may also require specific treatment . The 5-HT4 agonist prucalopride, the guanylate cyclase-C receptor agonist linaclotide, and chloride channel activators, such as lubiprostone, can be effective in constipation- predominant IBS. Trials of anti-inflammatory agents, such as ketotifen or mesalazine, and the antibiotic rifaximin may be considered in some patients with difficult symptoms but are best prescribed only after specialist referral. Psychological interventions, such as cognitive behavioural therapy, relaxation and gut-directed hypnotherapy, should be reserved for the most difficult cases. A range of complementary and alternative therapies exist; most lack a good evidence base but are popular and help some patients . Most patients have a relapsing and remitting course. Exac- erbations often follow stressful life events, occupational dissatisfaction and difficulties with interpersonal relationships. Ref Davidson edition23rd pg 826 -### End" -983,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cyst of the spleen are, with the following options: A: Hydatid syst, B: Dermatoid cyst, C: Pseudocyst, D: Lymphangioma - -### Response: -Pseudocyst or secondary cyst is the common cause for the development of cyst in the spleen ( constitutes 80% ). true cyst and parasitic cyst constitute 20% Reference: SRB 5th edition page no. 679 -### End" -984,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: With which heart diseases in Pregnancy is prognosis worst:, with the following options: A: Eisenmenger's syndrome, B: Aortic Stenosis, C: Mitral Stenosis, D: MVP - -### Response: -Ans. a (Eisenmenger's syndrome). (Ref. Textbook of obstetrics D C Dutta 6th ed. 296)HEART DISEASE IN PREGNANCY# The risk of fetal congenital malformations is increased by 3-10% if either parents have congenital lesions. In mother with AV septal defect, risk of having concordant abnormality in baby is very much high.# Most common heart disease in pregnancy is mitral stenosis.# Most common congenital heart disease during pregnancy is ASD.# Absolute indications for termination of pregnancy are = primary pulmonary hypertension, and Eisenmenger's syndrome as maternal mortality is otherwise found to be highest in them. -### End" -985,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rapidly absorbed in the stomach is: September 2006, with the following options: A: Protein, B: Carbohydrate, C: Fat, D: None - -### Response: -Ans. D: NoneOnly alcohol is absorbed from the stomach. -### End" -986,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Position of leg in fracture of neck of femur is- DELETE, with the following options: A: External rotation with patella facing inwards, B: External rotation with patella facing outwards, C: Internal rotation with patella facing outwards, D: Internal rotation with patella facing inwards - -### Response: -*In fracture neck femur, the limb is in external rotation with patella facing outwards. Ref: Essential of Ohopaedics surgery 3rd/e p. 1012 -### End" -987,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ESI act was made in -, with the following options: A: 1946, B: 1948, C: 1952, D: 1954 - -### Response: -- the ESI act passed in 1948 is an impoant measure of social security and health insurance in the country. - it provides for ceain cash and medical benefits to industrial employees in case of sickness, maternity and employment injury. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no: 815 <\p> -### End" -988,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following insulin can be given intravenously?, with the following options: A: Protamine zinc insulin, B: Ultra lente insulin, C: Semi lente insulin, D: Regular insulin - -### Response: -Ans. is 'd' i.e., Regular insulin o All preparations are administered by S.C. route except regular insulin which can be given -### End" -989,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cervical was are seen with which HPV ?, with the following options: A: 11,13, B: 6, 11, C: 17,18, D: 5, 8 - -### Response: -Ans. is 'b' i.e., 6, 11 -### End" -990,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most impoant pathophysiological cause of GERD is:, with the following options: A: Hiatus hernia, B: Transient LES relaxation, C: Hypotensive LES, D: Intermittent changes in LES pressure tone - -### Response: -Ans. b. Transient LES relaxation -### End" -991,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Position of the patient should be as described except, with the following options: A: Diagnostic laparoscopy- trendlelnburg with about 30 degree tilt, B: Colposcopy - Lithotomy, C: Transvaginal sonography in Gynecology - Lithotomy with full bladder, D: Hysteroscopy - Lithotomy - -### Response: -Bladder should be empty during a transvaginal ultrasound -### End" -992,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which part is first involved by mummification?, with the following options: A: Heart, B: Skin, C: Stomach, D: Muscles - -### Response: -Ans. is 'b' i.e., Skin Mummification* It is also a modification of putrefaction, which occurs in the absence of moisture. That is when there is excess air and warmth but no moisture (humidity), i.e. hot dry and windy climate, mummification takes place in place of normal putrefaction. Thus mummification occurs in deserts, especially in summer and also in bodies buried in shallow grave in sandy soil.* Mummification is characterized by dessication or drying of the dead body. There is drying, dehydration and shriveling of dead body. It proceeds from exterior to interior. Therefore first to be involved is skin, especially of exposed body parts like lips, nose tip, hands (fingers) and feet (toes). The skin is shrunken, contracted, dry, brittle, leathery, streched across bony prominences and rusty brown to black in color. Internal viscera also dry up, darken in color and blend with each other to form a single mass. Body emits smell like rotten cheese. Facial features and injuries are well preserved, thus identification of body and cause of death can be determined (like adipocere formation).* Time required for mummification varies between 3 months - 2 years. If properly preserved, a mummified body can remain for years. Chronic arsenic or antimony poisoning favor mummification.* Medicolegal importance: (i) Identification of body (facial features are preserved), (ii) cause of death (injury marks are preserved), (iii) time since death can be estimated. -### End" -993,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Housemaid knee is an inflammation of:, with the following options: A: Lateral bursa, B: Prepatellar bursa, C: Suprapatellar bursa, D: Anserine bursa - -### Response: -Prepatellar's bursitis is called ""housemaids knee"" or miner's kneePrepatellar bursitisIt is a common cause of swelling and pain above the patellaIt is due to inflammation of the prepatellar bursa.This structure is a superficial bursa with a thin synol lining located between the skin and the patella.The bursa develops within the first years of life as a result of mechanical pressure and friction, and it serves the purpose of reducing friction on underlying structures and allowing maximal range of motion in the knee.Aseptic prepatellar bursitis is commonly caused by repetitive work in a kneeling position, hence the name ""housemaid's knee"".Infrapatellar bursitis/clergyman's kneeIt is the inflammation of the infrapatellar bursa, which is located just below the patella.It is often called ""clergyman's knee"" due to its historical frequency amongst clergyman, who injured the bursa by kneeling on hard surfaces during prayer. -### End" -994,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malaria is transmitted by, with the following options: A: Female anopheles mosquito, B: Male anopheles mosquito, C: Culex mosquito, D: Aedes mosquito - -### Response: -Ans. a (Female anopheles mosquito). (Ref. Park, PSM, 17th/pg.l94)TRANSMISSION OF MALARIA IS BY THREE MODES:# Vector transmission--by female anopheline mosquito# Direct--IM, IV, blood transfusion, drug addicts# CongenitalEducational point:# Blood transfusion of a person in endemic region and who has had malaria should not be accepted as donor until 3 years later. -### End" -995,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cushing reflex is:, with the following options: A: | Mean arterial pressure with increased intracranial pressure, B: | Mean arterial pressure with decreased intracranial pressure, C: | Mean arterial pressure with increased intracranial pressure, D: | Mean arterial pressure with decreased intracranial pressure - -### Response: -Ans.(a) |Mean arterial pressure with increased intracranial pressureRef: Schwartz 10/e pi580-1583Cushing reflex is caused by increased ICP* C/B- Increase in Systolic BP, Decreased Heart Rate and Irregular respiration* Due to insufficient blood flow and arteriole compression -### End" -996,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Manifestation of squint in children are all EXCEPT, with the following options: A: Diplopia, B: Confusion, C: Detion of eye, D: Stereopsis - -### Response: -D i.e. Stereopsis Stereopsis means binocular depth perception. In squint due to detion of eye the two images formed in two eyes are vastly different and the brain is unable to fuse them resulting in diplopia, confusion, nausea & vomiting. Therefore, in squint there is no stereopsis Q -### End" -997,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following anterior dislocation of the shoulder, apt develops weakness of flexion at the elbow and lack of sensation over the lateral aspect forearm; nerve injured is -, with the following options: A: Radial nerve, B: Musculocutanous nerve, C: Axillary nerve, D: Ulnar nerve - -### Response: -The most common complication of anterior dislocation of the shoulder is axillary (circumflex) nerve injury. -There is consequent paralysis of the deltoid muscle, with a small area of anaesthesia at the lateral aspect of the upper arm. -However, in this question, the sensation is lost on the lateral aspect of the forearm (not arm). The lateral side of the forearm has sensory supply from the lateral cutaneous nerve of foreign, a branch of musculocutaneous nerve. The musculocutaneous nerve also supplies the biceps brachii (a flexor of elbow joint). -Therefore, musculocutaneous nerve injury will cause sensory loss over the lateral aspect of the forearm with the weakness of flexion at the elbow. -As occasionally other branches of brachial plexus (other than axillary nerve) can also be injured, the answer to this question is a musculocutaneous nerve. -### End" -998,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HLA complex is on chromosome?, with the following options: A: 6, B: 7, C: 8, D: 9 - -### Response: -Ans. is 'a' i.e., 6 HLA complex of genes is located on the sho arm of chromosome 6. -### End" -999,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disinfection of water is not required if the source is from-, with the following options: A: Tube well, B: Step well, C: Draw well, D: River - -### Response: -Ans. is 'a' i.e., Tube well -### End" -1000,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For PCR which of the following is not required, with the following options: A: Taq polymerase, B: d-NTP, C: Primer, D: Radiolabelled DNA probe - -### Response: -Taq polymerase: It is a heat stable enzyme used in polymerase chain reaction Primer: it is a small sequence of 20 t0 30 base pairs used in PCR dNTP s : they are deoxy nucleoside triphosphates which help in DNA synthesis Ref: Guyton and Hall textbook of medical physiology 12th edition, chapter : 20 -### End" -1001,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In chronic inflammation confined to the portal tract with intact limiting membrane and normal lobular parenchyma, the histopathological diagnosis would be -, with the following options: A: Active hepatitis, B: Chronic active hepatitis, C: Chronic persistent hepatitis, D: Acoholic heaptitis - -### Response: -Intact limiting membrane with inflammation confined to portal area is seen in chronic persistent hepatitis. -### End" -1002,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: LASIK (Laser assisted in situ keratomileusis) is useful in treatment of, with the following options: A: Myopia, B: Astigmatism, C: Hypermetropia, D: All of the above - -### Response: -Ans. d (All of the above) (Ref. Khurana's ophthalmology, 2nd ed., p 77; Parson's 20th/pg. 76)EXCIMER LASER IN SITU KERATOMILEUSIS (LASER)# Principle:- Myopia is corrected with preservation of Bowman's layer.- A superficial corneal flap (approx. 160 pm) is created with a microkeratome.- The keratome is withdrawn, the flap is reflected, and the exposed underlying corneal stroma is ablated with an excimer laser to correct the myopia.- Then the flap is repositioned on the corneal bed and fixed in place by force of its own adhesion.# Indication:- Severe myopia (up to 10-12 diopters).- Photoablation:* Excimer laser produces photoablation.* It produces UV light of very short wavelength, which breaks chemical bonds of biologic materials, converting them into small molecules that diffuse away.- Photorefractive keratectomy:* LASIK for correcting refractive errors and* LASIK for phototherapeutic keratectomy for corneal disease like ""band-shaped"" keratopathy.# LASIK is superior to photorefractive keratectomy in that it:- Less painful procedure* As LASIK does not expose raw corneal surface at the end of surgery it is less painful.- Can be repeated by lifting the flap created if further refinement is necessary- Gives a faster visual rehabilitation- Has less myopic regression- Causes less scarring than photorefractive keratectomy- Can Rx higher myopia* It can also treat a higher myopia, causes less scarring and has less myopic regression. However, because a flap needed to be created, it has a higher potential risk.* Involves the use of microtome* Is contraindicated in patients with thin cornea# Side effects of LASIK:- Reduced corneal sensation- Inaccurate biometry if the patient requires cataract surgery in later life- Tear film abnormality- Erroneously high intraocular pressure with applanation tonometer. -### End" -1003,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a direct content of the cavernous sinus?, with the following options: A: Ophthalmic division of trigeminal nerve, B: Trochlear nerve, C: Abducent nerve, D: Occulomotor nerve - -### Response: -Structures passing through the medial aspect of the sinus: 1. Internal carotid aery with the venous and sympathetic plexus around it. 2. Abducent nerve: inferolateral to the internal carotid aery The structures in the infra lateral wall and on the Lasseter medial aspect of the sinus are separated from blood, by the way, endothelial lining. Ref.BDC volume 3;sixth edition pg 193 -### End" -1004,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The non-sedative antihistamines are all except one, with the following options: A: Cinnarizine, B: Desloratadine, C: Levocetirizine, D: Fexofenadine - -### Response: -HIGHLY SEDATIVE -Diphenhydramine -Dimenhydrinate -Promethazine -Hydroxyzine -MODERATELY SEDATIVE -Pheniramine -Cyproheptadine -Meclizine -Cinnarizine -MILD SEDATIVE -Chlorpheniramine -Dexchlorpheniramine -Triprolidine -Clemastine -SECOND GENERATION ANTIHISTAMICS -Fexofenadine -Loratadine -Desloratadine -Cetirizine -Levocetirizine -Azelastine -Mizolastine -Ebastine -Rupatadine -### End" -1005,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lancefield group of streptococci belongs to:, with the following options: A: M-protein, B: Carbohydrate (C) antigen on cell- wall, C: Bile solubility, D: Sugar fermentation - -### Response: -Carbohydrate (C) antigen on cell- wall (Ref: Ananthnarayan-6thEd/Pg 188) ""Hemolytic streptococci were classified by Lancefield serologically into groups based on the nature of Carbohydrate antigen on the cell wall."" There are 20 groups, A to V, identified (without I & J). * The great majority of hemolytic streptococci that produce human infections belong to group A * Hemolytic streptococci of group A are called as Streptococcus. Pyogen -### End" -1006,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Effect of efferent aeriole constriction and afferent aeriole dilatation on GFR is?, with the following options: A: Increases, B: Decreases, C: No change, D: First increase then decrease - -### Response: -Increases REF: Ganong's 22"" chapter 38 Increase in renal blood flow increases GFR. Afferent aeriole brings blood to the nephron hence its dilation will increase renal blood flow, and efferent aeriole takes blood away from the nephrons, hence its constriction will cause increase filtration, hence increase in GFR. -### End" -1007,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about Parvovirus B-19 are true except-, with the following options: A: DNA virus, B: Crosses placenta in only <10% of cases, C: Can cause sever anemia, D: Can cause aplastic crises - -### Response: -parvo virus cause aplastic&severe anemia.it is a sdDNA virus REF:ANATHANARAYANAN MICROBIOLOGY NINTH EDITION PAGE.554 -### End" -1008,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following ion is exchanged in the stomach for H+ secretion?, with the following options: A: Na+, B: K+, C: Ca+, D: Cl- - -### Response: -The unique characteristic of gastric secretion is its high concentration of hydrochloric acid, a product of the parietal cells. As the concentration of H+ rises during secretion, that of Na+ drops in a reciprocal fashion. K+ remains relatively constant at 5-10 meq/L. Chloride concentration remains near 150 meq/L, and gastric juice maintains its isotonicity at varying secretory rates. Acid secretion at the apical membrane is accomplished by a membrane-bound H+/K+-ATPase (the proton pump); H+ is secreted into the lumen in exchange for K+. Ref: Dohey G.M., Way L.W. (2010). Chapter 23. Stomach & Duodenum. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e. -### End" -1009,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Warfarin effect may be enhanced by: March 2005, with the following options: A: Phenobarbitone, B: Ketoconazole, C: Rifampicin, D: Chronic alcoholism - -### Response: -Ans. D: Chronic Alcoholism Many commonly-used antibiotics, such as metronidazole or the macrolides, will greatly increase the effect of warfarin by reducing the metabolism of warfarin in the body. Other broad-spectrum antibiotics can reduce the amount of the normal bacterial flora in the bowel, which make significant quantities of vitamin K, thus potentiating the effect of warfarin. In addition, food that contains large quantities of vitamin K will reduce the warfarin effect. Thyroid activity also appears to influence warfarin dosing requirements; hypothyroidism (decreased thyroid function) makes people less responsive to warfarin treatment, while hypehyroidism (overactive thyroid) boosts the anticoagulant effect. Liver diseases, chronic alcoholism may enhance effect as synthesis of clotting factor may be deficient. -### End" -1010,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oxaloacetate is formed from, with the following options: A: Glutamate, B: Histidine, C: Aspaate, D: Alanine - -### Response: -Aminotransferase (transaminase) reactions form pyruvate from alanine, oxaloacetate from aspaate, and a-ketoglutarate from glutamate. Because these reactions are reversible, the cycle also serves as a source of carbon skeletons for the synthesis of these amino acids. Other amino acids contribute to gluconeogenesis because their carbon skeletons give rise to citric acid cycle intermediates. Alanine, cysteine, glycine, hydroxyproline, serine, threonine, and tryptophan yield pyruvate; arginine, histidine, glutamine, and proline yield a-ketoglutarate; isoleucine, methionine, and valine yield succinyl-CoA; tyrosine and phenylalanine yield fumarate. Reference: Harper; 30th edition; Page no: 165 -### End" -1011,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brown color of contusion is due to -, with the following options: A: Haematodin, B: Reduced hemoglobin, C: Haemosiderin, D: Bilirubin - -### Response: -Ans. is 'c' i.e., Haemosiderin Color change and age of bruise (Contusion!o After a bruise has appeared, it tends to get smaller from periphery to center and passes through a series of colour changes. These are due to disintegration of RBCs by hemolysis and breakdown of hemoglobin into the pigments haemosiderin, haematodin and bilirubin changes are: -At first: Red (oxyhemoglobin)Few hours to 3 days : blue (reduced hemoglobin)4th day : Bluish-black to brown (haemosiderin)5-6 days: Greenish (haematodin)7-12 days : Yellow (Bilirubin)2 weeks : Normal (absorption of pigment) -### End" -1012,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young adult presents with proximal weakness of upper limbs, features of facial palsy and winging of scapula. The most likely diagnosis is-, with the following options: A: Facio-Scapulo-Humeral Dystrophy, B: Limb-Girdle Dystrophy, C: Scapuloproneal Dystrophy, D: Duchene Muscular Dystrophy - -### Response: -*Condition typically has an onset in childhood or young adulthood., facial weakness is initial manifestation,weakness of shoulder girdle,loss of scapular stabilizing muscles makes arm elevation difficult,scapular winging becomes apparent with attempts at abduction and forward movement Ref Harrison20th edition pg 2567 -### End" -1013,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are Pharmacological methods of cervical ripening except?, with the following options: A: Pge2, B: Pge1, C: Mifepristone, D: Transcervical Catheter - -### Response: -Pharmacological method Non pharmacological method 1. Dinoprostone gel (pge2) 1. Stripping of membrane 2. Misoprostol (pge1) 2. Mechanical dilators - Transcervical catheter and Osmotic dilators 3. Mifepristone 3.Extra-amniotic saline infusion During cervical ripening,Collagen fibril diameter and proteoglycan and glycosaminoglycan within the matrix is increased. -### End" -1014,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About Neuropeptide Y all are true except, with the following options: A: It is mediated through melanocorticotropin hormone, B: Decreases thermogenesis, C: Its level decreases during starvation, D: Contains 36 aminoacid residues - -### Response: -Neuropeptide Y has 36 amino acid residues. It stimulates appetite, reduces thermogenesis by decreasing the energy expenditure and also decreases the activity of MSH. -During starvation, it is secreted at increased levels. -### End" -1015,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Today"" sponge contains which of the following:, with the following options: A: Nonoxynol, B: Deflon, C: Femshield, D: Desogestrel - -### Response: -Nonoxynol -### End" -1016,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Profuse expectoration of two months durations and clubbing may be seen, with the following options: A: Sarcoidosis, B: Polyaeritis nodosa, C: Pulmonary aery hypeension, D: Allergic bronchopulmonary aspergillosis - -### Response: -Allergic bronchopulmonary aspergillosis represents a hypersensitivity reaction to Aspergillus fumigatus.Episodes of bronchial obstruction with mucous plugs leading to coughing 'fits',breathlessness,pulmonary infiltrates.It can result in the development of bronchiectasis.Clubbing can be seen in this case. Reference:Harrison's Medicine-18th edition,page no:1658;Davidson's Medicine-22nd edition,page no:697. -### End" -1017,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an ocular side-effect of HAART therapy?, with the following options: A: Retinitis, B: Uveitis, C: Optic neuritis, D: Scleritis - -### Response: -Ans. b. Uveitis (Ref: Impact of highly active antiretroviral therapy on ophthalmic manifestations in human immunodeficency virus/ acquired immune deficiency syndrome by Kartik K Venkatesh, BA, J Biswas, MD; N, and N Kumarasamy, MBBS, PhD Indian Journal of Ophthalmology Year; 2008 | Volume : 56 | Issue : 5 | Page : 391-393 style=""font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"">articles/PMC2636132/)Impact of highly active antiretroviral therapy on ophthalmic manifestations in human immunodeficiency virus:Before the introduction of HAART, CMV retinitis affected 30-40% of HIV-infected individuals. At that time a study from our center documented CMV retinitis and cotton-wool spots caused by HIV-related microvasculopathy as the most frequently encountered ocular lesions.Additionally, a study conducted at our center in Indian children infected with HIV found a high prevalence of ocular and systemic lesions, most commonly anterior uveitis followed by CMV retinitis.Since the advent of HAART, immune recovery uveitis (IRU) has become an ocular manifestation described in patients with inactive CMV retinitis. The reported incidence of IRU has been shown to vary widely and limited data is available of possible risk factors.Some HIV-infected individuals experience clinical deterioration after initiating antiretroviral therapy that is believed to be a result of the restored immune system to mount an exuberant inflammatory response. Immune reconstitution syndrome can cause posterior segment inflammation in CMV retinitis and can lead to visual morbidity in patients with AIDS. -### End" -1018,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Volatile inhalational anesthetic contributes in all of the following component of general anesthesia except, with the following options: A: Loss of consciousness, B: Loss of reflex, C: Analgesia, D: Muscle relaxation - -### Response: -volatile inhalational anesthetic agent contributes in all the component of G.A except - analgesia. they can produce - loss of conciouness loss of reflex response Amnesia Muscle Relaxation -### End" -1019,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gram negative cocci is/are -, with the following options: A: Neisseria gonoorrhoeae, B: Bacillus, C: Staphylococci, D: Streptococci - -### Response: -Neisseria gonoorrhoeae- Gram negative cocci Streptococci - Gram Positive cocci Staphylococci- Gram Positive cocci Bacillus - Gram Positive Bacilli -### End" -1020,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In doing phrenic nerve block, it is best to infiltrate, with the following options: A: Scalenus anterior, B: Scalenus posterior, C: Posterior border of sternomastoid, D: Anterior border of sternomastoid - -### Response: -Phrenic nerve is blocked 3 cm above the clavicle at the posterior border of sternomastoid. -### End" -1021,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding Kaposi's sarcoma is all except?, with the following options: A: May occur even in the presence of a normal CD4+T cell count, B: HHV-8 has been strongly implicated as a cofactor in the pathogenesis, C: Koebner's Phenomenon may be seen, D: Lymph node involvement suggests worst prognosis - -### Response: -Ans. D. Lymph node involvement suggests worst prognosis.a. Kaposi's sarcoma is a multicentric neoplasm consisting of multiple vascular nodules appearing in the skin, mucous membranes, and viscera. The course ranges from indolent, with only minor skin or lymph node involvement, to fulminant, with extensive cutaneous and visceral involvement.b. In the initial period of the AIDS epidemic, KS was a prominent clinical feature of the first cases of AIDS, occurring in 79% of the patients diagnosed in 1981. By 1989 it was seen in only 25% of cases, by 1992 the number had decreased to 9%, and by 1997 the number was <1%. HHV-8 or KSHV has been strongly implicated as a viral cofactor in the pathogenesis of KS.c. Clinically, KS has varied presentations and may be seen at any stage of HIV infection, even in the presence of a normal CD4+ T cell count. The initial lesion may be a small, raised reddish-purple nodule on the skin, a discoloration on the oral mucosa, or a swollen lymph node.d. Lesions often appear in sun-exposed areas, particularly the tip of the nose, and have a propensity to occur in areas of trauma (Koebner phenomenon). Because of the vascular nature of the tumors and the presence of extravasated red blood cells in the lesions, their colors range from reddish to purple to brown and often take the appearance of a bruise, with yellowish discoloration and tattooing.e. Lesions range in size from a few millimeters to several centi- meters in diameter and may be either discrete or confluent. KS lesions most commonly appear as raised macules; however, they can also be papular, particularly in patients with higher CD4+ T cell counts. Con- fluent lesions may give rise to surrounding lymphedema and may be disfiguring when they involve the face and disabling when they involve the lower extremities or the surfaces of joints.f. Apart from skin, lymph nodes, gastrointestinal tract, and lung are the organ systems most commonly affected by KS. Lesions have been reported in virtually every organ, including the heart and the CNS. In contrast to most malignancies, in which lymph node involvement implies metastatic spread and a poor prognosis, lymph node involvement may be seen very early in KS and is of no special clinical significance. -### End" -1022,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Perl's stain or prussion blue test is for:, with the following options: A: Bilirubin, B: Calcium, C: Hemosiderin, D: Glycogen - -### Response: -Perls' stain (Prussian-Blue Reaction) is to demonstrate Ferric salts in tissues. These are seen as iron  granules in bone marrow macrophages, erythroblasts (Sideroblasts) and erythrocytes (Siderocytes) in  blood films and haemosiderin in spun urine. -### End" -1023,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5 year old male patient complains of multiple decayed teeth and gives a history of frequent snacking and consumption of sugar containing beverages and low socio-economic status. Intraoral examination shows multiple interproximal carious lesions. Which may be recommended by the dentist to this child?, with the following options: A: Aspartame, B: Xylitol, C: Complex carbohydrates, D: Saccharin - -### Response: -Xylitol is a sweetener that inhibits the growth of MS. Numerous studies seem to confirm its anticariogenic capability. Clinically effective levels of xylitol show MS strains with reduced adhesion to the teeth and other reduced virulence properties, such as less acid production. Xylitol has been tested as an additive to a variety of foods and to dentifrices. However, the vast majority of published data come from studies in which xylitol was incorporated into chewing  gum. Clinicians may consider recommending xylitol use to moderate- or high-caries-risk  patients.  Those  recommending  xylitol should be familiar with the product labeling and recommend  age-appropriate  products.  They  should  routinely reassess a child for changes in caries-risk status and adjust recommendations accordingly. -NOTE- MS- Mutans Streptococci. -### End" -1024,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of these are responsible for preferential shunting of well oxygenated blood from fetal right atrium to left hea, EXCEPT?, with the following options: A: Upper interatrial septum, B: Crista dividens, C: Pattern of blood flow in IVC, D: Size difference of left and right atrium - -### Response: -More oxygenated blood travels along the medial aspect of IVC and less along lateral aspect, facilitating shunting to opposite sides of hea, that is, more oxygenated travels to left hea through foramen ovale and less oxygenated to right ventricle. This is also facilitated by configuration of interatrial septum called crista dividens. So all are correct except option d. -### End" -1025,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Association of choledocholithiasis in cholithiasis, with the following options: A: <5%, B: 15%, C: 20-35%, D: 50% - -### Response: -Choledocholithiasis Found in 6-12% of patients with GB stones Retained stones discovered within 2 years of cholecystectomy Recurrent stones detected >2 years of cholecystectomy Ref: Sabiston 20th edition Pgno : 1494 -### End" -1026,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: With regard to paranasal sinuses, true is, with the following options: A: The maxillary sinus of the newborn is relatively large compared to that of the adult, B: The mucous membrane of the maxillary sinus and the upper premolar teeth have the same nerve supply, C: The frontal, spheroidal, maxillary and anterior ethmoidal sinuses drain into the middle meatus, D: The spheroidal sinuses are supplied by anterior ethmoidal nerves - -### Response: -Paranasal sinuses are rudimentary in newborn. Sphenoid sinus drains into sphenoethmoidal recess and not into middle meatus. Sphenoid sinus is supplied by posterior ethmoidal nerve. -### End" -1027,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a study of inheritance of the cystic fibrosis gene (CFTR), the genetic mutations in carriers and affected individuals are documented. Based on these findings, investigators determine that there is no simple screening test to detect all carriers of mutations of the CFTR gene. Which of the following is most likely to be the greatest limitation to development of a screening test for CFTR mutations?, with the following options: A: Both copies of the gene must be abnormal for detection, B: Fluorescence in situ hybridization is labor-intensive and expensive, C: Frequency of mutations among ethnic groups limits sensitivity, D: Less than 1 individual in 10,000 is a heterozygote - -### Response: -When a genetic disease (e.g., cystic fibrosis) is caused by many different mutations, with different frequencies among populations, there is no simple screening test that can detect all the mutations. Although 70% of patients with cystic fibrosis have a 3-base pair deletion that can be readily detected by PCR (the AF508 mutation), the remaining 30% have disease caused by several hundred allelic forms of CFTR. To detect all would require sequencing of the CFTR genes. This prohibits mass screening. The other listed options do not apply. -### End" -1028,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pethidine should not be given with -, with the following options: A: Reserpine, B: Propranolol, C: Atenolol, D: MAO inhibitors - -### Response: -Ans. is `d' i.e., MAO inhibitors o MAO inhibitors inhibit hydrolysis but not detmethylation --> more norpethidine is produced. Hydrolysis Mepridinic acid (major metabolic) Pethidine Dernekiation Norpethidine (minor metabolite) o MAO inhibitors selectively inhibit its hydrolysis without effecting demethylation -4 Accumulation of norpethidine --> Excitement. -### End" -1029,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are diagnostic barium follow-through features of ileocecal tuberculosis Except –, with the following options: A: Apple – core appearance, B: Pulled up contracted cecum, C: Widening of ileocecal angle, D: Strictures involving terminal ileum - -### Response: -Radiological features of ileocecal tuberculosis on barium enema - -Fleischner or inverted umbrella sign:- wide gaping of the ileocecal valve with narrowing of the terminal ileum. -Gooseneck deformity. -Conical cecum or Amputed cecum Cecum is shrunken in size and pulled out of the iliac fossa due to fibrosis and contraction of mesocolon. -Stierlin sign:- Narrowing of terminal ileum with rapid emptying into a shortened, rigid or obliterated cecum. -String sign -Widening of ileocecal (IC) angle -Purse string (napkin ring) stenosis -Discrete and transverse or star-shaped (stellate) ulcers with elevated margins. -### End" -1030,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tacrolimus level is increased by all except, with the following options: A: Erythromycin, B: Itraconazole, C: Danazole, D: Rifampicin - -### Response: -Ans. (D) Rifampicinwww.medscape.com/druginfo(Ref: KDT 8/e p940, )Erythromycin, itraconazol and danazol inhibit the metabolism of tacrolimus and thus increase the plasma concentration whereas rifampicin is an enzyme inducer and decrease its plasma level. -### End" -1031,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Golgi tendon organ helps in detection, with the following options: A: Muscle length, B: Reflex muscle tension, C: Nutrional status, D: Excretory function - -### Response: -(Reflex muscle tension): (232-33 Ganong24 edition, 910-A.KJain 5 ; 661-Guyton 12 )Golgi Tendon Organ Helps Control Muscle TensionGTO is an encapsulated sensory receptor through which muscle tendon fibers pass. About 10 to 15 muscle fibers are usually connected to each GTO, and the organ is stimulated when this small bundle of muscle fibers is ""tensed"" by contracting or stretching the muscle. Thus the major difference in excitation of the Golgi tendon organ versus the muscle spindle is that the spindle detects muscle length and changes in muscle length, whereas the tndon organ detects muscle tension as reflected by the tension in itself* GTO has both dynamic response and static response* GTO provide the nervous system with instantaneous information on the degree of tension in each small segment of each muscle* It acts as a protective reflexGolgi tendon organPathway responsible for the stretch reflex and inverse stretch reflex -### End" -1032,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nasolacrimal duct will not be formed with oblique facial cleft due to n on fusion of which of the following ridges?, with the following options: A: A to B, B: B to C, C: A to C, D: C to D - -### Response: -Ans. B. B to Ca. B (failure of fusion of lateral nasal process to maxillary process)1/1000. Clefts may also occur between the lateral nasal process and the maxillary prominence (oblique cleft) exposing the nasolacrimal duct or between the maxillary and mandibular primordial (lateral clefts). Although extremely rare, clefts can also form along the midline of the two mandibular prominences (median mandibular cleft). As the facial prominences fuse, the opposing epithelium disintegrates. Remnants of these epithelial seams may result in cyst formation. -### End" -1033,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are considered as first rank symptoms of Schizophrenia EXCEPT, with the following options: A: Thought broadcast, B: Third person auditory hallucination, C: Somatic passivity, D: Anhedonia - -### Response: -(D) Anhedonia # First Rank Symptoms (SFRS) of Schizophrenia:> Hallucinations:> Audible thoughts: Voices speaking out thoughts aloud or 'thought echo'> Voices heard arguing: Two or more hallucinatory voices discussing the subject in third person> Voices commencing on one's action> Thought Alienation Phenomena Thought withdrawal: Thoughts cease and subject experiences them as removed by external force Thought insertion: Subject experiences thoughts imposed by some external force on his passive mind. Thought diffusion or broadcasting: Subject experiences that his thoughts are escaping the confines of his self and are being experienced by others around.> Passivity Phenomena 'Made' feelings or affect 'Made' impulses 'Made' volition or acts. In 'made' effects, impulses and volitions, the subject experiences feelings, impulses or acts, which are imposed by some external force. In 'made' volition, one's own acts are experienced as being under the control of some external force, the subject being like a robot. Somatic passivity: Bodily sensations, especially sensory symptoms imposed on body by some external force> Delusional perception: Normal perception has a private and illogical meaning.> Anhedonia is lack of interest/pleasure and is seen significantly in depression. -### End" -1034,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trombiculid mite is the vector of:-, with the following options: A: Epidemic typhus, B: Endemic typhus, C: Scrub typhus, D: Q-fever - -### Response: -Disease Agent Vector Reservoir Epidemic typhus Endemic typhus Scrub typhus R. prowazekii R. typhi R. tsutsugamushi Louse Flea Trombiculid mite Humans Rodents Rodents Indian Tick typhus RMSF Rickettsial pox R. conori R. rickettsia R. akari Tick Tick Mite Rodents, dogs Rodents, dogs Mice Q Fever Trench Fever Coxiella burnetiid Baonella Quintana Nil Louse Cattle, sheep, goat Humans -### End" -1035,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Analysis of routine measurement aimed at detecting changes in the environment?, with the following options: A: Surveillance, B: Isolation, C: Monitoring, D: RCT - -### Response: -Monitoring is the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population. -### End" -1036,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 29–day old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. Most likely diagnosis is –, with the following options: A: Rheumatic fever, B: Tetralogy of Fallot, C: Transposition of great arteries, D: Ventricular septal defect - -### Response: -The answer is quite obvious. -TOF and TGA are cyanotic heart diseases and -Rheumatic fever can be ruled out on basis of age. (Age group of rheumatic fever is 5-15 yrs) - -Clinical manifestation of VSD - -The patients become symptomatic around 6 to 10 weeks of age. -At this time CHF may develop. -Frequent symptoms → Palpitation, dysnea on exertion and chest infections. - -Signs - -Hyperkinetic precordium with a thrill at the left sternal border. -Pansystolic murmur at left sternal border. -S1 & S2 are masked by pan-systolic murmur maximum intensity of murmur is at 3rd, 4th or 5th left interspace. -S2 can be make out at the pulmonary area (upper left sternal border) where it is not masked by pan-systolic murmur → S2 is widely split with accentuation of P2 -S3 may be audible at the apex. -A delayed diastolic murmur in mitral area. -Pulmonary systolic ejection murmur in pulmonary area. -### End" -1037,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Baroreceptor stimulation produces:, with the following options: A: Decreased hea rate & BP, B: Increased hea rate & BP, C: Increased cardiac contractility, D: All - -### Response: -A i.e. Decreased HR & BP Baroreceptors are the stretch receptors in the walls of hea & blood vessels eg carotid sinus & aoic arch receptors, receptors in walls of atria at enterance of SVC, IVC & pulmonary veins and receptors in pulmonary circulation (cardio- pulmonary receptors). These are stimulated by distension of the structure in which they are located 1/t vagal innervation of hea and producing vasodilation, venodilation, a drop in BP, bradycardia & decrease cardiac outputQ. -### End" -1038,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are used In bronchial asthma, except, with the following options: A: Salbutamol, B: Morphine, C: Aminophylline, D: Steroid - -### Response: -Salbutamol is a beta2 agonist which relaxes smooth muscles and relieves bronchospasm.Aminophylline is a phosphodiesterase inhibitor that produces bronchodilator effect along with anti-inflammatory effect.Steroids,both oral and inhalational,are also used in asthma because of their anti-inflammatory propey. WHO proposed step wise approach for management of bronchial asthma. Morphine is used in emergency management of acute myocardial infarction. Reference:Harrison's medicine-18th edition,page no:2110. -### End" -1039,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which type of mutations usually involves mutation of a gene coding for the following molecule?, with the following options: A: Silent mutation, B: Nonsence mutation, C: Missense mutation, D: Nonsense suppressor mutation - -### Response: -A nonsense suppressor mutation is a secondary mutation that reverses the effect of a primary nonsense or chain-termination mutation. Ordinarily, no transfer RNA (tRNA) molecule can recognize a nonsense codon; therefore, protein synthesis terminates when the ribosome reaches such a codon. A nonsense suppressor mutation usually involves the mutation of a tRNA gene, so that the anticodon of the tRNA is altered to a sequence that is complementary to a nonsense codon. The altered tRNA can then bind to the nonsense codon and inse an amino acid at that point in the protein sequence. Thus, protein synthesis is allowed to continue, and the nonsense mutation is suppressed. A silent mutation is one that causes no change in the amino acid sequence of a protein. A missense mutation causes a single amino acid change. A frameshift mutation is the result of an inseion or deletion that alters the reading frame of the ribosome, leading to the production of a garbled amino acid sequence. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 537 -### End" -1040,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stratum germinativum is synonymous to, with the following options: A: Stratum Basale, B: Stratum Spinosum, C: Stratum granulosum, D: Stratum corneum - -### Response: -Stratum basale: - -Also called stratum germinativum. -Made of single layer of columnar epithelium. -Contains keratinocytes and melanocytes. -### End" -1041,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 34 years old female after thyroidectomy was under observation in post operations ward after shows she developed tense swelling in neck and become breathless. How do you treat this patient?, with the following options: A: Intubate the patient and administer epinephrine, B: Infuse 10% calcium gluconate over 10 min, C: Open the sutures and evacuate the hematoma, D: Turn the patient sideways and give inj.salbutamol subcutaneously - -### Response: -Breathlessness within few hans of thyroidectomy and swelling in the neck suggest of tension hematoma, which is treated by removal of stucture & evacuating the hematoma. -### End" -1042,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following best denotes classical complement pathway activation in immuno inflammatory condition:, with the following options: A: C2, C4 and C3 decreased, B: C2 and C4 normal, C3 is decreased, C: C3 normal and C2, C4 decreased, D: C2, C4, C3 all are elevated - -### Response: -Answer is A (C2, C4 and C3 decreased): The final outcome of both the pathways is formation of membrane attack complex , which causes lysis of cells. -### End" -1043,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 1-month-old infant is brought to the physician by her parents. She has had repeated bouts of bilious vomiting over the past month and cannot be fed adequately She is in the 10th percentile for weight and the 50th percentile for length. An upper GI series discloses marked narrowing of the midportion of the duodenum. What is the most likely cause of this infant's GI obstruction?, with the following options: A: Annular pancreas, B: Duodenal polyp, C: Islet cell adenoma, D: Pancreatic pseudocyst - -### Response: -Annular pancreas is a congenital condition in which the head of the pancreas surrounds the second portion of the duodenum. The anomaly may be associated with duodenal atresia. Infants present with feeding disorders and growth retardation. Pyloric stenosis (choice E) involves the gastric outlet. Duodenal polyp (choice B) does not occur in infants.Diagnosis: Annular pancreas -### End" -1044,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Body cavity which is opened first on post moem examination, with the following options: A: Head, B: Neck, C: Thorax, D: abdomen - -### Response: -Routinely thorax is the first cavity most commonly opened on PM examination. In aspyxial deaths, dissection of the head is recommended prior to body because a bloodless field . In case of poisoning: After the opening of the skull we may immediately smell the presence of volatile, poisonous substances (e.g., ethanol, cyanide, solvents, etc.) without competing odours from thoracic and abdominal cavity -### End" -1045,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urinary D-Xylose test is used for the the study of:, with the following options: A: Proximal small bowel mucosal function, B: Distal small bowel mucosal function, C: Proximal small bowel serosal function, D: Distal small bowel serosal function - -### Response: -The urinary D-xylose test: Used for carbohydrate absorption Assesses proximal small-intestinal mucosal function. Ref: Harrison, E-18, P-2467. -### End" -1046,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most logical sequence?, with the following options: A: Impairment- Disease- Disability- Handicap, B: Disease- Impairment- Disability- Handicap, C: Disease- Impairment- handicap- Disability, D: Disease- Handicap- Impairment- Disability - -### Response: -The sequence of events leading to disability and handicap has been stated as follows: Disease- Impairment- Disability- HandicapAccident DiseaseLoss of foot - ImpairmentCannot walk - DisabilityUnemployed - HandicapPark 23e pg: 44 -### End" -1047,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 36-year-old woman has become increasingly icteric for 1 month. She has had several bouts of colicky, midabdominal pain for 3 years. On physical examination, she has generalized jaundice with scleral icterus. Her BMI is 32. There is tenderness in the right upper quadrant, and the liver span is normal. A liver biopsy is obtained, and microscopic examination shows bile duct proliferation and intracanalicular bile stasis, but no inflammation or hepatocyte necrosis. The level of which of the following is most likely to be increased in the patient's serum?, with the following options: A: Alkaline phosphatase, B: Ammonia, C: Antimitochondrial antibody, D: Hepatitis C antibody - -### Response: -The findings suggest obstructive jaundice from biliary tract disease (e.g., gallstones). Elevation of the serum alkaline phosphatase level is characteristic of cholestasis from biliary obstruction. The alkaline phosphatase comes from the bile duct epithelium and hepatocyte canalicular membrane. The blood ammonia concentration increases with worsening liver failure. When hepatic failure is sufficient to cause hyperammonemia, mental obtundation is seen. In this case, the patient has only jaundice. Primary biliary cirrhosis with an increased antimitochondrial antibody titer is much less common, and PBD eventually leads to bile duct destruction. Most cases of active HCV infection are accompanied by some degree of inflammation with fibrosis. In obstructive biliary tract disease, the direct bilirubin, not the indirect bilirubin, should be elevated. -### End" -1048,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chemoprophylaxis can be done for the following except-, with the following options: A: Meningitis, B: Typhoid, C: Cholera, D: Diphtheria - -### Response: -Chemoprophylaxis implies the protection from or prevention of disease. This may be achieved by causal prophylaxis of a disease or by clinical prophylaxis. 1)causal prophylaxis implies the complete prevention of infection by the early elimination of the invading or migrating causal factor 2)clinical prophylaxis implies the prevention of clinical symptoms Indications for chemoprophylaxis: Cholera,bacterial conjunctivitis,diphtheria,influenza,malaria,meningococcal meningitis,plague Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 137 -### End" -1049,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the following drug binds only with the aniotic site of cholinesterase?, with the following options: A: Physostigmine, B: Neostigmine, C: Edrophonium, D: Pyridostigmine - -### Response: -Ref:KD Tripathi pharmacology 7th edition (page.no: 105) Edrophonium and Tacrine attach only to the anionic site and don't form a covalent bond with the enzyme. so, edrophonium is a very sho-acting drug. While organophosphates attach only to the esteratic site forming a covalent bond. Carbamates (physostigmine, pyridostigmine, neostigmine) carbamylate the esteratic site of the enzyme -### End" -1050,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presented with B/L hilar lymphadenopathy with negative Mantoux test. Diagnosis is: (PGI Dec 2007), with the following options: A: Erythema nodosum, B: Sarcoidosis, C: Hepatitis, D: TB - -### Response: -Ans.: B (Sarcoidosis) Bilateral hilar fymphadenopathy with negative montaux test is the characteristic of sarcoidosis-Erythema nodosum, Hepatitis; uveitits may be the part of sarcoidosis]A positive gallium scan can support the diagnosis if increased activity is noted in the parotids and lacrimal glands (Panda sign) or in the right par a tracheal and left hilar area (lam bda sign)The Kviem-Siltzbach procedure is a specific diagnostic test for sarcoidosisTable : Frequency of Common Organ Involvement and Lifetime Risk Presentation %Follow-up, %cLungQ9594Skin2443Eye1229Extrathoracic lymph node1516Liver1214Spleen78Neurologic516Cardiac23 -### End" -1051,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Miniature end plate potential (MEPP) is:, with the following options: A: Inhibited by anticholinesterases, B: Recorded in resting muscle, C: Responsible for excitation of the muscle, D: Of 5 to 10 mV amplitude - -### Response: -EPP (END PLATE POTENTIAL) -Amplitude is 40 mV =Depolarization reach threshold- AP - contraction -Graded potential, forerunner of Action potential (AP) EPSP (EXCITATORY POSTSYNAPTIC POTENTIAL) -Developed in CNS synapses -Amplitude is 2,3,4 or 5 mV -Multi EPSP will summate to create Action potential MEPP (MINIATURE END PLATE POTENTIAL) -Even in resting conditions, small pockets of Ach released, creating MEPP -Amplitude is 0.5 microvolts -### End" -1052,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rotavirus infection is diagnosed by the presence of -, with the following options: A: Antigen in stool by ELISA, B: Virus in stool, C: Antigen in blood, D: AB - -### Response: -daignisis of rota virus by drminstration if virus instool&antigenic group by ELISA REF:ANATHANARAYANAN MICROBIOLOGY NINTH EDITION PAGE.561 -### End" -1053,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The earliest symptom to occur in corneal ulcer is, with the following options: A: Pain, B: Photophobia, C: Loss of sensation, D: Diminished vision - -### Response: -Ans. Pain -### End" -1054,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following statements concerning chorda tympani nerve are true except that it, with the following options: A: Carries secretomotor fibers to submandibulgar gland, B: Joins lingual nerve in infratemporal fossa, C: Is a brach of facial nerve, D: Contains postganglionic parasympathetic fibers - -### Response: -The chorda tympani is a branch of the facial nerve that originates from the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain. It joins the facial nerve (cranial nerve VII) inside the facial canal, at the level where the facial nerve exits the skull the petrotympanic fissure ref - BDC 6e vol3 pg279 -### End" -1055,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Foraminal brain herniation leads to?, with the following options: A: Ipsilateral pupillary dilatation, B: Locked in state, C: Respiratory arrest, D: Ipsilateral hemiplegia - -### Response: -Foraminal brain herniation leads to compression of the medulla leading to respiratory arrest. Third nerve palsy causing ipsilateral pupillary dilatation and ipsilateral hemiplegia occurs in uncal (midbrain) herniation Locked in state occurs due to a lesion of ventral pons. -### End" -1056,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hea disease is most commonly cause of sudden death in young athletes, with the following options: A: Aoic stenosis, B: Mitral regurgitation, C: Aoic regurgitation, D: HOCM - -### Response: -Ref Harrison 19 th ed pg 1568 Biopsy is not needed to diagnose hyperophic cardiomyopathy but can be used to exclude infiltrative and metabolic diseases. Rigorous athletic training (athlete's hea) may cause intermediate degrees of physiologic hyperophy difficult to differentiate from mild hyperophic cardiomyopathy. Unlike hyper- trophic cardiomyopathy, hyperophy in the athlete's hea regresses with cessation of training, and is accompanied by supernormal exer- cise capacity (VO2max >50 mL/kg/min), mild ventricular dilation, and normal diastolic function. -### End" -1057,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Changes in the respiratory system in pregnancy:, with the following options: A: Vital capacity is increased, B: Subcostal angle remains unchanged, C: Tidal volume remains unaltered, D: Residual volume is decreased - -### Response: -Changes in respiratory system during pregnancy: - -With the enlargement of the uterus, specially in the later months, there is elevation of the diaphragm by 4 cm. -Total lung capacity is reduced by 5% due to this elevation. -Breathing becomes diaphragmatic. Total pulmonary resistance is reduced due to progesterone effect. -The subcostal angle increases from 68° to 103°, the transverse diameter of the chest expands by 2 cm and the chest circumference increases by 5–7 cm. - A state of hyperventilation occurs during pregnancy leading to increase in tidal volume and therefore respiratory minute volume by 40%. -### End" -1058,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which substance will elicit the sensation of sour taste?, with the following options: A: Aldehydes, B: Alkaloids, C: Amino acids, D: Hydrogen ions - -### Response: -The taste sensation of sour is propoional to the logarithm of the hydrogen ion concentration caused by acids. The taste sensation of sweet is caused by a long list of chemicals, including sugars, alcohols, aldehydes, ketones, and amino acids The taste sensation of bitter is caused by many organic substances that contain nitrogen, as well as by alkaloids. -### End" -1059,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common posterior mediastinal tumor is:, with the following options: A: Neurofibroma, B: Thymoma, C: Germ cell Tumors, D: Aortic aneursym - -### Response: -Ans: A (Neruofibroma) Ref: Bobbins Pathologic basis of Disease, 8th ed.Explanation:Mediastinal TumorsAnterior (front) mediastinumGerm cell Tumors - The majority of germ cell neoplasms (60 to 70%) are benign and are found in both males and females.Lymphoma - Malignant tumors that include both Hodgkin's disease and non Hodgkin's lymphoma.Thymoma and thymic cyst - The most common cause of a thymic mass, the majority of thymomas are benign lesions that are contained within a fibrous capsule. However, about 30% of these may be more aggressive and become invasive through the fibrous capsule.Mediastinal Thyroid mass - Usually a benign growth, such as a goiter, these can occasionally be cancerous.Middle mediastinumBronchogenic cyst - A benign growth with respiratory origins.Mediastinal Lymphadenopathy - An enlargement of the lymph nodes.Pericardial cyst - A benign growth that results from an ''out-pouching"" of the pericardium (the heart's lining).Mediastinal Thyroid mass - Usually a benign growth, such as a goiter. These types of tumors can occasionally be cancerous.Tracheal tumors - These include tracheal neoplasms and non-euplastic masses, such as tracheobronchopathia osteochondroplastica (benign tumors).Vascular abnormalities including aortic aneurysm and aortic dissection.Posterior (back) mediastinumExtramedullary haematopoiesis - A rare cause of masses that form from bone marrow expansion and are associated with severe anemia.Mediastinal Lymphadenopathy- An enlargement of the lymph nodes.Mediastinal Neuroenteric cyst- A rare growth, which involves both neural and gastrointestinal elements.Mediastinal Neurogenic neoplasm- The most common cause of posterior mediastinal tumors, these are classified as nerve sheath neoplasms, ganglion cell neoplasms, and paraganglionic cell neoplasms. Approximately 70%. of neurogenic neoplasms are benign.Oesophageal abnormalities including achalasia oesophageal, oesophageal neoplasm and hiatal hernia.Paravertebral abnormalities including infectious, malignant and traumatic abnormalities of the thoracic spine.Mediastinal Thyroid mass- Usually a benign growth, such as a goiter, which can occasionally be cancerous. Vascular abnormalities - Includes aortic aneurysms. -### End" -1060,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Is the most common type of congenital cataract:, with the following options: A: Lamellar cataract, B: Cataracta centralis pulverulenta, C: Coronary cataract, D: Coralliform cataract - -### Response: -Ans. Lamellar cataract -### End" -1061,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vision 2020 ""The right to sight"" includes all except –, with the following options: A: Trachoma, B: Epidemic conjunctivitis, C: Cataract, D: Onchocerciasis - -### Response: -Vision 2020 : The Right to Sight : Global Initiative for Elimination of Avoidable blindness - -After the realization that unless blindness control efforts are intensified, the prevalence of blindness will double by 2020 AD, the WHO along with an International Partnership committee launched the Vision 2020 Initiative in 1995. -Three essential elements of a global plan were set out as follows. - - -Setting up strategies and targets for disease control. -Planning human resource needs and development. -Addressing infrastructure needs and development. - - -Under the global initiative for the elimination of all avoidable blindness by 2020 AD, all countries are commited to a minimum programme. Countries can include other problems than those identified under the minimum programme based on their local situation and needs. -The diseases identified for global elimination include : - - - - -Cataract blindness -Trachoma blindness and transmission -Onchorerciasis -Avoidable causes of childhood blindness -Refractive errors and low vision - - -Targets have been set up for each of the component diseases for the next 20 years. -Above 5 diseases were for global vision 2020. Indian vision 2020 includes following seven diseases. - - -Cataract blindness       -Trachoma blindness and transmission           -Childhood blindness     -Refractive errors and low vision -Glaucoma -Diabetic retinopathy -Corneal blindness -### End" -1062,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraindication to renal biopsy are all EXCEPT, with the following options: A: Bleeding diathesis, B: CRF with normal kidney, C: 60 % damage of kidney texture, D: Uncontrolled hypertension - -### Response: -(CRF with normal kidney) (871-CMDT-05) (796-97-CMDT-09)Indication of renal biopsyContraindication1. Unexplained ARF or CRF2. Acute nephritic syndrome3. Unexplained proteinuria and heamaturia4. Previously identified and treated lesions to plan future therapy5. Systemic disease associated with kidney dysfunction such as SLE, Good pasture's syndrome and Wegener's granulomatosis6. Suspected transplant rejection to differentiate it from other causes of ARF7. To guide treatment1. Solitary or ectopic kidney (exception transplant allograft)2. Horseshoe Kidney3. Uncorrected bleeding disorder4. Severe uncontrolled hypertension5. Renal infection, renal neoplasm6. Hydronephrosis, ESRD7. Congenital anomalies, multiple cysts or uncooperative patients* MRI is nearly 100% sensitive and diagnosis of renal artery* 96-98% specific for the stenosis -### End" -1063,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: End product of purine metabolism is?, with the following options: A: Alanine, B: Uric acid, C: Ammonia, D: Allantoin - -### Response: -ANSWER: (B) Uric addREF: Biochemistry 3rd edition by S C Rastogi page 366,In humans and higher primates, uric acid is the final oxidation (breakdown) product of purine metabolism and is excreted in urine.AUantoin is a natural end product of purine metabolism in most mammals other than humans. -### End" -1064,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following test detects spermine in semen during examination of seminal fluid in a case of sexual assault?, with the following options: A: Barberio test, B: Florence test, C: ELISA, D: Gettler's test - -### Response: -Barberio test detects spermine in semen. A saturated aqueous or alcoholic solution of picric acid when added to spermatic fluid produces yellow needle-shaped rhombic crystals of spermine picrate. The reaction depends on the presence of prostatic secretion. Ref: Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 370. -### End" -1065,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of Trachoma stage Ill, except:, with the following options: A: Herbe's pits, B: Pannus, C: Necrosis in scar, D: Scar on tarsal conjunctiva - -### Response: -Ans. Pannus -### End" -1066,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The complications of shoulder of the following except, with the following options: A: Fetal death, B: Uterine rupture, C: Obstructed labour, D: Shoulder dystocia - -### Response: -In true shoulder dystocia,the presentation is cephalic and the head is born ;but the shoulders cannot be delivered by usual methods and there is no other cause for the dystocia (refer pgno:390 sheila textbook of obstetrics 2 nd edition) -### End" -1067,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Expectant line of management in placenta praevia is contraindicated in:, with the following options: A: Pre term foetus, B: Live foetus, C: Breech presentation, D: Active labour - -### Response: -Active Interference -The indication of active treatment in placenta previa are: - -Bleeding is continuing -Baby is dead or known to be congenitally deformed -Bleeding occurs at or beyond 38 weeks of pregnancy -Patients is in emarginated state on admission -Patient is labour. -### End" -1068,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Source of ammonia in urine -, with the following options: A: Glutaminase, B: Urease, C: Glutamate dehydrogenase, D: Arginase - -### Response: -Ans. is 'a' i.e., Glutaminase o In many tissues like liver, kidney and brain, ammonia combines with glutamate to yield glutamine, by the action of glutamine synthase. The brain is a rich source of glutamine synthase and it predominantly detoxifies ammonia by this route.o Glutamine is a nontoxic major transport form of ammonia. The glutamine is transported by blood to liver where deamination (removal of amino group) of glutamine takes place. Glutaminase cleaves glutamine to yield glutamate and free ammonia (ammonium ion). The ammonia is converted by liver to urea.# Formation and secretion ammonia by renal tubular cells maintain acid base balance. Ammonia is formed from glutamine by glutaminase. Excretion of ammonia increases in metabolic acidosis and decreases in metabolic alkalosis. -### End" -1069,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child with pervasive developmental disorder will have all of the following except:, with the following options: A: Stereotype behaviour, B: Reduced social interaction, C: Poor language skills, D: Impaired cognition - -### Response: -Ans. d. Impaired cognition (Ref. Kaplan 10th/1191-1197; Niraj Ahuja 7/ep163-165)According to DSM-V, intellectual disability should he ruled out prior to a diagnosis of pervasive developmental defects.""The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD) is characterized by delays in the development of multiple basic functions including socialization and communication. ""Pervasive Developmental DisordersThe diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD) are characterized by delays in the development of multiple basic functions including socialization and communication.Pervasive Developmental Disorders arePervasive developmental disorder not otherwise specified (PDD-NOS), (includes atypical autism): Most commonAutismAsperger syndromeRett syndromeChildhood disintegrative disorder (CDD).The first three of these disorders are commonly called the autism spectrum disorders.Onset of PDD occurs during infancy, but the condition is usually not identified until the child is around three years old.Parents may begin to question the health of their child when developmental milestones are not met including age appropriate motor movement & speech production.DSMV: Diagnostic Criteria Autism Spectrum Disorder 299.00 (F84.0)Persistent deficits in social communication and social interaction across multiple contexts, as manifested by:Deficits in social-emotional reciprocityDeficits in nonverbal communicative behaviors used for social interactionDeficits in developing, maintaining, and understanding relationships.Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following:Stereotyped or repetitive motor movements, use of objects, or speechInsistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal-nonverbal behaviorHighly restricted, fixated interests that are abnormal in intensity or focusHyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environmentSymptoms must be present in the early developmental periodSymptoms cause clinically significant impairment in social, occupational, or other important areas of current functioningThese disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.Intellectual disability & autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability', social communication should be below that expected for general developmental level.Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals, who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.Autistic Disorder (Kartner's Autism)It is characterized by qualitative impairment in reciprocal social interaction, delayed and aberrant communication skills & a restricted repertoire of activities and interestsQ.By definition, the onset is before the age of 3 yearsQ.More common in boysQDevelopmental milestones are normalQ.Temporal lobe is believed to be critical area.Clinical FeaturesAutism (marked impairment in reciprocal social and interpersonal interaction)Marked impairment in language and non-verbal communicationAbnormal behavioral characteristicsMental retardation* Absent social smile* Lack of eye-to-eye- contact* Lack of awareness of others existence or feelings; treats people as furniture* Lack of attachment to parents and absence of separation anxiety.* No or abnormal social play; prefers solitary games.* Marked impairment in making friends* Lack of imitative behavior* Absence of fear in presence of danger* Lack of verbal or facial response to sounds or voices; might be thought as deaf initially.* In infancy, absence of communicative sounds like babbling.* Absent or delayed speech* Abnormal speech patterns and content. Presence of echolalia, perseveration, poor articulation and pronominal reversal is common.* Remote memory is usually good.* Abstract thinking is impaired.* Mannerisms* Stereotyped behaviour such as head-banging, bodyspinning, lining-up objects, rocking, clapping, twirling, etc.* Ritualistic & compulsive behaviour.* Resistance to even the slightest change in the environment.* Attachment may develop to inanimate objects.* Hyperkinesis is commonly associated.* Only about 25% of all children with autism have an IQ >70.* >50% of these children have moderate to profound mental retardation.* There appears to be a correlation between severity of mental retardation, absence of speech & epilepsy- in autism. Treatment of AutismBehaviour TheoryPsychotherapyPharmacotherapy* Development of a regular routine with as few changes as possible.* Structured classroom training, aiming at learning new material & maintenance of acquired learning.* Positive reinforcements to teach self- care skills.* Speech therapy and/or sign language teaching.* Behavioral techniques to encourage interpersonal interactions.* Parental counseling &* supportive psychotherapy can be very useful in allaying parental anxiety and guilt, and helping their active involvement in therapy.* However, overstimulation of child should be avoided during treatment.* Halo peridot decreases dopamine levels in brain, decreases hyperactivity & behavioral symptoms.* Risperidone, for treatment of autism in children aged 5 and above.* Anticonvulsants are used for the treatment of generalized or other seizures -### End" -1070,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pneumatosis intestinalis is diagnostic of, with the following options: A: Ileal perforation, B: Necrotizing enterocolitis, C: Meconium ileus, D: Colonic aganglionosis - -### Response: -.Necrotising enterocolitis is an acquired inflammatory disease commonly seen in infants and newborn but occasionally can occur in children and adults. It ismore commonly seen in premature babies. It is more common in formula fed babies than breast bed babies. Reduced gut flora make virulent pathogens to act and cause sepsis. * Common site is terminal ileum, caecum and ascending colon. Often it can involve entire small bowel. * Gas in the bowel wall and often in poal vein is typical. ref:SRB&;s manual of surgery ,ed 3,pg no 810 -### End" -1071,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old female complains of a mole on her upper back. The lesion is 6 mm in diameter, darkly pigmented, and asymmetric, with a very irregular border. The next step in management is:, with the following options: A: Tell the patient to avoid sunlight, B: Follow the lesion for any evidence of growth, C: Obtain metastatic workup, D: Obtain full-thickness excisional biopsy - -### Response: -Ans. D. Obtain full-thickness excisional biopsya. The lesion has characteristics of melanoma (pigmentation, asymmetry, irregular border), and a full-thickness excisional biopsy is required. Shave biopsy of a suspected melanoma is always contraindicated.b. Diagnosis is urgent; the lesion cannot be observed over time. Once the diagnosis of melanoma is made, the tumor must then be staged to determine prognosis and treatment. -### End" -1072,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corynebacterium diphtheriae can be grown within 6-8 hour on, with the following options: A: Potassiu, tellurite media with iron, B: McConkey's agar, C: Dorset egg medium, D: Loeffler's serum slope - -### Response: -The usual media employed for the cultivation of diphtheria bacilli are Loeffler's serum slope and Tellurite blood agar. Loeffler's serum slope: Diphtheria bacilli grow on Loeffler's serum slope very rapidly and colonies can be seen in 6-8 hours, long before other bacteria grow. Colonies are first small, circular white opaque discs but enlarge on continued incubation and may acquire a distinctly yellow tint. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 242 -### End" -1073,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CD16 and CD56 are markers of, with the following options: A: NK cells, B: B Lymphocytes, C: Helper T lymphocyte, D: Cytotoxic T lymphocyte - -### Response: -The function of NK cells is to destroy irreversibly stressed and abnormal cells, such as virus-infected cells and tumor cells. NK cells make up approximately 5% to 10% of peripheral blood lymphocytes. They do not express TCRs or Ig. NK cells are endowed with the ability to kill a variety of virus-infected cells and tumor cells, without prior exposure to or activation by these microbes or tumors. This ability makes NK cells an early line of defense against viral infections and, some tumors. Two cell surface molecules, CD16 and CD56, are commonly used to identify NK cells. CD16 is an Fc receptor for IgG, and it confers on NK cells the ability to lyse IgG-coated target cells. This phenomenon is known as antibody-dependent cell-mediated cytotoxicity (ADCC). The function of CD56 isnot known.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 6; Diseases of the Immune System; Page no: 192 -### End" -1074,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following condition has autosomal dominant inheritance?, with the following options: A: Best disease, B: Gyrate atrophy, C: Laurence Moon Biedl syndrome, D: Bassen-Kornzweig disease - -### Response: -Best disease (Juvenile-Onset Vitelliform Dystrophy) is an autosomal dominant disorder. Onset is usually in childhood. The fundoscopic appearance is variable and ranges from a mild pigmentary disturbance within the fovea to the typical vitelliform or ""egg yoke"" lesion located in the central macula. Visual acuity often remains good. An abnormal electro-oculogram (EOG) is the hallmark of the disease. Gyrate atrophy is an autosomal recessive disorder due to reduced activity of ornithine aminotransferase (OAT). Laurence Moon Biedl syndrome is inherited as autosomal recessive disorder. Bassen-Kornzweig disease is a rare autosomal recessive childhood disorder with the inherited metabolic disorders of the nervous system and commented upon with neuroacanthocytosis. Ref: Fletcher E.C., Chong N, Augsburger J.J., Correa Z.M. (2011). Chapter 10. Retina. In Riordan-Eva P, Cunningham E.T., Jr (Eds), Vaughan & Asbury's General Ophthalmology, 18e -### End" -1075,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ion exchange chromatography is based on -, with the following options: A: Size, B: Charge, C: Solubility, D: Polarity - -### Response: -Ans. is 'b' i.e.. Charge Property of protein usedMethodProtein solubility'Salting out' or salt extraction (precipitation of protein by ammonium sulfate)Molecular sizeo Gel filtration chromatography (molecular-sieve chromatography or size exclusion chromatography)o Ultracentrifugationo SDS-PAGE (Sodium dodecvl sulphate-polyacry lamide gel electrophoresis)o DialysisMolecular charge (Ionic charge)o Ion exchange chromatographyo High performance liquid chromatography (HPLC)o Electrophoresis (simple on cellulose acetate starch gel)o Isoelectric focusing (a variant of electrophoresis)Molecular charge and molecular w eightPAGE : polyacrylamide gel electrophoresisAffinity bindingAffinity chromatographyHvdnophobidty'Hydrophobic interaction chromatography -### End" -1076,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The differential diagnosis of the lesion, histologically resembling giant cell tumour in the small bones of the hands or feet, includes all of the following except, with the following options: A: Aneurysmal bone cyst, B: Fibrosarcoma, C: Osteosarcoma, D: Hyperparathyroidism - -### Response: -The histological differential diagnosis for GCT include all giant cell-containing lesions. -### End" -1077,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient is receiving linezolid therapy for 14 days, which of the following should be monitored-, with the following options: A: Renal function tests, B: Liner enzymes, C: Platelet monitoring, D: Monitoring of reflex - -### Response: -Ans. is 'c' i.e., Platelet monitoring o The major side effects oflinezolid are thrombocytopenia and neutropenia .Platelet and neutrophil count should be monitored. -### End" -1078,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ahlback Grade2 changes of Osteoarthritis of the knee means:, with the following options: A: Joint space obliterated or almost obliterated, B: Minor bone attrition (<5 mm), C: Moderate bone attrition (5-15 mm), D: Severe bone attrition (>15 mm) - -### Response: -Ans. A. Joint space obliterated or almost obliteratedAhlback Radiographic Grading Scale of Osteoarthritis of the Tibiofemoral Joint:Grade of OsteoarthritisDescription0 =No radiographic findings of osteoarthritis1 =Joint space narrowing <3mm2 =Joint space obliterated or almost obliterated3 =Minor bone attrition (<5mm)4 =Moderate bone attrition (5-15mm)5 =Severe bone attrition (>15mm) -### End" -1079,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In an incised wound, all of the following are true, except: COMEDK 07; NEET 14, 15, with the following options: A: It has clean-cut margins, B: Bleeding is generally less than in lacerations, C: Tailing is often present, D: Length of injury does not correspond with length of blade - -### Response: -Ans. Bleeding is generally less than in lacerations -### End" -1080,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common mode of inheritance for retinitis pigmentosa is:, with the following options: A: Autosomal recessive, B: Autosomal dominant, C: Sex linked, D: None of the above - -### Response: -Ans. Autosomal recessive -### End" -1081,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to Spetzler Martin Grading System for AV malformations, the score of a AV malformation of size 3-6 mm with deep venous drainage and location near internal capsule is, with the following options: A: 2, B: 3, C: 4, D: 5 - -### Response: -Ans. (d) 5Ref: Sabiston 20th Edition Page 1904* Spetzler - Martin Grading System is used for AVM grading in Brain.* This grading helps in management also.* Grade varies from 1-5 based on the following points: Size, Location and Deep venous drainage.* Lower score has good outcome.* Grade 1 AVM would be considered as small, superficial, and located in non-eloquent brain, and low risk for surgery.* Grade 4 or 5 AVM are large, deep, and adjacent to eloquent brain.Spetzler - Martin Grading System: for AVM brain Characteristic of lesionNumber of pointsSizeSmall (diameter <3cm)1 Medium (diameter 3-6cm)2 Large (diameter >6cm)3EloquenceNo eloquent siteEloquent site (sensorimoter, language, or thalamus; internal capsule; brain stem; cerebellar peduncles, or cerebellar nuclei)01Pattern of venous drainageSuperficial only0Any deep1 -### End" -1082,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following muscle in lid is a ached to upper margin of superior tarsus?, with the following options: A: Superior rectus, B: Muller's muscle, C: Levator palpebrae, D: Superior oblique - -### Response: -. -### End" -1083,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Erythematous lesions with Collarets of scales on trunk, with the following options: A: Pityriasis rubra, B: Pityriasis rosea, C: Pityriasis versicolor, D: Pityriasis alba - -### Response: -. -### End" -1084,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Light entering the eye passes through which retinal layer first?, with the following options: A: Inner nuclear layer, B: Outer nuclear layer, C: Outer plexiform layer, D: Retinal ganglion layer - -### Response: -The most anterior layer of the retina, through which light passes first, is the retinal ganglion layer. Light then passes through the other cell layers of the retina until it reaches the photoreceptors in the posterior region of the retina. Visual processing/Phototransduction occurs in the opposite direction(Photoreceptors- ganglion cell layer) -### End" -1085,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sympathetic root of otic ganglion, with the following options: A: Plexus around ICA, B: Plexus around facial aery, C: Plexus around ophthalmic aery, D: Plexus around middle meningeal aery - -### Response: -ROOTS OF OTIC GANGLION: Sensory root is by auriculotemporal nerve Sympathetic root is by sympathetic plexus around middle meningeal aery Secretomotor root is by lesser petrosal nerve from tympanic plexus formed by tympanic branch of cranial nerve IX Motor root is by a branch from nerve to medial pterygoid Ref BDC volume 3,sixth edition pg 311 -### End" -1086,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Father of modern psychiatry is ?, with the following options: A: Bleuler, B: Freud, C: Pinel, D: Kraepel in - -### Response: -Ans. is 'c' i.e., Pinel Father of psychoanalysis - Sigmund freud Father of modern psychiatry - Phileppel pinel -### End" -1087,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spermatozoa gets its nutrition from, with the following options: A: Glucose, B: Fructose, C: Galactose, D: Starch - -### Response: -Ans: B. Fructose(Ref KS Sanoop 3'd/e p.171)Nutrition to sperms is mainly provided by fructose.Fructose (f .5-6.5 mg/ml). -### End" -1088,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The regimens of Mg So4 for the management of severe preclampsia and eclampsia is known as, with the following options: A: Menon regime, B: Pritchard regime, C: Lean regime, D: Pinard's regime - -### Response: -(Pritchard regime) (236-D)* Magnesium sulphate is the drug of choice in preeclampsia and eclampsia, Pritchard and Zuspan or Sibai regime are used* Lvtic cocktail regime (Menon 1961) using chloropromazine, phenergan and pethidine (CPP)* Diazepam therapy (Lean)* Pinard's maneuver - frank breech extraction -### End" -1089,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The reagent used in Apt test is, with the following options: A: Sodium bicarbonate, B: KCL, C: Sodium hydroxide, D: Sodium chloride - -### Response: -Alkali denaturation test (Apt-Downey test / apt test)Used to detect differentiate Fetal or neonatal blood from maternal blood (Qualitative).PrincipleMethodFetal hemoglobin (alpha 2 gamma 2 subunits) is resistant to alkali (basic) denaturation, whereas adult hemoglobin (alpha2 beta 2 subunits) is susceptible to such denaturation.Exposing the blood specimen to sodium hydroxide (NaOH) will denature the adult but NOT the fetal hemoglobin.The fetal hemoglobin will appear as a pinkish color under the microscope while the adult hemoglobin will appear as a yellow-brownish colorThe blood is mixed with sterile water to cause hemolysis of the RBCs, yielding free hemoglobin,The 5 ml pink hemoglobin-containing supernatant is then mixed with 1 mL of 1% NaOH.Fetal hemoglobin will stay pink and adult hemoglobin will turn yellow-brown.Adult hemoglobin changes color because it is less stable and will conve to hematin.Clinical UsesVaginal bleeding in late pregnancy is tested to rule vasa pre.Neonatal bloody vomitus or bloody stool to rule out swallowed maternal blood.To detect the presence of fetal blood in the maternal circulation in cases of suspected fetal-maternal hemorrhage.Positive test indicates that blood is of fetal origin.Negative test indicates that the blood is of maternal origin. -### End" -1090,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a neuroparasite?, with the following options: A: Acantamoeba, B: Naegleria fowleri, C: Taenia solium, D: Trichinella spiralis - -### Response: -Trichinella spiralis is not a neuro parasite, it is seen in striated muscles. It causes trichinosis. Pigs are the most impoant reservoirs of human disease. Humans are infected by eating raw or undercooked meat containing larvae encysted in the muscle. The larvae excyst and mature into adults within the mucosa of the small intestine. Eggs hatch within the adult females, and larvae are released and distributed the bloodstream to many organs; however, they develop only in striated muscle cells. Within the muscle cells they can remain ble for several years but eventually calcify. Ref: Review of Medical Microbiology and Immunology By Warren Levinson, 11th Edition, Chapter 56; Self Assessment and Review Microbiology Immunology Revision at a Glance By Chaurasia, 4th Edition, 2009, Page 407 -### End" -1091,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The specific name of the anomaly shown in the following radiograph is:, with the following options: A: Dens in dente, B: Dilated odontome, C: Dens invaginatus, D: Ghost tooth - -### Response: -Dens in Dente  -(Dens invaginatus, dilated composite odontome) -The  ‘dens in dente’  is a  developmental variation which is thought to arise as a result of an invagination in the surface of tooth crown before calcification has occurred. Several causes of this condition have been proposed. These include increased localized external pressure, focal growth retardation, and focal growth stimulation in certain areas of the tooth bud. The permanent maxillary lateral incisors are the teeth most frequently involved,  and in the majority of cases the  ‘dens in dente’ appears to represent simply an accentuation in the development of the lingual pit. -Radiological signs -Dens in dente represent a tooth-shaped, enamel-covered mass within the crown and/or root of the tooth but which may traverse the length of the tooth. Dilated odontome represents the most extreme form of this anomaly and exhibits a grossly altered morphology that is internally outlined by a dense linear radiopacity. In both cases, the apical region may or may not display an open apex and there may be associated adjacent apical rarefaction. -### End" -1092,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient put on ventilator shows a reading of ABG analysis as | PaCO2, Normal PaO2 and pH 7.5, what is the likely diagnosis?, with the following options: A: Respiratory acidosis, B: Metabolic alkalosis, C: Metabolic acidosis, D: Respiratory alkalosis - -### Response: -The ABG analysis reading in this patient clearly ours for respiratory alkalosis. In respiratory alkalosis: ? |PaCO2 ? | HCO3/PaCO2 ratio ? |pH ? the plasma K is often reduced and Cl increased Respiratory alkalosis is commonly seen in anesthetized or mechanically ventilated patient. Ref: Harrison's Internal Medicine, 18th Edition, Pages 363-372 -### End" -1093,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spermin is detected in semen by which test -, with the following options: A: Barberio test, B: Florence, C: ELISA, D: Agglutination inhibition - -### Response: -Barberio's test → Yellow coloured crystals of spermin picrate. -Florence test → 4 Brown crystals of choline periodide. -### End" -1094,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Continuous fixed traction is provided by:, with the following options: A: Thomas splint, B: BB splint, C: Hamilton Russel, D: Gallows - -### Response: -Thomas splint is commonly used for the immobilization of hip and thigh injuries. The modified Thomas splint adapted the original Thomas splint to include a traction screw and foot plate and limb suppo built into the splint body. -### End" -1095,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old paddy farmer presented to the ER in shock. Attendants claim that he had sudden onset of fever with difficulty in breathing about 2 days ago and subsequently also developed haemoptysis. Sputum sample was collected, and Wayson staining was done. The organism isolated was indole, MR and VP positive and fermented glucose, mannitol and maltose. It also did not hydrolyse urea. Stalactite growth was seen in the ghee broth. What is the drug of choice of the above condition and which vector transmits the above What is the drug of choice of the above condition and which vector transmits the above disease: - 1. 2. 3. 4., with the following options: A: VECTOR = 1 / DRUG OF CHOICE = Streptomycin, B: VECTOR = 3 / DRUG OF CHOICE = Ampicillin, C: VECTOR = 2 / DRUG OF CHOICE = Gentamycin, D: VECTOR = 3 / DRUG OF CHOICE = Streptomycin - -### Response: -This is a case of pneumonic plague caused due to yersinia pestis which is transmitted by (vector 3 in the images shown above) rat flea (Xenopsylla cheopis) and its drug of choice is streptomycin. Sho incubation period, from a few hours to 2-3 days Acute onset of the symptoms Progression from segmental pneumonitis to lobar pneumonia to B/L lung involvement. X-ray chest shows B/L alveolar infiltrates Diffuse interstitial pneumonitis MICROBIOLOGY Yersinia pestis Gram-negative coccobacilli. Bipolar staining Pleomorphic on Wayson/ Wright-Giemsa staining Small, delicate, transparent colonies on nutrient agar Colourless colonies on MacConkey agar. Stalactite growth is seen in ghee broth. Biochemicals: - Indole+, catalase+, VP+, MR+, esculin+ -### End" -1096,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Open book and bucket handle injuries are seen in :, with the following options: A: Spine, B: Pelvis, C: Femur, D: Knee - -### Response: -(A) Bucket handle fracture: A type of pelvis fracture due to side-to-side compression of pelvis where there is fracture of pubic rami anteriorly and sacroiliac joint or ilium posteriorly but on the opposite side. (B)Open book fracture: A pelvic fracture due to anteroposterior compression of pelvis where the pubic symphysis is disrupted and pelvis opens up like a book. -### End" -1097,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of fungal orbital cellulitis in diabetes, with the following options: A: Aspergillus, B: Fusarium, C: Mucormycosis, D: Candida - -### Response: -Ans. (c) MucormycosisRef: Kanski 7/e, p. 91, Parson's 22/e, p. 242Mucormycosis often affects patients with diabetic ketoacidosis or immunosuppression. -### End" -1098,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hormone does not act through c-AMP:, with the following options: A: FSH, B: Progesterone, C: Estrogens, D: GH - -### Response: -GH -### End" -1099,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45-year-old woman undergoes an uneventful laparoscopic cholecystectomy for which she receives 1 dose of cephalosporin. One week later, she returns to the emergency room with fever, nausea, and copious diarrhea and is suspected of having pseudomembranous colitis. She is afebrile and has no peritoneal signs on abdominal examination. She has a mild leukocytosis with a left shift. Which of the following is the appropriate initial management strategy?, with the following options: A: Administration of an antidiarrheal agent, B: Exploratory laparotomy with left hemi-colectomy and colostomy, C: Exploratory laparotomy with subtotal abdominal colectomy and ileostomy, D: Administration of oral metronidazole - -### Response: -Treatment of C difficile colitis is metronidazole for firstline therapy and oral vancomycin as a second-tier agent. Recurrence appears in up to 20% of patients. Indications for surgical treatment are intractable disease, failure of medical therapy, toxic megacolon, and colonic perforation; surgical therapy consists of subtotal colectomy with end ileostomy. The diagnosis can be made by either detection of the characteristic appearance of pseudomembranes on endoscopy or detection of either toxin A or toxin B in the stool. Anti-diarrheal agents are contraindicated in suspected C difficile colitis as they may prolong the infection. -### End" -1100,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following peptides are not produced by the renal system?, with the following options: A: Renin, B: Angiotensin I, C: Erythropoietin, D: 1,25DHCC - -### Response: -The hormones produced in the kidneys are 1,25 Dihyrocholecalciferol, Renin and Erythropoetin. Angiotensin is an oligopeptide and is a hormone and a powerful dipsogen. It is derived from the precursor molecule angiotensinogen, a serum globulin produced in the liver. It plays an impoant role in the renin-angiotensin system. Ref: The Local Cardiac Renin-Angiotensin Aldosterone System By Edward D. Frohlich, Richard N. ; Ganong's Review of Medical Physiology, 22nd Edition, Pages 455, 459 -### End" -1101,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior belly of digastric develops from:, with the following options: A: 1st arch, B: 2nd arch, C: 3rd arch, D: 4th arch - -### Response: -Ans: B (2nd arch) Ref. BDC, 4 ed, Vol. III p. 289Anterior belly of digastric is derived from the 1sl arch, while the posterior belly develops from the 2nd arch.ARCHNERVEMUSCLESSTRUCTURESFROM CARTILAGE1stMandibularMedial pterygoidLateral PterygoidMasseterTemporalisMylohyoidAnt. Belly of DigastricTensor tympaniTensor palate Merckel's cartilage||MalleusIncus2ndFacialMuscles of facialexpressionPlatysmaStylohyoidOccipitofrontalisPosterior belly of DigastricStapediusReichert's cartilage||StapesStyloid processStylohyoid ligamentSmaller horn of HyoidSup. part of body of Hyoid3rdGlossopharyngealStylopharyngeusGreater cornu of hyoidLower part of body of hyoid4thSuperior laryngeal nerveMuscles of pharynx and larynxCartilages of larynx6thRecurrent laryngeal nerveMuscles of pharynx and larynx -### End" -1102,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hanup disease is mainly due to:, with the following options: A: Niacin deficiency, B: Defective transpo of tryptophan, C: Defective serotonin biosynthesis, D: Thiamine deficiency - -### Response: -Hanup's disease is an autosomal recessive disorder, in which there is: * Defect in neutral amino acid transpoer (tryptophan) * Failure to absorb tryptophan from intestine and also reabsorb it from kidneys =Clinical feature: Aminoaciduria i.e. tryptophan in urine Pellagra (niacin deficiency ) like symptoms (neurological and dermatologic), despite an adequate intake of both tryptophan and niacin. NORMAL AND ABNORMAL ROUTES OF TRYPTOPHAN METABOLISM -### End" -1103,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heat labile instruments for use in surgical procedure can be best sterlized by :, with the following options: A: Absolute alcohol, B: Ultra violet rays, C: Chlorine releasing compounds, D: Ethylene oxide gas - -### Response: -“Heat sensitive articles may be sterilized at 55-60 0 C by ethylene oxide which kills bacteria, spores, viruses.” - -It is highly penetrating and highly explosive. -CO2 or N2 decrease its explosive tendency and water vapour increase its efficacy. -It acts as alkylating agent. -It is specially used for sterlizing heart - lung machines, sutures, dental equipment, books, fabrics, plastic equipment, cardiac catheters, clothing, glass, plastics, metal and paper surfaces. -It is unsuitable for fumigating room since it is explosive. -### End" -1104,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following instrument is NOT used in intracapsular extraction of lens, with the following options: A: Cryo, B: Elschning's forceps, C: Phaco-emulsifire, D: Van-graefe's cataract knife - -### Response: -C i.e. Phaco-emulsifier Phacoemulsifier which emulsifies lens nucleus & coical matter by ultrasonic vibration (1 mm titanium needle vibrating 40,000 times/second) is used in phacoemulsification method of ECCE not in ICCE. -### End" -1105,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute emphysematous cholecystitis is caused by, with the following options: A: Pseudomonas aeruginosa, B: Staphylococcus, C: Clostridium perfringens, D: Streptococcus pyogenes - -### Response: -Emphysematous cholecystitis It is thought to begin with acute cholecystitis (calculous or acalculous), followed by ischaemia or gangrene of GB wall and infection by gas producing organisms. Causative organisms of Emphysematous Cholecystitis Anaerobes : Clostridium welchi or Cl. Perfringens Aerobes : E.coli Ref: Sabiston 20th edition Pgno : 1493 -### End" -1106,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A plant prick can produce sporotrichosis. All are true statements about sporotrichosis except, with the following options: A: Is a chronic mycotic disease that typically involves skin, subcutaneous tissue and regional lymphatics, B: Most cases are acquired cutaneous inoculation, C: Enlarged lymph nodes extending centripetally as a beaded chain are a characteristic finding, D: It is an occupational disease of butchers and doctors - -### Response: -Sporotrichosis is a chronic infection involving cutaneous, subcutaneous and lymphatic tissue. It is frequently encountered in Gardners, forest workers and manual labourers. It may develop in otherwise healthy individuals also. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition -### End" -1107,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following poisonings Mc Ewan Sign is seen?, with the following options: A: Acute alcohol intoxication, B: Carbon Monoxide poisoning, C: Barbiturate poisoning, D: Carbolic acid poisoning - -### Response: -In acute alcohol intoxication when patient goes to the stage of coma, the pupils are contracted but stimulation of the patient cause them to dilate with slow return. This is known as Mc Ewan Sign. Carbolic acid poisoning: Odour of breath, white patches on lips and mouth and carboluria. Carbon Monoxide poisoning: History of exposure to poisoning with gas, intermittent convulsions, cherry red colour of skin and carboxyhemoglobin in blood. Barbiturate poisoning: Shallow respiration, deep coma, no response to painful stimuli, deep reflexes are depressed, subnormal temperature, low blood pressure, dilated pupils. Ref: The Essentials of Forensic Medicine and Toxicology 29th Ed Page 511. -### End" -1108,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lid retraction is caused by ?, with the following options: A: Bimatoprost, B: Latanoprost, C: Brimonidine, D: Apraclonidine - -### Response: -Points to remember - Apraclonidine - -Sympathomimetic drug -Indication - Open-angle Glaucoma -Mechanism of action - Decrease aqueous secretion -Adverse effect - Upper lid retraction, eye allergy. -### End" -1109,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has hyperphosphatemia with sho metacarpals and associated cataract The diagnosis is-, with the following options: A: Pseudohypoparathyroidism, B: Hypophosphatasia, C: Hyperparathyroidism, D: Osteomalacia - -### Response: -the defects in metacarpal and metatarsal bones are sometimes accompanied by sho phalanges as well, and also associated cataract( Harrison 17 pg 2394) -### End" -1110,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For every 1,00,000 population, the highest prevalence of blindness in theworld is seen in -, with the following options: A: Sub-Saharan Africa, B: South Asia, C: Eastern Europe, D: Latin America - -### Response: -About 90% of the world&;s blinds live in developing countries and around 60% of the residing sub Saharan Africa , China and India. Ref- Park&;s textbook of Preventive and social medicine 24th edition. . -### End" -1111,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gutter fractures of the skull are most often seen with, with the following options: A: Axe injury, B: Stick injury, C: Stone injury, D: Bullet injury - -### Response: -Gutter fracture: seen in oblique bullet wounds a pa of the thickness of the skull bone is removed so as to form a gutter/ channel/ trench. usually accompanied by comminuted depressed fracture of the inner table of skulland the fragments causing injury to the meninges and brain -### End" -1112,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bih rate is, with the following options: A: Live bih X 1000\/ mid yr. Population, B: Bih X 1000\/ mid yr population, C: Live bih X 10000\/ mid yr. Population, D: Live bih X 10000\/Population of reproductive age group (15-45) - -### Response: -Bih rate = number of live bihs during the year X 1000/ estimated mid year population. Unsatisfactory measure of feility because the total population is not exposed to child bearing. Reference : Park&;s textbook of preventive and social medicine, 23rd edition, pg no: 488 -### End" -1113,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The major source of ammonia in kidney, with the following options: A: Glutamate, B: Glutamine, C: a-ketoglutarate, D: Alanine - -### Response: -Glutamic acid acts as a link between amino acids and ammonia.Ammonia, which is highly toxic, arises in humans primarily from the a-amino nitrogen of amino acids. Tissues, therefore, conve ammonia to the amide nitrogen of the nontoxic amino acid glutamine. Subsequently, in kidney cells, ammonia generated on purpose from glutamine with the help of Glutaminase.Ref: Harper&;s biochemistry; 30th edition; Chapter 28 Catabolism of Proteins & of Amino Acid Nitrogen -### End" -1114,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about alcoholic anonymous is, with the following options: A: It is a self help group, B: It follows 12 steps to quit alcohol, C: It includes recovered patients & volunteer, D: It provides incentives for quitting alcohol - -### Response: -Alcohol anonymous is a self help group and it doesn't provide any incentives for quitting alcohol. -### End" -1115,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Calculai 0112 tali population accordir 2012.f neonatal deaths- 450, number of stillbihs=2 number of live bihs-12,450., with the following options: A: 36, B: 15, C: 90, D: 56 - -### Response: -Ans. a. 36 -### End" -1116,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is seen on electron microscopy of medullary thyroid carcinoma specimens?, with the following options: A: Presence of electron-dense granules in the nucleus, B: Presence of electron-dense granules in the mitochondria, C: Presence of electron-dense granules in the endoplasmic reticulum, D: Presence of electron-dense granules in the cytoplasm - -### Response: -Medullary carcinoma on electron microscopy reveals variable numbers of membrane-bound electron-dense granules within cytoplasm of neoplastic cells. -### End" -1117,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Presenile dementia is defined as that which occur below the age of ....... years :, with the following options: A: 50, B: 55, C: 60, D: 65 - -### Response: -C i.e. 60 -### End" -1118,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The fatal period of Aconite is usually :, with the following options: A: 5-10 minutes, B: 15-30 minutes, C: 1-5 hours, D: 12-48 hours - -### Response: -C i.e. 1 - 5 hours Aconite causes hypotension (not hypeension)Q, cardiac arrhythmias (initial tachycardia f/b bradycardia) and AV block. And the fatal period is 2-6 hours Q. -### End" -1119,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of hypothyroidism which investigation is most informative and most commonly used:, with the following options: A: Serum TSH level, B: Serum T3 and T4 level, C: Serum calcitonin assay, D: Serum TRH assay - -### Response: -TSH* Most informative among thyroid function test parameters because of ultra-sensitivity* Can detect subclinical hypothyroidism & subclinical hypehyroidism* Hypothyroidism - TSH |* Hypehyroidism - TSH | -### End" -1120,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a heterophile reaction?, with the following options: A: Weil Felix test, B: Paul Bunnell test, C: Frie's test, D: Cold agglutinin test - -### Response: -HETEROPHILE REACTION :- Similar antigens on dissimilar organisms are called heterophile antigens Closely related antigens can occur on a wide variety of organisms. Antibodies reacting with such antigens are called heterophile antibodies. Serologic tests employing such antigens are called heterophile tests. Frie's test is used in the diagnosis of LGV. Antigen made from sterile pus aspirated from previously unruptured LGV abscesses, produces a reaction in patients with lymphogranuloma inguinale when injected intradermally. -### End" -1121,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bag of worm feel is seen in:, with the following options: A: Hernia, B: Varicocele, C: Hydrocele, D: Orchitis - -### Response: -Ans: b (Varicocele) Ref: Bailey, 24th ed, p. 1407Bag of worm feel on palpation is characteristically seen in varicocele.Varicocele* Condition in which veins of the pampiniform plexus becomes dilated and tortuous.* Usually left side is affected.* Impulse on coughing is more like a thrill.* On palpation it feels like a 'bag of worms'.* Rapid onset varicocele suggests a carcinoma of kidney.( Renal vein is often involved earlier by penneation and thus compress left spermatic vein which drain into left renal vein and on right side I.V.C is affected into which drains right spermatic vein)* Oligospermia -->>it interferes with the normal temperature control of scrotum and affects spermatogenesis (evidence for this is contradictory)Why left side common?* Left spermatic vein is longer than right.* Left spermatic vein enters the left renal vein at a right angle.* At times left testicular artery arches over left renal vein and compresses it.* Left colon when loaded may press on the left testicular vein.TreatmentTreatment of choice - Embolisation of the testicular vein under radiographic control.Varicocele is a common condition that tends to recur after surgical treatment. -### End" -1122,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In fetal circulation, pulmonary vascular resistance is more than systemic vascular resistance. At which stage, it becomes normal to adult level?, with the following options: A: 4-10 weeks, B: 3-7 weeks, C: 10-14 weeks, D: 20-22 weeks - -### Response: -By 2 months of age, pulmonary resistance may approximate adult levels. -“Immediately after birth, the lungs expand with air, dropping the pulmonary vascular resistance; and as the placenta is disconnected from the systemic circuit, the systemic resistance nearly doubles. The pulmonary arterioles continue to change gradually. The media becomes thinner and the lumen becomes wider. Thus, the pulmonary vascular resistance falls, almost reaching adult levels by the time the child is close to 8 weeks of age.” -### End" -1123,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about intrinsic allergic Asthma are true, except, with the following options: A: Nasal polyp, B: Normal IgE levels, C: Family history positive, D: More aggressive - -### Response: -These patients, with nonatopic or intrinsic asthma, usually show later onset of disease (adult-onset asthma), commonly have concomitant nasal polyps, and maybe aspirin-sensitive. They usually have more severe, persistent asthma. A minority of asthmatic patients (approximately 10%) have negative skin tests to common inhalant allergens and normal serum concentrations of IgE. The immunopathology in bronchial biopsies and sputum appears to be identical to that found in atopic asthma.Ref: Harrison's 18/e p2102, 17/e p1596 -### End" -1124,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which type of chromatography, the proteins are bound to another substance:, with the following options: A: Hydrophobic chromatography, B: Affinity chromatography, C: Paper chromatography, D: Gel chromatography - -### Response: -B i.e. Affinity chromatography -### End" -1125,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Modafinil is used for, with the following options: A: Narcolepsy, B: Psychogenic erectile dysfunction, C: OCD, D: Orthostatic hypotension - -### Response: -(A) Narcolepsy # MODAFINIL# Narcolepsy Narcolepsy is both a disorder of the ability to sustain wakefulness voluntarily and a disorder of REM sleep regulation The classic ""narcolepsy tetrad"" consists of excessive daytime somnolence plus three specific symptoms related to an intrusion of REM sleep characteristics (e.g., muscle atonia, vivid dream imagery) into the transition between wakefulness and sleep# Cataplexy: sudden weakness or loss of muscle tone without loss of consciousness, often elicited by emotion. Hallucinations at sleep onset (hypnogogic hallucinations) or upon awakening (hypnopompic hallucinations); and Muscle paralysis upon awakening (sleep paralysis). Narcolepsy: Treatment The treatment of narcolepsy is symptomatic. Somnolence is treated with wake-promoting therapeutics. Modafinil is now the drug of choice, principally because it is associated with fewer side effects than older stimulants and has a long half-life; 20CM00 mg is given as a single daily dose. Modafinil, like other stimulants, increases the release of monoamines, specifically the catecholamines norepinephrine and dopamine, from the synaptic terminals. However, modafinil also elevates hypothalamic histamine levels In the United States, modafinil is approved by the U.S. Food and Drug Administration only for the treatment of narcolepsy, obstructive sleep apnea/hypopnea and shift work sleep disorder. In some countries, it is also approved for idiopathic hypersomnia (all forms of excessive daytime sleepiness where causes can't be established). Older drugs such as methylphenidate (10 mg bid to 20 mg qid) or dextroamphetamine (10 mg bid) are still used as alternatives, particularly in refractory patients. -### End" -1126,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coiled spring appearance on barium enema is seen in:, with the following options: A: Carcinoma colon, B: Sigmoid volvulus, C: Intussusception, D: Deal atresia - -### Response: -Ans. Intussusception -### End" -1127,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If a 95% confidence interval for prevalence of cancer smokers aged> 65 years is 56% to 76%, the chance that the prevalence could be less than 56% is-, with the following options: A: Nil, B: 44%, C: 2.50%, D: 5% - -### Response: -Ref:Parks 23rd edition pg 849. 1SD : confidence limit = 68% 2SD : confidence limit = 95% 3SD : confidence limit = 99.7% Given, 95% values lie between 56 and 76% So, 5% values lie below 56 and above 76 altogether . So, 2.5% lies below 56. -### End" -1128,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: McMurray's test is positive in injury of:, with the following options: A: Anterior cruciate ligament, B: Posterior cruciate ligament, C: Medical meniscus injury, D: All - -### Response: -C i.e. Medial meniscus injury -### End" -1129,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: WHO Growth Cha has got information for all except:, with the following options: A: Immunisation Procedures, B: Child spacing, C: History of sibling health, D: History of maternal health - -### Response: -GROWTH CHA: Growth cha: (Road to health cha): Is a visible display of child&;s Physical growth and development. Growth cha is designed for: Longitudinal follow-up (growth monitoring) of a child. Growth cha is generally plotted between: Weight and Age. Growth cha provides information on: Identification and registration Bih date and bih weight Chronological age Weight-for-age Developmental milestones History of sibling health Immunisation procedure Introduction of supplementary foods Episodes of sickness Child spacing (Contraceptive/Family planning methods used) Reasons for special care. WHO HOME BASED GROWTH CHA : WHO grwoth cha has 2 reference curves: Upper Reference Curve(URC): 50th percentile for boys Lower Reference Curve(LRC): 3rd percentile for girls. Road to health: Is the space between two growth curves (weight channel). It includes Zone of normality for most populations i.e., 95% of healthy normal children used as reference fall in this area. WHO reference curves are based on: NCHS standards (National Centre for Health statistics, USA) The 3rd percentile (LRC) corresponds to approximately 2 SD below the median of weight-for-age reference value (i.e., URC) Ref: Park 25th edition Pgno: 580 -### End" -1130,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a branch from the root of the brachial plexus?, with the following options: A: Nerve to subclavius, B: Suprascapular nerve, C: Dorsal scapular nerve, D: Anterior thoracic nerve - -### Response: -. -### End" -1131,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acidic amino acids are -, with the following options: A: Asparagine, B: Arginine, C: None, D: Lysine - -### Response: -Proline is a unique amino acid and has an immino group (=NH) instead of an amino (NH2) group found in other amino acid. Methionine & Cysteine are sulfur containing aminoacids. The propey of photochromicity (i.e. absorbance of ultraviolet light at 250-290nm esp 280nm) is seen with aromatic amino acid (tryptophan > tyrosine > phenylalanine). Hydrophobic (non polar) aminoacids have no charge on their R group or side chain. Aliphatic (eg methyl, methylene, thioether & imino) side chains and aromatic side chains are nonpolar. So methyl (CH3) side chain of alanine; propyl (C3H7) side chain of valine; butyl (C4H9) side chain of leuicine & isoleucine; thioether side chain of methionine; and imino group/ pyrrolidine containing side chain of proline are nonpolar. Methyl (CH3) side chain of alanine is nonpolar. Serine, threonine, tyrosine containing hydroxyl group and cysteine containing sulfhydryl group, are polar aminoacids with neutral/uncharged/nonionic side chain. Positively charged basic amino (NH 3+)group side chain of histidine, arginine and lysine ; and negatively acidic carboxyl (COO-) side chain of aspaic acid and glutamic acid is polar. -### End" -1132,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vaginal delivery can be allowed in all except aEUR', with the following options: A: Monochrionic, monoamniotic twins, B: Mentoanterior, C: Extended breech, D: Dichorionic twins with first veex & second breech - -### Response: -Monochorionic, monoamniotic twins [Ref: Williams Obstetrics 23/e, Chap. 24 and 39; Danfroth's Obs. and Gynae 10/e Chap 14 & 22; Dutta Obstetrics 6/e, p 209. Mentoanterior face presentation, extended breech and dichorionic twins with first veex and second breech, all of these can be allowed for vagina delivery. Monochorionic monoamniotic twins are best delivered by caeserean section as soon as lung maturity is attained for fear of entanglement and tightening of umbilical cord which may lead to fetal distress and death. Monoamniotic twins are rare, complicating < 1% of monozygotic twins. They have a very high fetal moality rate of 40%. Besides cord entanglement these twins are at greater risk of congenital anomalies, conjoining, preterm bih and twin-twin transfusion syndrome (TTTS). Let's have a revision of twinning: Mode of delivery of twin pregnancy After the first twin is delivered vaginally, some norms are to be followed for delivery of second twin as depicted in thefollowing flowcha- ECV - External cephalic version, CPD - Cephalopelvic dispropoion. NVD - Normal vaginal delivery, IPV - Internal podalic version Unskilled in IPV. breech extraction and assisted breech delivery. Now let's have a look at mode of delivery for malpresetztations - ACOG - American College of Obstetrician and Gynecologists - 2006 guidelines Occipito posterior position is not dealt here as it is a malposition not rnalpresentation. -### End" -1133,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a patient, corneal scraping reveals narrow angled septate hyphae, which of the following is the likely etiological agent, with the following options: A: Mucor, B: Aspergillus, C: Histoplasma, D: Candida - -### Response: -Aspergillus has non pigmented septate hyphae with characteristic dichotomous branching at an angle of approximate 45degrees. it causes superficial infections like sinusitis, otomycosis and mycotic keratitis. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition . -### End" -1134,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A mother delivers a neonate with meconium staining and Apgar scores of 3 at 1 and 5 minutes of life. She had no prenatal care and the delivery was by emergency cesarean section for what the obstetricians report as ""severe fetal bradycardia."" Which of the following sequelae could be expected to develop in this intubated neonate with respiratory distress?, with the following options: A: Sustained rise in pulmonary arterial pressure, B: Hyperactive bowel sounds, C: Microcephaly with micrognathia, D: Cataracts - -### Response: -The low Apgar scores, meconium staining, and ensuing respiratory distress suggest that asphyxia has occurred. During a period of asphyxia, the resulting hypoxemia, acidosis, and poor perfusion can damage a neonate's brain, heart, kidney, liver, and lungs. The resulting clinical abnormalities include cerebral edema, irritability, seizures, cardiomegaly, heart failure, renal failure, poor liver function, disseminated intravascular coagulopathy, and respiratory distress syndrome. There can be excessively high pulmonary arterial pressure at the same time systemic blood pressure begins to fall, resulting in a persistent right-to-left shunt across a patent ductus arteriosus or foramen ovale. This condition is known as persistent pulmonary hypertension of the newborn (PPHN). -### End" -1135,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements regarding corneal transplantation is true –, with the following options: A: Whole eye needs to be preserved in tissue culture, B: Donor not accepted if age > 60 years, C: Specular microscopy analysis is used to assess endothelial cell count, D: HLA matching is mandatory - -### Response: -Specular microscopy of the donor endothelial cells provides a detailed microscopic analysis of individual cell morphology and an estimate of cellular density. Specular microscopy allows better and more precise assessment of corneal endothelium than an ordinary clinical slit lamp. -The donor cornea is most commonly preserved as a corneoscleral rim (button) although the whole globe may also be used. The whole globe is not preserved in tissue culture though it may be kept in a moist chamber for a short duration. -Donor age > 60 years is not a contraindication. -As the corneal tissue is avascular, it is considered an immunologically privileged site. Corneal transplants are unique in the sense that HLA typing and systemic immunosuppression is not mandatory. -### End" -1136,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are TRUE about Fabry disease, EXCEPT:, with the following options: A: X-linked dominant disorder, B: Premature atherosclerosis is seen, C: Retinitis pigmentosa is well described in Fabry, D: Accumulation of ceramide trihexoside in nerves and blood vessels - -### Response: -Fabry disease (angiokeratoma corporis diffusum) is an X-linked dominant disorder. Angiokeratomas are reddish-purple maculopapular lesions that are usually found around the umbilicus, scrotum, and perineum. Premature atherosclerosis is a feature that often lead to death by the fifth decade of life. Some patients also manifest a dilated cardiomyopathy. Fabry disease is due to mutations in the Alpha-galactosidase gene that leads to the accumulation of ceramide trihexoside in nerves and blood vessels. Retinitis pigmentosa is not a feature of Fabry, it is a feature of Refsum disease. Refsum disease can manifest with the classic tetrad of (1) peripheral neuropathy, (2) retinitis pigmentosa, (3) cerebellar ataxia, and (4) elevated CSF protein concentration. -### End" -1137,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following modalities can be used for in-situ ablation of liver secondaries, except, with the following options: A: Ultrasonic waves, B: Cryotherapy, C: Alcohol, D: Radio frequency - -### Response: -A i.e. Ultrasonic waves Ultrasonic waves (i.e. USG) have been used to improve placement of probe delivering intralesional ethanol injection, radiofrequency ablation and cryotherapyQ. It is not used for insitu abalation of liver tumor (primary & secoandary). Treatment modalities for liver secondaries Liver transplant (in patients with single lesion < 5 cm or three or fewer, lesions < 3 cm) but usually not recommended Hepatic aery embolization & chemotherapy (chemoemb olizati on)Q Intralesional insitu abalation ultrasound guided -Percutaneous ethanaol (alcohol) injection -Cryo ther apy Q -Radiofrequency ablationQ -Microwave coagulation therapy. -### End" -1138,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following nerve is responsible for the taste sensation of anterior two third of tongue?, with the following options: A: Facial nerve, B: Glossopharyngeal nerve, C: Lingual nerve, D: Vagus nerve - -### Response: -The chorda tympani branch of the facial nerve is responsible for carrying taste fibers from the anterior two thirds of the tongue and also provides secretory fibers to submandibular and sublingual salivary glands. The mandibular division of the trigeminal nerve (V3) provides sensory innervation for the anterior two-thirds of the tongue. The glossopharyngeal nerve provides both sensory innervation and taste sensation for the posterior third of the tongue. -### End" -1139,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old woman develops abdominal and pelvic discomfo. Physical examination reveals a large mass in the right lower quadrant, which is surgically resected. The mass consists of a large (25 cm) cystic sac containing thick mucinous fluid within a thin wall. On careful inspection, the pathologist finds an area of increased thickness in the cyst wall, which is sampled for histology. Microscopically, the tumor appears to be composed mostly of a single layer of nonciliated columnar cells arranged in papillary projections. The thickened area, however, displays stratification of epithelial cells, increased cytologic atypia, and high mitotic activity. Neveheless, no stromal invasion is found. Which of the following is the most likely diagnosis?, with the following options: A: Borderline mucinous tumor, B: Mucinous cystadenocarcinoma, C: Mucinous cystadenoma, D: Serous cystadenocarcinoma - -### Response: -Classification of ovarian tumors, like testicular tumors, is based on putative cell of origin. Thus, ovarian tumors can be divided into neoplasms of germ cells,surface epithelium, or stromal origin. Two thirds of all ovarian neoplasms derive from the surface (coelomic) epithelium. These cystic tumors may contain clear serous fluid or turbid mucinous fluid. Depending on whether a tumor is benign or malignant, surface epithelium tumors can be differentiated into serous cystadenoma or cystadenocarcinoma, and mucinous cystadenoma or cystadenocarcinoma. Borderline tumors are intermediate cases in which the epithelial lining shows malignant features (cytologic atypia and architectural disorganization) in the absence of stromal invasion. Thus, microscopic features of the ovarian tumor in this case are consistent with a borderline mucinous tumor. Mucinous cystadenocarcinoma shows obvious signs of malignancy, including foci of invasion of the stroma within the cystic wall. Mucinous cystadenoma is a cystic tumor with a mucin-rich fluid content. The epithelial lining is similar to intestinal or cervical epithelium, ie, a single layer of columnar cells with apical mucin and no cilia. Serous cystadenocarcinoma is the most frequent malignant ovarian tumor. Its epithelial lining is composed of columnar cells showing atypia and crowding. By definition, stromal invasion is present. Ref: Levy G., Purcell K. (2013). Chapter 50. Premalignant & Malignant Disorders of the Ovaries & Oviducts. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e. -### End" -1140,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Referred pain from all of the following conditions may be felt along the inner side of right thigh, EXCEPT:, with the following options: A: Inflamed ovaries, B: Pelvic abscess, C: Stone in pelvic ureter, D: Inflamed pelvic appendix - -### Response: -Inflamed appendix, inflamed ovaries and renal calculi are all associated with pain in the inner side of the thigh. In pelvic abcess pain is referred to the back of the hip. Ref: The Encyclopedia of Ahritis By Charles Michael Stein, Page 115; Anatomy of The Human Body By Henry Gray, 39th Edition, Pages 1126, 1128. -### End" -1141,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All except one is true regarding murmur heard in hypertrophic obstructive cardiomyopathy, with the following options: A: Systolic murmur decreases on squatting, B: Systolic murmur increases on valsalva manoeuvre, C: Systolic murmur increases with hand grip, D: Systolic murmur decreases on taking beta blocker - -### Response: -Murmur in HOCM decreases with handgrip -DYNAMIC CARDIAC ASCULTATION -Effect of Murmurs. -### End" -1142,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal platelet count is/are seen in -, with the following options: A: DIC, B: Shaken baby syndrome, C: Microangiopathic hemolytic anemia, D: Splenomegaly - -### Response: -DIC and microangiopathic hemolytic anemia cause thrombocytopenia. -Kasabach-Merritt syndrome (KMS) is defined as profound thrombocytopenia related to platelet tapping within a vascular tumor. -Splenomegaly (hypersplenism) may cause thrombocytopenia. -Shaken baby syndrome is not a cause of thrombocytopenia. -### End" -1143,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Red infarct is seen in?, with the following options: A: Small intestine, B: Kidney, C: Spleen, D: Heart - -### Response: -Ans. is 'a' i.e., Small intestine * Infarcts are of two types:-a) Red infarcts (haemorrhagic infarcts) :- It has well defined hemorrhagic red margins which later becomes brown. It occurs in ovary (venous occlusion due to torsion), lung (loose tissue) and small intestine.b) Pale infarct/white infarct (anemic infarct):- It has ill defined pale margins. It occurs in solid organs like heart, spleen, Liver, kidney and brain. -### End" -1144,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to CDC recommendations, HIV screening of pregnant women is:-, with the following options: A: Opt-in testing, B: Opt-out testing, C: Compulsory, D: Symptomatic - -### Response: -Opt-out testing: means performing an HIV test after notifying the patient that the test is normally performed, unless patient may elect to decline or defer testing. OPT-in testing: testing is offered and the patient is required to actively give permission before it can occur. WHO and CDC recommends opt-out testing policies in health care settings. Opt-out testing has a higher testing rate than opt-in testing. It does not eliminate the need for informed consent. -### End" -1145,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DNA supercoiling is done by :, with the following options: A: DNA polymerase I, B: DNA polymerase II, C: DNA topoisomerase, D: DNA gyrase - -### Response: -D i.e. DNA gyrase -### End" -1146,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metachromatic granules are seen in?, with the following options: A: Cornybacterium, B: E.coli, C: Yersinia, D: Pseudomonas - -### Response: -ANSWER: (A) corynebacteriumREF: Ananthnarayan 8th edition page 238Metachromatic granules are inclusion bodies in bacterial cells that alter the colour of particular stains. Methylene blue stains metachromatic granules pink; not blue. In corynebacteria, the metachromatic granules are composed of polyphosphates and act as energy storage sites.Features of corynebacterium:Gram-positive, catalase positive, non-spore-forming, non-motile, rod-shaped bacteria that is straight or slightly curved.The bacteria group together in a characteristic way, wThich has been described as the form of a ""V"", ""palisades"", or ""Chinese lettersThey may also appear elliptical. They are aerobic or facultatively anaerobic, chemoorganotrophs, with a 51-65% genomic G:C contentGranules known as babes emst or volutin granules composed of polymetaphosphate are seenSelective media: cysteine-tellurite blood agar or tinsdale medium rapid growth: loeffler's serum slope -### End" -1147,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The normal AV nodal delay is, with the following options: A: 0.16 sec, B: 0.13 sec, C: 0.09 sec, D: 0.03 sec - -### Response: -There is a delay of another 0.09 second in the A-V node itself before the impulse enters the penetrating poion of the A-V bundle, where it passes into the ventricles. A final delay of another 0.04 second occurs mainly in this penetrating A-V bundle, which is composed of multiplemallasciclesassing through the fibrous tissue separating the atria from the ventricles. Thus, the total delay in the A-V nodal and A-V bundle system is about 0.13 second. This delay, in q addition to the initial conduction delay of 0.03 second from the sinus node to the A-V node, makes a total delay of 0.16 second before the excitatory signal finally reaches the contracting muscle of the ventricles.Ref: Guyton and Hall textbook of medical physiology 13th edition. Page:125 -### End" -1148,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has Rinne test +ve for left ear and weber test is lateralized to right ear, what type of deafness may be seen in this case?, with the following options: A: Left conductive HL, B: Right conductive HL, C: Left sensorineural HL, D: Right sensorineural HL - -### Response: -Tuning fork tests and their interpretation Test Normal Conductive deafness SN deafness Rinne AC>BC (Rinne +ve) BC>AC (Rinne -ve) AC>BC Weber Not lateralized Lateralized to poorer ear Lateralized to better ear. -### End" -1149,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corona Radiata of ovum is formed from -, with the following options: A: Cumulus ovaricus, B: Zona pellucida, C: Formative yolk, D: Follicular cells - -### Response: -Ans - D -### End" -1150,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest cause of non traumatic subarachnoid hemorrhage, with the following options: A: Idiopathic, B: Berry aneurysm rupture, C: Hypertension, D: AV malformation - -### Response: -Ans. (b) Berry aneurysm ruptureRef: Bailey 26th 320 Schwartz 10th 1730* Most common cause of SAH - TRAUMA* Most common cause of non traumatic subarachnoid hemorrhage - BERRY ANEURYSM RUPTURE -### End" -1151,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hurt is defined by IPC:, with the following options: A: 317, B: 319, C: 320, D: 321 - -### Response: -Ans. (b) 319Ref: The Essentials ofFSM by K.S. Narayan Reddy 31st ed./384-85IPC SectionDefinitionSec 82A child under 7 yrs is incapable of committing an offence. Not applicable to railway act.Sec 83A child >7 &< 12 is presumed to be mature enough to be capable of committing an offence.Sec 84Act of a person of unsound mind/McNaughten's ruleSec 85Act of a person who's intoxicated against will.Sec 87A person less than 18 yrs cannot give valid consent to suffer any harm which may result from an act not intended or not known to cause death or grievous hurt. E.g. consent for wrestling contestSec 88 to93Legal protection to medical doctors. Sec 89 - a child < 12 yrs cannot give valid consent to suffer any harm which can occur by an act done in good faith or for itsbenefi t e.g. consent for operationSec 174Police inquestSec 176Magistrate's inquestSec 179Punishment for refusal to answer question by the policeSec 191Definition of perjurySec 193Punishment for perjurySec 197Issuing false certificate (3-7 years of punishment)Sec 201Disappearance of evidence (2 years of punishment)Sec 297Trespassing of burial placeSec 299Definition of Culpable homicideSec 300MurderSec 302Punishment for murder/infanticideSec 304Culpable homicide not amounting to murderSec 304 ACausing death by negligenceSec 304 BDowry death307Attempt to murder308Attempt to culpable homicide309Attempt to suicideSec 317Abandoning of infantsSec 318Concealment of death of childSec 319HurtSec 320Grievous hurtSec 321Voluntarily causing hurtSec 322Voluntarily causing grievous hurtSec 323Punishment for voluntary causing hurtSec 324Punishment for voluntary causing hurt by dangerous weapon/meansSec 325Punishment for voluntarily causing grievous hurtSec 326Punishment for voluntarily causing grievous hurt by a dangerous weapon/meansSec 351AssaultSec 354Assault to outrage the modesty of a woman.Sec 375Definition of rapeSec 376Punishment of rapeSec 377Unnatural sexual offenceSec 497Adultery -### End" -1152,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Endometrial cancer involving >50% of myometrium, extending to vagina, no pelvic extension, no pre and para aortic lymph nodes. Peritoneal lavage was positive staged as -, with the following options: A: III a, B: III b, C: III cl, D: III c2 - -### Response: -Ans. is 'b' i.e., IIIb FIGO STAGING OF ENDOMETRIAL CANCERSTAGE I Cancer confined to corpus uteriIA-Limited to endometriumIB-< 1/2 myometrial thicknessIC-> 1/2 myometrial thicknessSTAGE II Tumour involves cervix but does not extend beyond uterusIIa-Cervical glandular involvementlIb-Cervical stromal involvementSTAGE III Local and/or regional spreadIIIa-Uterine serosa, positive peritoneal washings Adnexal involvementIllb-Vaginal involvement (lymph node absent)IIIc-Positive lymph node no pelvis and paraaortic lymph nodeIIIc1-Positive pelvic nodesIIIc2-Positive para aortic nodesSTAGE IV Tumour widespreadIVa-Bladder or bowel mucosaIVb-Distant metastasis -### End" -1153,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about Insulin like Growth factor - 1 are true, except:, with the following options: A: Mainly secreted by the pancreas, B: Also known as Somatomedin C, C: Secretion is stimulated by Growth Hormone, D: Required for skeletal and Cailage growth - -### Response: -Insulin-like growth factor-1 also known as Somatomedin C is produced primarily in liver and serves as an endocrine (as well as paracrine and autocrine) hormone mediating the action of GH in peripheral tissues. Secretion of IGF-1 is stimulated by Growth Hormone after bih, and it has pronounced growth-stimulating activity required for both skeletal and Cailage growth. Feature Insulin IGF-I IGF-II Other names Insulin Somatomedin C Multiplication stimulating activity (MSA) Number of amino acids 51 70 67 Source Pancreatic beta cells liver and other tissues Diverse tissues Level regulated by Glucose Growth Hormone after bih. Nutritional status Unknown Plasma levels 0.3-2 ng/ml 10-700 ng/ml; Peaks at pubey 300-800 ng/mL Plasma binding proteins No Yes Yes Major Physiological Role Control of metabolism Skeletal and Cailage growth Growth during fetal development Ref: Ganong Pgno : 329 -### End" -1154,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Group of lymph node involved in breast carcinoma are all of the following except: March 2005, with the following options: A: Supraclavicular, B: Pretracheal, C: Axillary, D: Internal mammary - -### Response: -Ans. B: Pretracheal Lymphatic metastasis occurs primarily to the axillary and the internal mammary lymph nodes. Tumours in the posterior one-third of the breast are more likely to drain into the internal mammary lymph nodes. Involvement of supraclavicular nodes and any of the contralateral lymph nodes represent advance disease. -### End" -1155,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shirodkar stitch is given at ..... of pregnancy :, with the following options: A: 6 weeks, B: 12 weeks, C: 14-16 weeks, D: 20-24 weeks - -### Response: -14-16 weeks -### End" -1156,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypoglossal nerve is: September 2005, with the following options: A: 6th nerve, B: 7th nerve, C: 12th nerve, D: 9th nerve - -### Response: -12th nerve -### End" -1157,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blisters are classified as which type of burn?, with the following options: A: Superficial first degree burn, B: Superficial second degree burn, C: Third degree, D: Deep first degree - -### Response: -ANSWER: (B) Superficial second degree burnREF: With text""Clinically, first-degree burns are painful but do not blister' REF: Schwartzs Principles of Surgery 9th edition Chapter 8. Bums'""Second-degree burns are divided into two types: superficial and deep- All second-degree bums have some degree of dermal damage, and the distinction is based on the depth of injury into this structure. Superficial dermal burns are erythematous and pamtul, blanch to touch, and often blister.First degree -Superficial second degree -Deep second degree -Third degree -Fourth degree -These wounds spontaneously re-epithelialize from retained epidermal structures in the rete ridges, hair follicles, and sweat glands in 7 to 14 days. After healing, these burns may result in some slight skin discoloration over the long term. Deep dermal burns into the reticular dermis appear more pale and mottled, do not blanch to touch, but remain painful to pinprick. These burns heal in 14 to 35 days by re-epithelialization from hair follicles and sweat gland keratinocytes, often with severe scarring as a result of the loss of dermis"" REF: Sabiston Textbook of Surgery, 18th ed. -### End" -1158,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old man presented with multiple pathological fractures. His serum calcium was 11.5 mg/dl and phosphate was 2.5 mg/dl. Alkaline phosphatase was 940 I.U./dl. The most probable diagnosis is -, with the following options: A: Osteoporosis, B: Osteomalacia, C: Multiple myeloma, D: Hyperparathyroidism - -### Response: -Multiple pathological fractures, high calcium, low phosphate and high alkaline phosphatase suggest the diagnosis of hyperparathyroidism. -### End" -1159,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Marfan's syndrome, Aoic aneurysm occurs most commonly in:, with the following options: A: Ascending aoa, B: Descending aoa, C: Abdominal aoa, D: Arch or aoa - -### Response: -Answer is A (Ascending Aoa) Aoic aneurysms in Marfan's syndrome occur most frequently in the ascending aoa. Cardiovascular lesions in Marfan's syndrome Cardiovascular lesions are the most life threatening features of Marfan's syndrome. Mitral valve prolapseQ (MVP) Loss of connective tissue suppo in mitral valves leaflets makes them soft and blowy creating the so-called 'floppy valve'. Mitral regurgitation frequently results. Dilatation of Ascending Aoae Media undergoes cystic necrosis (cystic medionecrosis). Loss of medial suppo results in progressive dilatation of aoic valve ring and root of aoa Severe aoic incompetenceQ Aoic dissections -### End" -1160,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oncogenic DNA virus is ?, with the following options: A: Retrovirus, B: HBV, C: HIV, D: HTLV - -### Response: -Ans. is 'b' i.e., HBV -### End" -1161,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of subclan aery stenosis is in pa:, with the following options: A: 1st, B: 2nd, C: 3rd, D: Terminal - -### Response: -Subclan Aery is most commonly obstructed in the proximal poion -1st pa proximal to the origin of veebral and internal thoracic aery. It is focal and is usually an extension of atherosclerotic narrowing from the aoic arch into the aery. The stenosis is more common on left side - Left subclan is involved 3 times more frequently involved than the right. -### End" -1162,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following non opioid medication can be used to treat symptoms of opioid withdrawal syndrome?, with the following options: A: Chlordiazepoxide, B: Bupropion, C: Methadone, D: Clonidine - -### Response: -Ans. D. ClonidineClonidine, Alpha 2 receptor agonist, is used to suppress some of the symptoms of mild opioid withdrawal. Clonidine is given orally, starting with doses of 0.1to0.3mg three or four times a day. In outpatient settings, a daily dosage above 1mg is not recommended due to the risk of severe hypotension. It is more effective on symptoms of autonomic instability but is less effective than methadone in suppressing muscle aches, cravings, and insomnia. It is particularly useful in the detoxification of patients maintained on methadone or buprenorphine. -### End" -1163,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudouridine is seen in ?, with the following options: A: DNA, B: mRNA, C: rRNA, D: tRNA - -### Response: -Ans. is 'd' i.e., tRNA Transfer RNA (tRNA)The function of tRNA is to transpo amino acids in an activated form from cytosol to ribosome for protein synthesis.10-20% bases of tRNA may be modified and known as modified or unusual bases.A modified base is one that has been modified (altered) after nucleic acid chain has been formed, i.e. modified base is altered purine or pyrimidine, e.g. -i) Dihydrouridine (D) in which one of the double bonds of the base is reduced.ii) Ribothymidine (T) in which methyl group is added to uracil to form thymine. Thus, tRNA is the only RNA that can contain thymine though only some times.iii) Pseudouridine (iv) in which uracil is attached to ribose by a carbon-carbon bond rather than a nitrogen bond.t-RNA molecule get folded into a structure that appears like a clover leaf. There are four arms.1) Acceptor arm : It consists of a base paired stem that terminates in the sequence CCA at the 3' end. This is the attachment site for amino acids.2) D arm - It contains the base dihydrouridine (D).3) Anticodon arm - It contains anticodon that base pairs with the codon of coming mRNA. Anticodon has nucleotide sequence complementary to the codon of mRNA and is responsible for the specificity of the t RNA.4) T tlt C arm : It contains both ribothymidine (T) and pseudouridine (w).Proteins are synthesized from 20 amino acids. For each of these amino acids, there is at least one specific tRNA. For some amino acids, there may be more than one species of t RNA. -### End" -1164,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Consider the following characteristics of biological agents:-, with the following options: A: Infectiviry, B: Pathogenicity, C: Virulence, D: Communicability - -### Response: -A biological agent--also called bio-agent, biological threat agent, biological warfare agent, biological weapon, or bioweapon--that can be used purposefully as a weapon in bioterrorism or biological warfare.In addition to these living and/or replicating pathogens, biological toxins are also included among the bio-agents. More than 1,200 different kinds of potentially weaponizable bio-agents have been described and studied to date.most defining feature of a biological agent is pathogenicity,that is the ability to cause a disease. ref:park&;s textbook,ed 22,pg no 138 -### End" -1165,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Middle aged female with mass in sellaturcica hormone increased is-, with the following options: A: Prolactin, B: Thyroxine, C: Extrogen, D: ADH - -### Response: -hypopituitarism occurs as prolactin has an inhibitory effect from normal pituitary resulting in increased prolactin level( Harrison 17 pg2199) -### End" -1166,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year-old hypeensive lady is brought to the emergency room after being unresponsive following a sudden bout of severe headache, vomiting and neck rigidity at work. 0/E her BP is 180/100 mmHg and her respiration is irregular and of Cheyne-Stokes type. She is agitated and doesn't follow commands, but moves her extremities spontaneously. Most likely diagnosis will be: JIPMER 08; AIIMS 13, with the following options: A: Subarachnoid hemorrhage due to rupture cerebral aneurysm, B: Hypoglycemic coma, C: Conversion reaction, D: Addisonian crisis - -### Response: -Ans. Subarachnoid hemorrhage due to rupture cerebral aneurysm -### End" -1167,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Prolactin agonist EXCEPT:, with the following options: A: Associated with lactation, B: Stimulate milk production after child birth, C: Dopamine stimulate prolactin production, D: Dopamine inhibit prolactin production - -### Response: -Ans. (c) Dopamine stimulate prolactin productionRef. KDT 6th ed. / 235-236* Prolactin is produced from anterior pituitary and is associated with lactation.* Prolactin is under predominant inhibitory control of hypothalamus through PRIH (Prolactin Release Inhibitory Hormone), which is Dopamine that acts on pituitary lactotrope D2 receptor.* Dopaminergic agonist like bromocriptine, DA, cabergoline decrease plasma prolactin levels and is used to treat hyperprolactinemia* Dopaminergic antagonists like chlorpromazine haloperidol, metoclopramide causes hyperprolactinemia by blocking D2 receptors.* A progressive increase in prolactin occurs during pregnancy, peaking at term. After childbirth, this dopamine is inhibited and prolactin now stimulates milk production.Also Know* Milk production is stimulated by: Prolactin (remember production by prolactin).* Milk secretion is stimulated by: Oxytocin* DOC for hyperprolactinemia: Bromocriptine -### End" -1168,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arrange the steps of spermatogenesis in the sequence of their formation.(AIIMS May 2019) a) Spermatid b) Spermatocyte c) Spermatogonium d) Spermatozoa, with the following options: A: C>B >A>D, B: B>C >A>D, C: C>B>D>A, D: D>C >B>A - -### Response: -The sequence is as described in the image. Staing from primordial germ cell -spermatogonium - primary spermatocyte - secondary spermatocyte - spermatid - spermatozoa(sperm). -### End" -1169,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common causative organism causing lobar pneumonia is, with the following options: A: Staphylococcus aureus, B: Streptococcus pyogenes, C: Streptococcus pneumonia, D: Hemophilus influenza - -### Response: -Although Streptococcus pneumoniae is most common, other organisms must also be considered in light of the patient&;s risk factors and severity of illness.(Ref: Harrison's 18/e p2131) -### End" -1170,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The fraction of O2 in inspired air in mouth-to-mouth respiration is, with the following options: A: 0.16, B: 0.19, C: 0.21, D: 0.26 - -### Response: -The concentration of O2 in the expired air is 16%. That air is is transferred by mouth to mouth respiration. -### End" -1171,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'A' pattern squint is due to which muscle, with the following options: A: Superior rectus, B: Inferior rectus, C: Superior oblique, D: Inferior oblique - -### Response: -A pattern squint - superior oblique. -V pattern squint - inferior oblique. -### End" -1172,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prophylactic craniospinal irradiation is recommended in:, with the following options: A: Astrocytoma, B: Posterior fossa ependymoma, C: Meningioma, D: Medulloblastoma - -### Response: -PROPHYLACTIC CRANIOSPINAL IRRADIATION Prophylactic craniospinal irradiation is useful in CNS malignancy which disseminate CSF or any malignancy with high risk of CNS spreadQ. Common Indications Less Common Indications MedulloblastomaQ GlioblastomaQ GerminomaQ Small cell Carcinoma of LungQ ALLQ Non-Hodgkin's LymphomaQ Leptomeningeal RhabdomyosarcomaQ -### End" -1173,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Staphylococcal infection causes all the following skin diseases except:-, with the following options: A: Impetigo, B: Erysipelas, C: Ecthyma, D: Scalded skin syndrome - -### Response: -Erysipelas is caused by streptococcus pyogenes. Skin diseases caused by staphylococcus aureus are: Scalded skin syndrome Cellulitis Impetigo Carbuncles Furuncles Ecthyma -### End" -1174,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tumour arising from Rathke's pouch is, with the following options: A: Meningioma, B: Glioma, C: Craniopharyngioma, D: Ependymoma - -### Response: -Rathke's pouch develop at the roof of oral cavity from surface ectoderm to form most of pituitary . Posterior pituitary develops from diencephalon. Craniopharyngioma is a tumor that develop in the sella turcica. -### End" -1175,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pyridoxal phosphate is required for, with the following options: A: Gluconeogenesis, B: Glycogenolysis, C: Glycolysis, D: Fatty acid oxidation - -### Response: -Glycogen phosphorylase removes glucose as glucose-1-phosphate from glycogen (phosphorolysis). It contains pyridoxal. Formation of branches in glycogen phosphate (PLP) as a prosthetic group. The alpha-1,4 linkages in the glycogen are cleaved. removes glucose units one at a time. Enzyme sequentially hydrolyses alpha-1,4 glycosidic linkages, till it reaches a glucose residue, 3-4 glucose units away from a branch point. It cannot attack the 1,6 linkage at branch point.Ref: DM Vasudevan, 7th edition, page no: 124 -### End" -1176,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Severity of mitral stenosis Is assessed by -, with the following options: A: Loud opening snap, B: Loud opening snap Length of murmur, C: Loud S1, D: Splitting of sounds - -### Response: -In MS The first hea sound (S 1 ) is usually accentuated and slightly delayed. The pulmonic component of the second hea sound (P 2 ) also is often accentuated, and the two components of the second hea sound (S 2 ) are closely split. The opening snap (OS) of the mitral valve is most readily audible in expiration at, or just medial to, the cardiac apex. This sound generally follows the sound of aoic valve closure (A 2 ) by 0.05-0.12 s. The time interval between A 2 and OS varies inversely with the severity of the MS. The OS is followed by a low-pitched, rumbling, diastolic murmur, heard best at the apex with the patient in the left lateral recumbent position. In general, the duration of this murmur correlates with the severity of the stenosis in patients with preserved CO. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1931 ) -### End" -1177,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Free radicals are generated by all except, with the following options: A: FC and C3b, B: Receptor mediated endocytosis, C: Respiratory burst, D: Pseudopod extension - -### Response: -Ref Robbins 9/e p78 Accumulation of Oxygen-Derived Free Radicals (Oxidative Stress) Free radicals are chemical species with a single unpaired electron in an outer orbital. Such chemical states are extremely unstable, and free radicals readily react with inorganic and organic chemicals; when generated in cells, they avidly attack nucleic acids as well as a variety of cel- lular proteins and lipids. In addition, free radicals initiate reactions in which molecules that react with free radicals are themselves conveed into other types of free radicals, thereby propagating the chain of damage. Reactive oxygen species (ROS) are a type of oxygen- derived free radical whose role in cell injury is well estab- lished. Cell injury in many circumstances involves damage by free radicals; these situations include ischemia- reperfusion (discussed later on), chemical and radiation injury, toxicity from oxygen and other gases, cellular aging, microbial killing by phagocytic cells, and tissue injury caused by inflammatory cells. There are different types of ROS, and they are produced by two major pathways (Fig. 1-18). * ROS are produced normally in small amounts in all cells during the reduction-oxidation (redox) reactions that occur during mitochondrial respiration and energy genera- tion. In this process, molecular oxygen is sequentially reduced in mitochondria by the addition of four elec- trons to generate water. This reaction is imperfect, however, and small amounts of highly reactive but sho-lived toxic intermediates are generated when oxygen is only paially reduced. These intermediates include superoxide (O2 * ), which is conveed to hydro- gen peroxide (H2O2) spontaneously and by the action of the enzyme superoxide dismutase. H2O2 is more stable than O2 * and can cross biologic membranes. In the pres- ence of metals, such as Fe2+ , H2O2 is conveed to the highly reactive hydroxyl radical * OH by the Fenton reaction -### End" -1178,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Optic cup is derived from -, with the following options: A: Neural ectoderm, B: Surface ectoderm, C: Mesoderm, D: Neural crest - -### Response: -Ans. is 'a' i.e., Neural ectoderm PrecursorDerivativesNeural ectodermSmooth muscle of the iris, opticle vesicle and cup, iris epithelium, ciliary epithelium.Part of the vitreous. Retina, Retinal pigment epithelium, fibres of the optic nerve.Surface ectodermConjunctival epithelium. Corneal epithelium. Lacrimal glands, Tarsal glands, Lens.MesodermExtraocular muscles, corneal stroma, sclera, iris. Vascular endothelium. Choroid,Part of the vitreous.Neural crestCorneal stroma, keratocytes and endothelium, Sclera, Trabecular meshwork endothelium, Iris stroma. Ciliary muscles. Choroidal stroma, Part of the vitreous, Uveal and conjunctival melanocytes. Meningeal sheaths of the optic nerve,Ciliary ganglion, Schwann cells, orbital bones. Orbital connective tissue.Connective tissue sheath and muscular layer of the ocular and orbital blood vessels. -### End" -1179,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following drugs can reduce the efficacy of low dose oral contraceptive pill :, with the following options: A: Penicillin, B: Tetracycline, C: Ampicillin, D: Rifampicin - -### Response: -Rifampicin -### End" -1180,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which nerve is preserved in dissecting the superficial and deep lobes of parotid gland -, with the following options: A: Glossopharyngeal, B: Hypoglossal, C: Lingual, D: Facial - -### Response: -Ans. is 'd' i.e., Facial o The facial nerve separates parotid gland into superficial and deep lobes.o Mandibular branch of facial nerve is most vulnerable to injury during parotid surgery. -### End" -1181,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Patient on alcohol dependence was given a drug and was advised to avoid alcohol as drug interaction would lead to adverse drug reaction. Which of the following is the drug, with the following options: A: Disulfiram, B: Acamprosate, C: Naloxone, D: Naltrexone - -### Response: -When alcohol is ingested by a person who is on disulfiram, alcohol-derived acetal de hyde cannot be oxidised to acetate and this leads to an accumulation of acetaldehyde in blood. This causes the impoant disulfiram-ethanol reaction (DER) characterised by flushing, tachycardia, hypotension, tachypnoea, palpitations, headache, sweating, nausea, vomiting, giddiness and a sense of impending doom associated with severe anxiety. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.41 -### End" -1182,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following feature may be seen in thrombotic thrombocytopenic purpura, except :, with the following options: A: Fever, B: Haemolysis, C: Hypeension, D: Low platelets count - -### Response: -Answer is C (Hypeension): Blood pressure is normal in Thrombotic Thrombocytopenic purpura. Thrombotic Thrombocvtopenic purpura is a disorder of 'vessel wall' (--)characterised by lesions in n\\ arious organs that initiate formation of localised platelet thrombi and fibrin deposits at various s Clinical Pentad of TTP Microangiopathic Thrombocytopenia"" (due to consumption of platelets) Decreased Renal Function (--) (due deposits in the Renal Disturbed Neurological function e Characteristically diffuse and Fever? Hemolytic Anemia Q (Coomb's negative) - Haemolysis e Vasculature.) non focal eg. - Fragmentation Q of RBC's - Confusion - Increased LDH (elevated due to intra- vascular hemolysis) Q - Aphasia - Alteration in consciousness Tests of coagulation are essentially normal Q Normal PT Q - Normal APTTQ - Normal Fibrinogen concentrationQ - Normal Fibrin degradation ProductsQ Thus: PENTAD as mentioned above + normal coagulation tests: PATHOGNOMIC OF TTP -### End" -1183,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bazin&;s disease is also called as, with the following options: A: Erythema nodosum, B: Erythema induratum, C: Erythema multiforme, D: Erythema marginatum - -### Response: -Erythema induratum/nodular vasculitis Epidemiology :- * Women primarily; 30-40 yrs. Pathogenesis :- * May be a/w tuberculosis (erythema induratum of Bazin) or idiopathic (nodular vasculitis) # Tissue culture for mycobacteria usually negative. * PCR tests for M. tuberculosis more sensitive. * Likely type IV cell-mediated response to antigen . Clinical features :- * Tender, recurrent red-purple nodules and plaques on calves most commonly. * May ulcerate, drain and scar. Ref:- Review of Dermatology by Alikhan; pg num:-190 -### End" -1184,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Councilman bodies are seen in?, with the following options: A: Hea failure, B: Acute viral hepatitis, C: Cirrhosis of liver, D: Wilson's disease - -### Response: -In pathology, a Councilman body, also known as Councilman hyaline body or apoptotic body, is an acidophilic globule of cells that represents a dying hepatocyte often surrounded by normal parenchyma. They are found in the liver of individuals suffering from viral hepatitis, yellow fever, or other viral syndrome -### End" -1185,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meals supplied in mid day meals programme should provide: September 2005, March 2013 (g), with the following options: A: 1/2 calories and 1/2 proteins, B: 1/2 calories and 1/3 proteins, C: 1/3 calories and 1/2 proteins, D: 1/3 calories and 1/3 proteins - -### Response: -Ans. C: 1/3 calories and 1/2 proteins Mid-day meal programme/school lunch programme is in operation since 1961 with the major objective of attracting more children to schools and retain them so that literacy improvement of children could be brought about. The meal supply should provide at least one-third of the total energy requirement, and half of the protein need. Mid-day meal scheme/ National programme of nutritional suppo to primary education is launched in 1995. In September 2004 the scheme was revised to provide cooked mid day meal with 300 calories and 8-12 grams of protein to all children studying in classes I-V in Government and aided schools and EGS/AIE centers. In addition to free supply of food grains, the revised scheme provided Central Assistance for (a) Cooking cost Re 1 per child per school day, (b) Transpo subsidy was raised from the earlier maximum of Rs 50 per quintal to Rs. 100 per quintal for special category states, and Rs. 75 per quintal for other states, (c) Management, monitoring and evaluation costs 2% of the cost of food grains, transpo subsidy and cooking assistance, (d) Provision of mid day meal during summer vacation in drought affected areas -### End" -1186,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The frontal TMJ projection is called as:, with the following options: A: Transcranial projection, B: McQueen Dell technique, C: Zimmer projection, D: Infracranial projection - -### Response: -The frontal TMJ projection that shows medial displacement of fracture of condyle and fracture of neck of condyle is called transorbital or Zimmer's projection. -### End" -1187,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is TRUE about the liver enzymes which are responsible for dephosphorylation and phosphorylation?, with the following options: A: Phosphorylase is always activated by cAMP dependent Protein kinase, B: Always activates the enzyme, C: Catecholamines does not have any role in this process, D: Phosphorylation of glycogen synthase increases its activity - -### Response: -At the same time as phosphorylase is activated by a rise in concentration of cAMP ( phosphorylase kinase), glycogen synthase is conveed to the inactive form; both effects are mediated cAMP-dependent protein kinase. Phosphorylation is increased in response to cAMP formed from ATP by adenylyl cyclase in response to hormones such as epinephrine, norepinephrine, and glucagon. Phosphorylation of glycogen phosphorylase increases its activity; phosphorylation of glycogen synthase reduces its activity. Ref: Bender D.A., Mayes P.A. (2011). Chapter 19. Metabolism of Glycogen. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. -### End" -1188,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: EMLA cream is effective in relieving pain of:-, with the following options: A: Venipuncture, B: Aerial cannulation, C: Lumbar puncture, D: All of the above - -### Response: -Any procedure causing pain involving 2-4 mm skin depth can be effectively relieved by EMLA cream. EMLA can provide adequate dermal analgesia for procedures like: Split thickness skin-graft harvesting Venipuncture Laser removal of po wine stains Lithotripsy Circumcision -### End" -1189,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Randomized controlled trials are, with the following options: A: Clinical trials, B: Preventive trials, C: Before and after comparison studies, D: Evaluation of Health services - -### Response: -Experimental studies intervention studies include: Randomized control trials Field trials Community trials Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 70 -### End" -1190,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Putrefaction is facilitated by following except:, with the following options: A: Very high temp, B: Free air, C: Damp environment, D: Shallow grave - -### Response: -A i.e. Very high temperature - In females ovaries & non gravid uterusQ; and in males prostate & testisQ putrify very late only preceeded by skin, muscle, tendon & bone which are last organ to putrify. (in the same order) - Due to involution of gases, the liver becomes spongy in W. putrefaction and it is k/a Foamy or Swiss cheese or Honey combed liverQ - Greenish discolouration of flank over cecum i.e. right iliac fossaQ, which appears in about 12-24 hoursQ (6 hours in summer & > 24 hours in winter) is first external sign of putrefaction (decomposition). - In females ovaries & non gravid uterusQ; and in males prostate & testisQ putrify very late only preceeded by skin, niuscle, tendon & bone which are last organ to putrify. (in the same order) Casper's dictum relates to the rate of putrefaction of a dead body and helps in estimation of time since death. Putrefaction is arrested below 0degC & above 48degCQ as the activity of microorganism stops. Putrefaction is facilitated by free access of air, moisture & optimum temperature (10degC-450C), so decomposition is fast in shallow damp, marshy gravesQ in bodies without clothes & coffin. -### End" -1191,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urine extravasation occurs in the following in case of penile urethral rupture, EXCEPT -, with the following options: A: Ischiorectal fossa, B: Scrotum, C: Abdominal wall, D: Below superficial fascia of penis - -### Response: -Ans. is 'a' i.e., Ischiorectal fossa -### End" -1192,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Poal Vein develops from which of these structures?, with the following options: A: A, B: B, C: C, D: D - -### Response: -The image shows vitelline and umbilical veins development during liver development. A = Cardinal vein right side B = Left umbilical vein C = Right Vitelline vein D = Right Umbilical vein The inferior tubular structure is the duodenum and the anastomotic network of vitelline veins around it will develop to form the poal vein. Right vitelline vein forms right Hepatocardiac channel, which contributes to the hepatic poion of IVC Right umbilical vein regresses Proximal left umbilical vein regresses Distal left umbilical vein persists and forms the round ligament of liver Ductus venosus forms ligamentum venosum -### End" -1193,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5-month old baby presents to emergency with history of vomiting, irritability & jaundice. The baby was previously healthy. History of introducing fruit juices into the diet one week back. USG revealed hepatomegaly and liver function test were abnormal. The infants most likely has deficiency of which of the following enzymes?, with the following options: A: Fructokinase, B: Aldolase B, C: Galactose-1-phosphate uridyl transferase, D: Alpha glucosidase - -### Response: -b. Aldolase B(Ref: Nelson 20/e p 720-28)The given history of symptoms, on introduction of fruit juices, including hepatic dysfunction, points to a diagnosis of Hereditary fructose intolerance, which is due to deficiency of Aldolase B. -### End" -1194,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are complication of PEEP except :-, with the following options: A: Decreased urine ouput, B: Increased blood pressure, C: Increased intracranial pressure, D: Increased intrathoracic pressure - -### Response: -Positive end expiratory pressure decreases venous return and decreases cardiac output and hence blood pressure decreases and decreased perfusion so urine output can reduce. Pulmonary barotrauma is a frequentcomplicationofPEEPtherapy. Pneumothorax, pneumomediastinum, and interstitial emphysema may lead to rapid deterioration of a patient maintained on mechanical ventilation with an already compromised respiratory status. Positive end-expiratory pressure PEEP is a mode of therapy used in conjunction with mechanical ventilation. At the end of mechanical or spontaneous exhalation, PEEP maintains the patient's airway pressure above the atmospheric level by exeing pressure that opposes passive emptying of the lung. This pressure is typically achieved by maintaining a positive pressure flow at the end of exhalation. This pressure is measured in centimeters of water. PEEP therapy can be effective when used in patients with a diffuse lung disease that results in an acute decrease in functional residual capacity (FRC), which is the volume of gas that remains in the lung at the end of a normal expiration. FRC is determined by primarily the elastic characteristics of the lung and chest wall. In many pulmonary diseases, FRC is reduced because of the collapse of the unstable alveoli. This reduction in lung volume decreases the surface area available for gas exchange and results in intrapulmonary shunting (unoxygenated blood returning to the left side of the hea). If FRC is not restored, a high concentration of inspired oxygen may be required to maintain the aerial oxygen content of the blood in an acceptable range. Applying PEEP increases alveolar pressure and alveolar volume. The increased lung volume increases the surface area by reopening and stabilizing collapsed or unstable alveoli. This splinting, or propping open, of the alveoli with positive pressure improves the ventilation-perfusion match, reducing the shunt effect. After a true shunt is modified to a ventilation-perfusion mismatch with PEEP, lowered concentrations of oxygen can be used to maintain an adequate PaO2. PEEP therapy may also be effective in improving lung compliance. When FRC and lung compliance are decreased, additional energy and volume are required to inflate the lung. By applying PEEP, the lung volume at the end of exhalation is increased. The already paially inflated lung requires less volume and energy than before for full inflation. When used to treat patients with a diffuse lung disease, PEEP should improve compliance, decrease dead space, and decrease the intrapulmonary shunt effect. The most impoant benefit of the use of PEEP is that it enables the patient to maintain an adequate PaO2 at a low and safe concentration of oxygen (< 60%), reducing the risk of oxygen toxicity . Because PEEP is not a benign mode of therapy and because it can lead to serious hemodynamic consequences, the ventilator operator should have a definite indication to use it. The addition of external PEEP is typically justified when a PaO2 of 60 mm Hg cannot be achieved with an FIO2 of 60% or if the estimated initial shunt fraction is greater than 25%. No evidence suppos adding external PEEP during initial setup of the ventilator to satisfy misguided attempts to supply prophylactic PEEP or physiologic PEEP. -### End" -1195,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 year old boy has been complaining of headache, ignoring to see the objects on the sides for four months. On examination, he is not mentally retarded, his grades at school are good, and visual acuity is diminished in both the eyes. Visual chaing showed significant field defect. CT scan of the head showed suprasellar mass with calcification. Which of the following is the most probable diagnosis?, with the following options: A: Astrocytoma, B: Craniopharyngioma, C: Pituitary adenoma, D: Meningioma - -### Response: -Answer is B (Craniopharygioma): Presence of headache, visual field defects and suprasellar calcification suggests a diagnosis of suprasellar neoplastic lesions. The most common suprasellar neoplastic lesion in children (6 years) associated with suprasellar calcification is craniopharyngioma which is the single best answer of choice. -### End" -1196,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disruption or disorganization of biological rhythm is observed in:, with the following options: A: Schizophrenia, B: Anxiety, C: Depression, D: Mania - -### Response: -There are characteristic disturbances of sleep (early morning insomnia and reduced latency of REM sleep) in depression. -### End" -1197,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ultrasound of an early pregnancy, diagnosis is?, with the following options: A: Paial mole, B: Complete mole, C: Invasive mole, D: Choriocarcinoma - -### Response: -On USG - Complete moles produce a characteristic vesicular ultrasonographic pattern known as 'Snow storm appearance' or 'Honey Comb appearance' Paial moles - fetus is seen along with a multicystic placenta. Invasive Mole: vascular mass on doppler seen invading the myometrium. Multiple cystic spaces maybe seen within the myometrium Choriocarcinoma: May present as a discrete central infiltrative mass. Its a heterogeneous mass due to necrosis and hemorrhage within these tumors. Paial mole Complete mole Invasive mole Choriocacinoma -### End" -1198,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Female sterilization is absolutely contraindicated in:, with the following options: A: Hea disease, B: Diabetes mellitus, C: Hypeension, D: None of the above - -### Response: -There is no absolute medical contraindication for female sterilization. Also remember, : FEMALE STERILIZATION MALE STERILIZATION - Married - Married - 22-49 yrs old female - 22-60 yrs old male - >= 1 child - >= 1 child - No past history in self/ spouse sterilization - No past history in self/ spouse sterilization - MINILAP - Done by trained MBBS/ MD Gyn-obs/ DGO - Conventional vasectomy - Trained MBBS & above - Laproscopic sterilization- MD Gyn-obg /DGO - MS surgery - No scalpel vasectomy - Trained MBBS & above -### End" -1199,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest type of spinal T. B. is -, with the following options: A: Posterior, B: Paradiscal, C: Pedicle, D: Anterior - -### Response: -The commonest type of spinal T.B. is paradiscal. -In this contiguous areas of 2 adjacent vertebrae along with intervening disc are affected. -This special pattern of involvement is seen because of the embryology of the vertebra. -The lower half of one vertebra and upper half of the one below it, along with the intervening disc develop from pair of sclerotomes and have a common blood supply. -### End" -1200,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About 12 days after a mild upper respiratory infection, a 12-year-old boy complains of weakness in his lower extremities. Over several days, the weakness progresses to include his trunk. On physical examination, he has the weakness described and no lower extremity deep tendon reflexes, muscle atrophy, or pain. Spinal fluid studies are notable for elevated protein only. The most likely diagnosis in this patient is, with the following options: A: Bell palsy, B: Muscular dystrophy, C: Guillain-Barre syndrome, D: Charcot-Marie-Tooth disease - -### Response: -The paralysis of Guillain- Barre occurs about 10 days after a nonspecific viral illness. Weakness is gradual over days or weeks, beginning in the lower extremities and progressing toward the trunk. Later, the upper limbs and the bulbar muscles can become involved. Involvement of the respiratory muscles is life threatening. The syndrome seems to be caused by a demyelination in the motor and, occasionally, the sensory erves. Measurement of spinal fluid protein is helpful in the diagnosis; protein levels are increased to more than twice normal, while glucose and cell counts are normal. Hospitalization for observation is indicated. Treatment can consist of intravenous immunoglobulin, steroids, or plasmapheresis. Recovery is not always complete. Bell palsy usually follows a mild upper respiratory infection, resulting in the rapid development of weakness of the entire side of the face. Muscular dystrophy encompasses a number of entities that include weakness over months. Charcot- Marie-Tooth disease has a clinical onset including perineal and intrinsic foot muscle atrophy, later extending to the intrinsic hand muscles and proximal legs. -### End" -1201,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rekha a 45-years-old woman has negative pap smear with +ve endocervical curretage. Next step in management will be:, with the following options: A: Colposcopy, B: Vaginal hysterectomy, C: Conisation, D: Wertheim's hysterectomy - -### Response: -In the question, Rekha has negative pap smear along with positive endocervical curettage - it could mean endometrial cancer which has extended to cervix or adeno carcinoma of endocervix. To distinguish between the two - conization should be done. Colposcopy is of no use as it cannot usualize upper part of endocervix. -### End" -1202,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following pervasive developmental disorder only one modality is impaired, others are normal -, with the following options: A: Autism, B: Asperger syndrome, C: Rett syndrome, D: All of the above - -### Response: -Ans. is 'b' i.e., Asperger syndromeo Pervasive development disorders include several clinically similar conditions which are characterized by three symptom clustors:-i) Impairment of social interaction:- e.g., Lack of social smile or eye contact.ii) Impairment of communication (language and non-verbal):- Language problems, delayed or absent speech.iii) Restricted repititive and styerotyped behavior, interests and activities:- e.g., Sterotypy.iv) Another associated feature is mental retardation.o In Autism and Rett syndrome all three features are found. Where as:o In asperger syndrome -a) Only Social ineractiion is impaired, where asb) Intelligence is normal (The only pervasive development disorder in which intelligence is normal.)c) No language impairments. -### End" -1203,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following tests is not used in the diagnosis of insulinoma -, with the following options: A: Fasting blood glucose, B: Xylose test, C: C- peptide levels, D: Insulin/Glucose Ratio - -### Response: - Ref Harrison 20th edition pg 567 -### End" -1204,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Agent causing malignant hypehermia, with the following options: A: Succinyl choline, B: Dantrolene, C: Gallamine, D: Ketamine - -### Response: -Malignant hypehermia (MH) is a rare (1:15,000 in pediatric patients and 1:40,000 in adult patients) genetic hypermetabolic muscle disease, the characteristic phenotypical signs and symptoms of which most commonly appear with exposure to inhaled general anesthetics or succinylcholine (triggering agents). MH may occasionally present more than an hour after emergence from an anesthetic, and rarely may occur without exposure to known triggering agents. Most cases have been repoed in young males; almost none have been repoed in infants, and few have been repoed in the elderly. Neveheless, all ages and both sexes may be affected. The incidence of MH varies significantly from country to country and even among different geographic localities within the same country, reflecting varying gene pools. The upper Midwest appears to have the greatest incidence of MH in the United States. Anesthetic drugs that trigger MH include ether, halothane, enflurane, isoflurane, desflurane, sevoflurane, and depolarizing muscle relaxants, succinylcholine being the only anesthetic drug currently used. Desflurane and sevoflurane appear to be less potent triggers than halothane and produce a more gradual onset of MH. The onset may be explosive if succinylcholine is used. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e -### End" -1205,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HMG Co A production in liver is inhibited by, with the following options: A: Insulin, B: Thyroxine, C: Glucagon, D: Cortisol - -### Response: -Insulin -### End" -1206,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bone with a bone appearance is seen in, with the following options: A: Osteogenesis imperfecta, B: Osteopetrosis, C: Scurvy, D: Rickets - -### Response: -Bone within bone appearance is seen in : Osteopetrosis Acromegaly Bisphophonate therapy sickle cell anemia Healed phase of rickets and scurvy. Normal neonate. -### End" -1207,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The antrochoanal polyp is?, with the following options: A: Single and grows posteriorly, B: Multiple, C: Bleeding, D: None - -### Response: -Antrochoanal polyp is usually single and unilateral. More tendency to grow posteriorly and do not bleed. Unilateral nasal obstruction is the presenting symptom. Obstruction may become bilateral when polyp grows posteriorly into the nasopharynx and stas obstructing the opposite choana. (Ref - PL DHINGRA diseases of ear nose and throat, 7th edition, page no 193) -### End" -1208,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type1 Membranoproliferative glomerulonephritis is commonly associated with all except, with the following options: A: SLE, B: Persistent hepatitis C infection, C: Paial lipodystrophy, D: Neoplastic diseases - -### Response: -Refer Robbins page no p922 Robbins 8th mentioned that paial lipodystrophy is adsoscated with C3 nephritic factor (C3NeF). It is associated with type 2 Membranoproliferative glomerulonephritis -### End" -1209,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amyloid protein in human being is:, with the following options: A: A naturally present protein in normal individuals, B: Involves selectively blood vessels, C: Is visible by naked eyes as whitish cheesy material, D: A material which gets deposited in extracellular spaces - -### Response: -Ans. D. A material which gets deposited in extracellular spaces(Ref. Robbins and Cotran Pathologic basis of Disease 9/e Chapter 6)Amyloid FibrilsPhysical nature of amyloidX-ray crystallography and infrared spectroscopy demonstrate a characteristic cross-b-pleated sheet conformation. -### End" -1210,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Theirsch graft is:, with the following options: A: Full thickness, B: Partial thickness, C: Myocutaneous graft, D: Osesomyocutaneous graft - -### Response: -Ref: Bailey & Love's Short Practice of Surgery 25th Edition Plastic And Reconstructive Surgery Chapter 29 I pg 396-7Explanation:Grafts are tissues that are transferred without their blood supply, which therefore have to revascularise once they are in a new site.They include the following:Split-thickness skin grafts (of varying thickness). These are sometimes called Thiersch grafts. Fine punctate bleeding from a split-thickness skin graft donor site.Full-thickness skin grafts (Wolfe grafts). Used for smaller areas of skin replacement where good elastic skin that will not contract is required (such as fingers, eyelids, facial parts).Composite skin grafts (usually skin and fat, or skin and cartilage). Often taken from the ear margin and useful for rebuilding missing elements of nose, eyelids and fingertips.Nerve grafts-Usually taken from the sural nerve but smaller cutaneous nerves may be used.Tendon grafts taken from the palmaris longus or plantaris tendon (runs just anteromedial to the Achilles tendon ) and used for injury loss or nerve damage correction. -### End" -1211,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Beta 2 agonist used in rescue therapy in acute respiratory conditions are all except -, with the following options: A: Terbutaline, B: Salbutamol, C: Bambuterol, D: Ketotifen - -### Response: -Ans. is 'd' i.e., Ketotifen BronchodilatorsDrugs reducing inflammationa) b2 SympathomimeticsLeukotriene antagonistsMast cell stabilizersCorticosteroidsAnti-IgE antibodyo Salbutamolo Terbutalineo Montelukasto Sodium cromoglycatea) Systemico Omalizumabo Bambuteralo Salmeterolo Zafirlukasto Ketotifeno Hydrocortisone o Formoterolo Ephedrine o Prednisolone b) Inhalation b) Methylxanthines o Beclomethasome o Theophyllineo Aminophylline o Budesonide o Doxophylline o Fluticasone c) Anticholinergics o Flunisolide o Ipratropiumo Tiopratropium o Ciclesonide -### End" -1212,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Injury that comes under sec 320 IPC -, with the following options: A: Abrasion over face, B: Nasal bone fracture, C: Epistaxis, D: Lacerated wound over scalp - -### Response: -Sec 320 IPC defines grievous hurt and among the given options, only b (fracture) is grievous injury. -### End" -1213,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Postpartum lady after 48 hours of cesarean section, suffering from headache and signs of meningism. Headache gets relieved on lying down. Immediate treatment would be:, with the following options: A: Epidural blood patch, B: Do lumbar puncture, C: Foot end elevation, D: Sumatriptan - -### Response: -Ans. A. Epidural blood patchExplanationAs patient has signs of meningism, the treatment would be epidural blood patch.The Lybecker classification of severity for PDPH:Mild PDPH (Score 1)Postural headache with slight restriction of daily activities.Not bedridden.No associated symptoms.Responds well to non-opiate analgesics (Paracetamol, NSAID, Caffeine).Moderate PDPH (Score 2)Postural headache with significant restriction of daily activities.Bedridden part of the day associated symptoms may or may not present.Requires the addition of opiate derivatives.Severe PDPH (Score 3)Postural headache with complete restriction of daily activities.Bedridden all day associated symptoms present (photophobia, diplopia, tinnitus, nausea, vomiting).Not responsive to the above conservative management.If the question was like this: -### End" -1214,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is tarsometatarsal amputation?, with the following options: A: Sarmiento's Amputation, B: Lisfranc's Amputation, C: Chopart's Amputation, D: Syme's Amputation - -### Response: -Ans. is 'b' i.e., Lisfranc's Amputation AmputationLevelSyme's Amputationthrough ankle joint (0.6 cm proximal)Sarmiento's Amputation1.3 cm proximal to ankle jointWagner Amputationtwo stage syme's amputationChopart's Amputationthrough midtarsal jointsLisfranc's Amputationthrough tarso-metatarsal jointsPirogoff's Amputationanterior part of calcaneum is removed -### End" -1215,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: FeCI3 test is used in diagnosis of -, with the following options: A: HCI, B: Acetic acid, C: Alcohol, D: Phenol - -### Response: -Carbolic Acid Synonyms: Phenol, Hydroxy-Benzene Propeies * Colourless, prismatic, needle-like crystals that turns pink and liquefies when exposed to air * Has sweetish burning taste and phenol like smell * Concentrated phenol is a dark brown liquid and contains impurities like cresol * Lysol is 50% solution of cresol in saponified vegetable oil. However, phenol is 8 times more toxic than Lysol * Dettol is chlorinated phenol with turpineol * Household phenol (sold as phenyle) contains five percent phenol in water. * Derivatives of phenol 1. Cresol 2. Thymol 3. Creosate (coal tar) 4. Menthol 5. Tannic acid 6. Napthol 7. Resorcinol. Uses 1. Antiseptic and disinfectant 2. Manufacture of plastic Absorption, Metabolism and Excretion * Phenol is absorbed from skin, gastric mucosa, per rectum, per vagina and respiratory tract * Phenol is conveed into hydroquinone and pyrocatechol and excreted in urine. Traces are excreted by lungs, salivary glands, and skin. Fatal dose: * 2 gm crystals * 25 to 50 ml of household phenol Fatal period: 3 to 4 hours. Mechanism of Action * Phenol has local as well as systemic action * Locally it acts as corrosive agent and when absorbed, it causes CNS depression, metabolic acidosis and renal failure. * Carbolic acid has great penetrating power and it coagulates protein. * Phenols have a powerful antipyretic effect similar to that of salicylates. * Phenols and derivatives of phenols cause methemoglobinemia Clinical Features Local: When applied to skin or mucosa, it causes burning pain, numbness, tingling and anesthesia. It causes corrosion and produce white eschar (scar), which falls off in few days leaving brown stained area. Systemic: 1. GIT: Burning pain followed by tingling numbness and anesthesia. Nausea and vomiting. 2. RS: Respiration is slow and labored. 3. CNS: Headache, giddiness, unconsciousness, convulsions, coma. 4. Oliguria and hepatic failure. 5. Urine: May be colorless but on exposure to air turns green due to oxidation of phenol metabolites (hydroquinone and pyrocatechol). It is known as carboluria. 6. The hydroquinone and pyrocatechol may cause pigmentation in the cornea and various cailages, a condition known as oochronosis. Management * Skin: Wash with undiluted polyethylene glycol. * Oxygen/ventilatory suppo * Intravenous fluids and vasopressors to suppo blood pressure * Ingestion: Cautious stomach wash with sodium or magnesium sulfate solution * Lidocaine for ventricular arrhythmias * Benzodiazepines for seizures * Treat methemoglobinemia - if methemoglobinemia is > 30%, ingest Methylene blue (1-2 mg/kg). Exchange transfusion may be needed if methemoglobinemia is > 70%. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO300 -### End" -1216,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about histo-immunological type of breast cancer EXCEPT:, with the following options: A: Molecular classification is based on gene expression profiling, B: Most common type is Luminal A, C: Best Prognosis is Luminal B, D: Worst prognosis is triple negative breast cancer - -### Response: -Molecular classification of breast Ca is based on gene expression profiling. Molecular classification: Luminal A: ER & PR + ve, double positive HER - 2 - neu (-) ve Ki67 lowMost common type, best prognosis. Luminal B: two subtypes- 1. Luminal B HER(+) ER, PR - positive & Her - 2 - neu positive (triple positive) and Ki67 low/high 2. Luminal B HER(-) ER, PR - positive & Her - 2 - neu negative and Ki67 high Intermediate prognosis Basal cell type: triple negative ER, PR Her-2-neu (-)ve Ki67 high In BRCA 1 mutation most aggressive and Poorer prognosis because there are fewer targeted medicines available Her-2 type: Her-2-neu +veER, PR -ve aggressive and poor prognosis Normal like breast cancer- same like luminal A but prognosis poorer than luminal A Most common: luminal A Best prognosis: Luminal A Worst prognosis: Triple negative breast cancer -### End" -1217,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The corpus luteum of menstruation presents for:, with the following options: A: 5 days, B: 10 days, C: 14 days, D: 30 days - -### Response: -14 days -### End" -1218,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anemia of chronic disease is characterized by, with the following options: A: Increased sideroblasts, B: Increased TIBC, C: Increased bone marrow iron, D: Increased protoporphyrin - -### Response: -*Anemia of chronic disease- Impaired red cell production associated with any chronic diseases that would be infectious/inflammatory/neoplastic.*Chronic diseases produce a cytokine ""IL-6"" that increases the production of hepcidin from the liver. Hepcidin inhibits ferropoin function in macrophages and reduces the transfer of iron from the storage pool to developing erythroid precursors in bone marrow. *So the patient develops anemia irrespective of an increased amount of iron in macrophages.*Laboratory findings- Increased ferritin (storage iron), Low serum iron and reduced total iron binding capacity.-progenitors do not proliferate adequately because erythropoietin levels are inappropriately low for the degree of anemia.Whereas in iron deficiency anemia, the patient will have decreased ferritin, low serum iron, and high iron binding capacity. (Ref: Robbins 8/e p662) -### End" -1219,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The circumferential clasp when used with tooth supported partial dentures:, with the following options: A: Is usually the most logical clasp to use, B: Has good retentive and stabilizing ability, C: Both, D: None - -### Response: -The circumferential clasp is usually the most logical clasp to use with all tooth-supported partial dentures, because of its retentive and stabilizing ability. -Only when the retentive undercut may be approached better with a bar clasp arm or when esthetics will be enhanced, should the latter be used. -### End" -1220,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 50 year old male with scrotal pain for 2 days, pain decreases with elevation of testis. Clinical diagnosis is:, with the following options: A: Torsion, B: Epididymoorchitis, C: Hernia, D: Hydrocele - -### Response: -Ans. (b) EpididymoorchitisRef: Bailey 26th Edition, Page 1384* The sign demonstrated above is PREHN's SIGN* The sign is used to differentiate Orchitis and Torsion.* In Prehn's sign - Elevation of Testis reduces the pain in Orchitis. -### End" -1221,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Euthanasia legalized in, with the following options: A: Netherlands, B: Belgium, C: Switzerland, D: All of the above - -### Response: -(D) All of the above # Non-active euthanasia, or assisted suicide, is legal in three US states: 1. Oregon; 2. Washington; 3. Montana New Hampshire is currently considering a bill on assisted suicide Active euthanasia, commonly referred simply as euthanasia, is only legal in: 1. Netherlands 2. Belgium Euthenasia is legal in Switzerland. Assisted suicide is also legal in: 1. Albania 2. Luxembourg# Legal Aspects: Euthanasia is legal in the Netherlands, Belgium, and Luxembourg. It was legalized in the Northern Territory of Australia in 1995, but that legislation was repealed in 1997.> Euthanasia is not legal in any state in the United States. With certain conditions, in Switzerland, a layperson can legally assist suicide.> In the United States, physician-assisted suicide is legal in Oregon and Washington State if multiple criteria are met and then only after a process that includes a 15-day waiting period.> In 2009, the state supreme court of Montana ruled that state law permits physician-assisted suicide for terminally ill patients. In all other countries and all other states in the United States, physician-assisted suicide and euthanasia are illegal explicitly or by common law.DEFINITIONS OF ASSISTED SUICIDE AND EUTHANASIATermDefinitionLegal Status* Voluntary active euthanasiaIntentionally administering medications or other interventions to cause the patient's death with the patient's informed consentNetherlandsBelgium* Involuntary active euthanasiaIntentionally administering medications or other interventions to cause the patient's death when the patient was competent to consent but did not--e.g., the patient may not have been askedNowhere* Passive euthanasiaWithholding or withdrawing life-sustaining medical treatments from a patient to let him or her die (terminating life-sustaining treatments)Everywhere* Physician- assisted suicideA physician provides medications or other interventions to a patient with the understanding that the patient can use them to commit suicideOregonNetherlandsBelgium, Switzerland -### End" -1222,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Z track technique is used for, with the following options: A: Monitoring of lithium therapy, B: Monitoring of carbamazepine therapy, C: Administration of long acting depot antipsychotics, D: Administration of nicotine patches - -### Response: -Ans. (C) Administration of long acting depot antipsychotics(Ref: Kaplan and Sadock's Concise Text book of Clinical Psychiatry 11th Ed; Page No- 873)Guidelines for Administration of Long Acting Antipsychotic Depot Injections (LAAI)LAAIs are given to patient with psychosis or mania who have poor compliance to oral treatment.A test dose is given for all drugs except olanzapine, risperidone, paliperidone and aripiprazole.Route of administration is by intramuscular route with maximum permissible volume as given below.Deltoid2 mlDorsogluteal4 mlVentrogluteal (Safest site)4 mlRectus femoris5 mlVastus lateralis5 mlZ track technique is used for injection into all sites, except deltoid. The skin is stretched laterally from the intended site of injection and then insert the needle at 90deg angle. After 10 seconds of injecting the drug, skin is released to allow the displaced tissue to cover the needle track. It is done to maximize absorption in to muscles by preventing the drug from moving back to subcutaneous tissue.Z track technique is also used to inject iron. -### End" -1223,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60–year old male presented with discolouration, thickening and tunneling of 2 fingernails and one toe nail. Which of the following will clinch the diagnosis at the earliest?, with the following options: A: Wood's lamp examination, B: KOH mount, C: Slit smear (split skin smear), D: Gram stain - -### Response: -Discolouring and tunneling of the fingernails suggests onychomycosis (Tinea unguium) -Onychomycosis refers to nail infections caused by any fungus, including yeasts and nondermatophyte molds. -KOH mount is used for fungal infections. -### End" -1224,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If a patient has bilirubin 20 mg/dl, AST=313,, ALT=103 & GGT=44 IU/L. Most probable diagnosis is:, with the following options: A: Viral hepatitis, B: Alcoholic hepatitis, C: Billiary atresia, D: Drugs - -### Response: -Ans: B (Alcoholic...) Here, in Q AST > ALT(>3 times)- so most probable diagnosis is alcoholic hepatitisNormal value ofy-glutamyl transferase is 051IU/L L.D of Alcoholic Fatty Liver & Alcoholic HepatitisTestCommentASTincreased two-to-sevenfold,<400U/ L,greater than ALTALTIncreased two to sevenfold .less than 400U/ LAST/ALTUsually >1GGTPBilirubin5Not specific to alcohol, easily inducible .elevated in all forms of fatty liverMay be markedly increased in alcoholic hepatitis despite modest elevation in alkaline phosphatasePMNlf> 5500/uL predicts severe alcoholic hepatitis when discriminant function >32PMN- Polymorphonuclear cellsSERUM ENZ\ MES Harrison 18th/2527-30# The normal range for aminotransferases varies widely among laboratories, but generally ranges from 10-40 U/L.# Any type of liver cell injury can cause modest elevations in the serum aminotransferases. Levels of up to 300 U/L are nonspecific and may be found in any type of liver disorder. Minimal ALT elevations in asymptomatic blood donors rarely indicate severe liver disease; studies have shown that fatty liver disease is the most likely explanation. Striking elevations--i.e,, aminotransferases >1000 U/L--occur almost exclusively in disorders associated with extensive hepatocellular injury such as (1) viral hepatitis, (2) ischemic liver injury (prolonged hypotension or acute heart failure), or (3) toxin- or drug-induced liver injury.The pattern of the aminotransferase elevation can be helpful diagnostically. In most acute hepatocellular disorders, the ALT is higher than or equal to the AST. While the AST:ALT ratio is typically less than 1 in patients with chronic viral hepatitis and non-alcoholic fatty liver disease, a number of groups have noted that as cirrhosis develops this ratio rises to greater than 1.An AST.ALT ratio >2:1 is suggestive, while a ratio >3:1 is highly suggestive of alcoholic liver disease. The AST in alcoholic liver disease is rarely >300 U/L, and the ALT is often normal. A low level of ALT in the serum is due to an alcohol-induced deficiency of pyridoxa! phosphate.The aminotransferases are usually not greatly elevated in obstructive jaun dice.Enzymes that Reflect Cholestasis# The activities of three enzymes--alkaline phosphatase, 5'-nucleotidase, and g-glutamyi transpeptidase (GGT')--are usually elevated in cholestasis.Reflecting its more diffuse localization in the liver, GGT elevation in serum is less specific for cholestasis than are elevations of alkaline phosphatase or 5'-nucleotidase. Some have advocated the use of GGT to identify patients with occult alcohol use. Its lack of specificity makes its use in this setting questionable.Table (Harrison 18th/2530): Liver Test Patterns in Hepatobiliary DisordersType of DisorderBilirubinAminotrans ferasesAlkaline PhosphataseAlbuminProthrombin TimeHemolysis/Gilbert's syndromeNormal to 86 umol/L (5 mg/ dL) 85% due to indirect fractions No bilirubinuriaNormalNormalNormalNormalAcute hepatocellular necrosis (viral and drug hepatitis, hepatotoxins, acute heart failure)Both fractions may be elevated Peak usually follows aminotransferases BilirubinuriaElevated, often >500 1U ALT >ASTNorma] to <3 times normal elevationNormalUsually normal. If >5X above control and not corrected by parenteral vitamin K, suggests poor prognosisChronic hepatocellular disordersBoth fractions may be elevated BilirubinuriaElevated, but usually <300 IUNormal to <3 times normal elevationOften decreasedOften prolonged Fails to correct with parenteral vitamin KAlcoholic hepatitis CirrhosisBoth fractions may be elevatedBilirubinuriaAST:ALT > 2 suggests alcoholic hepatitis or cirrhosisNormal to <3 times normal elevationOften decreasedOften prolonged Fails to correct with parenteral vitamin KIntra- and extra-hepatic cholestasis(Obstructive jaundice)Both fractions may be elevated' BilirubinuriaNormal to moderate elevation Rarely >500IUElevated, often >4 times normal elevationNormal, unless chronicNormalIf prolonged, will correct with parenteral vitamin KInfiltrative diseases (tumor, granuloma- ta); partial bile duct obstructionUsually normalNormal to slight elevationElevated, often >4 times normal elevationFractionate, or confirm liver origin with 5' nucleotidase or g glutamyl transpep- tidaseNormalNormalTable (CMDT):Causes of serum aminotransferase elevations.Mild Elevations (<5x normal)Severe Elevations (> 15 x normal)Hepatic: ALT-predominantChronic hepatitis B, C, DAcute viral hepatitis (A-E, EBV, CMV)Steatosis/steatoh epatitisH emochromatosisMedications/toxinsAutoimmune hepatitis a 1 Antitrypsin deficiencyWilson diseaseCeliac diseaseHepatic: AST-predominantAlcohol-related liver injury (AST:ALT > 2:1)CirrhosisNonhepaticStrenuous exerciseHemolysisMyopathyThyroid diseaseMacro-ASTAcute viral hepatitis (A-E, herpes)Medications/toxinsIschemic hepatitisAutoimmune hepatitisWilson diseaseAcute bile duct obstructionAcute Budd-Chiari syndromeHepatic artery ligation -### End" -1225,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Each gram of fat supplies how many kcal of energy:, with the following options: A: 5, B: 9, C: 12, D: 13 - -### Response: -The various nutrients provide energy as follows: Nutrient Energy in kcal/ gram Protein 4 Carbohydrate 4 Fat 9 Dietary Fibres 2 Ref: Park 21st Edition, Page 585. -### End" -1226,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Interpret the Statistical graph given below:-, with the following options: A: Positive correlation, B: Negative correlation, C: Absent correlation, D: Spurious correlation - -### Response: -Scatter Diagram /Dot diagram - Used in depiction of correlation (Relation B/W two quantitative variable) Positive correlation : 0 > r > +1 (+1 is perfectly positive/ strong correlation) Negative correlation: -1 < r < 0 (-1 is perfectly negative correlation) No correlation r = 0 EXTRA EDGE: - Pearson product-moment correlation is used for ratio/interval scale data - Spearman rank-order correlation is used forordinal scale data -### End" -1227,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Peripheral flange is seen in which implant form?, with the following options: A: Subperiosteal implant, B: Extraoral implant, C: Disc shaped implant, D: Root form implant - -### Response: -Extraoral implants has peripheral flange for increased surface area for better osseointegration and retention. -### End" -1228,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are medically impoant streptococci except, with the following options: A: Streptococcus pyogenes, B: Streptococcus agalactiae, C: Streptococcus equisimilus, D: Streptococcus salivarius - -### Response: -Streptococcus viridans is a miscellany of streptococci, normally resident in the mouth and upper respiratory tract. Based on sugar fermentation, cell wall composition and production of dextrans and levans, they have been classified into: S. mitis S. mutans S. salivarius S. sanguis Reference: Textbook of Microbiology; Anathanarayan and paniker&;s; 9th edition; Page no: 218 -### End" -1229,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One year old male child with cat\'s eye reflex and raised IOT –, with the following options: A: Toxplasma gondii infection, B: Toxcara canis, C: Retinoblastoma, D: Retinopathy of prematurity - -### Response: -Leukocoria with raised IOT is characteristic of retinoblastoma. -### End" -1230,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following disorders are inherited except:, with the following options: A: Protein S deficiency, B: Antiphospholipid antibody syndrome, C: Protein C deficiency, D: Factor V Leiden mutation - -### Response: -Ans: B (Anti phospholipid antibody syndrome) Ref: Robbins Pathologic Basis of Disease, 8th edition, Harrison's Online > Chapter 117. Arterial and Venous Thrombosis >Explanation:Heritable Causes of Arterial and Venous ThrombosisArterial ThrombosisPlatelet ReceptorsIntegrinsP1A2 polymorphismGPIVGPIbThrombin receptorRedox EnzymesPlasma glutathione peroxidaseEndothelial nitric oxide synthaseParaoxonaseHomocysteineCystathionine -synthase5.10-methylene tetrahydrofolate reductase (MTHFR) 'Venous ThrombosisProcoagulant Proteins* FibrinogenProthrombinProtein C Anticoagulant PathwayFactor V LeidenThrombomodulinFibrinolytic Proteins with Known PolymorphismsTissue plasminogen activator (tPa)Plasminogen activator inhibitor (PAI-1)HomocysteineCystathionine-synthase5,10-methylene tetrahydrofolate reductase (MTHFR)Acquired Causes of Venous ThrombosisSurgeryNeurosurgeryMajor abdominal surgeryMalignancyAntiphospholipid syndromeOtherTraumaPregnancyLong-haul travelObesityOral contraceptives/hormone replacementMyeloproliferative disordersPolycythemia vera -### End" -1231,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding cutaneous amoebiasis which is not true -, with the following options: A: It is a spreading necrotizing inflammation of the skin and cutaneous tissue, B: Rapid improvement with anti-amoebic treatment occurs, C: Can occur in the perianal region, D: The infection reaches the skin through the blood stream - -### Response: -Option 1, 2, 3, 4 1. Cutaneous amoebiasis or Amoebiasis cutis- it is usually seen over the region adjoining a visceral lesion e.g. area of drainage of liver abscess or colostomy wound or from the rectum perianally. It may also be seen following anal intercourse. 2. Perianal skin ulcers: by direct extension of ulcers to perianal skin. 3. Amoeboma (Amoebic granuloma): a diffuse pseudotumor like mass of granulomatous tissue found in rectosigmoid region and sometimes growing sufficiently large to block the lumen 4.Rapid improvement with anti-amoebic treatment occurs. D.O.C:- metronidazole -### End" -1232,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old female with history of painless breast lump measuring 6.2x4.5 cm. Trucut biopsy showed carcinoma breast. She underwent surgical removal of and post operative biopsy showed with carcinoma breast with high grade necrosis with margin 4 mm. Which of the following is needed?, with the following options: A: Adjuvant chemotherapy, B: Adjuvant radiotherapy, C: Adjuvant chemoradiotherapy, D: No additional treatment - -### Response: -Ans. (c) Adjuvant Chemo RT(Ref Page 854/Sabiston 20th Edition)* Indications of RT:# Extracapsular nodal extension# Lymphovascular invasion# Close surgical margins# High grade necrosis# Age < 40 years -### End" -1233,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient receives a toxic dose of lignocaine i.v., the patient is likely to exhibit:, with the following options: A: Excessive salivation, B: Mydriasis and diarrhea, C: Respiratory paralysis, D: Seizures and coma - -### Response: -(Ref: KDT 6/e p356) lf LA reaches the blood stream, most prominent adverse effects are related to CNS and CVS. ln CNS, stimulation (convulsions) followed by depression (coma) is seen. Initial stimulation is due to inhibition of the inhibitory neurons. -### End" -1234,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atavistic epiphysis is seen in:, with the following options: A: Trochanters of femur, B: Lower end of radius, C: Tubercles of humerus, D: Coracoid process of scapula - -### Response: -Epiphysis: Bones end or tip, that ossifies from secondary centres are called epiphysis. There are four types of epiphysis. Pressure epiphysis, traction epiphysis aberrant epiphysis and atavistic epiphysis. Atavistic epiphysis is an independant bone which in man becomes fused to another bone. This type of epiphysis is seen in coracoid process of scapula and os trigonum. -### End" -1235,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding cystic hygroma is -, with the following options: A: Non transilluminant, B: Lined by columnar epithelium epithelium, C: Develops from jugular lymphatic sequestration, D: All - -### Response: -Cystic hygroma Cystic hygroma is a swelling usually occuring in the lower third of the neck It is most commonly seen in posterior triangle of the neck, but may also occur in axilla, groin & mediastinum It results due to sequestration of a poion of the jugular lymph sac from the lymphatic system. It usually manifests in the neonate or in early infancy (occasionally present at bih) The swelling is soft and paially compressible and invariably increases in size when the child coughs or cries. The characteristic that distinguishes it from all other neck swellings is that it is brilliantly translucent. The cysts are filled with clear lymph and are lined by endothelium. Ref : Bailey and love surgery text book 27th Ed. -### End" -1236,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Schizophrenia is characterised by A/E, with the following options: A: Formal thought disorder, B: Delusion of reference, C: Waxy flexibility, D: Altered sensorium - -### Response: -D i.e. Altered Sensorium -### End" -1237,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If a biochemical test gives the same reading for a sample on repeated testing, it is inferred that the measurement is:, with the following options: A: Precise, B: Accurate, C: Specific, D: Sensitive - -### Response: -Criteria of screening test - -Acceptability – The test should be acceptable to population to which it is going to be applied. -Repeatability  (reliability, precision, reproducibility)  –  The test must give consistent results when repeated more than once on the same individual or material under the same condition. -Validity (accuracy) – It refers to what extent the test accurately measures which it purports to measure. (it means it expresses the ability of a test to separate or distinguish those who have the disease from those who do not). Accuracy refers to closeness with which measured values agree with “true” value. - -It has two components: -i. Sensitivity – Ability of test of identify correctly all those who have disease. -ii. Specificity – Ability to test to identify correctly all those who do not have disease.  -So, if test gives the same reading for a sample on repeated testing means test is precise (i.e., reliable, reproducible, repeatable). -### End" -1238,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The HIV virus binds directly to the surface receptors of CD4 lymphocytes with _____., with the following options: A: Reverse transcriptase, B: Integrase, C: Hemagglutinin, D: Glycoprotein 120 - -### Response: -HIV’s envelope contains two glycoproteins, gp120 and gp41. gp120 binds specifically with CD4 surface receptors. -### End" -1239,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chocolate agar is an example of?, with the following options: A: Enriched medium, B: Enrichment medium, C: Selective medium, D: Transport medium - -### Response: -Ans. (a) Enriched mediumRef: Appendix-82 for ""Categories of artificial media -### End" -1240,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cherry red spot at macula is seen in :, with the following options: A: Macular infarction, B: Neimen picks disease, C: Commotio retinae, D: CRVO - -### Response: -D i.e. CRVO CRAO (not CRVO) presents with cherry red spot at macula Q -### End" -1241,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In putrifaction greenish discolouration is first seen in:, with the following options: A: Lion, B: Epigastrium, C: Right iliac fossa, D: Lower limb - -### Response: -C i.e. Right iliac fossa -### End" -1242,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gillette's space is, with the following options: A: Retropharyngeal space, B: Peritonsillar space, C: Parapharyngeal space, D: None - -### Response: -Retropharyngeal space, situated behind the pharynx and extending from the base of the skull to the bifurcation of the trachea. Space is divided into two lateral compaments (spaces of Gillette) by a fibrous raphe. Each lateral space contains retropharyngeal nodes which usually disappear at 3-4 years of age. Parapharyngeal space communicates with the retropharyngeal space. Infection of retropharyngeal space can pass down behind the oesophagus into the mediastinum. (Ref: Diseases of ear, nose and throat, PL Dhingra, 7thh edition, page no. 299) -### End" -1243,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Precursor of all steroid hormones -, with the following options: A: Pregnenolone, B: Deoxycortisol, C: Androstenedione, D: Dehydroepiandrosterone - -### Response: -Ans. is 'a' i.e., Pregnenolone o All steroid hormones originate from cholesterol.o Steps involved in biosynthesis of various steroid hormones are as follows :-Cholesterol is first acted upon by desmolase to form a 21-carbon product pregnenolone, which is the biosynthetic precursor of all steroid hormones.Pregnenolone is converted to progesterone by dehydrogenase.Progesterone is further converted to glucocorticoids and mineralcorticoids by hydroxy lotions. These reactions are affected by monooxygenases w'hich require cytochrome P-450 as an intermediate electrone carrier. These monooxygenases are -17-hydroxylase and 21-hydroxylase - Microsomal11-hydroxyalse - Mitochondrial -### End" -1244,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a person who is acclimatized to high altitude for a long time, which of the following changes is seen?, with the following options: A: Increased MCHC, B: Irregular respiration, C: Pulmonary arterial hypertension, D: Increased airway resistance - -### Response: -Ans: C (Pulmonary arterial hypertension) Ref: Ganong's Review of Medical Physiology, 21st ed, and Medical Physiology: Principles for Clinical Medicine by Rhoades RA 4th edition, pg 396 Explanation: ""Although the body undergoes many beneficial changes that allow acclimatization to high altitude, there are some undesirable effects. One of these is pulmonary hypertension (abnormally high pulmonary arterial blood pressure). Alveolar hypoxia causes pulmonary vasoconstriction. Remember that regional hypoxia redirects blood away from poorly ventilated regions in the lung without any change in pulmonary pressure. However, with generalized hypoxia, pulmonary pressure rises because all the preafveolar vessels constrict. In addition, prolonged hypoxia causes vascular remodeling in which pulmonary arterial smooth muscle cells undergo hypertrophy and hyperplasia. The vascular remodeling results in narrowing of the small pulmonary arteries and increases pulmonary vascular resistance, leading to a further significant increase in pulmonary vascular hypertension.'' Ref: Medical Physiology: Principles for Clinical Medicine by Rhoades RA, 4th edition, pg 396 Changes Seen in High Altitude Acclimatization Respiratory alkalosis produced by the hyperventilation shifts the oxygen-hemoglobin dissociation curve to the left, but there is a concomitant. Increase in red blood cell 2, 3-DPG, which tends to decrease the O2 affinity of hemoglobin. The net effect is a small increase in P50. Erythropoietin secretion increases promptly on ascent to high altitude and then falls somewhat over the following 4 days as the ventilatory response increases and the arterial PO2 rises. The increase in circulating RBCs triggered by the erythropoietin begins in 2-3 days and is sustained. | Alveolar PO2 | Hematocrit (Polycythemia) - | MCV and | MCHC. | RBC mass. | Concentration of capillaries in skeletal muscle tissue. | Myoglobin (Facilitates movement of O2 in tissues) | Mitochondria (the site of oxidative reactions). | Tissue cytochrome oxidase. | Aerobic enzyme concentration. | 2,3-BPG. Hypoxic pulmonary vasoconstriction leading to pulmonary arterial hypertension, Right ventricular hypertrophy. Also Note: Hypoxic hypoxia is a problem in normal individuals at high altitudes In high altitudes, the composition of air stays the same, but the total barometric pressure falls with increasing altitude. Therefore, the PO2 also falls. At 3000 m (approximately 10,000 ft) above sea level, the alveolar PO2 is about 60 mmHg and there is enough hypoxic stimulation of the chemoreceptors to definitely increase ventilation. As one ascends higher, the alveolar PO2 falls less rapidly and the alveolar PCO2 declines somewhat because of the hyperventilation. The resulting fall in arterial PCO2 produces respiratory alkalosis. Manifestations in unacclimatized subjects: o c At 3700 m - Mental symptoms o At 5500 m - Hypoxic symptoms o At above 6100 m (20,000 ft) - Unconsciousness and death. Acute ""Transient"" Mountain Sickness Occurs when unacclimatized persons first arrive at a high altitude. This syndrome develops 8-24 hours after arrival and lasts 4-8 days. It is characterized by headache, irritability, insomnia, breathlessness, and nausea and vomiting. Associated with cerebral edema. The low PO2 at high altitude causes arteriolar dilation, and if cerebral auto regulation does not compensate, there is an increase in capillary pressure that favors increased transudetion of fluid into brain tissue. Decreased urine output (Normally diuresis is seen at high altitude). High-altitude cerebral edema The capillary leakage in mountain sickness progresses to frank brain swelling, with ataxia, disorientation, and in some cases coma and death due to herniation of the brain through the tentorium. High-altitude pulmonary edema. It is a patchy edema of the lungs that is related to the marked pulmonary hypertension that develops at high altitude. Treatment of High Altitude illness All forms of high-altitude illness are benefited by: Descent to a lower altitude. Diuretic acetazolamide - This drug inhibits carbonic anhydrase. producing increased HCO3- excretion in the urine, stimulating respiration, increasing PaCO2. and reducing CSF formation. Oxygen supplementation / Hyperbaric chamber (Pulmonary edema). Glucocorticoids (Cerebral edema). Nifedipine can lower pulmonary artery pressure. Chronic Mountain Sickness (Monge's Disease) Due to aberration of normal physiological response to high altitude. Extremely increased hemoglobin levels. Pulmonary hypertension. Right ventricular failure. Treatment: Return to lower altitudes. -### End" -1245,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true regarding fresh frozen plasma, with the following options: A: Supplies major coagulation factors, B: ABO match not required, C: Should be used in replacement of factors in DIC / trauma, D: To be used within 30 minutes of having trauma - -### Response: -Shelf Life - - -Packed RBCs - plulcletz - Fresh frozen plasma - Cryoprecipitate -42 days - 5 days - 1 year - 1 year -### End" -1246,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is contraindicated in variant angina?, with the following options: A: Diltiazem, B: Nitrates, C: Propranolol, D: Verapamil - -### Response: -Variant angina is caused by coronary vasospasm DOC:Sublingual Nitroglycerine Prophylaxis : Calcium channel blockers (like verapamil and Diltiazem) and nitrates Beta blockers are avoided as they may precipitate coronary vasospasm by counteracting beta 2 mediated coronary vasodilation. Therefore they are avoided in variant angina. -### End" -1247,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10-year old child is undergoing squint surgery. He suddenly developed increased hea rate, arrhythmia, high fever, metabolic and respiratory acidosis on aerial blood gases and elevation of end tidal CO2. Which of the following would be the first agent of choice in the management of this condition?, with the following options: A: Dantrolene, B: Paracetamol, C: Procainamide, D: Sodium bicarbonate - -### Response: -Ans. a. Dantrolene Sudden development of increased hea rate, arrhythmia, high fever, metabolic and respiratory acidosis on aerial blood gases and elevation of end tidal CO, in a child undergoing squint surgery is highly suggestive of malignant hypehermia. Dantrolene would be the first agent of choice in the management of malignant hypehermia. ""Malignant Hypehermia: Dantrolene is the only drug effective in reversing the symptoms and preventing the episode. -### End" -1248,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Toxic megacolon is seen in, with the following options: A: Chronic non specific ulcerative colities, B: Crohn's disease, C: Colonic diveiculosis, D: Hamaomatous polyp - -### Response: -.Toxic megacolon * 1.5% incidence * Common in transverse colon * Colon is more than 6 cm in diameter * Colon is like wet blotting paper * Commonly seen in ulcerative colitis * Can occur in bacterial colitis, pseudomembranous colitis, fulminant amoebic colitis * May be precipitated by antidiarrhoeal drugs * Emergency surgery, colectomy, colostomy/ileostomy may be required * IV fluids, blood transfusion, antibiotics, steroids are also needed * Can be life threatening* Plain X-ray is very useful. ref:SRB's manual of surgery,ed 5,pg no 895 -### End" -1249,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Implants used in orthodontics are, with the following options: A: Endo-osseous implants, B: Trans-osseous implants, C: Micro implants, D: Bioresorbable implants - -### Response: -Anchorage is the most critical aspect of orthodontics. The anchorage savers do offer extra assistance to anchorage, most recent armamentarium in orthodontics was the introduction of mini screw implants (MSI) and skeletal anchorage system (SAS). Their small size has led to them being called- ""mini-implants, micro-implants, mini-screws or mini-pins"". -Textbook of Orthodontics, Gurkeerat Singh 2nd ed page 299 -### End" -1250,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are relations of left ureter EXCEPT:, with the following options: A: Sigmoid mesentery, B: Bifurcation of common iliac aery, C: Quadratus lumborum, D: Gonadal vessels - -### Response: -Left ureter is related posteriorly to psoas major muscle (not quadratus lumborum). Posterior relations:- Both the ureters run anterior to psoas major muscle and bifurcation of common iliac aery. Anterior relation:- Gonadal vessels cross the ureters anteriorly (medial to lateral) and descend down along with them. Medially the right ureter is related to inferior vena cava and left ureter is related to inferior mesenteric vein. -### End" -1251,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All is true about Brown - sequard syndrome except, with the following options: A: Hemisection of spinal cord, B: Ipsilateral loss of vibration sensations, C: Ipsilateral loss of crude touch sensations, D: Ipsilateral paralysis below the level of lesion - -### Response: -The patient present with contralateral loss of crude touch sensations, since anterior spinothalamic tract carrying these sensations, crosses the midline and runs on the opposite half of spinal cord. -### End" -1252,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the odds ratio for the following?Screening test resultsDiagnosis Total DiseasedNot diseasedPositiveabNegativecdTotala+bb+d, with the following options: A: ad/bc, B: ab/cd, C: ac/bd, D: bc/ad - -### Response: -Ans. a (ad/bc). (Ref: Park PSM 22nd/pg. 70, 75, 86)1. Relative riskRR =Incidence of disease (or death) among exposed-----------------------------Incidence of disease (or death) among non-exposed2. Odds Ratio (Cross-product ratio)Odds ratio = ad/bc# The odds ratio is a measure of effect size particularly important in Bayesian statistics and logistic regression.# It is defined as the ratio of the odds of an event occurring in one group to the odds of it occurring in another group, or to a data-based estimate of that ratio. These groups might be men and women, an experimental group and a control group, or any other dichotomous classification.# An odds ratio of 1 indicates that the condition or event under study is equally likely in both groups. An odds ratio greater than 1 indicates that the condition or event is more likely in the first group. And an odds ratio less than 1 indicates that the condition or event is less likely in the first group. The odds ratio must be zero or greater than zero. As the odds of the first group approaches zero, the odds ratio approaches zero. As the odds of the second group approaches zero, the odds ratio approaches positive infinity.3. Attributable RiskAR =Incidence of disease rate among exposed - incidence of disease rate among non-exposed--------------------------------------------------Incidence rate among exposedx 100 Screening test resultsDiagnosisTotal DiseasedNot diseased Positivea(true positive)b(faIse positive)a + bNegativec(False negative)d(True negative)C+dTotala + bb+da+b+c+d Sensitivity = TP/(TP+FN)Specificity= TN/(TN+FP)Positive predictive value=TP/(TP+FP)Negative predictive value = TN/(TN+FN)Accuracy=(TP+TN)/(TP+TN+FP+FN) Specificity = a---a + c Specificity = d---b + d Positive predictive value PPV = a---a + b Negative predictive value NPV = d---c + d Relative riskRR =Attributable riskAR =-Hardy-weinberg equilibriump2+2pq+q2=lp+q=l -### End" -1253,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Population explosion is defined as population growth rate of more than_______ per year., with the following options: A: 2, B: 1.75, C: 1.8, D: 1.5 - -### Response: -Ans. a (2.0) (Ref. Park PSM 22nd/pg. 443)Relation between growth rate and population:RatingAnnual rate of growth %Number of years required for the population to double in sizeStationary populationNo growth Slow growthLess than 0.5More than 139Moderate growth0.5 to 1.0139-70Rapid growth1.0 to 1.570-47Very rapid growth1.5 to 2.047-35""Explosive"" growth2.0 to 2.535-28""Explosive"" growth2.5 to 3.028-23 -### End" -1254,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Topical antifungal in fusarium infections is:, with the following options: A: Silver sulfadiazine, B: Natamycin, C: Ketoconazole, D: Flucytosine - -### Response: -Natamycin -### End" -1255,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At what period, Frequency is present in pregnancy:, with the following options: A: Before 16 weeks, B: After 18 weeks, C: After 20 weeks, D: After 24 weeks - -### Response: -Before 16 weeks -### End" -1256,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young patient presents with enlargement of the costochondral junction and with the white line of Fraenkel at the metaphysis. The diagnosis is -, with the following options: A: Scruvy, B: Rickets, C: Hyperparathyroidism, D: Osteomalacia - -### Response: -Enlargement of the costochondral junction (rosary) and white line of Frankel are seen both in scurvy and rickets. -However, the best answer here is scurvy as white line Fraenkel is seen in healing rickets, not in active rickets. And rickets (if not specified as healing rickets) refers to active disease. -### End" -1257,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In minimal change disease, which of the following is seen?, with the following options: A: Immunodeposits in glomerulus, B: Immunodeposits in mesangium, C: Immunodeposits in blood vessels, D: No immunodeposits - -### Response: -d. No immunodeposits(Ref: Nelson's 20/e p 2521-2528, Ghai 8/e p 477-482)In minimal change disease:Light microscopy: Glomeruli appear normal: No Ig/complement deposits, GBM: normalImmunofluorescence microscopy: No electron-dense depositsElectron microscopy: Diffuse effacement of foot processes of podocytes (""podocytopathy""). -### End" -1258,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HHV-8 causes ?, with the following options: A: Burkitt's lymphoma, B: Nasopharyngeal carcinoma, C: Kaposi sarcoma, D: Hepatic carcinoma - -### Response: -Ans. is 'c' i.e., Kaposi sarcoma -### End" -1259,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are used for myoclonic seizures except:, with the following options: A: Sodium valproate, B: Zonisamide, C: Carbamazepine, D: Topiramate - -### Response: -*'Carbamazepine and phenytoin can aggravate juvenile myoclonic epilepsy' Drugs useful for myoclonic seizures are: *Valproic acid (Drug of choice) *Benzodiazepines *Zonisamide *Levetiracetam *Topiramate *Lamotrigine REF : KATZUNG 14TH ED. -### End" -1260,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Active moiety of CoA is, with the following options: A: Acetyl group, B: Pantothenic acid, C: Thiol of beta alanine, D: Thiol of pantothenic acid - -### Response: -- Synthesis of coenzyme A from pantothenate occurs in a series of  reactions. Pantothenate is  first phosphorylated to  which  cysteine is  added. Decarboxylation, followed by addition of AMP moiety and a phosphate (each from ATP) results in  coenzyme A. --Coenzyme A serves as a carrier of activated acetyl or acyl groups (as thiol esters). -### End" -1261,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Hypothyroidism except:, with the following options: A: Delayed dentition, B: Widened fontanelle, C: Distended abdomen, D: All are true - -### Response: -d. All are true(Ref: Nelson's 20/e p 2669-2773, Ghai 8/e p 516-521)If left untreated, a child with Hypothyroidism develops the following features:Growth will be stunted, the extremities are shortFace: Depressed bridge of nose, swollen eyelids, thick, broad, protruding tongueDelayed Dentition, hoarse voice; Broad hands with short fingers; Dry and scaly skin with little perspiration -### End" -1262,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of vocal cord palsy is, with the following options: A: Surgical, B: Inflammatory, C: Trauma, D: Malignancy - -### Response: -Neuritis or surgical trauma (thyroidectomy) is the most impoant cause. Thyroid surgery is the most common cause when both recurrent and external laryngeal nerves of one side may be involved. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 6, page - 300 -### End" -1263,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are associated with pituitary apoplexy except:, with the following options: A: Hyperthyroidism, B: Diabetes mellitus, C: Sickle cell anemia, D: Hypertension - -### Response: -Ans. is 'a' i.e. Hyperthyroidism Pituitary apoplexy * Acute intrapituitary hemorrhagic vascular event causing substantial damage to pituitary.Symptoms of pituitary apoplexy * Endocrinal emergencySevere hypoglycemiaHypotensionCentral nervous system hemorrhage and death.Acute symptomsSevere headache with signs of meningeal irritationB/L visual changesOphthalmoplegiaCardiovascular collapse and loss of consciousness (in severe cases)Causes of pituitary apoplexyPreexisting adenoma (spontaneously)Postpartum (Sheehan's syndrome)Diabetes mellitusHypertensionSickle cell anemiaAcute shockDiagnosisCT or MRI reveal signs of intratumoral or sellar hemorrhage with deviation of pituitary stalk and compression of pituitary tissue.TreatmentPatient with no evidence of visual loss or impaired consciousnessManaged conservatively with high dose glucocorticoidPatient with significant visual loss and loss of consciousnessRequire urgent surgical decompressionVisual recovery is inversely correlated with the length of the time after the acute event -### End" -1264,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: McEwen's triangle is a landmark for, with the following options: A: Antral drain, B: Mastoid surgery, C: Submucous resection, D: Uncinectomies - -### Response: -Mac Ewen's (Suprameatal) Triangle: Boundaries of the triangle are: a. Anteriorly: posterosuperior border of the bony external auditory canal along with the spine of Henle. b. Posteriorly: a veical line drawn tangential to the posterior margin of the external, canal. c. Superiorly: the supramastoid crest. It is land mark for exposure of lateral surface of mastoid. -### End" -1265,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Defects in Enterohepatic Circulation of Bile Acids due to the altered canalicular function is seen in:, with the following options: A: Cirrhosis, B: Primary biliary cirrhosis, C: Gilbe's syndrome, D: Dubin johnson syndrome - -### Response: -Defects in Enterohepatic Circulation of Bile Acids Decreased Bile acid synthesis is affected in Cirrhosis decreased Biliary secretion due to Altered canalicular function Primary biliary cirrhosis Ref: Harrison, E-18, P-2462. -### End" -1266,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitriolage is punished under, with the following options: A: Sec 294 IPC, B: 326 A IPC, C: 354 A IPC, D: 326 B IPC - -### Response: -Refer the byte ""Legal sections"". -### End" -1267,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bile is concentrated in the gallbladder to _______ times, with the following options: A: 5, B: 10, C: 20, D: 50 - -### Response: -Functions of Gallbladder Reservoir of bile Concentration of bile 5-10 times Secretion of mucus, 20ml/day by tubuloalveolar glands Acidification of bile Ref: Sabiston 20th edition Pgno :1482 -### End" -1268,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antenatal mother with epilepsy on phenytoin therapy must be given:, with the following options: A: Folic acid supplementation, B: Vitamin B12 supplementation, C: Vitamin B6 supplementation, D: Vitamin A supplementation - -### Response: -Ans. (a) Folic acid supplementationRef: D. C Dutta 8th ed./ 585* Use of anti- epileptic drugs like phenytoin, valproate and even phenobarbitone has been shown in pregnancy to contribute to acquire folic acid deficiency.* If a lady is deficient in folic acid at the time of her pregnancy, then the baby most likely will born with neural tube defect.* Traditionally we study that folic acid should be taken peri-conceptionally 2 months before and 3 months later to pregnant status at dose of 400 micrograms.* However with the use of anti-epileptics drugs like phenytoin, valproate etc. the dose of folic acid needs to be supplemented at a dose of 4mg once per day. -### End" -1269,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A veterinary doctor had fever for 15 days. His blood culture in special laboratory media was positive for Gram-negative sho bacilli which were oxidase positive. Which one of the following is the likely organism grown in culture?, with the following options: A: Pasteurella spp., B: Francisella spp., C: Baonella spp., D: Brucella spp. - -### Response: -Pasteurella sp-Gram --ve bacilli oxidase +ve causes cellulitis but no fever Francisella sp-Gram --ve sho bacillus, oxidase +ve, causes Tularemia ahrosis but no PUO(Pyrexia of unknown origin) Baonella -- Gram --ve red, oxidase +ve Brucella, Gram --ve, sho bacillus causes PUO Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 339 -### End" -1270,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young man finds that every time he eats dairy products he feels very uncomfoable. His stomach becomes distended. He develops gas and diarrhoea frequently. These symptoms do not appear when he eats food other than dairy products. Which of the following is most likely enzyme in which this young man is deficient:, with the following options: A: Alpha amylase, B: Beta galactosidase, C: Alpha glucosidase, D: Sucrase - -### Response: -The patient has abdominal discomfo & diarrhoea after taking milk. Diagnosis is Lactose Intolerance. Enzyme deficient in this patient is b-Galactosidase which is also known as Lactase. It breaks down milk sugar lactose into glucose and galactose which can be easily absorbed. a-Amylase digests Starch (Option a) a- Glucosidase or Acid Maltase is minor pathway of Glycogen breakdown in lysosomes (Option c) If abdominal discomfo & diarrhea appear after taking sugar or sugarcane juice, then enzyme deficient is Sucrase (Option d) -### End" -1271,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: P.N.H is associated with all of the following conditions,except:, with the following options: A: Aplastic anemia, B: Increased LAP scores, C: Venous thrombosis, D: Iron deficiency anemia - -### Response: -PNH is not associated with increased LAP scores. In PNH, there is loss of hemoglobin and iron in urine - the negative iron deficit leading to iron deficiency anemia. The hypercoagulable state in PNH leads to Budd Chiari syndrome and this disorder, being an acquired stem cell defect can lead to aplastic anemia. The clinical syndrome can present with 3 types of symptoms including: (1) an acquired intracorpuscular hemolytic anemia due to the abnormal susceptibility of the RBC membrane to the hemolytic activity of complement; (2) thrombosis in large vessels, such as hepatic, abdominal, cerebral, and subdermal veins; and (3) a deficiency in hematopoiesis that may be mild or severe, such as pancytopenia in an aplastic anemia state. Flow cytometry is used to detect CD59 (MIRL), a glycoprotein, and CD55 (DAF) in regulation of complement action. Absence or reduced expression of both CD59 and CD55 on PNH RBCs is diagnostic. The Ham test (acidified serum lysis) establishes the diagnosis of paroxysmal nocturnal hemoglobinuria (PNH), demonstrating a characteristic abnormality of PNH red blood cells by acidified fresh normal serum. Heated serum at 56degC inactivates complement and prevents hemolysis in PNH cells. -### End" -1272,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: This has increased risk of, with the following options: A: Squamous cell carcinoma, B: Basal cell carcinoma, C: Melanoma, D: Liposarcoma - -### Response: -This is a cutaneous horn. Actinic (solar) keratoses (AK), i.e. cutaneous horns and keratoacanthomas, were considered to be premalignant lesions leading to SCC. Ref: Bailey and Love, 27e, page: 606 -### End" -1273,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Highest amount of saturated fatty acid is seen in ?, with the following options: A: Soyabean oil, B: Groundnut oil, C: Palm oil, D: Sunflower oil - -### Response: -Ans. is 'c' i.e., Palm oil Fatty- acids On the basis of presence or absence of double bond fatty acids are divided into :- 1.Saturated fatty acids Have no double bond. Examples --* Palmitie acid, lauric acid, stearic acid 2. Unsaturated fatty acids Have one or more double bonds i) Monounsaturated (Have single double bond) Oleic acid ii) Polyunsaturated (Have more than one double bonds) --) Linoleic acid. Linolenic acid,,4rachidonic acid, Eicosapentaenoic acid, Docosahexaenoic acid. Coming to question o Polyunsaturated are mostly found in Vegetal* oils and the saturated fatty acids mainly in animal fats. Q However, there are exceptions, as jOr example, coconut and palm oils, although vegetable oils, have on extremly high percentage of saturated acids on the other hand, fish oils, although they are not vegetable oils, contain poly and mono-unsaturated fatty acids. -### End" -1274,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of persistent hypeension in child with Intrinsic Renal disease is, with the following options: A: CGN, B: Chronic pyelonephritis, C: Obstructive uropathy, D: Renal tumor - -### Response: -ACEIs or ARBs, appropriate diuretic therapy, and dietary salt restriction make up the foundation for the treatment of HTN in CKD. Bedtime dosing of at least one antihypeensive medication improves BP control in patients with CKD. Reference: GHAI Essential pediatrics, 8th edition -### End" -1275,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Compared to breast milk colostrum is rich with :, with the following options: A: Protein, B: Fat, C: Lactose, D: Water - -### Response: -Colostrum -Colostrum is the first stage of breast milk that occurs during pregnancy and lasts for several days after the birth of the baby. -It is either yellowish or creamy in color. It is also much thicker than the milk that is produced later in breastfeeding. -Colostrums is high in protein, fat-soluble vitamins, minerals, and immunoglobulins. Immunoglobulins are antibodies that pass from the mother to the baby and provide passive immunity for the baby. -. Passive immunity protects the baby from a wide variety of bacterial and viral illnesses. 2-4 days after birth, colostrums will be replaced by transitional milk. -### End" -1276,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wh,he follow morphogenic as well as mitogenic?, with the following options: A: Fibroblast growth factor, B: Platelet derived growth factor, C: Bone morphogenetic protein, D: Insulin-like growth factor - -### Response: -Ans. c. Bone morphogenetic protein -### End" -1277,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscle of extensor Compament flexes the elbow ?, with the following options: A: ECRL, B: ECU, C: Anconeus, D: Brachioradialis - -### Response: -Ans. is `d' i.e., Brachioradialis -### End" -1278,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Action potential is generated in excitable cells. These cells are:, with the following options: A: Nerves, B: Muscle, C: Glands, D: All - -### Response: -All of them. Ie., A Nerves; B i.e. Muscle; C i.e. Glands Action potential develops in excitable cells such as nerves (neurons), muscle (skeletal, smooth and cardiac), and other contractile tissues such as few glandsQ. Glial cells such as neuroglial cells do not generate action potential. -### End" -1279,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Beams can be used for cancer treatment are, with the following options: A: g-rays, B: a-rays, C: Neutrons, D: All - -### Response: -A i.e. Gamma rays; B i.e. a-rays; C i.e. Neutron -### End" -1280,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To create a poo-caval shunt in a patient with poal hypeension, which of the following venous anastomosis should be performed?, with the following options: A: Superior mesenteric vein to inferior mesenteric vein, B: Right gastric vein to left gastric vein, C: Right gastric vein to right gastric vein, D: Left splenic vein to left renal vein - -### Response: -Poacaval shunting is major surgery. It involves a large cut (incision) in the belly area (abdomen). The surgeon then makes a connection between the poal vein (which supplies most of the liver's blood) and the inferior vena cava (the vein that drains blood from most of the lower pa of the body.)The new connection dives blood flow way from the liver. This reduces blood pressure in the poal vein and decreases the risk of a tear (rupture) and bleeding from the veins in the esophagus and stomach. Ref - Researchgate.net -### End" -1281,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A false belief unexplained by reality, shared by a number of people is:, with the following options: A: Superstition, B: Illusion, C: Delusion, D: Obsession - -### Response: -A. i.e. SuperstitionNormal thinking is characterized by smooth & continuous flow or fluency (continuity), reasonable speed, clear goal directed logical organization (clarity & organization), with a logic, sequence, intent and control. Whereas, constant/firm belief held on inadequate grounds is delusion. -### End" -1282,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Struma ovaril is composed entirely of ?, with the following options: A: Mature thyroid tissue, B: Immature thyroid tissue, C: Pimary ovarian carcinoid tissue, D: None of the above - -### Response: -Ans. is 'a' i.e., Mature thyroid tissue -### End" -1283,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trichology is the study of:, with the following options: A: Hair, B: Nail, C: Skin, D: Bones - -### Response: -Ans: a (Hair) Ref: Reddy, 27th ed, p. 84Trichology is the study of hair.NoteThanatology: Study of death in all aspects.Cheiloscopy: Study of lip markings for identification.Poroscopy: Study of microscopic pores present in the ridges of fingers.Dactylography: Study of finger prints. -### End" -1284,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has complaint of seeing coloured holoes in the evening and blurring of vision for last few days with normal 10P ?, with the following options: A: Prodromal phase of acute angle closure glaucoma, B: Acute angle closure glaucoma, C: Chronic glaucoma, D: Epidemic dropsy - -### Response: -Ans. is 'a' i.e., Prodromal phase of acute angle closure glaucoma Features of latent PACG (Prodromal stage) are :? Shallow anterior chamber Occasionally complain of halos around light Sometimes slight-haziness or blurring of vision Normal 10P It is the only phase of glaucoma, where IOP pressure is normal at all the time. Whereas in incipient stage, there is recurrent elevation of IOP by predisposing factors like dim light. -### End" -1285,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about Peroneus longus?, with the following options: A: Inveor of foot, B: Supplied by deep peroneal nerve, C: Maintains arches of foot, D: Arises from tibia - -### Response: -PERONEUS LONGUS origin: head of fibula Lateral surface of shaft of fibula.Inseion: lateral side of base of first metacarpal and adjoining medial cuneiform bone.Nerve supply: superficial peroneal nerve. Action: eveor of foot when the foot is off the ground.Maintain lateral longitudinal arch and transverse arch of the foot.Peroneus longus and Tibialis anterior are inseed into the same two bones, the two together forming a stirrup beneath the middle of sole. The presence of the sling keeps the middle of foot pulled up and prevent flattening of its arches. {Reference: BDC 6E pg no.100} -### End" -1286,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a 2 way communication-, with the following options: A: Lectures, B: Group discussion, C: Panel discussion, D: Symposium - -### Response: -The flow of communication is one way from the communicator to the audience.The familiar example is the lecture method in class rooms.This is known as Didactic method (refer pgno:855 park 23 rd edition) -### End" -1287,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6-year-old boy is often teased at school because he has stooled in his underwear almost daily for the last 3 months. He was toilet trained at 2 years of age without difficulty, but over the last 2 years he has developed ongoing constipation. His family is frustrated because they cannot believe him when he says, ""I didn't know I had to go."" He is otherwise normal; school is going well, and his home life is stable. His only significant finding on examination is stool in the rectal vault. The plain radiograph of his abdomen is shown. Initial management of this problem should include which of the following?, with the following options: A: Barium enema and rectal biopsy, B: Family counseling, C: Time-out when he stools in his underwear, D: Clear fecal impaction and short-term stool softener use - -### Response: -(d) Source: (Hay et al, pp 84-85. Kliegman et al, pp 73-75. McMillan et al, pp 672-674, 1920-1923. Rudolph et al, pp 1386-1389.) Encopresis is defined as the passage of feces in inappropriate locations after bowel control would be expected (usually older than 4 years). Encopresis is seen both with chronic constipation and overflow incontinence (retentive encopresis), and without constipation (nonretentive encopresis). Retentive encopresis is more common, and is the source of this child's problem. There is leakage of liquid stool around a large fecal impaction, resulting in fecal soiling. The radiograph demonstrates a dilated, stool-filled colon consistent with retentive encopresis. Treatment involves clearing the fecal mass, maintaining soft stools for a short period of time with mineral oil or stool softeners (3-6 months), and behavioral modification. Most children will grow out of this condition. Timeout would be ineffective, because these children usually have dysfunctional anal sphincters and little control over the problem; they do not know they are soiling their clothes until it is too late. Daily enemas could potentially be harmful. A rectal biopsy would help diagnose Hirschsprung disease, but the story presented is not consistent with that diagnosis. -### End" -1288,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 52-year-old man complains of impotence. On physical examination, he has an elevated jugular venous pressure, S3 gallop, and hepatomegaly. He also appears tanned, with pigmentation along skin folds. He has joint pain and bony overgrowth primarily affecting the second and third metacarpophalangeal joints bilaterally. The plasma glucose is 250 mg/dL, and liver enzymes are elevated. Which of the following studies will help establish the diagnosis?, with the following options: A: Detection of nocturnal penile tumescence, B: Determination of iron saturation, C: Determination of serum copper, D: Detection of hepatitis B surface antigen - -### Response: -Iron overload should be considered among patients who present with any one or a combination of the following: hepatomegaly, weakness, hyperpigmentation, atypical arthritis, diabetes, erectile dysfunction, unexplained chronic abdominal pain, or cardiomyopathy. Diagnostic suspicion should be particularly high when the family history is positive for similar clinical findings. The most frequent cause of iron overload is the common genetic disorder, idiopathic hemochromatosis. Secondary iron storage problems can occur after multiple transfusions in a variety of anemias. The most practical screening test is the determination of serum iron, transferrin saturation, and ferritin. Transferrin saturation greater than 50% in males or 45% in females suggests increased iron stores. Substantially elevated serum ferritin levels confirm total body iron overload. Genetic screening is now used to assess which patients are at risk for severe fibrosis of the liver. Definitive diagnosis can be established by liver biopsy. Determination of serum copper is needed when Wilson disease is the probable cause of hepatic abnormalities. Wilson disease does not cause hypogonadism, heart failure, diabetes, or arthropathy. Chronic liver disease caused by hepatitis B would not account for the heart failure, hyperpigmentation, or diabetes. Nocturnal penile tumescence and echocardiogram can confirm clinical findings but will not establish the underlying diagnosis. -### End" -1289,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: cat acts as reservoir in the following ?, with the following options: A: toxoplasma gondii, B: rabies, C: streptocerca infection, D: plague - -### Response: -Toxoplasma gondii * Worldwide * Zoonotic parasite; Toxoplasma is an oppounistic pathogen. * Infects animals, cattle, birds, rodents, pigs, and sheep. * and humans. * Causes the disease Toxoplasmosis. * Toxoplasmosis is leading cause of aboion in sheep and goats. * Intracellular parasite. * Final host (Felidae family, cat) * Intermediate host (mammals ) Toxoplasmosis 1. All parasite stages are infectious. 2. Risking group: Pregnant women, meat handlers (food preparation) or anyone who eats the raw meat ref : ananthanaryana 9rh ed -### End" -1290,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum concentration of coisol is seen at which time of day?, with the following options: A: Early morning, B: Noon, C: Late evening, D: Midnight - -### Response: -Coisol is the principal glucocoicoid produced by the zona fasciculata of the adrenal coex. It promotes gluconeogenesis and lipolysis, suppresses protein synthesis, inhibits inflammatory and immune responses, and has mild mineralocoicoid(for example, hypernatremic, kaliuretic, antidiuretic) effects. Most plasma coisol is bound to transcoin and albumin. Synthetic coisol administered as a drug is usually known by the alternative name hydrocoisone.Ref: Ganong&;s review of medical physiology;24th edition; page no-362 -### End" -1291,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not immunized previously in a 8 years male child which of the following vaccine is not given to that children, with the following options: A: Inactive polio vaccine, B: Hepatitis B vaccine, C: Acellular pertussis vaccine, D: Measles vaccine - -### Response: -C. i.e. (Acellular pertossis vaccine) (191- 94 - Ghai 6th)IMMUNIZATION1. If immunization status of a child is unknown, there is no harm in giving appropriate vaccine again2. A minimum interval of 4 weeks is required between the administration of two live antigen3. Measles, mumps and rubella vaccines should not be given to children, who were given immune globulin within the previous three monthsInactivated polio vaccine (IPV) - Should be used in immuno- compromised children those with AIDS family members of immuno deficient individuals partially immunized or unimmunized adults and in some tropical countries with poor facilities for cold chainPertussis vaccine - should not be given to children over 5-6 years old. There is no scientific basis for this and in countries where adult pertussis occurs.IAP recommends two booster doses one each in the 2nd and 5th year of life following immunization with three dosesHepatitis - B Vaccine|||Carrier motherHBs Ag negative mother||3- dose of vaccine0 months0-2 monthsgiven in infants1 - 2 month1 - 4 months 6 month6-18 monthsDose* 10 mg children < 10 years in deltoid or antero lateral thigh region* 20 mg Adults > 10 yearsImmuno compromised patients should receive twice the recommended dose* Rubella vaccine dose should be given at least 3 months prior to conception * ** -### End" -1292,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal tidal volume is ?, with the following options: A: 500 ml, B: 12 00 ml, C: 3000 ml, D: 2400 ml - -### Response: -Ans. is'a' i.e., 500 ml(Ref: Ganong 24e/e p.629) -### End" -1293,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Total duration of antibiotics in acute osteomyelitis, with the following options: A: 4 weeks, B: 2 weeks, C: 6weeks, D: 8 weeks - -### Response: -Appropriate antimicrobial therapy 2 weeks intravenous and 4 weeks oral Refer Maheshwari 6th/e p 168 -### End" -1294,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Latzko procedure is done in case of, with the following options: A: Uterine inversion, B: Retroverted uterus, C: Vesicovaginal fistula repair, D: Urethrocele repair - -### Response: -Latzko procedure is surgical technique for vesicovaginal fistula repair. -### End" -1295,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscle is irritated by retrocecal appendicitis?, with the following options: A: Psoas, B: Obturator, C: Gluteus maximus, D: Quadratus - -### Response: -Ans. (a) PsoasRef: Bailey and Love 27th edition, Page 1303On hyperextension of hip by putting psoas muscle into action -- retrocecal appendicitis pain is exhibited. -### End" -1296,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transport of two substances in the same direction is called as?, with the following options: A: Symport, B: Antiport, C: Exocytosis, D: Pinocytosis - -### Response: -When the transported molecule and cotransported ion move in the same direction, the process is called Symport; when they move in opposite directions, the process is called Antiport -### End" -1297,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Giardia lambia is, with the following options: A: Quadrinucleate cyst is infective form, B: Cysts can survive in water upto 3 months, C: Trophozoite has Axostyle to Adhere to surfaces., D: Exhibits falling leaf motility - -### Response: -Trophozoite has sucking disc to adhere to surfaces. -### End" -1298,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A pregnant mother at 32 weeks gestation presents in preterm labour. Therapy with antenatal steroids to induce lung maturity in the fetus may be given in all of the following condition except :, with the following options: A: Prolonged rupture of membranes for more than 24 hours, B: Pregnancy induced hypeension, C: Diabetes mellitus, D: Chorioamnionitis - -### Response: -The condition in which steroid are given to the patient is :- Premature rupture of membrane Polyhydramnios Hypeension Diabetes Severe anemia Indicated preterm delivery due to medical or obstetric complication We dont give steroids in Chorioamnionitis as it is an Infective condition and the risk of flare up of infection increases with steroids -### End" -1299,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 15 year old boy feels that the dirt has hung onto him whenever he passes through the dirty street. This repetitive thought causes much distress and anxiety. He knows that there is actually no such thing after he has cleaned once but he is not satisfied and is compelled to think so. This has led to social withdrawal. He spends much of his time thinking about dirt and contamination. This has affected his studies also. The most likely diagnosis is -, with the following options: A: Obsessive compulsive disorder, B: Conduct disorder, C: Agoraphobia, D: Adjustment disorder - -### Response: -In this question, the patient is presenting with classical features of OCD:- -Recurrent unwanted thoughts of dirt and contamination, i.e. obsession. -The thought is recognized as irrational and absurd (patient knows that there are no such things) -Irresistible thought causing marked distress and anxiety -Compulsion for cleaning -### End" -1300,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest Type of Intracranial Tumour is:, with the following options: A: Astrocytoma, B: Medulloblastoma, C: Meningioma, D: Secondaries - -### Response: -Astrocytoma -### End" -1301,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DNA enzyme for aging:, with the following options: A: Telosomerase, B: Topoisomerase, C: Telomerase, D: DNA polymerase - -### Response: -Ans. (c) TelomeraseRef: Harper's Biochemistry, 30th ed. pg. 374, 732, 26th ed. Pg- 318* The ends of each chromosome contain structures called telomeres.* Telomeres consist of short, repeat TG-rich sequences. Human telomeres have a variable number of repeats of the sequence 5'-TTAGGG-3', which can extend for several kilobases.* Telomerase, is related to viral RNA-dependent DNA polymerases (reverse transcriptases) and is the enzyme responsible for telomere synthesis and thus for maintaining the length of the telomere.* Telomere shortening has been associated with both aging and malignant transformation. Because of this reason, telomerase has become an attractive target for cancer chemotherapy and drug development. -### End" -1302,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a subcutaneous muscle?, with the following options: A: Sternocleidomastoid, B: Mylohyoid, C: Palmaris longus, D: Palmaris brevis - -### Response: -Palmaris brevisREF: Gray's anatomy 39th edition p. 919Subcutaneous muscles of body are:1. Platysma 2. Palmaris brevis 3. Daos muscle 4. Facial muscles -### End" -1303,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Croup syndrome is usually caused by-, with the following options: A: Rhinoviruses, B: Coxsackie A virus, C: Coxsackie B virus, D: All - -### Response: -Ans. is 'a' i.e., Rhinoviruses Croup (Laryngotracheobronchitis) o Croup is a viral infection of upper respiratory tract. o Children between the age of 1-5 years are affected. -### End" -1304,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is Nitroblue tetrazolium test used for?, with the following options: A: Phagocytosis, B: Complement, C: T cell, D: B cell - -### Response: -. Phagocytosis -### End" -1305,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blow out fracture of the orbit, most commonly leads to fracture of -, with the following options: A: Posteromedial floor of orbit, B: Medial wall of orbit, C: Lateral wall of orbit, D: Roof of orbit - -### Response: -""The most common site for a blowout fracture to occur is the posteromedial aspect of the orbital floor, medial to the infraorbital neurovascular bundle where the maxillary bone is very thin."" - The Internet Journal of Otorhinolaryngology. -### End" -1306,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Management of infected pancreatic necrosis includes all of the following except: March 2010, with the following options: A: Percutaneous drainage, B: Pancreatic necrosectomy, C: Manage conservatively with antibiotics alone, D: Nutritional suppo - -### Response: -Ans. C: Manage conservatively with antibiotics alone Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent endoscopic sphincterotomy. Patients with pancreatic necrosis should be followed with serial contrast enhanced computed tomography (CE-CT) and if infection is suspected fine needle aspiration of the necrotic area for bacteriology (FNAB) should be undeaken. If the aspirate is purulent, percutaneous drainage of the infected fluid should be carried out. In the presence of infection and worsening of sepsis despite percutaneous drainage, necrosectomy is indicated. Although traditionally this has been by open surgery, minimally invasive procedures are a promising new alternative. There are many unresolved issues in the management of pancreatic necrosis. These include, the use of antibiotic prophylaxis, the precise indications for and frequency of repeat CE-CT and FNAB and the role of enteral feeding. Nutritional suppo is essential -### End" -1307,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Krabbe's disease is caused by a defect of -, with the following options: A: Ceramidase, B: b galactosidase, C: a galactosidase, D: Galactosyl ceramidase - -### Response: -Ans. is 'd' i.e., Galactosyl ceramidaseLipid storage disordersDisorderEnzyme defectGaucher's diseaseb glucosidaseNiemann Pick diseaseSphingomyelinaseFabry's diseasea galactosidaseGM1 gangliosidosisb galactosidaseGM2 gangliosidosisHexosaminidase ASandhoff s diseaseHexosaminidase A and BKrabbe's diseaseGalactosyl ceramidaseMetachromatic leukodystrophyAryl Sulfatase AFarber's diseaseCeramidaseWolman's diseaseAcid lipase -### End" -1308,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pulmonary Plethora is seen in -, with the following options: A: TOF, B: TAPVC, C: CoA, D: Tricuspid Atresia - -### Response: -Pulmonary plethora It is a term used to describe the appearances of increased pulmonary perfusion on chest radiographs. It may occur in several situations : Total anomalous pulmonary venous return (TAPVC) Left-to-right cardiac shunts (e.g. ASD, VSD, PDA) Truncus Aeriosus Vein of Galen Malformation Transposition of the Great Aeries It may also been seen in pregnancy due to increased cardiac output. -### End" -1309,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A primipara is in labor and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is, with the following options: A: Ease of repair, B: Fewer breakdowns, C: Less blood loss, D: Less extension of the incision. - -### Response: -Midline episiotomies are easier to fix and have a smaller incidence of surgical breakdown, less pain, and lower blood loss. The incidence of dyspareunia is somewhat less. However, the incidence of extensions of the incision to include the rectum is considerably higher than with mediolateral episiotomies. Regardless of technique, attention to hemostasis and anatomic restoration is the key element of a technically appropriate repair. -### End" -1310,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oral hairy leukoplakia is associated with?, with the following options: A: Cytomegalovirus, B: Human immunodeficiency virus, C: EBV, D: HPV - -### Response: -ANSWER: (C) EBVREF: Jawetzs microbiology 24th edition chapter 33 Herpesviruses & Table 48-8Oral Hairy LeukoplakiaThis lesion is a wart-like growth that develops on the tongue in some HIV-infected persons and transplant patients. It is an epithelial focus of EBV replication. -### End" -1311,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme deficient in maple syrup urine disease -, with the following options: A: a-ketoacid decarboxylase, B: Transaminase, C: Isomerase, D: Mutase - -### Response: -Ans. is 'a' i.e., alpha-ketoacid decarboxylase Maple syrup urine disease (MSUD) or branched chain ketoaciduriao It is an inborn error of metabolism of branched chain amino acids valine, leucine and isoleucineo It is due to deficiency of enzyme that catalyzes the second reaction in these amino acids metabolism i.e. branched chain-a keto acid dehydrogenase which catalyses decarboxylation of branched chain amino acids As a result, the branched chain amino acids, leucine, isoleucine and valine, and their a-keto acids accumulate in blood, urine and CSF.o There is characteristic maple syrup odor to the urine. -### End" -1312,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 32-year-old teacher presents at her physician's office complaining of hearing loss in her right ear. Physical examination reveals cerumen completely obstructing the ear canal. Ear wax removal is recommended using which of the following?, with the following options: A: Jet irrigation (Water Pik), B: 3% hydrogen peroxide ear drops, C: Irrigation of the eardrum if perforated, D: Aqueous irrigation if a bean is present - -### Response: -Jet irrigation (e.g., Water Pik) should be avoided to remove cerumen impaction. Detergent ear drops (such as 3% hydrogen peroxide) may be used. Aqueous irrigation should be avoided if organic material is present because further swelling will be induced. -### End" -1313,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dilutional hyponatremia is seen in -, with the following options: A: Addison's disease, B: DI, C: Diuretic therapy, D: None - -### Response: -Dilutional hyponatremia, also known as water intoxication, it is a potentially life-threatening condition which occurs when a person consumes too much water without an adequate intake of electrolytes Ref - researchgate.net -### End" -1314,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Small round cell tumors are all EXCEPT:, with the following options: A: Synol carcinoma, B: Neuroblastoma, C: Embryonal rhabdosarcoma, D: PNET - -### Response: -Synol carcinoma REF: Khan, Javed, Nature Genetics 27, 64 (2001), http://en.wikipedia.org/wiki/Small-,_round,_ bluecell_tumour, Histopathology: Volume 53, Issue 1, pages 73-80 Small, round, blue-cell tumor: In histopathology, a small, round, blue-cell tumor (abbreted SRBCT), also known as a smallblue-round-cell tumor (SBRCT) or a small-round-cell tumor (SRCT), is a type of malignant neoplasms that has a characteristic appearance under the microscope, i.e. it consists of small round cells that stain with blue on routine H&E stained sections. These have following characteristics: These tumors are more typically seen in children than adults. They typically represent undifferentiated cells. The predominance of blue staining is due the fact that the cells consist predominantly of nucleus They have scant cytoplasm Tumors which have round cells are: Desmoplastic small-round-cell tumor Ewing's Sarcoma PNET (Primitive neuroectoderrnal tumor) Neuroblastoma Medulloblastoma Rhabdomyosarcoma Wilm's tumor Retinoblastoma Small-cell lymphoma Hepatoblastoma -### End" -1315,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cyanosis is seen in -, with the following options: A: Persistent ductus aeriosus, B: Tricuspid atresia, C: Ostium primumASD, D: All - -### Response: -Ans. is 'b' i.e., Tricuspid atresia -### End" -1316,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 41-year-old woman is diagnosed with CA Cervix. She has right hydronephrosis as evidenced by the intravenous pyelogram (IVP). The biopsy specimen confirms it is squamous cell cancer. Which of the following statements regarding this patient's condition is most accurate?, with the following options: A: The best treatment for her is surgical excision., B: The majority of cervical cancers are of adenomatous cell type., C: Chemoradiation is the preferred treatment, D: Radical hysterectomy is an option in the therapy of this patient. - -### Response: -Stage IIIB: Extension of cervical malignancy to pelvic side wall and/or hydronephrosis or non functioning kidney Broadly, the treatment of cervical cancer is surgical upto stage IIA1 (lesion size <4cm without parametrial involvement) after which the treatment involves chemoradiation, therefore here, chemoradiation is treatment of choice Most common histological type of cervical malignancy is squamous cell carcinoma -### End" -1317,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pemphigus vulgaris, tzank smear shows, with the following options: A: AcanthoIytic CellS, B: Fibroblasts, C: Macrophages, D: Neutrophils - -### Response: -tzank smear test: done in vesciculobullous disorders floor of a blister is scraped nd the material is spread on glass slide stained with giemsa stain. result 1.acantholytic cells- rounded cells with relatively large nucleus and peripherally condensed cytoplasm diagnostic of pemphigus vulgaris and foliaceous 2,balooning degeneration and multinucleated gaint cells seen in herpes simplex,herpes zoster and varicella. IADVL textbook of dermatology page 110 -### End" -1318,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A male 60 years old wants a denture made. He is on oral hypo-glycaemics. Intraoral examination reveals edentulous arches with firm ridges and good alveolar height. Which of the following can be used in this patient for impression making?, with the following options: A: ZOE paste, B: Impression plaster, C: Impression compound, D: All of the above - -### Response: -Inelastic impression materials, such as ZOE paste and plaster, are ideal for making impressions of edentulous jaw structures or soft tissue because, in the proper consistency, they do not compress the tissue during seating of the impression tray. Impression compound is often used to make trays for the construction of full dentures. -Reference: Phillips’ science of dental materials / Kenneth J. Anusavice, Chiayi Shen, H. Ralph Rawls.—12th ed.Page no 153 -### End" -1319,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is wrong regarding ophthalmic aery, with the following options: A: Present in dura along with optic nerve, B: Supplies anterior ethmoidal sinus, C: Aery to retina is end aery, D: Leaves orbit through inferior orbital fissure - -### Response: -Ans. is 'd' i.e., Leaves orbit through inferior orbital fissure Ophthalmic aery does not leave the orbit. It terminates near the medial angle of eye by dividing into supratrochlear and dorsal nasal branches.It lies along with optic nerve in a common dural sheath.It supplies anterior ethmoidal sinus by its anterior ethmoidal branch.Central aery to retina (branch of ophthalmic aery) is an end aery. -### End" -1320,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An old man was brought to OP by his son telling that his father is having habit of washing his hands 'n' number of times and repetition of other daily routines as well. Characteristic of obsession are all, EXCEPT:, with the following options: A: Repetitive behavior, B: Repetitive behavior, C: Ego dystonic, D: Compulsion - -### Response: -According to the DSM-IV, obsessive-compulsive disorder (OCD) is characterized by recurrent obsessions or compulsions that are ego-dystonic and time-consuming and that interfere with normal functioning. Compulsions or compulsive behavior may result when patients engage in repetitive behavior in an attempt to reduce anxiety or cope with these obsessive thoughts. Obsessions refer to thoughts, ideas, or images which recur and are distressing or unwanted. Ref: Handbook of Neuropsychology and Aging edited by Paul David Nussbaum, 1997, Page 83. -### End" -1321,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a cause of panuveitis, with the following options: A: Behcet's syndrome, B: Syphillis, C: Sarcoidosis, D: Sympathetic ophthalmitis - -### Response: -Syphillis is not a common cause for panuveitis Panuveitis: Inflammation of all the layers of uveal tissue iris, ciliary body and choroid. Diseases causing granulomatous panuveitis. *Tuberculosis *Vogt Kayanaga Harada *Behcet's syndrome *Sarcoidosis *Sympathetic Ophthalmitis -### End" -1322,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adenovirus causes all except -, with the following options: A: Hemorrhagic cystitis, B: Diarrhea, C: Respiratory tract infection, D: IMN - -### Response: -Infectious mononucleosis is caused by EBV -### End" -1323,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brazilian purpuric fever is caused by?, with the following options: A: Haemophilus haemolyticus, B: Haemophilus aphrophilus, C: Haemophilus aegyptius, D: Haemophilus parainfluenzae - -### Response: -Brazilian purpuric fever is caused by Haemophilus aegyptius. It is characterised by conjunctivitis which proceeds to fulminant septicemia in infants and children. There is high fatality. It was first recognized in Brazil in 1984. Ref: Ananthanarayan and Paniker's Textbook of Microbiology, 9th edition, p330,331. -### End" -1324,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following in not a pa of Epithalamus:, with the following options: A: Pineal body, B: Posterior commissure, C: Trigonum Habenulae, D: Geniculate bodies - -### Response: -D i.e. Geniculate body -### End" -1325,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are side effects of clozapine expect:, with the following options: A: Granulocytopenia, B: Seizures, C: Sedation, D: Extrapyramidal side effects - -### Response: -Ref: KDT 8th ed Clozapine is an atypical antipsychotic drug. It does not block D2 receptors, therefore chances of extrapyramidal symptoms are least with this drug. -### End" -1326,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Postitional veigo is, with the following options: A: Lateral, B: Superior, C: Inferior, D: Posterior - -### Response: -The disease is caused by the disorder of posterior semicircular canal. Otoconial debris when settles in the cupula of the posterior semicircular canal in a critical head position causes displacement of cupula and veigo. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition) -### End" -1327,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antithyroid drug of choice in pregnancy is, with the following options: A: Propylthiouracil, B: Carbimazole, C: Propranolol, D: Lugol's iodine - -### Response: -Propylthiouracil -### End" -1328,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Approved drug for prostate cancer is, with the following options: A: Bicalutamide, B: Apalutamide, C: Ibalizumab, D: Ivacaftor - -### Response: -Apalutamide was approved by FDA in 2018 for the treatment of HIV. It is androgen antagonist. Nilutamide, flutamide, bicalutamide are old drugs used in prostate cancerRef: /= 3 mEq/L in acute overdoses. Ref: Meyer J.M. (2011). Chapter 16. Pharmacotherapy of Psychosis and Mania. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -1336,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DOC for management of visceral Leishmaniasis:, with the following options: A: Parenteral Sodium stibogluconate, B: Liposomal Amphotericin B, C: Miltefosine, D: Pentamidine - -### Response: -Ref: Goodman & Gillman 13th ed. P 996* Drug of choice for visceral leishmaniasis: Liposomal Amphotericin B.# Note: AmpB can be used even during pregnancy# Side effect: Renal toxicity, hypokalemia, hypomagnesemia* Other agents for management of leishmaniasis:# Sodium stibogluconate: Given parenterally 20mg/kg/day for 20 days in cutaneous disease and 28 days in visceral leishmaniasis. Due to increased resistance it has now become obsolete in India. At present oral preparation is available and shows better result.- Side effect: Pancreatitis, Hepatotoxicity, Bone marrow suppression, haemolytic anemia and renal failure# Pentamidine can be used in doses of 2-3mg/kg IV or IM daily or every second day for 4-7 doses to treat cutaneous leishmaniasis.- Side effect: Nephrotoxic, Hypoglycemia# Miltefosine: Oral agent. Can be used in visceral and cutaneous leishmaniasis.- Only oral preparation available. Teratogenic - Not used in pregnancy -### End" -1337,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are used to measure ECF volume, excepta) Sucroseb) Sodium chloridec) Inulind) Heavy water, with the following options: A: c, B: d, C: ab, D: bd - -### Response: -Indicators used for fluid volumes -1.       Total body water (TBW)- Deuterium Oxide D2O, Tritium oxide, Aminopyrine, Antipyrine -2.       ECF- Inulin, Sucrose, Mannitol, Sodium thiosulphate, Na22 -3.       Plasma volume- Evan’s blue, radioactive iodine labelled serum albumin (I125) -  -4.       Blood cell volume- Cr51 labelled RBC -### End" -1338,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most afferent fibers from the lateral geniculate nucleus terminate in the primary visual coex in:, with the following options: A: Layer 1, B: Layer 2 & 3, C: Layer 4, D: Layer 5 & 6 - -### Response: -LGB has 6 layers - (i) Layers 1 & 2: They are called magnocellular (contain large cells). The M ganglion cells project to magnocellular poion of LGB, (ii) Layers 3-6: They are called parvocellular (contain small cells). P ganglion cells project to the parvocellular poion of LGB The visual coex has 6 layers. The magnocellular and parvocellular neurons project to layer 4 and 4C of the visual coex. The axons from the interlaminar region end in layers 2 and 3. -### End" -1339,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Iron is predominantly absorbed in -, with the following options: A: Stomach, B: Duodenum, C: Colon, D: Ileum - -### Response: -Ans. is 'b' i.e., Duodenum IMPORTANT FACTS ABOUT ABSORPTIONo Absorption pattern of duodenum and jejunum is almost same. Following mentioned nutrients are absorbed both in duodenum and jejunum, however their absorption differs quantitatively : -Mainly absorbed in duodenum : - Calcium. Iron.Mainly absorbed in jejunum : - Amino acids, water soluble vitamins (B1. B2, B3, B5, B6, Biotin and VitaminC), fat soluble vitamins (A, E, D, K), Fats (Triglycerides, Cholesterol), Sugars (monosaccharides, disaccharides), water, NaCl (electrolytes).o Following are absorbed in the Ileum: - Bile & bile salts. Vitamin B12, Na+, water.# Vitamin B12. (cyanocobalamine) is absorbed in the ileum. Intrinsic factor (of castle) is necessary for its absorption IF is secreted by oxyntic cells of stomach. In the lumen of the small intestine, IF forms a complex with vitamin B12. Vitamin B12-IF complex binds with a specific receptor on the surface of the epithelial ceils of the ileum r. Vitamin B12 is transported into the enterocytes leaving behing IF at the brush border.o Following are absorbed in colon : - Water and electrolytes (Na & Cl )Water and electrolyte absorptiono Water and electrolytes need no digestion and are absorbed as such. There is approximately 9 liters of water input: Ingested water: 2.0 litres, Saliva: 1.5 litres, gastric juice: 2.5 litres, bile 0.5 litre, pancreatic juice: 1.5 litres, and small intestine secretions 1.0 litre. Out of these 9 litres, 7.7 litres (85%) is absorbed in small intestine and 1.0 - 1.5 litres (5-10%) is absorbed in large intestine (colon). Total 8.8 litres of water is absorbed and 0.2 litre is excreted in feces. In small intestine, most of the water is reabsorbed in the jejunum.o Na+ and Cl. are also absorbed maximally in jejunum with some absorption in colon. -### End" -1340,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surgery of choice in patient with congenital ptosis with good levator action is, with the following options: A: LPS resection, B: Muller's Resection, C: Fascia lata sling surgery, D: Fasanella Servat operation - -### Response: -SURGICAL CORRECTION * Levator resection : very commonly done in congenital ptosis with moderate and severe grades of ptosis * Fascia lata sling surgery : done in patients having severe ptosis with no levator function. In Marcus Gunn Jaw Winking Ptosis , LPS excision is combined with frontalis sling operation and in Congenital Ptosis with bad elevation we do Sling surgery. * Fasanella Servat operation : - done in patients having mild ptosis with good levator function - it is also done in Horners syndrome *Avoid ptosis surgery in Myasthenia Gravis and Paial third nerve palsy induced ptosis as they usually resolve with medical treatment and with time -### End" -1341,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ideal time gap between 2 live vaccinations is about, with the following options: A: 2 weeks, B: 4 weeks, C: 8 weeks, D: 12 weeks - -### Response: -(B) 4 weeksGUIDELINES FOR SPACING OF LIVE & INACTIVATED ANTIGENSAntigen CombinationRecommended minimum interval between doses>= InactivatedNone; can be administered simultaneously or at any interval between dosesInactivated & LiveNone; can be administered simultaneously or at any interval between doses>=2 live parenteral*4-week minimum interval, if not administered simultaneously * Live oral vaccines (E.g., Ty21a typhoid vaccine, oral polio vaccine) can be administered simultaneously or at any interval before after inactivated or live parenteral vaccines.If live parenteral (injected) vaccines (MMR, MMRV, Varicella zoster, and yellow fever) and live intranasal influenza vaccine (LAIV) are not administered at the same visit, they should be separated by at least 4 weeks.VACCINATION CHART FOR BABIES IN INDIABCGNewborn*. Bacilli Calmette-Guerin (BCG):*. Vaccination is given to combat Tuberculosis & prevent TB Meningitis in child.*. Vaccine contains live culture of the bacterium that causes TB in humans, but in a weakened form, which triggers the immune system of the child, preventing TB to attack the body. It is given at birth.Hep BNew born 1st6th week 2nd6th month 3rd*. Hepatitis B vaccination:*. It is given to prevent liver diseases caused by the Hepatitis B virus, which can cause liver cancer, liver failure and in some cases, death.*. The first dose of vaccination is given at birth.*. RECOMBIVAX HB Hepatitis B vaccine is non- infectious and is created out of a genetic recombination.*. It is made with the help of yeast.OPV6th month 1st9th month 2nd4-6 years 3rd*. Oral Polio Vaccine (OPV):*. It is given to prevent the polio disease. It can be given orally (OPV) or via injection (IPV). OPV is a polio vaccine, It is made up of an inactivated non-wild strain of the virus which helps produce antibodies within the body.IPV6th week 1st10th week 2nd14th week 3rd16th-18th month B1*. Inactivated Polio Vaccine (IPV):*. It is given to prevent polio disease in child. It is a mandatory vaccine for all children.*. It contains a wild strain of inactivated polio virus.*. It is usually given along with the DTP vaccine.DTP6th Week 1st10th week 2nd14th week 3rd16th-18th month B1 4-6 years B2*. Diphtheria, Tetanus, & Pertussis (DTP):*. Commonly known as a whooping cough, this vaccination is mandatory.*. Vaccine is a combination of three antigens-Diphtheria toxoid, Tetanus toxoid, and Pertussis.*. These antigens are inactivated to create the DTP vaccine.*. On receiving the vaccine, antibodies are produced within the body to fight occurrence of the diseases.Rota V6th week 1st 10th week 2nd 14th week 3rd*. This vaccination is essential to protect a child against Rotavirus infection which can cause severe diarrhea in children.*. Rota virus vaccine is composed of 5 strains of inactivated rotaviruses.*. It is developed using DNA technology to build immunity in the infants against rotavirus infection.PCV6th week 1st 10th week 2nd 14th week 3rd 13th-15th month Booster*. Pneumococcal Conjugate Vaccine (PCV):*. It is given to prevent Pneumococcal infections in child.*. Pneumococcal bacteria causes ear infections, pneumonia of the lungs, bacteremia of the blood and brain meningitis.*. PCV vaccine is inactivated & does not contain any live Pneumococcal bacteria.Influenza type B (HiB)6th week 1st10th week 2nd 14th week 3rd 16th-18th month B1*. This vaccination is necessary to protect a child against Haemophilus Influenza type B (HiB) - a bacteria that causes diseases like Meningitis, Pneumonia and Epiglottitis.*. HiB is a conjugate vaccine.*. It consists of inactivated bacterial components which on being introduced to the body helps create immunity against the bacteria.MMR9th month 1st 13th-15th month 2nd 4-6 years 3rd*. Measles, Mumps & Rubella (MMR):*. Vaccination is mandatory to prevent from diseases like Measles, Mumps, and Rubella (MMR).*. Vaccine contains live, attenuated measles, mumps and rubella virus with Moraten & Edmonston- Zagreb strain in Genotype A.Typhoid9th-12th month 24th month*. Typhoid Conjugate Vaccine (TCV):*. It is given to prevent typhoid in child. It is made up of Purified Vi polysaccharide from the TY2 S or Typhi Strain.Hep A12th month 1st 18th month 2nd*. Hepatitis A vaccination is a mandatory one to prevent chronic liver infections, protection from Hepatitis A Virus.*. Hepatitis A is made from sterile suspension of inactivated virus (Strain HM175) propagated in MRC-5.Varicella13rd-15th month 1st 4-6 years 2nd*. Varicella vaccine:*. It is a vaccine that protects against chickenpox.*. One dose of vaccine prevents 95% of moderate disease & 100% of severe disease.*. Two doses of vaccine are more effective than one. -### End" -1342,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hasse rule is related to(Kerala 2007repeat), with the following options: A: Age of fetus, B: Weight of fetus, C: Height of fetus, D: Severity of burns - -### Response: -Ans) a (Age of fetus) Ref: Reddy 27th ed p68Rule of Hasse-It is used for calculating the age of the foetus. In the first five months of pregnancy the square root of crown rump length gives the approximate age of foetus in months.In the last five months the length in centimeters divided by 5 gives the age in months. -### End" -1343,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least likely cause of renal papillary necrosis?, with the following options: A: Sickle cell disease, B: Analgesic nephropathy, C: Posterior urethral valves, D: Diabetes with UTI - -### Response: -c. Posterior urethral valves(Ref: Nelson's 20/e p 2562-2567Ghai 8/e p 485-486)Sickle cell disease, use of analgesics and Diabetes are important causes of Renal papillary necrosis. -### End" -1344,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coracoid process is, with the following options: A: Pressure epiphysis, B: Traction epiphysis, C: Aberrant epiphysis, D: Atavistic epiphysis - -### Response: -Coracoid process is directed forwards and slightly laterally. It is bent finger like. It is atavistic type of epiphysis. B D Chaurasia 7th edition Page no : 9 -### End" -1345,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of following is hypeonic?, with the following options: A: 5%dextrose, B: 0.45% normal saline, C: 0.9%normal saline, D: 3% normal saline - -### Response: -3% normal saline REF: Fluids & electrolytes by By Lippincott Williams & Wilkins page 264 Isotonic Hypeonic Hypotonic Dextrose 5% in water 5% dextrose in half normal saline 0.45% normal saline 0.9% normal saline (NaC1) 5% dextrose in normal saline Ringer lactate Dextrose 10% in water -### End" -1346,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In recent memory loss, probable lesion is in, with the following options: A: Thalamus, B: Temporal lobe, C: Frontal lobe, D: All of the above - -### Response: -The Neuropsychology of Autobiographical Memory The medial temporal lobe memory system includes the hippocampus formation and the adjacent parahippocampal and perirhinal coices. The hippocampus is not the place where the content of memories is stored, but rather appears to contain a set of neural links to the content, which is distributed widely throughout the coex. Memories of an episode in one's life typically contain information from more than one modality: vision, hearing, and even taste, touch, and smell. Each of these components is stored in a unimodal sensory area, for example, the visual components of an episodic memory are stored in the visual coex in the occipital lobe, while the auditory components are stored in the auditory coex in the temporal lobe. These distributed representations are linked to a central index in the hippocampus. When recent episodes are retrieved, the index is reactivated, causing activation to spread to each of the associated unimodal areas. This is more correct of recent episodes, however. Once a representation of an episode has been fully consolidated, activation can spread between the separate features themselves, so that hippocampal activation is no longer needed. We are also beginning to gain an understanding of the brain areas that comprise the frontal components of the medial temporal lobe memory system. Medial temporal and hippocampal regions tend to be more involved in spatial context memory, while the frontocoical region, the diencephalon, and the temporal lobes are involved in temporal context memory. Much has also been learned about the neural bases of sho-term memory systems located in the frontal lobes. Psychologists have had trouble determining whether there is one type of sho-term memory, or several. The time span involved - exactly what 'sho' means - is also not widely agreed upon. In the 1980s, however, neuroscientists began exploring a large area in the dorsolateral poion of the prefrontal lobes. This area seems to be responsible for a so of memory that has been called 'working memory' - a concept that at least overlaps with the psychologist's concept of sho-term memory. Ref Harrison20th edition pg 2235 -### End" -1347,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about pelvic abscess, with the following options: A: Uncommon cause of intraperitoneal abscess, B: Identified by CT if there is a full bladder, C: Associated with pyothorax, D: May spontaneously drain via rectum - -### Response: -Ans. (d) May spontaneously drain via rectumRef: Sabiston I9th edition Page 1312* Pelvic abscess is the mc site of abscess formation in sitting position.* Rutherford Morrison pouch is the mc site of abscess formation in lying position.* Pelvic abscess is drained via rectum.* Pelvic abscess is associated with diverticulitis.* Pelvic abscess is identified after emptying the bladder in USG and CECT abdomen much clearly. -### End" -1348,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50 year old male presents to the OPD with complaints of fever with chills, headache, abdominal pain, and diarrhoea. He gives history of consuming raw refrigerated vegetables 24 hours back. What is the most likely etiologic organism?, with the following options: A: Staphylococcus aureus, B: Vibrio cholerae, C: Listeria monocytogenes, D: Bacillus cereus - -### Response: -The given clinical picture is suggestive of food poisoning caused by Listeria monocytogenes. This organism can grow at low refrigeration temperatures. Listeria moves from cell-to-cell using host cell actin framework. Shows tumbling motility at 25degC. The drug of choice is high dose intravenous ampicillin. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition -### End" -1349,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primordial prevention for CAD is: March 2011, with the following options: A: Screening, B: Regular checkups, C: Preserving traditional lifestyle, D: Treatment for raised BP - -### Response: -Ans. C: Preserving traditional lifestyle Preserving traditional lifestyles is a primordial level of prevention Levels of Prevention Model This model, advocated by Leaven and Clark in 1975, has influenced both public health practice and ambulatory care delivery worldwide. This model suggests that the natural history of any disease exists on a continuum, with health at one end and advanced disease at the other. The model delineates three levels of the application of preventive measures that can be used to promote health and arrest the disease process at different points along the continuum. The goal is to maintain a healthy state and to prevent disease or injury. It has been defined in terms of four levels: Primordial prevention Prevention of the emergence or development of risk factors in population or countries in which they have not yet appeared. Effos are directed towards discouraging children from adopting harmful lifestyles. Primary prevention An action taken prior to the onset of disease, which removes the possibility that the disease will ever occur. It includes the concept of positive health, that encourages the achievement and maintenance of an ""acceptable level of health that will enable every individual to lead a socially and economically productive life. A holistic approach Secondary prevention Action which halts the progress of a disease at its incipient stage and prevents complications. The domain of clinical medicine An imperfect tool in the transmission of disease More expensive and less effective than primary prevention Teiary prevention All measures available to reduce or limit impairment and disabilities, minimize suffering caused by existing depaures from good health and to promote the patient's adjustment to irremediable conditions. Modes of intervention Health promotion Specific protection Early diagnosis and treatment Disability limitation Rehabilitation Health promotion The process of enabling people to in areas to control over and to improve health Health education Environmental modifications Nutritional interventions Lifestyle and behavioral changes Specific protection Immunization Specific nutrients Chemoprophylaxis Protection against occupational hazards Protection from carcinogens Avoidance of allergens Rehabilitation The combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability. Examples-schools for blind, reconstructive surgery in leprosy, provision of aids for the crippled -### End" -1350,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Labia minora lacks all except, with the following options: A: Eccrine glands, B: Hair follicles, C: Apocrine glands, D: Sebaceous glands - -### Response: -Labia minora lacks hair follicles, eccrine glands and apocrine glands. But has many sebaceous glands. -### End" -1351,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which treatment would be least effective for asystole?, with the following options: A: External pacemaker, B: Intravenous epinephrine, 10 ml. of 1:10,000., C: Intravenous calcium gluconate, 10 ml. of 10% solution, D: Intravenous atropine, 0.5 mg. - -### Response: -Recommended treatment for asystole is administration of atropine. If atropine is unsuccessful epinephrine is given. Ultimately cardiac pacing is necessary if atropine and epinephrine do not establish an adequate heart rate. Calcium has no clear role in treating asystole. -### End" -1352,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following features are true for tetralogy of Fallot, except –, with the following options: A: Ventricular septal defect, B: Right ventricular hypertrophy, C: Atrial septal defect, D: Pulmonary stenosis - -### Response: -Tetralogy of Fallot - -The classical example of cyanotic patients with pulmonic stenosis is tetralogy of fallot. -TOF is the commonest congenital heart disease. -Constituents of TOF -Ventricular septal defect                        -Pulmonic stenosis           -Overriding or dextroposed aorta     -Right ventricular hypertrophy. -### End" -1353,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: X-ray finding more suggestive of ulcerative colitis than Crohn's disease:, with the following options: A: Rectal sparing, B: Loss of haustrations, C: Tracking of contrast within the bowel wall, D: Discontinuous lesions - -### Response: -Ans. (b) Loss of haustrationsRef: Sabiston 20th edition, Page 1342* Lead pipe appearance: Loss of haustrations* Rectal sparing is a feature of Crohn's* Skip lesions are also seen in Crohn's. -### End" -1354,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Based on epidemiological studies, which of the following has been found to be most protective against colon cancer?, with the following options: A: High fiber diet, B: Low fat diet, C: Low selenium diet, D: Low protein diet - -### Response: -ENVIRONMENTAL FACTORS & ITS ASSOCIATED RISK TO CAUSE COLON CANCER: INCREASED RISK PROTECTIVE FACTORS High intake of dietary lipids Pelvic irradiation Streptococcus bovis endocarditis Ureterosigmoidostomy High fiber diet NSAIDs Hormone Replacement Therapy -### End" -1355,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Absence of Corpus callosum leads to-, with the following options: A: Hemiparesis, B: Hemisensory loss, C: Astereognosis, D: No neurological manifestations - -### Response: -Ans. is 'd' i.e., No neurological manifestations o Agenesis of corpus callosum is a rare birth defect (congenital disorder) in which there is complete or partial absence of corpus callosum.o Corpus callosum is a band of tissue connecting the two hemispheres of the brain. Fibres of corpus callosum arise from the superficial layers of the cerebral cortex and they project to the homotypic regions of the contralateral cortex by passing through the corpus collosum while crossing the midline.Clinical features of Agenesis of corpus callosum:-o Signs and symptoms of agenesis of corpus callosum vary greatly among individuals.o ""Patients usually do not have any neurological manifestations"".o However, some features common in agenesis of corpus callosum are# Vision impairment# Low muscle tone (hypotonia)# Poor motor coordination# Delay in motor milestones such as sitting and walking.# Low perception of pain# Delayed toilet training# Chewing and swallowing dijficulties# Early speech and language delays# Social difficultieso Other characteristics sometimes associated with callosal disorders are# Seizures# Spasticity# Early feeding difficulties and or gastric reflux# Hearing impairments# Abnormal head and facial features# Mental retardationInvestigationo CT and MRI reveals ""Bat wing"" deformity of the ventricles.Treatmento There are currently no specific medical treatments for callosal disorders. -### End" -1356,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following TCA cycle intermediate may not be added or removed by other metabolic pathways?, with the following options: A: Oxaloacetate, B: Isocitrate, C: Citrate, D: Fumarate - -### Response: -Oxaloacetate may be formed from pyruvate during gluconeogenesis. Degradation of tyrosine and phenylalanine may produce fumarate. Citrate is transpoed out of mitochondria to be used as a source of cytoplasmic acetyl CoA. Isocitrate is formed and removed in TCA cycle. Ref: Textbook of Biochemistry for Medical Students by D.M. Vasudevan, 6th Edition, Page: 218 -### End" -1357,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28 years female G2P1 presents to antenatal clinic at 24 weeks for routine check up. USG shows a normal for gestational age fetus at 24 weeks of gestation in frank breech position, with no other abnormalities. What is the most appropriate next step in mgt?, with the following options: A: Glucose challenge test with 50 gm of glucose, B: Culture for Neisseria gonorrhoeae and Chlamydia trachomatis (normally done at initial visit and in certain high-risk GRPs at 32-36 weeks along with GRP B streptococcal screening), C: ECV, D: Immediate LSCS - -### Response: -Ans. is a, i.e. Glucose challenge test with 50 gm of glucoseRef. Read belowPoints worthnoting here are:Patient is presenting to antenatal clinic at 24 weeks for routine check up and a coincidental finding on USG is fetus in frank breech position, with no other abnormalities.Now friends at 24 weeks, breech should not worry you as most of the times it spontaneously rotates and becomes cephalic by 32 weeks of pregnancy. Thus options 'c' i.e. ECV and 'd' i.e. immediate LSCS and 'e' i.e. immediate induction and vaginal delivery are ruled out.Culture for Neisseria gonorrhoeae and Chlamydia trachomatis--It is normally done at initial visit and in certain high risk groups at 32-36 weeks along with group B streptococcal screening, so it is also ruled out.24 weeks gestational age is the correct time for screening for gestational diabetes therefore we will do glucose challenge test with 50 gm of glucose.Friends, mentioning about breech presentation was just given to confuse you, actually examiner wants to know whether you know the correct time for different screening tests or not. -### End" -1358,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Krukenberg's spindles are characteristically seen in which of the following condition?, with the following options: A: Chalazion, B: Pigmentary glaucoma, C: Sympathetic opthalmitis, D: Retinitis pigmentosa - -### Response: -Krukenberg's spindles refers to deposition of pigment granules on the posterior surface of the cornea. It is seen in pigmentary glaucoma. Pigmentary glaucoma: It is a type of secondary open angle glaucoma wherein clogging up of trabecular meshwork occurs by pigment paicles. Characteristic glaucomatous features are similar to primary open angle glaucoma. It is associated with deposition of pigment granules in the anterior segment structures such as iris, posterior surface of cornea, trabecular meshwork, ciliary zonules and crystalline lens. Gonioscopy shows: Accumulation of pigment along the Schwalbe's line inferiorly (Sampaolesi's line). Iris transillumination shows radial slit like transillumination defects in the mid periphery (Pathognomonic feature). -### End" -1359,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The active immunity offered by tetanus toxoid is effective in nearly -, with the following options: A: 25% of the patients, B: 50% of the patients, C: 75 % of the patients, D: 100% of the patients - -### Response: -The aim of active immunisation with tetanus toxoid is to vaccinate the entire community and ensure a protective level of antitoxin approximately 0.01 IU/ml serum throughout life Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 330 -### End" -1360,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60-year-old male, chronic smoker presented with gross hematuria, pain in the left flank along with significant history of weight loss, fever and shoness of breath for 3 months. O/E, a mass was palpated in the left flank which was firm in consistency and about 5x5 cm in dimensions along with a left sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was also done. Chest X-ray CECT pelvis All of the following are approved for the above condition except: -, with the following options: A: Sunitinib, B: Pazopanib, C: Temsirolimus, D: Nilotinib - -### Response: -Nilotinib is a tyrosine kinase inhibitor given in CML. This is a case of metastatic renal cell carcinoma with cannon ball metastasis in lungs. Chest x-ray shows multiple, bilateral, rounded soft tissue density massessuggestive of cannon ball metastasis in renal cell carcinoma. CT image shows the classical renal cell carcinoma. HPE image is classical of clear cell renal carcinoma. DRUGS APPROVED FOR RENAL CELL CARCINOMA: - Cytokines: - High dose interleukin-2, Interferon-alpha Tyrosine kinase inhibitors: - Sorafenib, Sunitinib, Pazopanib, Axitinib, Carbozantinib, Lenvatinib VEGF ligand antibody: - Bevacizumab mTOR inhibitors: - Temsirolimus, Everolimus PD-1 inhibitor: - Nivolumab -### End" -1361,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bradycardia in athletes is due to, with the following options: A: Increased vagal tone, B: Increased sympathetic tone, C: Decreased cardiac output, D: Low venous return - -### Response: -(A) (increased vagal tone)Persons undergoing long term training develop bradycardia at rest. The resting pulse rates in some top class sportsmen/ atheletes (for example. Zatopek. Borg) are quite low. This bradycardia is believed to be due to excessive tone of the vagi. On the other hand, exercise of some intensity will cause less rise of pulse rate after trainingAthletic pseudonephritis ; prolonged, heavy exercise, increases proteins, cells and other abnormal substance in urine due to1. Decrease in renal blood flow (RBE) produces glomerular capillary hypoxia, and increases permeability to large molecules2. Increase in plasma proteins during exercise3. Decreased rate of RBF, thus larger time is required to filter these moleculerCauses of BradycardiaPhysiologicalPathologicalDrugs* Sleep* Athletes* Hypothermia* Hypothyroidism* Heart attack* CHD* Degenerative process of aging* Obstructive jaundice* Increased intracranial pressure* Beta blockers* Channel blocker* Digitalis and antiarrhythmic drugs. -### End" -1362,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 69-yrs-old man with a 60 pack-year history for smoking presents with dizziness and visual disturbances. Physical examination reveals a purplish discoloration of his face, arms, and neck; retinal vein engorgement; and visible distention of his neck veins. His complete blood count reveals a normocytic anemia. The pathophysiology of this patient's clinical presentation most likely involves, with the following options: A: Right hea failure secondary to left hea failure, B: Obstruction of the superior vena cava by a primary tumor arising in the lungs, C: Metastatic disease to the cervical lymph nodes with compression of the jugular veins, D: Polycythemia rubra vera - -### Response: -The patient has the superior vena caval syndrome (SVCS). Malignancy accounts for 80% to 90% of cases of SVCS. Most cases are caused by a primary lung cancer extending into the neck and obstructing the superior vena cava. Clinically, patients have a puffy face with a blue to purple discoloration of the face, arms, and shoulders. Retinal vein engorgement results from increased venous pressure. Central nervous system findings include dizziness, convulsions, and visual disturbances. Increased venous pressure is noted in the upper extremities. The diagnosis is confirmed by venography, and the prognosis is poor. -### End" -1363,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about Fluconazole is most accurate, with the following options: A: It is it effective in the treatment of Aspergillosis, B: It does not penetrate the blood brain barrier, C: It's oral bioavailability is less than that of ketoconazole, D: It inhibits demethylation of lanosterol - -### Response: -Ref-KDT 6/e p761 Azoles act by inhibiting the enzyme lanosterol-14-alpha-demethvlase.resulting in reduced ergosterol synthesis. It has very good CNS penetration and oral bioavailability. It is not very effective against aspergillosis (voriconazole is thedrug of choice). -### End" -1364,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Baby presents with froth in mouth after 3 days of birth, coughing on feeding:, with the following options: A: TE fistula, B: Choanal atresia, C: Cleft palate, D: Diaphragmatic hernia - -### Response: -Ans. A. TE fistula Ref: Nelson Textbook of Pediatrics 20th/ed pl783ExplanationConditionPresentationTE fistulaMaternal polyhydramnois and single umbilical artery Excessive drooling soon after birth with frothing. Choking and cyanosis on feedingChoanal atresiaCyanosis which improves on cryingCleft palateMorphological defect presentDiaphragmatic herniaScaphoid abdomen, respiratory distress -### End" -1365,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding hepatitis E virus is:, with the following options: A: Seen in Post transfusion cases, B: Associated with increased moality in pregnant female, C: Associated with hepatitis B virus, D: All - -### Response: -Answer is B (Associated with increased moality in pregnant women) Hepatitis E is associated with increased moality in pregnant women and is acquired by fecooral route. Hepatitis E is not associated with transfusion with Hepatitis B virus infection. Most common virus associated with transfusion associated hepatitis is HCV Hepatitis E is associated with increased moality in pregnant females A unique feature of Hepatitis E virus is the clinical severity and high case fatality rate of 20-40% in pregnant women, especially in the last trimester of pregnancy. Hepatitis D is associated with Hepatitis B infection and not Hepatitis E -### End" -1366,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about oculocardiac reflex -, with the following options: A: Increase heart rate with eye movement, B: Decrease heart rate with eye movement, C: Increase heart rate by traction on medial rectus, D: Decrease heart rate by traction on medial rectus - -### Response: -Ans. is 'd' i.e., Decrease heart rate by traction on medial rectus Oculocardiac reflexo Traction on the extraocular muscles or pressure on globe (eye ball) causes bradycardia, AV block, ventricular ectopy or asystole. It is especially seen with traction on the medial rectus, but can occur with stimulation of any of the orbital contents, including the periosteumo The reflex is trigeminovagal, i.e., afferent is via trigeminal and efferent is via vagal pathwayo The oculocardiac reflex is most common in pediatric patients undergoing strabismus surgery. Nonetheless, it can be evoked in all age groups and during a variety of ocular procedures including cataract extraction, enucleation, and retinal detachment repair.o Anticholinergic drugs (atropine, glycopyrrolate) is often helpful in preventing oculocardiac reflex.o Management of oculocardiac reflex includes cessation of surgical stimulus; adequate ventilation, oxygenation & anesthesia; intravenous atropine; infiltration of rectus muscles with local anesthetic. -### End" -1367,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following bacteria contains mycolic acid in the cell wall, with the following options: A: Escherichia, B: Mycoplasma, C: Mycobacteria, D: Staphylococcus - -### Response: -Mycobacterium are slender rods that sometimes show branching, filamentous forms resembling fungal mycelium. In liquid cultures, they form a mould like a pellicle. they do not stain readily, but once stained, resist decolourisation with dilute mineral acids, due to the presence of mycolic acid in their cell wall. They are called acid-fast bacilli. Mycobacterium are slow-growing, aerobic, non-motile, non-capsulated and non-sporing. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th edition; Pg;351 -### End" -1368,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neuroblastomas - good prognositc factor is, with the following options: A: N-myc amplification, B: RAS oncogene, C: Hyperdiploidy, D: Translocations - -### Response: -Ref : Sabiston 20th edition Pgno : 1887-1888 Neuroblastoma prognostic factors Favorable prognosis Unourable Prognosis Age <1 year Thoracic primary lesion Shimada index showing well differentiated stromal rich tumor Increased ratio of VMA/HVA Normal serum ferritin Hyperdiploid or near triploid High level of expression of Trk-A gene N-myc amplification (>10) Deletion of 1p(most characteristic cytogenetics abnormality) and gain of 17q Expression of multidrug resistance protein Over expression of telomerase Increased serum ferritin Diploid Older patients of stages III and IV -### End" -1369,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with fever, uicaria, itching and swelling followed by injection of Penicillin. It is due to, with the following options: A: IgG Hypersensitivity, B: IgE Hypersensitivity, C: Delayed Hypersensitivity, D: Immune complex Hypersensitivity - -### Response: -There are two clinical pictures that can result from penicillin allergy, namely acute (Type I) and sub-acute reactions (Type II) mediated by IgE and IgG antibodies respectively. The acute allergic reaction arises immediately or rapidly within minutes to an hour or two and includes sudden anaphylaxis with hypotension, bronchospasm, angioedema and uicaria. Acute reactions result from reaction with preformed IgE to penicillin as a result of previous exposure. A less dramatic picture may occur 7 to 10 days after penicillin treatment stas or 1-2 days after repeat therapy. In this setting, the picture is sub-acute and can include uicaria, fever and ahralgias or ahritis. The sub-acute reaction is caused by preformed IgG to penicillin as a result of previous penicillin treatment. The IgG antibody results in the activation of the complement reactions producing inflammation resulting in the symptoms. Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 166,167 -### End" -1370,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a feature of Kallman syndrome?, with the following options: A: Micropenis, B: Primary amenorrhea, C: Mirror movements of hands, D: Mental retardation - -### Response: -Kallman Syndrome occurs due to defective synthesis of GnRH (Gonadotropin releasing hormone). KAL gene is X linked. During fetal life, the GnRH neurons originate in Olfactory Placode and then migrate along fetal olfactory neuron. They eventually wend their way to the hypothalamus. Presenting features Associated with Males: delayed pubey and micro-penis. Females: Primary amenorrhea and failure of development of secondary sexual characteristics Anosmia Colour blindness, optic atrophy SN deafness Mirror movements of hands (synkinesia) Cleft palate Renal abnormalities Mirror movements -### End" -1371,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Consider the following health hazards. Which of the associated with enviromental lead exposure?, with the following options: A: Lowering of IQ in children \/ Lowering of systolic blood pressure \/ Reduced RBC survival and reduced heme biosynthesis & Higher rates of miscarriages, stillbihs and preterm deliveries, B: Lowering of IQ in children & Lowering of systolic blood pressure, C: Lowering of IQ in children \/ Reduced RBC survival and reduced heme biosynthesis & Higher rates of miscarriages, stillbihs and preterm deliveries, D: Lowering of IQ in children \/ Lowering of systolic blood pressure & Reduced RBC survival and reduced heme biosynthesis - -### Response: -parks textbook of preventive and social medicine 23rd edition. *lead poisons many systems in the body and it is paicularly damage to children devoloping brain and nervous system elevated lead levels in children is associated with impaired neuropsychologic devolopment as measued by loss of IQ,poor scholl preformance and behavioural difficulties. -### End" -1372,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hysteria is characterised by, with the following options: A: Indifference to suffering, B: Flight of ideas, C: Pressure of speech, D: Autistic thinking - -### Response: -(A) Indifference to suffering # The characteristics of HYSTERIA are :> Impulsive, uncontrolled behavior (impulse dyscontrol).> Manipulative, exhibitionistic, emotional, dramatic, and/or seductive behavior (histrionic personality traits).> Absence of objective signs of organic illness.> Presence of multiple vague somatic symptoms, especially in a female patient (masked depression, somatization disorder or Briquet's hysteria).> Hypochondriasis; Any mental illness.> Presence of certain symptoms which are not explainable in the context of present organic illness (functional overlay, conversion symptoms).> Difficult patient; poor doctor-patient communication.> 'Sick' role or 'abnormal illness behavior'.; Psychosomatic disorders.; Malingering. ; Psychosexual dysfunctions. -### End" -1373,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true Fanconi's anaemia except, with the following options: A: Defect in DNA repair, B: Bone marrow hyperplasia, C: Congenital anomaly present, D: Increased chances of cancer - -### Response: -Ref Robbins 8/e p1090; 9/e p630 Fanconi anemia (FA) is an autosomal recessive disease characterized by congenital anomalies, bone marrow failure, and leukemia susceptibility. FA cells show chromosome instability and hypersensitivity to DNA cross-linking agents such as mitomycin C. Recent studies indicate that there are at least 8 genetically distinct FA groups (A, B, C, D1, D2, E, F, G). To date, 6 genes (for A, C, D2, E, F, and G) have been cloned. In this review, we describe the structures and functions of FA proteins. Increasing evidence indicates that the multiple FA proteins cooperate in a biochemical pathway and/or a multimer complex. FANCD2, a downstream component of the FA pathway, has recently been shown to be ubiquitinated in response to DNA damage and to translocate to nuclear foci containing BRCA1, a breast cancer susceptibility gene product, suggesting a role for this protein in DNA repair functions. We also describe 2 emerging issues: genotype-phenotype relationships and mosaicism. The FA pathway is likely to play a critical role as a caretaker of genomic integrity in hematopoietic stem cells. Clarifying the molecular basis of this disease may provide new insights into the pathogenesis of bone marrow failure syndromes and myeloid malignancies. -### End" -1374,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Theophylline therapeutic blood ranges, with the following options: A: 0-5, B: 10-May, C: 15-May, D: 20-May - -### Response: -(5-20) (221-KDT6th)* Therapeutic ranges 5-20 as shown in above figure* Theophylline has a narrow margin of safety. Dose dependent toxicity starts from upper part of therapeutic concentration -### End" -1375,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common cause of acute osteomyelitis is DLETE, with the following options: A: Trauma, B: Surgery, C: Fungal infection, D: Hematogenous spread - -### Response: -Hematogenous osteomyelitis is the commonest form of osteomyelitis and most common source if bone and joint infection is Hematogenous Refer Maheshwari 6th/e 168 -### End" -1376,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The patient with the following show the maximum deposits of lipofuscin in -, with the following options: A: Gaucher's disease, B: Tay sach's disease, C: Acute Enteric fever, D: Severe malnutrition - -### Response: -Ans. is 'd' i.e., Severe malnutrition -### End" -1377,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about 1st pa of duodenum, except ?, with the following options: A: 5 cm long, B: Is superior pa, C: Develops from foregut, D: Supplied by superior mesenteric aery - -### Response: -Ans. is 'd' i.e., Supplied by superior mesenteric aeryDuodenum Duodenum is 'C' shaped, shoest, widest and most fixed pa of small intestine. It is 25 cm long. It is devoid of mesentery. Most of the duodenum is retroperitoneal and fixed, except at its two ends where it is suspended by folds of peritoneum, and is therefore mobile. Duodenum lies opposite Ll, L2 and L3 veebrae.Duodenum is C-shaped curve which encloses the head of pancreas and is subdivided into four pas :1. First pa (Superior pa) : It is 5 cm (2 inches) long. It begins at the pylorus and meet the second pa at superior duodenal flexure. This pa appears as duodenal cap on barium studies.2. Second pa (Descending pa) : It is about 7.5 cm (3 inches) long. It is veical pa which begins at superior duodenal flexure and meet the third pa at inferior duodenal flexure. The interior of second pa of duodenum shows following features :i) Major duodenal papilla : It is present 8-10 cm distal to the pylorus. The hepatopancreatic ampulla or ampulla of Vater (joint pa of bile duct and pancreatic duct) opens here.ii) Minor duodenal papilla : It is present 6-8 cm distal to the pylorus. Accessory pancreatic duct opens here.3. Third pa (Horizonal pa) : It is 10 cm (4 inches) long. It begins at inferior duodenal flexure and passes towards the left in front of IVC behind superior mesenteric vessels and root of mesentery to meet 4th pa of duodenum.Fouh pa : It is 2-5 cm (1 inches) long and runs upward immediately to the left of aoa. It ends at duodenojejunal flexure by joining the jejunum.Aerial supplyThe pa of duodenum before the opening of bile duct (major duodenal papilla) develops from foregut and therefore is supplied by coeliac trunk through superior pancreaticoduodenal aery, a branch of gastroduodenal aery, which in trun is a branch of common hepatic aery. Pa of duodenum distal to opening of bile duct is developed from midgut and therefore is supplied by superior mesenteric aery through inferior pancreaticoduodenal aery. First pa of duodenum receives additional supply from right gastric aery, supraduodenal aery (a branch of common hapatic aery), retroduodenal branch of gastrodudenal aery and right gastropiploic aery. -### End" -1378,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Unsegmented eggs are seen in which of the following, with the following options: A: Trichuris trichura, B: Necator americanus, C: Ankylostoma, D: Dracunculus - -### Response: -Manner of egg layingOrganismsOviparous Unsegmented eggsAscaris lumbricoides , Trichuris trichiuraSegmented eggsAncylostoma duodenale, Necator americanusEgg containing larvaEnterobius vermicularisViviparous Dracunculus medinensis, Trichinella spiralis , Brugia spp, Wuchereria bancrofti , OvoviviparousStrongyloides stercoralis(Ref: K.D Chatterjee 13th edition, p205-206) -### End" -1379,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Actinomycetoma is caused by-, with the following options: A: Actinomyces, B: Nocardias, C: Streptomyces, D: All - -### Response: -Ans. is 'a' i.e., Actinomyces; 'b' i.e., Nocardia; 'c' i.e., Streptomyces -### End" -1380,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are primarily restrictive operations for morbid obesity, except:, with the following options: A: Veical band gastroplasty, B: Duodenal switch operation, C: Roux-en-Y gastric bypass, D: Laparoscopic adjustable gastric banding - -### Response: -Types of Bariatric Surgeries: Bariatric operation Mechanism of action Veical banded gastroplasty Laparoscopic adjustable gastric banding (Safest & reversible) Restrictive Roux-en-Y gastric bypass (RYGB): MC performed procedure now-a-days Largely Biliopancreatic diversion- Duodenal switch Largely Malabsorptive/Mildly Restrictive -### End" -1381,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tripod fracture is -, with the following options: A: Displaced fracture of calcaneum, B: Zygomatiomaxillary fracture, C: Sphenoid Wing Fracture, D: Coronal Shear pilon Fracture - -### Response: -Ans. is 'b' i.e., Zygomatiomaxillary fracture o Zygomaticomaxillary complex (ZMC) fractures, also known as a tripod, tetrapod, quadripod, malar or trimalar fractures, are seen in the setting of traumatic injury to the face. They comprise fractures of the:# Zygomatic arch# Inferior orbital rim, and anterior and posterior maxillary sinus walls# Lateral orbital rim -### End" -1382,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Quinsy is -, with the following options: A: Peritonsillar abscess, B: Retropharyngeal abscess, C: Parapharyngeal abscess, D: None - -### Response: -Ans. is 'a' i.e., Peritonsillar abscess Peritonsillar abscess (Quinsy)o Quinsy consists of suppuration outside the capsule in the area around the capsule. There is collection of pus between the capsule of tonsil and the superior constrictor muscle, i.e. in the peritonsillar area. Peritonsillar abscess is a complication of tonsillitis and is most commonly caused by group A beta - hemolytic streptococcus.Clinical features of Quinsyo Clinical features are divided intoGeneral: They are due to septicaemia and resemble any acute infection. They include fever (up to 104degF), chills and rigors, general malaise, body aches, headache, nausea and constipation.Local:Severe pain in throat. Usually unilateral.Odynophagia. It is so marked that the patient cannot even swallow his own saliva which dribbles from the angle of his mouth. Patient is usually dehydrated.Muffled and thick speech, often called ""Hot potato voice"".Foul breath due to sepsis in the oral cavity and poor hygiene.Ipsilateral earache. This is referred pain via CN IX which supplies both the tonsil and the ear.Trismus due to spasm of pterygoid muscles which are in close proximity to the superior constrictor.Examination findingsThe tonsil, pillars and soft palate on the involved side are congested and swollen. Tonsil itself may not appear enlarged as it gets buried in the oedematous pillars.Uvula is swollen and oedematous and pushed to the opposite side.Bulging of the soft palate and anterior pillar above the tonsil.Mucopus may be seen covering the tonsillar region.Cervical lymphadenopathy is commonly seen. This involves jugulodigastric lymph nodes.Torticollis : Patient keeps the neck tilted to the side of abscess.Treatment of peritonsillar abscesso IV fluidso Antibiotics : High dose penicllin. (iv benzipenicillin) is the DOC. In patients allergic to penicillin erythromycin is the DOC.o Incision and drainage per orally, if the abscess does not resolve depite high dose of iv antibioticso Tonsillectomy is done 6 weeks following an attack of quinsy (interval tonsillectomy) -### End" -1383,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following prominence is unpaired:, with the following options: A: Frontonasal, B: Maxillary, C: Mandibular, D: None of the above - -### Response: -The frontonasal prominence is a single unpaired structure; the other prominences are paired. Ref: Langman's embryology 11th edition Chapter 16. -### End" -1384,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following enzymes are involved in oxidation-reduction reactions, except:, with the following options: A: Dehydrogenases, B: Hydrolases, C: Oxygenases, D: Peroxidases - -### Response: -Hydrolases does not belong to oxidoreductase family. Oxidoreductases are enzymes which catalyse the transfer of electrons from one molecule (reductant) to another molecule (oxidant). It plays a major role in biodegradation pathways. Enzymes present in oxidoreductase family are oxygenase, reductase, dehydrogenase and peroxidase. Ref: Microorganisms in Environmental Management: Microbes and Environment By T. Satyanarayana, Bhavdish Narain Johri, Anil Prakash, Page 233; Biochemical Engineering By Gummadi, Page 89 -### End" -1385,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Technique used for Aspiration of sperm directly from Testes for In-vitro feilization is:, with the following options: A: IVF, B: ICSI, C: TESA, D: GIFT - -### Response: -Testicular sperm aspiration (TESA) is a procedure sample of sperm cells are removed from the testicle through a small needle attached to a syringe. Other methods used are PESA: Percutaneous Epididymal Sperm Aspiration both TESA and PESA can be done under LA. MESA: Microsurgical Epididymal Sperm Aspiration TESE: Testicular Sperm Extraction MESA is the best technique for getting useable sperms since the epididymal sperms are the 'Ready'sperms which are ejaculated with the sexual act MESA allows for diagnosis and possible reconstruction of ductal pathology and because it usually yields very large numbers of sperm, sperm cryopreservation and avoidance of repeat surgery may be possible ICSI: Intracytoplasmic sperm injection GIFT: Gamete intra fallopian tube transfer IVF: In vitro feilisation -### End" -1386,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patients should be cautioned not to consume alcohol when given a prescription for any of the following EXCEPT:, with the following options: A: Cefixime, B: Cefoperazone, C: Chlorpropamide, D: Metronidazole - -### Response: -Drugs showing disulfiram like reaction with alcohol are: Cefamandole, Cefoperazone, Cefotetan Moxalactam Chlorpropamide Metronidazole Griseofulvin Procarbazine -### End" -1387,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child's criteria is used in Cirrhosis, with the following options: A: Pancreatitis, B: Cirrhosis, C: Multiple myeloma, D: AIDS - -### Response: -Variables of CTP score Serum albumin Serum bilirubin Prothrombin time Ascites Encephalopathy Ref: Sabiston 20th edition Pgno : 1436 -### End" -1388,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spike and Dome pattern is seen in: March 2007, with the following options: A: Petitmal seizures, B: Grandmal seizures, C: Clonic seizures, D: Myoclonic seizures - -### Response: -Ans. A: Petitmal seizures This classification is based on observation (clinical and EEG) rather than the underlying pathophysiology or anatomy. Paial seizures (Older term: focal seizures) Simple paial seizures - consciousness is not impaired (With motor, sensory, autonomic or psychic symptoms) Complex paial seizures - consciousness is impaired (Older terms: temporal lobe or psychomotor seizures) Paial seizures evolving to secondarily generalized seizures Generalized seizures -- Absence seizures (Older term: petit mal) - Myoclonic seizures - Tonic seizures - Tonic-clonic seizures (Older term: grand mal) - Atonic seizures Unclassified epileptic seizures Absence seizures: This condition however usually affects children(aged 4-8 year) as opposed to adults, and no warning are given e.g Aura, although the patient may act strangely including a blank stare. It can be defined as 5 - 30 sec of unconsciousness, during which muscles undergoe twitchlike contractions, normally the head region e.g blinking of the eyes. The contractions are usually followed by consciousness and resumation of previous activities. The brain wave pattern is typified by a spike and dome reading. Where the spike region of the recording is almost identical to the spikes that occur in Grand Mal epilepsy, but the dome region's are distinctly different. -### End" -1389,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year-old man presented with painless haematuria. Bimanual examination revealed a ballottable mass over the right flank. Subsequently right nephrectomy was done and the mass was seen to be composed of cells with clear cytoplasm. Areas of hemorrhage and necrosis were frequent cytogenetic analysis of this mass is likely to reveal the abnormality of-, with the following options: A: Chromosome 1, B: Chromosome 3, C: Chromosome 11, D: Chromosome 17 - -### Response: -Clear cell type RCC (70%): This is the most common pattern. The clear cytoplasm of tumour cells is due to the removal of glycogen and lipid from the cytoplasm during the processing of tissues Sporadic and familial (Homozygous loss of VHL gene located on chromosome 3) Ref: Textbook of pathology Harsh Mohan 6th edition page 695 -### End" -1390,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phase 3 is, with the following options: A: High Stationary Stage, B: Late expanding stage, C: Low Stationary stage, D: Early expanding stage - -### Response: -Demographic cycle based on CBR & CDR Demographic cycle CBR CDR 1st stage High stationary High High 2nd stage Early expanding High Sta decreasing 3rd stage Late expanding Sta decreasing Already decreasing 4th stage Low stationary Low Low 5th stage Decline CDR > CBR -### End" -1391,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: As per WHO classification 'X2' stage of xerophthalmia refers to:, with the following options: A: Conjunctival xerosis, B: Bitot's spots, C: Corneal xerosis, D: Corneal ulceration - -### Response: -Ans. Corneal xerosis -### End" -1392,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Direct action on Nm Cholinoreceptors is shown by-, with the following options: A: Physostigmine, B: Neostigmine, C: Both the above, D: None of the above - -### Response: -Ans. is 'b' i.e.'b' Neostigmine Comparative features of physosdgmine and neostigmine PhysostigmineNeostigmine1. SourceNatural alkaloid form Physosiigma venenosum (Calabar bean)Synthetic2. ChemistryTertiaryr amine derivativeQuaternary' ammonium compound3. Oral absorptionGoodPoor4. CNS actionsPresentAbsent5. Applied to eyePenetrates corneaPoor penetration6. Direct action on Xm cholinoceptorsAbsentPresent7. Prominent effect onAutonomic effectorsSkeletal muscles& Important useMiotic (glaucoma)Myasthenia gravis9. Dose0-5-1 mg oral/parenteral0-I-T0%eye drops0-5-2-5mgi.m./s.c.15-30 mg orally10. Duration of actionSystemic 4-6 hrsIn eye 6 to 24 hrs3-4 hrs. -### End" -1393,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antimalarial of choice in a pregnant woman (I timester) who is chloroquine resistant is?, with the following options: A: Quinine, B: Proguanil, C: Dapsone & pyrimethamine, D: Mefloquine - -### Response: -Ans. is 'a' i.e., Quinine ""Quinine is the only widely available drug that is acceptable as suitable for treating chloroquine - resistant infections during pregnancy"". -### End" -1394,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contrast agent which are not used for CT scan:, with the following options: A: Water, B: CO2, C: Barium compounds, D: Iodinated high-osmolality contrast media - -### Response: -Ans. B. CO2Ref Sumer Sethi 6th/20; Radiology 6 Imaging by Thayalan159; Dahne Radiology Manual 7th/1147-48Radiocontrast agents are a type of medical contrast medium used to improve the visibility of internal bodily structures in X-ray-based imaging techniques such as computed tomography (CT), radiography & fluoroscopy.Radiocontrast agents are typically iodine or barium compounds.When an agent improves visibility of an area, it is called ""contrast enhancingGadolinium is a key component of the contrast material most often used in magnetic resonance (MR) exams.Saline (salt water) and air are also used as contrast materials in imaging exams.Barium sulfate contrast media continue to be the preferred agents for opacification of the gastrointestinal tract for conventional fluoroscopic examinationsThe current use of iodinated water-soluble contrast media is primarily limited to select situationsTwo commercid water-soluble iodinated high-osmolality contrast media (HOCMs) specifically designed for enteric opacification are in common use. Gastrografin and, Gastroview -### End" -1395,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about Cefepime is true, with the following options: A: It is a 4th generation cephalosporin, B: Once a day dosing is given, C: It is not active against pseudomonas, D: It is a prodrug - -### Response: -Refer Goodman Gilman 12th/1498 Cefepime is 4th generation cephalosporin with good activity against pseudomonas. It is given 8-12 hourly -### End" -1396,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Predisposing factors for skin cancer are, with the following options: A: Smoking, B: Uv light, C: Chronic ulcer, D: Infrared light - -### Response: -Ref Robbins 9/e p1155; Harrison 16/e p497 Uvrays and chronic ulcer are also the answers proliferation. Dysplasia is encountered principally in epi- thelial lesions. It is a loss in the uniformity of individual cells and in their architectural orientation. Dysplastic cells exhibit considerable pleomorphism and often possess hyperchro- matic nuclei that are abnormally large for the size of the cell. Mitotic figures are more abundant than usual and frequently appear in abnormal locations within the epithe- lium. In dysplastic stratified squamous epithelium, mitoses are not confined to the basal layers, where they normally occur, but may be seen at all levels and even in surface cells. There is considerable architectural anarchy. For example, the usual progressive maturation of tall cells in the basal layer to flattened squames on the surface may be lost and replaced by a disordered scrambling of dark basal- appearing cells (Fig. 5-6). When dysplastic changes are marked and involve the entire thickness of the epithelium, the lesion is referred to as carcinoma in situ, a preinvasive stage of cancer (Chapter 18). Although dysplastic changes often are found adjacent to foci of malignant transforma- tion, and long-term studies of cigarette smokers show that epithelial dysplasia almost invariably antedates the appear- ance of cancer, the term dysplasia is not synonymous with cancer; mild to moderate dysplasias that do not involve the entire thickness of the epithelium sometimes regress completely, par- ticularly if inciting causes are removed. Clinical Features Although most of these lesions arise in the skin, they also may involve the oral and anogenital mucosal surfaces, the esophagus, the meninges, and the eye. The following com- ments apply to cutaneous melanomas. Melanoma of the skin usually is asymptomatic, although pruritus may be an early manifestation. The most impoant clinical sign is a change in the color or size of a pigmented lesion. The main clinical warning signs are 1. Rapid enlargement of a preexisting nevus 2. Itching or pain in a lesion 3. Development of a new pigmented lesion during adult life 4. Irregularity of the borders of a pigmented lesion 5. Variegation of color within a pigmented lesion These principles are expressed in the so-called ABCs of melanoma: asymmetry, border, color, diameter, and evolu- tion (change of an existing nevus). It is vitally impoant to recognize melanomas and intervene as rapidly as pos- sible. The vast majority of superficial lesions are curable surgically, while metastatic melanoma has a very poor prognosis. The probability of metastasis is predicted by measuring the depth of invasion in millimeters of the veical growth phase nodule from the top of the granular cell layer of the overlying epidermis (Breslow thickness). Metastasis risk also is increased in tumors with a high mitotic rate and in those that fail to induce a local immune response. When metastases occur, they involve not only regional lymph nodes but also liver, lungs, brain, and viually any other site that can be seeded hematogenously. Sentinel lymph node biopsy (of the first draining node of a primary melanoma) at the time of surgery provides additional information on biologic aggressiveness. In some cases, metastases may appear for the first time many years after complete surgical excision of the primary tumor, suggesting a long phase of dormancy, during which time the tumor may be held in check by the host immune response. Recognition of the likely role of the host immune response has led to therapeutic trials of immunomodula- tors. Some impressive responses in patients with advanced -### End" -1397,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Single best moality indicator-, with the following options: A: CDR, B: PMR, C: ASDR, D: CFR - -### Response: -Ans. is 'c' i.e., ASDR o Age standardized death rate (ASDR) is best moality indicator. -### End" -1398,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Waxy flexibility, stereotype verbal, behavioural signs and negative symptoms are feature of?, with the following options: A: Paranoid schizophrenia, B: Hebephrenic schizophrenia, C: Catatonic schizophrenia, D: Simple schizophrenia - -### Response: -Ans. C. Catatonic schizophrenia. (Ref Neeraj Ahuja 5th /pg. 68; Kaplan & Sadock's synopsis of psychiatry:10th/Tab 13-5)Schizophrenia (Catatonic Type )A form of schizophrenia that is characterized by marked psychomotor activity, a variety of catatonic symptoms.Features Of Catatonic Schizophrenia# Bizarre posturing# Rigidity# Echolalia, echopraxia# Mutism# Waxy flexibility# Ambitendancy (no goal directed actions)# Stupor# Negativism (motiveless resistance to all commands and doing opposite)# Other signs (mannerisms, stereotype verbal and behavioural automatic obedience, verbigeration)SchizophreniaParanoidHebephrenic (Disorganized)CatatonicSimpleOccur in later life(3rd or 4th decade).Occurs in early 2nd decade.Occurs in late 2nd or 3rd decade.Occurs in early life (2nd decade).Onset is insidious and course is progressive.Onset is insidious and course is progressive.Onset is usually acute course is episodic.Onset is insidious and course is progressiveProminent preoccupation with a specific delusional system and who otherwise do not qualify as having disorganized-type disease.Disorganized speech and behavior are accompanied by a superficial or silly affect.Clinical presentation is dominated by profound changes in motor activity, negativism, and echolalia or echopraxia. Has best prognosis compared to other subtypes. Completely recovery does not occur.Worst prognosisRecovery from episode is usually complete.Prognosis is usually poor.Schizophrenias||||||| Commonest TypeAmphetamine causesEarly onset & Bad prognosisLate onset & best prognosisVery late (3rd,4th Deacde)Worst pronosis & most difficult to diagnose|||||| ParanoidParanoidhebephrenicCatatonicParanoidSimple Paranoid- Delusions of persecution or grandeur- Often accompanied by hallucinations( voices)Catatonic- Complete stupor or pronounced decrease in spontaneous movements- Alternatively, can be excited and evidence extreme motor agitationDisorganized- Incoherent, primitive, uninhibited- Unorganized behaviors and speech- Active, butr aimless- Pronounced thought disorderUndifferentiated- Psychotic symptoms but does not fit paranoid, catatonic, or disorgazized diagnosesResidual- Previous episode, but not prominent psychotic symptoms at evaluation- Some lingering negatilve symptoms Negative symptomsPositive sympytom- Loss of function- Loose associations- Anhedonia- Hallucinations and delusions- Decreased emotional expression- Bizarre behavior, and- Impaired concentration, and- Increased speech- Diminished social engagement)SCHNEIDER'S FIRST-RANK SYMPTOMS OF SCHIZOPHRENIA INCLUDE:# Withdrawal or broadcasting;# Auditory hallucinations;# Impulses or actions;# Somatic passivity (Mnemonic: WAIST MD)# Thought insertion,# Made feelings,# Delusional perception.EUGEN BLEULER'S FUNDAMENTAL SYMPTOMS OF SCHIZOPHRENIA (4 A'S)# Ambivalence (marked inability to decide for or against)# Autism (withdrawal into self)# Affect blunting (disturbance of affect)# Association disturbances (loosening of association, thought disorder) -### End" -1399,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Internal pudendal aery supplies all except, with the following options: A: Perineum, B: Penis, C: Anal canal, D: Anterior abdominal wall - -### Response: -It arises from the anterior division of internal iliac aery. It runs on the lateral pelvic wall.It exits the pelvic cavity through the greater sciatic foramen, inferior to the piriformis foramen, to enter the gluteal region.It then curves around the sacrospinous ligament to enter the perineum through the lesser sciatic formen.It travels through the pudental canal with the internal pudental vein and the pudental nerve. ref - BDC 6e vol2 pg364 -### End" -1400,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Puberty happens due to pulasatile release of -, with the following options: A: GnRH, B: Estrogen, C: LH/ICSH, D: Testosterone - -### Response: -Ans. is 'a' i.e., GnRH o Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction.o It is initiated by the release of GnRH hormone in pulseso On average, girls begin puberty around ages 10-11; boys around ages 11-12. Girls usually complete puberty around ages 15-17,while boys usually complete puberty around ages 16-17.o The major landmark of puberty for females is menarche, the onset of menstruation, which occurs on average between ages 12-13;for males, it is the first ejaculation, which occurs on average at age 13 -### End" -1401,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Axillary nerve supplies:, with the following options: A: Deltoid + Teres major, B: Deltoid + Teres minor, C: T. major + T. minor, D: Corachobrachialis + Sho head of biceps - -### Response: -B i.e. Deltoid + Teres minor -### End" -1402,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin which is not required in the TCA cycle?, with the following options: A: Pyridoxine, B: Niacin, C: Pantotheic acid, D: Riboflavin - -### Response: -Vitamins, in the form of their respective coenzymes, are required for proper functioning of the TCA cycle. vitamins needed in the TCA cycle are: Thiamine as TPP Riboflavin as FAD and FMN Niacin as NAD and NADH Pantothenic acid as a pa of Coenzyme A Reference: Harpers illustrated biochemistry 30th edition -### End" -1403,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old patient presents with features of poor perfusion following MI. On examination, hea rate is 40/min with BP of 60 mmHg systolic. Atropine was given twice over 5 minutes, but the condition of the patient is not improving. What is the next best step?, with the following options: A: Transvenous Pacing, B: Transcutaneous Pacing, C: Implantable cardioveer defibrillator, D: Repeat atropine - -### Response: -ACLS 2015 guidelines: Case of symptomatic bradycardia with signs of poor perfusion--> Transcutaneous pacing is recommended. -### End" -1404,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heinz bodies are removed by?, with the following options: A: Macrophages, B: Lymphocytes, C: Neutrophills, D: Fibroblasts - -### Response: -Ans. is 'a' i.e., Macrophages Heinz bodies* Heinz bodies are formed by damage and denaturing to the hemoglobin component of red blood cells, most commonly by oxidative stress, rarely by genetic abnormalities in hemoglobin.* The oxidative stress denatures portions of the hemoglobin, causing the hemoglobin to precipitate and produce Heinz Bodies, which becomes an antigenic agent. Thus, macrophages detect the antigen and remove the damaged portions of the cell, its damaged membrane and the denatured hemoglobin (now called the Heinz Body).* These are associated clinically with congenital hemolytic anemia, G6PD deficiency, hemolytic anemiasecondary to drugs such as phenocetin, some hemoglobinopathies (thalossemia), and after splenectomy. -### End" -1405,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 40yr old male patient having pain with daily morning stiffness of spine for 30 minutes and reduced chest movements. Most probable diagnosis is, with the following options: A: Ankylosing spondylitis, B: Rheumatoid ahritis, C: Gouty ahritis, D: Osteoahritis - -### Response: -The information in question are 40yr male Morning stiffness in spine Limited chest expansion *****all fit into clinical criteria for diagnosis of Ankylosing spondylitis x ray of ankylosing spondylitis -BAMBOO SPINE AS is a chronic, progressive immune-mediated inflammatory disorder that results in ankylosis of the veebral column and sacroiliac joints . * The spine and sacroiliac joints are the common affected sites -- Chronic spinal inflammation (spondylitis) can lead to fusion of veebrae (ankylosis) . Characteristic Pathologic Features : * Chronic inflammation in: - Axial structures (sacroiliac joint, spine, anterior chest wall, shoulder and hip) - Possibly large peripheral joints, mainly at the lower limbs (oligoahritis) - Entheses (enthesitis) * Bone formation paicularly in the axial joints Axial manifestations: * Chronic low back pain * With or without buttock pain * Inflammatory characteristics: - Occurs at night (second pa) - Sleep disturbance - Morning stiffness * Limited lumbar motion * Onset before age of 40 years Refer maheswari 9th ed -### End" -1406,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Taking off once clothes and running in public is called, with the following options: A: Mooning, B: Exhibitionism, C: Voyeurism, D: Undinism - -### Response: -EXHIBITIONISM: An exhibitionist is one who, over a period of 6 months or more, experiences recurrent, intense sexually arousing urges or behaviors involving the exposure of one's genitals to an unsuspected stranger. It usually occurs before adulthood. It is done mostly by male, often to children or to the persons of the opposite sex. In some cases, the act is impulsive and spontaneous, while in other cases it is premediated. Occasionally women may expose themselves in public. Majority of them are psychopathic or suffer from compulsion neuroses. It is an obscene act, punishable under S.294, I.P.C. with imprisonment up to 3 months or fine. REF: THE SYNOPSIS OF FORENSIC MEDICINE AND TOXICOLOGY 29th edition page no: 227. -### End" -1407,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Destruction of zona glomerulosa will deplete:, with the following options: A: Aldosterone, B: Cortisol, C: Testosterone, D: Catecholamines - -### Response: -The zona glomerulosa, a thin layer of cells that lies just  underneath  the  capsule, constitutes about 15 percent of the adrenal cortex. These cells are the only ones in the adrenal gland capable of secreting significant amounts of aldosterone because they contain the enzyme aldosterone synthase, which is necessary for synthesis of aldosterone. The secretion of these cells is controlled mainly by the extracellular fluid concentrations of angiotensin II and potassium, both of which stimulate aldosterone secretion. -### End" -1408,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most commonly liver transplant in infants is done for, with the following options: A: Biliary atresia, B: Hemochromatosis, C: Biliary cirrhosis, D: Uremia - -### Response: -10-15% of liver transplantation in children is done for biliary atresia. Acute liver failure from hemochromatosis is the primary indication for liver transplantation in the neonatal population. Cirrhosis is the most common indication for liver transplantation in adults Reference Bailey and love&;s edition 24 page 202 -### End" -1409,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intermediate mesoderm is the precursor of the:, with the following options: A: Heart, B: Body wall, C: Urogenital system, D: Somites - -### Response: -Intermediate Mesoderm -The intermediate mesoderm forms most of the genitourinary system, e.g., kidneys, testes, ovaries, etc. -The intermediate mesoderm is a longitudinal strip of intraembryonic mesoderm lying on either side of notochord between paraxial mesoderm and lateral plate mesoderm. After folding of embryo the intermediate mesoderm forms a longitudinal elevation of mesoderm along the dorsal body wall on each side of dorsal aorta/dorsal mesentery of gut. This longitudinal elevation is called urogenital ridge. -The medial part of urogenital ridge that gives rise to the genital system is called genital ridge and lateral part of urogenital ridge that gives rise to the urinary system is called nephrogenic cord. -### End" -1410,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about inspiration; the intrapleural pressure becomes:, with the following options: A: More - ye, B: More +ve, C: Same, D: Initially positive, then negative - -### Response: -A i.e. More - ve -### End" -1411,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Binding site present on β subunit of Na+ - K+ pump is, with the following options: A: Na+, B: K+, C: ATP, D: Glycosylation - -### Response: -β subunit shows three Glycosylation sites extracellularly, with attached carbohydrate residues. -### End" -1412,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CARE is associated with -, with the following options: A: ICDS, B: CRY, C: Ford Foundation, D: RCH scheme - -### Response: -Cooperative for Assistance and Relief Everywhere was founded in Noh america.Its world largest independent ,non-profit ,non secretarian international relief and devolopment organization.CARE provides emergency aid and long term devolopment assistance. CARE India focused its food suppo in the ICDS programme and in devolopment of programmes in areas of health and income supplementation.Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 924 -### End" -1413,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the following is orally active direct Xa inhibitor?, with the following options: A: Rivaroxaban, B: Agrataban, C: Dabigatran, D: Bilverudin - -### Response: -Ans. a. RivaroxabanRivaroxaban, apixaban & edoxaban are factor Xa inhibitors.Dabigatran etexilate is direct thrombin inhibitor. -### End" -1414,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the adrenal gland, androgens are produced by the cells in the-, with the following options: A: Zonaglomerulosa, B: Zonareticularis, C: Zonafasciculata, D: Medulla - -### Response: -adrenal coex with zona fasciculata produce adrenal androgens (Davidson 21 pg 769) -### End" -1415,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common bacterial infection in lymphedema is:-, with the following options: A: Staphylococcus, B: Streptococcus, C: E. coli, D: Pseudomonas - -### Response: -The most common complication of both primary and secondary lymphedema is Erysipelas(streptococcus infection) Cellulitis may occur concurrently in lymphedema because of pooling of protein rich lymph fluid makes it easier for the patient to develop an infection. -### End" -1416,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Absolute lymphocytosis is seen in, with the following options: A: SLE, B: TB, C: CLL, D: Brucellosis - -### Response: -ref to P.JMehta 14/e p374 CLL and brucellosis is also the answer Leukocytosis is white cells (the leukocyte count) above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, but may also occur following ceain parasitic infections or bone tumors as well as leukemia -### End" -1417,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anteversion of uterus is maintained by, with the following options: A: Cardinal ligaments, B: Uterosacral ligaments, C: Pubocervical ligaments, D: Round ligaments - -### Response: -(D) Round ligaments[?]POSITIONS OF UTERUS:Anteversion of uterus: Long axis of uterus is bent forward on long axis of vagina, In most women.Also, long axis of body of uterus is bent forward at level of internal as with long axis of cervix (anteflexion of uterus). Thus, in erect position and with bladder empty, uterus lies in an almost horizontal plane.Fundus and body of uterus are bent backward on vagina so that they lie in rectouterine pouch (pouch of Douglas). Uterus is therefore retroverted. If body of the uterus is, in addition, bent backward on cervix, it is also retroflexed.Angle of Anteflexion is 125degStructures assist in keeping the uterus in position:Sustainer structures: Urogenital diaphragm, Levator ani muscle, Perineal bodySuspensory Structures:Pubocervical ligament, Cardinal ligament (parametrium)Uterosacral ligamentRound ligament of UterusStructures assist in keeping the uterus in Antever- s ion-anteflexion:Cardinal ligament (parametrium):Supports Anteversion, the uterine angle between cervix & body.-Between Vagina & CervixRound Ligament of Uterus:Maintains Anteflexion of the uterus (a position where the fundus of the uterus leans ventrally).-During Pregnancy it gives support to the anteversion as well.Angle of Anteversion 90deg: Maintained by Round & uterosacral ligaments.It has even more significant role during pregnancy. When the uterus grows during pregnancy, the round ligaments can stretch causing pain.#. Position:!. Non pregnant uterus is within the pelvis.!. It is anteverted & anteflexed in position.!. Long axis of cervix is bent on long axis of vagina this is called Anteversion.!. Body of uterus is bent forwards over cervix at the isthmus and is known as Anteflexion.#. Pubocervical ligament:!. Attached Anteriorly to posterior aspect of body of pubis!. Passes to neck of bladder.!. Anterior fornix of vagina.!. Pubocervical ligaments help to maintain normal angle of 45deg between the vagina & horizontal.!. Decrease may cause a cystocoele. -### End" -1418,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for ventricular arrhythmia due to myocardial infarction is, with the following options: A: Quinidine, B: Amiodarone, C: Xylocaine, D: Diphenylhydantoin - -### Response: -Refer kDT 6/e p 519 Drug of choice for ventricular arrhythmias with myocardial infarction is lignocaine Drug of choice for supraventricular arrhythmia after myocardial infection is beta blockers cardiac function is adequate -### End" -1419,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Windkassal effect is seen in:, with the following options: A: Large elastic vessel, B: Capillaries, C: Capacitance vessel, D: Venules - -### Response: -Ans. (a) Large elastic vessel -### End" -1420,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Subpoena is also called: MAHE 06, with the following options: A: Summons, B: Panchnama, C: Requisition, D: Inquest papers - -### Response: -Ans. Summons -### End" -1421,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child with prolonged apTT underwent laprotomy and still did not develop any bleeding complications. Which of the following clotting factors is most likely to be deficient?, with the following options: A: Factor VII, B: Factor X, C: Factor XII, D: Factor XIII - -### Response: -Factor XII deficiency : - -Associated with increased aPTT -Usually asymptomatic -Results in thrombosis rather than bleeding. -### End" -1422,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are major complications of massive transfusion, except -, with the following options: A: Hypokalemia, B: Hypothermia, C: Hypomagnesemia, D: Hypocalcemia - -### Response: -Major complications in blood transfusion are fever,chills,tachycardia ,flushing ,rigor,uicaria,abdominal pain,shoeness of breath,anaphylactic shock,transmission of infection,air embolism ,thrombophlebitis,circulatory overload. Since very rapid hemolysis is a compliacation of transfusion ,hyperkalemia occurs.Reference:Davidson's principles & practice of medicine 22nd edition pg no 1016. -### End" -1423,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A woman is presenting with low-grade fever since 6 weeks. Chest X ray shows bilateral hilar adenopathy with clear lung fields. All of the following investigations are useful in making the diagnosis except:, with the following options: A: CD4/CD8 counts in the blood, B: Serum ACE levels, C: CECT of chest, D: Gallium scan - -### Response: -Patient is showing features of sarcoidosis. Lymphocyte markers such as CD4 and CD8 are used to determine the CD4/CD8 ratio in the BAL fluid. A ratio of >3.5 is strongly suppoive of sarcoidosis. Sarcoidosis is an inflammatory disease characterized by the presence of non caseating granulomas. Sarcoidosis can affect viually every organ of the body, lung is most commonly affected. Other organs commonly affected are the liver, skin, and eye. Cough and dyspnea are the most common presenting symptoms. Nonspecific symptoms include fever, fatigue, night sweats, and weight loss. Investigations: Chest X-ray shows bilateral hilar adenopathy and is the most commonly used tool to asses lung involvement. PET (positive emission tomography) scan has replaced gallium 67 scan. Serum ACE levels is helpful in diagnosis, but has low sensitivity and specificity. CT of chest is rarely helpful, it may identify early fibrosis and active alveolitis. CD4/CD8 ratio >3.5 in BAL fluid is strongly suggestive of sarcoidosis. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 329 -### End" -1424,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Features of vernal keratitis are:, with the following options: A: Papillary hyperophy, B: Follicular hyperophy, C: Herbe's pits, D: All - -### Response: -A i.e. Papillary hyperophy -### End" -1425,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a patient with cervical disc prolapse the management includes, with the following options: A: Immediate restrictive exercises, B: Skeletal traction and manipulation, C: Immediate surgery to prevent neurological complications, D: Medical management only - -### Response: -(C) Immediate surgery to prevent neurological complications # Cervical disc prolapse the management includes:> Heat and analgesics are soothing but, as with lumbar disc prolapse, there are only three satisfactory ways of treating the prolapse itself.> Rest: A collar will prevent unguarded movement; it may be made of felt, sponge-rubber or plastic. It seldom needs to be worn for more than a week or two.> Reduce: Traction may enlarge the disc space, permitting the prolapse to subside. The head of the couch is raised and weights (up to 8 kg) are tied to a harness fitting under the chin and occiput. Traction is applied intermittently for no more than 30 minutes at a time.> Remove: If symptoms are refractory and severe enough, if there is a progressive neurological deficit or if there are signs of an acute myelopathy then surgery is indicated The disc may be removed through an anterior approach; bone grafts are inserted to fuse the affected area and to restore the normal intervertebral height. If only one level is affected, and there is no bony encroachment on the intervertebral foramen, anterior decompression can be expected to give good long-term relief from radicular symptoms. -### End" -1426,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is an ominous sign in case of severe head injury, with the following options: A: Development of diabetes insipidus, B: Anisocoria, C: New focal deficit, D: Depressed skull fracture - -### Response: -Head Injury A sudden Enlargement (dilatation) of one pupil (anisocoria) is an ominous sign Abnormal posturing (decoicate posturing) a characteristic positioning of the limbs caused by severe diffuse injury or high ICP is an ominous sign Ref: Harrison's 19th edition Pgno :1774 -### End" -1427,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Beta blockers used in CHF is, with the following options: A: Timolol, B: Atenolol, C: Acebutalol, D: Carvedilol - -### Response: -[D) (Carvedilol): (523-KDT7th edition)CARVEDILQL is a Betaj + Beta2 + Alpha! adrenoceptor blocker produces vasodilatation due to Alpha 1 blockade as well as calcium channel blockade and has antioxidant property. It has been used in hypertension and is the Beta blocker especially employed as cardioprotective in CHF (151-KDT7th)* b1 blockers mainly (metoprolol, bisoprolol, nebivolol) in mild to moderate CHF treated with ACE inhibitor + diuretic digitalis* There is no place for b blockers in decompensated patients. b blockers should be stopped during an episode of acute heart failure and recommended at lower doses followed by uptitration after compensation is restored -### End" -1428,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cryptomenorrhea occurs due to:, with the following options: A: Imperforate hymen, B: Asherman's syndrome, C: Mullerian agenesis, D: All - -### Response: -Ans. is a, i.e. Imperforate hymenRef: Dutta Gynae 6th/ed, p450; Shaw 15th/ed, p96-97* Cryptomenorrhea is defined as occurrence of menstrual symptoms without external bleeding.* Menstrual blood fails to come out from genital tract due to obstruction in the outflow passage.* Causes:CongenitalAcquiredImperforate hymen (commonest)Transverse vaginal septumAtresia of upper third vagina & cervixCervical stenosis following:* Amputation* Cauterization* Conization* 'Radium' treatment for malignant conditions -### End" -1429,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Many factors affect tooth/cavity preparation. Which of the following would be the least important factor?, with the following options: A: Extent of the defect., B: Size of the tooth., C: Fracture lines., D: Extent of the old material. - -### Response: -Obviously, a tooth preparation is dictated by the extent of the carious lesion or old restorative material, the creation of appropriate convenience form for access and vision, and the anticipated extensions necessary to provide an appropriate proximal contact relationship. Fracture lines present should normally be included in the restoration. However, it is rare that the size of the tooth will affect the design of the tooth preparation. -### End" -1430,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Feature of hemorrhagic disease of new born is?, with the following options: A: Prolonged prothrombin time, B: Defective platelet count, C: Prolonged bleeding time, D: Prolonged thrombin time - -### Response: -Answer is A (Prolonged prothrombin time) Hemorrhagic disease of new born results from a deficiency of vitamin K. Prothrombin time is the single best laboratory test to detect vitamin K deficiency as vitamin k deficiency may present with isolated prolongation of PT Laboratory features of vitamin k deficiency (CMDT-2008) Both PT and PTT are prolonged but prolongation of PT is a more sensitive test to detect vitamin K deficiency than PTT - The PT is prolonged to a greater extent than PTT - With mild vitamin K deficiency only the PT is defective Fibrinogen level, Thrombin time and platlet count are not affected - CMDT -### End" -1431,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug effective against both hepatitis B as well as HIV is, with the following options: A: Acyclovir, B: Foscarnet, C: Lamivudine, D: Cidofovir - -### Response: -Lamivudine is NI used in both HIV and hepatitis B (low dose).Lamivudine is effective in chronic hepatitis B;this is due to longer intracellular t1/2 of lamivudine in HBV infected cells than in HIV infected cells. Acyclovir - effective against HSV-1>HSV-2>VZV=EBV. Foscarnet -effective against H.simplex,CMV,other herpes group viruses and HIV. Cidovofir- effective against HSV,CMV,pox and adenoviruses. -### End" -1432,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which enzyme joins two substrates-, with the following options: A: Lyase, B: Ligase, C: Isomerase, D: Synthase - -### Response: -Ans. is 'b' i.e., Ligase* An enzyme which joins two substrates in an energy dependent process is called ligase# Examples includeLigases, Synthetases, Carboxylases* Enzymes are classified into 6 classes:i) Oxidoreductasesii) Transferasesiii) Hydrolasesiv) Lyasesv) Isomerasesvi) LigasesI. Oxidoreductases catalyse oxidation or reduction reactions of the primary substrate. Hence they are in turn classified as those which mediate:# Oxidation reactions# Reduction reactions* Those which mediate oxidation reactions can be classified as those which mediate oxidation by:# Removal of hydrogen ion or# Addition of oxygen# Those which cause REMOVAL OF HYDROGEN can again be classified depending upon the acceptor* NAD/FAD/NADP as acceptor - DehydrogenasesExamples - Lactate Dehydrogenase, Pyruvate Dehydrogenase both remove hydrogen ion from Lactate and Pyruvate respectively and donate the hydrogen ions to NAD forming NADH and H+* Oxygen as acceptor - OxidasesExample - L Aminoacid oxidase removes hydrogen atoms from aminoacid and that is donated to Oxygen molecule forming hydrogen peroxide# Those which add oxygen can be classified depending upon whether one or both the atoms are used asMonooxygenases* Monooxygenase allows oxygen molecule to react with a substrate. However, it incorporates only one oxygen atom into the substrate. The substrate thereby gets converted into hydroxylated form.* RH + O2 - ROH + H2O* So the other name for monooxygenases is hydroxylases* Example Phenylalanine hydroxylase, tyrosine hydroxylaseDioxygenases* Dioxygenase allows oxygen molecule to react with a substrate. It incorporates both the oxygen atoms into the substrate.* E.g., Homogentisate oxidase# Those which mediate REDUCTION REACTIONS can be given various namesPeroxidases* If hydrogen peroxide is getting reduced, it is called as peroxidase* E.g., glutathione peroxidaseCatalases* For reduction of hydrogen peroxide, if hydrogen peroxide is used as a source of hydrogen, it is catalase.Reductases* A substance is reduced using reducing equivalentsII. TRANSFERASES transfer a group from one substrate to another. Depending upon the group that is transferred, they are classified as -Kinases /Phosphotransferases# They transfer phosphate group from one substrate to another# Example hexokinase or glucokinase transfers phosphate group from ATP to glucose or any hexose respectivelyTransketolases# Transfers ketone group from one substrate to anotherTransaldolase# Transfers aldehyde group from one substrate to anotherAcyltransferase# Transfers acyl group or fatty acid from one substrate to another# Example Glycerol phosphate acyl transferase transfers acyl group or fatty acid from acyl CoA to glycerol phosphate forming triacylglycerolGlucosyltransferase - glycogen synthaseIII. HYDROLASES catalyse cleavage of a covalent linkage by addition of water# These enzymes can cleave only ester (phosphate/peptide) / ether (glycosidic) linkages# Examples include:a) Amidasese) Phospholipasesb) Peptidasesf) Glycosidasesc) Esterasesg) Ribonucleasesd) PhosphatasesIV. LYASES catalyse cleavage of a C-N /C-C linkage without adding water# Since all reactions are reversible, they can also synthesise the same linkage back# Examples include:a) Decarboxylasesd) Aldolaseb) Hydratasee) Lyasesc) Dehydratasef) SynthasesV. ISOMERASES catalyse the conversion of one form of a substance to another form of substance without altering the molecular formula# Examples include:a) Isomerasesc) Epimeraseb) Racemased) Mutase - shifts a group from one carbon atom to anotherVI. LIGASES catalyse the Synthesises a covalent linkage using ATP as a source of energy# Examples includea) Synthetasesb) Carboxylases -### End" -1433,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for cheese reaction is, with the following options: A: Prazosin, B: Phentolamine, C: Pentazocine, D: Phenoxybenzamine - -### Response: -Phentolamine is the drug of choice in CHEESE REACTION It is a rapidly acting alpha blocker with sho duration of action (in minutes). It is non selective alpha blocker therefore blocks both alpha 1 and 2 Non Selective a Blockers Selective a1 Blockers Irreversible - Phenoxybenzamine - Used for pheochromocytoma Reversible - Phentolamine, Tolazoline,ergotamine - DOC for cheese reaction and clonidine withdrawal Prazosin Terazosin Doxazosin Alfuzosin - These drugs are used for BHP and HTN. - Also used for scorpion sting -### End" -1434,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Scissor reflex is seen in -, with the following options: A: Open angle glaucoma, B: Phlyctenular conjunctivitis, C: Keratoconus, D: Interstitial keratitis - -### Response: -Ans. is 'c' i.e., Keratoconus Kerotoconuso Keratoconus is a progressive, noninflammatory, bilateral ectatic corneal disease, characterized paraxial stromal thinning and weakening that leads to corneal surface distortion,o Essential pathological changes are thinning and ectasia which occur as a result of defective synthesis of mucopolysaccharide and collagen tissue,o It usually starts at puberty and progresses slowly.o Symptoms usually begins as blurred vision with shadowing around images.o Vision becomes progressively more blurred and distorted with associated glare, halos around lights, light sensitivity and ocular irritation.o Visual loss occurs primarily from irregular astigmatism and myopia, and secondarily from corneal scarring.o The hallmark of keratoconus is central or paracentral stromal thinning, apical protrusion of anterior corneaand irregular astigmatism.o The cornea thins near the centre and progressively bulges forwards, with the apex of cone always being slightly below the centre of the cornea,o Important findings an examination are -Distorted window reflex (Corneal reflex)Q.Fleisher's ringQ.Yawning reflex (Scissor reflex).Oil drop reflex.Munson's signso Treatment includesSpectacles for regular or mild irregular astigmatism.Rigid gas permeable contact lens for higher astigmatism.Epikeratoplasty in patients intolerant to lens and without significant corneal scarring.Keratoplasty penetrating or deep lamellar if there is significant corneal scarring. -### End" -1435,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of peritonsillar abscess is:, with the following options: A: Abscess tonsillectomy, B: Conservative treatment, C: Drainage by Hilton's method, D: Abscess drainage and interval tonsillectomy - -### Response: -Ans: D (Abscess drainage and interval tonsillectomy) Ref: Diseases of the Ear Nose and Throat by PL Dhingra.5th edn .20I0.pg279Explanation:Peritonsillar abscessAlso called as QuinsyPus collects between the capsule of the tonsil and the superior constrictorMixed infection of aerobes and anaerobesMore common in adultsPresents with fever, odynophagia muffled or hot potato voice, halitosis, trismusO/E unilateral tonsillar enlargement with congestion seen, pushing the uvula to the opposite side, enlarged and tender jugulodigastric nodes.Treatment is incision and drainage at the most prominent point or the junction of anterior pillar with the line drawn from the base of uvulaCan lead to parapharyngeal abscess -### End" -1436,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Constriction of efferent aeriolar produces:, with the following options: A: Biphasic response on GFR, B: Increased per-tubular oncotic pressure, C: Increased per-tubular absorption, D: All - -### Response: -Constriction of efferent aeriolar produces: Increased per-tubular oncotic pressure Decreased hydrostatic pressure Increased reabsorption of water In less than 3 fold increase in resistance GFR increases In more than 3 fold increase in resistance GFR decrease Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:471-474 -### End" -1437,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The production of mature spermatozoa from spermatogonia, with the following options: A: Takes 32 days, B: Takes 70 days, C: Takes 150 days, D: Is unaffected by Kallmann's syndrome - -### Response: -It takes approximately 65 to 70 days to develop spermatozoa from the earliest stages of spermatogonia. Because the production of sperm depends on LH and FSH, a lack of GnRH (Kallmann's syndrome) will reduce the production of LH, FSH, and sperm. Temperature is impoant in regulating sperm production. Optimal sperm production occurs at 2 to 30C lower than body temperature. -### End" -1438,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The right gastroepiploic artery is a branch of -, with the following options: A: Right hepatic artery, B: Gastroduodenal artery, C: Hepatic artery, D: Superior mesenteric artery - -### Response: -Right gastroepiploic artery → a branch of the gastroduodenal artery, which in turn is a branch of the common hepatic artery. -Left gastroepiploic artery → a branch of the splenic artery. -### End" -1439,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic feature of Otosclerosis are all except-, with the following options: A: Conductive deafness, B: Positive rinne's test, C: Paracusis willisii, D: Mobile ear drum - -### Response: -You are aware of all options given in Question. -Just Remember: The following otoscopic findings in otosclerosis. -Remember: - -Tympanic membrane is normal and mobile in 90% cases. (i.e. option d is correct). -Schwartz sign—Flammingo cases pink colour of tympanic membrane is seen in 10% cases. It indicates active focus with increased vascularity. -Stapes footplate—Shows a rice grain / biscuit type appearance -Blue mantles are seen histopathologically. -### End" -1440,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements is false regarding botulism?, with the following options: A: Infant botulism is caused by ingestion of preformed toxin, B: Cl. botulinum A, B, E and F cause human disease, C: The gene for botulinum toxin is encoded by a bacteriophage, D: Clostridium baratii may cause botulism - -### Response: -Infant botulism is caused by ingestion of preformed toxin is a false statement. Option 1 Infant botulism- sporulated honey ingestion (unlike food poisoning) is caused by neurotoxins produced in vivo by C. botulinum that have colonized the gastrointestinal tract of the infants. C/F- constipation, lethargy, weakness, weak and altered cry, loss of head control, etc. The condition may progress to flaccid paralysis and respiratory arrest. The infants excrete toxins in their feces. Option 2 All types can cause human disease, but type A, B and E are most common, less commonly type F. Type C & D- associated with outbreaks in cattle & wild fowl. Option 3 - Toxin production in clostridium botulinum appears to be determined by presence of bacteriophage (at least in type C & D). Option 4 - Clostridium baratii have also been found to produce toxin- botulism. -### End" -1441,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which vaccine is not including in Indradhanush mission?, with the following options: A: Tuberculosis, B: Measles, C: Meningococcal meningitis, D: Diphtheria - -### Response: -Ans. c. Meningococcal meningitisThe Mission Indradhanush, depicting seven colors of the rainbow, targets to immunize all children against seven vaccine preventable diseases namely:DiphtheriaPertussisTetanushildhood tuberculosisPolioHepatitis BMeasles -### End" -1442,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Odd beliefs, oddities of speech, fantasies mannerism, odd clothing with magical thinking is seen in which type of personality disorder:, with the following options: A: Schizoid, B: Paranoid, C: Schizotypal, D: Borderline - -### Response: -Odd behavior including odd speech, mannerism and magical thinking is seen in Schizotypal personality disorder. This disorder is a pa of Cluster A Personality disorder. Schizotypal PD also has a strange way of communication and decompensate in period of stress. Other types of cluster A personality personality disorder are Paranoid PD and Schizoid PD. Cluster B PD has four types- Histrionic PD , Narcissistic PD, Antisocial PD and Borderline PD. Cluster C PD has three types- Avoidant PD , Dependent PD, Obsessive Compulsive PD -### End" -1443,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cizotinib is inhibitor of which receptor ?, with the following options: A: Tyrosine kinase, B: VEGF receptor, C: TNF alpha receptor, D: PDGF receptor - -### Response: -Ans. is 'a'i.e., Tyrosine kinaseRefCardio - oncology: principles, prevention and management, by puja Mehta, p. 10)CrizotinibIt is a small molecule multitargeted tyrosine kinase receptor inhibitor targeting ALK, MET, ROS1 kinases.By inhibiting ALK tyrosine kinase activity, crizotinib inhibits cell proliferation, induces Gl - S phase cell cycle arrest and apoptosis.It is approved for the first line in the management of metastatic non-small cell lung cancer with an ALK mutation. -### End" -1444,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is the most significant risk factor for development of gastric carcinoma ?, with the following options: A: Paneth cell metaplasia, B: Pyloric metaplasia, C: Intestinal metaplasia, D: Ciliated metaplasia - -### Response: -Ans. is 'c' i.e., Intestinal metaplasia""The risk of tumor development is greatly increased in patients in whom mucosal inflammation progresses to multifocal mucosal atrophy and intestinal metaplasia""- Robbins`Serial endoscopic examinations of the stomach in patients with atrophic gastritis have documented replacement of the usual gastric mucosa by intestinal type cells. This process of intestinal metaplasia may lead to cellular atypia and eventual neoplasia. - HarrisonFactors Associated with Increased incidence of Gastric CarcinomaEnvironmental Factors1. Infection by FL Pylorio Present in most cases of intestinal-type carcinomaDieto Nitrites derived from nitrates (water, preserved food)o Smoked and salted foods, pickled vegetables, chili peppers o Lack of fresh fruit and vegetablesLow socioeconomic statusCigarette smokingGenetic FactorsSlightly increased risk with blood group AFamily history of gastric cancer3. Hereditary nonpolyposis colon cancer syndromeFamilial gastric carcinoma syndrome (E-cadherin mutation)Decreased risk of stomch cancer is seen witho Vitamine C & E o Diet high in green leafy vegetables and citrus fruitso Aspirin o Beta - Carotene -### End" -1445,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True pelvis refers to :, with the following options: A: Upper pa of pelvis, B: Lower pa of pelvis, C: Either of these, D: Neither - -### Response: -Lower pa of pelvis -### End" -1446,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscles are known as 'Triceps surae'?, with the following options: A: Gastro-soleus, B: Popliteus, C: Extensor hallucis longus, D: Extensor digitorum longus - -### Response: -TRICEPS SURAE:-Two heads of gastrocnemius + soleus (""three-headed of the calf"") These muscles both inse into the calcaneus and form the major pa of the muscle of the posterior leg, ie calf muscle. GastrosoleusLarge size of gastrosoleus is a human character and is directly related to the adoption of an erect posture and to the bipedal gait of man. GASTROCNEMIUS:-Superficial to soleus Origin:- medial and lateral head.Medial head- larger. Arises from medial condyle of femur behind the adductor tubercle, capsule of knee joint, and popliteal surface of femur.Lateral head:-lateral condyle, lateral supracondylar line, and capsule of knee joint. SOLEUS:-sole-shaped, multipennate Origin: fibula- head and upper 1/4th of shaft.Tibia-soleal line,medial border of shaft.Tendinous soleal arch. Inseion: fuses with tendon of soleus to form tendocalcaneus or tendoachilles.Inseed into the middle 1/3 rd of posterior surface of calcaneum. Nerve supply: Tibial nerve (S1, S2) Action:-strong plantar flexors of foot. The gastrocnemius is also a powerful flexor of knee.Soleus- more powerful Gastrocnemius- fast acting In walking soleus overcomes the ineia of the body weight, like the button gear of a car.when movement, is underway, the quicker acting gastrocnemius increase the speed. Soleus/ peripheral hea:-Contractions of these muscles help in venous return from the lower limb. There are large, valveless, venous sinuses in its substance. When the muscle contracts the blood in these sinuses pumed out. When it relaxes, it sucks the blood from the superficial veins through the perforators. {Reference: BDC 6E pg no.106, chapter 9} -### End" -1447,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ostmann fat pad is related to ?, with the following options: A: Ear lobule, B: Buccal mucosa, C: Eustachian tube, D: Tip of nose - -### Response: -Ans. is 'c' i.e., Eustachian tube There are small fat bodies located infermedial to Eustachian tube. These are called Ostmann fat pads. They are impoant in normal closure of eustachian tube and preventing transmission of nasopharyngeal pressure to middle ear. These fat pads are absent in Patulous tube syndrome. -### End" -1448,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bleomycin causes damage to, with the following options: A: Type 1 pneumocytes, B: Type 2 pneumocytes, C: Both Type 1 and Type 2 pneumocytes, D: Pulmonary endothelial cells - -### Response: -Bleomycin causes damage to Type 1 pneumocytes with compensatory hyperplasia of Type 2 pneumocytes. -### End" -1449,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 7 month old boy is brought to pediatrics emergency by his parents with chief complaints of runny nose, cough and failure to thrive. On examination, the following lesion is noted with absence of tonsils and lymph nodes. Chest x ray is performed with following findings. Laboratory tests revealed marked lymphopenia. The child improved on TMP-SMX therapy. Which of the following will not be a differential diagnosis in above clinical scenario?, with the following options: A: HIV infection, B: Digeorge syndrome, C: SCID, D: Chronic granulomatous disease - -### Response: -The failure to thrive, thrush and CXR with symmetrical interstitial radio-opacities-likely pneumonia. As patient is improving with TMP-SMX , it is s/o pneumocystis jerovecii as diagnosis. The differential diagnosis are: HIV infection SCID Bare lymphocyte syndrome Ataxia telengectasia Atypical digeorge syndrome(thymic aplasia) SCIDs characterized by: Block in T cell development and thus the complete absence of these cells. Clinical manifestations are: recurrent oral candidiasis failure to thrive protracted diarrhea acute interstitial pneumonitis caused by Pneumocystis jiroveci Lymphocytopenia is s/o SCID in >90% of cases. Thymic shadow is absent on a chest x-ray may be suggestive of SCID. T cell quantification of receptor excision circles (TREC) by using the Guthrie card is a reliable diagnostic test for newborn screening. -### End" -1450,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 16-year old boy suffering from drug abuse presents with cross-over of sensory perceptions, such that, sounds can be seen and colors can be heard. Which of the following is the most likely agents responsible for drug abuse-, with the following options: A: Cocaine, B: LSD, C: Marijuana, D: PCP - -### Response: -Cross-over of sensory perception is termed as `synesthesia' and is typically experienced under the influence of LSD. -### End" -1451,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of Downs syndrome is -, with the following options: A: Maternal nondisjunction, B: Paternal nondisjunction, C: Translocation, D: Mosaicism - -### Response: -Down syndrome is the most common of the chromosomal disorders. About 95% of affected persons have trisomy 21, so their chromosome count is 47 The correlation with maternal age suggests that in most cases the meiotic nondisjunction of chromosome 21 occurs in the ovum. Indeed, in 95% of cases the extra chromosome is of maternal origin. (Robbins Basic Pathology,9th edition,pg no. 237 ) -### End" -1452,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 9-year-old child was brought to OPD for being restless annd hyperactive. His mother gives the history that his teacher complaints that he does not listen to the chapters taught at school and disturbs other students, he also shows less interest in playing. The likely diagnosis is:, with the following options: A: Cerebral palsy, B: ADHD, C: Delirium, D: Mania - -### Response: -Hyperactivity and sho attention span suggest a diagnosis of ADHD. Lack of concentration, impulsivity & hyperactivity are essential features of ADHD. Onset upto 12 years of age. Symptoms of ADHD: - Inattention - Hyperactivity - Impulsivity - Other symptoms- Destructive behavior, irritability, and aggression. Pharmacotherapy: Stimulants Non stimulants Methylphenidate, dexmethylphenidate Atomoxetine Amphetamines Bupropion Modafinil Clonidine, Guanfacine Venlafaxine -### End" -1453,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Risk factors for Alzheimer's include:-, with the following options: A: Klinefelter syndrome, B: Noonam syndrome, C: Down's syndrome, D: Turner syndrome - -### Response: -Alzheimer disease is associated with deposition of amyloid beta(AB) plaque which is produce from amyloid associated protein(APP) which is coded from gene present on chromosome 21. This is called pre senile dementia or premature Alzheimer. Noonan syndrome : defect in gene PTPN11, KRAS, SOS1 leading to defect in signaling protein. Patient have pulmonary valve stenosis, VSD or hyperophic cardiomyopathy. -### End" -1454,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mature defence mechanism is ?, with the following options: A: Sublimation, B: Denial, C: Projection, D: Distoion - -### Response: -Ans. is 'a' i.e., Sublimation Defence mechanism Narcissistic (Psychotic) :- Denial, disoion, projection. Immature :- Blocking, introjection, passive-aggressive behavior, acting out, hypochondriasis, regression, schizoid fantasy, somatization. Neurotic :- Controlling, Displacement, inhibition, externalization, intellectualization, isolation, rationalization, dissociation, reaction formation, repression, sexualization, conversion, undoing, inhibition. Mature :- Asceticism, suppression, altruism, sublimation, humor, anticipation. -### End" -1455,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about duodenal diverticula except:, with the following options: A: Whenever found, should be treated due to increased risk of complications, B: Most common site is periampullary region, C: Can cause acute pancreatitis, D: Most are asymptomatic - -### Response: -Ans. (a) Whenever found, should be treated due to increased risk of complicationsRef: Sabiston 19th edition, Pages 1265-1266 Incidentally found:* Meckel's -- resect* Jejunal diverticula -- leave it* Duodenal diverticula -- leave it* Colon diverticula -- leave it -### End" -1456,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The pressure used in pneumatic tourniquet in upper limb is upto:, with the following options: A: Systolic Blood Pressure + 50, B: Systolic Blood Pressure + 75, C: Systolic Blood Pressure + 100, D: None of the above - -### Response: -Pneumatic tourniquet is a narrow rubber bag to be wound around a limb, pressure being applied by pumping air into the inflatable cuff. -A bloodless field is obtained by applying pressure through pneumatic tourniquet for accurate surgery. Usually pressure applied 75 mmHg over systolic blood pressure for not more than 2 hours. -### End" -1457,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For detection of carcinoma lip, stain used is?, with the following options: A: Giemsa, B: Crystal violet, C: Toulidine blue, D: Hematoxylin and eosin - -### Response: -Ans. (c) Toulidine blue(Ref: Early Diagnosis and Treatment of Cancer Series: Head and Neck Cancers, Wayne Koch Pg. 54)*Toluidine blue stain is used as a marker to differentiate lesions at high risk of progression in order to improve early diagnosis of oropharyngeal carcinomas.*Toluidine blue, an acidophilic metachromatic dye of thiazine group selectively stains acidic tissue components (sulfates, carboxylates and phosphate radicals), thus staining DNA and RNA. -### End" -1458,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is least likely to cause constrictive pericarditis, with the following options: A: Tuberculous pericardial effusion, B: Staphylococcal effusion, C: Post cardiac surgery, D: Acute rheumatic fever - -### Response: -Causes of constrictive pericarditis include: Tuberculosis Incomplete drainage of purulent pericarditis Fungal and parasitic infections Chronic pericarditis Postviral pericarditis Postsurgical, streptococcal effusion Following MI, post-myocardial infarction In association with pulmonary asbestos Ref Harrison 20th edition pg 1456 Ref Davidson 23rd edition pg 463 -### End" -1459,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with post - paum hemorrhage had about 2 liters of blood loss. Investigation revealed normal PT and a prolonged aPTT. Test to differentiate between coagulation factor deficiency and factor inhibitor is:, with the following options: A: Tissue thromboplastin inhibition time, B: Ecarin clotting time, C: Dilute Russel viper venom time, D: Mixing studies - -### Response: -Mixing studies are used to distinguish between a factor deficiency and an inhibitor. Normal plasma and patient plasma are mixed in a 1:1 ratio, and the aPTT or PT is determined immediately and after incubation at 37degC for 30, 60, and/or 120 min. Isolated factor deficiencies aPTT will correct with mixing and stay corrected with incubation Lupus anticoagulant mixing and incubation will show no correction Acquired neutralizing factor antibodies initial assay may or may not correct immediately after mixing but will prolong with incubation at 37degC. Other inhibitors or interfering substances- heparin, fibrin split products, and paraproteins -### End" -1460,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increase in false positive cases in a community is due to:, with the following options: A: High specificity, B: High sensitivity, C: High prevalence, D: Low prevalence - -### Response: -Low prevalence Repeat from May 10 -### End" -1461,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old lorry driver from Bihar presented with multiple necrotic ulcer which are painful on the penis. Tender inguinal lyphadenopathy was also present. What is the diagnosis ?, with the following options: A: H. ducreyi, B: Herpes simplex, C: Syphilis, D: Chlamydia infection - -### Response: -Chancroid is a sexually transmitted infectious disease characterized by painful genital ulcers, bubo formation, and painful inguinal lymphadenopathy. The causative organism is Haemophilus ducreyi. It is a gram-negative, fastidious, facultative, anaerobic coccobacillus. It is usually located in the extracellular spaces and is strictly a human pathogen. -### End" -1462,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 23-year-old woman has had several episodes of severe wheezing over the past 3 years. She is a nonsmoker and feels well in between episodes. She has no personal or family history of atopy. The wheezing episodes are most likely to occur in spring. Which of the following is the most likely mechanism of wheezing in this woman?, with the following options: A: elevated IgE levels, B: mast cell instability, C: nonspecific hyperirritability of the tracheobronchial tree, D: disordered immediate hypersensitivity - -### Response: -There is a constant state of hyperreactivity of the bronchi, during which exposure to an irritant precipitates an asthmatic attack. A following subacute phase has been described that can lead to late complications. The presence of inflammation in the airways has resulted in increased usage of inhaled corticosteroids for maintenance therapy. Many cases of asthma have no discernible allergic component. -### End" -1463,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is NOT contraindicated about the use of β blockers in CHF, with the following options: A: These should be started at very low dose and slowly titrated upwards, B: Carvedilol is most widely used β blocker, C: These are drug of choice in acute decompensated heart failure, D: These can reduce mortality in CHF patients - -### Response: -Beta blockers are contraindicated in acute decompensated heart failure. -### End" -1464,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is most preferred graft in CABG?, with the following options: A: Saphenous vein, B: Radial aery, C: Internal mammary aery, D: Internal jugular vein - -### Response: -Vascular graft Bioprosthetic Synthetic Autograft Homograft (allograft) Heterograft (xenograft) Tissue engineered Textile Dacron Non textile ePTFE Polyurethane Best natural vascular graft: Reversed saphenous vein Best synthetic vascular graft: Dacron Best vascular graft for supra inguinal bypass: Dacron Best vascular graft for infra inguinal bypass: Saphenous vein Best vascular graft for aoa: Dacron Most preferred graft for CABG: LIMA (left internal mammary aery) > Saphenous vein MC used graft for CABG: Saphenous vein -### End" -1465,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest cause of Cushings syndrome is -, with the following options: A: Adrenal adenoma, B: Carcinoma, C: Hyperplasia, D: Atrophy - -### Response: -""In most cases, the cause is bilateral adrenal hyperplasia due to hypersecretion of pituitary ACTH or ectopic production of ACTH by a nonpituitary source.""- Harrison -### End" -1466,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: TURP fluid used -, with the following options: A: NS, B: Glycine, C: Hemaccel, D: Methylcellulose - -### Response: -Ans. is 'b' i.e., Glycine ""TUR is performed with a nonhemolytic fluid such as 1.5% glycine. Saline cannot be used because electrolytes in the irrigation fluid will dissipate the electric current used to resect the prostate ""-- Schwartz 8/e pi530 (not given in 9/e)o During transurethral resection of prostate strips of tissue are cut from the bladder neck down to the level of verumontanum.o This cutting is performed by a loop mounted on the hand held trigger of the resectoscope in which Diathermy current is being passed.o We all know that normal saline is a very good conductor of electricity (as it contain ions - Na+ & Cl- ions). So if it is used while performing TURP, the diathermy current used in the procedure will cause electrolyte diassociation of normal saline and the current will not be localized in the loop and hence cutting of the tissue will not be proper.o You can put up a question that the same can occur with the use of distilled water too.o Distilled wrater can also conduct electricity-but the current used during TURP is not very strong and distilled water is not as good conductor of electricity' as Normal saline. (You must be aware that distilled water is a worse conductor of electricity than normal water.)o There were also arguments that distilled water causes fluid overload and therefore should not be used in TURP.True, distilled water causes fluid overload or TURP syndrome but this complication is not commonDistilled water is being replaced by 1[?]5% glycine but still can be used for TURP (and is used in many centres when glycine is not available)o Do not get confused by what is Written in -Bailey 24th/ep. 1377, 1378 (23/e, pi245, 1246)If you go through it carefully, you will find that Bailey states that normal saline is used after the operation i.e. it is used for post operative irrigation. -### End" -1467,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Highly lipid soluble agent would be associated with –, with the following options: A: Potent anaesthetic action, B: Potent analgesic action, C: Excellent muscle relaxant action, D: Least respiratory depression - -### Response: -High lipid solubility (high oil-gas partition coefficient) indicates high potency. -### End" -1468,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug which causes renal papillary necrosis is?, with the following options: A: Acetophenetidin, B: Gentamicin, C: Gold, D: Methicillin - -### Response: -Ans. (a) AcetophenetidinRef: Robbiris pathology 9th ed. /423. 936t* Renal papillary necrosis due to acetophenetidin/ phenacetin is a gradual process with slow loss of renal function.* The most common cause of renal papillary necrosis is diabetic glomerulopathy -### End" -1469,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Rt kidney except -, with the following options: A: Rt renal vein is shorter then left, B: Related to duodenum, C: Rt kidney is preferred over left for transplantation, D: Rt kidney is placed at the lower level than left - -### Response: -The longer renal vein is with the left kidney. So more preference for transplantation is left kidney. -### End" -1470,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common presentation of Meckels diveculum?, with the following options: A: Lower GI bleeding, B: Upper GI bleeding, C: Diarrhorea, D: Abdominal pain - -### Response: -.Presentations in Meckel's Diveiculum * Asymptomatic - in majority cases. * Severe haemorrhage most common, seen in children aged 2 years or younger (Maroon coloured blood). * Intestinal obstruction due to bands/adhesions/ intussusception. * Perforation. * Intussusception, volvulus of small bowel. * Peptic ulceration. * Diveiculitis--features mimic acute appendicitis. * Littre's hernia--It is presence of Meckel's diveiculum in hernial sac as content. It is observed in inguinal/femoral hernia. * Silent Meckel's diveiculum found during laparotomy or laparoscopy or by radioisotope study. * Carcinoid or GIST can occur in Meckel's diveiculum. ref:SRB&;s manual of surgery,ed 3,pg no 798 -### End" -1471,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5-year-old unimmunized child presented with high fever, sore throat, dysphagia & voice change. Throat swab from a whitish lesion showed the following diagnosis., with the following options: A: Diphtheria, B: Mumps, C: Pertussis, D: Streptococcal pharyngitis - -### Response: -a. DiphtheriaOn Albert staining, C. diphtheriae appears green colored rod shaped bacteria with bluish black metachromatic granules at the poles -### End" -1472,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a child with suspected diagnosis of epiglottitis, indicate your first line of treatment:, with the following options: A: Order an X-ray of soft tissue lateral view neck to establish the diagnosis, B: Take throat swab and blood culture and start intravenous fluids, C: Perform a laryngoscopy, D: Secure an airway by intubation - -### Response: -In epiglottitis, the epiglottis and aryepiglottic folds are swollen obstructing the airway. Any attempt to disturb the child such as taking throat swab, blood culture, starting I/V lines may precipitate respiratory obstruction.Treatment is directed to airway establishment. Child is taken to operation room, anaesthetised and intubated. Blood culture and epiglottic swabs are then taken and antibiotics (second or third generation cephalosporins) started. In the absence of a skilled anaesthetist, a tracheotomy may be performed. -### End" -1473,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All agents can be given for induction of anaesthesia in children except ?, with the following options: A: Halothane, B: Sevoflurane, C: Morphine, D: N2O - -### Response: -Morphine is not an inducing agent. -Sevoflurane is the agent of choice and is used in N2O + O2 gas mixture. Halothane is the second choice inducing agent. -### End" -1474,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Follicles are present in which pa of lymph nodes, with the following options: A: Red pulp, B: White pulp, C: Coex, D: Medulla - -### Response: -The outer coex consists mainly of the B cells arranged as follicles,INDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:132 -### End" -1475,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tyrosine is required for the synthesis of all of the following except:, with the following options: A: Melatonin, B: Epinephrine, C: Norepinephrine, D: Thyroxine - -### Response: -Ans. A. MelatoninMelatonin is a hormone, synthesized by pineal gland. The amino acid required is tryptophan. It is also called N-acetyl 5- methoxy serotonin. Melatonin is involved in circadian rhythms.Epinephrine, Nor-epinephrine and thyroxine are all synthesized by Tyrosine. -### End" -1476,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Management of subclan aery injury due to inadveent central catheter inseion include all of the following except, with the following options: A: Closure device, B: Mechanical Compression, C: Covering stent, D: Tract embolization - -### Response: -Answer- B. Mechanical CompressionUse of aerial closure devices can be attempted, especially when the distance from the skin to the aery tract is less than 5 cm and access to the aery is still available. Tract embolization with Gelfoam can be employed. -### End" -1477,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fibrocailage is present in all, EXCEPT:, with the following options: A: Pinna, B: Symphysis pubis, C: Interveebral disc, D: Menisci of knee joint - -### Response: -Fibrocailage is a white opaque structure due to dense collage fibres (type I and II). When a fibrous tissue is subjected to pressure it is replaced by fibrocailage. It is seen in joints, symphysis, interveebral discs, menisci and labra (shoulder joint and hip joint). Pinna is a type of elastic cailage. Elastic cailages are seen at sites concerned with production or reception of sounds eg external acoustic meatus (lateral pa), auditory tube and epiglottis. -### End" -1478,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A vitreous aspirate has been collected in an emergency at 9 pm. Which of the following is the most appropriate requisite for overnight storage of the sample?, with the following options: A: The sample should be kept at 4degC, B: The sample should be incubated at 37 degC, C: The sample should be refrigerated in deep freezer, D: The sample should be refrigerated for the initial 3 hours and then incubated at 37degC - -### Response: -Vitreous humor is usually stored at 0-4 degree celsius. Ref: Forensic Chemistry Handbook By Lawrence F. Kobilinsky, Page 466; Comprehensive Ophthalmology By AK Khurana, 4th Edition, Pages 243, 248. -### End" -1479,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to strasberg classification, lateral CBD injuries are classified as, with the following options: A: Type B, B: Type C, C: Type D, D: Type E - -### Response: -Strasberg classification of Laparoscopic Biliary injuries Type A- Bile leaks from minor ducts still in continuity with the CBD IIncludes leakage from cystic duct stump and from a subvesical duct of Luschka. MC cause of biliary leaks seen after cholecystectomy. Type B- Occlusion of a pa of the biliary tree, almost always an aberrant right sectoral duct Type C- Transection without ligation of an aberrant right sectoral duct. Type D- A lateral injury to an extrahepatic duct. Type E- Includes biliary strictures, divided into E1 to E5 as classified by Bismuth Ref: Sabiston 20th edition Pgno :1502 -### End" -1480,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IOP is most accurately measured by, with the following options: A: Schiotz tonometer, B: Applanation tonometer, C: Non contact tonometer, D: Digital tonometer - -### Response: -Answer: b) Applanation tonometer (BASAK 4th ED, P-262)Measurement of IOP:1. Contact Tonometer* Indentation tonometer> When placed on a eye, the plunger together with a present weight, indents the cornea.> The amount of indentation is measured on a scale and the IOP can be calculated> Not accurate since IOP measured is influenced by scleral rigidity> Types# Schiotz (manual)# MacKay-Marg (electronic)* Applanation tonometer> Based on the principle of Imbert-Fick's law> Applanation tonometer measures the IOP by flattening the cornea over a specific area (3.06mm)> More accurate since the pressure values are not influenced by scleral rigidity> Types# Goldmann (slit-lamp mounted)# Parkins' (hand-held)2. Non-Contact tonometer3. Digital tonometry: IOP is roughly assessed by digital palpation, fluctuating the down-turned eye between two index fingers through the upper lid -### End" -1481,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Punishment for voluntarily causing grievous injury comes under which section of IPC -, with the following options: A: 325, B: 320, C: 326, D: 324 - -### Response: -Ans. is 'A' i.e., 325 Grievous injury: 320IPC. It includes Emasculation Permanent privation of sight of either eye Permanent privation of hearing of either ear Privation of any member or joint Destruction or permanent impairing of the power of any member or joint Permanent disfiguration of the head or face Fracture or dislocation of bone or tooth Any hurt which endangers life, or which causes victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days. Dangerous injuries: are those which cause imminent danger to life, either by involvement of important organs or structures or extensive area of body. The injury is fatal in absence of surgical aid.eg gunshot, spleen rupture, o Section 325 IPC- punishment for voluntarily causing grievous injury. -### End" -1482,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common staphylococcal phage strain causing hospital infection -, with the following options: A: 80/81, B: 79/80, C: 3A/3C, D: 69/70 - -### Response: -Ans. is 'a' i.e., 80/81 Hospital strains of staphylococcus aureuso Certain strains of staphylococcus are the common cause of post operative wound infections and other infections in the hospital environment,o These strains are known as hospital strains,o The hospital strains show the following characteristics:1 They are resistant to penicillin, methicillin and other routinely used antibiotics.2 They belong to certain bacteriophage types.3.Some of the strains ( eg phage type 80/81) are known to cause hospital infections throughout the wrorld. Such strains are called as epidemic strains. -### End" -1483,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following organisms, when isolated in the blood, requires the synergistic activity of penicillin plus an aminoglycoside for appropriate therapy -, with the following options: A: Enterococcus faecalis, B: Staphylococcus aureus, C: Str. pneumoniae, D: Bacteroides fragilis - -### Response: -Organism Features Enterococcus faecalis Resistant to penicillins, aminoglycosides and sulfonamides. Intrinsic resistance to cephalosporins and cotrimoxazole. In c/o resistance -combine- Penicillin + Aminoglycoside as they act synergestically. Staphylococcus aureus Rx : Parenteral therapy for serious infections Oral therapy for skin and soft tissue infections Sensitive to penicillin- DOC: Penicillin G Sensitive to methicillin-DOC: Nafcillin or oxacillin Resistant to methicillin (MRSA)- DOC: Vancomycin Sensitive to methicillin- DOC: Dicloxacillin, cephalexin Resistant to methicillin (MRSA) - DOC: Clindamycin Streptococcus pneumoniae Rx DOC- Penicillin G Alternative : Cephalosporins(ceftriaxone) Bacteroides fragilis Obligately anaerobe, non-spore forming gram-negative bacilli C/F- Brain abscess, subdural empyema, epidural abscess, and meningitis Endocarditis, meningitis, septic ahritis and osteomyelitis Colonies- Brilliant red fluorescence Rx- Metronidazole -### End" -1484,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Specific cell surface proteins, such as alkaline phosphatase, and lipoprotein lipase, are anchored to the cell membrane. This anchoring is accomplished by covalent binding through an oligosaccharide bridge to the component of the cell membrane. This component is, with the following options: A: Sphingomyelin, B: Phospphatidic acid, C: Phosphatidylserine, D: Phosphatidylinositol - -### Response: -Phosphatidylinositol derivatives play several distinct roles in the cell membrane, one of which is that they anchor several cell surface proteins. Cell surface proteins bound to phosphatidylinositol are also found in several parasitic protozoa. By altering these proteins, these protozoa can change their antigenic propeies and avoid immunosurveillance. Being attached a telatively long chain to the membrane phosphatidylinositol, rather than being a pa of the membrane itself, allows these proteins lateral movement on the cell surface. The proteins can be cleaved from the membrane by the action of phospholipase C. The other compounds listed are also phospholipids, but they do not anchor proteins in the membrane. -### End" -1485,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest presentation of congenital dislocation of the knee is -, with the following options: A: Varus, B: Valgus, C: Flexion, D: Hyperextens ion - -### Response: -The patient presents with hyperextension deformity of the knee. -### End" -1486,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dilution of epinephrine in anaphylactic shock is, with the following options: A: 1: 100 inhalational route, B: 1: 1000 IM, C: 1:10000 IV, D: All the above - -### Response: -. -### End" -1487,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not true of mandible -, with the following options: A: From second pharyngeal arch, B: Body and ramus are its two parts, C: Strongest bone of skull, D: Has 16 sockets for teeth - -### Response: -Ans. is 'a' i.e., From second pharyngeal arch o The mandible, or the lower jaw. is the largest and the strongest bone of the face.o It develops from the first pharyngeal arch. It has a horseshoe-shaped body which lodges the teeth, and a pair of rami which project upwards from the posterior ends of the body.o The rami provide attachment to the muscles of mastication,o Upper (alveolar) border of body bears sockets for teeth ( usually 16). -### End" -1488,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of genital tuberculosis is-, with the following options: A: Ovary, B: Cervix, C: Fallopian tubes, D: Uterus - -### Response: -Ans. is 'c' i.e., Fallopian tubes -### End" -1489,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following conditions commonly predisposes to Colonic carcinoma ?, with the following options: A: Ulcerative colitis, B: Crohn's disease, C: Diveicular disease, D: Ischaemic colitis - -### Response: -Ulcerative colitis The cardinal symptoms are rectal bleeding with passage of mucus and bloody diarrhoea. The presentation varies, depending on the site and severity of the disease , as well as the presence of extra-intestinal manifestations. The first attack is usually the most severe and is followed by relapses and remissions. Emotional stress, intercurrent infection, gastroenteritis, antibiotics or NSAID therapy may all provoke a relapse. Proctitis causes rectal bleeding and mucus discharge, accompanied by tenesmus. Some patients pass frequent, small-volume fluid stools, while others pass pellety stools due to constipation upstream of the inflamed rectum. Constitutional symptoms do not occur. Left-sided and extensive colitis causes bloody diarrhoea with mucus, often with abdominal cramps. In severe cases, anorexia, malaise, weight loss and abdominal pain occur and the patient is toxic, with fever, tachycardia and signs of peritoneal inflammation Ref Davidson edition23rd pg816 -### End" -1490,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fever is produced by ?, with the following options: A: PGF2a, B: PGE2, C: PGI2, D: PGD2 - -### Response: -Ans. is 'b' i.e., PGE2Fever is elevated body temperature due to resetting of hypothalamic thermostat above the normal level.IL-1 (most potent), TNF-a and IL-6 are pyrogens (fever producing cytokines).But they do not act directly.They stimulate the release of PGE2, which resets the hypothalamic thermostat at higher level.Thus, PGE2 is the final effector in production of fever. -### End" -1491,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phospholipid used to investigate syphilis by the regain test is, with the following options: A: Cardiolipin, B: Plasminogen, C: Palmi lecithin, D: Serine - -### Response: -Ans. a (Cardiolipin). (Ref. Ananthanarayan, Microbiology, 6th/pg.378; 7th ed. pg. 381)SEROLOGICAL TESTS FOR SYPHILISThese tests form the mainstay of laboratory' diagnosis.A Large number of tests have been described, of which only a few are now employed.These are follows:1. Tests for antibodies reacting with cardiolipin antigen (Non-specific reagin tests; standard tests for syphilis; STS)2. Tests for antibodies reacting with group specific treponemal antigen3. Tests for specific antibodies to pathogenic treponema (T. pallidum).Reagin antibody testsThese tests use the lipoid or cardiolipin antigens and are known as 'standard tests for syphilis' or STS.The first of the reagin antibody tests was the Wassermann complement fixation test (1906).It is no longer in use now.# The first flocculation test used widely was tube flocculation test of Kahn.# The Kahn test has been replaced by the simpler and more rapid VDRL test., which gives more quantitative result.# VDRL test can be used for testing CSF also, but not plasma. CSF need not be heated prior to test.# A number of modifications of the VDRL have been developed, of which the Rapid Plasma Reagin (RPR) test is the most popular.Sensitivity of Serodiagnostic Tests in Untreated SyphilisMean Percentage Positive (Range) at Indicated Stage of DiseaseTestPrimarySecondaryLatentTertiaryVDRL, RPR78 (74-87)10095 (88-100)71 (37-94)FTA-ABS84 (70-100)10010096TP-PA89100100NA -### End" -1492,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is derived from 3rd pharyngeal arch?, with the following options: A: Cricoid cailage, B: Thyroid cailage, C: Lesser cornu of hyoid, D: Greater cornu of hyoid - -### Response: -Lesser cornu of hyoid- 2nd Thyroid cailage- 4th arch Cricoid- 6th arch -### End" -1493,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The refracting structures of the eye constitute a homocentric system of lenses. Refractive power of cornea is:, with the following options: A: 1.31, B: 1.33, C: 1.37, D: 1.42 - -### Response: -Refractive power Value Cornea Aqueous humor Lens Vitreous humor 1.37 1.33 1.42 1.33 Ref: Comprehensive Ophthalmology by A K Khurana, 4th edition, Page 26. -### End" -1494,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presented with seizures. On examination an Oval hypopigmented macules noted on the trunk, Low IQ and angiofibroma on face. What is the most probable diagnosis, with the following options: A: Tuberous sclerosis, B: Neurofibromatosis, C: Von-Hippel Lindan syndrome, D: Sturge - weber syndrome - -### Response: -Vogt's triad of Tuberous sclerosis:- EPiloa -### End" -1495,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lung carcinoma most common associated with:, with the following options: A: Asbestosis, B: Silicosis, C: Byssinosis, D: Beryllium - -### Response: -Remember some important points. -  -Silicosis—currently the most prevalent chronicoccupational disease in the world -  -Silicosis is associated with an increased susceptibility to Tuberculosis. The radio logical feature—EGG SHELL calcification in the hilarlymphnodes. -  -Berylliosis cause an interstitial granulomatousdisease similar to Sarcoidosis. -  -The most dangerous particles to cause Pneumoconiosis from 1 to 5 micrometer in diameter because they may reach in the terminal small airways, air sacs and settle in their lining. -  -Cotton dust is associated with Byssinosis. -  -Sugarcane dust is associated with Bagassois -### End" -1496,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Danazol has which of the following actions ?, with the following options: A: Weak androgenic, B: Progestational, C: Anabolic, D: All the above - -### Response: -Ans. is 'd' i.e., All the above Danazole It has weak androgenic, anabolic and progestational activity. The most prominent action is suppression of gonadotropin (FSH/LH) from pitutary in both men and women - inhibition of testicular/ovarian function. Uses are : Endometriosis (major use) Fibrocystic breast disease Infeility Menorrhagia Hereditary angioneuretic edema Side effects are complete amenorrhoea, androgenic effects (acne, hirusitism, decreased breast size, deepening of voice, edema, weight gain), loss of libido in men, hot flushes in women, night sweats and muscle cramp. Liver enzyme may be raised. -### End" -1497,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ASA classification is done for:, with the following options: A: Status of patient, B: Risk, C: Pain, D: Lung disease - -### Response: -A i.e. Status of patient -### End" -1498,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about bronchial circulation are true, except :, with the following options: A: Contribute 2% of systemic circulation, B: Contribute to gaseous exchange, C: Cause venous admixing of blood, D: Provide nutritive function to lung - -### Response: -Bronchial circulation does not contribute to gas exchange. Ref: The Mechanics of the Circulation By C. G. Caro, T. J. Pedley, R. C. Schroter, W. A. Seed, K. H. Parker, Page 475; Equine Respiratory Medicine and Surgery By Bruce C. McGorum, Padraic M. Dixon, N. Edward Robinson, Page 34; Medical Physiology : Principles for Clinical Medicine By Rodney Rhoades, David R. Bell, Page 371. -### End" -1499,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about superior oblique origin and inseion?, with the following options: A: Originate from common tendinous ring and inseed into sclera behind the equator, B: Originate from the body of sphenoid and inseed into the sclera behind the equator, C: Originate from lesser wing of sphenoid and inseed into sclera in front of equator, D: Originate from greater wing of sphenoid and inseed into sclera in front of equator - -### Response: -Superior Oblique muscle: Origin : from body of sphenoid (superomedial to optic canal - opening in lesser wing of sphenoid ) Inseion - Sclera of the eyeball posterior to equator of eyeball Trochlea gives trochlear nerve supplying S.O.M Actions of S.O.M: depression, abduction & intorsion -### End" -1500,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prolonged muscle paralysis in a healthy individual may be caused by:, with the following options: A: d-Tubocurarine, B: Cisatracurium, C: Pancuronium, D: Succinylcholine - -### Response: -Pseudocholinesterase deficiency is an inherited enzyme abnormality that results in abnormally slow metabolic degradation of exogenous choline ester drugs such as succinylcholine and mivacurium. If there is a deficiency in the plasma activity of pseudocholinesterase, prolonged muscular paralysis may occur, resulting in the extended need for mechanical ventilation. A variety of pathologic conditions, physiologic alterations, and medications also can lower plasma pseudocholinesterase activity. Succinylcholine apnea may be seen suddenly in healthy individual due to deficiency of pseudocholinesterase . -### End" -1501,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Striae of Retzius are prominent in which of the following zones of enamel caries:, with the following options: A: Translucent zone., B: Dark zone., C: Body of the lesion., D: Surface zone. - -### Response: -Body of the lesion - -Between unaffected surface and dark zone -Area of greatest demineralization -Pore volume – 5% in periphery and 25% in center -Quinoline inhibition – body appears transparent -Water inhibition – Positive birefringence compared to sound enamel -Striae of Retzius - prominent -### End" -1502,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kisselbach's plexus is formed by septal branches of all expect, with the following options: A: Posterior ethmoidal aery, B: Anterior ethmoidal aery, C: Sphenopalatine aery, D: Greater palatine aery - -### Response: -Kiesselbach's Plexus: Aerial plexus of Little's area Formed by s Septal branches of Anterior ethmoidal Superior labial Sphenopalatine Greater palatine aery Ref: Dhingra 7e pg 197. -### End" -1503,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an indication for a class II -activator:, with the following options: A: Mandibular retrusion, B: Horizontal/anterior type of mandibular growth, C: Crowding lower anteriors, D: Upright lower anteriors - -### Response: -Class-II and III malocclusions, class-I open bite and deep bite malocclusions, children with lack of vertical development in lower facial height, and upright mandibular incisors are indications of activators. -Activators may produce moderate mandibular rotation (anteriorly down words), so they are contraindicated in vertical growers. -### End" -1504,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following studies are 'analytical', except:, with the following options: A: Field trials, B: Coho studies, C: Case control studies, D: Ecological studies - -### Response: -Field trial is a type of experimental or interventional study. Coho study, case control study and ecological study are all types of analytical studies. Ref: Park's Textbook of Preventive and Social Medicine, By K. Park, 19th Edition, Page 58 -### End" -1505,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oxidative phosphorylation is inhibited by all EXCEPT:, with the following options: A: CO, B: Antimycin A, C: Malonate, D: Thermogenin - -### Response: -Uncouplers of ETC: Dinitrophenol, Thermogenin Oxidative phosphorylation means ETC. Inhibitors of ETC are given in table below: Inhibitors of ETC Complex Inhibitors Complex I Rotenone, Phenobarbitone, Amobarbital Piericidin A Complex II Malonate (3C) Carboxin (fungicide) TTFA (Trienoyl Tri Fluoro Acetone) Complex III Phenformin Antimycin A BAL {British Anti Lewisite or Dimercaprol Complex IV Co, CN, H2S, Sodium Azide Extra Information Uncouplers of ETC: Dinitrophenol, Thermogenin ADP to ATP conversion is inhibited by: Oligomycin ADP to ATP transfer is inhibited by: Atractyloside Thermogenin is uncoupler i.e. it inhibits Phosphorylation but not Oxidation. -### End" -1506,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The marker for B lymphocyte is:, with the following options: A: CD19, B: CD68, C: CD34, D: CD4 - -### Response: -Answer is A (CD19) : CD 19 is a marker fir B lymphocytes. Primarily B cell associated antigens include CD10 and CD19 to CD23 i.e. CD10, CD19, CD20, CD21, CD22, CD23 Primarily T cell associated antigens include CD1 to CD8 with the exception of CD6 i.e. C'D1, CD2, CD3, CD4, CD5, CD6, CD7, CD8. Primarily monocyte macrophage associated antigens CD13 to CD15 and CD33 i.e. CD13, CD14, CD15, CD33. Primarily NK cell associated antigens includeQ CD16 and CD56. (Do remember the antigens associated with NK cells. CD] 6 and CD56 being the primary ones, and also CD2 which is found expressed in a subset.Q) -### End" -1507,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a true statement about smooth muscle ?, with the following options: A: Have multiple nuclei, B: Have striations, C: Sarcomeres are absent, D: There are cross bridges formed in the smooth muscle during contraction - -### Response: -Smooth muscle cells Lack sarcomeres. Instead, actin filaments are arranged obliquely in the cytoplasm. Some filaments have their plus ends anchored at points in the plasma membrane termed dense plaques, whereas other filaments have plus ends anchored in dense bodies in the cytosol. Option 1: Skeletal (not smooth) muscles have multiple nuclei in the sarcoplasm, just beneath the sarcolemma. Option 2: Striations are present in skeletal & cardiac muscles (not smooth muscles). Striations appear due to regular arrangement of myofilaments in sarcomeres. Option 4: Unlike skeletal muscle, there are no cross bridges formed in the smooth muscle during contraction but instead it has a regulatory protein molecule called calmodulin. -### End" -1508,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about short bowel svndrome-, with the following options: A: Hypergastrinemia & high gastric secretion is seen, B: Diarrhea, dehydration and malnutrition, C: Hirsutism, D: Chronic TPN dependence - -### Response: -Ans. is 'c' i.e., Hirsutism Short bowel syndrome -o Presence of less than 200 cm of residual small bowrel in adult patients.o Insufficient absorptive capacity of small intestine results in diarrhea, dehydration and malnutition.Causes - Small intestine resection (massive) due toMassive resection in singleCumutative effect of multipleoperation as in acute mesentericoperations of small intestineischemia, malignancyresected as in Crohn's diseaseo In pediatric patients, MC etiologies are intestinal atresia, volvulus and necrotizing enterocolitis. Resection of less than 50% of small intestine is generally well tolerated.o Clinically significant malabsorption occurs when more than 50 to 80% of small intestine has been resected.o Resection ofjejunum is better tolerated than resection of ileum.o Presence of healthy colon, intact ileocecal valve and healthy residual small bowel are factors associated with decreased severity of malabsorption.o Malabsorption in short bowel syndrome is exacerbated by a characteristic hypergastrinemia associated gastric acid hypersecretion which persists for 1 to 2 years post operatively.Management -1. Medical- a)TPNHigh dose H-, reseptor antagonist/PPLAntimotility agents - Loperamide.Octreotide - reduces volume of GI secretions.o Levels of Iron, Magnesium, Zinc, Copper and vitamins must be monitored closely and deficienc ies prevented.1 Surgery -Non transplant surgery : Goal is to increase nutrient and fluid absorption by slowing intestinal transit or increasing intestinal length.Segmental reversal of small bowel.Colon interpositionSmall intestinal valves construction.Electrical pacing of small intestine.Bianchi's Intestinal lengthening operation (generally used in pediatric patients with dilated small bowel).Serial transverse enteroplasty (2003).Intestinal transplantation : Indicated for life threatening complications of intestinal failure or chronic TPN therapy -Impending/overt liver failure.Thrombosis of major central veins.Frequent cathater related sepsis.Frequent episodes of severe dehydration. -### End" -1509,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Complementary RNA sequence of 5&; AGTCTGACT3&;, with the following options: A: 5' UCAGACUGA 3', B: 5' UCAGACUGA 3', C: 5' UCAGACUGA 3', D: 5' UCAGACUGA 3' - -### Response: -Adenine complementary to uracil in RNA Guanine complementary to cytosineRef: DM Vasudevan, 7th edition, page no: 457 -### End" -1510,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Key enzyme of gluconeogenesis are all except?, with the following options: A: Pyruvate carboxylase, B: PEP carboxykinase, C: Pyruvate kinase, D: Glucose-6-phosphatase - -### Response: -Ans. is 'c' i.e., Pyruvate kinase -### End" -1511,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shigella are be divided into subgroup on the basis of ability to ferment -, with the following options: A: Lactose, B: Maltose, C: Fructose, D: Mannitol - -### Response: -Ans. is 'd' i.e., Mannitol Fermentation of mannitol is of impoance in classification Shigella Mannitol fermenting Mannitol nonfermenting . Sh. flexneri (sub group B) Sh. dysenteriae (sub group A) . Sh boydii (sub group C) . Sh. Sonnei (sub group D) -### End" -1512,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about lignocaine are true EXCEPT:, with the following options: A: It blocks active sodium channels with more affinity than resting sodium channels, B: It can cause cardiotoxicity, C: It is given orally for treatment of cardiac arrhythmias, D: Adrenaline increases the duration of action of lignocaine when used for infiltration anaesthesia. - -### Response: -Lidocaine, also known as lignocaine, is a medication used to numb tissue in a specific area (local anesthetic). It is also used to treat ventricular tachycardia and to perform nerve blocks. Lidocaine mixed with a small amount of adrenaline(epinephrine) is available to allow larger doses for numbing, to decrease bleeding, and to make the numbing effect last longer. When used as an injectable, lidocaine typically begins working within four minutes and lasts for half an hour to three hours. Lidocaine mixtures may also be applied directly to the skin or mucous membranes to numb the area. -### End" -1513,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lipids and proteins interact in membrane by: (PGI June 2007), with the following options: A: Hydrophobic interactions, B: Both hydrophobic and covalent interactions, C: Covalent bonds, D: H bonds - -### Response: -Ans. D (Hydrogen bond) ""Integral protein interacts with hydrophobic region of the membrane through van der waais contact Q & peripheral membrane protein interacts with lipid through ionic or hydrogen bond Q""- Chatterjea & Shinde 7th/12Protein Within Cell MembraneIntegral / Transmembrane Proteins# They interact with the phospholipids and require the use of detergents for their solubilization.Generally span the lipid bilayerQDistributed asymmetrically across the lipid bilayerQAre usually globular proteinsQThey are in amphipathic natureIntegra] proteins are amphipathic in nature and contain both hydrophobic and hydrophilic regionsHydrophilic regions are located at the ends while the transmembrane region i.e. region that traverses the core of the bilayer is composed of a stretch of hydrophobic amino acids.Qintegral protein are in Vander Walls contact with hydro phobic region of membranePeripheral (Extrinsic) ProteinsPeripheral protein present embedded in either the inner or outer leaflet of the lipid hi layer.They do not interact directly with the phospholipids in the bilayer and do not require use of detergents for their releaseThey are weekly bound to the surface of the membrane by ionic interaction or hydrogen bondsAll major lipids in membranes contain both hydrophobic and hydrophilic regions and are therefore termed amphipathicQ.""-Harper 28th/ 408Membranes are complex structures composed of lipid, proteins & carbohydrateQ-containing molecules"" Harper 28th/407The Major Lipids in Mammalian Membranes are Phospholipids, Glycosphingolipids, & Cholesterol. The amount of each depends upon the type of cell, but in the majority of cases phospholipids are the most abundant. Example of the major cases membrane phospholipids are : phosphatidyicholine(Lecithin), phosphatidylethanolamine, phosphatidylinositol, phosphatidylserineQ.Membranes are asymmetric structuresQ -### End" -1514,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding Mitral valve prolapse syndrome is all,except-, with the following options: A: More common in female, B: Mostly symptomatic, C: Mostly symptomatic, D: Transient cerebral ischemia can occur - -### Response: -MVP, also variously termed the systolic click-murmur syndrome, Barlow's syndrome, floppy-valve syndrome, and billowing mitral leaflet syndrome, MVP is more common in women and occurs most frequently between the ages of 15 and 30 years; Most patients are asymptomatic and remain so for their entire lives. Transient cerebral ischemic attacks secondary to emboli from the mitral valve due to endothelial disruption have been repoed. Infective endocarditis may occur in patients with MR and/or leaflet thickening. (Harrison's Principles of internal medicine, 18 th edition, page 1937 ) -### End" -1515,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mummification odor is:, with the following options: A: Pungent, B: Putrid, C: Odorless, D: Rotten - -### Response: -Ref. Textbook of forensic medicine. Krishnan Vij. Page. 96  -  -Mummification -Mummification the shriveling up of a tissue - -The Optimum Conditions for Mummification - dry & warm climate -Once the changes are complete, the body will remain in that condition indefinitely. -Also seen in newborn infants (sterile) -It’s odourless -No growth of micro organisms. Mummification is partial -25% of body weight is preserved. - -Medico-legal Importance of Mummification - -Identification -Time estimation -Cause of Death -### End" -1516,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a zoonotic disease -, with the following options: A: Hydatid cyst, B: Malaria, C: Filariasis, D: Dengue fever - -### Response: -- zoonoses have been defined as those disease and infection which are naturally transmitted between veebrate animals and man. - hydatid disease is a zoonotic disease of man . It is caused in man by the metacystode stage of the canine intestinal tapeworm, Echinococcus. The adult worms are found in dogs and other carnivores. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:276, 303 <\p> -### End" -1517,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs can be used for intestinal ameobiasis except -, with the following options: A: Metronidazole, B: Chloroquine, C: Diloxanide furoate, D: Tinidazole - -### Response: -Ans. is 'b' i.e., Chloroquine -### End" -1518,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kleiner syndrome is diagnosed by, with the following options: A: Karvo typing, B: USG abdomen, C: Triple test, D: Echocadiography - -### Response: -Klinefelter syndrome - -Extra x chromosome (47 XXY) karyotype -Small testes with hyalinised seminiferous tubules -Delayed puberty -Delayed secondary sexual characters Small penis -Tall & underweight -Mental retardation -Gynaecomastia -### End" -1519,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fracture of proximal forearm cast position is, with the following options: A: Pronated flexion, B: Neutral position, C: Supinated position, D: Position does not matter - -### Response: -Definition of supination. -1: rotation of the forearm and hand so that the palm faces forward or upward; also : - -a corresponding movement of the foot and leg in which the foot rolls outward with an elevated arch. - -2: the position resulting from supination. -### End" -1520,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a drug of choice for treatment of Obsessive Compulsive Disorder (OCD) in adults?, with the following options: A: Imipramine, B: Fluoxetine, C: Chlopromazine, D: Benzodiazepine - -### Response: -The selective serotonin reuptake inhibitors (SSRIs) are now considered to be first-line drug treatments in the management of obsessive compulsive disorder. Fluoxetine is the drug of choice. The doses are usually higher than for anti-depressant action. Clomipramine is still considered as a good option when fluoxetine does not work. Clomipramine has the most specific seratoninergic effects among the Tricyclic Antidepressants (TCAs). Ref: Kaplan & Sadock's Synopsis of Psychiatry 9 Edition, Page 622-23, 209; Harrison's Principles of Internal Medicine 16th Edition, Page 2552; A Sho Textbook of Psychiatry by Neeraj Ahuja, 8th Edition, Page 100 -### End" -1521,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arrange the following preparations in increasing order of their resisting area, with the following options: A: A < B < C, B: B < A < C, C: C < B < A, D: C < A < B - -### Response: -The resisting area decreases as the preparation taper increases. - -For a cylinder with no taper, the resisting area would cover half the axial walls (A). -For an deafly-tapered tooth preparation, the resisting area covers somewhat less than half the axial walls (B). -An over-tapered (20 degrees) preparation has only a small resisting area near the occlusal surface (C). -### End" -1522,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a type of dental caries based on senility of dental caries:, with the following options: A: Rampant caries., B: Arrested caries., C: Recurrent caries., D: None. - -### Response: -Based on whether it is new or occurring at margin of restoration - -Primary -Recurrent (Secondary) - -Based on senility of dental caries - -Rampant -Arrested -### End" -1523,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is diagnostic of menopause?, with the following options: A: Serum FSH >40, B: Serum LH >20, C: Serum FSH <40, D: Serum estradiol <30 - -### Response: -Ans, is a, i.e. Serum FSH > 40Ref: Shaw's Textbook of Gynecology 15th/ed, p62Diagnostic Criteria for Menopause* Estrogen (E2) low at 10-20pg/mL* Estrone (E1) - 30-70pg/mL* E2/E1 < 1* Urine FSH >40IU/L -### End" -1524,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Net ATPs produced by substrate level phosphorylation when one molecule of fructose is conveed to two molecules of pyruvate?, with the following options: A: 2, B: 3, C: 4, D: 5 - -### Response: -ATP yield of fructose is same as that of glucose. One may argue that fructose enters glycolysis bypassing the energy investment step (fructose-1-phosphate to fructose 1,6 bisphosphate) and thus 1 ATP should be obtained extra. but one extra ATP is used for conversion of glyceraldehyde to GAP. So ATP consumption (total 2 per fructose) is same as glycolysis of glucose. Look at the ATP used in the image when fructose enter glycolysis. Hence Net ATP yield is also 4 ATP produced- 2 ATP used = 2 ATPs -### End" -1525,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true regarding relaxation of pelvic joints at term in pregnancy, with the following options: A: Is permanent and not accentuated in subsequent pregnancies., B: Allows for an increase in transverse diameter of the mid - pelvis., C: Results in marked mobility of pelvis at term because of downward gliding movement of the sacroiliac joint., D: Displacement of sacroiliac joint increase outlet diameters by 1.5 to 2.0 cm in dorsal lithotomy position. - -### Response: -Pelvic Joints during pregnancy show marked relaxation caused by upward gliding of sacroliac joint. The Displacement which is greatest in dorsal lithotomy position, may increase diameter of outlet by 1.5 to 2.0 cm. -### End" -1526,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for mushroom poisoning is:, with the following options: A: Atropine, B: Physostigmine, C: Adrenaline, D: Carbachol - -### Response: -Ref: KD Tripathi pharmacology 7th edition (page.no: 104) Mushroom poisoning causes muscarinic actions. It is reversed by Atropine which is a muscarinic antagonist. -### End" -1527,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diagnosis of CO poisoning post-moem -, with the following options: A: Blood thin and red coloured, B: Congestion of all organs, C: Cyanosis, D: Blister on skin - -### Response: -Autopsy findings cherry red discoloration of skin,mucous membrane,nail bed blood is fluid fine froth in mouth and nose congestion of lungs,pulmonary edema hemorrhages in meninges and cox Features of asphyxia REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 360 -### End" -1528,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thayer-Main medium is used for culture of, with the following options: A: Mycobacteria, B: Neisseria, C: Moraxella, D: Salmonella - -### Response: -Blood agar, Chocolate agar, and Mueller-Hinton starch casein hydrolysate agar are the media commonly used for culturing meningococci.Modified Thayer-Main (with vancomycin, Colistin, and Nystatin) is a useful selective medium.Ref: Ananthanarayan; 7th edition; Page no: 223 -### End" -1529,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Midyear population calculated on?, with the following options: A: 1st june, B: 30th june, C: 1st july, D: 31st june - -### Response: -ANSWER: (C) 1st JulyREF: Park 18th ed p.639Mid year population is estimated population on 1st of julyCensus estimation is done at end of first quarter in the first year after a decade (end of march) -### End" -1530,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following cranial nerves are involved in Acoustic neuroma, except -, with the following options: A: Vagus, B: Glossopharyngeal, C: Oculomotor, D: Facial - -### Response: -Ans. is 'c' i.e., Oculomotor Clinical features of acoustic neuromao The clinical features depend on the extent of tumor and involved structureWhen tumor is still confined to the internal auditory canalCochleovestibular symptoms are the earliest symptoms of acoustic neuroma when tumour is still confined to internal auditory canal. The commonest presenting symptoms are unilateral deafness or tinnitus, or a combination of both. Hearing loss is retrocochlear sensorineural type. There is marked difficulty in understanding speech, out of proportion to the pure tone hearing loss, a characteristic feature of acoustic neuroma. Vestibular symptoms are imbalance or unsteadiness. True vertigo is very rare.When tumor extends beyond IAC and involves other structuresVth cranial nerve It is the earliest nerve to be involved. There is reduced corneal sensitivity and loss of corneal reflex which is the earliest sign of acoustic neuroma. Numbness or paraesthesia of face mayoccur. Involvement of Vth nerve indicates that tumor is roughly 2.5 cm in diameter and occupies the CP angle.VIIth nerve :- Sensory fibres of facial nerve are involved. There is hypoesthesia of posterior meatal wall (Hitzelberg's sign), loss of taste, and loss of lacrimation on Schirmer's test. Motor fibres are more resistant.IXth and Xth nerves :- Dysphagia and hoarseness due to palatal, pharyngeal and laryngeal paralysis.Brainstem :- Ataxia, weakness, numbness of arms & legs, exaggerated tendon reflexes.Cerebellum :- Ataxia, Dysdiadochokinesia, Nystagmus.Due to raised ICT:- Headache, neusea, vomiting, diplopia due to VIth nerve involvement, and papilloedema. -### End" -1531,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: With MAO inhibitors, food not given is -, with the following options: A: Cheese, B: Beer, C: Fish, D: All of the above - -### Response: -Ans. is 'd' i.e., All of the above -### End" -1532,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'A 46 years-old male patient has Cushing's syndrome due to the adrenal tumor. Which of the following drugs would be expected to reduce the symptoms in this case?, with the following options: A: Betamethasone, B: Coisol, C: Fludrocoisone, D: Ketoconazole - -### Response: -High dose Ketoconazole has been used in Cushing's syndrome to decrease coicosteroid production ketoconazole- steroid synthesis inhibitor (Ref. Essentials of medical pharmacology TD Tripathi 7th edition page no.793.) -### End" -1533,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How do you manage an established freys syndrome?, with the following options: A: Facial nerve stimulation, B: Physiotherapy, C: Antidepressants, D: Tympanic neurectomy - -### Response: -MANAGEMENT OF ESTABLISHED FREY'S SYNDROMEAntiperspirants, usually containing aluminium chloride;Denervation by tympanic neurectomy;The injection of botulinum toxin into the affected skin.PreventionTechniques described to prevent Frey's syndrome following parotidectomy. These include:Sternomastoid muscle flap;Temporalis fascial flap;Inseion of aificial membranes between the skin and the parotid bed.Ref: Bailey and love, page no: 795 -### End" -1534,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child with recurrent muscle cramps and spams On analysis there is hypokalemia , metabolic alkalosis , hypocalciuria but increased urinary magnesium . What is the most probable diagnosis ?, with the following options: A: Bartter syndrome, B: Gittelman syndrome, C: Liddle syndrome, D: None of the above - -### Response: -Gittelman syndrome  : -Defect in Na-Cl co-transporter. -Hypokalemic metabolic alkalosis. -Hypocalciuria - No stones in urine. -Hypomagnesemia due to ↑ urinary magnesium. -### End" -1535,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following structure does not pass through flexor retinaculurn, with the following options: A: Ulnar N., B: Median N., C: Flexor digitorum profundus, D: Flexor digitorum superficialis - -### Response: -Ulnar nerve Flexor retinaculum (F.R.)Is a thickening of deep fascia which bridges the ant. concavity of the carpus and conves it into an osteofascial tunnel, the carpal tunnel.Structures passing beneath the flexor retinaculum from medial to lateral are:Flexor digitorum superficialis tendon & post. to these flexor digitorum profundus tendonsMedian N.Flexor pollicis longusFlexor carpi radialis -### End" -1536,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sonographic finding of spina bifida – a) Ventriculomegalyb) Obliteration of cisterna magnac) Small BPDd) Abnormal curvature of cerebellume) Club foot, with the following options: A: acd, B: bcd, C: abc, D: abd - -### Response: -Sonographic findings of spina bifida - -Most common site is lumbosacral region. -Ventriculomegaly with hydrocephalus. -Banana sign - cerebellum is stretched around the brain stem with effacement of cisterna magna. -Lemon sign - Flattening of frontal bones on transverse image. -Bony defect in spine: - - V shaped profile due to outward flaring of two posterior ossification centres. - Presence of intact sac on posterior aspect of spine. - Sac filled with fluid or solid tissue in meningocele or myelomeningocele. -### End" -1537,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Marfan's syndrome lens dislocation is commonly seen –, with the following options: A: Upwards, B: Downwards, C: Supero–temporally, D: Nasally - -### Response: -In Marfan syndrome there is superolateral (superotemporal) dislocation of lens. -### End" -1538,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young adults presents with night blindness and tubular vision. On examination, IntraocularPressure was observed to be 18mm and the anterior segment was unremarkable. Fundoscopyshowed attenuation of aerioles and waxy pallor of the optic disc with bony corpuscles like spicules of pigmentation in mid peripheral retina. Ring scotomas were observed on perimetry. Which of thefollowing is the most likely diagnosis -, with the following options: A: Pigmentary Retinal Dystrophy, B: Primary Open Angle Glaucoma, C: Lattice degeneration of Retina, D: Diabetic Retinopathy - -### Response: -RETINITIS PIGMENTOSA This primary pigmentary retinal dystrophy is a hereditary disorder predominantly affecting the rods more than the cones. Inheritance Most common mode is autosomal recessive, followed by autosomal dominant. X-linked recessive is the least common. Incidence  It occurs in 5 persons per 1000 of the world population.  Age. It appears in the childhood and progresses slowly, often resulting in blindness in advanced middle age.  Race. No race is known to be exempt or prone to it.  Sex. Males are more commonly affected than females in a ratio of 3:2.  Laterality. Disease is almost invariably bilateral and both the eyes are equally affected. Clinical features (A) Visual symptoms 1. Night blindness. It is the characteristic feature and may present several years before the visible changes in the retina appear. It occurs due to degeneration of the rods. 2. Dark adaptation. Light threshold of the peripheral retina is increased; though the process of dark adaptation itself is not affected until very late. 3. Tubular vision occurs in advanced cases. 1. Retinal pigmentary changes. These are typicallyperivascular and resemble bone corpuscles in shape. Initially, these changes are found in the equatorial region only and later spread both anteriorly and posteriorly. 2. Retinal aerioles are attenuated (narrowed) and may become thread-like in late stages. 3. Optic disc becomes pale and waxy in later stages and ultimately consecutive optic atrophy occurs 4. Other associated changes which may be seen are colloid bodies, choroidal sclerosis, cystoid macular oedema, atrophic or cellophane maculopathy. (C) Visual field changes Annular or ring-shaped scotoma is a typical featurewhich corresponds to the degenerated equatorial zone of retina. As the disease progresses, scotoma increases anteriorly and posteriorly and ultimately only central vision is left (tubular vision). Eventually even this is also lost and the patient becomes blind. Ref : AK khurana 4/e page no 268. -### End" -1539,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Giving commission to other doctor is, with the following options: A: Dichotomy, B: Covering, C: Professional secrecy, D: Professional neglect - -### Response: -Ans. a (Dichotomy). (Ref. Textbook of FMT by Parikh-5th ed. 558)Dichotomy is giving commission to the other doctor for favouring or referring the patient, recommending or procuring any patient for medical, surgical or other treatment (fee-sharing).Covering is a RMP protecting a non-medical person who practices medicine. -### End" -1540,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lucio phenomenon is treated with:, with the following options: A: Steroids, B: Lenalidomide, C: Clofazimine, D: Exchange transfusion - -### Response: -Lucio phenomenon seen in leprosy- recurrent crops of large, sharply marginated, ulcerative lesions paicularly on the lower extremities. These are frequently fatal as a result of secondary infection and consequent septic bacteremia. Neither glucocoicoids nor thalidomide is effective against this syndrome. Optimal wound care and therapy for bacteremia are indicated. Ulcers tend to be chronic and heal poorly. In severe cases exchange transfusion is indicated. Extra edge : Lenalidomide (thalidomide derivative) is the drug of choice in MDS patients with 5q deletion, MDS with 5q deletion is lenalidomide responsive. -### End" -1541,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cation used in PCR is, with the following options: A: Calcium, B: Lithium, C: Magnesium, D: Sodium - -### Response: -All polymerases require divalent cations for their activity but some tend to function in buffers containing Mn2+ as well, although a little less efficiently.dNTPs and oligonucleotides bind to Mg2+ and therefore its concentration should exceed the molar concentration of phosphate groups that are contributed from both the dNTPs and primers.dNTPs bind in equimolar concentration with Mg2+. -### End" -1542,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following vitamin is a component of ETC:, with the following options: A: Vitamin B12, B: Riboflavin, C: Nicotinic acid, D: Thiamine - -### Response: -In ETC, Complex I (FMN, Fe-S ) & Complex II (FAD , Fe-S) are involved, which contains FAD, FMN made of riboflavin. Therefore Riboflavin (Vitamin B2) is a component of ETC. Vitamin Constituent of Riboflavin (Vitamin B2) FAD, FMN. Nicotinic acid (Niacin) (Vitamin B3) NAD, NADP. Pantothenic acid (Vitamin B5) Coenzyme A. There are two different questions asked on this, BE CAREFUL: Vitamin, which is component of ETC, is Riboflavin as it is present in complex I & II, in the form of FMN & FAD respectively (Figure below). NAD or NADH is not a component of ETC complexes. NADH is a just a substrate for ETC complex I (Figure below) So, one can interpret that Vitamins which are used in ETC are both B2 & B3 as FADH2 or NADH can be the staing materials for ETC -### End" -1543,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about renal trauma-, with the following options: A: Urgent IVP is indicated, B: Exploration of the kidney to be done in all cases, C: Lumbar approach to kidney is preferred, D: Renal artery aneurysm is common - -### Response: -Approach to kidney should be transperitoneal to exclude the possibility of damage to other abdominal organs. Approach should not be Lumbar. -Aneurysm of renal artery is a rare complication -Bailey -### End" -1544,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following findings can be seen during clinical examination of a pregnant female with hea disease compared with normal pregnancy?, with the following options: A: Pedal edema, B: Engorged neck veins, C: Dyspnea, D: Exercise intolerance - -### Response: -In normal pregnancy, functional systolic hea murmurs are common; respiratory effo is accentuated and at times suggests dyspnea; edema in the lower extremities after mid pregnancy is common; and fatigue and exercise intolerance develop in most women. Some systolic flow murmurs may be loud. Clinical indicators of hea disease during pregnancy: Symptoms: Progressive dyspnea or ohopnea Nocturnal cough Hemoptysis Syncope Chest pain Clinical Findings Cyanosis Clubbing of fingers Persistent neck vein distension Systolic murmur grade 3/6 or greater Diastolic murmur Cardiomegaly Persistent arrhythmia Persistent split second sound Criteria for pulmonary hypeension Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 44. Cardiovascular Disease. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. -### End" -1545,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5 year old child presents with perivascular IgA deposition and neutrophilic collection. There is erythematous rash on the lower limb and nonblanching purpura. Probable diagnosis is, with the following options: A: Henoch-Schonlein purpura, B: Wegener's granulomatosis, C: Vasculitis, D: Kawasaki's disease - -### Response: -Henoch schonlein purpura : It is one of the most common vasculitic disorder of childhood. Characterised by the presence of nonthrombocytopenic , palpable purpura, transient ahralgia and abdominal symptoms. The illness begins with a rash more prominent over the extensor aspects of lower extremities and buttocks. It may be macular, maculopapular or even uicarial to begin with . Glomerulonephritis seen in one third of cases. Gastrointestinal manifestations usually occur in first 7-10 days if illness. Abdominal pain is intermittent, colicky and periumbilical.vomitingseen , whereas melena and hemetemesis are less common. Rare manifestations include CNS vasculitis, coma, Guillain Barre syndrome, pulmonary hemorrhage, carditis and orchitis. Criteria for childhood HSP:- Palpable purpura in the presence of at least one of the following 4 features: 1. Diffuse abdominal pain. 2. Any deposit showing IgA deposition. 3. Ahritis/Ahralgia. 4. Renal involvement. Investigation: Nonspecific rise in total serum IgA levels. Skin biopsy shows leukocytoclastic vasculitis. On indirect immunofluorescence there are mesangial deposits of IgA andC3 in skin and renal biopsy. Reference: GHAI essential Paediatrics -### End" -1546,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a usual feature of Ascariasis -, with the following options: A: Abdominal pain, B: Uicaria, C: Anaemia, D: Loefflers syndrome - -### Response: -Ans. is 'c' i.e., Anemia Ascariasis o Infections usually remain asymptomatic. o There may be pain, weight loss, diarrea, vomiting, and Anorexia. o Loeffer's syndrome is caused by pulmonary ascariasis --> Fever, cough, dysnea, wheeze, uicaria and eosinophilia. -### End" -1547,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation to diagnose the Laryngo pharyngeal reflux, with the following options: A: Esophageal pH monitoring, B: Dual Probe Impedance pH monitoring, C: Barium Esophagogram, D: Scintigraphy - -### Response: -Ans. (b) Dual Probe Impedance pH MonitoringRef: Shackelford Page 222/8th Edition* pH monitoring at the level of Pharynx is not helpful because the acid refluxed is neutralized by the Pharyngeal secretions.* Hence a Dual (Bifurcated) catheter measuring both pH and Impedance is used across Upper esophageal sphincter, thereby permitting detection of Pharyngeal reflux -### End" -1548,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a prognostic factor for acute pancreatitis :, with the following options: A: Hypocalcemia, B: Hyperglycemia, C: AST elevation, D: Increased serum amylase - -### Response: -Ans. is 'd' i.e. Increased serum amylase. Ranson has identified a series of prognostic signs for early identification of patients with severe pancreatitis.There are 11 objective parameters, 5 are to be measured at the time of admission, whereas the remaining 6 are measured within 48 hours of admission.Morbidity and mortality of the disease are directly related to the number of signs present.Number of Ranson's signs Approximate mortality0-2-0%3-4-15%5-6-50%>6-70-90 % Ranson's Prognostic signs of Acute PancreatitisAt admissionDuring the initial 48hAge > 55 y WBC > 16,000/mm3 Blood glucose > 200 mg/dL Serum LDH> 350IU/L Serum AST > 250 U/dLHematocrit fall >10 points BUN elevation > 5 mg/dL Serum calcium < 8 mg/dL Arterial P02 < 60 mm Hg Base deficit > 4 mEq/L Estimated fluid sequestration > 6 L Also knowThe above given criteria are for Pancreatitis caused by causes other than gallstones.The prognostic criteria for acute gall stone pancreatitis are slightly different. These are: Criteria for gallstone pancreatitis At admissionDuring the initial 48 hAge > 70 y WBC > 18,000/mm3 Blood glucose > 220 mg/dL Serum LDH > 400IU/L Serum AST > 250 U/dLHematocrit fall > 10 points BUN elevation > 2 mg/dL Serum calcium < 8 mg/dL Base deficit > 5 mEq/L Estimated fluid sequestration > 4L -### End" -1549,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which type of breech is seen more commonly in primigravidas?, with the following options: A: Complete breech, B: Frank breech, C: Footling breech, D: Knee presentation - -### Response: -Ans. is 'b' i.e., Frank breech Types of Breech* Complete: Full flexed attitude, thighs are flexed at the hips and legs are flexed at the knees,so the presenting part comprises of the buttocks, external genitalia and two feet. It is usually seen in multipara.IncompleteA) Frank breech: Thighs are flexed at the hips and legs are extended at the knees. The presenting part consists of external genitalia and buttocks. It is commonly seen in primigravidas (70%) due to tight abdominal wall, good uterine tone and early engagement.B) Footling presentation: Both the thighs and the legs are partially extended bringing the legs at the pelvic brim.C) Knee presentation: Thighs are extended but the knees are flexed, bringing the knees to the pelvic brim. -### End" -1550,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a good media to use for diagnosis of Legionnaires disease -, with the following options: A: Thayer Martin Media, B: BCYE agar, C: Bordet Gengu media, D: Chocolate agar - -### Response: -BCYE media: Buffered charcoal yeast extract with cysteine and antibiotics -### End" -1551,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of analgesia is by:, with the following options: A: Nociceptin stimulation, B: Nocistatin stimulation, C: O.L.R.I, D: All - -### Response: -B i.e. Nocistatin stimulation -### End" -1552,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A rapid method of chromosome identification in intersex is -, with the following options: A: FISH, B: PCR, C: SSCP, D: Karyotyping - -### Response: -Ans is a. ie. FISH * The above-mentioned site writes about FISH- * ""FISH can be used in interphase cells to determine the chromosome number of one or more chromosomes as well as to detect some specific chromosome rearrangements that are characteristic for certain cancers. The primary advantage of interphase FISH is that it can be performed very rapidly if necessary, usually within 24 hours, because cell growth is not required.* A good example is the Aneuploid Screen test which is performed on amniotic fluid cells when there is a strong clinical indication for one of the common trisomies. The sample nuclei are denatured and hybridized with DNA probes for chromosomes 13, 18, 21, X, and Y and results usually obtained within 24 hours. Routine Cytogenetics is included with an Aneuploid Screen to confirm the results or detect any abnormalities not detected by interphase FISH.""Fluorescent IN SITU Hybridization (FISH)Fluorescent In Situ Hybridization (FISH) is a relatively new technology utilizing fluorescently labeled DNA probes to detect or confirm gene or chromosome abnormalities that are generally beyond the resolution of routine cytogenetics. The sample DNA (metaphase chromosomes or interphase nuclei) is first denatured, a process that separates the complementary strands within the DNA double helix structure. The fluorescently labeled probe of interest is then added to the denatured sample mixture and hybridizes with the sample DNA at the target site as it reanneals (or reforms itself) back into a double helix. The probe signal can then be seen through a fluorescent microscope and the sample DNA scored for the presence or absence of the signal.FISH can be used in metaphase cells to detect specific microdeletions beyond the resolution of routine cytogenetics or identify the extra material of unknown origin. It can also help in cases where it is difficult to determine from routine cytogenetics if a chromosome has a simple deletion or is involved in a subtle or complex rearrangement. In addition, metaphase FISH can detect some of the specific chromosome rearrangements seen in certain cancers.Microdeletion Syndromes Currently Diagnosable with FISHCri-du-Chat * Kallman SyndromeMiller-Dieker Syndrome * Williams SyndromeSmith-Magenis Syndrome * Wolf-HirschhornSteroid Sulfatase Deficiency * Prader-Willi/Angelman SyndromeDiGeorge/Velo-Cardio-Facial/CATCH-*22/Shprintzen SyndromeSingle-stranded conformation polymorphism (SSCP)SSCP is the electrophoretic separation of single-stranded nucleic acids based on subtle differences in sequence (often a single base pair) which results in a different secondary structure and a measurable difference in mobility through a gel.The mobility of double-stranded DNA in gel electrophoresis is dependent on strand size and length but is relatively independent of the particular nucleotide sequence. The mobility of single strands, however, is noticeably affected by very small changes in sequence, possibly one changed nucleotide out of several hundred. Small changes are noticeable because of the relatively unstable nature of single-stranded DNA; in the absence of a complementary strand, the single strand may experience intrastrand base pairing, resulting in loops and folds that give the single strand a unique 3D structure, regardless of its length. A single nucleotide change could dramatically affect the strand's mobility through a gel by altering the intrastrand base pairing and its resulting 3D conformation (Melcher, 2000).Single-strand conformation polymorphism analysis takes advantage of this quality of single-stranded DNA. SSCP analysis offers an inexpensive, convenient, and sensitive method for determining genetic variationThe SSCP analysis method detects point mutations by analyzing their unique electrophoretic mobility that results from small changes in the variant's nucleotide sequences.Polymerase chain reaction is a sensitive and rapid method for amplifying a specific DNA sequence. -### End" -1553,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child with diarrhoea since 2 days shows the following sign. It is said to be very slow when it takes?, with the following options: A: > 2 s, B: > 3 s, C: > 4 s, D: >5 s - -### Response: -Skin pinch test -assess severity of dehydration in patients with diarrhoea. Pinch the skin on dorsum of hand or on abdomen- show skin turgor. If skin goes back quickly- normal hydration. If skin goes back slowly(<2 sec but not immediately)- moderate dehydration. If skin goes back very slowly (>2 sec) - severe dehydration. No Dehydration Some Dehydration Severe Dehydration Consciousness Ale ""Irritable"" ""Lethargic"" Eyes Normal Sunken Very sunken Thirst Normal ""drinks eagerly"" ""Unable to drink"" Buccal mucosa Normal Dry Very dry Skin pinch Goes back quickly ""Slowly"" ""Very slowly"" Tears Present Absent Absent Treatment Plan a Plan b Plan c -### End" -1554,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice in hyperprolactinemia is which of the following?, with the following options: A: CT brain, B: MRI brain, C: Prolactin estimation, D: CH estimation - -### Response: -The diagnosis of hyperprolactinemia is made by estimation of fasting morning prolactin. -### End" -1555,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest cause of moality in Ivor Lewis operation, with the following options: A: Pulmonary atelectasis, B: Anastmotic leak, C: Thorasic duct fistula, D: Sub diphragmatic collection - -### Response: -Ivor Lewis operation is done for esophageal carcinoma. It is a 2 stage operation, in which abdomen is opened first, closed and then thoracotomy is performed. As it involves esophago- gastric anastomosis, Major complication causing moality is anastomotic leak. Aggressive investigation for leak is mandatory in case of unexplained fever or clinical event. Reference: Bailey and love, 27th edition, page 1092,1093 -### End" -1556,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reticulocyte level in newborn is?, with the following options: A: 0.2-1.5%, B: 1-1.6%, C: 2.5-6%, D: 6-10.2% - -### Response: -Ans. is 'c' i.e., 2.5-6% o Reticulocyte count is the percentage of reticulocytes in total red blood cells. Number of reticulocytes Reticulocyte count --____________________________ x 100 Total number of RBCs o The reticulocyte count serves as an impoant tool to indicate shoened RBC survival and the subsequent appropriate response by the bone marrow to increase RBC production. o Reticulocytes are young RBCs that have just left the marrow but still contain residual RNA. o Normally, they remain for only 1 to 1.5 days in the blood. o Normal reticulocytes count in an adult is 0.5% to 2%. o In normal newborn range is 1.8% to 5.8%. -### End" -1557,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hemodialysis is useful in all of the following except:, with the following options: A: Barbiturate poisoning, B: Methanol poisoning, C: Salicylate poisoning, D: Digoxin poisoning - -### Response: -Ans. C. Salicylate poisoningDialysis will not remove drugs which have high Vda. Dialysis will not remove drugs which have high plasma protein bindingb. Digoxin, diazepam, organophosphates have high Vd.Drugs having high Vd are: (hemodialysis is ineffective)a. Dialysis--Diazepamb. Ko--Kerosene poisoningc. A--Amphetamined. V--Verapamile. 0--Organophosphorus, opioidsf. I--Imipramineg. uD--Digitalis -### End" -1558,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One is not the indication of total parenteral nutrition ?, with the following options: A: Acute pancreatitis, B: Enterocolic fistula, C: Chronic liver disease, D: Faecal fistula - -### Response: -Ans is 'c' i.e. Chronic liver disease Parenteral nutrition involves the continuous infusion of a hyperosmolar solution containing carbohydrates, proteins, fat and other necessary nutrients through an indwelling catheter inseed into (usually) the superior vena cava. Indications for Total parenteral Nutrition (Ref: Sabiston 18/e p168, 17/e p162) The principal indications for parenteral nutrition are found in seriously ill patients when use of the gastrointestinal tract for feeding is not possible. In some instances intravenous nutrition may be used to supplement inadequate oral intake. (A)As primary therapy I. Gastrointestinal cutaneous fistula including enteroenteric, enterocolic, enterovesical or enterocutaneous fistula. 2. Renal failure (Acute tubular necrosis) 3. Sho bowel syndrome 4. Severe burns 5. Hepatic failure (acute decompensation superimposed on cirrhosis) 6. Crohn's ds 7. Anorexia nervosa (B) As a suppoive therapy I. Acute radiation enteritis Acute chemotherapy toxicity Prolonged ileus Weight loss preliminary to major surgery (C) Areas under Intensive study Patients with cancer Patients with sepsis About Pancreatitis TPN was once a preferred route of providing nutritional suppo to patients with sever acute pancreatitis, but now jejunal enteral feeding is the preferred method with TPN required for few cases when - there is delay in providing jejuna] enteral nutrition to patient with significant malnutrition for more than 3- 4 days there is persistent ileus there is exacerbation of pancreatitis after enteral nutrition -### End" -1559,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Koebners phenomenon is seen typically with, with the following options: A: Scabies, B: Lupus vulgaris, C: Psoriasis, D: Eczema - -### Response: -Koebner phenomenon is the development of isomorphic pathologic lesions in the traumatized uninvolved skin of patients who have cutaneous diseases. Trauma is followed by new lesions in the traumatized but otherwise normal skin, and these new lesions are clinically and histopathologically identical to those in the diseased skin. three disease processes that display the true isomorphic response of Koebner: psoriasis, lichen planus vitiligo iadvl Textbook of dermatology page 136 -### End" -1560,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ultrasound is done in 1st trimester for all except: March 2009, with the following options: A: Multiple pregnancy, B: Fetal anomalies, C: To estimate gestational age, D: To know the position of the placenta - -### Response: -Ans. D: To know the position of the placenta Benefits of first trimester USG: Viability of the fetus Pregnancy dating Multiple pregnancy detection Detection of ectopic pregnancy Detection of H.Mole Detection of fetal anomalies Placental localization can be done with USG in second half of pregnancy. -### End" -1561,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PO2 is maximum, with the following options: A: Base of lung, B: Posterior lobe, C: Apex of lung, D: Middle lobe - -### Response: -Paial pressure of oxygen is maximum at the apex of the lung Ref: guyton and hall textbook of medical physiology 12 edition page number: 332,333,334 -### End" -1562,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Immune Reconstitution Inflammatory syndrome (IRIS) except:, with the following options: A: It occurs when CD4 cell count is < 50 cells/mm3, B: Develops after initiation of anti-retroviral therapy, C: Associated with delayed type of hypersensitivity, D: Does not require a specific antimicrobial therapy for recovery - -### Response: -Immune Reconstitution Inflammatory syndrome (IRIS) In patients with CD4 count <100 cells/mm3. In HIV infection, an exaggerated inflammatory reaction to a disease-causing microorganism that sometimes occurs when the immune system begins to recover following treatment with antiretroviral (ARV) drugs. 2 IRIS scenarios : Unmasking- Flare-up of an underlying occult oppounistic infection. Paradoxical- Symptomatic relapse of a prior infection despite microbiologic treatment success. MECHANISM : Increased inflammation as the recovering immune system recognizes the antigens , there is hypothesized reconstitution of antigen-specific T cell-mediated immunity with activation of the immune system following HIV therapy against persisting antigen, whether present as intact organisms, dead organisms, or debris.(as body's immune response recovers following HAA) There is a cytokine storm with a predominant type-1 helper T-cell interferon-gamma response. (Delayed hypersensitivity) Cryptococcus neoformans is the usual pathogen eliciting more severe disease Rx- Systemic coicosteroids during IRIS may be beneficial in preventing death or progressive neurological deterioration. -### End" -1563,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apple jelly nodules are seen in?, with the following options: A: Lupus vulgaris, B: Scrofuloderma, C: Chancre, D: Atypical mycobacterial infection - -### Response: -Ans. (a) Lupus vulgarisRef: Rook's 8/e, p 31.14 -### End" -1564,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In congenital adrenal hyperplasia, deficient enzyme is - most womon-, with the following options: A: 11 hydroxylase deficiency, B: 21 a hydroxylase deficiency, C: 3a hydroxylase deficiency, D: 17a hydroxylase deficiency - -### Response: -Ans. is 'b' i.e., 21-a Hydroxylase dificiency Congenital adrenal hyperplasia (CAH)Group of AR disorderMC adrenal disorder in childhoodMost common 21-hydroxylase deficiencyIn 21a-hyroxylese deficiencyThere is deficiency of mineralocorticoids & glucocorticoid.This leads to hypoglycemia, hyponatremia. -### End" -1565,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is absolutely essential for wound healing, with the following options: A: Vit D, B: Carbohydrates, C: Vit C, D: Balanced diet - -### Response: -refrobbins 7/e p 114;9/e p106 synthesis of collagen. It is also a highly effective antioxidant protecting cells from damage by free radicals. Studies have shown that the vitamin can help speed thehealing process of wounds. -### End" -1566,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lecithin Sphingomyelin ratio in amniotic fluid is used to assess the maturity of :, with the following options: A: Fetal liver, B: Fetal lung, C: Placenta, D: Fetal kidney - -### Response: -Fetal lung -### End" -1567,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient present with skin bullae on the sun exposure. The defect is of, with the following options: A: Sugar changes, B: DNA methylation, C: Thymidine dimers, D: Trinucleotide repeats - -### Response: -A pair of abnormally chemically bonded adjacent thymine bases in DNA, resulting from damage by ultra-violet irradiation. The cellular processes that repair this lesion often make errors that create mutations. -### End" -1568,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with hyperacusis, loss of lacrimation and loss of taste sensation in the anterior 2/3rd of the tongue. -Inflammation extends up to which level of facial nerve, with the following options: A: Vertical part, B: Vertical part proximal to nerve to stapedius, C: Vertical part and beyond nerve to stapedius, D: Proximal to geniculate ganglion - -### Response: -• If facial nerve inflammation extends proximal to geniculate ganglion, the clinical features are: Loss of lacrimation (later may present with crocodile syndrome); hyperacusis (loss of stapedial reflex); decreased salivation and loss of taste sensation on anterior 2/3rd tongue; paralysis of muscles of facial expression. -### End" -1569,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inferior mesenteric vein drains into vein :, with the following options: A: Splenic, B: Hepatic, C: Poal, D: Inf. vena cava - -### Response: -A. i.e. Splenic vein Inferior mesenteric vein begins as superior rectal vein & drains into splenic veinQ behind the body of pancreas. Inferior mesenteric vein receives superior rectal, sigmoid & left colic veins. -### End" -1570,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Male to Female ratio is -, with the following options: A: Males for 1000 population, B: Females for 1000 males, C: Males for 1000 females, D: None - -### Response: -Ans. is 'b' i.e., Females for 1000 males -### End" -1571,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IVRA is contraindicated in -, with the following options: A: Cancer of hematogenous system, B: Sickle cell disease, C: Coagulopathy, D: Hypeension - -### Response: -Intravenous regional anaesthesia (IRVA) was first described by Augustus Bier in 1908; his technique was repopularised by Holmes in 1963. The administration of intravenous local anaesthetic in an isolated limb by means of an ischaemic cuff is a simple and effective technique, with a low incidence of failure and high degree of safety Contraindications to IVRA Severe Raynaud's Disease (intermittent aeriolar vasospasm of the distal limbs after cold or emotional stimuli). Sickle Cell Disease (IVRA is relatively contraindicated, unless meticulous exsanguination of the limb takes place prior to cuff inflation). Crush injury to the limb, IVRA may provoke fuher tissue damage secondary to hypoxia. Age - young children are generally not amenable to IVRA alone, however in combination with sedation and additional analgesia it can be used successfully. Patients should be starved, as there may be a possibility of conversion to a general anaesthetic, alternatively the patient may require sedation in addition to IVRA to improve co-operation. Ref -pubmed.com , journal on Bier's block -### End" -1572,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aplastic anemia can progress to all except:, with the following options: A: AML, B: Myelodysplastic anemia, C: Pure red cell aplasia, D: Paroxysmal nocturnal hemoglobinuria - -### Response: -Ans. (c) Pure red cell aplasia(Ref: Robbins 9th/pg 653-655)Aplastic anemia can progress toAMLMyelodysplastic anemiaParoxysmal nocturnal hemoglobinuriaAplastic anemia cannot progress to Pure red cell aplasia -### End" -1573,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A healthy 75-year-old man bleeds from a duodenal ulcer. Medical management and endoscopic measures fail to stop the bleeding. What is the next step in management?, with the following options: A: Continued transfusion of 8 U of blood, B: Administration of norepinephrine, C: Oversewing of the bleeding point, D: Oversewing of the bleeding point, vagotomy. and pyloroplasty - -### Response: -In general, surgery for peptic ulcer bleeding is indicated at an earlier stage in an older patient because vessels are atherosclerotic and less likely to stop bleeding spontaneously. In addition, diminished perfusion of the heart, brain, and kidneys is less well tolerated in elderly patients. At surgery, the gastroduodenal artery is oversewn, and a vagotomy and drainage procedure is performed. -### End" -1574,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brill Zinsser disease is caused by, with the following options: A: C. burnetti, B: R. typhi, C: R. slovaca, D: R. prowazekii - -### Response: -DiseaseEtiologyDescriptionGroup Affected/Epidemiologic FactorsClinical SyndromeEpidemic typhusRickettsia prowazekiiMaculopapular eruption appearing inaxillae, spreading to trunk and later toextremities; usually spares face, palms, soles;evolves from blanchable macules to confluent eruption with petechiae; rash evanescentin recrudescent typhus (Brill-Zinsserdisease)Exposure to body lice;occurrence of recrudescenttyphus as relapseafter 30-50 yearsHeadache, myalgias;moality rates 10-40% ifuntreated; milder clinicalpresentation in recrudescentformRef: Harrison; 19th edition; Page no: 128 -### End" -1575,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common vector of Japanese encephalitis is:, with the following options: A: Anopheles, B: Culex, C: Ixodes, D: Aedes - -### Response: -b. Culex(Ref: Nelson 20/e p 1627)Culex tritaeniorhynchus summarosus, a nightbiting mosquito that feeds preferentially on large domestic animals & birds but only infrequently on humans, is the principal vector of JE in northern Asia. -### End" -1576,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Munchausen's syndrome by proxy involves:, with the following options: A: Drug abuse, B: Toxin mediated neuropsychiatric disorder, C: Illness caused by caregiver, D: All of the above - -### Response: -Munchausen syndrome by proxy This rare disorder is where a parent or caregiver repeatedly fabricates an illness or disability in a child they are looking after, for the benefit of themselves. The adult involved is most frequently the child's mother, but not always. There are several impoant aspects to this condition The physical harm caused to the child through falsification of illness The impact upon the child's physical and emotional development The psychological status of the adult involved The majority of children involved are under 5 years. -### End" -1577,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Windswept deformity in foot is seen in -, with the following options: A: Rickets, B: RA, C: Hyperparathyroidism, D: Scurvy - -### Response: -Ans. is 'b' i.e., RA Please notice, foot in the question. For foot, the correct answer is ""RA"", for knee it's Rickets. Windswept deformity Knee : - A valgus deformity of one knee in association of varus deformity of other knee is know as windswept deformity. It is seen in : Rickets, Physeal oseochondromatosis, Hereditary dysplasia (epiphyseal dysplasia) of bone and Rheumatoid arthritis. Foot: - Deviation of all - toes in one direction (usually laterally) is known as windswept deformity. It is seen in Rheumatoid arthritis. Hand : - Deviation of all fingers (usually medialy) is know as windswept deformity. It is seen in Rheumatoid arthritis, SLE, and Jacoud's arthropathy. -### End" -1578,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 58-year-old male bricklayer is admitted to the hospital with severe pain that radiates from his lower back to the pubic region. Ultrasound examination reveals that a kidney stone is partially obstructing his right ureter; the examination also indicates the presence of a second ureter on the right side. Which of the following is the most likely cause of this latter finding?, with the following options: A: Failure of ureteric bud to form, B: Early splitting of the ureteric bud, C: Failure of urorectal septum to develop, D: Persistent urachus - -### Response: -The ureteric bud is responsible for the development of the ureter, and thus an early splitting of the ureteric bud would result in formation of a second ureter on the ipsilateral side. Failure of the ureteric bud to form would cause a complete absence of the ureter, whereas failure of the ureteric bud to branch occurs normally during embryonic development and results in one ureter joined to each kidney. The urorectal septum is a section of tissue of mesenchymal origin that develops between the allantois and hind- gut. Failure of this structure to develop would not result in an additional ureter. Finally, a persistent urachus acts as an abnormal fistula that runs from the bladder to the umbilicus, resulting in urine leaking from the external abnormal wall. -### End" -1579,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in reiter's syndrome except ?, with the following options: A: Subcutaneous nodules, B: Oral ulcers, C: Keratoderma blenorrhagicum, D: Circinate balanitis - -### Response: -Reiter's syndrome has reactive arthritis, conjuctivitis, urethritis, circinate balanitis, keratoderma blenorrhagicum, oral ulcers. -### End" -1580,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The PEFR of a group of 11 year old girls follow a normal distribution with mean 300 1/min and standard deviation 201/min, with the following options: A: About 5% of girls have PEFR below 260 l/min, B: The girls have healthy lungs, C: About 95% of the girls have PEFR between 260 and 340 l/min, D: All the PEFR must be less than 340 l/min - -### Response: -In Normal distribution, - -– Mean ± 1SD (m ± 1σ) covers 68% values -– Mean ± 2SD (m ± 2σ) covers 95% values -– Mean ± 3SD (m ± 3σ) covers 99% values -In the given question, - -Mean of PEFR (μ) = 300 l/min -Standard deviation of PEFR (σ) = 20 l/min - -Thus, - -68% of girls will have PEFR in the range Mean ± 1SD (m ± 1σ) = 300 ± 20 l/min, i.e. between (300 – 20) and (300 + 20) 1/min - -– 280 – 320 l/min range covers 68% of girls - -95% of girls will have PEFR in range Mean ± 2SD (m ± 2σ) = 300 ± 2(20) l/min, i.e. between (300 – 40) and (300 + 40) 1/min - -– 260 – 340 l/min range covers 95% of girls - -99% of girls will have PEFR in range Mean ± 3SD (m ± 3σ) = 300 ± 3(20) l/min, i.e. between (300 – 60) and (300 + 60) 1/min - -– 240 – 360 l/min range covers 99% of girls - -Now, 260 – 340 l/min range covers 95% of girls, thus rest 5% of girls are outside this range, i.e. they have PEFR either < 260 l/min or > 340 l/min - -– Even this will be symmetrically distributed (Normal curve is bilaterally symmetrical), thus - -2.5% girls will have PEFR < 260 l/min -2.5% girls will have PEFR > 340 l/min - -– Girls having PEFR less than 340 l/min: 97.5% - -Since the normal range of PEFR for girls is not given in the question, it cannot be concluded that all girls have healthy lungs. -### End" -1581,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is not a pyridoxine dependent disorder –, with the following options: A: Homocystinuria, B: Methyl–malonic–acidemia, C: Cystathioninuria, D: Xanthurenic aciduria - -### Response: -For methyl malonic acidemia, Vit B1, isgiven. -I am not sure about option c & d. -### End" -1582,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an ionophore:, with the following options: A: 2,4 dinitrophenol, B: Valinomycin, C: Thermogenin, D: Oligomycin - -### Response: -Ans. B. Valinomycinlonophores are ion carrier molecules. They are lipid soluble substances, capable of binding and carrying specific cations (other than H+) through the mitochondrial membrane. Oxidative phosphorylation can be prevented by certain ionophores. They differ from uncoupling agents in that they promote the transport of other cations through the membrane. For e.g. The toxic antibiotic Valinomycin allows penetration of K+ through the mitochondrial membrane, discharging the membrane potential across inner membrane. Gramicidin also acts as an ionophore for K+ and Na+ thus abolishing pH gradient, inhibiting phosphorylation. -### End" -1583,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type of collagen predominant in basement membrane:, with the following options: A: Type I, B: Type II, C: Type III, D: Type IV - -### Response: -In the basement membrane, polymers of laminin and collagen type IV form tightly bound networks. Ref: Robbins 8th edition Chapter 3. -### End" -1584,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Autosplenectomy is seen in:, with the following options: A: Hereditary spherocytosis, B: Sickle cell disease, C: Thalassaemia, D: Autoimmune anemia - -### Response: -- In sickle cell anemia initially, congestive splenomegaly is seen. - Later, sickled RBC causes aerial occlusion - ischemic damage to spleen - resulting in Fibrosis of spleen / autosplenectomy. -### End" -1585,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Functions of basal ganglia, with the following options: A: Gross motor, B: Skilled movements, C: Emotions, D: Maintenance of equilibrium - -### Response: -B i.e. Skilled movement -### End" -1586,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mirizzi's syndrome is:, with the following options: A: GB stone compressing common hepatic duct, B: GB carcinoma invading IVC, C: GB stone causing cholecystitis, D: Pancreatic carcinoma - -### Response: -Mirizzi's Syndrome (Functional Hepatic Syndrome) Obstruction of the common hepatic duct or CBD by external compression or by erosion of stone in the Hamann pouch or cystic duct -### End" -1587,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A male infant presented with distension of abdomen shortly after birth with passing of less meconium. Subsequently a full-thickness biopsy of the rectum was performed. The rectal biopsy is likely to show:, with the following options: A: Fibrosis of submucosa, B: Lack of ganglion cells, C: Thickened muscularis propria, D: Hyalinization of the muscular coat - -### Response: -b. Lack of ganglion cells(Ref: Nelson's 20/e p 1894-1897, Ghai 8/e p 285-286)""Whenever neonate presents with delayed passage of stool, Hirschsprung's disease should be suspected"". -### End" -1588,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is a feature of papilloedema -, with the following options: A: Shrinkage of blind spot, B: Blurring of disc margin, C: Low vision, D: Loss of pupillary reflex - -### Response: -Ans. is 'b' i.e., Blurring of disc margin o Blurring of disc margin is earliest sign. Vision is normal initially. In 25% of patients visual symptoms occur only in advanced severe papilloedema, when optic atrophy sets in. Typically, there is recurring brief episodes (transient) of visual obscurations (Amaurosis fugax) lasting less then 30 seconds, in which vision turns grey or blacks, sometimes decribed as if a veil has fallen over the eyes. The symptoms usually affect both eyes at once as papilloedema is bilateral. Central vision is affected late in the disease. Initially there is enlargement of blind spot and progressive contraction of the visual field (visual field becomes smaller). Complete blindness sets in eventually. Thus, characteristically there is gradually progressive painless loss of vision. -### End" -1589,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First line of defence against tumour and virus?, with the following options: A: NK cell, B: T cell, C: Histiocyte, D: Macrophage - -### Response: -NK cells Ability to kill virus-infected cells and tumor cells NK cells act as an early line of defense against viral infections and some tumors. Two cell surface molecules, CD16 and CD56, are commonly used to identify NK cells. CD16 is an Fc receptor for IgG, and it confers on NK cells the ability to lyse IgG-coated target cells. This phenomenon is known as antibody-dependent cell-mediated cytotoxicity (ADCC). The functional activity of NK cells is regulated by a balance between signals from activating and inhibitory receptors NK cell inhibitory receptors recognize self-class I MHC molecules, which are expressed on all healthy cells. The inhibitory receptors prevent NK cells from killing normal cells. Virus infection or neoplastic transformation often enhances expression of ligands for activating receptors and at the same time reduces the expression of class I MHC molecules. -### End" -1590,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary spermatocytes, chromosome is ?, with the following options: A: 23-X, B: 23-Y, C: 46-XY, D: None - -### Response: -Ans. is 'c' i.e., 46-XY -### End" -1591,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rofecoxib as compared to indomethacin is:, with the following options: A: Less likely to cause gastric ulcer and their complications, B: Likely to be more effective in rheumatoid ahritis, C: Not likely to produce renal complications, D: All of the above - -### Response: -Selective COX-2 inhibitors are less likely to cause GI complications like PUD. However as COX-2 is also present constitutively in the kidney, chances of renal complications are similar. These drugs have similar or less efficacy than non-selective COX inhibitors. -### End" -1592,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: This patient had hypercalcemia with a suppressed parathyroid hormone level. What is the diagnosis?, with the following options: A: Hodgkin's lymphoma, B: Hyperthyroidism, C: Parathyroid carcinoma, D: Small-cell lung cancer - -### Response: -Answer A. Hodgkin's lymphomaBilateral hilar lymphadenopathy with hypercalcemia and a suppressed parathyroid hormone level is most consistent with Hodgkin's lymphoma, which is associated with unregulated activation of vitamin D. -### End" -1593,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Black piedra is caused by, with the following options: A: Piedraia hoae, B: Trichosporon asahii, C: Trichosporon ovoides, D: Trichosporon inkin - -### Response: -

PIEDRA/trichomycosis nodularisPiedra is a superficial fungal infection of the hair shaft characterised by small nodules attached to the hair shaft. Black piedra:- caused by Piedraia hoae. Characterised by firmly attached dark pigmented nodules affecting the scalp hair. White piedra:- caused by Trichosporon beigelli). Characterised by loosely attached light pigmented nodules affecting the scalp,beard, moustache,axillary and pubic hair.soft and less firmly attached to hair shaft. Treatment- shaving hair from affected pa.Systemic terbinafine, topical keratolytics-black piedra.Topical azoles- white piedra. Iadvl textbook of dermatology page 277 -### End" -1594,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pinch purpura is seen in?, with the following options: A: Primary systemic amyloidosis, B: Vitamin C deficiency, C: Purpura fulminans', D: Kawasaki disease - -### Response: -Ans. (a) Primary systemic amyloidosis(Ref: Harrison 18th/chapter 112)Cutaneous lesions associated with primary systemic amyloidosis are often pink in color and translucent.Common locations are face, especially periorbital and perioral regions, and flexural areas.On biopsy, homogeneous deposits of amyloid are seen in the dermis and in the walls of blood vessels;These deposits lead to an increase in vessel wall fragility.As a result, petechiae and purpura develop in clinically normal or abnormal skin following minor trauma, hence the term pinch purpura. -### End" -1595,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old woman presents with a 2-week history of febrile illness and chest pain. She has an erythematous, macular facial rash and tender joints, particularly in her left wrist and elbow. A CBC shows mild anemia and thrombocytopenia. Corticosteroids are prescribed for the patient. The patient is noted to have increased serum levels of ceruloplasmin, fibrinogen, a2-macroglobulin, serum amyloid A protein, and C-reactive protein. Together, these markers belong to which of the following families of proteins?, with the following options: A: Acute phase proteins, B: Anaphylatoxins, C: Inhibitors of platelet activation, D: Protease inhibitors - -### Response: -Acute phase proteins. These proteins are synthesized primarily by the liver and are released into the circulation in response to an acute inflammatory challenge. Changes in the plasma levels of acute phase proteins are mediated primarily by cytokines (IL-1, IL-6, and TNF-a). Increased plasma levels of some acute phase proteins are reflected in an accelerated erythrocyte sedimentation rate, which is an index used clinically to monitor the activity of many inflammatory diseases. None of the other choices describe the set of serum markers listed in this question.Diagnosis: Systemic lupus erythematosus -### End" -1596,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dangerous area of eye:, with the following options: A: Ciliary body, B: Optic nerve, C: Sclera, D: Choroid - -### Response: -A i.e. Ciliary body -### End" -1597,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prostaglandins are derived from :, with the following options: A: Coicosteroids, B: Oleic acid, C: Linoleic acid, D: Arachidonic acid - -### Response: -Prostaglandins are derived from arachidonic acid through the cyclooxygenase (COX) pathway.Two isoforms of COX have been recognized.COX-1 is expressed constitutively, whereas COX-2 is induced by growth factors, tumor promoters, and proinflammatory cytokines.COX catalyzes oxidative cyclization of arachidonic acid to prostaglandin endoperoxide, which is the immediate precursor of prostaglandins, thromoboxane, and prostacyclin -### End" -1598,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest side effect of cryotherapy for carcinoma cervix in situ :, with the following options: A: Hemorrhage, B: Persistent watery discharge, C: Cervical stenosis, D: Ulceration - -### Response: -Persistent watery discharge -### End" -1599,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Methicillin Resistance in MRSA, EXCEPT:, with the following options: A: Resistance is produced as a result of altered PBP's, B: Resistance may be produced by hyper production of Beta Lactamase, C: Resistance is primarily mediated /transmitted plasmids, D: Resistance may be missed at incubation temperature of 37degC during susceptibility testing - -### Response: -Multi drug-resistant Staphylococcus aureus (MRSA) becomes resistant to Methicillin due to the alteration in the Penicillin Binding Proteins (PBP-2A) which carries out the functions of PBP's which are inactivated by Methcillin. This is transmitted the MeC A gene. Which is a chromosomal gene (and not a plasmid). Borderline resistance to methicillin may be produced due to hyper production of Beta Lactamases and low resistance to MRSA (hetero resistance) may be missed at 37degC and temperature of incubation no higher than 35degC is recommended but however these are not the primary cause. Ref: Methicillin-Resistant Staphylococcus Aureus (MRSA) Protocols By Yinduo Ji, Volume 391; Lippincott's Illustrated Reviews: Pharmacology, 4th Edition, Page 326 -### End" -1600,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dumping syndrome occurs least with ?, with the following options: A: Selective vagotomy, B: Truncal vagotomy, C: Highly selective vagotomy, D: Syndrome occurs with all of the above commonly - -### Response: -Ans. is 'c' i.e., Highly selective vagotomy It is least seen with highly selective vagotomy because the motility of the stomach is least affected in highly selective vagotomy and is most common with gastrectomy. -### End" -1601,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hemoglobin is isolated from the erythrocytes of a young child with anemia. Hemoglobin electrophoresis reveals the presence of an unstable hemoglobin, known as hemoglobin Cranston (HbCr), containing an abnormal b-globin chain. The normal sequence of the b-globin gene (HbNl) and the sequence of the HbCr b-chain are presented in the table below. HbNl: AAGUAUCACUAAGCUCGC HbCr: AAGAGUAUCACUAAGCUCGCUUUC >>> UAU UAA Which of the following would account for the development of HbCr?, with the following options: A: A frameshift mutation resulted in the deletion of several amino acid residues in the b-chain, B: A mutation in the stop codon resulted in elongation of the b-chain, C: A point mutation resulted in the inseion of a stop codon in the b-chain, D: A two base pair addition resulted in the elimination of a stop codon in the b-chain - -### Response: -Looking at the coding segment of the normal b-gene of hemoglobin, one should read the information codon by codon, as follows: AAG UAU CAC UAA GCU CGC 1 2 3 4 5 6 The normal b-globin gene has a stop codon (UAA) at the 4th position, therefore the last 2 codons (GCU and CGC) are not translated and do not code for amino acid residues found in the protein. Comparing this information to the coding segment of the mutated b-gene of hemoglobin Cranston, one would notice the following: AAG AGU AUC ACU AAG CUC GCU UUC UAU UAA 1 2 3 4 5 6 7 8 etc etc The inseion of two base pairs (AG) results in a frameshift mutation that eliminates the stop codon at position 4, thereby causing the addition of amino acids normally not translated in the hemoglobin b-chain of the child. Since the chain is now too long, this destabilizes the tetrameric conformation of hemoglobin. A frameshift mutation resulting in deletion of several amino acids is wrong, since such a mutation would have inseed a stop codon (UAA, UGA or UAG) before position 4. A mutation in the stop codon would have resulted in a longer-than-normal b-globin gene, but the information given does not indicate any changes in the stop codon at position 4. Interestingly, a chain elongation by mutation in the stop codon exists and is known as hemoglobin Constant Spring, affecting the a-chain of hemoglobin. A point mutation is the result of a single base pair change, which is not the case here. A point mutation resulting in the inseion of a new stop codon is called a nonsense mutation, and it would result in a shoer-than-normal protein. Ref: Weil P. (2011). Chapter 37. Protein Synthesis & the Genetic Code. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. -### End" -1602,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common ocular involvement in sarcoidosis is, with the following options: A: Iritis, B: Keratitis, C: Cataract, D: Glaucoma - -### Response: -M/C - Iritis. -### End" -1603,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Pseudomyxema Peritonei, mucinous cyst - adenocarcinoma of which of the following organ is involved?, with the following options: A: Pancreas, B: Kidney, C: Ovary, D: Abdominal testis - -### Response: -In Pseudomyxema Peritonei, Ovarian mucinous cyst - adenocarcinoma occurs. -### End" -1604,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient comes to hospital with a history of sore throat, diarrhoea and sexual contact 2 weeks before. The best investigation to rule out HIV is -, with the following options: A: P24 antigen assay, B: ELISA, C: Western blot, D: Lymphnode biopsy - -### Response: -following a single massive imfection the p24Ag is the earliest marker appear in blood REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.577 -### End" -1605,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is least absorbable in renal tubules?, with the following options: A: Creatinine, B: Glucose, C: Urea, D: Sucrose - -### Response: -Creatinine is an end product of creatine metabolism and is expoed into our blood continuously by skeletal muscle. The rate is propoional to skeletal muscle mass, and to the extent that muscle mass is constant in a given individual, the creatinine production is constant. Creatinine is freely filtered and not reabsorbed. A small amount, however, is secreted by the proximal tubule. Therefore, the creatinine appearing in the urine represents a filtered component (mostly) and a much smaller secreted component. Because of the secretion, creatinine clearance is slightly higher than the GFR, normally by about 10% to 20%. Ref: Eaton D.C., Pooler J.P. (2013). Chapter 3. Clearance. In D.C. Eaton, J.P. Pooler (Eds), Vander's Renal Physiology, 8e. -### End" -1606,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding rectal carcinoma EXCEPT:, with the following options: A: Early morning spurious diarrhea and tenesmus can occur, B: Adenocarcinoma is a rare variant of rectal carcinoma., C: Growth confined to the rectal mucosa is stage A of modified Duke's staging., D: Hamann's operation is done in old debilitated patients. - -### Response: -Rectal carcinoma: MC site of large bowel malignancy Adenocarcinoma is the most common variant of rectal carcinoma. C/F- MC symptom- bleeding PR Early morning spurious diarrhea Tenesmus Weight loss IOC- rigid sigmoidoscopy+ biopsy Hamann's operation is done in old debilitated patients. -### End" -1607,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Beta2-agonist cause all except, with the following options: A: Hyperkalemia, B: Hyperglycemia, C: Tremer, D: Palpitaion - -### Response: -Ans. is 'a' i.e., Hyperkalemia Adverse effects of inhalational agonists The most common side effects are muscle tremor and palpitation Hypokalemia Hyperglycemia Tolerance Throat irritation Ankle edema Other side effects are anxiety, headache, muscle cramps, dry mouth, arrhythmia, flushing (due to vasodilatation), hypoxemia, MI, disturbance of sleep and behaviour. -### End" -1608,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: N K cells activity is enhanced by-, with the following options: A: IL-1, B: TNF, C: IL-2, D: TGP-b - -### Response: -Interleukin 2 activates NK cells. Interleukin-2 (IL-2) is an interleukin, a type of cytokine signaling molecule in the immune system. It is a 15.5 - 16 kDa proteinthat regulates the activities of white blood cells (leukocytes, often lymphocytes) that are responsible for immunity. IL-2 is pa of the body's natural response to microbialinfection, and in discriminating between foreign (""non-self"") and ""self"". IL-2 mediates its effects by binding to IL-2 receptors, which are expressed by lymphocytes. The major sources of IL-2 are activated CD4+ T cells, activated CD8+ T cells, NK cells, and dendritic cells Basic Pathology, Robbins. Page no.: 206 -### End" -1609,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Methysergide is banned as it causes ?, with the following options: A: Pulmonary fibrosis, B: Pleural effusion, C: Syncope, D: Myocarditis - -### Response: -Ans. is 'a' i.e., Pulmonary fibrosis Methysergide It is chemically related to ergot alkaloids and antagonizes the action of serotonin on smooth muscles including that of blood vessels, withot producing ergot like effects. It is a potent 5HT2A/2C antagonist. It has been used for migraine prophylaxis, carcinoid and postgastrectomy dumping syndrome. Prolonged use has caused abdominal, pulmonary and endocardial fibrosis, because of which it has gone into disrepute. -### End" -1610,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most frequent site of branchial cyst is at, with the following options: A: Upper third of posterior border of sternocleidomastoid, B: Lower third of anterior border of sternocleidomastoid, C: Upper third of anteromedial border of sternocleidomastoid, D: Supraclavicular fossa - -### Response: -BRANCHIAL CYST - -It arises from the remnants of second branchial cleft. Normally, 2nd, 3rd, 4th clefts disappear to form a smooth neck. Persistent 2nd cleft is called as cervical sinus (of His) which eventually gets sequestered to form branchial cyst.  -Swelling in the neck beneath the anterior border of upper third of the sternomastoid muscle. It is smooth, soft, fluctuant, often transilluminant with a sensation of ‘Half-filled double hot water bottle’. -It is equal in both sexes. Even though congenital, it is seen in late adolescents and early 3rd decade. -It contains cholesterol crystals which is from the lining of mucous membrane which contains sebaceous gland. Cheesy toothpaste like material is typical. -### End" -1611,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glycerol test is done in, with the following options: A: Otosclerosis, B: Lateral sinus thrombosis, C: Meniere's disease, D: None of the above - -### Response: -Glycerol is a dehydrating agent. When given orally, it reduces endolymph pressure and thus causes an improvement in hearing. It is diagnostic of Meniere's disease. The patient is given glycerol(1.5ml/kg) with an equal amount of water and a little flavouring agent or lemon juice. Audiogram and speech discrimination scores are recorded before and 1-2 hr after ingestion of glycerol. An improvement of 10db in two or more adjacent octaves or gain of 10 c/o in discrimination score makes the test positive. There is also improvement in tinnitus and in the sense of fullness in the ear. The test has a diagnostic and prognostic value. These days, the glycerol test is combined with electrocochleography. Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra 7th Edition page no.113 -### End" -1612,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stimulation of ovary in the early follicular phase is by:, with the following options: A: Oestrogen, B: Progesterone, C: FSH, D: LH - -### Response: -Stimulation of ovary in early follicular phase is by FSH, as the growth and differentiation of primordial follicles are under the control of FSH. Presence of FSH prevents follicles from undergoing Atresia. Stimuation of ovary in later follicular phase is predominantly by FSH but also LH is required in later follicular stage for the final maturity of the follicle before rupture. -### End" -1613,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following Salmonellae are motile except?, with the following options: A: S. typhi, B: S. enteridis, C: S. gallinarum pullorum, D: S. chester - -### Response: -Ans. is 'c' i.e., S. gallinarum pullorum * All salmonellae are motile with peritrichate flagella except S. gallinarum pullorum, which is non-motile. -### End" -1614,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood supply of lungs are:, with the following options: A: Pulmonary aery, B: Pulmonary vein, C: Bronchial aery, D: All - -### Response: -A. i.e. Pulmonary aery; B. i.e. Pulmonary vein; C. i.e. Bronchial aery -### End" -1615,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serious complication of oral contraceptive is:, with the following options: A: Leg vein thrombosis, B: Headache, C: Break through bleeding, D: Breast tenderness - -### Response: -(Leg vein thrombosis): Ref: (432-Park 20th)Venous thrombo-embolism (VITE): - The overall risk is to the extent of 4 - 6 times more than the non users. Pre- existing hypertension, diabetes, obesity and elderly (over 35 years with smoking habits) are of the important risk factor for OCP.CONTRAINDICATION OF COMBINED ORAL PILLSABSOLUTERELATIVE(A) Circulatory disease (Past or present)(B) Disease of the liver(C) Others(1) Obesity (2)Varicosities (3)Epilepsy (4) Bronchial asthma (5) Depression and fluctuation of the mood (6) Age over 35 years (7) Nurshing mothers in the first six months (8) Smoking (9) Gall bladder disease1. Arterior or venous thrombosis2. Severe hypertension3. Valvular heart disease Ischaemic heart disease4. Hyperlipidemia5. Focal migraine* Active liver disease* History of cholestatic jaundice in pregnancy* Liver adenoma carcinoma* Pregnancy* Undiagnosed genital tract bleeding* Estrogen dependent neoplasm eg breast cancer -### End" -1616,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 58-year-old man whom you have followed dies suddenly, spurring you into doing some research on sudden death. Which of the following is the most likely cause for this individual?, with the following options: A: extensive coronary atherosclerosis, B: electrolyte disturbance, C: pulmonary embolism, D: acute stroke - -### Response: -Sudden death, defined as death within 1 hour of onset of symptoms, is usually caused by cardiac disease in middle-aged and elderly patients, but in younger age groups noncardiac causes predominate. There is a bimodal distribution in the population, with the first peak before 6 months of age (sudden infant death syndrome). The most common coronary artery finding is extensive chronic coronary atherosclerosis, although acute syndromes do occur. -### End" -1617,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Morphologically diagnostic feature of cancer cells -, with the following options: A: T Size, B: T Mitotic activity, C: T Cytoplasm, D: T Lysosomes - -### Response: -Ans. is 'b' i.e., T Mitotic activity Benign Vs malignant neoplasm Criteria o Differentiation o Growth limits o Growth rate o Invasivness o Metastasis o Mitotic figures o Cell size & shape o Nuclear to cytoplasmic ratio o Stroma o Cell orientation (Polarity) o Nuclear chromatin o Blood supply Benign Well differentiated Limited, encapsulated Usually slow Non-invasive Non-metastatic Rare Uniform Normal (I :4 to 1:6) Abundant Normal Normal Adequate Malignant (cancer) Well differentiated to undifferentiated (anaplastic) Unrestricted, no surrounding capsule Often rapid, but can be slow Invasive Metastatic Atypical, with increased number Pleomorphism Increased (1:1) Often scanty Disorganized (loss of polarity) Hyperchromatasia Often inadequate thus areas of necrosis -### End" -1618,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is mirabegron?, with the following options: A: Alpha 2 agonist, B: Beta 3 agonist, C: Beta 1 agonist, D: Beta 2 agonist - -### Response: -Mirabegron used in overactive bladder which is a selective b3 agonist. -### End" -1619,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The optical density of gross fog typically is:, with the following options: A: 0.6 to 3.0, B: 0.2 to 0.3, C: 0.2 to 0.4, D: 0.6 to 4.0 - -### Response: -An unexposed film, when processed, shows some density. This appearance is caused by the inherent density of the base and added tint and the development of a few unexposed silver halide crystals. This minimal density is called base plus fog and typically is 0.2 to 0.3. Radiographic density is influenced by exposure and the thickness and density of the subject. -Image receptors in Oral and Maxillofacial Radiology, pg -16, White and Pharoah, 7th ed, pg- 75 -### End" -1620,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lowest incidence of trachoma is in, with the following options: A: Punjab, B: Orissa, C: Rajasthan, D: Uttar Pradesh - -### Response: -• Prevalence rate of active trachoma infection in India 0-14 years (1986-89): – -Punjab: 21.8% -Haryana: 15% -Rajasthan: 17.1% -UP: 11.7% -Orissa: 10.2% -### End" -1621,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anti-IgE used in asthma is:, with the following options: A: Trastuzumab, B: Epratuzumab, C: Toclizumab, D: Omalizumab - -### Response: -Omalizumab -### End" -1622,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The immediate precursor in the formation of acetoacetate from acetyl-CoA in the liver is:, with the following options: A: Mevalonate, B: HMG-CoA, C: Acetoacetyl-CoA, D: 3-hydroxyl-butyryl-CoA - -### Response: -Ans. B. HMG-CoA(Ref: Harper 31/e page 210)Hydroxy-3-methylglutaryl-CoA lyase then causes acetyl-CoA to split off from the HMG-CoA, leaving free acetoacetate. -### End" -1623,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not used topically is:, with the following options: A: Lignocaine, B: Bupivicaine, C: Dibucaine, D: Tetracaine - -### Response: -Bupivicaine -### End" -1624,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary amenorrhoea with anosmia is seen in :, with the following options: A: Kallman syndrome, B: Laurence moon Biedl syndrome, C: Foster - kennedy syndrome, D: Sheehan's syndrome - -### Response: -Ans. is a i.e. Kallman Syndrome Friends, you know the answer to this question quite well. Here I would like to point out that in solving PGMEE Questions of previous years, it is not only impoant to know the correct answer with its details, it is equally impoant to know the details of incorrect options (as Questions might be asked on these incorrect options in future). So, let's know : Laurence Moon Biedl Syndrome It is an autosomal recessive disorder characterized by GnRH deficiency (hypogonadism) (FSH < 40 mIU/m1) and associated with : Obesity Mental retardation Polydactyly Retinitis Pigmentosa Sheehan's syndrome : Kindly see details from answer No. 5. Foster Kennedy Syndrome : Do not get confused with this option : It is the same Foster Kennedy Syndrome as you have read in Ophthalmology, characterized by papilloedema in one eye and optic atrophy in the other. It results from raised intracranial pressure and simultaneous optic nerve compression secondary to tumor - classically, a meningioma of the olfactory groove, or more commonly, due to meningioma of the sphenoid wing. -### End" -1625,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?, with the following options: A: Tear of the medial meniscus, B: Ruptured fibular collateral ligament, C: Tenderness on pressure along the fibularcollateral ligament, D: Injured posterior cruciate ligament - -### Response: -The ""unhappy triad"" of the knee joint is characterized by: tear of the medial meniscus, rupture of the tibial collateral ligament, and rupture of the anterior cruciate ligament. This injury may occur when a cleated shoe, as worn by football players, is planted firmly in the turf and the knee are struck from the lateral side. Tenderness along the medial collateral ligament and over the medial meniscus and swelling on the front of the joint are due to excessive production of synol fluid, which fills the joint cavity and the suprapatellar bursa. -### End" -1626,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fasanella Servan operation is specifically indicated in:, with the following options: A: Congenital ptosis, B: Steroid induced ptosis, C: Myasthenia gravis, D: Homer's syndrome - -### Response: -D i.e. Horner's Syndrome Fasanella servat procedure is indicated in ptosis due to Horner's syndrome Q Frontalis suspension is indicated in Marcus Gunn jaw winking syndrome, blepharophimosis syndrome, total 3rd nerve palsy, aberrant regeneration of 3rd nerve. -### End" -1627,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 26-year-old woman complains of the abrupt onset of her chest pounding. She is diagnosed with paroxysmal atrial tachycardia. Which of the following is the most effective agent for conveing paroxysmal atrial tachycardia to normal sinus rhythm, with the following options: A: Digoxin, B: Lidocaine, C: Atropine, D: Adenosine - -### Response: -DRUGS FOR PSVT An attack of PSVT can be terminated by reflex vagal stimulation through Valsalva maneuver, splashing ice cold water on face, hyperflexion (head between knees), etc. Alternatively, or if it does not work, the drug of choice is adenosine (i.v.). Other alternatives are i.v. injection of verapamil/diltiazem/esmolol. Advantages of adenosine for termina-tion of PSVT are: * Efficacy equivalent to or better than verapamil. * Action lasts < 1 min; adverse effects (even cardiac arrest, if it occurs) are transient. * No haemodynamic deterioration; can be given to patients with hypotension, CHF or those receiving b blockers. Verapamil is contra-indicated in these situations. * Safe in wide QRS tachycardia (verapamil is unsafe). * Effective in patients not responding to verapamil. Adverse effects:- Transient dyspnoea, chest pain, fall in BP and flushing, ventricular standstill for few sec or VF occurs in some patients. Bronchospasm may be precipitated in asthmatics; verapamil is the drug of choice for such patients. Ref:- kd tripathi; pg num:-536 -### End" -1628,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chi-square test is used for, with the following options: A: Comparing percentage, propoions & fractions in paired data, B: Comparing percentage, propoions & fractions in two or more different group of individuals, C: Comparing percentage, propoions & fractions in matched paired data, D: Comparing percentage, propoions & fractions in two unpaired samples - -### Response: -- Chi-square test is used for comparing percentage, propoions & fractions in two or more different group of individuals. - Degree of freedom = - more accurate -### End" -1629,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following doesn't show pleural effusion with low glucose levels?, with the following options: A: Rheumatoid ahritis, B: Empyema, C: Dressler's syndrome, D: Malignancy - -### Response: -Low glucose is seen in option rheumatoid ahritis, empyema, and malignancy. Hemorrhagic pleural effusion is seen in Trauma, Tumor and TB. Dressler's syndrome is a type of pericarditis, inflammation of the sac surrounding the hea (pericardium). Inflammation associated with Dressler's syndrome is believed to be an immune system response following damage to hea tissue or the pericardium, such as a hea attack, surgery or traumatic injury. -### End" -1630,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: L.B.W. Baby -, with the following options: A: 2.9- 2.6 kg, B: 2.7-2.9 kg, C: 3.2-3.5kg, D: 1.5-2.5 kg - -### Response: -Ans. is 'd1 i.e., 1.5-2.5 kg o Low birth weight-2.5 - 1.5 kgo Very low birth weight-1.5 - 1.0 kgo Extremely low birth weight-< 1.0 kg -### End" -1631,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lamellar inclusion bodies are present in?, with the following options: A: Type I cells, B: Type II cells, C: Both of the above, D: None of the above - -### Response: -The alveoli are lined by two types of epithelial cells. Type I cells are flat cells with large cytoplasmic extensions and are the primary lining cells of the alveoli, covering approximately 95% of the alveolar epithelial surface area. Type II cells (granular pneumocytes) are thicker and contain numerous lamellar inclusion bodies. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 35. -### End" -1632,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not the branch of maxillary branch of external carotid aery?, with the following options: A: Inferior alveolar, B: Middle meningeal, C: Anterior tympanic, D: Posterior tympanic - -### Response: -Maxillary aery is the larger terminal branch of the external carotid aery, given off behind the neck of mandible. It has three pasmandibular paPterygoid paPterygopalatine paBranches of respective pas are:Mandibular- deep auricular, anterior tympanic, Middle meningeal, accessory meningeal, Inferior alveolarPterygoid- massetric, deep temporal, Pterygoid, buccalPterygopalatine- posterior superior alveolar, Infraorbital, greater palatine, pharyngeal, Aery of pterygoid canal, sphenopalatine.(Ref: BDC pa-111, fifth edition, pg-153 table 10.2) -### End" -1633,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Panic attack is characterized by all of the following except:, with the following options: A: Felling of impending doom, B: Auditory hallucinations, C: Trembling, D: Shortness of breath - -### Response: -Ans. B. Auditory hallucinationsDiagnostic criteria for panic attack - A discrete period of intense fear or discomfort, in which four or more of the following symptoms developed abruptly and reached a peak within 10 min.1. Palpitations, pounding heart or accelerated heart rate.2. Sweating.3. Trembling or shaking.4. Sensations of shortness of breath of smothering.5. Feeling of choking.6. Chest pain or discomfort.7. Nausea or abdominal distress.8. Feeling dizzy, unsteady, lightheaded or faint.9. Derealization (feeling of unreality) or depersonalization (being detached from oneself)10. Fear of losing control or going crazy.11. Fear of dying.12. Parenthesis (numbness or tingling sensations).13. Chills or hot flushes. -### End" -1634,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The voice in a patient with Bilateral abductor paralysis of the larynx is, with the following options: A: Puberphonia, B: Phonasthenia, C: Dysphonia plicae ventricularis, D: Normal or good voice - -### Response: -The vocal cord vibrates during speech to produce speech. These vibrations occur due to subglottic airflow when the cord is in adduction (Median & paramedian). -During normal phonation the vocal cords are in median position and during strong whisper vocal cords are in paramedian position. -So, for proper voice, the vocal cords should be in median or paramedian position. -Same occurs in bilateral recurrent laryngeal nerve paralysis, where the vocal cords are in median or paramedian position → Voice is less likely to be impaired. - -Now, the question comes to the mind immediately : - Why the voice is affected in unilateral paralysis, in which the cord is in median or paramedian position. The answer is : - - -In unilateral vocal cord paralysis, one cord is paralysed and vibrates abnormally or does not vibrate at all, therefore cannot coordinate with the other side (normal) vocal cord. This results in voice problems. -In bilateral paralysis, both vocal cords vibrate abnormally but coordinate with each other, therefore voice is less affected. -### End" -1635,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The only thrombolytic agent approved for the treatment of acute ischemic stroke is:, with the following options: A: Tissue Plasminogen activator, B: Streptokinase, C: Urokinase, D: Pro-urokinase - -### Response: -Answer is A (Tissue plasmiogen Activator): Recombinant Tissue plasminogen Activator (RtPA) is the only thrombolytic agent that is approved for the treatment of acute ischaemic stroke The use of all other thrombolytics except Recombinant Tissue plasminogen activator has been stopped because of associated high rates of intracranial hemorrhage. -### End" -1636,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non -sterile hypopyon is seen in-, with the following options: A: Pneumococcus infection, B: Pseudomonas infection, C: Fungal infection, D: Gonococcal infection - -### Response: -In fungal ulcer, usually, a big hypopyon is present even if the ulcer is small. -Unlike the bacterial ulcer,the hypopyon may not be sterile as the fungi can penetrate into the anterior chamber without perforation -### End" -1637,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: all are causes of hypeension with hypokelemia except, with the following options: A: bilateral renal aery stenosis, B: end stage renal disease, C: primary hyperaldosteronism, D: cushings disease - -### Response: -liddle syndrome severe hypeension Hypokalemia and metabolic alkalosis Polyuria polydipsia and muscle weakness low aldosterone and reninn levels Autosomal dominant Blood pressure does not improve with Aldactone but does improve with triamterene or amilor-ide Other Causes of Hypeension and pokalemia Renovascular Disease Diuretic therapy Cushing&;s Syndrome Licorice ingestion CAH Rare renin-secreting tumors ref : harrisons 21sted -### End" -1638,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyperbilirubinemia in newborn involving palm & sole-, with the following options: A: 8mg/dl, B: 10mg/dl, C: 14 mg/dl, D: > 15 mg/dl - -### Response: -Ans. is 'd' i.e.,>15 mg/dl Jaundice is area of bodyBilirubin levelHead & Neck5 mg/dlUpper trunk & proximal upper limb10 mg/dlLower trunk & thigh12 mg/dlLegs15 mg/dlPalm (hands) & sole (feet)> 15 mg/dl -### End" -1639,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The role of vitamin K in epoxide cycle is -, with the following options: A: Carboxylation of aspartate, B: Dehydrogenation of glucatamate, C: Carboxylation of glutamate, D: Dehydrogenation of aspartate - -### Response: -Ans. is 'c' i.e., Carboxylation of glutamate o The only known biological role of vitamin K is as a cofactor for an enzyme carboxylase that catalyzes carboxylationQ of glutamic acid (glutamate )Q residues on vitamin K-dependent proteins. The important vitamin K dependent proteins are ; -i) Coagulation proteins: - Factor IIQ (prothrombinQ), factor VIIQ (proconvertin0), factor IXQ (christmas factor), and factor XQ (Stuart-Prower factor),ii) Anticoagulation proteins : - Proteins Q S and Z.iii) Gas 6 -### End" -1640,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about aminoglycosides is all EXCEPT:, with the following options: A: Excreted unchanged in urine, B: Distributed only extracellularly, C: Are bacteriostatic, D: Teratogenic - -### Response: -The aminoglycosides are bactericidal antibiotics, all having the same general pattern of action. -### End" -1641,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are complications of peptic ulcer surgery except:, with the following options: A: Duodenal stump blowout, B: Dumping syndrome, C: Delayed gastric emptying, D: Steatorrhea - -### Response: -Duodenal stump blowout occurs after Billroth II operations, where back-pressure in the duodenal stump results in a breakdown of this stump closure, leading to abdominal sepsis. Dumping syndrome and postvagotomy diarrhea are complications of peptic ulcer surgery. They represent two different syndromes, both of which are predominately related to the vagotomy poion of the operation. Delayed gastric emptying occurs frequently after peptic ulcer surgery, for a variety of reasons, but it is most common after elective peptic ulcer surgery for gastric outlet obstruction. Steatorrhea is not necessarily related to peptic ulcer surgery but is a complication of pancreatic insufficiency. -### End" -1642,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are the contents of second layer of sole except:-, with the following options: A: Flexor hallucis longus, B: Flexor digitorum longus, C: Flexor digitorum accessorius, D: Flexor hallucis brevis - -### Response: -Second layer of sole consist of two extrinsic tendons flexor hallucis longus & flexor digitorum longus and two intrinsic muscles flexor digitorum accessorius & four lumbricals. Flexor hallucis brevis is the muscle of third layer. -### End" -1643,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which anti-tubercular drug combination is safer in a patient who develops hepatitis while on ATT?, with the following options: A: Streptomycin + Isoniazid, B: Streptomycin + Ethambutol, C: Ethambutol + Isoniazid, D: Ethambutol + Rifampicin - -### Response: -Streptomycin and Ethambutol are the only antitubercular drugs which have no hepatotoxicity thus are safer in a patient who develops hepatitis while on ATT as they dont have hepatic metabolism and are excreted by kidneys only. IMPOANT POINTS ABOUT FIRST LINE ATT: Drug Action Hepatotoxic Bacteria Inhibited Isoniazid CIDAL Yes Both Rifampicin CIDAL Yes Both Pyrazinamide CIDAL Yes Intracellular Ethambutol STATIC No Both Streptomycin CIDAL No Extracellular -### End" -1644,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tako- Tsubo cardiomyopathy is a type of, with the following options: A: Dilated cardiomyopathy, B: Restrictive cardiomyopathy, C: Hyperophic cardiomyopathy, D: Toxic cardiomyopathy - -### Response: -Ref Harrison 19 th ed pg 1565 TAKOTSUBO CARDIOMYOPATHY The apical ballooning syndrome, or stress-induced cardiomyopathy, occurs typically in older women after sudden intense emotional or physical stress. The ventricle shows global ventricular dilation with basal contraction, forming the shape of the narrow-necked jar (takotsubo) used in Japan to trap octopi. Originally described in Japan, it is increas- ingly recognized elsewhere during emergency cardiac catheteriza- tion and intensive care unit admissions for noncardiac conditions. Presentations include pulmonary edema, hypotension, and chest pain with ECG changes mimicking an acute infarction. The left ventricular dysfunction extends beyond a specific coronary aery distribution and generally resolves within days to weeks. -### End" -1645,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements is/are true about ostium secundum ASD, with the following options: A: Fixed splitting of 2nd hea sound, B: Narrow splitting of 2nd hea sound, C: Lt axis detion in ECG, D: Shunt murmur prominent - -### Response: -Ostium secundum ASD characterized by wide fixed split second hea sound,ejection systolic murmur in pulmonary area,shunt murmur will be absent. ECG shows right axis detion & right ventricular hyperophy. Ref : Ghai essential of pediatrics, 8th edition, p.no:413 -### End" -1646,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child is brought to the paediatric OPD with fever of 24 hours furation. History reveals 3 episodes of chest infection and passage of foul smelling stools. The most probable diagnosis is, with the following options: A: Cystic Fibrosis, B: Maple syrup urine Disease, C: Bilirubin Congugation Defect, D: Criggler Najar Syndrome - -### Response: -The symptoms are suggestive of cystic fibrosis. Ref : Essential paediatrics,O.P.Ghai,7 th edition,pg no:369 -### End" -1647,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following is true except aEUR', with the following options: A: NADPH oxidase acts superoxide ions, B: Chediak-Higashi syndrome is due to defective phagolysosome, C: In Brutons agammaglobulinemia opsonisation is not affected, D: Myeloperodixase action is mainly due to OCIaEUR' - -### Response: -In Brutons aganunaglobulinemia opsonisation is not affected [Ref : Harrison 171h/e p. 381; Bobbin's 7""Ve p. 60, 61, 62, 210, 591 During phagocytosis there is rapid respiratory burst which is brought about by rapid burst in the activity of NADPH oxidase. Increased NADPH oxidase activity leads to increased oxidative proesses and there by increased production of superoxide anion (02-) Superoxide is then conveed to hydrogen peroxide (1-1,02) free radical. The 11,0, generated by NADPH oxidase system is not able to kill the bacteria itself However, the azurophilic , granules of the neutrophils contain the enzyme myeloperoxidase (MPO) which in presence of halide such as Cl? conves H202 to hypochlorite (HOCI). Hypochloth'e (HOCI) is a potent antimicrobicidal agent that destroys microbes by halogenation. The H20,- MPO - halide system is the most efficient bactericidal system in neutrophils. Chediak higashi syndrome It is an autosomal recessive disorder. Chediak higashi syndrome is caused due to mutation in the LYST gene. This gene provides instructions for making a protien known as lysosomal trafficking regulator. This protein plays a role in transpo of materials into lysosomes. Lysosomes contain several enzyme. They use these enzymes to kill various microorganism, break down several toxins. During phagocytosis, lysosomes fuse with phagosome, forming phagolysosome. Once the phagolysosomes are formed, lysosomes secrete enzymes to kill the bacterial. Mutation in the LSYT protein disrupts the size, structure and function of lysosomes. Lysosomes cannot fuse with phagosome to form phagolysosome. Thus this syndrome is a disease with impaired bacteriolysis due to impaired phagolysosome formation. As a result, most people with chediak higashi syndrome have repeated and persistent infections, staing in infancy or early childhood. These infections are life threatening. Besides, the granules of lysosomes, the secretory / storage granules of various other cells are also affected. The other cells involved are ? - Melanosotnes of melanocytes - Dense bodies of platelets - Granules of schwann cells In pigment cells called melanocytes the melanosome become abnormally large so there is reduced production of melanin. Thus people with chediak Higashi syndrome have occulocutaneous albinism i.e the colour (-)f skin, hair and eye is reduced. Abnormality in platelets produce bleeding disorders. Defective granules in schwann cells lead to neurological symptoms e.g. peripheral neuropathy. More on chediak higashi syndrome Most children with chediak Higashi syndrome ultimately reach a stage of the disorder known as accelarated phase (lymphoma like stage). This severe phase of the disease is thought to be triggered by viral infection (E.B.virus). In the accelarated phase, defective white blood cells divide uncontrollably and invade many of the body's organs. The accelarated phase is associated with fever, episodes of abnormal bleeding, overwhelming infections and organ failure. They are usually life threatening and lead to death. Bruton's agammaglobulinemia Bruton's agammaglobulinemia is an X-linked disease that occurs mainly in males. It is caused due to defect in the gene Bruton's tyrosine kinase. Bruton's tyrosine kinase plays a crucial role in B cell maturation as well as mast cell activation. Defect in Bruton's tyrosine kinase leads to failure of maturation of B cells. B cells cannot mature beyond pro B cell stage. In the absence of mature B cell, patient lacks lymphoid tissue and fails to develop plasma cells, (the cells that produce antibodies). Thus there is absence of immunoglobulins of all classes in Bruton's agammaglobulinemia. Germinal centres, where B cells proliferate and differentiate are poorly developed, in all lymphoid tissues including the .spleen, tonsils, adenoids, peripheral lymph nodes. Peyer patches in the intestine are small or absent. Clinical features Patients with Bruton's agammaglobulinemia do not manifest any symptoms till 6 months of life (due to the presence-of maternal antibodies). These patients are susceptible to infections with capsulated bacterias because antibody response is vital to kill encapsulated bacterias. Antibodies help in opsonization of encapsulated bacterias such as staphylococcus aureus, 11 ifluenzae, streptococcus pneumoniae. The polysaccharide capsule that surrounds the encapsulated bacteria is a potent virulent agent. It protects the bacteria from phagocytosis. These bacterias can only be phagocytosed when they are opsonised (coated) with specific proteins (opsoni us). Opsonized (coated) bacterias become attractive targets for phagocytes because phagocytes express high affinity receptors for opsonins. The major opsonins present in the body are IgG antibody and C3b complement. In Bruton's agammaglobulinemia antibodies are absent therefore opsonisation is defective. -### End" -1648,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient with thin painless otorrhoea, multiple perforations of the tympanic membrane and failure to respond to antimicrobial treatment. What is the most probable causative organism -, with the following options: A: Mycobacterium tuberculosis, B: Staphylococcus aureus, C: Candida albicans, D: Aspegillusfumigatus - -### Response: -Ans. is 'a' i.e., Mycobacterium tuberculosiso Thin painless otorrhoea, multiple perforations of the tympanic membrane and failure to respond to antimicrobial treatment are the features of tubercular otitis media and it is caused by Mycobacterium tuberculosis.Tubercular otitis mediao Tuberculosis of middle ear is a comparatively rare entity usually seen in association with or secondary to pulmonary tuberculosis, infection reaches the middle ear through eustachian tube.o The rare modes of infection are through hematogenous spread from tubercular focus in lung, tonsils, cervical lymph nodes; or due to ingestion of infected cow's milk,o It usually affects children and young adults.Clinical featureso Generally, tuberculosis of middle ear is unilateral.o It is characterized by painless otorrhoea which fails to respond to the usual antimicrobial treatment. There is painless watery otorrhea.o Single or multiple perforation of tympanic membrane. There may be multiple perforations in the early stages, but they coalesce into a large tympanic membrane perforation accompanied by a pale granulation tissue.o Periauricular fistulae, lymphadenopathy and facial palsy are infrequent findings.o Late complications include facial paralysis, labyrinthitis, postauricular fistulae, subperiosteal abscess, petrous apicitis and intracranial extension of infection -### End" -1649,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A comminuted fracture of the Patella should be treated by, with the following options: A: Inseing screws and wires, B: Physiotherapy alone, C: Removal of all the patella, D: Removal of smallest piece only - -### Response: -C i.e. Removal of all the patella -### End" -1650,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is the best for management of a 3 cm stone in renal pelvis without evidence of hydronephrosis?, with the following options: A: ESWL, B: PCNL, C: Antegrae pyeloplasty, D: Retrograde pyeloplasty - -### Response: -Generally, ESWLis anon-invasive method used for removal of renal calculi but themaximum size of stone that can be removed by ESWL is up to 1.5 cm If the size of the stone is more than 2 cm then the preferred treatment option is PercutaneousNephrolithotomy (PCNL) Other contraindications to ESWL are obese patient, pregnancy, & patients taking oral anti-coagulants. -### End" -1651,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PML is caused by, with the following options: A: CMV, B: Papova virus, C: HIV, D: Polio virus - -### Response: -(B) Papova virus # Human papova virus has been isolated from a number of patients with impaired immunity> J.C. virus one type of papova virus which is isolated from patient with : HIV Hodgkin lymphoma Progressive Multi focal leukoencephalopathy (PML). Progressive multifocal leukoencephalopathy (PML) is a rare and usually fatal viral disease characterized by progressive damage or inflammation of the white matter of the brain at multiple locations. It is caused by the JC virus, which is normally present and kept under control by the immune system. JC virus is harmless except in cases of weakened immune systems. PML occurs almost exclusively in patients with severe immune deficiency, most commonly among patients with acquired immune deficiency syndrome (AIDS), but people on chronic immunosuppressive medications including chemotherapy are also at increased risk of PML, such as patients with transplants, Hodgkin's Lymphoma, multiple sclerosis, psoriasis and other autoimmune diseases. -### End" -1652,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Tzanck smear multinucleated cells are seen in –, with the following options: A: Chicken pox, B: Psoriasis, C: Molluscum contagiosum, D: Pemphigus vulgaris - -### Response: -Blisters of varicella-zoster (chicken pox) show multinucleated gaint cells on Tzanck smear. -### End" -1653,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best indicator for sterilization by autoclaving ?, with the following options: A: Bacillus subtilis, B: Geobacillus, C: Bacillus pumilis, D: Clostridium - -### Response: -Ans. is 'b' i.e., Geobacillus Biological indicators Biological indicators are standardised preparations of microorganisms used to assess the effectiveness of a sterilization process. They usually consist of a population of bacterial spores placed on an ine carrier, for example a strip of filter paper, a glass slide or a plastic tube. Most commonly, spores of Bacillus stereothermophilus (Geobacillus stearothermophilus) are used. Spores of Bacillus subtilis and Bacillus pumilis are alse used. -### End" -1654,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thiamine deficiency is seen in all except, with the following options: A: Chronic diarrhoea, B: Chronic alcoholism, C: Homocystinemia, D: Food faddist - -### Response: -Homocysteinemia Thiamine was the first vitamin to be identified and is therefore called as vitamin Bl. Thiamine deficiency or beriberi refers to the lack of thiamine pyrophosphate, the active form of the vitamin . Thiamine pyrophosphate acts as a coenzyme in carbohydrate metabolism through the decarboxylation of alphaketoacids and in the formation of glucose by acting as a coenzyme for the transketolase in the pentose monophosphate pathway Causes of Thiamine deficiency Persons may become deficient in thiamine either by not ingesting enough vitamin B-1 through the diet or by excess use, which may occur in hypehyroidism, pregnancy, lactation, or fever (sates of high energy consumption, such as hypehyroidism, pregnancy, or severe illness, require more thiamine and other nutrients.) Prolonged diarrhea may impair the body's ability to absorb vitamin B-1, and severe liver disease impairs its use. Decreased absorption is seen in - Diarrhea - Chronic intestinal disease - Alcoholism - Malnutrition - Gastric bypass surgery - Malabsorption syndrome - Celiac and tropical sprue - Hyperemesis gravidarum - Long term starvation - Fad diets( Fad diets often do not contain necessary amounts of thiamine) Increased depletion is seen in - Diuretic therapies - Peritoneal dialysis - Hemodialysis(Dialysis robs thiamine from the circulation) Alcohol is known to interfere directly with the absorption of thiamine and with the synthesis of thiamine pyrophosphate.( thiamine should always be replenished when refeeding a patient with alcoholism, as carbohydrate repletion without adequate thiamine can precipitate acute thiamine deficiency.) Beriberi has been repoed among refugees who are relying on emergency food aids. This is due to the lack of available micronutrition supplementation Food faddism and fad diet are terms which refer to the tendency for idiosyncratic diets and eating patterns. A fad diet is supposed and promoted to improve health but may do nothing at all, or even have the opposite results if it is nutritionally unbalanced and unconfirmed by scientific studies Developing countries are known to have more vitamin deficiency problems in general Pathophysiology (Beriberi) In healthy individuals who are deprived of thiamine, thiamine stores are depleted in approximately 1 month. However, within a week of no thiamine intake, healthy people develop a resting tachycardia, weakness, and decreased deep tendon reflexes and some people develop a peripheral neuropathy. Nervous system involvement is termed dry beriberi. Dry beriberi involves both the peripheral and the central nervous systems. - Peripheral nerve involvement is typically a symmetric motor and sensory neuropathy with pain , parasthesias, and loss of reflexes. The legs are affected more than the arms. - Central nervous system involvement results in Wernicke-Korsakoff syndrome. - Wernicke's encephalopathy consists of nystagmus progressing to ophthalmoplegia, truncal ataxia, and confnsion. When there is additional loss of memory and a confabulatory psychosis, the syndrome is known as WernikeKorsakoff syndrome. Wet beriberi is the term used for the cardiovascular involvement of thiamine deficiency. Wet beriberi is characterized by marked peripheral vasodilation resulting in high-output hea .failure with dyspnea, tachycardia, cardiomegaly, and pulmonary and peripheral edema, with warm extremities mimicking cellulitis. Diagnosis In most instances, the clinical response to empiric thiamine therapy is used to suppo a diagnosis of thiamine deficiency. The most commonly used and widely available biochemical tests are measurement of erythrocyte transketolase activity and urinary thiamine excretion -### End" -1655,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which organophosphate is NOT an aryl phosphate?, with the following options: A: Parathion, B: Tik-20, C: Malathion, D: Paraoxon - -### Response: -All are aryl phosphate except malathion which is a alkyl phosphate. Alkyl phosphates are: HETP TEPP (Tetron) OMPA Dimefox Isopestox Malathion (Kill bug; Bugsolin) Sulfotepp Demeton Trichlorfon Aryl phosphates are: Parathion (nitrostigmine) (Follodol; Kill phos; Ekato) Paraoxon Methyl-parathion (Metacide) Chlohion Diazinon (Diazion; Tik 20) Ref: The essentials of forensic medicine and toxicology by Dr K S Narayan Reddy, 27th edition, Page 457. -### End" -1656,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bias can be eliminated by all except-, with the following options: A: Matching, B: Blinding, C: Randomization, D: Multivariate analysis - -### Response: -Bias may arise due to errors of assessment of the outcome due to the human element. 3 sources: subject variation, observer bias, bias in evaluation. Selection bias: cases and controls may not be representative of cases and controls in population. There may be a systemic difference in characteristic between cases and controls. (refer pgno:83 park 23 rd edition) -### End" -1657,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fordyce&;s (Spots) Granules in oral cavity arise from, with the following options: A: Sebaceous glands, B: Mucous glands, C: Minor salivary glands, D: Taste buds - -### Response: -Fordyce spots They are aberrant sebaceous glands present under the buccal or labial mucosa and shine through it as yellowish or yellow-brown spots. They are seen with equal frequency in both males and females and are considered normal. Ref:- Dhingra; pg num:-220 -### End" -1658,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are intermediates of TCA cycle, except :, with the following options: A: Malonate, B: alpha -ketoglutarate, C: Succinate, D: Fumarate - -### Response: -Ans. a) Malonate is not an intermediate of TCA cycle Malonate Malate competitive inhibitor of succinate dehydrogenase intermediate in TCA cycle. TCA cycle intermediates are Citrate, Isocitrate, a-ketoglutarate, succinyl-CoA, Succinate, Fumarate, Malate, oxaloacetate. Acetyl-CoA is completely oxidised Oxaloacetate is regenerated. -### End" -1659,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False regarding delirium tremens, with the following options: A: Tremors, B: Opthalmoplegia, C: Visual hallucination, D: Clouding of consciousness - -### Response: -The classic sign of alcohol withdrawal is tremulousness, although the spectrum of symptoms can expand to include psychotic and perceptual symptoms (e.g., delusions and hallucinations) & seizures. In addition to the symptoms of delirium, the features of alcohol intoxication delirium include autonomic hyperactivity such as tachycardia, diaphoresis, fever, anxiety, insomnia, and hypeension; perceptual distoions, most frequently visual or tactile hallucinations; and fluctuating levels of psychomotor activity, ranging from hyperexcitability to lethargy. Reference: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition, page 631. -### End" -1660,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 16-year-old girl was on anti-epileptic for treatment of focal seizure episodes while asleep. She has had no seizure for last 6 months. NCCT and EEG is normal. What is the fuher management?, with the following options: A: Stop treatment, B: Continue for 2 years, C: Lifelong treatment, D: Stop treatment and follow up with 6 monthly EEG - -### Response: -AED is withdrawn after 2 years in a patient who meets following criteria: Complete medical control for 1-5 years Single seizure type (eg focal /GTCS) with adequate control. Normal neurological examination Normal cognition, Normal EEG Juvenile myoclonic epilepsy (JME) also occurs in adolescent age group but the seizures occurs after awakening and are usually myoclonic jerks or GTCS. Some have absence seizures but focal seizures are not seen in JME. AED should not be stopped immediately as it will lead to rebound epilepsy -### End" -1661,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lower Segment Caesarean Section (LSCS) can be carried out under all the following techniques of anesthesia, except –, with the following options: A: General anesthesia, B: Spinal anesthesia, C: Caudal anesthesia, D: Combined spinal epidural anesthesia - -### Response: -Either epidural or spinal anaesthesia is preferred. A combined spinal and epidural technique is also common. If there is massive bleeding, cord prolapse or fetal distress, general anaesthesia by rapid sequence induction is given. -### End" -1662,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Foetus starts hearing by what time in intrauterine life:, with the following options: A: 14 weeks, B: 20 weeks, C: 32 weeks, D: 33 weeks - -### Response: -Formation of cochlea is complete by 20 weeks & a fetus can hear by 20 weeks. -### End" -1663,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Pulsus bisferiens:, with the following options: A: Double peak, one is systole and another in diastole, B: Double peak, both in systole, C: Seen in patients with dilated cardiomyopathy, D: Seen only when aortic stenosis is associated with aortic regurgitation - -### Response: -Ans. b (Double peak, both in systole). (Ref. Harrison Medicine /16th ed., 1305 & 1416).ARTERIAL PULSESVARIOUS ARTERIAL PULSESMECHANISMETIOLOGYPulsus paradoxusDecrease in SBP (< 10 mm Hg) that normally accompanies decrease in arterial pulse amplitude during inspiration.It refers to a fall in systolic pressure >10 mmHg with inspiration.Airway obstruction accentuated# Pericardial effusion# Pericardial temponadeQ# Pulmonary embolism (massive)# SVC obstruction# Hemorrhagic shock# Severe obstructive lung disease# Tension pneumothorax.Pulsus bigeminusRegular alteration of pressure pulse amplitude, but it is caused by a premature ventricular contraction that follows each regular beat.PVCsPulsus alternansRegular alteration of pressure pulse amplitude, despite regular rhythm.(defined by beat-to-beat variability of pulse amplitude. And is present only when every other phase 1 Korotkoff sound is audible as the cuff pressure is lowered slowly, typically in a patient with a regular heart rhythm and independent of the respiratory cycle)# LVF/severe left ventricular systolic heart failure# PAT after premature beatsPulsus bisferiens OR Bifid pulse (percussion & tidal wave)Two systolic peaks (MH 2006).A bifid pulse is easily appreciated in patients on intra-aortic balloon counterpulsation (IABP), in whom the second pulse is diastolic in timing.Advanced AR/HOCM (A bifid pulse described in patients with HOCM, with inscription of percussion and tidal waves)Dicrotic pulse2 palpable waves, 1 in systole 1 in diastoleDCMPulsus parvus (hypokinetic)Small weak pulseA weak and delayed pulse (pulsus parvus et tardus) defines severe aortic stenosis (AS).# LVF,# MS,# Restrictive pericardial diseasePulsus tardusDelayed systolic peak# ASHyperkinetic # CHB,# Anemia,# Fever,# Exercise,# HyperthyroidismAnacrotic pulseA slow, notched, or interrupted upstroke (with a thrill or shudder).Some patients with ASCorrigan's or water- hammer pulse)The carotid upstroke has a sharp rise and rapid fall-off.Chronic severe ARBounding pulse # VSD,# Chronic AR# Ruptured sinus of Valsalva# MR,# HypertensionNote: The character of the pulse is best appreciated at the carotid level. -### End" -1664,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Interstitial Fibrosis, Except, with the following options: A: FVC < 80% Predicted, B: FEV 1 /FVC < 0.7, C: DLCO is decreased, D: TLC is decreased - -### Response: -Answer is B (FEV1/FVC < 0.7): Interstitial lung disease like interstiul fibrosis are characterized by a normal or elevated FEV IFVC ratio which is characteristically> 0.7. PFT results comparing obstructive and restrictive disease (may not be applicable for all forms of lung (disease) FEVI=foreed expiratory volume in one second; FVC=Forced Vital Capacity; FEF25_75=Foreed Expiratory Flow at 25%=75% vital capacity; TLC= Total Lung Capacity; DLCO=Diffusion Capacity of the Lung for Carbon monoxide. -### End" -1665,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cereals are deficient in:, with the following options: A: Tryptophan, B: Threonine, C: Lysine, D: Methionine - -### Response: -Lysine -### End" -1666,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 years old man Ramu has fasting and post prandial blood sugar within normal limit but urine sugar is 3 plus (+++). The diagnosis is -, with the following options: A: Renal Glycosuria, B: Pancreatic insufficiency, C: Alimentary glycosuria, D: High carbohydrate diet taken in the morning - -### Response: -Ans is option 1 - renal glycosuria Renal glycosuria is characterized by excretion of glucose at normal concentration of glucose in blood. Here patient has normal blood glucose in both fasting and postprandial., Ref Harrison 15/2315 -### End" -1667,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coronary ligaments of the knee joint connect ?, with the following options: A: Menisci to tibia, B: Menisci to femur, C: Lateral meniscus to capsule, D: Anterior horns of both menisci - -### Response: -CORONARY LIGAMENT * Fibrous Capsule is attached to periphery of Menisci. * Connects the periphery of the menisci to the tibia * They are the poion of the capsule that is stressed in rotary movements of the knee ref : maheswari 9th ed -### End" -1668,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Caspases is?, with the following options: A: Involved in apoptosis, B: Cause necrosis, C: Involved in pain pathway, D: Are cytokines inhibitor - -### Response: -ANSWER: (A) Involved in apoptosisREF: Robbins pathology 7th edition page 27-29Caspases are essential in cells for apoptosis, or programmed cell death, in development and most other stages of adult life, and have been termed ""executioner"" proteins for their roles in the cell Some Caspases are also required in the immune system for the maturation of lymphocytes -### End" -1669,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Schiller-Duval bodies are characteristically seen in, with the following options: A: Dysgerminoma, B: Brenner's Tumor, C: Teratoma, D: Endodermal Sinus Tumor - -### Response: -Inclusion bodiesDiseasesAschoff bodies Rheumatic fever Asteroid body Sarcoidosis & Sporotrichosis Babes Ernst granules Corynebacterium diphtheriaBodies of Arantius Aoic valve nodules Body of Highmore Mediastinum testis Bollinger bodies Fowl pox Brassy body Dark shrunken blood corpuscles in malaria Call Exner bodies Granulose theca cell tumourChromatid bodies Entamoeba histolytica pre-cyst Citron bodies Clostridium septicum Civatte bodies Lichen planusCoccoid X bodiesPsittacosisCouncilman bodies HepatitisCreola bodies Asthma Donovan bodies Granuloma inguinale Ferruginous body AsbestosisGamma gandy bodies Congestive splenomegaly Guarnieri bodies VacciniaHeinz bodiesG6PD deficiency Henderson Peterson bodiesMolluscum contagiosum Hirano bodies Alzheimer's disease Keratin pearls Squamous cell carcinoma Lafora body Myoclonic epilepsy Leishman Donovan bodies Kala - azarLevinthal Coles Lile bodiesPsittacosisLewis bodies Parkinsonism Mallory bodies Primary biliary cirrhosis , Alcoholic hepatitis , Wilson's disease , Chronic cholestasis , Hepatocellular carcinoma Michaelis Gutmann body Malacoplakia Miyagawa's corpuscles Buboes from LGV Mooser bodies Endemic typhusMoot bodiesMultiple myeloma Owl - eye inclusions CMV and herpes Pick body Pick's disease Psammoma bodies Papillary carcinoma of thyroid , serous cystadenoma of ovary , meningioma , mesothelioma Reilly bodies Hurler's syndrome Rokitansky bodiesTeratoma Ross's bodies SyphilisRushton bodies Odontogenic cyst Russell bodies Multiple myeloma Sandstorm bodies Parathyroid glandsSchaumann bodies Sarcoidosis Schiller Duval bodies Yolk sac tumourSclerotic bodies ChromoblastomycosisTorres body Yellow fever Verocay bodies SchwannomaWahin - Finkeldey giant cells Measles Winkler bodies SyphilisZebra bodies Metachromatic leukodystrophy -### End" -1670,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding transpo of substances through the cell membrane, all are true except, with the following options: A: Glucose is transpoed Via facilitated diffusion, B: Active transpo is an energy driven proces, C: Facilitated diffusion requires energy, D: Facilitated diffusion requires carrier protein - -### Response: -Diffusion primarily depends on the concentration of molecules. Passage of ions or molecule from a region of higher concentration to lower concentration without the expenditure of energy is called diffusion. (REF: TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, PAGE NO - 4) -### End" -1671,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dryness of eye is caused by injury to facial nerve at:, with the following options: A: Chorda tympani, B: Vertical segment, C: Tympanic segment, D: Geniculate ganglion - -### Response: -(d) Geniculate ganglion(Ref. Cummings, 6th ed., 2606)Whenever there is injury before or at the origin of the greater superficial petrosal nerve (i.e. before or at the Geniculate ganglion) which is responsible for lacrimation there will be dry eye on the same side.Tympanic segment, Vertical segment and Chorda tympani all are beyond the geniculate ganglion. -### End" -1672,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for acyclovir resistant herpes is?, with the following options: A: Cidofovir, B: Gancyclovir, C: Valacyclovir, D: Foscarnet - -### Response: -Ans. (d) FoscarnetRef KDT 6/e -### End" -1673,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a male newborn the adrenogenital syndrome (congenital hyperplasia of the adrenal glands) is most often associated with, with the following options: A: Normal appearing genitalia, B: Hypoglycemia, C: Pseudohermaphroditism, D: Persistent paramesonephros (Mullerian ducts) - -### Response: -Adrenogenital syndrome is defined as Over secretion of adrenal sex hormones, resulting in intense masculinizing of the body.mulleian ducts area pair of embryonic ducts which give rise to the genital passages in the female, but disappear in the male.Ref: Ganong&;s review of medical physiology;24th edition; page no-374 -### End" -1674,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amaurosisfugax is due to -, with the following options: A: TIA, B: Tobacco, C: Optic neuritis, D: Papilloedema - -### Response: -Amaurosis fugax is sudden temporary and painless loss of vison due to transient failure of retinal circulation. -It may occur in carotid transient ischemic attack (TIA) -Amaurosis is complete loss of sight in one or both eyes, in the absence of ophthalmoscopic or other marked objective signs. -  -Amaurosis fugax -It refers to sudden, temporary and painless monocular visual loss occurring due to a transient failure of retinal circulation. -Common causes are :- -Carotid transient ischaemic attacks (TIA) -Embolization of retinal circulation -Papilledema -Giant cell arteritis -Raynaud's disease -Migraine -As a prodromal symptom of central retinal artery or carotid artery occlusion -Hypertensive retinopathy -Venous stasis retinopathy -  -Typically described by the patients as a curtain that descends from above or ascends from below to occupy the upper or lower halves of their visual fields. The attack lasts for two to five minutes and resolves in the reverse pattern of progression, leaving no residual deficit. -  -Uraemic amaurosis -  -It is sudden, bilateral, complete loss of sight occuring probably due to the effect of certain toxic materials upon the cells of the visual centre in patients suffering from acute nephritis, eclampsia of pregnancy and renal failure.It is associated with dilated pupils which generally react to light. Usually, the vision recovers in 12-48 hours. -### End" -1675,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MIC-2 is a marker of?, with the following options: A: Ewing sarcoma, B: Chronic lymphocytic leukemia, C: Mantle cell lymphoma, D: All of these - -### Response: -Harshmohan textbook of pathology 7th edition ☆ In Ewings sarcoma - the cell surface marker by the tumor cells of ES / PNET group is CD99 which is a product of MIC2 gene located on X and Y chromosome. -### End" -1676,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4 month pregnant lady on treatment with valproate regularly asked for your advice regarding taking the drug during pregnancy. What is the best course of action, with the following options: A: Immediately tape off valproate and sta lamotrigine, B: Change to carbamazepine, C: Continue valproate and monitor blood levels, D: Slowly tape dose of valproate - -### Response: -K.D Tripathy essentials of medical pharmacology 7th edition . *Valproate used during pregnancy produced spina bifida and other neural tube defects in off spring:should be avoided *Incidence of minor foetal malformation repoed with carbamazepine * -### End" -1677,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alveolar hemorrhage and hemosiderin laden macrophages ?, with the following options: A: Sarcoidosis, B: Goodpasture syndrome, C: Bronchial pneumonia, D: Bronchieactasis - -### Response: -Ans. is 'b' Goodpasture syndrome Goodpasture syndromeGoodpasture syndrome is a rare condition characterized by rapid destruction of the kidney and diffuse pulmonary hemorrhage.It is an autoimmune disease characterized by presence of circulating autoantibodies targeted against basement membrane of lung and kidney.These antibodies are directed against the noncollagenous domain of the a-3 chain of type IV collegen (collegen of basement membrane).The antibodies initiate an inflammatory destruction of the basement membrane in kidney glomeruli and lung alveoli.In Goodpasture syndrome, immune reaction is type II hypersensitivity.Morphological changesLungThe lungs are heavy, with areas of red brown consolidation.There is focal necrosis of alveolar walls associated with intraalveolar hemorrhages. Alveoli contain hemosiderin-laden macrophages.Linear deposits of immunoglobulins along the basement membranes of the septal walls.KidneyDiffuse proliferative rapidly progressive glomerulonephritis.Focal necrotizing lesion and crescents in >50% of glomeruli.Linear deposits of immunoglobulins and complement along glomerular basement membrane.Clinical manifestationsOccur typically in young males.Most cases begin clinically with respiratory symptoms, principally hemoptysis.Soon, manifestations of glomerulonephritis appear and typically present as nephritic syndrome - hematuria, nephritic urinary sediment, subnephrotic proteinuria, rapidly progressive renal failure.The common cause of death is renal failure. -### End" -1678,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Retrograde ejaculation is a characteristic side effect of which psychotropic medication?, with the following options: A: Lithium carbonate, B: Phenelzine, C: Diazepam, D: Thioridazine - -### Response: -Of all the antipsychotic medications, thioridazine is the only one with a strongly recommended dosage ceiling. Dosages exceeding 800 mg daily have been linked to the development of retinitis pigmentosa. Other side effects of thioridazine include ejaculatory inhibition. Although it also produces sedation, a side effect that can be of clinical value in treating agitated psychotic individuals, thioridazine causes fever extrapyramidal side effects than most other neuroleptics. Haloperidol is a widely used butyrophenone antipsychotic that can produce significant extrapyramidal side effects. However, because it is non-sedating and causes little autonomic disturbance, it is effective in low dosages in treating agitation in elderly persons. MAO inhibitors such as phenelzine are used to treat mood disorders.Persons on MAO inhibitor therapy must remain on a diet free of tyramine-containing foods (e.g., aged cheese) to avoid a potentially fatal hypeensive crisis, which can present as severe headache. Lithium carbonate is used in the treatment and prophylaxis of bipolar disorder. The dosage must be adjusted according to blood level. Side effects commonly associated with rising or mildly toxic blood levels include fine tremor of the hands, nausea, anorexia, and diarrhea. Ref: Meyer J.M. (2011). Chapter 16. Pharmacotherapy of Psychosis and Mania. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -1679,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common indication for liver transplantation in end stage liver disease is, with the following options: A: Wilson's disease, B: Chronic hepatitis B, C: Chronic hepatitis C, D: Alcoholic liver injury - -### Response: -. -### End" -1680,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triple H therapy for subarachnoid hemorrhage consists of all except:-, with the following options: A: Hypeension, B: Hypervolemia, C: Hemodilution, D: Hypothermia - -### Response: -The combination of induced hypeension, hypervolemia, and hemodilution (triple-H therapy) is often utilized to prevent and treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage(SAH) -### End" -1681,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common cardiac defects seen in congenital rubella syndrome is, with the following options: A: Pulmonary aery stenosis and coarctation of aoa, B: Vantricular septal defect (VSD) and patent ductus aesian (PDA), C: VSD and pulmonary aery stenosis, D: Pulmonary aery stenosis and PDA - -### Response: -Common cardiac defects in congenital rubella syndrome is PDA and PS. Ghai essential of pediatrics, eighth edition, p.no:401 -### End" -1682,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shape of the arterial pulse is influenced by, with the following options: A: Viscosity of blood, B: Velocity of blood, C: Arterial wall expansion, D: Cross sectional area of artery - -### Response: -Arterial pulse is caused by the ventricular systole that leaves a pressure wave along the arterial wall during each contraction. -### End" -1683,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19-year-old man has had recurrent bleeding occur in his knee when playing contact sports. He has no history of spontaneous bleeding, but his brother had similar problems. Consultation with a specialist reveals that he has ""mild"" hemophilia A. Which of the following factor abnormalities is consistent with this diagnosis?, with the following options: A: abnormal factor VIII function, B: decreased levels of functional factor VIII, C: decreased factor IX level, D: decreased von Willebrand factor - -### Response: -In hemophilia A, there are decreased levels of functioning factor VIII. This can be due to reduced amounts of normal VIII, the presence of a functionally abnormal protein, or a combination of both. The activated partial thromboplastin time (APTT) is prolonged, and the prothrombin consumption test is abnormal. The prothrombin time, thrombin clotting time, and bleeding time are usually normal. -### End" -1684,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The normal time required to culture mycobacterium TB is :, with the following options: A: 4-8 weeks, B: 2-3 weeks, C: 6-10 weeks, D: 21 days - -### Response: -M. tuberculosis 4-8 weeks is required before growth is detected. New methods have decreased the time required for bacteriologic confirmation of TB to 2-3 weeks. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 1350 -### End" -1685,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to ICD 10, the symptoms of schizophrenia should persist for how long for its diagnosis?, with the following options: A: 2 months, B: 1 month, C: 6 months, D: 2 weeks - -### Response: -According to recent ICD 10, It is 1 month and according to DSM 5 it is 6 months to diagnose schizophrenia Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 365 -### End" -1686,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Immunisation with Rotavirus should be completed by the age of:, with the following options: A: 2 months, B: 3 months, C: 12 months, D: 18 months - -### Response: -- Immunization with Rotavirus should be completed by the age of 12 months. - 3 types of vaccines of rotavirus & their schedule Rotarix (RV1) - 2 doses at 10 & 14 weeks RotaTeq ( RV5) - 3 doses at 6, 10 & 14 weeks Rotavac - 3 doses at 6, 10 & 14 weeks - This vaccination is avoided in acute gastroenteritis - Caution is taken in infants with high risk of intussusception. -### End" -1687,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the folloowing is not true about pulmonary embolus, with the following options: A: Most of the emboli cause infarction, B: Most lesions affect are in the lower lobes, C: Small arterioles are blocked, D: Saddle embolus may cause sudden death - -### Response: -• Large emboli lodge in the main pulmonary artery or its major branches or at the bifurcation as a saddle embolus. It may lead to sudden death. -• Smaller emboli travel out into the more peripheral vessels, where they may cause hemorrhage or infarction. In patients with adequate cardiovascular function, the bronchial arterial supply can sustain the lung parenchyma. Hemorrhages may occur, but there is no infarction. The underlying pulmonary architecture is preserved, and resorption of the blood permits reconstitution of the preexisting architecture. -Also know: NEET points -• Only about 10% of emboli actually cause infarction, which occurs when the circulation is already inadequate, as in patients with heart or lung disease. -• Pulmonaryinfarcts tend to be uncommon in the young. -• About 3/4thof all infarcts affect the lower lobes  -• Inmore than half, multiple lesions occur. -• Typically, they extend to the periphery of the lung substance as a wedge with the apex pointing toward the hilus of the lung. -### End" -1688,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Selective serotonin reuptake inhibitors are drugs of choice for all of the following conditions except:, with the following options: A: Acute panic attack, B: Social phobia, C: Post traumatic stress disorder, D: Generalized anxiety disorder - -### Response: -Ref: KDT 6/e p448,449 *SSRIs are drug of choice for depression,sustained treatment of panic disorder and generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, social and other phobia and bulimia. *In acute panic attacks and for acute treatment of generalized anxiety disorder, benzodiazepines are preferred. -### End" -1689,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bipolar staining is characteristic of -, with the following options: A: Yersinia pestis, B: Proteus mirabilis, C: Pseudomonas aeruginosa, D: All of the above - -### Response: -Option a, b, c, d Bipolar staining (safety pin appearance): with both ends densely stained and a clear central area of the bacteria. 1. Yersinia pestis 2. Vibrio parahaemolyticus 3. Calymmatobacterium (Donovania) granulomatis 4. H. Ducreyi 5. Pasteurella multocida 6. Burkholderia species -### End" -1690,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is seen in osteoporosis-, with the following options: A: Low Ca, high PO4, high alkaline phosphatase, B: Low Ca, low PO4, low alkaline phosphatase, C: Normal Ca, normal PO4, normal alkaline phosphatase, D: Low Ca, low PO4, normal alkaline phosphates - -### Response: -*Serum calcium, phosphate and alkaline phosphatase are normal in osteoporosis. aboratory diagnosis and Biochemical assessment of osteoporosis * Serum and urine calcium. * Alkaline phosphatase. * Hydroxyproline. * Ostecalcin. * Hydroxylysine glycosides. * Procollagen I extension peptides * Crosslink assays * Alpha2 HS glycoprotein * Acid phosphatase * Biochemical estimation of bone loss. Ref: Ebnezar 4th/e p.669 -### End" -1691,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true regarding vancomycin except: September 2009, with the following options: A: Excreted unchanged mainly by glomerular filtration, B: Poorly distributed in the body fluids, C: May cause red man syndrome, D: Not absorbed orally - -### Response: -Ans. B: Poorly distributed in the body fluids Vancomycin undergoes limited absorption when administered orally and is therefore restricted to parenteral administration for the treatment of systemic infections. It is distributed widely to various tissues and body fluids. Penetration of vancomycin may vary by site and concomitant disease states. For example, limited CSF penetration may be enhanced by the presence of inflamed meninges. The orable penetration of vancomycin into skin tissues may be significantly impaired in patients with diabetes. Vancomycin penetration into lung epithelial lining fluid is limited relative to that of simultaneous serum concentration (the ratio of lung tissue to serum concentration is about 0.25). Vancomycin's primary route of elimination is renal excretion of unchanged drug. The rate of elimination is directly related to creatinine clearance. Rapid intravenous injection may cause chills, fever, uicaria and intense flushing-called 'red man syndome'. -### End" -1692,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient of cirrhosis with liver failure comes to you for stem cell transplantation your method will be?, with the following options: A: Transfer of stem cells from other persons liver, B: Taking patient skin stem cell and transferring into liver, C: Tranfer hepatocytes from the same person for regeneration, D: Transfer hepatic progenitor cells (HPCs) of same person for regeneration - -### Response: -Ans. (d) Transfer hepatic progenitor cells (HPCs) of same person for regeneration(Ref: Nature Cell Biology 17, 971 -983 (2015)Hepatocytes and cholangiocytes self-renew following liver injury. But after severe injury like cirrhosis and acute liver failure hepatocytes are increasingly senescent. In this case there are two options: first diseased-donor liver and living- donor transplantation, in which a just portion of a healthy donor's liver is used for transplantation or second hepatic progenitor cells (HPCs), which contribute significantly to restoration of liver parenchyma, regenerating hepatocytes and biliary epithelia, highlighting their in vivo lineage potency. The best option is D among the options. -### End" -1693,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About t-RNA, TRUE is:, with the following options: A: No intrabasal pairing, B: Clover leaf pattern, C: Inveed T appearance, D: Each specific for one m-RNA - -### Response: -B i.e. Clover leaf pattern -### End" -1694,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following compounds are mitogens that stimulate human T cells to proliferate, EXCEPT:, with the following options: A: Lipopolysaccharide, B: Concanavalin A, C: Anti CD3 antibody, D: Phytohemagglutinin - -### Response: -All of the listed compounds are T-cell mitogens except lipopolysaccharide, which is a B-cell mitogen. Ref: Harrison's Principles of Internal Medicine, 17th Edition, Chapter 310, Page 2055 -### End" -1695,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an adverse effect of Furosemide?, with the following options: A: Hyper uricemia, B: Hypokalemia, C: Ototoxicity, D: Hypercalcemia - -### Response: -Furosemide is a loop diuretic which acts by inhibiting Na-K-Cl cotranspo in the thick ascending limb of Loop of Henle. It increases calcium excretion and cause hypocalcemia. Other side effects of furosemide are hypokalemia, ototoxicity, hyperuricemia and hypomagnesemia. -### End" -1696,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are used to assess the nutritional status titan individual , except -, with the following options: A: Urinary nitrogen excretion, B: Mid arm circumference, C: Serum immuringlobul in, D: Scrum transterrin - -### Response: -Ans. is 'c' i.e., Serum immunogloholin -### End" -1697,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Xeroderma pigmentosa is due to:, with the following options: A: Base excision defect, B: Nucleotide excision defect, C: Sos repair defect, D: Cross linking defect - -### Response: -Ans: b (Nucleotide excision defect) Ref: Vasudevan, 4th ed, p. 403; 5th ed, p. 421Steps in nucleotide excision repair:Repair: Excision endonuclease makes nick on both sides of thymine dimer and removes defective DNA. DNA polymerase fill the gap by synthesising DNA in 5'-3' direction. DNA Ligase seals the nick in the repaired strand .Most DNA repair occurs in G1 phase. Mismatch repair occurs in G2 phase. -### End" -1698,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest radiological change in RA -, with the following options: A: Decreased joint space, B: Articular erosion, C: Periarticular osteopenia, D: Subchondral cyst - -### Response: -""The radiographic findings in early RA are normal or soft tissue swelling and periarticular osteopenia"". ___ Mayo clinic -### End" -1699,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute opioid withdrawl is characterizedby, with the following options: A: Rhinorrhoea, B: Piloerection, C: Insomnia, D: All - -### Response: -A, B, C i.e. Rhinorrhoea, Piloerection, Insomnia -### End" -1700,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coagulative necrosis is seen ill, with the following options: A: T.B., B: Sarcoidosis, C: Cryptococcal infection, D: All - -### Response: -Ans. is ' a' i.e., Gangrene > Tuberculosis ""Gangrene (Dry) occurs as a result of ischaemic coagulative necrosis of tissues due to aerial obstruction"". ""Caseous necrosis (occuring in TB) is a distinctive forms of coagulative necrosis but unlike a coagulative necrosis the tissue architecture is completely obliterated"". - Robbins illustrated (basis), 6/e, p17. o Thus both gangrene and tuberculosis are variants of coagulative necrosis. You may choose your answer. Gangrenous necrosis o Gangrenous necrosis is of two types:? Dry gangrene Wet gangrene Dry gangrene It is a clinically distinct variant of coagulative necrosis. It occurs most commonly in the soft tissue of lower limbs (Leg, foot, toes) as a result of ischemia due to aerial occlusion, that leads to coagulative necrosis. Then, why is it called gangrenous necrosis not coagulative necrosis ? Lets see. Since the extent of vascular occlusion is frequently global in the lower limbs, which impedes or prevents the migration of leukocytes in to the area of coagulative necrosis, it is called gangrenous necrosis because the dead tissue is not digested and removed but remains mummified. Wet gangrene o When overlying skin of dry gangrenous tissue is devitalized, bacterial infection is superimposed and the coagulative necrosis is modified by liquifactive necrosis. So, o Dry gangrene --> Variant of Coagulative necrosis. Wet gangrene --> Liquifactive necrosis is superimposed on coagulative necrosis. -### End" -1701,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The ideal treatment for hemothorax greater than 500ml/hr, with the following options: A: wait and watch, B: Needle aspiraton, C: Intercostal tube, D: Open thoracotomy with ligation of vessels - -### Response: -Following are indications of thoracotomy in blunt chest trauma: Initial drainage of blood > 1000 ml, especially if fresh. Continued brisk bleeding > (100 ml/15 minutes) from the intercostal drain Continued bleeding of > 200 ml/hr for > 3 hrs Rupture of bronchus, aoa, esophagus or diaphragm Cardiac tamponade (if needle aspiration unsuccessful). Ref : Bailey & Love 24/e p872 -### End" -1702,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Comparing economic benefits of a program with the cost of that program, it is called -, with the following options: A: Cost-accounting analysis, B: Input-output analysis, C: Cost-effective analysis, D: Cost-benefit analysis - -### Response: -parks textbook of preventive and social medicine 23rd edition. *management technique in which economic benefits of any programme are compared with the cost of that programme . *benefits are expressed in monetary erms to determine wheather a given programme is economically sound and to select the best out of several alternate programme and is called cost benefit analysis *if benefits are expressed in terms of result acheived they are called cost effective analysis . -### End" -1703,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is an effect of fillers in composite is:, with the following options: A: Increased thermal expansion., B: Decreased thermal expansion., C: Increased thermal contaction., D: Increased polymerization shrinkage. - -### Response: -Fillers in composite -Generally between 30% to 70% by volume or 50% to 85% by weight of a composite -Benefits of Fillers -Reinforcement- compressive strength, tensile strength, modulus of elasticity (i.e., stiffness or rigidity), and toughness - -Reduction of polymerization shrinkage/contraction -Reduction in thermal expansion and contraction -Control of workability/viscosity -Decreased water sorption -Imparting radiopacity -### End" -1704,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most potent stimulator of naive T cell is?, with the following options: A: Mature dendritic cell, B: Follicular dendritic cell, C: Macrophages, D: B cell - -### Response: -There are 2 types of dendritic cells:Interdigitating dendritic cells and Follicular dendritic cells. Interdigitating dendritic cells - These are the most potent antigen presenting cells for T cells. These are present in the lymphoid tissues & non lymphoid organs. Immature dendritic cells present in the skin are called as Langerhans cells. They are non phagocytic & express high levels of MHC -II molecules & B7-1, B7-2. Follicular dendritic cells -Theses are present in germinal centers of lymphoid follicles. These can bind to antigen bound to antibody & present it to B cell. Ref: Robbins 8th Ed Pg 187. -### End" -1705,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deep vein thrombosis post-operatively is diagnosed by :, with the following options: A: USG, B: Ascending venography, C: X-ray, D: Clinically - -### Response: -Venography is the most definitive test for the diagnosis of DVT in both symptomatic and asymptomatic patients. It is the gold standard to which other modalities are compared. This procedure involves placement of a small catheter in the dorsum of the foot and injection of a radiopaque contrast agent. Venography is not routinely used for the evaluation of lower extremity DVT because of the associated complications discussed previously. Currently, venography is reserved for imaging before operative venous reconstruction and catheter-based therapy. It does, however, remain the procedure of choice in research studies evaluating methods of prophylaxis for DVT. Ref : Liem T.K., Moneta G.L. (2010). Chapter 24. Venous and Lymphatic Disease. In T.R. Billiar, D.L. Dunn (Eds), Schwaz's Principles of Surgery, 9e. -### End" -1706,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient with HNPCC (hereditary nonpolyposis colon cancer) has genes with microsatellite instability. This is due to failure of which repair mechanism of DNA, with the following options: A: Mismatch repair, B: Base excision repair, C: Homologous end joining repair, D: Non homologous end joining repair - -### Response: -Mismatch repair: It is one of the repair mechanisms in DNA replication. It operates when there is mismatched base paining. For eg: when A pairs with C. This repair mechanism is defective in HNPCC. -### End" -1707,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of middle ear papilloma is ?, with the following options: A: Myringotomy and simple excision, B: Myringectomy and simple excision, C: Tympanomastoidectomy, D: Local infiltration with podophyllin - -### Response: -Ans. is 'c' i.e., Tympanomastoidectomy Middle ear pappilomas The middle ear papillomas are rare presentations and medical literature is mainly limited to case repos or case series. These include aggressive pappilary tumors, schneiderian type of pappilomas and inveed pappilomas. They are associated with hearing difficulty and veigo and may be associated with Von Hippel Lindau syndrome. They tend to be slowly growing, locally aggressive non metastasizing neoplasms The approach for treatment of such pathology is usually radical and tympanomastoidectomy is considered the treatment of choice. This gives the best chance of cure. -### End" -1708,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alpha rhythm on EEG is seen in:, with the following options: A: Awake state, B: Mental work, C: Light sleep, D: Deep sleep - -### Response: -Alpha wave is seen when the person is awake, in a quiet, resting stage of cerebration. Mental work (focused attention) will convert alpha to beta wave. Light sleep converts alpha to theta wave. -### End" -1709,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding Staphylococcal food poisoning is -, with the following options: A: Caused by eating of dairy producrs, B: Caused by endotoxins, C: Caused by fishes, D: Associated with abnormal movements - -### Response: -Cows suffering from mastitis have been responsible for outbreak of staphylococcal food poisoning involving milk and milk products. The foods involved are salads, custards, milk and milk products which get contaminated by staphylococci. The illness becomes manifest by the sudden onset of vomiting, abdominal cramps and diarrhoea. PARK&;S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23rd edition, page 238 -### End" -1710,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Manoeuvre for diagnosing rupture of medial collateral ligament is: March 2010, with the following options: A: Posterior drawer test, B: Anterior drawer test, C: Lachmann's test, D: Valgus stress test - -### Response: -Ans. D: Valgus Stress Test Tests to Detect Ligament Injury Lachman Test - The Lachman test is the best test to diagnose an ACL tear. - With the patient lying flat and relaxed, the examiner bend the knee slightly, about 20 degrees. The examiner then stabilizes the thigh while pulling the shin forward. - Both the amount of translation (shifting) as well as the feel of the endpoint offer information about the ACL. Anterior Drawer Test - The anterior drawer test is also performed with the patient lying flat. The knee is bent 90 degrees and the shin is pulled forward to check the stability of the ACL. - An intact ACL will only allow the shin to come forward slightly. - A torn ACL will allow the shin to move fuher forward. Pivot Shift Test - The pivot shift test is a difficult maneuver to perform on a patient who is not under anesthesia. This test places a stress on the knee joint that forces a subluxation (paial dislocation) in patients who do not have an ACL. - This test recreates the type of instability that caused the ACL injury. Posterior Drawer Test - The posterior drawer is performed similarly to the anterior drawer test. - This test detects injury to the PCL. - By pushing the shin backward, the integrity of the PCL is tested. - Excessive movement of the shin backwards is a sign of PCL injury. Varus and Valgus Instability - Varus and valgus instability tests check the LCL (lateral collateral ligament) and MCL (medial collateral ligament), respectively. - With the patient lying flat, and the knee held at about 30 degrees of flexion, gentle adduction and abduction force is applied. - Insufficiency of the LCL or MCL will allow the knee to ""open up"" excessively. - The test is repeated with the leg straight. If the knee still opens up excessively, then more than just the LCL or MCL was torn. -### End" -1711,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following inherited disorders is a Potassium Channelopathy?, with the following options: A: Hyperkalemic periodic paralysis, B: Hypokalemic periodic paralysis, C: Beckers's disease, D: Anderson Tawil syndrome - -### Response: -d. Anderson Tawil syndrome(Ref: Harrison's 19/e p 462)Channelopathies are progressive syndromic cluster of symptoms not localizing to single lesionImportant Channelopathies: (All of these are autosomal dominant & show episodic weakness)FeatureCalcium ChannelSodium ChannelPotassium ChannelHypokalemic PPHypokalemic PPParamyotonia CongenitaAndersen-Tawil syndromeAge of onsetAdolescenceEarly childhoodEarly childhoodEarly childhoodMyotoniaNoYesYesNoFrequency of attacks of weaknessDaily to yearlyMay be 2-3/dayWith cold, usually rareDaily to yearly -### End" -1712,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pulse pressure in severe aoic regurgitation is equal to-, with the following options: A: 30-45mmHg, B: 45-60mmHg, C: 60-75 mmHg, D: 75-90 mm Hg - -### Response: -Therefore, a defining characteristic of aoic regurgitation is an increase in aoic pulse pressure (systolic minus diastolic pressure). ... Early in the course of regurgitant aoic valve disease, there is a large increase in left ventricular end-diastolic pressure and left atrial pressure.pulse pressure usually between 75-90 mm/hg Ref Davidson 23rd edition pg 450 -### End" -1713,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most preferred method to manage the case of an apprehensive 7 year old child having a history of unpleasant experience with dental treatment?, with the following options: A: Voice control, B: Premedication, C: Desensitization, D: Postponing appointment - -### Response: -The objectives of tell-show-do are to: teach the patient important aspects of the dental visit and familiarize the patient with the dental setting, and shape the patient’s response to procedures through desensitization and well-described expectations.  -Note: This method was given by Addleston. -### End" -1714,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is more common in children?, with the following options: A: Gingivitis, B: Periodontitis, C: ANUG, D: Pericoronitis - -### Response: -Recent recognition that periodontal disease may have its origins in childhood has led dentists to be more aggressive in treatment. Studies confirm a high prevalence of gingival inflammation in children. -Reference: McDONALD AND AVERY’S DENTISTRY for the CHILD and ADOLESCENT, 10th ed page no 243 -### End" -1715,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Denominator in General fertility rate is?, with the following options: A: Married women in reproductive age group in a given year, B: Women in reproductive age group in a given year, C: Married women in any specified age group, D: Women in any specified age group - -### Response: -ANSWER: (B) Women in reproductive age group in a given yearREF: Parks textbook 20th edition page419Repeat from December 2008General fertility rate: Number of live births per 1000 women in reproductive age group in a given yearGeneral marital fertility rate: Number of live births per 1000 married women in reproductive age group in a given yearAge specific fertility rate: Number of live births in a year to 1000 women in any specified age groupAge specific marital fertility rate: Number of live births in a year to 1000 married women in any specified age group -### End" -1716,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following operations are done for gastroesophageal reflux disease Except, with the following options: A: Heller's cardiomyotomy, B: Belsey operation, C: Nissen fundoplication, D: Hill procedure - -### Response: -Antireflux surgery is the only effective long-term beneficial therapy. Laparoscopic fundoplication (most popular), Collis - Nissen veical gastroplasty and fundoplication, resection of OG junction when metaplasia is present, Belsey Mark 4 operation (technically difficult) are the procedures used now. * Total (Nissen's) or paial (Toupet) fundoplication wherein after narrowing the crus of the diaphragm, mobilised fundus is wrapped around the area of O-G junction either totally or paially. *Hill's operation--Fixing O-G junction posteriorly to preaoic fascia--to an arcuate ligament. * Boerema operation--Fixing O-G junction anteriorly to the abdominal wall. * The Belsey-mark-4 operation is plication of the oesophagus to the diaphragm through many sutures and so as to push the lower end of oesophagus downwards and make it intra-abdominal--thoracic approach. Ref: SRB&;s manual of surgery,3 rd ed, pg no 724 -### End" -1717,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 44-year-old man with a stab wound was brought to the emergency depament and a physician found that the patient was suffering from a laceration of his right phrenic nerve. Which of the following conditions has likely occurred?, with the following options: A: Injury to only general somatic efferent fibers, B: Difficulty in expiration, C: Loss of sensation in the pericardium and mediastinal pleura, D: Normal function of the diaphragm - -### Response: -Loss of sensation in the pericardium and mediastinal pleura because Phrenic nerve supply (sensory) central pa of diaphragm, pain from pericardium, mediastinal and diaphragmatic pleurae and peritoneum in the undersurface of diaphragm. Difficulty in inspiration on injury to phrenic nerve. -### End" -1718,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During starvation, brain utilizes -, with the following options: A: Glycogen, B: Fattey acids, C: Ketone bodies, D: None - -### Response: -Ans. is 'c' i.e.. Ketone bodies o There is no stored fuel in brainQ, but it utilized 60% of total energy under resting conditionsQ,o Glucose is virtually the sole fuel for the brainQ, except in prolonged starving when ketone bodies are the major sourceQ.o Fatty acids do not serve as fuel for the brain, because they are bound to albumin in plasma; hence cannotcross blood-brain barrier.ORGANFEDFASTINGSTARVATIONBrainGlucoseGlucoseKetone bodiesHeartFatty acidsFatty acidsKetone bodiesLiverGlucoseFatty acidsAmino acidsMusclesGlucoseFatty acidsFatty acids & ketone bodiesAdipose tissueGlucoseFatty acidsFatty acids & ketone bodiesRBCsGlucoseGlucose -### End" -1719,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of following substances inhibit succinate dehydrogease in Kreb cycle?, with the following options: A: Flouroacetate, B: Arsenite, C: Malonate, D: Fluoride - -### Response: -Inhibitors of TCA Cycle - -Aconitase noncompetitively inhibited by Flouroacetate  -Alpha Ketoglutarate Dehydrogenase noncompetitively inhibited by Arsenite  -Succinate Dehydrogenase is competitively inhibited by Malonate.(Inhibitor of complex II of ETC). - -Harper 30th edition pg-162 -### End" -1720,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following helps in differentiation of follicular carcinoma from follicular adenoma of thyroid, with the following options: A: Huhle cell, B: Lining of tall columnar and cuboidal cell, C: Vascular invasion, D: Increased mitoses - -### Response: -Ref Robbins 9/e p1094 Microscopically most follicular carcinomas are composed of uniform cells forming small follicles.follicular carcinomas may be grossly infiltrative or minimally invasive. The latter are sharply demarcated lesions on gross examination . This distinction requires extensive histologic sampling to exclude capsular or vascular invasion -### End" -1721,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest presenting feature of cystic fibrosis in neonate is:, with the following options: A: Biliary cirrhosis, B: Meconium ileus, C: Pancreatic insufficiency, D: Respiratory obstruction - -### Response: -Ans: b (Meconium ileus) Ref: Nelson, 18th ed, p. 1807; 17th ed, p. 1440* Presenting feature in new bom is meconium ileus in 15-20% of newborn infants.* Biliary cirrhosis is seen only in 2-3% of patients.* Pancreatic insufficiency is usually seen after 10 years of life.So, among the options provided, most appropriate is meconium ileus.Cystic fibrosis* It is an inherited multisystem disorder of children and adults characterized chiefly by obstruction and infection of airways and by maldigestion and its consequences.* Dysfunction of epithelialised surfaces is the predominant pathogenic feature.* CF is inherited as autosomal recessive trait.* Gene mutation that contribute to the CF syndrome occur at a single locus on the long arm of chromosome 7.Diagnostic criteria for cystic fibrosis1. Presence of typical clinical features (respiratory, gastrointestinal or genitourinary)2. A history of CF in a siblingOR3. A positive newborn screening testPLUSLaboratory evidence for CFTR dysfunction1. Two elevated sweat chloride concentrations obtained on separate daysOR2. Identification of two CF mutationsOR3. An abnormal nasal potential difference measurementIn case of patients with equivocal or frankly normal sweat chloride values the increased potential differences across nasal epithelium can be used for diagnosis. (AIIMS nov 2007)Conditions in which there is elevated sweat chloride other than cystic fibrosis* Untreated adrenal insufficiency* Ectodermal dysplasia* Hereditary nephrogenic diabetes insipidus* Glucose 6 phosphatase deficiency* Hypothyroidism* Hypoparathyroidism* Familial cholestasis* Pancreatitis* Mucopolysaccharoidosis* Fucosidosis* Malnutrition -### End" -1722,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following infection affects fetal growth?, with the following options: A: CMV, B: Rubella, C: Herpes simplex, D: All - -### Response: -Ans: d (All) Ref: Dutta, 6th ed, p. 296All the above infections cause IUGR.Causes oflUGR:3. Placental* Placenta previa* Abruptio placenta* Circumvallate placenta* Infarction4. Idiopathic - 40%1. Maternal* Constitutional* Maternal nutrition* Maternal diseases - anaemia, HTN, heart disease etc.* Toxins - alcohol, drugs, smoking2. Fetal* Chromosomal abnormalities - Trisomies 13,18,21 and Turner syndrome.* Structural abnormalities - C VS, renal etc* Infections - Toxoplasma, rubella, CMV, HSV, malaria.* Multiple pregnancy -### End" -1723,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug does not cause hypokalemia -, with the following options: A: Gentamicin, B: Diuretics, C: Amphotericin B, D: Amiodarone - -### Response: -Ans. is 'd' i.e., Amiodarone Drugs causing hypokalemia agonist o Licorice o Penicillin derivatives o Amphotericin B o Theophylline o Steroids alpha Blockers o Toluene abuse o Gentamicin o Insulin o Vitamin B12 o Diuretics Carbenoxalone -### End" -1724,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aery of hindgut is, with the following options: A: Descending aery, B: Superior mesenteric aery, C: Inferior mesenteric aery, D: Coeliac trunk - -### Response: -Aerial supply of hindgut is inferior mesenteric aery imageref - researchgate.net -### End" -1725,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the underlying abnormality in this child with seizures?, with the following options: A: Tuberous sclerosis, B: Sturge-Weber syndrome, C: McCune Albright syndrome, D: Neurofibromatosis - -### Response: -b. Sturge-Weber syndromePort wine stain of half of the face involving ophthalmic & maxillary divisions of trigeminal nerve suggest Sturge-Weber syndrome -### End" -1726,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The population frequency for phenylketonuria is 1 in 10,000. What is the carrier frequency for the disease?, with the following options: A: Jan-50, B: 1/100, C: 1/500, D: 1/1000 - -### Response: -a. 1/50(Ref: Nelson's 20/e p 598)It is based on Hardy Weinberg principle: Simplifying it,Carrier frequency for an autosomal recessive disorder = twice the square root of disease incidenceSo 2 X square root of 1/10,000 gives 1/50 as the answer. -### End" -1727,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3-month old male child with normal genitalia presents to the emergency depament with severe dehydration, hyperkalemia and hyponatremia. The measurement blood levels of which of the following will be helpful ?, with the following options: A: 17-hydroxy progesterone, B: Renin, C: Coisol, D: Aldosterone - -### Response: -Ans. is 'a' i.e., 17 hydroxyprogesterone o This is a case of congenital adrenal hyperplasia due to deficiency of 21 - hydroxylase deficiency. o Because of the enzyme block ,there is increased formation of 17- hydroxyprogesterone, which is then shunted into the production of testosterone. o Levels of coisol and aldosterone are reduced. -### End" -1728,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 26-yrs-old patient has had three consecutive spontaneous aboions early in her pregnancy. As pa of an evaluation for this problem, the least useful tests would be Hysterosalpinogram Chromosomal analysis of the couple Testing for TORCH infections Endometrial biopsy in the luteal phase Postcoital test, with the following options: A: Option 1,3,5, B: Option 1,3, C: Option 3,5, D: Option 5 only - -### Response: -A major cause of spontaneous aboions in the first trimester is chromosomal abnormalities; however, the causes of losses in the second trimester are more likely to be anatomical in origin for which an HSG can be done, endometrial biopsy in luteal phase rules out luteal phase defect A postcoital test is useful for couples who cannot conceive, due to abnormal sperm cervical interaction, but does not address post-conception losses. -### End" -1729,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Site of fatty acid synthesis -, with the following options: A: ER, B: Mitochondria, C: Cytosol, D: Microsoma - -### Response: -Ans. is 'c' i.e., Cytosol o Has been explained in previous years -### End" -1730,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most reliable method of identification of a person is :, with the following options: A: Gustafson method, B: Galion method, C: Anthropometry, D: Scars - -### Response: -B i.e. Galton method -### End" -1731,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are contraindicated in renal failure except:, with the following options: A: Pancuronium, B: Pethidine, C: Enflurane, D: Midazolam - -### Response: -Ans. D. Midazolam. (Ref. PauVs anaesthesia 5th/Pg. 254; Table 11-2; KDT 6th ed. 459)# With the exception of methoxyflurane and possibly enflurane, anesthtic agents do noy directly cause renal function or interfere with the normal compensatory mech activated by stress response.# Pancuronium. Clearance is decreased in renal and hepatic failure, demonstrating that excretion is dependent on bothOrgans........... Paul's anaesthesia 5th/pg. 435.# Pethidine: Nearly completely metabolized in liver. Acidification of urine increases excretion of unchanged pethidine. Renal failure patients given repeated doses of pethidine may experience effects of similar to that of its overdose - tremors, mydriasis, hyperreflexia, delirium, myoclonus, and convulsions............ KDT 6th ed. Pg. 459.# Midazolam: The hepatic clearance of IV anesthetics with a high (e.g., etomidate, propofol, ketamine) or intermediate (e.g., methohexital, midazolam) extraction ratio is largely dependent on hepatic blood flow, with most of the drug being removed from the blood as it flows through the liver (so- called perfusion-limited clearance). Midazolam undergoes extensive oxidation by hepatic enzymes to form water-soluble hydroxylated metabolites, which are excreted in the urine. The hepatic clearance rate of midazolam is five times greater than lorazepam and 10 times greater than diazepam. Although changes in liver blood flow can affect the clearance of midazolam, age has relatively little influence on midazolam's elimination half-life.......... Paul's anaesthesia 5th/pg. 338.Some Drugs with Significant Renal Excretion Encountered in Anesthesiology# Aminoglycosides# Quinolones# Cephalosporins# Digoxin# Procainamide# Atenolol# Edrophonium# Pyridostigmine# Nadolol# Neostigmine# Penicillins# Pancuronium# Doxacurium# Pipecuronium# Rocuronium# Enflurane6 -### End" -1732,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Among the pulses, the highest quantity of protein is present in -, with the following options: A: Green gram, B: Red gram, C: Soyabean, D: Black gram - -### Response: -Among tha pulses soybean contain 40percent of protein. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 580 -### End" -1733,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Unilateral proptosis in a 40 year old lady is commonly due to: March 2011, with the following options: A: Cavernous hemangioma, B: Orbital cellulitis, C: Graves ophthalmopathy, D: Metastasis - -### Response: -Ans. C: Graves ophthalmopathy Graves ophthalmopathy (dysthyroid eye disease) is the most common cause of unilateral or bilateral proptosis in adults between the ages of 25-50 years Graves' ophthalmopathy/ Thyroid eye disease (TED)/ dysthyroid/thyroid-associated orbitopathy (TAO), Graves' orbitopathy It is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, and bulging eyes (proptosis). It is pa of a systemic process with variable expression in the eyes, thyroid, and skin, caused by autoantibodies that bind to tissues in those organs, and, in general, occurs with hypehyroidism. The most common form of hypehyroidism is Graves' disease. The autoantibodies target the fibroblasts in the eye muscles, and those fibroblasts can differentiate into fat cells (adipocytes). Fat cells and muscles expand and become inflamed. Veins become compressed, and are unable to drain fluid, causing edema. Cigarette smoking, which is associated with many autoimmune diseases, raises the incidence 7.7-fold. Epidemiology The pathology mostly affects persons of 30 to 50 years of age. Females are four times more likely to develop TAO than males. When males are affected, they tend to have a later onset and a poor prognosis. Pathophysiology In mild disease, patients present with eyelid retraction. In fact, upper eyelid retraction is the most common ocular sign of Graves' orbitopathy. This finding is associated with lid lag on infraduction (Von Graefe's sign), eye globe lag on supraduction (Kocher's sign), a widened palpebral fissure during fixation (Dalrymple's sign) and an incapacity of closing the eyelids completely (lagophthalmos). Due to the proptosis, eyelid retraction and lagophthalmos, the cornea is more prone to dryness and may present with chemosis, punctate epithelial erosions and superior limbic keratoconjunctivitis. The patients also have a dysfunction of the lacrimal gland with a decrease of the quantity and composition of tears produced. In moderate active disease, the signs and symptoms are persistent and increasing and include myopathy. The inflammation and edema of the extraocular muscles lead to gaze abnormalities. The inferior rectus muscle is the most commonly affected muscle and patient may experience veical diplopia on upgaze and limitation of elevation of the eyes due to fibrosis of the muscle. This may also increase the intraocular pressure of the eyes. The double vision is initially intermittent but can gradually become chronic. The medial rectus is the second-most-commonly-affected muscle, but multiple muscles may be affected, in an asymmetric fashion. In more severe and active disease, mass effects and cicatricial changes occur within the orbit. This is manifested by a progressive exophthalmos, a restrictive myopathy that restricts eye movements and an optic neuropathy. With enlargement of the extraocular muscle at the orbital apex, the optic nerve is at risk of compression. The orbital fat or the stretching of the nerve due to increased orbital volume may also lead to optic nerve damage. The patient experiences a loss of visual acuity, visual field defect, afferent pupillary defect, and loss of color vision. Diagnostic Graves' ophthalmopathy is diagnosed clinically by the presenting ocular signs and symptoms, but positive tests for antibodies (anti-thyroglobulin, anti-microsomal and anti-thyrotropin receptor) and abnormalities in thyroid hormones level (T3, T4, and TSH) help in suppoing the diagnosis. Orbital imaging is an interesting tool for the diagnosis of Graves' ophthalmopathy and is useful in monitoring patients for progression of the disease. Ultrasonography may detect early Graves' orbitopathy in patients without clinical orbital findings. It is less reliable than the CT scan and magnetic resonance imaging (MRI), Thus, CT scan or MRI is necessary when optic nerve involvement is suspected. On neuroimaging, the most characteristic findings are thick extraocular muscles with tendon sparing, usually bilateral, and proptosis. Classification of Graves' eye disease Mnemonic: ""NO SPECS"": Class 0: No signs or symptoms Class 1: Only signs (limited to upper lid retraction and stare, with or without lid lag) Class 2: Soft tissue involvement (oedema of conjunctivae and lids, conjunctival injection, etc.) Class 3: Proptosis Class 4: Extraocular muscle involvement (usually with diplopia) Class 5: Corneal involvement (primarily due to lagophthalmos) Class 6: Sight loss (due to optic nerve involvement) Treatment The first step is the regulation of thyroid hormone levels by a physician. Topical lubrication of the ocular surface is used to avoid corneal damage caused by exposure. Tarsorrhaphy is an alternative option when the complications of ocular exposure can't be avoided solely with the drops. Coicosteroids are efficient in reducing orbital inflammation, but the benefits cease after discontinuation. Radiotherapy is an alternative option to reduce acute orbital inflammation. A simple way of reducing inflammation is smoking cessation, as pro-inflammatory substances are found in cigarettes. Surgery may be done to decompress the orbit, to improve the proptosis, and to address the strabismus causing diplopia. Surgery is performed once the patient's disease has been stable for at least six months. Eyelid surgery is the most common surgery performed on Graves ophthalmopathy patients. TAO is an orbital autoimmune disease. The thyroid-stimulating hormone receptor (TSH-R) is an antigen found in orbital fat and connective tissue, and is a target for autoimmune assault. On histological examination, there is an infiltration of the orbital connective tissue by lymphocytes, plasmocytes, and mastocytes. The inflammation results in a deposition of collagen and glycosaminoglycans in the muscles, which leads to subsequent enlargement and fibrosis. There is also an induction of the lipogenesis by fibroblasts and preadipocytes, which causes orbital volume enlargement due to fat deposition. Poor prognostic indicators Age greater than 50 years Rapid onset of symptoms under 3 months Cigarette smoking Diabetes Severe or uncontrolled hypehyroidism Presence of pretibial myxedema High cholesterol levels (hyperlipidemia) Peripheral vascular disease -### End" -1734,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The ductus aeriosus is derived from the following aoic arch, with the following options: A: 3rd, B: 4th, C: 5th, D: 6th - -### Response: -The pa of the left sixth arch aery, between the branch to the lung bud and aoa,forms the ductus aeriosus HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:255 -### End" -1735,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased serum calcium is seen in all except:, with the following options: A: Myxedema, B: Multiple myeloma, C: Sarcoidosis, D: Primary hyperparathyroidism - -### Response: -Answer is A (Myxoedema): Hypercakemia is a feature of Hypehyroidism and not hypothyroidism (Myxoedema) -### End" -1736,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not included in the SAFE strategy?, with the following options: A: Surveillance, B: Antibiotics, C: Facial hygiene, D: Environmental modification - -### Response: -In order to deal with the blindness caused by trachoma, the WHO has declared the SAFE strategy which includes the following: S - Surgery A - Antibiotics F - Facial hygiene ( Face washing) E - Environmental modification Surveillance is not included in the SAFE strategy. Ref: Park's Textbook of Preventive and Social Medicine 19th edition; pages 258 - 260; Parson's Textbook of Ophthalmology 19th Edition, Page 595 -### End" -1737,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a minor criteria for diagnosis of Rheumatic fever (RF) according to modified Jones criteria -, with the following options: A: ASO titre, B: Past history of Rheumatic fever, C: Fever, D: Subcutaneous nodules - -### Response: -Ans. is 'c' i.e., Fever Fever is a minor criteria -### End" -1738,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: OKA strain is used to produce vaccine for ?, with the following options: A: Mumps, B: Measles, C: Japanese encephalitis, D: Chickenpox - -### Response: -Ans. is 'd' i.e., Chickenpox -### End" -1739,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient undergoing chemotherapy with cisplatin has severe nausea. Which of the following would be the drug to use in this patient, with the following options: A: Scopolamine, B: Ondansetron, C: Naloxone, D: Cyclizine - -### Response: -5-HT3 ANTAGONISTS Ondansetron Mech of action:- It blocks the depolarizing action of 5-HT exeed through 5-HT3 receptors on vagal afferents in the g.i.t. as well as in NTS and CTZ. uses:- Cytotoxic drugs/radiation produce nausea and vomiting by causing cellular damage - release of mediators including 5-HT from intestinal mucosa - activation of vagal afferents in the gut -emetogenic impulses to the NTS and CTZ. Ondansetron blocks emetogenic impulses both at their peripheral origin and their central relay. thus, used to control cancer chemotherapy/radiotherapy induced vomiting, and later found to be highly effective in PONV and disease/drug associated vomiting as well. Ref:- kd tripathi; pg num:-668 -### End" -1740,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following approach of brachial block is most suitable for catheter placement:-, with the following options: A: Supraclavicular, B: Infraclavicular, C: Axillary, D: All - -### Response: -The infraclavicular brachial plexus blocks are an alternative to axillary block for anaesthetizing the elbow, forearm, and hand when positioning is compromised by limited abduction at the shoulder, for example, rheumatoid ahritis or an immobilized/traumatized arm. It is also an alternative to supraclavicular block for anaesthetizing the upper arm. The veical infraclavicular is better than the lateral approaches in this respect and has similar rates of pneumothorax but less frequent phrenic nerve paresis. The lateral approach performed with ultrasound control has a minimal risk of phrenic nerve paresis or pneumothorax and so may be a better choice in those with respiratory compromise, but provides less reliable upper arm anaesthesia. Complications are rare and less frequent than supraclavicular approaches and vary depending on the specific infraclavicular technique used. Although the axillary block provides safe and straightforward regional anaesthesia of the arm, the infraclavicular approach does offer an alternative in some specific situations and can be considered a ble routine alternative in experienced hands. It has some advantages in providing upper arm anaesthesia, securing infusion catheters to the chest wall, and ease of patient positioning -### End" -1741,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about reticular activating system except?, with the following options: A: Involved in arousal, B: Polysynaptic pathway, C: Receives collateral from all sensory pathway, D: Produces a-block on EEG - -### Response: -Ans. is 'd' i.e., Produces a-block on EEGReticular activating system (RAS) is the ascending polysynaptic pathway that extends from brainstem reticularformation to non-specific thalamic nuclei (intralarninar and midline nuclei) and projects diffusely to cerebral coex.Long sensory tracts give collateral to the RAS, as they ascend in brainstem. Thus RAS receives inputs from the medial and trigeminal leminisci as well as from the visual, auditory and olfactory systems.Therefore, the RAS is a non-specific system which can be excited by any sensation.Activation of RAS causes activation of cerebral coex and arousal from sleep.On arousal from sleep, the EEG pattern changes to high frequency low voltage activity (b - wave) from high voltage slow waves (d - waves) of sleep - d-block (not a-block). -### End" -1742,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gold poisoning leading to exfoliative dermatitis is Rx by:, with the following options: A: Chloroquine, B: Steroid, C: Antibiotics, D: Antihistaminics - -### Response: -Rx of exfoliative dermatitis: Topical: Emollients Systemic: Systemic steroids Cyclosporine Antimetabolites Antibiotics only for secondary infection. -### End" -1743,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of first trimester abortion is:, with the following options: A: Chromosomal abnormalities, B: Syphilis, C: Rhesus isoimmunization, D: Cervical incompetence - -### Response: -Ans. is a, i.e. Chromosomal abnormalitiesRef. Dutta Obs. 7/e, p 159,160; COGDT 10/e, p 259; Williams Obs. 23/e, p 215Abortion is spontaneous termination of pregnancy before 22 weeks or weight of fetus less than 500 gm.Incidence: About 15% of all conceptions end up in spontaneous abortions. Out of these 80% occur before 12 weeks i.e. in 1st trimester and among these 50-75% are due to chromosomal anomalies (Germplasm defect). -### End" -1744,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stye is other name of -, with the following options: A: Chalazion, B: Hordeolum internum, C: Hordeolum externum, D: None of the above - -### Response: -Ans. is 'c' i.e., Hordeolum externum o Acute infection of Zeis (Moll) glando Acute infection of tarsal gland (Meibomian gland)o Chronic infection of tarsal gland (Meibonium gland)-Stye (Hardoleum externum)- Hardoleum internum -Chalazion -### End" -1745,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anterior scalloping of veabrae seen in -, with the following options: A: Obsteogenesis imperfecta, B: Aoic aneurysm, C: Metastasis, D: Renal Cell Ca - -### Response: -Ans is option 2... Aoic aneurysm Anterior scalloping is seen in following conditions Aoic aneurysm, tuberculous spondylosis, lymphadenopathy, delayed motor development (in downs syndrome) Posterior scalloping is seen in Tumors in spinal canal (ependymoma, lipoma,, neurofibroma), neurofibromatosis, acromegally, achondroplasia, congenital syndromes like Ehler-Danlos, Marfans, Hurlers etc Ref Chapman 3/e p 88,89 -### End" -1746,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old male cigarette smoker has a history of respiratory infections and has also been found to have hematuria. A high value for diffusing capacity is noted during pulmonary function testing. This finding is consistent with which of the following disorders?, with the following options: A: Anemia, B: Cystic fibrosis, C: Emphysema, D: intrapulmonary hemorrhage - -### Response: -(Braunwald, 15/e, pp 1450-1451.) Carbon monoxide (CO) diffusing capacity provides an estimate of the rate at which oxygen moves by diffusion from alveolar gas to combine with hemoglobin in the red blood cells. It is interpreted as an index of the surface area engaged in alveolar-capillary diffusion. Measurement of diffusing capacity of the lung is done by having the person inspire a low concentration of carbon monoxide. The rate of uptake of the gas by the blood is calculated from the difference between the inspired and expired concentrations. The test can be performed during a single 10-second breath holding or during 1 minute of steady-state breathing. The diffusing capacity is defined as the amount of carbon monoxide transferred per minute per millimeter of mercury of driving pressure and correlates with oxygen transpo from the alveolus into the capillaries. Primary parenchymal disorders, anemia, and removal of lung tissue decrease the diffusing capacity. Conversely, polycythemia, congestive hea failure, and intrapulmonary hemorrhage tend to increase the value for diffusing capacity. In this patient, the possibility of Goodpasture syndrome would be considered. -### End" -1747,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: fanconi bickel syndrome is due to mutation of ?, with the following options: A: glut 1, B: glut 2, C: glut 4, D: na+iodine channels - -### Response: -FANCONI--BICKEL SYNDROME * Hepatic glycogenesis with renal fanconi syndrome. * Rare AR disorder. * &;deficiency of GLUT 2 in .hepatocytes , pancreatic beta cells, intestinal * Proximal renal tubular dysfunction. * Presents in 1st year of life as FTT , rickets , hepatomegaly , renomegaly. ref : guyton and hall -### End" -1748,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Impairment of moral and social sense, lack of initiation and difficulty in planning with flight of ideas is a feature of lesion in the:-, with the following options: A: Frontal lobe, B: Parietal lobe, C: Temporal lobe, D: Occipital lobe - -### Response: -Lesion in the frontal lobe may result in the frontal lobe syndrome. Sectioning the connections between prefrontal coex and diencephalon will also cause prefrontal coex to be put out of action - prefrontal leucotomy. Such lesions are characterized by: (i) flight of ideas, difficulty in planning; (ii) euphoria; (iii) memory impairment with loss of moral and social sense; (iv) restlessness and lack of concentration; (v) lack of initiative; (vi) emotional instability, (vii) patient becomes less self-critical, holding an exalted opinion of his abilities (though his higher intellectual faculties are impaired). -### End" -1749,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pneumatocoele is most commonly caused by: September 2005, 2010, with the following options: A: Streptococcus pneumoniae, B: Klebsiella, C: Hemophilus influenzae, D: Staphylococcus aureus - -### Response: -Ans. D: Staphylococcus aureus Inflammatory pneumatocoeles result from a rapidly progressive inflammation in which there are plugging of the smaller bronchi in the affected areas, destruction of the distal alveolar tissue, and cystic hyperexpansion of the air space. Pneumatocoeles are found much more often in children than in adults. They are seen paicularly in infants and children with staphylococcal pneumonia. However, they have also been described in pneumonia due to other micro-organisms such as Streptococcus pneumoniae, Klebsiella, Hemophilus influenzae, and in measles pneumonitis. On chest radiographs, they appear as thin-walled,rounded radiolucencies in areas of pneumonic consolidation. They can be single or multiple. As the surrounding consolidation resolves, the pneumatocoeles become more apparent and/or enlarge. Thus, they are usually seen during the resolution stage of pneumonitis. Most often, however, they resolve slowly and disappear within two to three weeks -### End" -1750,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stomach is supplied by, with the following options: A: Celiac trunk, B: Splenic aery, C: Gastroduodenal aery, D: Inferior pancreaticoduodenal aery - -### Response: -The left gastric aery is a branch of celiac trunk. The left gastroepiploic aery supplies left half of greater curvature of the stomach is a branch of splenic aery. The sho gastric aeries that supply the fundus are also branches of the splenic aery. The right gastroepiploic aery that supplies the right half of greater curvature of the stomach is a branch of gastroduodenal aery.Reference: clinical anatomy for students a problem-solving approach, Neeta v Kulkarni, page no 615, 616. -### End" -1751,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following antiepileptic agents acts on the GABAergic system to decrease the uptake of GABA into neurones and glial cells-, with the following options: A: Vigabatrin, B: Progabide, C: Gabapentin, D: Tiagabine - -### Response: -Ans. is 'd' i.e., Tiagabine Mechanism of action of Tiagabine. o Tiagabine inhibits the GABA transpoer GAT-1 o Inhibition of GABA transpoer reduces the uptake of GABA into neurones and glia. o In this way the duration of inhibitory synaptic currents is increased, because the inhibitory transmitter GABA stays at the synpatic junction for longer durations, as its reuptake into the glial and neuronal cells is prevented. -### End" -1752,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of action of d-tubocurarine is:-, with the following options: A: Competitive, nondepolarizing block at the Nm cholinergic receptor, B: Non-competitive, nondepolarizing block at the Nm cholinergic receptor, C: Competitive, depolarizing block at the Nm cholinergic receptor, D: Noncompetitive, depolarizing block at the Nm cholinergic receptor - -### Response: -Neuro Muscular blockers Depolarising or Non-competitive Non-depolarising or competitive Succinylcholine Dexamethonium Curium Curonium Atracurium Cisatracurium Mivacurium Pancuronium Pipecuronium Vecuronium Rocuronium Rapacuronium -### End" -1753,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meniere's disease is:, with the following options: A: Perilymphatic hydrops, B: Endolymphatic hydrops, C: Otospongiosis, D: Coalescent mastoiditis - -### Response: -(b) Endolymphatic hydrops(Ref. Cummings, 6th ed., 2331)Meniere's is also known as endolymphatic hydrops.There is no condition called Perilymphatic hydrops.Otospongiosis also known as otosclerosis is fixation of foot plate of stapes.Coalescent mastoiditis is infection of the mastoid air cells and is a complication following ASOM/ unsafe CSOM. -### End" -1754,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Needle-shaped crystals negatively birefringent on polarized microscopy is characteristic of which crystal associated ahropathy?, with the following options: A: Gout, B: CPPD, C: Neuropathic ahropahty, D: Hemophilic ahropathy - -### Response: -Crystal of pseudogout:Made up of calcium pyrophosphateWeakly positive birefringent, rhomboidCrystal of goutMade up of uric acid (monosodium urate)(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 433, 434) -### End" -1755,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following conditions cause an increase in AFP except?, with the following options: A: Hepatoblastoma, B: Multiple gestation, C: Increased maternal weight, D: Anterior abdominal defect - -### Response: -Decreased maternal weight is associated with an increase in AFP levels. Other causes of increased AFP levels are anencephaly, spina bifida, abdominal wall defects, renal anomalies, multiple pregnancy, IUFD and wrong gestational dates. Reference: Encyclopedia of Women's Health edited by Sana Loue, page 85. -### End" -1756,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atopic dermatitis may be associated with, with the following options: A: Conjunctivitis, B: Keratoconus, C: Cataract, D: All of the above - -### Response: -Ans. All of the above -### End" -1757,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Conservative surgical excision would be appropriate treatment and probably curative for which of the following?, with the following options: A: Nodular fasciitis, B: Fibromatosis, C: Fibrosarcoma, D: Rhabdomyosarcoma - -### Response: -Nodular fasciitis is a rapidly developing reactive lesion that typically does not recur following excision. Fibromatosis is an aggressive nonencapsulated lesion that has significant recurrence potential. The other lesions listed are malignancies and require more than simple excision to prevent recurrence -### End" -1758,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following are indication for doing Medical Termination of pregnancy except :, with the following options: A: Pregnancy from rape, B: Substantial risk of delivering seriously handicapped baby, C: Very poor socio economic position of the family, D: Injury to physical and mental health of the pregnant women - -### Response: -C i.e. Very poor socio economic position of the family -### End" -1759,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carnitine helps in -, with the following options: A: Transport of fatty acids from mitochandria to cytosol, B: Transport of fatty acids from cytosol to mitochondria, C: Transport of pyrurate into mitochondria, D: Transport of Malate in Malate shuttle - -### Response: -Ans. is 'b' i.e., Transport of fatty acids from cytosol to mitochondria o Activated long chain fatty acid (acyl CoA) cannot penetrate inner mitochondrial membrane.o Acyl group of acyl CoA is transferred to carnitine, resulting in formation of acylcarnitine.o Acylcarnitine is then transported across the inner mitochondrial membrane into the mitochondrial matrix by translocase.o Once inside the mitochondrion, acyl group of acylcarnitine is transferred back to CoA, resulting in formation of acyl-CoA which undergoes b-oxidation.o Production of malonyl-CoA is the initialQ and rate limiting step in fatty acid synthesis.o Acetyl-CoA needs to be converted to activated form, which will serve as the donor of carbon units to growing fatty- acid chain.o Malonyl-CoAQ) a 3-carbon compound is such activated form.o It is produced by carboxylation of acetyl-CoA, a reaction catalyzed by acetyl-CoA caroxy laseQ. Acety 1-CoA carboxylase requires biotin as a cofactorQ.o Acetyl-CoA carboxylase is a multienzyme protein containing variable number of identical subunits, each containingbiotin carboxylase, biotin carboxyl carrier protein and transcarboxylase.o The reaction also requires HCO3- (as a source of CO2) and ATPo The reaction takes place in two steps: (i) Carboxylation of biotin involving HCO3 and ATP, and (ii) transfer of the carboxyl group to acetyl-CoA to form malonyl-CoA. -### End" -1760,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adhesive remnant index score 3?, with the following options: A: 3/4remnant, B: 1/4 remnant, C: Not remnant, D: Complete remnant - -### Response: -Artun and Bergland used an adhesive remnant index system to evaluate the amount of adhesive left on tooth after debracketing. This index was developed on basis of a pilot study of 20 extracted teeth and criteria includes -Score 0... No adhesive left on tooth -Score 1...less than half of adhesive left on tooth -Score 2...more than Half of adhesive left on tooth -Score 3...all adhesive left on tooth with a distinct impression of bracket mesh. -### End" -1761,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the lower motor neuron lesion diseases, there is, with the following options: A: Spastic paralysis, B: There may be wasting of muscles in long standing cases, C: Exaggerated tendon reflexes, D: Absence of fasciculations - -### Response: -(B) There may be wasting of muscles in long standing cases # UMN LESION - Spasticity, Weakness, loss of superficial reflexes, brisk DTR, Clonus present, Babinski sign positive, Hypertonia Clasp Knife spasticity)# LMN lesion - Flaccidity, Decreased tone, loss of superficial & deep reflexes, plantar B/L Flexor, Wasting, Fibrillations.Signs That Distinguish Patterns of WeaknessSIGNS THAT DISTINGUISH PATTERNS OF WEAKNESSSignUpper Motor NeuronLower Motor NeuronMyopathicAtrophyNoneSevereMildFasciculationsNoneCommonNoneToneSpasticDecreasedNormal/decreasedDistribution of weaknessPyramidal/ regionalDistal/segmenta 1ProximalTendon reflexesHyperactive Normal/hypoactiveBabinskils signPresentHypoactive/absent AbsentAbsent -### End" -1762,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corononal 3rd root fracture occurs:, with the following options: A: Above bone crest., B: Below bone crest., C: Any of the above., D: None of the above. - -### Response: -Middle 3rd root fracture occurs below bone crest. -### End" -1763,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Indium labelled WBC scan is used to locate:, with the following options: A: Occult malignancy, B: Occult bleeding, C: Abscess, D: Aneurysm - -### Response: -Inflammatory process and abscess which are difficult to locate with routine scanning can be diagnosed by Radionuclied scanning. They are, 1. Technitium 99 scan 2. Gallium 67 citrate scan 3. Indium 111 scan Ref: Harrison, Edition-18, Page-163. -### End" -1764,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 47-year-old woman with a family history of breast cancer mutations in the BRCA1 and BRCA2 genes has made a decision to have an elective hysterectomy as a prophylactic treatment. During ligation of the uterine artery which of the following adjacent structures must the surgeon be careful not to injure?, with the following options: A: Ureter, B: Internal iliac artery, C: Internal iliac lymph nodes, D: Obturator nerve - -### Response: -During a hysterectomy, ligation of or injury to the ureter can happen relatively easily because it is the most susceptible structure due to its location. The ureter is located below the uterine vessels in the pelvic cavity approximately 1 cm lateral to the supravaginal cervix. The internal iliac artery bifurcates near the pelvic brim but is not in close proximity to the uterine vessels in the vicinity of the cervix. The obturator nerve travels along the pelvic sidewall and is not close to the site of ligation of the uterine vessels. The lumbosacral trunk is located on the lateral side of the sacrum and the pelvic sidewall, not in close proximity to the uterine vessels. -### End" -1765,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pellagra is caused by deficiency of which vitamin?, with the following options: A: B2, B: B3, C: B1, D: Folic acid - -### Response: -Niacin (Vit B3) or nicotinic acid is also known as pellagra preventive (P.P.) factor of Goldberg Pellagra Photosensitive Dermatitis: Symmetric dermatitis in the sun-exposed areas Casal's Necklace The rash form a ring around the neck 4 Ds of Pellagra Dermatitis (Photosensitive Dermatitis) Dementia Diarrhoea Death ref DM Vasudevan 8th ed page 470 -### End" -1766,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following organism is biggest -, with the following options: A: Balantidium coli, B: Entamoeba coli, C: Escherichia coli, D: Entamoeba histolytica - -### Response: -largest protozoal parasite of human Lives in large intestine Two stages- trophozoite and cyst (refer pgno:82 baveja 3 rd edition ) -### End" -1767,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are causes of sensorineural deafness except, with the following options: A: Old age, B: Acoustic neuroma, C: Ototoxic drugs, D: Rupture of tympanic membrane - -### Response: -Acquired causes of sensorineural deafness: Infections of labyrinth Trauma to labyrinth Noise induced hearing loss Ototoxic drugs Presbycusis Meniere's disease Acoustic neuroma Sudden hearing loss Systemic disorders Any disease which interferes with the conduction of sound to reach cochlea causes conductive deafness which occurs in case of rupture of tympanic membrane Ref: Dhingra 7e pg 34. -### End" -1768,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skin surface elevation caused by hyperplasia and projections of the epidermis form an undulating surface under microscopic examination. What is this known as?, with the following options: A: Saw toothing, B: Papillomatosis, C: Villi, D: Parakeratosis - -### Response: -Papillomatosis of skin Skin surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae. Papillary projections of the epidermis form an undulating surface under microscopic examination. -### End" -1769,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication of central venous catheter, with the following options: A: Local bleeding, B: Thrombosis, C: Catheter related infection, D: Pneumotherax - -### Response: -C i.e. Catheter related infection -### End" -1770,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about direct ophthalmoscopy except, with the following options: A: Erect image, B: Viual image, C: 15 X magnification, D: Need condensing lens - -### Response: -Direct opthalmoscopy is the most commonly practised method for routine fundus examination. The modern direct opthalmoscope works on the basic principle of glass plate opthalmoscope introduced by von Helmholtz. Characteristics of image formed. In direct opthalmoscopy, the image is erect, viual and about 15 times magnified in emmetropes (more in myopes and less in hypermetropes) Reference : A.K.Khurana; 6th edition; Page no: 587 -### End" -1771,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypertensive treatment in the elderly, with the following options: A: Elder patients are less compliant than young, B: Elder patients have less tolerance than young, C: It is the same in both, D: ACE inhibitors are useful - -### Response: -(A) Elder patients are less compliant than young > Hypertensive patients who are over age 65, and particularly those over age 75, offer substantial challenges to the physician.> Several studies have reported that healthy elderly patients, whether male or female, who are treated with relatively modest doses of antihypertensive agents show a substantial reduction in strokes and stroke-related deaths. This is true whether the patient has systolic and diastolic hypertension or isolated systolic hypertension. -### End" -1772,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about lymphoma of the thyroid except, with the following options: A: More common in females, B: Slow growing, C: Clinically confused with undifferentiated tumours, D: May present with respiratory distress and dysphagia - -### Response: -Primary thyroid lymphoma diagnosis is considered in patients with a goiter, especially one that has apparently grown significantly in a sho period. Other initial symptoms include hoarseness, dysphagia, and fever. Rapid growth, nerve involvement may raise suspicion of anaplastic carcinoma Thyroid lymphoma occurs four times more frequently in women than in men Approximately half of primary thyroid lymphomas occur in the setting of pre existing Hashimoto thyroiditis. Source : Sabiston 20 th edition Pg : 911 -### End" -1773,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for anti-psychotic induced Parkinsonism, with the following options: A: Pimavanserin, B: Trihexyphenidyl, C: Droxidopa, D: Pramipexole - -### Response: -Central anticholinergics are used for treatment of drug induced parkinsonism -### End" -1774,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Section 53 IPC is -, with the following options: A: Kidnapping, B: An accused can be examined by a medical practitioner at request of police, even without his consent or by force, C: Toure, D: Penjury - -### Response: -When a person arrested on a charge of commiting an offence of such anature & under such circumstances that there are reasonable grounds for believing that an examination of his person will offer some evidence , it shall be lawful for a registered medical practioner acting at the request of a police officer not below the rank of sub inspector.sec 363 is kidnapping. From Textbook of forensic medicine, V.V.Pillai, pg no 15 (16 edition) -### End" -1775,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28-year-old man presents to the clinic for evaluation of painful urination and cloudy-color penile discharge. The symptoms started 2 days ago and are not associated with any other symptoms. His past medical history is not significant and he is not on any medications.His physical examination is completely normal except for a purulent discharge that can be expressed from his penis. A swab of the fluid reveals Gram-negative diplococci within neutrophils. Which of the following is the most appropriate treatment?, with the following options: A: intramuscular ceftriaxone plus oral doxycycline, B: oral penicillin G, C: intramuscular penicillin V, D: intramuscular ampicillin and oral penicillin V - -### Response: -This patient has gonorrhea, and since 1986, increasing penicillin resistance has meant that penicillin/ampicillin are no longer drugs of choice. Alternatives to ceftriaxone include ciprofloxacin, ofloxacin, or cefixime given orally, with 7 days of doxycycline, or a single 1 g dose of azithromycin in case of coinfection with Chlamydia. In Asia and the Pacific (as well as in California), quinolones are not considered first-line therapy because of the high rate of resistant organisms. In these locations, ceftriaxone is the drug of choice. In pregnant women, erythromycin replaces doxycycline. Disseminated gonococcal infection should be treated in a hospital with IV antibiotics. -### End" -1776,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Duret hemorrhage, EXCEPT:, with the following options: A: Seen in conjunctiva, B: ICT increase, C: Cushing's triad, D: Seen in brain - -### Response: -Duret haemorrhage: ""Progressive rise in ICP cause fuher downward herniation into the foramen magnum or coning. This result in shearing of perforators supplying the brain stem causing haemorrhage known as duret haemorrhage. Tractional damage to pituitary stalk can result in diabetes insipidus. With progressive herniation the pupils become midsize & non reacting. These are invariably irreversible events leading to brainstem death"". In case of increased ICP downward herniation of brainstem occur, which cause stretching of perforators of basilar aery & may results in bleed (duret haemorrhage). The local syndrome may include cushing's triad (aerial hypeension, bradycardia & respiratory irregularity). Duret haemorrhage is small area of bleeding in ventral & paramedian pa of upper brainstem (midbrain and pons). It usually indicates a fatal outcome, however survival has been repoed. Diagnosis is made on CT or MRI"". Ref: Love & Bailey, 24th Edition, Page 611; Operative Neurological Techniques by Henry, 5th Edition, Page 35 -### End" -1777,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female patient of childbearing age is on valproate for JME. Which drug should be used to replace valproate and can be prescribed as monotherapy?, with the following options: A: Levetiracetam, B: Lincosamide, C: Carbamazepine, D: Phenytoin - -### Response: -Ans. a. Levetiracetam (Ref: Harrison 19/e p2544, 18/e p3265, 3253; Current Management in Child Neurology 4/e p127, 163)Levetiracetam can be prescribed as monotherapy in a female patient of childbearing age is on valproate for JME, because of no known significant drug interactions.Drug of choice for the treatment of JME is sodium valproate.Valproate should be avoided in women of childbearing age, because of significantly increased risk of fetal malformations and neurodevelopmental delay.Levetiracetam or lamotrigine are alternative first-line options if valproate is contraindicated.Treatment of Juvenile Myoclonic Epilepsy:Valproate is often used to treat juvenile myoclonic epilepsy.Other epilepsy drugs are effective in juvenile myoclonic epilepsy:LevetiracetamTopiramateLamotrigineAntiepiieptic Drugs in the treatment sequence of Juvenile Myoclonic Epilepsy (JME)First choiceValproateQ, LamotrigineQSecond choiceLevetiracetamQ, ClonazepamConsiderTopiramate, Zonisamide, Phenobarital PrimidoneJuvenile Myoclonic EpilepsyJuvenile myoclonic epilepsy (JME) is a generalized seizure disorder of unknown cause that appears in early adolescenceCharacterized by bilateral myoclonic jerks that maybe single or repetitive.Myoclonic seizures are most frequent in the morning after awakening and can be provoked by sleep deprivationQ.Consciousness is preserved unless the myoclonus is especially severe.Many patients also experience generalized tonic-clonic seizures, and up to one-third have absence seizures.Although complete remission is relatively uncommon, the seizures respond well to appropriate anticonvulsant medication.There is often a family history of epilepsy, and genetic linkage studies suggest a polygenic cause.Treatment:Valproate is often used to treat juvenile myoclonic epilepsy.Other epilepsy drugs are effective in juvenile myoclonic epilepsy:LevetiracetamQTopiramateQLamotrigineQFor most people with JME, treatment is long-term, and often lifelongQ.However, treatment is effective, allowing most people with juvenile myoclonic epilepsy to go five years or more between seizures. -### End" -1778,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of metastasis in choriocarcinoma, with the following options: A: Liver, B: Lung, C: Kidney, D: Spleen - -### Response: -(Lung) (233 - Shaw's 14th)CHORIOCARCINOMA - Malignant growths arising in the body of uterus* Most common, metastases are seen in the lungs (80%), brain and liver* Less common sites are GIT, kidney, spleen, genital tract and lymphnodes (10%)* ""Cannon ball"" metastasis in lung is typical of a malignant lesion* beta - hCG is very specific marker*** Purple haemorrhagic projections either into the lower third of the vagina or around the vaginal orifice is characteristic and pathognomic of chorio carcinoma* The development of chorio carcinoma following H. mole ranges between 2 - 10%* A post molar GTN may be benign or malignant. But a GTN after non-molar pregnancy is always a choriocarcinoma (201 - Dutta 6lh) -### End" -1779,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Length of external auditory canal is?, with the following options: A: 12 mm, B: 24 mm, C: 36 mm, D: 48 mm - -### Response: -ANSWER: (B) 24 mmREF: Dhingra 4th edition page 400'External auditory canal of an adult is 24 mm in length. Outer one-third (8 mm) is cartilaginous and inner two thirds (16 mm) are bony'1 -### End" -1780,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hemoglobin's affinity for oxygen is increased due to ?, with the following options: A: An increase in CO2, B: Raise in the temperature, C: Higher value, D: A decrease in 2,3 DPG - -### Response: -ANSWER: D A decrease in 2,3 DPG -### End" -1781,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Stylalgia most common nerve affected is, with the following options: A: Glossopharyngeal nerve, B: Abducent nerve, C: Auditory nerve, D: Greater petrosal nerve - -### Response: -The patient complains of pain in tonsillar fossa and upper neck which radiates to the ipsilateral ear. It gets aggravated on swallowing. Ref: Textbook of ENT, Dhingra; 6th edition; Pg no: 272 -### End" -1782,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true about newborn assessment -, with the following options: A: APGAR at 7 min indicates neonatal moality depression, B: APGAR at 1 min, indicators for neonatal resuscitation, C: Fetus can rapidly washout CO2 through placenta, D: Anaerobic metabolism causes acidemia - -### Response: -Ans is 'a' i.e., APGAR at 7 min indicates neonatal moality depression Later times APGAR score (after 5 minutes) indicates about long term neurological damage (not neonatal moality) Interpretation ofAPGAR Score The test is generally done at one and five minutes after bih, and may be repeated later if the score is and remains low. Scores 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to I 0 generally normal. o A low score on the one-minute test may show that the neonate requires medical attention (e.g. resuscitation) but is not necessarily an indication that there will be long-term problems, paicularly if there is an improvement by the stage of the five-minute test. If the Apgar score remains below 3 at later times such as 10, 15 or 30 mintues, there is a risk that the child will suffer longer-term neurological damage. There is also a small but significant increase of the risk of cerebral palsy. However, the purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care; it was not designed to make long-term predicitions on a child's health. CO2 transpo across placenta o CO2 is cleared by placenta by simple diffusion. CO2 is produced abundantly in the fetus, and the PCO2 of fetal blood is higher than maternal blood. CO2 therefore diffuses from fetal blood, through the placenta, into the maternal circulation, and is disposed by expiration from mother's lung. Anaerobic metabolism causes acidemia due to lactate (lactic acid) production o Anoxic perfusion causes an increase in glucose consumption which is more than two fold higher than that seen in the oxygenated perfusion, resulting finally in placental uptake of glucose not only from the maternal but also from the fetal circulation. o Lactate production is increased during the anoxic perfusion, while the final tissue energy value lies between the values observed for fresh tissue and for the oxygenated perfusion. The shift to anerobic metabolism shown by placental tissue in anoxic conditions enables continued functioning of the tissue over the 2-h perfusion period but it appear that under anoxic conditions the tissue may incur an energy debt not observed in oxygenated perfusions. -### End" -1783,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Black powder composition:, with the following options: A: 15 % potassium nitrate + 10 % sulphur + 10% charcoal, B: 15 % potassium nitrate + 8 % sulphur + 10% charcoal, C: 75 % potassium nitrate + 8% sulphur + 15% charcoal, D: 75 % potassium nitrate + 10% sulphur + 15% charcoal - -### Response: -There are two types of Powder 1. Black Powder - consists of 75% KNO3-, 10% Sulphur and 15% Charcol 2. Smokeless powder - It consists of nitroglycerine, nitrocellulose and nitroguanide 3. Semi smokeless gun powder - Black (80%) + Smokeless (20%) - It is designated as FG, FFG, FFFG, etc., depending on the size of the grains. The more number of F's as number of fineness increases. -### End" -1784,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First branch of the facial nerve is, with the following options: A: Greater petrosal nerve, B: Lesser petrosal nerve, C: Chorda-tympanic nerve, D: Nerve to the stapedius - -### Response: -Greater petrosal nerve arises from geniculate ganglion Ref: Dhingra 6th edition pg. 90 -### End" -1785,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The condition associated with the pathology show in USG are all Except, with the following options: A: Salphingitis, B: IUCD, C: Plastic procedure on the tube, D: Clomiphene citrate therapy - -### Response: -Image is showing free fluid in the abdomen which is caused by rupture of ectopic pregnancy. Risk Factors for Ectopic Pregnancy Pelvic Inflammatory disease (PID) usually caused by gonorrhea or cWamydia Previous ectopic Previous tubal surgery Progestine contraceptives specially progesterone bearing IUDs. Pregnancy after tubal ligation Ovulation induction or ovarian stimulation. -### End" -1786,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudo buboes are found in -, with the following options: A: Chancroid, B: LGV, C: Granuloma inguinale, D: All of the above - -### Response: -Ans-C -### End" -1787,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He repos that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work.He also has intrusive thoughts about stabbing his coworkers.He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters?, with the following options: A: Acetylcholine, B: Dopamine, C: Norepinephrine, D: Serotonin - -### Response: -Patient's behavior is suggestive of Obsessive Compulsive Disorder. Although multiple neurotransmitters and regulatory mechanisms are thought to contribute to the clinical expression of OCD ,serotonin is the primary pharmacological target. First-line treatment is a selective serotonin reuptake inhibitor(SSRI) antidepressant. -### End" -1788,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following statements are true with respect to a child with marasmus except, with the following options: A: It is a severely wasted and has skin and bone monkey facies, B: Child appears ale and active, C: Child is more prone for infection and has higher moality compared to kwashiorkor, D: Appetite is good - -### Response: -Nutrient deficiency is the main cause of marasmus. It occurs in children that don&;t ingest enough protein, calories, carbohydrates, and other impoant nutrients. This is usually due to povey and a scarcity of food. There are several types of malnutrition. Reference: GHAI Essential pediatrics, 8th edition -### End" -1789,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Herpes zoster oticus is caused by-, with the following options: A: Herpes virus type I, B: Herpes virus type 2, C: Herpes virus type 3, D: Herpes virus type 4 - -### Response: -Ans. C. Herpes virus type 3Herpes Zoster oticus or Ramsay - Hunt syndrome is caused by varicella (herpes) Zoster virus also know as Human herpes virus type-3. -### End" -1790,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wiskott Aldrich syndrome is associated with all of the following except :, with the following options: A: Thrombocytopenia, B: Recurrent infections, C: Low levels of IgG, D: Deficient cell mediated immunity - -### Response: -Answer is C (Low levels of IgG) : 'Immunoglobulin defect in Wiskott-Aldrich syndrome include low serum concentration of IgM. IgA & IgG are normal and IgE is frequently increased' - Harrison 'Serum IgM levels is low but IgG and IgA levels are normal or elevated' - Ananthnaravanan -### End" -1791,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An auto rickshaw ran over a child's thigh, there is a mark of the tyre tracks, it is an example of: AIIMS 10, with the following options: A: Patterned bruise, B: Patterned abrasion, C: Pressure abrasion, D: Graze abrasion - -### Response: -Ans. Patterned abrasion -### End" -1792,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person is declared dead if not seen by relatives for how many years ?, with the following options: A: 3 years, B: 7 years, C: 10 years, D: 12 years - -### Response: -Ans. is 'b' i.e., 7 years A person is legally declared dead if not seen for 7 years from the date of declared missing. -### End" -1793,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lens used to treat astigmatism: September 2005, with the following options: A: Concave lens, B: Spherical lens, C: Convex lens, D: Cylindrical lens - -### Response: -Ans. D: Cylindrical lens Corneal astigmatism is created when the cornea is not a perfect sphere. The astigmatic cornea is curved more in one meridian than it is in the other. These meridians are usually 90 degrees apa (regular astigmatism). The lens can have astigmatism also, this is termed lenticular astigmatism. Lenticular astigmatism is evident when there is a significant difference between the astigmatism as measured on the keratometer and refractive astigmatism Astigmatism is corrected optically with a cylindrical lens. A combination of a spherical lens and a cylindrical lens (spherocylindrical lens) is used to correct a spherical error with an astigmatic error. -### End" -1794,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following DOESN'T develop from bronchial pouch:, with the following options: A: Superior parathyroid, B: Inferior parathyroid, C: Thymus, D: Thyroid - -### Response: -Ans. (d) ThyroidRef : LB. Singh 9th ed. /116-17* Superior parathyroid derived from 4th branchial pouch* Inferior parathyroid and thymus develops from 3rd branchial arch* Most of the thyroid gland develops from thyroglossal duct (endodemal duct at foramen cecum). -### End" -1795,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Significant weight loss is -, with the following options: A: 5% over 6-12 months, B: 10% over 6-12 months, C: 5% over 6 weeks, D: 10% over 6 weeks - -### Response: -Ans. is 'a' i.e., 5% over 6-12 months o Clinically important weight loss is defined as the loss of 10 pounds (4.5 kg) or < 5% of one's body weight over a period of 6-12 months. -### End" -1796,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amenorrhoea due to high LH and FSH is due to :, with the following options: A: Asherman syndrome, B: Pituitary adenoma, C: Ovarian failure, D: All - -### Response: -Ovarian failure -### End" -1797,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tumor Exclusively seen in Parotid gland is:, with the following options: A: Mucoepidermoid, B: Adenocystic, C: Warthin tumor, D: Pleomorphic adenoma - -### Response: -Ans. (c) Warthin's TumorRef Surgery Sixer 3rd Edition Page 190, Extra Mile Warthin's Tumor Salient Points:* Occurs exclusively in Parotid gland.* MC in Males* MC in Smokers* MC in Lower pole of parotid (at angle of mandible)* 10% cases are Bilateral -### End" -1798,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of The following statements about congenital rubella are true except:, with the following options: A: IgG persists for more than 6 months, B: IgM antibody is present at birth, C: Most common anomalies are hearing and heart defects, D: Increased risk of congenital malformation if infection occur after 16 weeks - -### Response: -Ans. d. Increased risk of congenital malformation if infection occur after 16 weeks Fetal malformations are more common after maternal infection in the first trimester and tend to be more severe and to involve more organ systems. Infection in the second trimester may cause deafness but those infected after 16 weeks suffer no major abnormality.Rubella* Rubella is a teratogenic virus, can be transmitted from fetus to mother.* The fetus is at risk for congenital rubella only during primary infection.* The rate of transmission of rubella varies w ith gestational age. It is highly variable even during the first trimester.Characteristic Features:* Fetal malformations are more common after maternal infection in the first trimester and tend to be more severe and to Involve more organ systems. Infection in the second trimester may cause deafness but those infected after 16 weeks suffer no major abnormality.Risk for congenital defects is related to the gestational age at the time of infectionGestational ageRisk for congenital defectsBefore 11 weeks90%11-12 weeks33%13-14 weeks11%15-16 weeks24%Rubella* Other uncommon abnormalities are: Fetal and neonatal growth retardation, hepatosplenomegaly, thrombocytopenia, meningoencephalitis, radiolucoency of the long bones, myocardial necrosis.* Rare abnormalities: Microcephaly, brain calcifications* Late onset features appearing after 3-12 months include: Interstitial pneumonitis, chronic rubella like rash, recurrent infections, hypogammaglobulinemia, chronic diarrhoea, diabetes mellitus. progressive CNS deteriorationDiagnosis of congenital rubella:* Congenital infection is considered to have occurred if the infant has IgM rubella antibodies shortly after birth or if IgG antibodies persist for >6 months by which time maternally derived antibodies would have disappeared. -### End" -1799,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a calcium channel blockers, with the following options: A: Enalapril, B: Nifedipine, C: Verapamil, D: Diltiazem - -### Response: -Refer kDT 7/e p562 Calcium channel blockers are prescription medications that relax blood vessels and increase the supply of blood and oxygen to the hea while also reducing the hea's workload. Examples of calcium channel blockers include: Amlodipine (Norvasc) -### End" -1800,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Lakes of pus or sheets of pus"" is seen in, with the following options: A: Erythrodermic psoriasis, B: Von zumbush type, C: Guttate psoriasis, D: Inverse psoriasis - -### Response: -Von zumbush type is the generalized form of pustular psoriasis which shows ""Lakes of pus or sheets of pus"" -### End" -1801,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are direct DNA interacting cytotoxic agents except, with the following options: A: Melphalan, B: Hydroxyurea, C: Carmustine, D: Ifosfamide - -### Response: -All other agents are alkylating agents , whereas hydroxyurea is an anti metabolite acts at S phase of cell cycle indirectly affect DNA molecules. -### End" -1802,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Examining the patient without consent amounts to: Delhi 11, with the following options: A: Assault, B: Unethical act, C: Indecent act, D: Negligence - -### Response: -Ans. Assault -### End" -1803,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Seroconversion rate is how much after 3 doses of Hepatitis B vaccine?, with the following options: A: 30%, B: 50%, C: 70%, D: 95% - -### Response: --Seroconversion rates exceed 95% after 3 doses of Hepatitis B vaccine. - Antibody titre > 10mIU/ml is protective - This Vaccine usually induces long-term immunity- so, booster doses are not routinely recommended - Double dose of vaccine/ boosters - recommended in pts with chronic kidney disease / immunodeficiency - in whom titers may wane -### End" -1804,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adenomyosis is:, with the following options: A: Endometriosis interna, B: Endometriosis externa, C: Uterine sarcoma, D: Leiomyoma - -### Response: -Ans: a (Endometriosis internal) Ref: Shaw, 13th ed, p. 448; Robbins, 7th ed, p. 1083Adenomyosis (uterine endometriosis) is also called endometriosis interna.Commonest symptom of adenomyosis - MenorrhagiaCommonest symptom of endometriosis - DysmenorrhoeaPelvic examinationUterus symmetrically enlarged- SoftSize not more than 14 weeksInvestigation- USGHysteroscopy + curettageTreatment of choiceTotal hysterectomy (No role of hormone therapy) -### End" -1805,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28 year old man with 3 weeks of fever presented with tricuspid valve vegetation. What is the MOST common cause of Endocarditis in I.V. drug abusers?, with the following options: A: Staph.aureus, B: Candida albicans, C: Pseudomonas, D: Streptococcus viridans - -### Response: -Endocarditis among IV drug users especially that involving the tricuspid valve, is commonlycaused by Staph.aureus, many strains of which are methicillin resistant. Left-sided valve infection in addicts have more varied etiology. In addition to the usual causes of endocarditis, these cases are caused by pseudomonas aeruginosa and candida species and sporadically by unusual organisms such as Bacillus, Lactobacillus and corynebacterium species. Polymicrobial endocarditis occurs among IV drug users. Ref: Karchmer A.W. (2012). Chapter 124. Infective Endocarditis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -1806,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following structure is involved in Dupuytren's contracture -, with the following options: A: Thickening of the palmar fascia, B: Thickening of the dorsal fascia, C: Contracture of the flexor tendons, D: Post burns contracture - -### Response: -Dupuytren&;s contracture is characterised by a flexion deformity of one or more fingers due to thickening and shoening of palmar aponeurosis.Normally palmar aponeurosis is thin but tough membrane lying Immediately beneath the skin of the palm. Proximally it is in continuation with palmaris longus tendon. Distally it divides into slips one for each finger. The slip bends with the fibrous flexor sheaths covering the flexor tendon of the finger , and extends upto the middle phalanx. In Dupuytren&;s contracture aponeurosis or a pa of it becomes thickened and slowly contracts, drawing the fingers into flexion at the metacarpo-phalangeal and proximal interphalangeal joints. Reference- Essential ohopaedics- Maheshwari- 5th edn- pg no 302 -### End" -1807,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Out of 10 relatives exposed to a primary case, of measles, 6 developed measles. Secondary attack rate of measles-, with the following options: A: 10-Apr, B: 10-Jun, C: 6-Apr, D: 4-Jun - -### Response: -Ans. is 'b' i.e., 6/10 Secondary attack rate (SAR)o SAR is defined as ""the number ofexposed persons developing the disease within the range of incubation period, following exposure to primary caseSAR=No of exposed persons developing disease withinthe range of the incubation period-----------------------Total number of exposed/susceptible contactx 100 SAR =610x 100 -### End" -1808,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common extracranial solid tumor in children is, with the following options: A: Wilm's tumor, B: Neuroblastoma, C: Hydronephrosis, D: Rhabdomyosarcoma - -### Response: -Neuroblastoma is the most common extracranial solid tumor in children and the most commonly diagnosed malignancy in infants. Reference: Nelson; Neuroblastoma; Page no: 2461 -### End" -1809,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which ATT will cause transient memory loss, with the following options: A: Ethionamide, B: INH, C: Ethambutol, D: Pyrazinamide - -### Response: -The impoant side effects of INH include rash (2%), fever (1.2%), jaundice (0.6%) and peripheral neuritis (0.2%). If pyridoxine is not given concurrently, peripheral neuritis (most commonly paresthesia of feet and hands) is the most common reaction of INH and occurs in about 2% of persons receiving 5mg/kg of the drug daily. Neuropathy is more frequent in slow acetylators, individuals with DM, poor nutrition or anemia. The prophylactic administration of pyridoxine prevents the development of not only peripheral neuritis but also of most other nervous system disorders in practically all instances even when therapy lasts as long as 2 years. Precipitation of seizures, optic neuritis, and atrophy, muscle twitching, dizziness, ataxia, paresthesias, stupor, toxic encephalopathy are other neurotoxicity features Mental abnormalities with INH includes euphoria. TRANSIENT IMPAIRMENT OF MEMORY, separation of ideas and reality loss of self-control and florid psychosis. Ethionamide causes mental depression, drowsiness, and asthenia. Other neurological symptoms include olfactory disturbances, blurred vision, diplopia, dizziness, paresthesias, headache, restlessness, and tremors. The concomitant use of pyridoxine is recommended for patients being treated with ethionamide.. -### End" -1810,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common age for depression is:, with the following options: A: Middle age female, B: Middle age male, C: Young girl, D: Children - -### Response: -Middle age female -### End" -1811,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tuberculosis verrucosa cutis is a form of:, with the following options: A: Tuberculid, B: Primary tuberculosis, C: Postprimary tuberculosis with good resistance, D: Post primary tuberculosis with poor resistance - -### Response: -C i.e. Postprimary tuberculosis with good resistance: Tuberculosis verrucosa cutis is postprimary tuberculosis with good resistaneQ. -### End" -1812,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presented to the casualty with seizures. On examination, multiple oval hypo-pigmented macules were noted on the trunk, along with sub-normal IQ. Probable diagnosis of the child is? NOT RELATED- MEDICINE, with the following options: A: Tuberous sclerosis, B: Sturge Weber syndrome, C: Incontinentia Pigmenti, D: Neurofibromatosis - -### Response: -. -### End" -1813,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Crystalline miliaria is due to obstruction to, with the following options: A: Sweat gland, B: Sebaceous glands, C: Accessory sweat gland, D: Hair roots - -### Response: -Miliaria crystallina is caused by obstruction of the sweat ducts close to the surface of the skin Miliaria rubra, caused by obstruction of the sweat ducts deeper in the epidermis; Miliaria profunda, the result of sweat leaking into the middle layer of skin (dermis). Ref Harrison20th edition pg 1207 -### End" -1814,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 29-year-old woman presents with increasing shortness of breath and coughing. She had asthma as a child but has not required any treatment for the past 10 years. On examination, she has expiratory wheezes. Which of the above may cause bronchodilation?For the above patient with a clinical symptom, select the most appropriate medication., with the following options: A: albuterol, B: ethanol, C: amitriptyline, D: NSAIDs - -### Response: -Ephedrine, isoproterenol, and albuterol are beta-adrenergic agonists and cause bronchodilatation. Ipratropium bromide also results in bronchodilatation by its anticholinergic effect. In susceptible individuals, the beta2-adrenergic blocking effect of propranolol can cause life-threatening bronchoconstriction. The other medications listed have no effect on bronchial airways. -### End" -1815,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a population of 100 prevalence of candida glabrata was found to be 80%. If the investigator has to repeat the prevalence with 95% confidence what will the prevalence be, with the following options: A: 78-82%, B: 72-88%, C: 76-84%, D: 74-86% - -### Response: -Confidence Intervals for Population proportions (For 95% Confidence) -CI = P + 2 SEP = P + 2 √pq/n -Here, P=0.80 (80%); p=0.80; -q= 1-p = 1-0.80 = 0.20; -n=100 CI = 0.80 + 2 √0.8*0.2/100 -= 0.80 + 0.08 -= 0.72, 0.88 (72%, 88%) -### End" -1816,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a ourable prognostic marker in pediatric acute lymphoblastic leukemia (ALL)?, with the following options: A: Hypodiploidy, B: 2-10 years of age, C: Low WBC count, D: t(12;21) - -### Response: -Favourable prognostic markers in pediatric ALL include age between 2 and 10 years a low white cell count hyperdiploidy trisomy of chromosomes 4, 7, and 10 the presence of a t(12;21) Several factors are associated with a worse prognosis: age younger than 2 years, largely because of the strong association of infantile ALL with translocations involving the MLL gene presentation in adolescence or adulthood peripheral blood blast counts greater than 100,000, which probably reflects a high tumor burden. -### End" -1817,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thoracic duct doesn't drain :, with the following options: A: Right upper pa, B: Left upper pa, C: Left lower pa, D: Right lower pa - -### Response: -Right upper pa drains lymphatics into the right lymphatic duct whereas the rest of the body drains into the thoracic duct. The thoracic duct is a continuation of cistern chyle as it pass through aoic hiatus at the level of T12. At T5, it crosses to left side and drains at left jugulosubclan venous angle at C5. Ref: Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 979. -### End" -1818,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cytogenetics for synovial cell sarcoma, with the following options: A: t (9,22), B: t (11,14), C: t (8,14), D: t (x,18) - -### Response: -t (x,18) is seen in synovial cell sarcoma and it produces fusion genes like SS18-SSXl-SSX2-SSX4 -### End" -1819,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with barotrauma pain without middle ear inflammation. Management is:, with the following options: A: Antibiotics, B: Myringotomy, C: Suppoive, D: Grommet - -### Response: -Otitic Barotrauma (Aero otitis media) in mild cases does not require any specific treatment apa from decongestants. -### End" -1820,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following take pa in oxidative phosphorylation except, with the following options: A: NADH, B: FADH2, C: NADPH, D: ATP - -### Response: -The NADPH system is responsible for generating free radicals in immune cellsNADPH is also used for anabolic pathways, such as lipid synthesis, cholesterol synthesis, and fatty acid chain elongation.Reference: -### End" -1821,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 68-year-old woman develops new symptoms of burning when voiding. She has no fever, chills, or back discomfort. Her urinalysis reveals numerous white cells and bacteria. Which of the following medical comorbidities is most likely to coexist in this patient?, with the following options: A: anemia, B: exercise, C: diabetes mellitus, D: influenza - -### Response: -Urinary tract infections (UTIs) are increased in diabetes mellitus as well as in pregnancy, sickle cell disease, polycystic disease, and structural abnormalities of the urinary tract. -### End" -1822,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A study measures a patient's serum cholesterol before and after a new lipid-lowering therapy has been given. What type of significance test should be used to analyze the data?, with the following options: A: Paired t-test, B: Student's t-test, C: Chi-squared test, D: Pearson's test - -### Response: -Ans. a (Paired t-test)SIGNIFICANCE TESTS: TYPESThe type of significance test used depends on whether the data is parametric (usually normally distributed) or non- parametric.Parametric Tests# Student's t-test - paired or unpaired# Pearson's - correlationNon-parametric Tests# Wilcoxon matched-pairs - compares the medians obtained# Mann-Whitney - unpaired data# Chi-squared test - used to compare proportions or percentages# Spearman, Kendall rank - correlationTypes of Scales in StatisticsType of scaleDescriptionKey wordsExamplesNominal (categorical)Different groups""This"" as opposed to ""that""Gender, comparing among treatment interventionsOrdinalGroups in sequenceComparitive quality, rankOlympic medals, class rank in medical schoolIntervalExact differences among groupsQuality, mean and standard deviationHeight, weight, blood groups drug dosageRatioInterval + true zero pointZero means zeroTemperature measured in degrees KelvinTypes of Scales and Basic Statistical TestsVariableName of statistics testIntervalNominalCommentPearson20Is there a linear relationship?Chi-square02Any number of groupst-test11Two groups onlyOne-way ANOVA11Two or more groupsMatched pairs t-test11Two groups, linked data pairs, before and afterRepeated measures ANOVA11More than two groups, linked dataPaired data refers to data obtained from a single group of patients, e.g., measurement before and after an intervention. Unpaired data comes from two different groups of patients, e.g., comparing response to different interventions in two groups. -### End" -1823,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5-year-old woman presents with dry cough and progressive breathlessness of two years duration. Examination reveals clubbing, cyanosis and bibasilar crepts. What is the probable diagnosis -, with the following options: A: Bronchiectasis, B: Lung abscess, C: Interstitial lung disease, D: Pulmonary tuberculosis - -### Response: -Interstitial lung diseases like pulmonary fibrosis are characterised by the the presence of exeional dyspnea,a nonproductive cough,and bi-basilar inspiratory crackles with or without digital clubbing.Cyanosis can be present due to respiratory compromise. Ref:Harrison's med:18th edition,page no:2165. -### End" -1824,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60-year-old man, a heavy smoker, presents for advice to stop smoking. On physical examination, he is thin and has a ruddy complexion. He has a productive cough and a barrel-shaped chest. He sits leaning forward with his lips pursed to facilitate his breathing. A diagnosis of emphysema is made. Which of the following is the most likely histologic finding in the lungs?, with the following options: A: Bronchial smooth muscle hyperophy with proliferation of eosinophils, B: Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces, C: Dilation of air spaces with destruction of alveolar walls, D: Hyperplasia of bronchial mucus-secreting submucosal glands - -### Response: -Emphysema is an example of COPD. Due to the destruction of alveolar walls, a lack of elastic recoil causes air to become trapped in alveoli, and, thus, airflow obstruction occurs on expiration. In COPD, FEV1 is decreased, whereas FVC is normal or increased; therefore, patients with COPD have a decreased FEV1 :FVC ratio. -### End" -1825,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following conditions are known to cause diabetes insipidus except -, with the following options: A: Multiple sclerosis, B: Head injury, C: Histiocytosis, D: Viral encephalitis - -### Response: -Causes of Central Diabetes insipidus Causes of Nephrogenic Diabetes insipidus ref - Researchgate.net -### End" -1826,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vagina develops from:, with the following options: A: Mesonephric duct, B: Genital tubercle, C: Urogenital sinus, D: None of the above - -### Response: -Ans. a) Urogenital sinus Ref Novak's 14th ed Pg 100Vagina forms in the 3rd month of embryonic life.Superior part of vagina from - paramesonephric ductInferior part of vagina from - sinovaginal bulb on the posterior wall of urogenital sinus.Sex is not apparent until about 12th week of embryonic life. -### End" -1827,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Flea bitten kidney is seen in all of the following except: September 2007, with the following options: A: Malignant hypeension, B: Henoch-Schonlein purpura, C: DM, D: Polyaeritis nodosa - -### Response: -Ans. C: DM Diseases such as microscopic polyaeritis, accelerated hypeension and Henoch-Schonlein purpura (and other disorders in which there is destruction of small vessel walls) produce microinfarcts, which are usually multiple ('flea-bitten kidney'). -### End" -1828,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common dyslipidaemia associated Diabetes mellitus is:, with the following options: A: | HDL, B: | Triglycerides, C: triglycerides, D: cholesterol - -### Response: -Answer is B (iTriglycerides): The most common pattern of Dyslipidemia seen in patients with diabetes mellitus is hyperiglyceridemia (1Triglycerides) and reduced HDL cholesterol (jHDL) levels. -### End" -1829,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After laparoscopic cholecytectomy, if biopsy reveals insitu cancer of gallbladdet(Stage - I), then the appropriate management is, with the following options: A: Follow up, B: Extended cholecystectomy, C: Excision of all po sites, D: Radiotherapy - -### Response: -Treatment of carcinoma Gallbladder Gallbladder cancer: Incidental pathological finding after laparoscopic cholecystectomy T1a with negative cystic duct margin : No fuher therapy T1a with postive cystic duct margin : Reresection of cystic duct or CBD to negative margin T1b, T2, T3 tumor with no evidence of metastasis : Reresection, extended cholecystectomy (possible CBD or extended hepatic resection) T4: Extended cholecystectomy with extended right hepatectomy N2 or M1 disease : Clinical trial (Chemoradiation or chemotherapy) in good performance status. Laparoscopic trocar site scars are excised for staging purpose to identify M1 disease than for any potential therapeutic benefit Ref: Sabiston 20th edition Pgno : 1512-1514 -### End" -1830,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dose of digoxin is NOT altered in :, with the following options: A: Old age, B: Hepatic disease, C: Renal disease, D: Hypercalcemia - -### Response: -Ans. is 'b' Hepatic disease Make it clear once and for all that Digitalis is the parent compound. Digitalis is applied as a collective term for the whole group and has come to mean a cardiac glycoside.Digoxin and digitoxin are two of the many types of cardiac glycoside.Digoxin is a polar glycoside, and is excreted by kidney, does not undergo hepatic metabolism. So does need not be altered in hepatic disease.Digitoxin undergoes hepatic metabolism and its dose has to be altered in hepatic disease. -### End" -1831,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Counter current multiplier system is primarily driven by ?, with the following options: A: Concentration of Na+, B: H+ at loop of Henle, C: Concentration of Na+-, D: H+ at ascending loop of henle, Osmolality at Loop of Henle - -### Response: -Ans. is 'a' i.e., Concentration of Na+Countercurrent multiplierThe loop of HenleQ gives the nephron a peculiar shape. The descending limb, in which the tubular fluid flows towards the hairpin bend (downwords) and the ascending limb, in which the tubular fluid flows 'upwards' lie close to each other. Two such tubes with fluid flowing through them in opposite directions provide an oppounity for the countercurrent multiplication.The thick ascending limb of loop of Henle is impermeable to water but it actively reabsorbs NaCI. The thin descending limb of loop of Henle is relatively impermeable to solutes but highly permeable to water. The most impoant cause of the high medullary osmolarity is active transpo of sodiumQ and co-transpo of potassiumQ, chlorideQ and other ions out of the thick ascending limb of loop of HenleQ into the medullary interstitium. Most impoant among all these is NaClQ, for maintenance of high medullary interstitium.Consider the Na+ is continuously flowing in from glomerulus into the tubule. However, most of the Na+, instead of flowing out, gets trapped in a circular path and recycles between the ascending and descending limbs of the loop of Henle. Consequently, the Na+ concentration becomes very high at the tip of the loop. -### End" -1832,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Active fluoride concentration in the cavity varnish duraphat is:, with the following options: A: 22,900 ppm, B: 7,600 ppm, C: 22,600 ppm, D: 11,600 ppm - -### Response: -Duraphat, the first fluoride varnish developed in Germany. - It is a viscous yellowish material, containing 22,600 ppm fluoride as sodium fluoride in a neutral colophonium base (NaF varnish containing 2.26% fluoride in organic lacquer).  -Duraphat has shown caries reduction between 30% and 40% in the permanent dentition and in between 7% and 44% in the primary dentition. - -Essentials of preventive and community dentistry -Soben Peter -5th edition -page no. 255 -### End" -1833,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about methicillin-resistance Staphylococcus aureus (MRSA) is, with the following options: A: Isoxazolyl penicillin is highly effective, B: All MRSA are multidrug resistance, C: Vancomyin is effective, D: MRSA are more virulent then sensitive strains - -### Response: -Penicillin resistance may also be due to alterations in penicillin-binding protein PBP2a and changes in bacterial surface receptors, reducing the binding affinity 0f beta-lactam antibiotics to cells. This mechanism impas resistance to all beta-lactam antibiotics and has been named methicillin-resistant S.aureus{MRSA}as it was found to be resistant to penicillinase-resistant penicillins like methicillin and cloxacillin. The majority of these strains also show resistance to other antibiotics like erythromycin, tetracyclines, aminoglycosides and cause outbreaks of hospital infection. Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; Tenth Edition pg no 202 -### End" -1834,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with progressive jaundice with clay coloured stool and dark urine. The following investigations can be used, EXCEPT:, with the following options: A: Oral cholecystography, B: PTC, C: ERCP, D: USG - -### Response: -Oral cholecystography is of no value in patients with intestinal malabsorption, vomiting, obstructive jaundice, and hepatic failure. Biliary obstruction causes progressive dilatation of the intrahepatic bile ducts as intrabiliary pressures rise. Hepatic bile flow is suppressed, and reabsorption and regurgitation of conjugated bilirubin into the bloodstream lead to jaundice accompanied by dark urine (bilirubinuria) and light-colored (acholic) stools. PTC, ERCP and USG can be used for the evaluation in this patient. Ref: Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J.L., Loscalzo J. (2012). Chapter 311. Diseases of the Gallbladder and Bile Ducts. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -1835,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Potential Suppo Ratio (PSR) is defined as:, with the following options: A: Number of persons aged 15-65 per children below 15 years, B: Number of persons aged 15-65 per one older person aged >/= 65 years, C: Number of person aged 15-65 per one older person aged > 65 and younger person < 15 years, D: Number of persons aged 15-65 persons older person aged > 60 and younger person < 15 years - -### Response: -PSR =Potential Suppo Ratio (PSR) is defined as Number of persons aged 15-65 per one older person aged >/= 65 years Gives burden on working population PSR a 1/ Old age dependency ratio -### End" -1836,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When Class III elastics are used, the maxillary first molars will _____., with the following options: A: Move distally and intrude, B: Move mesially and extrude, C: Move mesially and intrude, D: Move only mesially; there will be no movement in the vertical direction - -### Response: -Class III elastics are worn from the maxillary first molars to the mandibular canines. The force system created by Class III elastics will produce mesial movement and extrusion of the maxillary first molars -### End" -1837,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are false regarding classes if immunoglobulin except :, with the following options: A: IgM has maximum half-life of 23 days, B: IgE has least serum concentration of 0.00004 mg/ml, C: IgG has maximum sedimentation co-efficient of 19, D: IgD has a carbohydrate concentration of 8 % - -### Response: -Highest serum half-life and serum concentration is of IgG. Least serum half-life and serum concentration is of IgE. Highest sedimentation coefficient is of IgM IgG IgM IgA IgD IgE Serum concentration 12 mg/ml 1.2 mg/ml 2 mg/ml 0.03 mg/ml 0.00004 mg/ml Half-life 23 d 5 d 6 d 2-8 d 1-5 d Molecular wt. 150,000 900,000 160,000 180,000 190,000 Carbohydrate 2-3% 12% 8% 13% 12% Sedimentation coeff 7 19 7 7 8 -### End" -1838,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of cataract following radiation is –, with the following options: A: Posterior subcapsular, B: Anterior subcapsular, C: Tear drop cataract, D: Diffuse cataract - -### Response: -Radiation causes posterior sub capsular cataract. -### End" -1839,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nicoldoni sign is also known as:, with the following options: A: Murray sign, B: Frei sign, C: Darner sign, D: Branham sign - -### Response: -Branham sign Nicoladoni sign* or Branham sign* Pressure on the aery proximal to an A-V fistula causes the swelling to diminish in size, a thrill or bruit to cease, the pulse rate to fall and the pulse pressure return to normal. Aeriovenous fistula (AVF) AVF may be congenital or acquired (by trauma of a penetrating wound, or surgically created for renal dialysis) Structural effect on veins Veins are aerialised*, they become dilated touous and thick walled. Physiological effects of fistula ? Increased pulse pressure (Increased systolic & decreased diastolic) Enhanced venous return result in Increased HR* and Increased CO*. Left ventricular enlargement and later cardiac failure may occur A congenital .fistula in the young may cause overgrowth of limb*. In the leg, indolent ulcers may result* from relative ischemia below the sho circuit. Clinical signs A pulsatile swelling* A thrill on palpation* Continuous bruit on auscultation* Nicoladoni sign* or Branham sign* Pressure on the aery proximal to fistula causes the swelling to diminish in size, a thrill or bruit to cease, the pulse rate to. fall and the pulse pressure return to normal. -### End" -1840,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is a contact poison -, with the following options: A: BHC, B: BaSO4, C: A + B of above, D: Paris green - -### Response: -Insecticides are substances used to kill insects.They are 3 gruops: contact poison,stomach poison,fumigants. Contact poisons- BHC,DDT,lindanediazinon,malathion,fenthion. Stomach paoisons are paris green and sodium flouride . Fumigants are hydrogencyanide,methyl bromide,sulpher dioxide. Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 783 -### End" -1841,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transitional cell carcinoma of bladder is associated with-, with the following options: A: Schistosomiasis, B: Naphthylamine, C: Smoking, D: All - -### Response: -Ans. is 'a' i.e., Schistosomiasis; 'b' i.e., Naphthylamine & 'c' i.e., SmokingRisk factors for transitional cell carcinoma (TCC) of bladder ?I. Smoking ---> Major etiological factor.Occupational exposure to chemicals Nephthylamine benzidine, aniline dyes, acrolein.Schistosoma haematobium (Bilharziasis) ---> It is a risk factor for both TCC & SCC.Drugs --> PhenacetinCyclophosphamide therapyPelvic irradiations -### End" -1842,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following are required for wound healing except ?, with the following options: A: Zinc, B: Copper, C: Vitamin C, D: None - -### Response: -Ans. is 'None' -### End" -1843,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 22-year-old woman presents with chronic diarrhea. She has no abdominal discomfort, feels well, and reports no weight loss or systemic symptoms. Physical examination reveals a healthy young woman who is 5'7"" tall and weighs 150 lb. The complete physical examination is normal. Which of the following is the most likely cause of a secretory diarrhea in this young woman?, with the following options: A: surreptitious use of stimulant laxatives, B: carcinoid tumor, C: ulcerative colitis, D: lactose deficiency - -### Response: -Although carcinoid tumor can cause diarrhea, it is very uncommon. This young woman is overweight, suggesting an eating disorder, which is associated with laxative abuse. Abuse of stimulant laxatives such as senna can cause a secretory diarrhea. Magnesium-based laxatives will cause an osmotic diarrhea. -### End" -1844,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common causative organism for bacterial meningitis beyond 3 years of age is -, with the following options: A: Pneumococcus, B: Staphylococcus aureus, C: Meningococcus, D: H. influenzae Type b - -### Response: -Most common causative organism for bacterial meningitis beyond 3 years of age is - Pneumococcus -### End" -1845,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not prion associated disease:, with the following options: A: Scarpie, B: Kuru, C: Creutzfeldt-Jakob disease, D: Alzheimer's disease - -### Response: -Ans. (d) Alzheimer's disease Various prion disease are as follows: Kuru Creutzfeldt-Jakob disease (CJD) Fatal familial insomnia (FFI) Gerstmann-Straussler-Scheinker disease (GSS) Sporadic fatal insomnia (SFI) Scrapie Transmissible mink encephalopathy Bovine spongiform encephalopathy (mad cow disease) Chronic wasting disease Feline spongiform encephalopathy Exotic ungulate encephalopathy -### End" -1846,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Features of Barrett's esophagus are all Except, with the following options: A: Metaplasia, B: Always gastric type of epithelium, C: Adenocarcinoma more common, D: Present as patchy or ring involvement - -### Response: -Barrett's esophagus is specialized columnar metaplasia that replaces the normal squamous mucosa of the distal esophagus in some persons with GERD. Barrett's epithelium is a major risk factor for adenocarcinoma of the esophagus and is readily detected endoscopically, due to proximal displacement of the squamocolumnar junction.Barrett's metaplasia, endoscopically recognized by tongues of reddish mucosa extending proximally from the gastroesophageal junction or histopathologically by the finding of specialized columnar metaplasia , is associated with a substantiallyincreased risk for development of esophageal adenocarcinomaRef: Harrison; 19th edition; Page no: 1895 -### End" -1847,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of non traumatic subarachnoid hemorrhage -, with the following options: A: Idiopathic, B: Berry aneurysm rupture, C: Hypertension, D: AV malformation - -### Response: -Ans. is 'b' i.e., Berry aneurysm o Excluding head trauma, most common cause of subarachnoid hemorrhage is rupture of a saccular (Berry) aneurysm. -### End" -1848,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Extent of esophagus is, with the following options: A: C3 - C6, B: C6 - T11, C: T10 - T12, D: C3 - T6 - -### Response: -The esophagus has cervical, thoracic, and abdominal pas, extending from the lower end of the pharynx (C6 veebrae) to the cardiac opening of the stomach (T11 or 12 veebral level). It is about 25 to 30 cm long -### End" -1849,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vegetable fat differs from animal oil in being -, with the following options: A: More saturated, B: More stable, C: More atherosclerotic, D: Contains less fat soluble vitamin - -### Response: -Vegetable oil has less fat soluble vitamin. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 21ST EDITION. PAGE NO - 612 -### End" -1850,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Absolute contra indications to peussis vaccine includes all of the following except-, with the following options: A: Static neurological disease, B: Progressive neuorological disease, C: Anaphylaxis after previous dose, D: Encephalopathy within seven days of previous dose - -### Response: -.the contraindications to peussis vaccination are anaphylactic reaction,encephalopathy,a personal or strong family history of epilepsy,convulsions or similar CNS disorders,any febrile upset untill fully recovered or a reaction to one of the previously given triple vaccine injections. ref:park&;s textbook ,22 nd edition,pg no 155 -### End" -1851,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Two students, Vineet and Kamlesh were asked to demonstrate in dogs the role of sinus nerve in hypo-volemic shock. Vineet severed the sinus nerve when the mean blood pressure (MBP) was 85 mm Hg and Kamlesh cut the sinus nerve when the mean blood pressure was 60 mm Hg. On cutting the sinus nerve, with the following options: A: Vineet recorded the increase in MBP but Kamlesh recorded a decrease in MBP, B: Vineet recorded a decrease in MBP but Kamlesh recorded an increase in MBP, C: Both recorded an increase in MBP, D: Both recorded a decrease in MBP - -### Response: -C i.e. Both recorded an increase in MBPWhen carotid sinus nerve is sectionedLoss of inhibitory impulse from carotid sinus nerve --> Medullary vasomotor center activated -* 1' sympathetic discharge -> Vasoconstriction ( TBP), IHR & T CO.The baroreceptors do not fire when mean BP is below 30 mm Hg (fire maximally at mean BP of 150 mm Hg) Carotid sinus nerve and vagal fibres from aoic arch commonly called Buffer nerves.* Severing only carotid sinus nerve will not lead to decrease in BP because aoic arch baroreceptors are still functional. If both are severed the BP rise to more than 200-300 mm Hg. -### End" -1852,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After using transdermal nitroglycerin skin patches for 1 week, a patient with an 8-month history of chronic stable angina pectoris observes an increasing frequency of mild angina episodes during exeion. The patient has been conscientiously applying a new patch every morning immediately after removing the old one. The patient's increased frequency of anginal attacks is most likely because of, with the following options: A: A sudden onset of vasospastic angina, B: Engaging in vigorous exercise, C: Cellular tolerance to organic nitrates, D: Induction of cytochrome P450 enzyme by nitroglycerin - -### Response: -Tolerance to organic nitrates may develop in a few days or less, depending on the dose and frequency of administration. Continuous exposure to nitroglycerin through use of a transdermal skin patch has frequently caused nitrate tolerance. A daily 10-to-14-hour drug-free period will prevent nitrate tolerance. Nitrate tolerance is a cellular tolerance caused by depletion of sulfhydryl groups required for receptor signal transduction. The drug-free interval allows time for these groups to replenish before the next period of drug exposure. Nitrates are metabolized by hepatic nitroreductase, and there is neither evidence of cytochrome P 450 involvement nor of induction of this enzyme by drugs. Although the patient's symptoms could be caused by increased physical activity or onset of vasospasm, these are less likely causes in a patient with continuous nitroglycerin exposure. Vasospasm is also unlikely because the episodes occurred during exeion. Ref - Harrison's principles of internal medicine 20e pg427,1860 / researchgate.net -### End" -1853,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a post-operative patient, 21 years old with 70 kg weight, 1 unit of packed RBC will raise the hematocrit by:, with the following options: A: 1, B: 5-Mar, C: 10-Jul, D: 15 - -### Response: -A rise in the hemoglobin of 1 g/dL ( hematocrit rise of 3%) occurs after transfusion of one unit of whole blood or PRBC in an adult. -### End" -1854,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following statements is false with regard to pyuria in children –, with the following options: A: Presence of more than 5 WBC/hpf (high power field) for girls and more than 3 WBC/hpf for boys, B: Infection can occur without pyuria, C: Pyuria may be present without Urinary tract infection, D: Isolated pyuria is neither confirmatory nor diagnostic for Urinary tract infection - -### Response: -Pyuria is the presence of more than 5 WBCs / high power field, both for boys and girls.            —CPDT -Pyuria suggests infection, but infection can, occur in the absence of pyuria.                               —Nelson -Pyuria can present without UTI.                                                                                                              — Nelson -So, Isolated pyuria is neither confirmatory nor diagnostic for UTI. -### End" -1855,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Decision regarding surgery in a case of hemothorax due to blunt trauma chest should be based on:, with the following options: A: Chest symptoms, B: Hemodynamic status, C: Nature of chest tube output, D: X-ray finding - -### Response: -The nature of chest tube drainage and the Hemodynamic status, both provide vital clues that may form an indication for Thoracotomy. But only the Hemodynamic status can decide the need for a surgery. Ref: Trauma Manual: Companion to trauma, 4th Edition, Page 165; Bailey and Love's Sho Practice of Surgery, 25th Edition, Page 345 -### End" -1856,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The action potential of the the sinoatrial node, with the following options: A: Reuslts from the activation of rapid Na+ channels, B: Results from opening of the slow Ca2+ channels, C: Is equivalent in height and conduction velocity to that of the atrial muscle, D: Results from an increase in conductance to K+ - -### Response: -The action potential of the sinoatrial node and atrio­ventricular node results from the opening of the slow Ca2+ channels and the influx of Ca2+(some Na+ may also enter through these slow Ca2+channels). An action potential is elicited when the membrane potential reaches threshold. Spontaneous depolarization is an intrinsic property of nodal tissue and can occur in the absence of nerves. The low resting potential results in a small action potential that propagates slowly. The rapid Na+ channels are inactivated in nodal tissue. An increase in the conductance to K+ would hyperpolarize the membrane. -### End" -1857,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Middle meningeal aery is a branch of aery :, with the following options: A: Maxillary, B: Posterior cerebellar, C: ECA, D: Veebral - -### Response: -A. i.e. Maxillary aeryMiddle meningeal aery, commonest source of extradural haemorrhage is branch of Ist pa of maxillary aery(terminal branch of external carotid aery) -### End" -1858,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which nerve is most commonly affected in diabetic mononeuropathy: March 2013, with the following options: A: Optic, B: Oculomotor, C: Facial, D: Vagus - -### Response: -Ans. B i.e. Oculomotor -### End" -1859,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are risk factors for increased lactic acidosis in patients on metformin therapy except, with the following options: A: Advanced age, B: Liver dysfunction, C: Renal dysfunction, D: Smoking - -### Response: -Metformin can result in lactic acidosis and the risk factors includes old age,renal and liver insufficiency, alcoholics. -Smoking is not a risk factor. -### End" -1860,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Purposeful movement is staed at, with the following options: A: 6 months, B: 8 months, C: 9 months, D: 12 months - -### Response: -Palmer grasp goes at age of 4 monthTransfer object hand to hand 5.5 monthThe purposeful movement staed when there is an absence of Palmer group, so an above option best answer is 6 month(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2798) -### End" -1861,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: >50% PUFA is/are seen in – a) Mustard oilb) Soyabean oilc) Safflower oild) Corn oil e) Palm oil, with the following options: A: abc, B: acd, C: bcd, D: bd - -### Response: -> 50% of PUFA is seen in: Safflower oil, Sunflower oil, Corn oil, Soybean oil. -### End" -1862,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intraosseous line is placed in which bone in children?, with the following options: A: Femur, B: Tibia, C: ASIS, D: Iliac crest - -### Response: -Ans. (b) TibiaRef.: Nelson's 18"" ed./ch. 66* If venous access is not available in an arrest situation within 1 min, an intraosseous line should be placed in the anterior tibia (with care taken to avoid traversing the epiphyseal plate)* The needle should penetrate the anterior layer of compact bone, with its tip advanced into the spongy interior of the bone.* Intraosseous needles are special rigid, large-bore needles that resemble those used for marrow aspiration. Current recommendations urge the use of intraosseous cannulation in patients for whom intravenous access proves difficult or unattainable, even in older children.* Once the patient has received initial drug and fluid therapy through the IO line, every effort should be made to obtain more conventional central venous access and remove the 10 line as soon as possible.* Alternative sites for intraosseous (IO) insertion include the distal tibia, distal femur, sternum, and humerusComplications of 10 Infusion* Extravasation of fluid is the most common complication and occurs when a needle is misplaced* Compartment syndrome is a risk with IO insertion.* Extravasation of hypertonic or caustic medications, such as sodium bicarbonate, dopamine, or calcium chloride, can result in necrosis of the muscle.* Infection and osteomyelitis are relatively rare complications and occur most commonly if aseptic technique is not followed during insertion.* Other possible complications include local hematoma, pain, fracture and growth plate injuries (with incorrect placement), and fat microemboli (not clinically significant) and compartment syndrome -### End" -1863,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest feature of parkinsonism?, with the following options: A: Anosmia, B: Rigidity, C: Postural instability, D: Freezing - -### Response: -Ans. (a) AnosmiaRef: Harrison 19th ed. / 2609Non-motor symptoms may precede motor symptoms of Parkinsons diagnosis by years. The most recognizable early symptoms include:* Loss of sense of smell, constipation* REM behavior disorder* mood disorders* Orthostatic hypotensionSubsequently Motor Features Appear1. Tremors (resting 4-6 Hz)2. Rigidity3. Bradykinesia4. Good Response to levodopa -### End" -1864,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Interferon is...in nature -, with the following options: A: Protein, B: Lipid, C: Polysaccharides, D: All of the above - -### Response: -IFN – α → Non glycosylated protein -IFN – β → Glycoprotein -IFN – γ → Glycoprotein -### End" -1865,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Whip-lash' injury is caused due to -, with the following options: A: A fall from a height, B: Acute hyperextension of the spine, C: A blow on top to head, D: Acute hyperflexion of the spine - -### Response: -Whiplash injury is caused by sudden unexpected hyperextension of cervical spine followed immediately by flexion. -### End" -1866,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Retrolental fibroplasia is due to -, with the following options: A: Hypocapnia, B: CO2, C: Hypoxia, D: Hyperoxygenemia - -### Response: -Ans. is 'd' i.e., Hyperoxygenemia Retrolental fibroplasia (Retinopathy of prematurity) Predisposing factor Prematurity (less gestational age) Precipitating factor --> Hyperoxia -### End" -1867,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best anaesthetic agent for out patient anasthesia is, with the following options: A: Fentanyl, B: Morphine, C: Alfentanyl, D: Penthidine - -### Response: -C i.e. Alfentanyl -### End" -1868,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mannitol is used in the management of:-, with the following options: A: Congestive cardiac failure, B: Acute congestive glaucoma, C: Acute renal failure, D: Pulmonary edema - -### Response: -Option A: Treated by Lasix (Furosemide), morphine, O2, Positioning (LMNOP) Option C: Managed by Hemodialysis -### End" -1869,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Long chain fatty acid is transported into inner mitochondria membrane by, with the following options: A: Acyl carrier protein, B: Acyl carnitine, C: Simple diffusion, D: Energy mediated - -### Response: -Acyl carnitine  - -Activated long chain fatty acid (acyl CoA) cannot penetrate the inner mitochondrial membrane. -Acyl group of acyl CoA is transferred to carnitine, resulting in the formation of acylcarnitine. - - -Acylcarnitine is then transported across the inner mitochondrial membrane into the mitochondrial matrix by translocase. - - -Once inside the mitochondrion, an acyl group of acylcarnitine is transferred back to CoA, resulting in the formation of acyl-CoA which undergoes β -oxidation. -### End" -1870,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Branches of brachial aery are all except, with the following options: A: Profunda brachii, B: Superior ulnar collateral, C: Inferior ulnar collateral, D: Radial collateral - -### Response: -Profunda brachial aery arises just below the teres major and accompanies the radial nerve. Superior ulnar collateral arises in the upper pa of arm and accompanies ulnar nerve. Inferior ulnar collateral arises in the lower pa and takes pa in the anastomosis around elbow joint. Radial collateral arises from anterior branch of profunda brachial aery and anastomoses with radial recurrent aery in front of the lateral epicondyle of humerus. B D Chaurasia 7th edition Page no: 95,111 -### End" -1871,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Retinoblastoma differs from pseudoglioma by, with the following options: A: Decreasing Intraocular pressure, B: Blurring of vision, C: Enlargement of optic foramen, D: All the above - -### Response: -There is increased intraocular pressure in retinoblastoma. Blurring of vision can be seen in pseudo glioma also Refer khurana 6/e p 303 -### End" -1872,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antigenic variation seen in which of the following-, with the following options: A: Influenza virus, B: Hepatitis virus, C: Yellow fever virus, D: Leptospira - -### Response: -The influenza A virus is unique among the viruses because it is frequently subject to antigenic variation, both major and minor. When there is a sudden complete or major change, it is called a shift, and when the antigenic change is gradual over a period of time, it is called a drift. Ref:PARK&;S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23rd edition,Page:154 -### End" -1873,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following is the 1st respiratory reflex which helps in the first breath of newborn, with the following options: A: Hering - Breuer's reflex, B: J - reflex, C: Head's Paradox reflex, D: None of the above - -### Response: -Hypoxia stimulates inflation of lungs. Inflation augments furthur inflation. -### End" -1874,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ridley's scale is used in classification of which disease?, with the following options: A: Tuberculosis, B: Malaria, C: Leprosy, D: Measles - -### Response: -Ridley's logarithmic scale is used to grade the response to treatment in case of leprosy. Ref: Park 21st edition, page 293. -### End" -1875,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Laryngeal mask airway, all are true except, with the following options: A: Less invasive, B: Prevents aspiration, C: Easy to insert, D: Less complications - -### Response: -LMA cannot prevent aspiration. -### End" -1876,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 7-year-old male child present with normal vision 6/6 in right eye & hand movement perception close to the face in left eye. On fundoscopy, his right eye was normal & left eye showed retinal detachment, subretinal yellowish exudates and telangiectatic vessels. The most likely diagnosis is?, with the following options: A: Coats' disease, B: Sympathetic ophthalmitis, C: Familial exudative vitreoretinopathy, D: Retinopathy of prematurity - -### Response: -Coats Disease Type of telangiectasia D/d of unilateral leukocoria More frequently in males Yellowish exudates around the vessels seen Neovascularization can be seen Seen in 1st decade of life Association with Turners syndrome seen Can cause retinal detachment. Elevated lesions are generally not present in contrast to Retinoblastoma. -### End" -1877,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The presence of active bronchospasm intravenous anaesthetic agent of choice :, with the following options: A: Ketamine, B: Thiopentone, C: Propofol, D: Etomidate - -### Response: -Ketamine has well-characterized bronchodilatory activity. In the presence of active bronchospasm it is agent of Choice. Propofol is also bronchodilator etomidate is also bronchodilator all inhalational agents are bronchodilator Halothane is best -### End" -1878,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ATP synthetase is a marker of -, with the following options: A: Golgi apparatus, B: Mitochondria, C: Cytosol, D: Endoplasmic reticular - -### Response: -Ans. is 'b' i.e., MitochondriaOrganelle or fractionMarkersMitochondriaInner membrane : - ATP synthase, Succinate dehydrogenaseIntermembrane space : - Creatine kinase, Adenyl kinase.Matrix : - Glutamate dehydrogenase. Pyruvate dehydrogenase, enzymes of TCA cycle & b-oxidation of fatty acidsPlasma membrane5'-ISucleotidase. Adenyl cyclase, Na+K+ ATPaseLysosomeAcid phosphataseGolgi ApparatusGalactosyl transferase, Golgi mannosidase II,Sialyl transferase, GIcNAc transferase IEndoplasmic reticulumGlucose-6-phosphatasePeroxisomeCatalase, Urate (uric acid) oxidaseCytosolLactate dehydrogenaseNucleusDNARibosomeHigh content of RNA -### End" -1879,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gonococci in gram-stained smears are seen inside the, with the following options: A: Lymphocytes, B: Neutrophils, C: Mast cells, D: Macrophages - -### Response: -Gonococci, in smears from the urethral discharge in acute gonorrhea, appears as diplococcus with adjacent sides concave being typically kidney-shaped. Found predominantly within the polymorphs, some cells containing as many as a hundred cocci. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 230 -### End" -1880,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Basophilic stippling is seen which of the following cells: UPSC 11; UP 11; NEET 14, with the following options: A: Neutrophils, B: RBC's, C: Basophils, D: Eosinophils - -### Response: -Ans. RBC's -### End" -1881,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apnea of prematurity -, with the following options: A: > 10 sec, B: > 15 sec, C: > 20 sec, D: > 30 sec - -### Response: -Ans. is 'c' i.e., > 20 sec o Apnea of prematurity defined as sudden stoppage of breathing that lasts for 20 sec or is associated with bradycardia or cyanosis.Apnea of prematurity should be differentiated from periodic breathing which is normal phenomenon is preterm neonate. -### End" -1882,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also reports that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab result reveal a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L. Most appropriate treatment for his elevated BUN and creatinine?, with the following options: A: Large volume paracentesis, B: Hemodialysis, C: Mesocaval shunt, D: Liver transplantation - -### Response: -This patient with well advanced cirrhosis and portal hypertension has developed the onset of renal insufficiency consistent with hepatorenal syndrome. This occurs during the end stages of cirrhosis and is characterized by diminished urine output and low urinary sodium. In the setting of end-stage liver disease, renal vasoconstriction occurs, and the distal convoluted tubule responds by conserving sodium. Unless the renal function is allowed to deteriorate further, liver transplantation will reverse this vasoconstriction and kidney function will return to normal. -A large volume paracentesis may relieve the ascites but will have no significant benefit on the impaired renal function. There are no indications in this question to suggest that the patient requires acute hemodialysis.  A mesocaval shunt  is a surgical procedure that may decompress the portal pressure but will not have any benefit on renal function. Renal transplantation is of no value in this patient since the underlying lesion is in the liver; the kidneys will return to normal function if there is improvement in hepatic function. -### End" -1883,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of Medial medullary syndrome?, with the following options: A: Contralateral hemiparesis, B: Ipsilateral paralysis of tongue, C: Contralateral loss of proprioception, D: Horner's sydrome - -### Response: -Horner's syndrome occurs due to a lesion involving the sympathetic fibers. It is seen in lateral medullary syndrome. Medial medullary syndrome occurs d/t occlusion of anterior spinal aery. CN XII :Ipsilateral paralysis of the tongue Pyramidal tract :Contralateral hemiplegia Medial lemniscus : Impaired tactile and proprioception over the contralateral half of the body -### End" -1884,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for paroxysmal supraventricular tachycardia is:, with the following options: A: Verapamil, B: Diltiazem, C: Digoxin, D: Phenytoin - -### Response: -Verapamil decreases conduction velocity and increases the refractory period of the AV node, thus useful in PSVT. It is a CCB, Class 4 antiarrhythmic drug Adenosine and magnesium sulfate can also be used for PSVT REF: Essentials of Pharmacology KD Tripathi 8th ed. -### End" -1885,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum soft tissue bruising in neck is seen in -, with the following options: A: Strangulation, B: Hanging, C: Burking, D: Smothering - -### Response: -Ans. is 'a' i.e., Strangulation o As manual strangulation (throttling) is among the most violent form of asphyxia, hyoid fracture and other injury to neck structures is more common.HangingStrangulationGeneral characteristics 1. There is suspension of body.1. No suspension.2. Compression on neck is by a ligature.2. Compression on neck is by a ligature, hands, slicks, elbow, knee or foot.3. Force of compression is the weight of body (endogenous force).3. It is outside force applied (exogenous force).Local external P.M. findings 4. Ligature mark is above the thyroid is oblique, symmetrical and incomplete.4. Mark is on or below the thyroid. Is horizontal, complete and continuous (in absence of ligature mark there are other injuries on neck depending upon type of strangulation).5. Knot usually present.5. Usually absent.6. Usually no mark at site of knot:6. Mark is horizontal, complete and continuous.y In fixed knot, mark is inverted ' V' shaped.y In running noose, mark is transverse. 7. Mark usually single.7. Usually multiple marks.8. Surface of mark abraded or contused.8. Usually lacerated.9. Surface may show pattern of ligature used.9. Pattern not seen.10. Surface hard.10. Soft, due to frank bleeding.11. Mark-yellowish brown in colour.11. Black.12. Margins of mark showr petechial haemorrhages.12. Frank bleeding present.13. Surrounding skin shows few petechial haemorrhages.13. Multiple haemorrhages present.14. Depth of mark is less.14. More, like a groove.Local internal P,M, findings 15. Under the mark area is seen as dry, white, glistening pad of fat.15. Area is haemmorrhagic16. Muscles may be lacerated.16. Lacerated.17. Usually no laceration of blood vessels and their walls, (lacerated injudicial hanging).17. Lacerated.18. May be fracture of trachea, thyroid and larynx.18. Usually fractured.19. Cervical vertebrae fractured usually at C2-C3 and rarely C3-C4 or C1-C2, injudicial hanging.19. Fracture cervical vertebrae uncommon.20. Fracture of hyoid bone in uncommon.20. Fracture of hyoid bone, of adduction type (inward compression fracture), very common in throtting.21. Injury to spinal cord, pons and medulla common injudicial hanging.21. No injury to spinal cord, pons and medulla.Signs of struggle and violence 22. Signs of struggle and violence absent.22. Due to struggle, abrasions and contusions present on the body.23. No question of sexual assault on female victim, as this is usually suicidal and it is uncommon in females.23. May be sexual assault on female victim.24. Since hanging is usually suicidal no question of hiding the cause of death.24. Since strangulation is usually homicidal there is attempt at hiding the crime. Dead body may be hanged; thrown in water, jungle, or acid: may be burnt.General external RM. findings 25. Features of asphyxia mild.25. Greatly marked.26. Head tilted to side, opposite to knot.26. No such tilting.27. Neck stretched.27. No stretching.28. Face usually pale.28. Deeply congested and deeply cyan used.29. Mild cyanosis on nose, lips, tongue, ears and nails.29. Severe cyanosis.30. Few petechial haemorrhages in eyes and on face.30. Multiple petechial haemmorrhages and eye protruded out31. Tongue usually inside.31. Tongue-protruded, bitten and black.32. Bloody froth at nose and mouth is sometimes present.32. Usually present.33. Usually there is dribbling of saliva from angle of mouth.33. Usually absent. -### End" -1886,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Usage of female undergarments for sexual gratification is seen in, with the following options: A: Undinism, B: Frotteurism, C: Fetichism, D: Transvestism - -### Response: -Fetichism Fetish is an object for sexual stimulation. Fetichism means using these objects for sexual gratification. It is usually seen in males and they use the undergarments like bras, petticoat, stocking, panty hose,etc. of the females as an object for sexual stimulation. Person with this perversion may steal these objects for the above purpose. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 312 -### End" -1887,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Immune rejection in fetus is prevented by, with the following options: A: HCG, B: HPL, C: Oestrogen, D: Progesterone - -### Response: -Chorionic gonadotropin (human chorionic gonadotropin (HCG) (hCG) is a glycopeptide hormone that is produced by cells of the fetal placenta and maintains the function of the corpus luteum during the first few weeks of pregnancy. It is thought to promote steroidogenesis in the fetoplacental unit and tostimulate fetal testicular secretion of testosterone. It can be detected by immunoassay in the maternal urine within days after feilization; this provides the basis for the most commonly used pregnancy test. Due to its highly negative charge, hCG may repel the immune cells of the mother, protecting the fetus during the first trimester. It has also been hypothesized that hCG may be a placental link for the development of local maternal immunotoleranceRef: Ganong&;s review of medical physiology;24th edition; page no:-414 -### End" -1888,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Isolation period of hepatitis A is, with the following options: A: 1 week, B: 2 weeks, C: 3 weeks, D: 4 weeks - -### Response: -2 weeks -### End" -1889,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epistaxis in elderly patient is commonest in, with the following options: A: Nasapharyngeal carcinoma, B: Foreign body, C: Bleeding disorder, D: Hypeension - -### Response: -The major cause for epistaxis in an elderly person is hypeension. Ref: Dhingra 7e pg 198. -### End" -1890,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady with 8 wks pregnancy presented with random blood glucose of 177mg/dl. The treatment is :, with the following options: A: Phenformin, B: Sulfonylurea, C: Insulin, D: Glipizide - -### Response: -Ans. is 'c' is insulin (Ref Dutta 6/e, p 288 (5/e, p. 304); Holland and Brews, 16/e, p. 107).Insulin is the only antidiabetic drug given in pregnancy to control increased blood sugar.Oral hypoglycemics are contraindicated in pregnancy because they cross placenta and have teratogenic effect on fetus.They cause fetal hypoglycemia and increase m fetal bilirubin.Moreover the increase demand in pregnancy cannot be met by oral hypoglycemics. -### End" -1891,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Molten wax appearance is seen in, with the following options: A: Achondroplasia, B: Pseudogout, C: Melorheostosis, D: Osteopetrosis - -### Response: -Motten wax or Flowing candle wax appearance feature of Melorheostosis. -### End" -1892,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of primary hyperparathyroidism ?, with the following options: A: Hyperplasia, B: Solitary Adenoma, C: Carcinoma, D: Multiple adenomas - -### Response: -Ans. is 'b' i.e., AdenomaHyperparathyroidismHyperparathyroidism is caused by elevated parathyroid hormone.Primary hyperparathyroidism : an autonomous overproduction of parathyroid hormone (PTH), usually resulting from an adenoma or hyperplasia of parathyroid tissue. -### End" -1893,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is a feature of narcolepsy-, with the following options: A: Insomnia, B: Hypersomnia at day time, C: Bimism, D: Somnambulism - -### Response: -Ans. is 'b' i.e., Hypersomnia at day time Narcolepsyo This is characterized by excessive day time sleepy often disturbed night time steep and disturbances in the REM sleep. Age of onset is between 10-20 years. There is irresistable desire to sleep and bouts of sudden sleep each Lasting for 10-30 minutes occuring during day time. In majority of cases narcolepsy is associated with one or more accessory symptoms :-Cataplexy It is the most common accessory symptom and is characterized by sudden decrease in muscle tone either, local or generalized.Hypnagogic hallucination :- Hallucination occuring just before falling asleep. When hallucination occurs just before awakening it is called hyponopompic hallucinations.Sleep paralysis (least common). -### End" -1894,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 34 year old chronic smoker presents to you with progressive claudication of the left arm with ulcers on the ring finger. The patient also gives history suggestive of recurrent superficial phlebitis. There is also history of Raynaud's phenomenon. What is the best treatment for the patient?, with the following options: A: Steroids, B: Aspirin, C: Pentoxifylline, D: Abstinence from tobacco - -### Response: -The triad of claudication, Raynaud's phenomenon and migratory superficial thrombophlebitis in a young male smoker is typical of thromboangiitis obliterans (Buerger's disease). An aeriography will show segmental occlusion with collaterals. Histopathology will show sharply segmental acute and chronic vasculitis of small and medium aeries of the affected area. Ref: S. Das, Edition 5, Page 68 -### End" -1895,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anitschow cells are ?, with the following options: A: Modified macrophages, B: Modified neutrophils, C: Modified B cells, D: Modified RBCs - -### Response: -Ans. is 'a' i.e., Modified macrophagesPathologic Features of Acute Rheumatic Fever :?Aschoff bodiesFocal inflammatory lesions consisting of foci of T lymphocytes, occasional plasma cells, and plump activated macrophages.These activated macrophages called Anitschkow cells (pathognomonic for Rheumatic Fever) have abundant cytoplasm and central round-to- ovoid nuclei (occasionally binucleate) in which the chromatin condenses into a central, slender, wavy ribbon (hence also called ""caterpillar cells"").Pancarditis - During acute RF, diffuse inflammation and Aschoff bodies may be found in any of the three layers of the hea, resulting in pericarditis, myocarditis, or endocarditisVerrucae are small (1 to 2 mm) vegetations overlying necrotic foci and along the lines of closure of valves.MacCallum plaques are irregularly thickened subendocardial lesions usually in the left atrium.Mitral stenosis Fish Mouth or Button - Hole stenosis. -### End" -1896,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 42-year-old man with known valvular heart disease develops a fever for 1 week. He appears unwell; findings include a pansystolic murmur at the apex that radiates to the axilla and a soft S1 sound. He has petechiae on his conjunctival sac, linear hemorrhages under a few fingernails, and painful, tender, and erythematous nodules on some of the distal fingertips. Which of the following is the most responsible mechanism for these physical findings?, with the following options: A: direct bacterial invasion, B: immune response, C: vascular phenomena, D: valvular damage - -### Response: -Common findings in infective endocarditis include petechiae, Roth's spots, Osler's nodes, Janeway lesions, splinter hemorrhages, stroke, and infarction of viscera, or extremities.Many of the complications are thought to be embolic but may include vasculitis. Autopsy studies reveal that many systemic emboli go unrecognized. Brain, lung, coronary arteries, spleen, extremities, gut, and eyes are common locations for emboli. -### End" -1897,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Munsen sign is seen in: March 2013 (h), with the following options: A: Corneal dystrophy, B: Perforated corneal ulcer, C: Keratoconus, D: Marfan syndrome - -### Response: -Ans. C i.e. Keratoconus Keratoconus Protrusion of central pa of cornea with thinning, Corneal nerves are visible, Associated features: - Munsen's sign, - Fleischer sign -### End" -1898,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hydatidiform mole follow up reliable fest-, with the following options: A: BetaHCG, B: US, C: Clinical examination, D: Serum estradiol levels - -### Response: -Ans-A i.e., Beta HCG Follow up in a hydatidiform mole:o Serum beta HCG levels measured using radioimmunoassay tests in serum and urine are the most reliable for follow up of cases of hydatidiform mole.It usually regresses to normal in 3 months following the evacuation of hydatidiform mole.Persistent or rising beta HCG levels warrant further evaluation and management. -### End" -1899,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inulin clearance is equal to, with the following options: A: 55 ml/min, B: 625 ml/min, C: 125 ml/min, D: 40 ml/min - -### Response: -Inulin clearance is equal to about 125ml/min, which is the GFR. -### End" -1900,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most reliable criteria in Guastafson method of age estimation is -, with the following options: A: Attrition, B: Secondary dentin deposition, C: Transparency of root, D: Cementum apposition - -### Response: -Transparency of root is the most reliable criterion in Gustafson's method. -### End" -1901,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Duchenne muscular dystrophy, the defect is in the gene producing the following protein:, with the following options: A: Dystrophin, B: Alpha-actinin, C: Nebulin, D: Desmin - -### Response: -Duchenne & Becker muscular dystrophy are X linked recessive disorders due to defect in Dystrophin gene on Chr X -### End" -1902,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 65-year-old woman complains of severe, acute onset left temporal headache and changes in left eye vision. She presents to her physician with sweating, malaise, and temperature of 99oF. Medical evaluation reveals, with the following options: A: Myocardial infarction (MI), B: Pneumonia, C: Diabetes, D: Temporal aeritis - -### Response: -Temporal aery inflammation causes severe throbbing unilateral temporal headache, low-grade fever, visual changes, sweating, and malaise. Acute treatment with prednisone can be followed by temporal aery resection -### End" -1903,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement for axial flap is :, with the following options: A: Carries its own vessels within it, B: Kept in limb, C: Transverse flap, D: Carries its own nerve in it - -### Response: -A flap is a partially or completely isolated segment of tissue with its own blood supply. -A graft does not carry its own blood supply, but is completely dependent on early diffusion & late ingrowth of vessels from the recipient’s bed. -### End" -1904,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which gas accumulates in cavities post general anaesthesia?, with the following options: A: Nitrous oxide, B: Halothane, C: Ether, D: Sevoflurane - -### Response: -Ans: A. Nitrous oxideRef: Ajay Yadov, Short Textbook of Anesthesia, 1st edition, pg59.Explanation:NITROUS OXIDE ( LAUGHING GAS)Stored as liquid in blue color cylinder1.5 times more heavier than air35 times more soluble than nitrogenAnesthetic propertiesIt is not a complete anesthetic.It is used as a carrier gas to other anestheticsMAC is 104% (It is not possible to deliver, so not a complete anesthetic)Maximum concentration which can be given is 66%A minimum of 33% of Oxygen has to be given (Otherwise can cause severe hypoxia)It is usually given as N2O 66% and O2 33%' mixtureBlood gas coefficient is 0.47 making it agent with faster induction and recoveryGood analgesicNot a muscle relaxantWhen given with other inhalational agent, it increases the concentration of that agent (Second gas effect) and also its own concentration (Concentration effect)Sudden stoppage can lead to Diffusion Hypoxia)Shou 1 d always be tapered slowly by giving 100% oxygen)MetabolismIt is not metabolized in human body.It is excreted unchanged in lungsSmall amount is excreted v ia skin (Percutaneous excretion)Impurities in N20 cylinder can cause severe laryngospasm. methhemoglobinemia & Pulmonary edemaSystemic ActionsCVS: It does not depress the myocardium in vivo, so it can be safely used in patients with cardiac disease and shockCNS: It increases cerebral metabolic rate and raises intra cranial tensionRS: It causes tachypnea and decrease tidal volume, maintaining minute volumeVentilatory response to hypoxia is bluntedNo significant effect on Liver and KidneysSide EffectsHematological: li inactivates vitamin B12 (If used for >6 hours) - defective folate metabolism - Bone marrow depression - Aplastic anemia and Megaloblastic anemiaCNS: Vitamin B 12 deficiency can cause Demy el i nation of spinal cord (Subacute degeneration of spinal cord) especially involving posterior columns and lateral spinothalamic tractsClosed Gas Spaces: Compliant spaces like gut, penumoperironeum, pneumothorax and non- compliant spaces like middle ear cavity, pneumoencephalum can develop very high pressure following nitrous oxide inhalation.This happens because for I mole of nitrogen removed, 35 moles of nitrous oxide enter (35 times more soluble than nitrogen.Therefore, Nitrous oxide is contraindicated inPneumothoraxPneumoperitoneumPneumoencephalumMiddle ear surgeryPosterior fossa surgeryLaproscopie surgeryAcute intestinal obstruction and volvulus of gutEye surgeriesUses in AnesthesiaAs a supplement to anesthesia (not a complete anesthetic)As a carrier gas for inhalational agentsAs analgesic in obstetrics, dental pain, burn dressing and acute trauma -### End" -1905,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cold abscess in chest wall is most common due to -, with the following options: A: T.B spine, B: T.B rib, C: T.B. pelvis, D: T.B pleura - -### Response: -It is a straight-forward question. -Most common site of skeletal TB is spine, and pus from the Dorsal spine can travel along intercostal neurovascular bundle in the intercostal space in chest wall to form a cold abscess. -### End" -1906,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about crude bih rate is all except, with the following options: A: Ratio, B: Feility indicator, C: Stillborn excluded, D: Not affected by age distribution of the population - -### Response: -Bih rate = Number of live bihs during the year X 1000/ estimated mid year population Unsatisfactory measure of feility because the total population is not exposed to child bearing Bih rate is not a ratio. In ratio, the numerator is not a component of denominator Reference : Park&;s textbook of preventive and social medicine, 23rd edition, pg no: 55,488 -### End" -1907,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Otitis and osteomyelitis is seen in?, with the following options: A: Hepatitis B vaccine, B: BCG, C: Measles vaccine, D: IPV - -### Response: -Ans. (b) BCGRef : OP Ghai 8th ed./191BCG* Although BCG vaccination often causes local reactions, serious or long-term complications are rare. Reactions that can be expected after vaccination include moderate axillary or cervical lymphadenopathy and induration and subsequent pustule formation at the injection site; these reactions can persist for as long as 3 months after vaccination.* Most serious complication of BCG vaccination is disseminated BCG infection.* The most frequent disseminated infection is BCG osteomyelitis -### End" -1908,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epiphyseal enlargement occurs in, with the following options: A: Sheurmann's disease, B: Paget's disease, C: Juvenile rheumatoid ahritis, D: Epiphyseal dysplasia - -### Response: -Epiphyseal enlargement - juvenile rheumatoid ahritis , hypehyroidism, rickets, spondyloepiphyseal dysplasia. EPIPHYSEAL dysgenesis/ fragmented or punctuate epiphysis - Hypothyroidism. -### End" -1909,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aortic hiatus pierces diaphragm at what level?, with the following options: A: T8, B: T10, C: T11, D: T12 - -### Response: -Ans. D T12Ref: BDC, 6th ed. vol. II pg. 333* Diaphragm has several openings for the passage of structures from thorax to abdomen.Main openings in the diaphragm and their levelsOpeningLevelStructure PassingAORTIC OPENING-Osseo aponeurotic opening (not a true opening)Str passing: ""Remember ATA""T12* Aorta* Thoracic duct* Azygous veinESOPHAGEAL OPENING- lies in muscular part of diaphragmT10* Esophagus* Gastric or vagus nerve* Esophagheal branch of left gastric arteryVENA CAVAL OPENING- lies in central tendon of diaphragmT8* Inferior vena cava* Right phrenic nerve branchesExtra Mile* Only motor nerve to diaphragm- PHRENIC NERVE (C3, C4, C5)* It is the principle muscle of inspirationExtra MileStructures and level of piercing in diaphragm: (Mn: I ate, 10 Eggs, At 12)* IVC: T8* Esophagus: T10* Aorta: T12 -### End" -1910,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mycoplasma pneumoniae (Eaton agent) is an infectious agent that:, with the following options: A: Lacks steroids in its cytoplasmic membrane, B: Contains muramic acid in its cell wall, C: Contains only DNA, D: Causes primary atypical pneumonia - -### Response: -Mycoplasma pneumoniae is the causative agent of primary atypical pneumonia, which was initially described by Eaton, giving rise to the eponym Eaton agent. Mycoplasma pneumoniae requires sterols for growth, usually in the form of cholesterol that is incorporated into the cell membrane. Mycoplasma pneumoniae lacks muramic acid in its cell wall as do all micro-organisms belonging to genus Mycoplasma. Similarly, and in harmony with other species of the genus, Mycoplasma pneumoniae contains both DNA and RNA. Mycoplasma pneumoniae is completely resistant to Penicillin, which inhibits cell wall synthesis, because Mycoplasma pneumoniae does not have a cell wall. Mycoplasma may cause a hemolytic anemia (cold agglutination). Ref: Ray C.G., Ryan K.J. (2010). Chapter 38. Mycoplasma and Ureaplasma. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. -### End" -1911,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to American diabetic association, which of the following indicates prediabetic condition?, with the following options: A: Fasting plasma glucose - 100 to 125 mg/dl, B: 2-hour plasma glucose - 100 mg/dl, C: HbA1C > 6.5%, D: All of the above - -### Response: -Option B indicates normal person and option C indicates full-blown diabetic. American Diabetic Association criteria for diagnosing Diabetes Mellitus Normal Prediabetic Diabetic FPG <5.6 mmol/L 5.6-6.9 mmol/L (100-125 mg/dL) >= 7.0 mmol/L (126 mg/dL) 2-h PG (100 mg/dL) 7.8-11.0 mmol/L (140-199 mg/dL) >= 11.1 mmol/L (200 mg/dL HbA1C 3.8% - 5.7% 5.7-6.4% >= 6.5% -### End" -1912,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following X-ray foot is showing features of which disease-, with the following options: A: Gout, B: Rheumatoid arthriris, C: Osteoarthritis, D: Psoriatic arthristis - -### Response: -.Ans. is 'a' i.e., Gout* Given X-ray image is showing juxtra-articular erosive changes around the first metatarsophalangeal joint with overhanging edges and moderate soft tissue swelling.* Note the tophus, classical finding of gout. -### End" -1913,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dose of centchroman is ?, with the following options: A: 30 mg, B: 60 mg, C: 120 mg, D: 240 mg - -### Response: -Ans. is 'a' i.e., 30 mg Cetchroman (Saheli) Ormeloxifene, research product of Central Drug Research Institute, Lucknow, India. It is a potent non - steroidal compound with potent anti - estrogenic and weak estrogenic propeies. It is taken orally (30 mg) twice a week for first three months then once a week. It works primarily by preventing implantation of feilized ovum. It does not inhibit ovulation. It is avoided in PCOD, with liver and kidney diseases and in tuberculosis. There may be a tendency of oligomenorrhoea. The failure rate is 1 - 4/100 woman years of use. Failure rate is less with increased doses. It is devoid of any significant adverse metabolic effect. This may also be used as a emergency contraceptive. -### End" -1914,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Crocodile tears are seen in:, with the following options: A: Frey's Syndrome, B: Conjunctivitis, C: Lacrimal tumour, D: Abnormal VII nerve regeneration - -### Response: -Ans. (d) Abnormal VII nerve regenerationRef P L Dhingra p. 103* Crocodile tears are seen in Abnormal regeneration of 7th nerve* It is one of the complication following facial nerve palsy. It is characterized by unilateral lacrimation with mastication and is due to faulty regeneration of parasympathetic fibres which now supply lacrimal gland instead of salivary glands. -### End" -1915,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prolonged use of the following drug has been implicated in the causation of subacute myelo-optic neuropathy (SMON):, with the following options: A: Diloxanide furoate, B: Quiniodochlor, C: Emetine, D: Furazolidone - -### Response: -Prolonged/repeated use of relatively high doses of quiniodochlor causes a neuropathic syndrome called ""subacute myelo-optic neuropathy"" (SMON) 8-hydroxyquinolines like quiniodochlor were widely used treat infection by Entamoeba, Giardia, Trichomonas, some fungi (dermatophytes, Candida) and some bacteria. They kill the cyst forming amoebic trophozoites in the intestine, but do not have tissue amoebicidal action. -### End" -1916,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most emetogenic anti CA drug:, with the following options: A: 5 FU, B: Methotrexate, C: Cisplatin, D: All - -### Response: -Ref: Katzung 14th ed. pg. 956; KDT, 6th ed. pg. 828* Cisplatin is a platinum coordination complex that is hydrolyzed intracellularly to produce a highly reactive moiety which causes cross linking of DNA by platinum compound.* It is a highly emetic drug. Antiemetics are routinely administered before infusing cisplatin.* DOC for cisplatin induced vomiting: Ondansetron* Major s/e of cispltin: Ototoxicity and nephrotoxicity. -### End" -1917,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ferning of cervical mucus depends on :, with the following options: A: Estrogen, B: Progesterone, C: FSH, D: LH - -### Response: -Estrogen -### End" -1918,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following malignant tumors is radioresistant?, with the following options: A: Ewing's sarcoma, B: Retinoblastoma, C: Osteosarcoma, D: Neuroblastoma - -### Response: -Osteosarcoma is a radioresistant tumor; therefore treatment focuses on chemotherapy and surgery. Ref: Encyclopedia of Cancer, Volume 1, By Manfred Schwab, 2008, Page 2201; Aicle: Pahenolide and Ionizing Radiation Synergistically Induce Cell Death in LM7 Osteosarcoma Cells, 2012. -### End" -1919,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Double rise of temperature in 24 hrs is seen in case of -, with the following options: A: Kala azar, B: Malaria, C: TB, D: Hodgkin's lymphoma - -### Response: -Double rise of temperature in 24 hrs is seen in case of Kala azar. Option 1, 2, 3, 4 1. L. donovani donovani, infection of the classic kala-azar (""black sickness"") or dumdum fever type occurs in many pas of Asia, Africa and Southeast Asia. 2. Kala-Azar Fever: In the early stages of the disease, there is a mild irregular fever becoming intermittent at later stage and in 20% cases pyrexia shows a double rise in 24 hrs. Bone marrow involvement leads to: Anemia, leucopenia, thrombocytopenia Hypergammaglobulinemia Spleen |, Liver | Fever and Hyperpigmentation (Indian cases) LN| (African but not in Indian cases) -### End" -1920,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pneumocystis carinii is a fungus because ?, with the following options: A: rRNA, mitochondrial protein gene sequence & presence of thymidylate synthase, B: Cell wall contains glucans, C: Angifungals are effective against P. carini, D: All - -### Response: -Ans. is 'a' i.e., rRNA, Mitochondrial protein gene sequence & presence thymidylate synthase; `b' i.e., Cell wall contains glucans; 'c' i.e., Antifungals are effective against p. carinii . The taxonomic classification of Pneumocystis as a fungus is based on factors: 1. Analysis of gene sequence for ribosomal RNA, mitochondria! proteins and major enzymes. 2. Presence of b-1, 3 glucan in the cell wall. 3. The efficacy of antifungal drugs that inhibit b-glucan synthesis. . In contrast to most fungi. 1. Pneumocystis lacks ergosterol 2. Not susceptible to antifungal drugs that inhibit ergosterol synthesis. -### End" -1921,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of spontaneous abortion in first trimester:, with the following options: A: Chromosomal anomalies, B: Uterine anomalies, C: Antiphospholipid antibody syndrome, D: Hypothyroidism - -### Response: -Ans: A (Chromosomal anomalies) Ref: Dutta: Textbook of Obstetrics 7th ed pg 160Explanation:COMMON CAUSES OF MISCARRIAGEFirst TrimesterGenetic factors Endocrine Immunological disorders InfectionUnexplainedSecond TrimesterAnatomicCervical incompetenceBicomuate uterusSeptate uterusUterine synechiaeUterine fibroidMaternal medical illnessUnexplained -### End" -1922,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What will be the consequence if the left optic nerve is cut, with the following options: A: Left eye complete blindness with loss of contralateral direct and ipsilateral consensual light reflex, B: Left eye complete blindness with loss of ipsilateral direct and contralateral consensual light reflex, C: Left eye complete blindness with no effect on light reflex, D: Bitemporal hemianopia - -### Response: -Answer- B. Left eye complete blindness with loss of ipsilateral direct and contralateral consensual light reflexLesion of optic nerve causes-Complete visual field loss of the ipsilateral eye (blindness);Abolition of ipsilateral direct and contralateral consensual light reflex; -### End" -1923,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2-year-old boy is brought to clinic because of poor development as well as vomiting, irritability, and a skin rash. The boy's mother also notes that his urine has a strange ""mousy"" odor. Physical examination reveals the child has an eczema-like rash, is hyperreflexive, and has increased muscle tone. He has a surprisingly fair-skinned complexion compared to the rest of his family. What is the most likely diagnosis?, with the following options: A: Tay-Sachs disease, B: Mcardle disease, C: Phenylketonuria, D: Pyruvate dehydrogenase deficiency - -### Response: -Phenylketonuria: Phenyl ketone i.e. Phenyl Pyruvate found in urine of these patients (Pyruvate is a Keto-acid). Affected children are normal at bih but fail to reach developmental milestones Clinical features: Body odour - mousy or musty because of phenylacetate. Severe mental retardation due to excess Phenylalanine. Tyrosine becomes essential Deficiency of pigment Melanin (formed from Tyrosine), leads to fair skin, blue eyes and light hair color. OTHER FEATURES: Microcephaly, rash, hypeoma, seizures, hyperactivity, exaggerated tendon reflexes, wide-spaced teeth, enamel hypoplasia. Rx:- Decreased dietary phenylalanine (which is contained in many foods, including aificial sweeteners). Dietarytyrosine supplementation(In patients with pKU, tyrosine cannot be derived from phenylalanine) Currently, screeningis mandatory and performed6 days to 2 weeksafter bih using high-performance liquid chromatography. -### End" -1924,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is this study?, with the following options: A: Retrograde Pyelogram, B: Ultrasound, C: X Ray KUB, D: Contrast CT KUB - -### Response: -Retrograde ureterogram demonstrating the collecting system. The radiolucent filling defect in the renal pelvis is caused by radiolucent calculus -### End" -1925,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pre- exposure prophylaxis for rabies vaccine is given at?, with the following options: A: 0, 7 days, B: 0, 3, 7, 14 days, C: 0, 3, 7, 14, 30 days, D: 0, 7, 28 days - -### Response: -- Pre-exposure prophylaxis of Rabies - 3 intramuscular doses at 0, 7, 21/28 days - Post-exposure prophylaxis - on days 0, 3, 7, 14 & 28 - Essen/ WHO schedule Additional dose on day 90 - advised in immunocompromised/ severely malnourished individuals -### End" -1926,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Peritonsillar Abscess, pain is referred to ear due to, with the following options: A: Facial Nerve, B: Glossopharyngeal Nerve, C: Vagus Nerve, D: AuriculoTemporal Nerve - -### Response: -In Peritonsillar Abscess or Quinsy, pain is referred to ear Glossopharyngeal Nerve (Tympanic or Jacobson's branch of Tympanic Plexus) because it is passing close to the peritonsillar space which might get irritated due to inflammation. Thus leading to referred otalgia in the patient -### End" -1927,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2 month old baby with acute viral hepatitis like illness slips into encephalopathy after 48 hours. The mother is a known hepatitis B carrier. Mother's hepatitis B virus serological profile is most likely to be:, with the following options: A: HbsAg positive only, B: HbsAg and HbeAg positive, C: HbsAg and Hbe antibody positive, D: HBVDNA positive - -### Response: -HBeAg-positive women in third trimester frequently transmit infection to the fetus (80-90%) in the absence of immunoprophylaxis, whereas those who are negative rarely infect the fetus. After delivery both HBIG and Hepatitis B vaccine is given to the neonate. Ref: Kliegman, Behrman, Jenson, Stanton (2008), Chapter 355, ""Viral Hepatitis"", In the book, ""NELSON TEXTBOOK OF PEDIATRICS"", Volume 2, 18th Edition, New Delhi, Page 1683. -### End" -1928,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not the action of TGF-b, with the following options: A: Anti-inflammatory, B: Proliferation of fibrous tissue, C: Inhibition of metalloproteinases, D: Anaphylaxis - -### Response: -Ans. (d) Anaphylaxis(Ref: Robbins 9th/pg 86-87, 105, Immunology: Mucosal and Body Surface Defences, 4.8)Transforming growth factor-b (TGF-b) is the most important cytokine for the synthesis and deposition of connective tissue proteins. Other functions: Angiogenesis. Anti-inflammatory cytokineUp-regulation of tissue inhibitor of metalloproteinas- es-3 gene expression is done by TGF-beta in articular chondrocytes -### End" -1929,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudo-isomorphic phenomenon is seen in ?, with the following options: A: Psoriasis, B: Lichen planus, C: Vitiligo, D: Molluscum contagiosum - -### Response: -Ans. is 'd' i.e., Molluscum contagiosum -### End" -1930,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A six yr. old female presents with constipation and urinary retention. On examination a presecral mass is noted. Most probable dignosis is, with the following options: A: Pelvic neuroblastoma, B: Rectal duplication cyst, C: Sacrococcygeal teratoma, D: Anterior Sacral meningocele - -### Response: -.meningocele It is the herniation of meninges through a weak point of spine where bony fusion has not taken place effectively. Swelling is covered with pia mater and arachnoid mater without dural covering and contains CSF. Clinical Features - * Present since bih. * Soft, cystic, fluctuant with transillumination. * Signs of compressibility. * Expansile impulse when asked to cough or when child cries. Location * Lumbosacral - commonest. * Occipito cervical - 2nd most common. ref:SRB&;s manual of surgery,ed 3,pg no 1053 -### End" -1931,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In spinal anaesthesia the drug is deposited between, with the following options: A: Dura and arachnoid, B: Pia and arachnoid, C: Dura and veebra, D: Into the cord substance - -### Response: -Ans. is 'b' i.e., Pia and arachnoid matter Spinal anaesthesia In spinal anaesthesia LA is injected into subarachnoid space (space between pia matter and arachnoid matter). Structure pierced during SA (from outside in) - Skin - Subcutaneous tissue --> Supraspinous & intraspinous ligament --> Ligamentum falvum --> Duramater -->Arachnoidmater. Site of spinal anaesthesia L2_3 or L3_4 interveebral space in adult (In adult spinal cord ends at lower border of Ll veebrae). L4_5 interveebral space in children (spinal cord ends at lower border of L3 veebrae in children). Spinal anaesthesia leads to creation of a zone of differential blockade, ie motor fibres are blocked two levels lower and autonomic fibres are blocked two levels higher than the sensory blockade due to different sensitivity of different fibres. -### End" -1932,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amphotericin B treatment mandates the monitoring of which of the following electrolytes -, with the following options: A: Na+, B: Ca2+, C: Mg2+, D: None - -### Response: -Ans. is `c i.e. Mg+2 -### End" -1933,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Minimal change disease is :, with the following options: A: Appears normal under light microscopy but electron microscope shows loss of foot processes., B: Mesangial deposits, C: Tram Track appearance, D: Gross haematuria - -### Response: -Answer is A (Appears normal under light microscope but Electron microscope shows loss of foot processes) It is characterised by diffuse loss of foot processes of epithelial cells, which however, is detectable by electron microscopy only; Glomeruli appear normal by Light microscopy. No electron dense deposits are seen in minimal change disease. Mesangial deposits are a feature of mesangioproliferative G.N. eg. Ig A nephropathy. Tram-track appearance is a feature of membrano-proliferative G.N. Haematuria is not a feature of minimal change disease. Gross haematuria is seen in glomerulonephritis that cause acute nephritic syndrome eg. post streptococcal G.N. and IgA G.N. -### End" -1934,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is elevated in Pyridoxal Phosphate deficiency?, with the following options: A: FIGLU, B: Homocystine, C: Methylmalonic acid, D: Xanthurenic acid - -### Response: -Xanthurenic acid >> Homocysteine (Both are increased in PLP deficiency) 3-OH Kynurenine is one of the intermediate in Tryptophan catabolism Normally conveed to next intermediate and this conversion requires vitamin B6/ PLP. But in B6 deficiency, 3-OH Kynurenine is diveed to form alternate metabolite= Xanthurenic acid (See fig) which is excreted in urine. Homocystine is a chemical compound consisting of two homocysteine molecules joined by a disulfide. -### End" -1935,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with severe atherosclerosis of the external iliac aery and adjacent femoral aery is scheduled for coronary aery bypass surgery. The surgeon decides to use a long, mostly unbranched muscular vein found on the medial aspect of the leg both above and below the knee. Through which of the following structures does this vein pass to eventually join the femoral vein?, with the following options: A: Anatomic snuff box, B: Antecubital fossa, C: Fossa ovalis, D: Inguinal canal - -### Response: -The vein described is the greater (long) saphenous vein, which stas on the dorsal surface of the foot, wraps proximally to follow the medial aspect of the leg below and past the knee, and then dives into the deep fascia through the fossa ovalis (also called the saphenous opening) to reach the femoral vein, which becomes the external iliac vein sholy after it is joined by the greater saphenous vein. The anatomic snuff box is on the wrist. Some authors also refer to an ""anatomic snuff box of the foot,"" through which the saphenous vein does pass, but this is early in its course, and not just before it joins the femoral vein. The antecubital fossa is at the elbow. The inguinal canal contains structures going to and from the testes. -### End" -1936,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carbamazepine in elderly causes:, with the following options: A: Hypernatremia, B: Hyponatremia, C: Hyperkalemia, D: Hypokalemia - -### Response: -Carbamazepine Chemically related to imipramine, it was introduced in the 1960s for trigeminal neuralgia; is now a first line antiepileptic drug. Carbamazepine modifies maximal electroshock seizures as well as raises threshold to PTZ and electroshock convulsions. It also inhibits kindling. Though its action on Na+ channels (prolongation of inactivated state) is similar to phenytoin, the profile of action on neuronal systems in brain is different. Carbamazepine exes a lithium-like therapeutic effect in mania and bipolar mood disorder. It also has antidiuretic action, probably by enhancing ADH action on renal tubules. Adverse effects Carbamazepine produces dose-related neurotoxicity-sedation, dizziness, veigo, diplopia and ataxia. Vomiting, diarrhoea, worsening of seizures are also seen with higher doses. Acute intoxication causes coma, convulsions and cardiovascular collapse. Hypersensitivity reactions are rashes, photosensitivity, hepatitis, lupus like syndrome, rarely agranulocytosis and aplastic anaemia. Some degree of leucopenia due to hypersensitivity is more common. Water retention and hyponatremia can occur in the elderly because it enhances ADH action. Increased incidence of minor foetal malformations has been repoed. Its combination with valproate doubles teratogenic frequency. Ref: K D Tripathi 8th edition -### End" -1937,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to Mental Health Care Act, 2017, the punishment for suicide attempt is:, with the following options: A: 1 year imprisonment, B: 3 year imprisonment, C: 5 year imprisonment, D: None of the above - -### Response: -Mental Health Care Act, 2017 Mental health establishment Everyone has the capacity to make mental healthcare and treatment decisions. Advanced directive( Patient has the right to choose about the treatment options and from whom he should recieve the treatment) Nominated representative Ban on direct ECT(ECT done directly without giving anesthesia or muscle relaxant) Ban on ECT in minors Ban on psychosurgery Decriminalization of suicide -### End" -1938,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About Langerhans cell histiocytosis, true are all EXCEPT, with the following options: A: Peak incidence less than 3 years of age, B: Radiosensitive, C: Diffuse form is known as Letterer -siwe-disease, D: Gonadal involvement occurs - -### Response: -DISCUSSING THE OPTIONS ONE BY ONE: a. Peak incidence less than 3 years of age - True; More common and more severe in younger children b. Radiosensitive -True - as Bone lesions & Pituitary lesions causing DI, respond well to radiotherapy c. Diffuse form is known as Letterer-siwe disease -True d. Gonadal involvement occurs - False; Gonadal involvement is usually not seen in LCH. - Involvement of bones, scalp, pituitary, lungs, hematopoiesis is seen -### End" -1939,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In atherosclerosis, increased LDL in monocyte macrophage due to -, with the following options: A: LDL receptors on macrophage, B: LDL receptors on macrophage, C: Lipids in LDL'get oxidized, D: Lipids in LDL'get oxidized - -### Response: -Ans. is 'c' i.e., Lipids in LDL gets oxidized -### End" -1940,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of tuberculous pleural effusion?, with the following options: A: LDH > 60% serum LDH, B: Adenosine deaminase, C: WBC count 5000 - 10000, D: Increased mesothelial cells - -### Response: -The effusion caused by post primary tuberculosis (TB) represents a delayed hypersensitivity reaction to spillage of organisms into the pleural space. The pleural fluid has the qualities of an exudates. The glucose concentration may be low (<60 mg/dL). pH of tuberculous effusion is below 7.2. Lymphocytes predominate and will be >50%. Mesothelial cells are scarce (<2%). The white cell count averages 5,000 to 2,000/mL. Adenosin deaminase levels are higher ( > 45 IU/L) for tuberculosis. Pleural fluid gamma-interferon (> 140 pg/mL) is also elevated. Positive polymerase chain reaction (PCR) is seen. -### End" -1941,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are indirect radiologic signs of collapse of lung EXCEPT -, with the following options: A: Mediastinal displacement, B: Hilar displacement, C: Compensatory hyperinflation, D: Loss of aeration - -### Response: - -### End" -1942,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to the treatment plan plaque control, root planning under:, with the following options: A: Preliminary phase., B: Etiotropic phase., C: Surgical phase., D: Restorative phase. - -### Response: -Phase 1 is also known as Etiotropic phase which includes plaque control, diet control, scaling, root planning and temporary restorations. -### End" -1943,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are examples of microdeletion syndromes, EXCEPT:, with the following options: A: Wilms' tumor-aniridia complex, B: Miller Dieker syndrome, C: Velocardiofacial syndrome, D: None of the above - -### Response: -The term contiguous gene syndrome refers to genetic disorders that mimic a combination of single-gene disorders. They result from the deletion of a small number of tightly clustered genes. Because some are too small to be detected cytogenetically, they are termed microdeletions. The application of molecular techniques has led to the identification of at least 18 of these microdeletion syndromes. Some of the more common ones include the Wilms' tumor-aniridia complex (WAGR), Miller Dieker syndrome (MDS), and velocardiofacial (VCF) syndrome. WAGR is characterized by mental retardation and involvement of multiple organs, including kidney (Wilm's tumor), eye (aniridia), and the genitourinary system. Ref: Harrison's principle of internal medicine 17th edition, chapter 64. -### End" -1944,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following antibiotics binds to penicillin-binding protein-2 (PBP-2)?, with the following options: A: Penicillin, B: Amdinocillin, C: Amphotericin, D: Chloramphenicol - -### Response: -The antibiotics in these questions have significantly different modes of action. Recent evidence suggests that while penicillin inhibits the final cross-linking of the cell wall, it also binds to penicillin-binding proteins and inhibits certain key enzymes involved in cell-wall synthesis. The mechanism is complex. Amdinocillin, although classified as a penicillin, selectively binds to penicillin-binding protein-2 (PBP-2). Binding to PBP-2 results in aberrant cell-wall elongation and spherical forms, seen when E. coli, for example, is exposed to mecillinam. -### End" -1945,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nocturnal enuresis is commonly treated with:, with the following options: A: Imipramine, B: Chlordiazepoxide, C: Haloperidol, D: Chlorpromazine - -### Response: -In children above 5 years, imipramine 25 mg at bedtime is effective, but bed wetting may again sta when the drug is stopped. Eldery subjects with bed wetting have also benefited. Ref KD Tripati 8th ed. -### End" -1946,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: BRCA 1 gene is located on?, with the following options: A: Chromosome 13, B: Chromosome 11, C: Chromosome 17, D: Chromosome 22 - -### Response: -BRCA 1 gene is located on chromosome 17 BRCA 2 gene is located on chromosome 13 BRCA 1 mutation is having more risk than BRCA 2 mutation in breast carcinoma ref ;(page no;530) 5th edition of SRB&;S Manual of SURGERY -### End" -1947,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triacylglycerol and Cholesteryl ester are, with the following options: A: Non polar lipids, B: Polar lipids, C: Amphipathic lipids, D: None of the above - -### Response: -In general, lipids are insoluble in water since they contain a predominance of non polar (hydrocarbon) groups. However, fatty acids, phospholipids, sphingolipids, bile salts, and to a lesser extent, cholesterol contain polar groups. Therefore, a part of the molecule is hydrophobic, or water insoluble; and a part is hydrophilic, or water. Such molecules are described as amphipathic. Water interfaces with the polar group in the water phase and the non polar group in the oil phase. A bilayer of such amphipathic lipids is the basic. -### End" -1948,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following muscles are supplied by recurrent laryngeal nerve except:, with the following options: A: Cricothyroid, B: Arytenoid, C: Cricoarytenoid, D: None - -### Response: -Nerve Supply of muscles of larynx: -Motor Nerves - -Recurrent laryngeal nerve supplies posterior cricoarytenoid, lateral cricoarytenoid, transverse and oblique arytenoid, aryepiglottic, thyroarytenoid, thyroepiglottic muscles.  -It supplies all intrinsic muscles except cricothyroid. -External laryngeal nerve only supplies the cricothyroid muscle. - -Sensory Nerves - -The internal laryngeal nerve supplies the mucous membrane up to the level of the vocal folds.  -The recurrent laryngeal nerve supplies it below the level of the vocal folds. - -Key Concept:  -Cricothyroid is supplied by external laryngeal branch of superior laryngeal nerve. -### End" -1949,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. On examination 6th cranial nerve shows weakness. What is he is most likely to be suffering from?, with the following options: A: Delirium tremens, B: Korsakoff s psychosis, C: Wernicke encephalopathy, D: De Clerambault syndrome - -### Response: -Wernicke encephalopathy is an acute disorder which is a triad of ataxia, ophthalmoplegia and confusion. It is caused by thiamine deficiency and is most common in chronic alcoholics, it can also occur from malnutrition from any cause. The major sites of involvement are medial thalamic nuclei, mammillary bodies, periaqueductal and periventricular brainstem nuclei (especially oculomotor, abducens, and acoustic nerves), and superior cerebellar vermis. Cerebellar and vestibular involvement both contribute to the ataxia. Other classic findings includes an amnestic syndrome or global confusional state, horizontal or combined horizontal veical nystagmus, bilateral lateral rectus palsies, and absent ankle jerks. Ref: Clinical Neurology By Roger P. Simo, 7th Edition, Chapter 3; CURRENT Diagnosis & Treatment Emergency Medicine, 7th Edition, Chapter 37 -### End" -1950,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Swimming pool conjunctivitis is caused by, with the following options: A: Picorna virus, B: Chlamydia trachomatis, C: Adenovirus type 8, D: Gonococcus - -### Response: -ADULT INCLUSION CONJUNCTIVITIS Etiology : Inclusion conjunctivitis is caused by serotypes D to K of Chlamydia trachomatis. The primary source of infection is urethritis in males and cervicitis in females. The transmission of infection may occur to eyes either through contaminated fingers or more commonly through contaminated water of swimming pools (hence the name swimming pool conjunctivitis). Reference :- A K KHURANA;6th edition , page:- 68 -### End" -1951,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: X-rays are formed when electrons hit:, with the following options: A: Water, B: Anode, C: Radium source, D: None of the above - -### Response: -Ans. Anode -### End" -1952,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding medical treatment of endometriosis except?, with the following options: A: Oral progestins cause decidualization of endometrial tissue, B: Injectable progestagen is used once in 3 months in the management of pain of endometriosis, C: Levonorgestrel releasing intrauterine system reduces dysmenorrhoea in endometriosis, D: Gestrinone is given orally 2.5 - 5 mg per day to induce endometrial atrophy - -### Response: -Gestrinone has a long half life. It is a 19-noestosterone derivative. It is given orally 2.5 to 5 mg twice weekly for 6 to 9 months. It has androgenic, antiprogestagenic, antioestrogenic and antigonadotrophic action. Ref : Shaw's Textbook of Gynaecology -### End" -1953,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disinfection duration of alginate impression, when immersion method is used, should not exceed, with the following options: A: 10 min, B: 20 min, C: 5 min, D: 30 min - -### Response: -Feedback -The current protocol for disinfecting hydrocolloid impression is to use household bleach 1:10 dilution , iodophors or synthetic phenols. The time of immersion should not exceed 10min, when immersion method is used. -### End" -1954,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: RNA fragments are sequenced by -, with the following options: A: Eastern-blot, B: Western blot, C: Northern blot, D: Southern-blot - -### Response: -Blotting techniques combine a fractionation and a detection method to provide a sensitive technique for analysis of DNA, RNA and Protein. - - -Southern blot  :  For 'DNA' -Northern blot   :  For 'RNA' -Western blot    :  For 'Protein' (Immunoblotting) -### End" -1955,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Useful screening test for lead is measurement of, with the following options: A: Amino-laevulinic acid in urine, B: Coproprophyrin in urine, C: Lead in blood, D: Lead in urine - -### Response: -Diagnosis of lead poisoning: -### End" -1956,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year-old man without a significant medical history comes to the emergency room with a 3-day history of fever and shaking chills, and a 15-minute episode of rigor. He also reports a cough productive of yellow-green sputum, anorexia, and the development of right-sided pleuritic chest pain. Shortness of breath has been present for the past 12 hours. Chest x-ray reveals a consolidated right middle lobe infiltrate, and CBC shows an elevated neutrophil count with many band forms present. Which feature would most strongly support inpatient admission and IV antibiotic treatment for this patient?, with the following options: A: Recent exposure to a family member with influenza, B: Respiratory rate of 36/min, C: Recent sexual exposure to an HIV-positive patient, D: Purulent sputum with gram-positive diplococci on Gram stain - -### Response: -Because of the development of effective oral antibiotics (respiratory fluoroquinolones, extended spectrum macrolides), many patients with community-acquired pneumonia (CAP) can be managed as an outpatient as long as compliance and close follow-up are assured. The CURB-65 score is a validated instrument for determining if inpatient admission (either observation or full admission) is indicated. Factors predicting increased severity of infection include confusion, urea above 19 mg/dL, respiratory rate above 30, BP below 90 systolic (or 60 diastolic), and age 65 or above. If more than one of these factors is present, hospitalization should be considered.This patient's presentation (lobar pneumonia, pleuritic pain, purulent sputum) suggests pneumococcal pneumonia. The pneumococcus is the commonest organism isolated from patients with CAP. Fortunately, Spneumoniae is almost always sensitive to oral antibiotics such as clarithromycin/azithromycin and the respiratory fluoroquinolones. A Gram stain suggestive of pneumococci would therefore only confirm the clinical diagnosis. Exposure to influenza is an important historical finding. Patients with influenza often have a prodrome (upper respiratory symptoms, myalgias, prostrating weakness), but influenza would not cause a lobar infiltrate. Staphylococcus aureus pneumonia can sometimes follow influenza. Acute lobar pneumonia, even in an HIV-positive patient, is usually due to the pneumococcus and can often be treated as an outpatient. Pneumocystis jiroveci pneumonia is usually insidious in onset, causes diffuse parenchymal infiltrates, and does not cause pleurisy or pleural effusion. Physical examination signs of consolidation confirm the CXR finding of a lobar pneumonia (as opposed to a patchy bronchopneumonia) and would simply affirm the importance of coverage for classic bacterial pathogens (i.e., pneumococci, H influenzae). Atypical pneumonias (due to Mycoplasma, Chlamydia, or Legionella) are usually patchy and do not usually cause pleural effusion. Currently recommended treatment regimens for CAP cover both typical and atypical pathogens. -### End" -1957,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vertuccis type III canal configuration is represented as, with the following options: A: 1/2/2001, B: 2/1/2002, C: 1-Feb, D: 1-2-1-2 - -### Response: -Type I…1; type II….2-1; Type III 1-2-1; type IV …2; type V..1-2, Type vi…2-1-2, type VII..1-2-1-2; type VIII…3 -### End" -1958,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Marble bone disease is, with the following options: A: Osteogenesis imperfect, B: Osteopetrosis, C: Osteomyelitis, D: Osteoporosis - -### Response: -(Osteopetrosis): (307- Malushwari 4th edition)OSTEOPETROSIS (Marble bones, Alber's - Schonberg disease)* Characterised by dense but brittle bones* Autosomal dominant disorderCP-* Pathological fractures* Cranial nerve compression]---Due to bone encroachment on foramena* Jaw osteomyelitis (After tooth extraction)* Anemia* X-ray shows - Increased density of the all the all the bones* Cortices are widened leaving narrow medullary canal Sclerotic vertebral end plates producing a striped appearance (rugger Jersey spine)* Skull is thickened and the base densely sclerotic -### End" -1959,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common heart lesion in down syndrome:, with the following options: A: Endocardial cushion defect, B: ASD with ostium secundum, C: VSD, D: Coarctation of aorta - -### Response: -a. Endocardial cushion defect(Ref: Nelson's 20/e p 610-614)Most common cardiac defect in Down syndrome is Endocardial cushion defect or Atrioventricular septal defect -### End" -1960,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25 year old male was hospitalized with liver cyst due to Echinococcus granulosus. He refused to undergo surgery for removal of cyst. Therefore, albendazole was used at high dose for 3 months. This patient should be monitored for the toxicity to:, with the following options: A: Gonads, B: Kidney, C: Liver, D: Peripheral nerves - -### Response: -When used for 1-3 days, albendazole is nearly free of significant adverse effects. Mild and transient epigastric distress, diarrhea, headache, nausea, dizziness, lassitude, and insomnia can occur. In long-term use for hydatid disease, albendazole is well tolerated, but it can cause abdominal distress, headaches, fever, fatigue, alopecia, increases in liver enzymes, and pancytopenia. Hence blood counts and liver function should be monitored during long-term therapy. -### End" -1961,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A chest physician performs bronchoscopy in the procedure room of the outpatient depament. To make the instrument safe for use in the next patient waiting outside, the most appropriate method of disinfection is by:, with the following options: A: 70% alcohol for 5 min, B: 2% glutaraldehyde for 20 min, C: 2% formaldehyde for 10 min, D: 1% sodium hypochlorite for 15 min - -### Response: -Techniques for Sterilization Steam Surgical instruments Ethylene Oxide Hea lung machine, respirators , dental labs Hot air oven Glass syringe, test tubes, flasks, cutting instruments Irradiation (gamma rays) Industrial packing Paraacetic acid (STERIS) Flexible endoscopes Isopropyl alcohol Clinical thermometer Beta propiolactone > Formaldehyde Fumigation of OT, labs, wards 2% Glutaraldehyde Endoscope (Cystoscope, Bronchoscope) Autoclaving Culture media, suture materials except catgut Ref: Bailey 24th edition Pgno: 135 -### End" -1962,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IL2 is secreted by?, with the following options: A: Neutrophills, B: Helper T-cells, C: Macrophages, D: NK cells - -### Response: -Ans. is 'b' i.e., Helper T-cells o IL-2 is secreted by lectin- or antigen-stimulated helper T cellsSelected important cytokinesNameMajor Cellular SourceSelected Biologic EffectsIFN-a, -bLeukocytes (IFN-a), fibroblasts (IFN-b)Antiviral, pyrogenicIFN-( interferon)T cells, NK cellsActivates mononuclear phagocytesTNF-a (tumor necrosis factor alpha)Macrophages, NK cellsCell activation, fever, cachexia, antitumorTNF -b (tumor necrosis factor beta), LT (lymphotoxin)T cells, B cellsActivates leukocytes, antitumorIL-1 (interleukin - 1)Macrophages, epithelial cellsT cell and macrophage activation,fever, cachexiaIL-2 (interleukin - 2)T cells (CD4 Helper T-cells)T cell growth and activationIL-3 (interleukin - 3)T cells, thymic epithelial cellsHematopoiesisIL-4 (interleukin - 4)T cells, mast cells, NK cellsB cell proliferation and switching to IgEIL-5 (interleukin - 5)T cellsDifferentiation of eosinophils(NEET)IL-7 (interleukin - 7)Bone marrow stromal cellsLymphoid progenitor differentiation -### End" -1963,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tributary of the cavernous sinus includes all of the following, except, with the following options: A: Superior petrosal sinus, B: Inferior petrosal sinus, C: Superficial middle cerebral vein, D: Deep middle cerebral vein - -### Response: -FROM THE ORBIT Superior ophthalmic vein Branch of inferior ophthalmic vein Central vein of retina may either drain either into the superior ophthalmic vein or into the cavernous sinus FROM THE BRAIN *superficial middle cerebral vein *inferior cerebral veins FROM THE MENINGES Sphenoparietal sinus Frontal trunk of the middle meningeal vein may drain either into the pterygoid plexus through the foramen ovale or to sphenoparietal or cavernous sinus. Ref:BDC vol 3 page no:194 -### End" -1964,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug develops the resistance by inactivating enzymes:, with the following options: A: Aminoglycosides., B: Beta lactams., C: Chloramphenicol., D: All of the above. - -### Response: -Drug resistance by Inactivating  enzymes:  -A – Aminoglycosides  -B – Beta lactams  -C – Chloramphenicol -### End" -1965,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the rate of BER in the stomach?, with the following options: A: About 1.5/min in the stomach., B: About 15/min in the stomach., C: About 4/min in the stomach., D: About 0.4/min in the stomach. - -### Response: -About 4/min in the stomach. Basic Electrical Rhythm (BER): Smooth muscle cells of the gastrointestinal tract have spontaneous rhythmic fluctuations in membrane potential between about -65 and -45 mV. BER initiated by Pacemaker cells called ""Interstitial cells of Cajal"" Metrics: The threshold for the action potential is -50 mV. The rate of BER: About 4/min in the stomach. About 12/min in duodenum About 8/min - distal ileum (falls down) In Colon: Rate rises from about 2/min at Cecum -----------> about 6 min at the Sigmoid colon. -### End" -1966,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The basis of combining ritonavir with lopinavir:, with the following options: A: Pharmaceutical compatibility, B: C4P3A4 inhibition by ritonavir, C: Long elimination half life of ritonavir, D: Ability to counteract side-effects of lopinavir - -### Response: -Five protease inhibitors-Indinavir (IDV), Nelfinavir (NFV), Saquinavir (SQV), Ritonavir (V) and Lopinavir (in combination with ritonavir LPV /r) have been marketed in India for use against HIV.All are extensively metabolized by CYP3A4 and other CYP isoenzymes. All (especially ritonavir and lopinavir) are potent inhibitors of CYP3A4, while few other CYP isoenzymes are induced. The Pis interact with many drugs. Nelfinavir and ritonavir induce their own metabolism.Ritonavir: It is a potent PI; also a potent CYP3A4 inhibitor. .ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:772,773,774 -### End" -1967,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of Adenomatoid goitre which carcinoma is commonest to occur -, with the following options: A: Medullary Ca, B: Follicular Ca, C: Papillary Ca, D: Anaplastic Ca - -### Response: -""An increased incidence of cancer (usually follicular) has been reported from endemic areas. Dominant or rapidly growing nodules in longstanding goitres should always be subjected to aspiration cytology."" - Bailey & Love -### End" -1968,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True/false about mediastinal masses Thymoma is most common anterior mediastinal mass. Neurogenic tumour is most common posterior mediastinal mass. IOC to evaluate anterior and posterior mediastinal mass is MRI. Extramedullary hematopoiesis is a type of anterior mediastinal mass. Mediastinal mass forms an acute angle with lung surface., with the following options: A: TTTFF, B: TFTFF, C: TFFFF, D: FFFFF - -### Response: -Thymoma is most common anterior mediastinal mass. Neurogenic tumour is most common posterior mediastinal mass. LEFT- A lung mass abutts the mediastinal surface and creates acute angles with the lung. RIGHT: A mediastinal mass will sit under the surface of the mediastinum, creating obtuse angles with the lung. -### End" -1969,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following conditions is commonly encountered in a female newborn and requires no therapy?, with the following options: A: Enlarged clitoris, B: Labial fusion, C: Mucoid vaginal discharge, D: Prolapsed urethra - -### Response: -Ans. C. Mucoid vaginal dischargeIn a female newborn, presence of a white mucoid discharge at the vulva may be due to influence of maternal estrogen transmitted trans placentally to the fetus. It resolves by itself. Rarely bleeding from vagina may also be seen which is also physiological and requires no treatment. -### End" -1970,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 49 year old man suffering from carcinoma of prostate was x -rayed. He showed areas of sclerosis and collapse of T10 and T11 vertebrae in x-ray. The spread of this cancer to the above vertebrae was through, with the following options: A: Sacral canal, B: Lymphatic vessels, C: Internal vertebral plexus of veins, D: Superior rectal vein - -### Response: -Ans. is 'c' i.e. Internal vertebral plexus of veins Prostatic cancer spreads to the bones through blood vessels; first into the periprostatic venous plexus* and then into the internal vertebral plexus of veins. This metastasis is possible because of valveless communication* between the periprostatic and vertebral plexus of veins.Points of importance -Most common sites * of bony metastasis for prostatic CA-: Lumbar vertebrae > Proximal femur > Pelvis Bony metastasis of prostate CA are mainly osteoblastic* and cause sclerotic lesions. -### End" -1971,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Good prognosis factors of ALL are all EXCEPT:, with the following options: A: Hyperdipoidy, B: Female sex, C: Pre B cell ALL, D: T (12:2) translocation - -### Response: -Pre B cell ALL REF: Devita's ed p. 2240, Nelson 17"" ed p. 1695 Prognostic factors for ALL Determinants Favourable Unourable WBC count Low High Age 3-7 yrs <1, > 10 yrs Sex Female Male Race White Black Hepatosplenomegaly and lymphadenopathy Absent present Testicular involvement Absent Present CNS Absent Ove FAB classification L1 L2 PLOIDY Hyperdiploidy hypoploidy Cytogenetic markers Trisomy 4,10, 7 7 t(12:21) tel:aml t(9:22) (bcr:abl) t(4:11) (mil af4) t(1:19) Time of remission <14 d >28 d Minimal residual disease <10-4 >10-3 Immunophenotype Early pre B cell T cell -### End" -1972,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Parasympathetic stimulation induces salivary acinar cells to release the protease:, with the following options: A: Bradykinin, B: Kallikrein, C: Kininogen, D: Kinin - -### Response: -Ans. B. KallikreinParasympathetic stimulation induces the release of kallikrein by the salivary acinar cells, which converts kininogen to form lysyl-bradykinin (a potent vasodilator). Bradykinin is a vasoactive peptide. Kininogen is the precursor for kinins. Kinins include bradykinin and lysyl-bradykinin. Aminopeptidase releases amino acids from the amino end of peptides and is found in the brush border membrane and cytoplasm of enterocytes -### End" -1973,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is only vascular disease with panarteritis where internal elastic lamina is preserved, with the following options: A: Buerger's disease, B: Takayasu arteritis, C: Raynaud's disease, D: Churg Strauss syndrome - -### Response: -Buerger's disease is only panarteritis where internal elastic lamina is preserved. -### End" -1974,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement regarding migraine in pregnancy is:, with the following options: A: Ketorolac is preferred, B: NSAIDs are first line drugs, C: Improved symptoms with pregnancy, D: Sumatriptan preferred over chlorpromazine - -### Response: -Ans: (b) NSAIDs are first line drugsRef: Harrison's Principles of Internal Medicine, 19th edition, Page 2592Treatment of Acute MigraineNSAIDsNaproxen, lbuprofen,Tolfenamic acid Diclofenac, Acetominophen5-HT1 Receptor AgonistsOral: Ergotamine, Naratriptan, Rizatriptan, Sumatriptan, Frovatriptan, Almotriptan, Eletriptan, ZolmitriptanNasal: Sumatriptan, Zolmitriptan Parenteral: Dihydroergotamine, SumatriptanDopamine Receptor AntagonistsOral: Metoclopramide, ProchlorperazineParenteral: Chlorpromazine, Metoclopramide, ProchlorperazineOthersNasal: Butorphanol Parenteral: OpioidsMigraine During PregnancyImprovement in 'migraine without aura'Worsening of 'migraine with aura'Ergot derivatives are contraindicated due to possibility of uterine hypertonicity and vascular disruption leading on to miscarriageSafety of Triptans during pregnancy is not fully confirmed. Can be used only if other drugs are not effectiveTreatmentFirst line: NSAIDs and paracetamolTriptans are avoidedProphylaxis: Magnesium, Metoprolol -### End" -1975,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 year old male child presented with deterioration of renal functions. On examination, he is mentally retarded and has got athetosis. There are multiple healed wounds on his body. His mother reassures you that it was as a result of self inflicted injuries. USG showed bilateral renal calculi. Which of the following statements is FALSE regarding the above mentioned condition?, with the following options: A: Allopurinol may be used in treating the condition, B: Death from end stage renal disease during adolescence is common, C: It is an autosomal recessive condition, D: Kelley - Seegmiller syndrome is a milder variant of the condition - -### Response: -Lesch - Nyhan syndrome is an X linked recessive condition and is seen in males. In this condition there is complete lack of hypoxanthine guanine phosphoribosyl transferase. This causes the accumulation of both hypoxanthine and guanine, it is subsequently metabolised to xanthine and finally to uric acid. In Kelley - Seegmiller syndrome occurs due to paial deficiency of HP. Ref: Essential revision notes for MRCP by Philip A Kalra, Edition 3, Page 323 -### End" -1976,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Good prognostic Factors for ALL include all of the following, Except:, with the following options: A: Hyperdiploidy, B: Female sex, C: Pre B cell ALL, D: t (12 : 21) translocation - -### Response: -Answer is C (Pre B cell ALL) Hyperdiploidy, Female sex and translocation t (12, 21) are associated with good prognosis. Pre B cell ALL may be associated with a poor prognosis and is the single answer of exclusion. -### End" -1977,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Flumazenil is:, with the following options: A: Opiate antagonist, B: Diazepam antagonist, C: Opiate agonist, D: Antianginal drug - -### Response: -Diazepam antagonist -### End" -1978,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neutral substances are transported across the cell membrane by, with the following options: A: Porins, B: lonophore, C: Lipopolysaccharides, D: Diffusion - -### Response: -Neutral substances cross membranes based on their concentration gradient. That occurs by diffusion. -### End" -1979,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 13-year-old, previously healthy boy has had pain in the right leg for the past month. There is no history of trauma or recent illness. On physical examination, there is warmth and tenderness to palpation of the right lower thigh anteriorly, and the circumference of the right thigh is slightly larger than that of the left. His temperature is 39degC. A radiograph of the right leg shows a 6-cm expansile mass in the diaphyseal region of the right lower femur that extends into the soft tissue and is covered by layers of reactive bone. A biopsy of the mass is done, and microscopic examination shows sheets of closely packed primitive cells with small, uniform nuclei and only scant cytoplasm. Karyotypic analysis of the tumor cells shows a t(11;22) translocation. What is the most likely diagnosis?, with the following options: A: Chondrosarcoma, B: Ewing sarcoma, C: Giant cell tumor, D: Metastatic carcinoma - -### Response: -The histologic appearance is characteristic of an Ewing sarcoma. The radiologic appearance of the mass in this child is typical for a malignant tumor, with bone destruction and soft-tissue extension. The two most common malignant bone tumors in children are osteosarcoma and Ewing sarcoma. Osteosarcomas typically arise in the metaphyseal region, whereas Ewing sarcoma arises in the diaphyseal region of long tubular bones, as seen in this case. This tumor usually occurs in patients 10 to 15 years old. The t (11;22) translocation is present in about 85% of Ewing sarcomas and the related primitive neuroectodermal tumors (PNETs), which belong to the small round cell tumors of childhood that can be difficult to distinguish microscopically. The translocation gives rise to the EWS-FLI1 fusion gene, now considered the definitive test for the diagnosis of these tumors. Ewing sarcomas often produce tender masses with fever and leukocytosis, mimicking acute osteomyelitis. Chondrosarcoma can occur across a wide age range, in contrast to most primary malignancies arising in bone, which occur most often in the first two decades; most are sufficiently differentiated so that a cartilaginous matrix is apparent on microscopic examination. A giant cell tumor is a benign but locally aggressive lesion that arises in the epiphysis of the long bones of young adults and has a ""soap bubble"" radiographic appearance. Metastatic carcinoma is the most common tumor of adults involving bone because there are far more carcinomas than primary bone malignancies; childhood bone metastases are rare. Osteosarcoma typically arises in the metaphyseal region, and the malignant spindle cells produce an osteoid matrix. A plasmacytoma produces a focal lytic lesion within the bone, and microscopically there are recognizable plasma cells. -### End" -1980,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about blood coagulation, except, with the following options: A: Factor X is part of both intristic and extrinsic path ways, B: Extrinsic pathway is activatied by contact with negatively charged surfaces, C: Intrinsic pathway can be activated in vitro, D: Calcium is required in several steps of coagulation - -### Response: -harshmohan textbook of pathology 7 th edition extrinsic pathway is activated only by tissue damage which causes release of thromboplastin where as intrinsic pathway is activated by surface contact. factor x is a part of common pathway. -Ca2+ is required for conversion of 1x -1xa ,prothrombin to thrombin -### End" -1981,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following antifungals cannot be given in candidal infections?, with the following options: A: Itraconazole, B: Griseofulvin, C: Fluconazole, D: All of the above - -### Response: -Griseofulvin is not effective in candidal infections. -### End" -1982,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trochlear nerve, with the following options: A: Supplies the inferior oblique muscle of the eyeball, B: Is the only cranial nerve to emerge from the dorsal aspect of the brainstem, C: Has its nucleus of origin in the midbrain at the level of the superior colliculus, D: Enters the orbit through the middle compartment of the superior orbital fissure - -### Response: -(B) Is the only cranial nerve to emerge from the dorsal aspect of the brainstem # TROCHLEAR NERVE emerges from the superior medullary velum near the frenulum veli just below the inferior colliculus.> Trochlear nerve is the only cranial nerve which emerges on the dorsal aspect of the brainstem.> When the trochlear nerve is damaged, diplopia occurs on looking downwards: vision is single so long as the eyes look above the horizontal plane. -### End" -1983,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recommended dose of Oseltamavir for a 9 month old baby for treating swine flu is:, with the following options: A: 2 mg/ kg twice daily for five days, B: 2.5 mg/ kg twice daily for five days, C: 3 mg/ kg twice daily for five days, D: 3.5 mg/ kg twice daily for five days - -### Response: -Recommended dose of Oseltamavir: age dose 0-1 month 2 mg/ kg twice daily for five days >1-3 month 2.5 mg/ kg twice daily for five days 3-12 month 3 mg/ kg twice daily for five days For infants older than 1 year of age and for children 2 to 12 years of age recommended doses are as follows: 15kg or less - 30 mg orally twice a day for 5 days 15-23 kg -45 mg orally twice a day for 5 days 24-40 kg - 60 mg orally twice a day for 5 days >40kg - 75 mg orally twice a day for 5 days Ref: Park's textbook of Preventive and Social Medicine, 21stedition, page-148 -### End" -1984,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Slow waves in EEG is seen in, with the following options: A: Depression, B: Mania, C: Schizophrenia, D: Delirium - -### Response: -schizophrenia: widespread slow activity, dysrhythmia, spikes, and spike-wave complexes) generally have been regarded as nonspecific. mood disorders : depression: an increase of alpha and/or beta activity left frontal regions in depressed patients. ( decreased left frontal activation) manic episode: Less alpha power and higher EEG frequencies in manic patients with respect to healthy subjects have been interpreted as a sign of overarousal Delirium: diffuse slowing of the background rhythms from alpha (8 to 13 Hz) to theta (4.0 to 7.5 Hz) activity. Delta activity (<3.5 Hz) usually does not become prominent until the patient approaches non-responsiveness. The typical changes are slowing or even loss of the posterior dominant rhythm, slow wave increase, reduced reactivity to eye-opening, and intermittent, especially frontally located, rhythmic delta activity (FIRDA). EEG changes in mood disorders, schizophrenia are non-specific. The changes in delirium are consistent than other conditions. Considering the best answer to go with D) Delirium Reference: Page No.237 1.15 Applied Electrophysiology CTP -### End" -1985,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The amniotic membrane is characterised by all except:, with the following options: A: Provides maximum tensile strength, B: Highly vascular, C: It develops after 2 - 7 days of gestation, D: Foetal ectoderm - -### Response: -Ans. is b i.e. Highly vascular Amnion and chorion are fetal membranes. The Amnion : tmpoant points - It is the innermost fetal membrane and is in contact with the amniotic fluid. At term, amnion is tough and tenacious. Almost all of the tensile strength of the fetal membranes is due to amnion.deg It is avasculardeg and plicabledeg. Amnion has 5 separate sublayers. The impoant missing elements of human amnion are : Smooth muscle cells Nerves Lymphatics Blood vessels The amnion and chorion though slightly adherent are never intimately connected and can be separated easily, even at term. Remember -- Earlier it was believed that amnion is derived from trophoblast but now it is generally accepted that epithelial cells of amnion are derived from fetal ectoderm of the embryonic disc. - The human amnion is first identifiable about 7"" -- 8"" day of embryo development. Function : Amnion is metabolically active and is involved in solute and water transpo to maintain amniotic fluid hemostasis and produce a variety of bioactive compounds including vasoactive peptides. growth factors and cytokines. -### End" -1986,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for leptomeningeal carcinomatosis:, with the following options: A: PET, B: SPECT, C: Gd enhanced MRI, D: CT scan - -### Response: -Ans is 'c' i.e. Gd-enhanced MRI Leptomeningeal carcinomatosis is a special form of metastasis where the tumor cells are widely disseminated throughout the meninges and the ventricles. Common sources are - adenocarcinoma of breast, lung, and gastrointestinal tract; melanoma; childhood leukemia; and systemic lymphoma. (Ref: Adam and Victor's Principles of Neurology 8/e p563)Haaga writes- ""The greater sensitivity of MRI for detecting leptomeningeal tumor spread has established this technique as the diagnostic modality of choice for the evaluation of possible leptomeningeal carcinomatosis.""Harrison writes- ""Leptomeningeal metastases are particularly challenging to diagnose as identification of tumor cells in the subarachnoid compartment may be elusive. MR imaging can be definitive in patients when there are clear tumor nodules adherent to the cauda equina or spinal cord, enhancing cranial nerves, or subarachnoid enhancement on brain imaging. Imaging is diagnostic in approximately 75% of patients and is more often positive in patients with solid tumors. Demonstration of tumor cells in the CSF is definitive and often considered the gold standard. However, CSF cytologic examination is positive in only 50% of patients on the first lumbar puncture and still misses 10% after three CSF samples."" -### End" -1987,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic congenital anomalies in the fetus of a diabetic women is/are :, with the following options: A: Sacral agenesis, B: Hypoplastic lung, C: Cardiac anomalies, D: Anencephaly - -### Response: -Sacral agenesis -### End" -1988,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stagnant hypoxia is seen in ?, with the following options: A: COPD, B: Anemia, C: CO poisoning, D: Shock - -### Response: -Ans. is 'd' i.e., Shock -### End" -1989,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Naegler's reaction is used for:, with the following options: A: Cl. Tetani, B: Cl. Botulinum, C: Cl. Perfringens, D: Cl. Septicum - -### Response: -Nagler's reaction Nagler's reaction is an example of Neutralization test done for detection of a toxin (lecithinase) produced by C. perfringens. The alpha toxin of C. perfringens has phospholipase activity , when grown on a medium containing egg yolk phospholipid, the organism can break this insoluble triglyceride. Phosphoryl choline release is seen as an area of opacity around the bacterial colonies. Antitoxin can inhibit a positive Nagler's response. -### End" -1990,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A woman assaulted by neighbor was brought to you in the emergency depament with fracture of middle tooth. Injury was extended medially to the mouth and there was also contusion to bilateral leg. What is the nature of the injury, with the following options: A: Grievous injury, B: Simple injury, C: Dangerous injury, D: Assault - -### Response: -Ans. a. Grievous injury Fracture or dislocation of a bone or a tooth constitute Grevious injury. Grevious Injury (Sec 320 IPC) Emasculation Permanent privation of either eyedeg Permanent privation of either ear Privation of any member (pa, organ or limb) or joint Permanent disfiguration of head or facedeg Fracture or dislocation of a bone or a toothdeg Destruction or permanent impairing of powers of any member or joint Any hu which endangers life, or which causes the sufferer to be, during the space of 20 days, in severe body pain, or unable to follow his daily routinedeg. -### End" -1991,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hill-sachs lesion is associated with, with the following options: A: Recurrent dislocation of shoulder, B: Recurrent dislocation of hip, C: Pehes' disease, D: Fracture neck of femur - -### Response: -A i.e. Recurrent dislocation of shoulder -### End" -1992,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Residual auditory defect is a common complication in meningitis caused by, with the following options: A: Staphylococcus, B: Meningococcus, C: Escherichia coli, D: Haemophilus influenzae - -### Response: -Residual auditory defect is caused by Haemophilus meningitis .so BERA is the investigation of choice done in them. Reference: GHAI Essential pediatrics, 8th edition -### End" -1993,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are true about dobutamine:, with the following options: A: Selective (3 2 receptor agonist, B: T ventricular filling pressure, C: Half life is about 2 min, D: Dopamine receptor agonist - -### Response: -Ans. (C) Half life is about 2 minDobutamine:Derivative of dopamine, but not a Dl ot D2 receptor agonist.Has action on alpha & beta receptors also.Yet, only prominent action of clinically employed doses is increased force of cardiac contraction & outPut, without significant change in hea rate, peripheral resistance & BP.Considered to be a relatively selective beta-1 agonist.Half-life of about 2 minutes & onset of action is rapid.Used as an inotroPic agent in pump failure accompanying myocardial infarction, cardiac surgery & for sho term management of severe congestive hea failure. -### End" -1994,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Use of oral contraceptives decreases the incidence of all of the following except :, with the following options: A: Ectopic pregnancy, B: Epithelial ovarian malignancy, C: Hepatic adenoma, D: Pelvic inflammatory disease - -### Response: -Benefits of combined pills -It effectively controls feility. -As it causes regular and scanty menstruation, it is useful in menorrhagia and polymenorrhoea. -By viue of nonovulation, it can relieve dysmenorrhoea and premenstrual tension. -It prevents anaemia by reducing the menstrual loss. -It has proved to lower the incidence of benign breast neoplasia such as fibrocystic disease. -It reduces the incidence of functional ovarian cyst (50%) and ovarian and uterine malignancy. The incidence of ovarian cancer is reduced by 40% and uterine malignancy by 50% if taken for 1 year, and this effect lasts as long as 10 years after stoppage. The risk decreases with duration of its use. -The incidence of PID is reduced, though it does not reach the same low level as seen with the barrier method. This effect is due to the thick cervical mucus caused by progestogen, preventing the organisms entering into the uterine cavity. -Reduced incidence of ectopic pregnancy is due to suppression of ovulation and reduction in PID. -It protects against rheumatoid ahritis. -Reduces the risk of anorectal cancer by 30-40%. -It is useful in acne, PCOD and endometriosis. Reference: Shaw's Textbook of gynaecology 16th edition page no 274 -### End" -1995,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non - noxious stimuli perceived as pain is termed as:, with the following options: A: Allodynia, B: Hyperalgesia, C: Hyperesthesia, D: Hyperpathia - -### Response: -Terminology Sensory disturbance Allodynia Situation in which a non - painful stimulus, once perceived, in experienced as painful, even excruciating. An example is elicitation of a painful sensation by application of a vibrating tuning fork. Hyperalgesia Severe pain in response to a mildly noxious stimulus Hyperpathia Threshold for a sensory stimulus is increased and perception is delayed, but once felt, it is unduly painful. Broad term encompasses all the phenomena described by hyperesthesia, allodynia, and hyperalgesia. -### End" -1996,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Medial boundry of Cubital fossa ?, with the following options: A: Brachioradialis, B: Pronator teres, C: Supinator, D: None - -### Response: -Ans. is 'b' i.e., Pronator teres -### End" -1997,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudo-myxoma peritonei occur due to?, with the following options: A: Dysgerminoma, B: Brenner s tumor, C: Theca cell tumor, D: Mucinous cystadenosarcoma - -### Response: -Pseudomyxoma peritonei (PMP) is a clinical condition caused by cancerous cells (mucinous adenocarcinoma) that produce abundant mucin or gelatinous ascites. -The primary tumor appears to arise from the MUC2 expressing goblet cells and most commonly from these cells in the appendix. The K-Ras and p53 genes may be involved in the oncogenesis. It may be diagnosed with a range of conditions. -While the majority of these cases are associated with appendiceal carcinoma other conditions may also be found, including disseminated peritoneal adenomucinosis (DPAM), peritoneal carcinomas, several mucinous tumors (mucinous adenocarcinoma, mucinous cystadenoma, and mucinous cystadenocarcinoma), as well as other disease states -This will result in compression of organs and will destroy the function of colon, small intestine, stomach, or other organs. Prognosis with treatment in many cases optimistic, but the disease is lethal if untreated, with death by cachexia, bowel obstruction, or other types of complications. -### End" -1998,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Receptors on cell membrane that activate ion channel after binding with agonists are, with the following options: A: Nicotonic Cholinergic, B: Muscarinic Cholinergic, C: Optoid n receptors, D: All - -### Response: -A i.e. Nicotinic cholinergic receptorReceptors with intrinsic ion channelThese cell surface receptors enclose ion selective channels (Na+, Ca2+, CO within their molecule. Agonist binding opens the channels & causes depolarization / hyperpolarization depending on the ion that flows through.This includes: - Nicotinic cholinergic receptorQ Glutamate receptor Glycine receptor GABAA receptorQ - 5HT3 receptorReceptorActs'ThroughMuscarinic receptor, opioid andG- protein coupledGABABreceptorMl, M3 (muscarinic)IP3-DAGM2 muscarinic, Opioid 11,6CAMP TIC+, Ca+2,1.GABAB -### End" -1999,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme deficient in alkaptonuria is, with the following options: A: Homogentisic acid oxidase, B: Tyrosinase I, C: Tyrosinase II, D: Acid maltase - -### Response: -Ans. a (Homogentisic acid oxidase). (Ref. Harper, Biochemistry, 25th ed., 332)Disorders of amino acid and urea cycle metabolismAmino acid metabolism NameEnzyme deficiencyMetabolism affected1AlbinismTyrosinaseTyrosine2AlkaptonuriaHomogentisate oxidasePhenylalanine, tyrosine3CystathioninuriaCystathionine lyaseCysteine, methionine, serine4HistidinemiaHistidine ammonia lyaseHistidine5HomocystinuriaCysthionine sythaseCysteine, methionine, serine6Maple syrup urine diseaseBranched-chain keto acid dehydrogenaseValine, isoleucine, leucine7Phenylketonuria(PKU)Phenylanine hydroxylasePhenylalanine8TyrosinosisHydroxyphenylpyruvate hydroxylaseTyrosine transaminase Urea cycle1ArgininemiaArginase2ArgininosuccinaturiaArgininosuccinate lyase3CitrullinemiaArgininosuccinate synthetase4Hyperammonemia-IOrnithine transcarbamoylase5Hyperammonemia-llCarbamoyl-phosphate synthetase-l -### End" -2000,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following is blood flow not increased in REM sleep?, with the following options: A: Primary visual coex, B: Anterior cingulate coex, C: Pons, D: Amygdala - -### Response: -Positron emission tomography (PET) scans of humans in REM sleep show increased activity in the pontine area, amygdala, and anterior cingulate gyrus, but decreased activity in the prefrontal and parietal coex.Activity in visual association areas is increased, but there is a decrease in the primary visual coex. This is consistent with increased emotion and operation of a closed neural system cut off from the areas that relate brain activity to the external world. -### End" -2001,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vascular sign of Narath is noticed in, with the following options: A: Fracture neck of femur, B: Pehes disease, C: Posterior dislocation of hip, D: All of the above - -### Response: -C i.e. Posterior dislocation of hip Vascular sign of narath is positive in posterior dislocation of hip joint. Due to posterior dislocation, the hip joint falls on the femoral aery, and this causes feeble or absent femoral pulse. -### End" -2002,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apoptotic bodies are?, with the following options: A: Clumped chromatin bodies, B: Pyknotic nucleus without organelles, C: Cell membrane bound with organelles, D: No nucleus with organelles - -### Response: -Ans. is 'c' i.e., Cell membrane bound with organellesApoptotic bodies are formed during the process of Apoptosis, by fragmentation of surface blebs of the apototic cell. These are membrane bound bodies composed of cytoplasm and tightly packed organelles, with or without nucleus. -### End" -2003,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Romana&;s sign occur in -, with the following options: A: Babesiosis, B: Leishmaniasis, C: Trypanosomiasis, D: Schistosomiasis - -### Response: -Entry of T.cruzi through conjunctiva Patient develops painless unilateral oedema and conjunctivitis It is known as Romana,a sign ( refer pgno:50 baveja 3 rd edition) -### End" -2004,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trantas spots are seen in-, with the following options: A: Vernal conjunctivitis, B: Eczematous conjunctivitis, C: Ophthalmia nodosa, D: Tularemia - -### Response: -Signs of vernal keratoconjunctivitis in Bulbar form : (i) presence of discrete whitish raised dots along the limbus (Tranta's spots) (ii) gelatinous thickened accumulation of tissue around the limbus; and (iii) dusky red triangular congestion of bulbar conjunctiva in palpebral area; ref: A K KHURANA OPHTALMOLOGY,E4, Page-75 ref img -### End" -2005,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clinical feature of minimal change glomerulonephritis are all except-, with the following options: A: Hypeension, B: Edema, C: Selective proteinuria, D: Fever - -### Response: -Ans. is 'a' i.e., HypeensionMinimal change diseaseo Minimal Change Disease is the most common cause of Nephrotic syndrome in children.o Edema and Selective proteinuria are features of nephrotic syndrome. Fever may be present on account of increased susceptibility to infection.o Minimal change disease prsents with insidious onset of nephrotic syndrome in children below 6 years of age.o Hypeension is not a feature of nephrotic syndrome and is rare in Minimal change disease. Hematuria (a finding of nephritic syndrome) is also rare.o Pathological findings include1. Light microscopy --> No abnormality2. Electron microscopy --> Obliteration (loss) and fusion offoot processes of epithelial cells.3. Immunofluorescence ----> No deposits of immune reactants4. Serum complements --> Normal levels o Minimal change disease has very good prognosis with excellent response to steroids. -### End" -2006,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bluish discoloration of flank is known as:, with the following options: A: Grey turner sign, B: Cullen sign, C: Trousseau sign, D: None - -### Response: -Ans. (a) Grey Turner signRef: Sabiston 20th edition Page 1526* Flank discoloration -- Grey turner* Peri umbilical -- Cullen sign* Inguinal -- Fox sign -### End" -2007,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Collecting duct is derived from:, with the following options: A: Ureteric bud, B: Mesonephros, C: Metanephros, D: Allantois - -### Response: -Ans. (a) Ureteric budRef : LB. Singh 9th ed./252* During the fifth week of gestation, the mesonephric duct develops an outpouching, the ureteric bud, near its attachment to the cloaca. This bud, also called the metanephrogenic diverticulum, grows posteriorly and towards the head of the embryo.* The elongated stalk of the ureteric bud, called the metanephric duct, later forms the ureter. As the cranial end of the bud extends into the intermediate mesoderm, it undergoes a series of branchings to form the collecting duct system of the kidney. It also forms the major and minor calyces and the renal pelvis. -### End" -2008,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bilateral cryptorchidism usually results in oligospermia and infeility. Orchiopexy for cryptorchidism is done at the age of:, with the following options: A: 1 to 2 years, B: 5 to 6 years, C: Pubey, D: Neonatal period - -### Response: -Cryptorchidism is defined as testes that have not fully descended into the scrotum and, unlike retractile testes cannot be manipulated into the scrotum with gentle pressure. Surgical repair (orchiopexy) is done at 6-12 months of age and has a success rate (99%). Ref: Blueprints Pediatrics By Bradley S. Marino, Katie Katie Snead Fine, 2009, Page 221. -### End" -2009,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is barrier contraception?, with the following options: A: Male sterilization, B: Female sterilization, C: Spermicidal jelly, D: Natural - -### Response: -Ans: c (Spermicidal jelly) Ref: Park, 19th ed, p. 393The aim of barrier method is to prevent live sperm from meeting the ovum. It includes:Physical methods:a) Condomb) Female condomc) Diaphragmd) Vaginal spongeChemical methods: (Spermicidal)Foams, creams, jellies, suppositories, soluble filmsCombined methods:Condom is the most widely used barrier device by the males around the world. It can be highly effective method of contraception if used correctly. An important advantage is that it protects against STDs also.Sterilization is the permanent method of contraception. -### End" -2010,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nutrition to sperm is provided by-, with the following options: A: Glucose, B: Fructose, C: Galactose, D: Starch - -### Response: -Ans. is 'b' i.e., Fructose ""Nutrition to sperms is mainly provided by fructose"". -### End" -2011,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following conditions, the medical treatment of ectopic pregnancy is contraindicated:, with the following options: A: Sac size is 3 cm, B: Blood in pelvis is 70 mL, C: Presence of fetal heart activity, D: Previous ectopic pregnancy - -### Response: -Ans. is c, i.e. Presence of fetal heart activityRef Dutta Obs. 7/e, p 186; Leon Speroff 7/e, p 1287, 1288; Novak 14/e, p 624; Williams Gynae 7/e, p 166Methotrexate: It is a folic acid analogue which inhibits dehydrofolate reductaseQ and prevents synthesis of DNA.QCandidates for methotrexate (Williams 24/e, p 384, Table 19.2): --Leon Speroff 7/e, p 1290Absolute requirementsHemodynamic stabilityQNo evidence of acute intra-abdominal bleedingQReliable commitment to comply with required follow-up careQNo contraindications to treatment viz woman should not be breast feeding/renal/hepatic dysfunction.Preferable requirementsAbsent or mild painSerum beta hCG level less than 5,000IU/L (best results seen with HCG<2000IU/L)Q It is the single best prognostic indicator of treatment success.Absent embryonic heart activityQEctopic gestational mass less than 4 cm in diameter without cardiac activity and < 3.5 cm with cardiac activityQFriends, there is no doubt on this issue that presence of cardiac activity is a relative contraindication according to books like Williams Obs 23/e, Williams Gynae 1/ed and Leon Speroff 7/ed.""Fetal cardiac activity - Although this is a relative contraindication to medical therapy; the admention is based on limited evidence."" --William Obs. 23/e, p 247""The presence of embryonic heart activity is not an absolute contraindication for medical management but the likelihood of failure and the risk of tubal rupture are substantially increased (therefore it is a relative contraindication)."" --Leon Speroff 7/e, p 1287As far as fluid in cul-de-sac is concerned: Earlier, it was also considered a relative contraindication to medical treatment, but studies have shown that free peritoneal fluid can be seen in almost 40% of women with early unruptured ectopic pregnancy and so it's presence and absence does not accurately predict the success or failure of medical treatment.Contraindications to methotrexate treatment: (Williams 24/e, p 384, Table 19.2)Breast feedingQ Immunodeficiency statesQAlcoholism or evidence of chronic liver disease (elevated transaminases) QRenal disease (elevated serum creatinine) QHematological abnormalities (severe anemia, leukopenia or thrombocytopenia) QKnown sensitivity to methotrexateQActive pulmonary diseaseQPeptic ulcer disease. QEvidence of tubal rupture -### End" -2012,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sin needle used to kill animals made of -, with the following options: A: Dhatura seeds, B: Rati seeds, C: Lead peroxide, D: Arsenic - -### Response: -Abrus Botanical name: Abrus precatorius Common name: Rati, gunja, jequirity Medicolegal Impoance 1. Accidental poisoning may occur in children while exploring the seeds. 2. Homicide by sui prepared with abrin (sui is needle or spike made with crushed seed alone or mixed with onion paste. Then the needle is dried under sun. The sui is kept between two fingers and is pushed into skin of other person). 3. Cattle poison. 4. Malingerers use powder of abrus seed to produce conjunctivitis. 5. When intact seeds are swallowed or when seeds are boiled or cooked, they are not poisonous. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 316 -### End" -2013,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Post polio, a child has gastronemius power - Grade 2, peroneus longus- Grade 3, tibialis anterior - Grade 4. Deformity present is:, with the following options: A: Calcaneo valgus, B: Calcaneo varus, C: Equino valgus, D: Equino varus - -### Response: -Ans: a (Calcaneo valgus)Ref: Textbook of Orthopaedics - Ebenezar, 4th ed.Tibialis anterior and peroneus longus which are the primedorsiflexor and evertor position the foot in calcaneo valgusdue to unequal muscle pull in the above case.Calcaneo valgus - Dorsiflexion at ankle and (eversion) at subtalar joint.Calcaneo varus - Dorsiflexion at ankle and varus (inversion) at sub talar joint.Equino valgus - Plantar flexion at ankle and valgus at subtalar jointEquino varus - Plantar flexion at ankle and varus at subtalar joint. -### End" -2014,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true statement about Meckel's diveiculum except:, with the following options: A: Occurs in 2% of the population, B: Common on antimesenteric border, C: Diarrhea very common, D: Peroration occurs - -### Response: -Ans is 'c' i.e. Diarrhea very common -### End" -2015,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following can reverse one or more smooth muscle effects of circulating histamine in humans?, with the following options: A: Granisetron, B: Adrenaline, C: Ranitidine, D: Sumatriptan - -### Response: -Adrenaline is a physiological antagonist of histamine. It reverses bronchoconstriction caused by histamine. Ranitidine is an H2 antagonist that decreases gastric acid secretion but has no effect on smooth muscles. -### End" -2016,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Composition of Nova-T :, with the following options: A: Copper and silver, B: Copper only, C: Copper and selenium, D: Copper and molybdenum - -### Response: -NOVA-T can be distinguished by a silver core over which the copper wire is wrapped. It has silver added to copper wire increasing it's life span to 5 yrs. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23rd EDITION PAGE NO 496 Shaw's textbook of Gynecology - 17 th edition, page no. 258. -### End" -2017,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 20% loss of blood is supplemented by, with the following options: A: Colloids & Crystalloids, B: Cryoprecipitate, C: Plasma, D: Packed calls - -### Response: -(A) Colloids & Crystalloids > Ideally, blood loss should be replaced with crystalloid or colloid solutions to maintain intravascular volume (normovolemia) until the danger of anemia outweighs the risks of transfusion. At that point, further blood loss is replaced with transfusions of red blood cells to maintain hemoglobin concentration (or hematocrit) at that level.> For most patients, that point corresponds to a hemoglobin between 7 and 10 g/dL (or a hematocrit of 21-30%). Below a hemoglobin concentration of 7 g/dL, the resting cardiac output has to increase greatly to maintain normal oxygen delivery -### End" -2018,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following intercellular communications occur extracellular chemical messengers except, with the following options: A: Paracrine, B: Gap junctions, C: Neurohormones, D: Autocrine - -### Response: -Gap junctions form direct intercellular communications and donot require extracellular chemical messengers as seen in indirect communication. Gap junctions are made of connexons. Each connexon is made up of six proteins subunits called connexins. Mutation in the gene coding for connexon causes Clouston syndrome Erythrokeratodermia variable Inherited deafness X-linked Charcot Marie Tooth Disease Predisposition to atherosclerosis , myoclonic epilepsy, cataract Ref: Harper's Illustrated Biochemistry 30th edition Pgno: 494 -### End" -2019,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with sensory loss on adjacent sides of the great and second toes and impaired dorsiflexion of the foot. These signs probably indicate damage to which of the following nerves?, with the following options: A: Superficial peroneal, B: Tibial nerve, C: Deep peroneal, D: Sural - -### Response: -The deep peroneal nerve supplies the anterior muscles of the leg, including the tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus teius muscles, which dorsiflex the foot. The medial branch of the deep peroneal nerve supplies the skin of adjacent sides of the great and second toes, whereas the lateral branch supplies the extensor digitorum brevis and extensor hallucis brevis. The superficial peroneal nerve innervates the peroneus longus and brevis, which plantar flexes the foot, and supplies the skin on the side of the lower leg and the dorsum of the ankle and foot. The tibial nerve innervates the muscles of the posterior compament that plantar flexes and supplies the skin on the heel and plantar aspect of the foot. The sural nerve supplies the skin on the posterolateral aspect of the leg and the lateral aspect of the foot and the little toe. -### End" -2020,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Standardised moality rate is stadardised for, with the following options: A: Age, B: Disease, C: Region, D: A paicular time period - -### Response: -Ans. is 'a' i.e., Age -### End" -2021,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In ankle sprain, the commonest ligament torn is?, with the following options: A: Tibio-talar ligament, B: Deltoid ligament, C: Posterior talo-fibular ligament, D: Anterior talo-fibular ligament - -### Response: -Ankle sprain is an inversion injury and anterior talo-fibular ligament is first to be damaged. More severe injury can also damage origin of extensor digitorum brevis and calcaneo-fibular ligament. -### End" -2022,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: a child has come with depressive symptoms and was staed on anti depressent. which is the antidepressent used in children, with the following options: A: clomipramine, B: fluoxetine, C: amitriptilline, D: escitaloprm - -### Response: -SSRI * IMPOANCE Most widely prescribed antidepressant * MECHANISM Specifically acts on serotonin transpoers and increases serotonin in synapse. DRUGS FLUOXETINE FLUVOXAMINE DAPOXETINE CITALOPRAM ESCITALOPRAM ESCITALOPRAM SERALINE PAROXETINE USE FLUOXETINE=============CHILDHOOD DEPRESSION FLUVOXAMINE===========OCD DAPOXETINE==============PME ESCITALOPRAM===========HEA SAFE, PATHOLOGICAL EMOTIONS PAROXETINE=========SEDATING, PANIC DISORDER IMPULSE CONTROL DISORDERS PME PARAPHILIA SIDE EFFECTS Paradoxical SUICIDE, this is a type of suicide where an antidepressant used to treat depression and decrease suicide increase the chance of suicidal attempt ( IT'S A PARADOX). The explanation that is given is SSRI initially activates the patient and decreases fatigue, thus patients with low mood and suicidal ideas will have more energy to act on the ideas. GIT- thus it should not be given in an empty stomach SD- delays ejaculation. This mechanism is used for its prescription in patients with premature ejaculation ANXIETY INSOMNIA Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, 955 -### End" -2023,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is the drug of choice for treating systemic fungal infection ?, with the following options: A: Griseofolvin, B: Amphotericins, C: Ketoconazole, D: trimoxazole - -### Response: -Amphotericin B is an antifungal medication used for serious fungal infections and leishmaniasis. The fungal infections it is used to treat include aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, and cryptococcosis. For ceain infections it is given with flucytosine Ref Harrison20th edition pg 1078 -### End" -2024,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurotoxicity is seen with excess of ?, with the following options: A: Vitamin B6, B: Vitamin B12, C: Vitamin B2, D: Vitamin C - -### Response: -Ans. is 'a' i.e., Vitamin B6 -### End" -2025,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 42-year-old male was undergoing elective hernioplasty. End tidal carbon dioxide (ETC02) was found to be increased. Abdominal wall gradually showed rigidity, along with the presence of tachycardia and tachypnea. Blood gas analysis shows an increased mixed acidosis, along with a serum lactate of 3.4 mmol/L. Which of the following has most likely resulted in the present situation?, with the following options: A: Neuroleptic malignant syndrome, B: Malignant hyperthermia, C: Serotonin syndrome, D: Pheochromocytoma - -### Response: -Answer: b) Malignant hyperthermiaMALIGNANT HYPERTHERMIADrug- or stress-induced hypermetabolic syndrome.Vigorous muscle contractions, an abrupt increase in temperature, subsequent cardiovascular collapseUncontrolled release of Ca2+ from the sarcoplasmic reticulum due to defect in the ryanodine receptor (RYR1) is the initiating eventInherited as autosomal dominant fashion, with variable penetrance & expressivity.Triggers: Stress, excitement, anoxia, viral infections, lymphoma, ischemia or hypoxia.Early signs: masseter muscle contracture, muscle rigidity, metabolic acidosis, sinus tachycardia, supraventricular tachyarrhythmias, mottling or cyanosis of the skin, increased CO2 production, and hypertension.Two signs helpful in making a prehyperthermic diagnosisIncreased end-tidal CO2Masseter spasmM/C with combination of depolarizing blocking agent and anesthetic.Drugs known to trigger malignant hyperthermiaDrugs safe in malignant hyperthermia* Halothane* Methoxyflurane* Enflurane, isoflurane* Succinylcholine* Decamethonium* Gallamine* Diethyl ether,* Ethylene, Ethyl chloride* Trichloroethylene* Ketamine* Phencyclidine* Cyclopropane* Nitrous oxide* Barbiturates* Diazepam* Tubocurarine* Pancuronium, vecuronium* OpiatesManagement of Malignant HyperthermiaDiscontinue volatile anesthetic and succinylcholine.Hyperventilate with 100% O2 at high flows.Administer sodium bicarbonate, 1-2 mEq/kg intravenously.Mix dantrolene sodium with sterile distilled water and administer 2.5 mg/kg ivInstitute cooling measures (lavage, cooling blanket, cold intravenous solutions).Administer additional doses of dantrolene if needed.Treat severe hyperkalemia with dextrose, 25-50 g IV, and regular insulin, 10-20 U intravenously (adult dose). -### End" -2026,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Early post-operative complication of ileostomy in the post-operative period, with the following options: A: Obstruction, B: Necrosis, C: Diarrhea, D: Prolapse - -### Response: -.Ileostomy is placed in right iliac fossa lateral to right rectus muscle. * Ileostomy may be temporary (loop) or permanent (end) * Brooke's classic end non continent ileostomy or Koch's continent ileostomy (with continent intra abdominal pouch) are used * Ileum should project as a spout at least 4 cm above the skin surface, which facilitates the effluent to pass directly into the bag * Ileostomy usually acts in 48 hours * Ileostomy bag, ileostomy care, nutrition and electrolyte management are impoant. * Complications like prolapse, stenosis, haemorrhage, retraction can occur. ref:SRB&;s manual of surgery,ed 3,pg no 828 -### End" -2027,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of lymphangioima is-, with the following options: A: kidney, B: head and Neck, C: Groin, D: Hea - -### Response: -Lymphangiomas are the benign lymphatic counterpa of hemangiomas. Simple (capillary) lymphangiomas are slightly elevated or sometimes pedunculated lesions up to 1 to 2 cm in diameter that occur predominantly in the head, neck, and axillary subcutaneous tissues. Cavernous lymphangiomas (cystic hygromas) typically are found in the neck or axilla of children, and more rarely in the retroperitoneum. (Robbins basic pathology,9th edition,pg no.359) -### End" -2028,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: High dose of morphine is used without much danger in ?, with the following options: A: Gall bladder surgery, B: Labour, C: Myocardial infarction, D: Head injury - -### Response: -Ans. is 'c' i.e., Myocardial infarction Morphine should be given promptly in myocardial infarction to allay apprehension and reflex sympathetic stimulation. Morphine should be used cautiously in gall bladder and biliary tract dysfunction as it causes spasm of sphincter of oddi and can cause acute rise of intrabiliary pressure. Used during labour, morphine can cause neonatal respiratory distress. Head injury is a contraindication for morphine use. -### End" -2029,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NOT a relation of sphenoid sinus:, with the following options: A: Optic nerve, B: Mandibular nerve, C: Maxillary nerve, D: Vidian nerve - -### Response: -Structures related to sphenoid sinus are foramen rotundum (maxillary nerve), optic canal (optic nerve and ophthalmic artery), vidian canal (with nerve), internal carotid artery. - Mandibular nerve is not related to sphenoid sinus. -### End" -2030,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In sickle cell anaemia true is -, with the following options: A: Autosplenectomy due to thrombosis &infarction, B: Microcytosis, C: Microcardia, D: Splenomegaly - -### Response: -Ans. is 'a' i.e., Autosplenectomy due to thrombosis and infarction Clinical manifestations of sickle cell anemia o The clinical manifestations of sickle cell anemia are. Chronic hemolysis o Irreversible sickle cells have rigid, nondeformable cell membranes that lead to difficulty in negotiating the splenic sinusoids, sequestation, and rapid phagocytosis. This results in extravascular hemolysis. o Some intravascular hemolysis may also occur because of increased machanical fragility of severely damaged cells. Vasoocclusive symptoms o Reversible sickle cells express higher than normal levels of adhesion molecules and are abnormally sticky that is responsible for occlusion of microcirculation especially of bones, lungs, liver, brain, spleen and penis. o Vasoocclusive symptoms are the most common manifestation of sickle cell anemia. o They commonly manifest as - (i) Painful bone crises In children, painful bone crises are extremely common and often difficult to distinguish from acute osteomyelitis. They frequently manifest as a dactylitis of bones of the hands or feet are both --> Hand-foot syndrome. (ii) Autosplenectomy Because of its narrow vessels and function in clearing defective red blood cell, the spleen is frequently affected. It is usually infarcted before the end of childhood. This autosplenctomy increases the risk of infection from encapsulated organisms. (iii) Acute chest syndrome A condition characterized by fever, chest pain, difficult breathing due to sickling and vaso-occlusion within pulmonary vascular beds. (iv) Sequestration crises Massive sequestration of sickled red cells leads to acute painful enlargement of spleen. (v) Aplastic crises Infection by parvovirus B19 can cause cessation of bone marrow erythropoiesis ---> aplastic crises. (vi) CNS symptoms Seizure and stroke (vii) Priapism and infarction of penis (viii) Leg ulcers Remember o Sickle cell trait (hetrozygous state) is almost always asylnptomatic and the only significant manifestation is the renal concentration defect presenting with isothenuria. -### End" -2031,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The objective methods to measure errors of refraction are all except, with the following options: A: Retinoscopy, B: Refractometry, C: Keratometry, D: Binocular balancing - -### Response: -The procedure for determining and correcting refractive errors is termed as refraction. It is an a that can only be mastered by practice. The refraction comprises two complementary methods, objective and subjective. OBJECTIVE REFRACTION The objective methods of refraction include: *Retinoscopy *Refractometry and *Keratometry SUBJECTIVE REFRACTION Subjective refraction is meant for finding out the most suitable lenses to be prescribed. It should always be carried out after getting a rough estimate of the refractive error by the objective refraction as described above. The proper subjective refraction includes three steps: I. Subjective verification of refraction II. Subjective refinement of refraction, and III. Subjective binocular balancing Subjective binocular balancing: The final step in the subjective refraction is binocular balancing--a process sometimes known as 'equalizing the accommodative effo' or 'equalization of vision'. This allows both eyes to have the retinal image simultaneously in focus. Reference : Khurana Comprehensive Ophthalmology; 4th edition ; Pages: 547, 548, 554, 557. -### End" -2032,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tumorogenesis in aging is due to, with the following options: A: Telomerase reactivation, B: Telomerase inactivation, C: Increased apoptosis, D: Suppression of proto-oncogenes - -### Response: -Telomerase, also called terminal transferase, is a ribonucleoprotein that adds a species-dependent telomere repeat sequence to the 3' end of telomeres. A telomere is a region of repetitive sequences at each end of a eukaryotic chromosomes in most eukaryotes. Telomeres protect the end of the chromosome from DNA damage or from fusion with neighbouring chromosomes. The fruit fly Drosophila melanogaster lacks telomerase, but instead uses retrotransposons to maintain telomeres. Telomerase is a reverse transcriptase enzyme that carries its own RNA molecule (e.g., with the sequence ""CCCAAUCCC"" in veebrates) which is used as a template when it elongates telomeres. Telomerase, active in normal stem cells and most cancer cells, is normally absent from, or at very low levels in, most somatic Cells. -### End" -2033,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is amylin analogue-, with the following options: A: Exenatide, B: Sitagliptin, C: Pramlintide, D: Glucomannan - -### Response: -Ans. is 'c' i.e., Pramlintide -### End" -2034,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Willem Einthoven got Nobel Prize for, with the following options: A: Insulin, B: ECG, C: Plasmodium life cycle, D: Penicillin - -### Response: -List of Nobel Laureates - -Willem Einthoven : ECG. -Sir Alexander Fleming : Penicillin. -Paul. H. Muller : DDT. -Sir Godfrey N.Hounsfield : Human blood groups. -Karl Landsteiner : Human blood groups. -Paul Ehrlich : Immunity. -Sir Peter Mansfield : MRI. -### End" -2035,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement regarding pathology of pneumocystis jiroveci pneumonia:, with the following options: A: Alveoli is filled with foamy exudates, B: Interstitial pneumonitis with foamy vacuoles, C: Necrotising hemorrhage, D: Pleural effusion - -### Response: -Ans: A (Alveoli is filled with foamy exudates) Ref: Rubin's Pathology: Clinicopathologic Foundations of Medicine, 6th edition, pg 554Explanation:Pathology of Pneumocystis Jiroveci Pnuemonia* The classic lesion of pneumocystis pneumonia are:o interstitial infiltrate of plasma cells and lymphocytes.o Hyperplasia of type 2 pneumocytes.Alveoli are filled with a characteristic foamy exudate, in which the organism appear as small hubbies in a background of proteinaceous exudates.With silver impregnation, cysts appear as round or indented (Crescent moon) bodies, 5 microns in diameter.A darkly stained focus represents focal thickening of the capsule.After sporozoites develop within the cyst, it ruptures and assumes an indented shape.Sporozoites develop into trophozoites, which may be seen with stains such as Giemsa in cytology specimens.Granulomatous inflammation is rare but seen in upto 5% HIV patients.Rarely, diffuse alveoar damage is seen.Chest X-ray FindingsDiffuse bilateral infiltrates extending from the perihilar region are visible in most patients with P jiroved pneumonia (PJP).Less-common findings include patchy asymmetric infiltrates and pneumatoceles.Pleural effusions and /r?fraf/iorac/c adenopathy are rare. -### End" -2036,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In anti retroviral therapy, Zidovudine should not be combined with:, with the following options: A: Lamivudine, B: Nevirapine, C: Didanosine, D: Stavudine - -### Response: -Nucleoside reverse transcriptase inhibitors (Nis): Zidovudine: It is a thymidine analogue (azidothymidine, AZT), the prototype NI. After phosphorylation in the host cell-zidovudine triphosphate selectively inhibits viral reverse transcriptase (RNA-dependent DNA polymerase) in preference to cellular DNA polymerase Stavudine (d4T): It is also a thymidine analogue which acts in the same way as AZT. By utilizing the same thymidine kinase for activation, AZT antagonises the effect of stavudine. Stavudine and zidovudine exhibit mutual antagonism by competing for the same activation pathway. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:770,771 -### End" -2037,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about suspended animation: PGI 10, with the following options: A: Common phenomenon, B: Can be voluntary, C: Similar to molecular death, D: None - -### Response: -Ans. Can be voluntary -### End" -2038,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following provisions are included in the primary health care according to the Alma Ata declaration except, with the following options: A: Adequate supply of safe drinking water, B: Provision of food supply, C: Provision of free medicines, D: Basic sanitation - -### Response: -Ans. c. Provision of free medicines Primary Health Care The Alma Ata Conference has defined primary health care as -- an essential health care made universally accessible to individuals and acceptable to them, through their full paicipation and at a cost the community and country can The Alma -- Ata Declaration has outlined 8 essential components of primary health care Education concerning prevailing health problems and the methods of preventing and controlling themQ Promotion of food supply and proper nutritionQ An adequate supply of safe water and basic sanitationQ Maternal and child health care, including family planningQ Immunization against major infectious diseasesQ Prevention and control of locally endemic diseasesQ Appropriate treatment of common diseases and injuriesQ Provision of essential drugsQ The principles of primary health care include Equitable distributionQ Community paicipationQ Intersectoral co-ordinationQ Appropriate technologyQ -### End" -2039,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: &;Homans' sign is seen in, with the following options: A: Deep vein thrombosis, B: Pulmonary embolism, C: Peripheral vascular disease, D: Lymphanitis - -### Response: -Signs are seen in DVTHoman's sign: calf pain on dorsiflexion of the footBancroft&;s sign or Moses&; sign: pain is elicited when the calf muscle is compressed These signs are neither sensitive nor specific for the presence of thrombosis, and not done in fear of dislodgment of clotRef: Bailey and Love 27e pg: 281 -### End" -2040,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: EPI (Expanded Program on Immunization) by WHO does NOT include, with the following options: A: Tuberculosis, B: Pertussis, C: Chickenpox, D: Measles - -### Response: -(C) Chickenpox # WHO EPI Global Advisory Committee has strongly recommended BCG and Polio vaccine to be given at birth or at first contact in countries where tuberculosis and polio have not been controlled.> In all countries routine immunization with DPT and oral polio vaccine can be safely and effectively initiated at 6 weeks of age.> New vaccines are being added for the vaccination schedule E.g., hepatitis B, rubella and Japanese encephalitis vaccines are now included in several country's programmes.NATIONAL IMMUNIZATION SCHEDULEFor Infants* At birthBCG and OPV-O dose (for institutional deliveries)* At 6 weeksBCG (if not given at birth) DPT-1, OPV-1 and Hepatitis B-l* At 10 weeksDPT-2, OPV-2 and Hepatitis B-2* At 14 weeksDPT-3, OPV-3 and Hepatitis B-3* At 9 monthsMeasles* At 16-24months- DPT and OPV* At 5-6 yearsDT - the second dose of DT should be given at an interval of one month if there is no clear history or documented evidence of previous immunization with DPTAt 10 and at 16 yearsTetanus Toxoid -The second dose of TT vaccine should be given at an interval of one month if there is no clear history or documented evidence of previous immunization with DPT, DT or TT vaccinesFor Pregnant Women* Early in pregnancyTT-1 or Booster* One month afterTT-1-TT-2 -### End" -2041,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 23-year-old woman is diagnosed with mitral valve prolapse as seen on echocardiography for evaluation of a systolic murmur. Which of the following is most characteristic of mitral valve prolapse?, with the following options: A: a pansystolic murmur, B: usually a benign course, C: sudden death, D: infective endocarditis - -### Response: -The most common pathogenic mechanism is thought to be excessive or redundant mitral leaflet tissue, with the posterior leaflet more commonly involved. Myxomatous degeneration can also be seen on pathologic examination. Reassurance regarding the benign nature of the disease is the mainstay of management. When a murmur is present, antibiotic prophylaxis for endocarditis is warranted. -### End" -2042,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The treatment of choice for a mucocele of gallbladder is:, with the following options: A: Aspiration of mucous, B: Cholecystectomy, C: Cholecystostomy, D: Antibiotics and observation - -### Response: -Ans. (b) CholecystectomyRef: Bailey 26/e p 1107-1108* Early Cholecystectomy is advised for Mucocele as it may get converted to Empyema, Perforation, Gangrene. -### End" -2043,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epidemics of Relapsing Fever are caused by:, with the following options: A: Louse, B: Soft tick, C: Hard tick, D: Rat flea - -### Response: -Louse -### End" -2044,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enterogastric reflex is stimulated by all except:, with the following options: A: Alkaline content of small intestine, B: Hyperosmolarity of chyme, C: Distension of duodenum, D: None - -### Response: -A i.e. Alkaline Content of small intestine -### End" -2045,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most serious drug interaction with Tadalafil occurs with:, with the following options: A: NItrates, B: Alpha-Blockers, C: Ketoconazole, D: Rifampicin - -### Response: -Most serious drug interaction with Tadalafil occurs with Nitrates. Administration of Tadalafil to patients using anu form of organic nitrate is contraindicated as it can cause potentially fatal hypotension. This is thought to result from the combined effects of nitrates and Tadafanil on the nitric oxide/cGMP pathway. Phosphodiesterase inhibitors (sildenafil, vardenafil, tadalafil) used to treat erectile dysfunction enhance nitric oxide production and can cause potentially fatal hypotension when used in combination of nitrates. These two drugs should not be used together within 24 hours (sildenafil) or 48 hours (vardenafil, tadafanil) due to this. Tadafanil drug Interactions (FDA Prescribing Information) Contraindicated Use with Caution Nitrates (Potentiates Hypotensive effect. May cause fatal Hypotension) Alpha-Blocker (Potentiates hypotensive Effect) Anti-hypeensives (Potentiates Hypotensive Effect) Alcohol (Potentiates Hypotensive Effect) CYP3A4 inhibitors (eg., Ketoconazole, Ritonavir) may increase levels of tadafanil CYP3A4 inducers (eg., Rifampicin) may decrease levels of Tadafanil When Tadafanil is co-adminstered with an alpha blocker; patients should be stable on alpha-blocker therapy prior to initiating treatment with Tadafanil and tadafanil should be initiated at the lowest recommeded dose. For patients taking Tadafanil (for use as needed) , concominant potent inhibitors of CYP3A4, such as ketoconazole or ritonavir, the maximum recommended dose of Tadafanil is 10 mg, not to exceed once every 72 hours. For patients taking Tadafanil (once daily), concomitant potent inhibitors of CYP3A4; such as ketoconazole or ritonavir, the dose should not exceed 2.5mg. Ref: The second Princeton consensus on sexual dysfunction and cardiac risk; new guidelines for sexual medicine -### End" -2046,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reactive tubercular ahritis:, with the following options: A: Spina ventusa, B: Pott's disease, C: Poncet's disease, D: None - -### Response: -Ans. is. 'c' i. e. Poncet's disease -### End" -2047,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organisms with characteristic School of fish appearance in stained smears is observed in wof condition, with the following options: A: Granuloma inguinale, B: Chancroid, C: Lymphogranuloma venereum, D: Herpes genitalis - -### Response: -Ref:- Sima Jain; pg num:- 218 -### End" -2048,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true regarding solitary rectal ulcer ?, with the following options: A: 20% are multiple, B: Recurrent rectal prolapse is a cause, C: Involves Posterior wall., D: Managed by digital reposition - -### Response: -Ans is 'c' ie Involves posterior wall Causes of solitary rectal ulcer syndrome Due to a combination of - internal intussusception anterior rectal wall prolapse - increase in intrarectal pressure Symptoms -4 pain, bleeding, mucus discharge or outlet obstruction Treatment Nonoperative therapy (high fibre diet, defecation training to avoid straining, and laxatives or enemas) is effective in the majority of patients. Surgery (either abdominal or perineal repair of prolapse) is reserved for highly symptomatic patients, who have failed all medical intervention e.g. rectopexy -### End" -2049,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The protective effects of breast milk are known to be associated with:, with the following options: A: IgM antibodies, B: Lysozyme, C: Mast cells, D: IgA antibodies - -### Response: -d. IgA antibodies(Ref: Nelson's 20/e p 286-290, Ghai 8/e p 150-161)Although antibodies & lysozyme, both are important for protective effects of breast milk, antibodies (IgA) play a major role. -### End" -2050,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Karyotyping is useful in diagnosis of-, with the following options: A: Autosomal recessive disorders, B: X-linked recessive disorders, C: Chromosomal abnormalities, D: Biochemical abnormalities - -### Response: -A karyotype is a photographic representation of a stained metaphase spread in which the chromosomes are arranged in order of decreasing length.A variety of techniques for staining chromosomes have been developed. With the widely used Giemsa stain (G banding) technique, each chromosome set can be seen to possess a distinctive pattern of alternating light and dark bands of variable widths . The use of banding techniques allows identification of each chromosome, and can detect and localize structural abnormalities. Karyotype analy- sis of chromosomes by G banding remains the classic approach for identifying changes at the chromosomal level; however, as might be expected, the resolution with this technique is fairly low. In order to identify subchromo- somal alterations, both focused analysis of chromosomal regions by FISH and global genomic approaches such as comparative genomic hybridization (CGH) have become popular. Fluorescence in Situ Hybridization (FISH) FISH utilizes DNA probes that recognize sequences spe- cific to chromosomal regions of greater than 100 kilobases in size, which defines the limit of resolution with this tech- nique for identifying chromosomal changes. Such probes are labeled with fluorescent dyes and applied to metaphase spreads or interphase nuclei. The probe hybridizes to its complementary sequence on the chromosome and thus labels the specific chromosomal region that can then be visualized under a fluorescence microscope. The ability of FISH to circumvent the need for dividing cells is invaluable when a rapid diagnosis is warranted (e.g., in a critically ill infant suspected of having an underlying genetic disorder). Such analysis can be performed on prenatal samples (e.g., cells obtained by amniocentesis, chorionic villus biopsy, or umbilical cord blood), peripheral blood lymphocytes, and even archival tissue sections. FISH has been used for detection of numeric abnormalities of chromosomes (aneuploidy) (Fig. 6-37, A); for the demonstration of subtle microdeletions (Fig. 6-37, B) or complex transloca- tions not detectable by routine karyotyping; for analysis of gene amplification (e.g., NMYC amplification in neuroblastomas); and for mapping newly isolated genes of interest to their chromosomal loci. Array-Based Genomic Hybridization It is obvious from the preceding discussion that FISH requires previous knowledge of the one or few specific chromosomal regions suspected of being altered in the test sample. However, chromosomal abnormalities may also be detected without previous knowledge of what these aber- rations may be, using a global strategy known as array- based CGH. Here the test DNA and a reference (normal) DNA are labeled with two different fluorescent dyes (most commonly, Cy5 and Cy3, which fluoresce red and green, respectively). The differentially labeled samples are then hybridized to an array of segments of genomic DNA ""spotted"" on a solid matrix, usually a glass slide (Fig. 6-38, A). These segments of DNA are representations of the human genome at regularly spaced intervals, and cover all 22 autosomes and the sex chromosome (Fig. 6-38, A). Amplifications and deletions in the test sample produce an increase or decrease in signal relative to the normal DNA that can be detected down to a 10-kilobase (kb) resolution (Fig. 6-38, B). Newer generations of microarrays using single-nucleotide polymorphisms (SNPs) (see fuher on) provide even higher resolution (with more than 1 million SNPs from the human genome on a single microarray!) and are currently being used to uncover copy number abnor- malities in a variety of diseases, from cancer to autism. (Robbins Basic Pathology, 9 th edition. page : 263) -### End" -2051,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Delusion that someone from high socioeconomic status is loving you is, with the following options: A: Othello syndrome, B: Capgras syndrome, C: De Clerambault syndrome, D: Franklin syndrome - -### Response: -Delusion is defined as a false , fixed, firm belief which is impervious to other experiences, person holds it with subjective ceainty , leads to compelling counterargument and which is outside the social , cultural and educational background. There are several types of delusions Some of the named delusions are ERATOMANIC DELUSION- De clerambault syndrome- patient has a delusion that person from a higher social class is in love with the patient. They may even STALK the person on whom they have delsuion. INFIDELITY DELUSION-OTHELLO syndrome. This is most common in ALCOHOLIC MALES. patient presents with doubt regarding infedility of the wife Delusional misidentification-CAPGRAS SYNDROME-patient with this delusion have an idea that a familiar person is replaced by an imposter Ref- Fish Psychopathology, 3e, pg 123. -### End" -2052,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which element is required by phosphofructokinase?, with the following options: A: Magnesium, B: Inorganic phosphate, C: Manganese, D: Copper - -### Response: -Phosphofructokinase (PFK) is --300 amino acids in length, and structural studies of the bacterial enzyme have shown it comprises two similar (alpha/beta) lobes: one involved in ATP binding and the other housing both the substrate-binding site and the allosteric site (a regulatory binding site distinct from the active site, but that affects enzyme activity). The identical tetramer subunits adopt 2 different conformations: in a 'closed' state, the bound magnesium ion bridges the phosphoryl groups of the enzyme products (ADP and fructose-1,6- bisphosphate); and in an 'open' state, the magnesium ion binds only the ADP, as the 2 products are now fuher apa -### End" -2053,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about cardiac muscle, with the following options: A: Cardiac muscle cannot be tetanized due to long absolute refractory period, B: Gap junctions in intercalated discs provide strong union between muscle fibers, C: T tubules located at A-I junction, D: Phase 2 of cardiac muscle action potential is due to opening of K+ channels - -### Response: -During phases 0 to 2 and about half of phase 3 (until the membrane potential reaches approximately -50 mV during repolarization), cardiac muscle cannot be excited again; that is, it is in its absolute refractory period. It remains relatively refractory until phase 4. Therefore, tetanus of the type seen in skeletal muscle cannot occur. The T system in cardiac muscle is located at the Z lines rather than at the A-I junction, where it is located in mammalian skeletal muscle. Along the sides of the muscle fibers next to the disks, the cell membranes of adjacent fibers fuse for considerable distances, forming gap junctions. These junctions provide low-resistance bridges for the spread of excitation from one fiber to another. Plateau (phase 2) is due to a slower but prolonged opening of voltage-gated Ca2+ channels.Reference: Ganong's review of Medical Physiology, 25th ed, pages: 112, 113, 114 -### End" -2054,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prostatic carcinoma commonly arises from: March 2012, with the following options: A: Central zone, B: Peripheral zone, C: Transitional zone, D: None of the above - -### Response: -Ans: B i.e. Peripheral zone Zones of prostate & clinical impoance Central zone (CZ) lies posterior to the urethral lumen & above the ejaculatory ducts. Peripheral zone (PZ) lies posteriorly & from this, most carcinoma arises There is a periurethral transitional zone (TZ), from which most benign prostatic hyperplasia (BPH) arises. -### End" -2055,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common was are caused by which virus:September 2006, March 2013 (h), with the following options: A: Cytomegalovirus, B: Human papilloma virus, C: Hepatitis B virus, D: Epstein-Barr virus - -### Response: -Ans. B: Human papilloma virusWas are common, and are caused by a viral infection, specifically by the human papillomavirus (HPV) and are contagious by contact with the skin of an infected person.It is also possible to get was from using handtowels or other objects used by an infected person. They typically disappear after a few months but can last for years and can recurWas are caused by a virus called human papilloma virus or HPV.Types 1, 2, and 3 cause most of the common was.Type 1 is associated with deep plantar (sole of the foot) and palmar (palm of the hand) was.Type 2 causes common was, filiform was, plantar was, and mosaic plantar was.Type 3 causes plane was, commonly known as flat was.Anogenital was are caused by types 6, 11, 16, 18, 30, 31, 33, 34, 35, 39, 40 and others.HPV types 6 and 11 cause about 90% of genital was cases.HPV types 16 and 18 currently cause about 70% of cervical cancer cases and also cause some vulvar, vaginal, penile and anal cancers -### End" -2056,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gerlach tonsil in waldeyer's ring is, with the following options: A: Tubal tonsil, B: Palatine tonsil, C: Pharyngeal tonsil, D: Lingual tonsil - -### Response: -Tubal tonsil is otherwise called Gerlach`s tonsil, seen towards the tubal openingWaldeyer&;s ring consists of - Adenoids, Palatine, Lingual, Tubal tonsils, and Lateral pharyngeal bandsRef: Hazarika; 3rd ed; Pg 436 -### End" -2057,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deep peroneal nerve supplies?, with the following options: A: First web space of foot, B: Anterolateral aspect of leg, C: Fourth web space of foot, D: Lateral aspect of foot - -### Response: -First web space of foot is supplied by deep peroneal nerve while the rest three web spaces are supplied by superficial peroneal nerve. -### End" -2058,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The compression fracture is commonest in -, with the following options: A: Cervical spine, B: Upper thoracic spine, C: Lower thoracic spine, D: Lumbosacral region - -### Response: -Lower cervical and lower thorasic (dorsal) spine are the most common sites for vertical compression (Burst fracture). ""In axial load injuries (compression injuries), the most common site of trauma is at the thoracolumbar junction"". — Neurotrauma -### End" -2059,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: WHO guidelines for minimal sperm count is: September 2007, with the following options: A: 10 million/ ml, B: 20 million/ml, C: 50 million/ ml, D: 60 million/ ml - -### Response: -Ans. B: 20 million/ml According to WHO guidelines, minimum sperm values of normal sperm are Volume: 2 ml Concentration:20 million/ ml Motility: 50% Normal morphology: 30% -### End" -2060,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following can cause tachycardia except:, with the following options: A: Fever, B: Exercise, C: Sympathetic nervous system stimulation, D: Parasympathetic nervous system stimulation - -### Response: -Option D: Parasympathetic nervous system stimulation of the heart decreases the heart rate as well as the force of contraction, rate of impulse conduction and blood flow through the coronary vessels. Fever, exercise, and sympathetic stimulation all increase the heart rate. -### End" -2061,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about hormone functions except, with the following options: A: Thyroid hormones regulate metabolism, B: ADH regulates blood osmolality, C: Insulin regulates blood glucose, D: Coisol regulates plasma volume - -### Response: -Coisol the principal glucocoicoid produced by the zona fasciculata of the adrenal coex. It promotes gluconeogenesis and lipolysis, suppresses protein synthesis, inhibits inflammatory and immune responses, and has mild mineralocoicoid (for example, hypernatremic, kaliuretic, antidiuretic) effects. Most plasma coisol is bound to transcoin and albumin. Thyroid hormones are iodothyronines secreted by the thyroid gland, principally thyroxine (tetraiodothyronine or T4) and triiodothyronine (T3).Insulin is a double-chain protein formed from proinsulin in the beta cells of the islets of Langerhans in the pancreas. Insulin promotes the storage of glucose and the uptake of amino acids, increases protein and lipid synthesis, and inhibits lipolysis and gluconeogenesis. play an impoant role in maintaining normal blood glucose level. Antidiuretic hormone(ADH) a hormone that decreases the production of urine by increasing the reabsorption of water by the renal tubules. It is secreted by cells of the hypothalamus and stored in the neurohypophysis. ADH is released in response to a decrease in blood volume, an increased concentration of sodium or other substances in plasma, pain, stress, or the action of ceain drugs.Ref: Ganong&;s review of medical physiology; 24th edition; page no-362 -### End" -2062,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a ketone body -(PGI 84), with the following options: A: Acetone, B: Acetic acid, C: Acetoacetate, D: Beta-hydroxybutyric acid - -### Response: -Ketone bodies are three water - soluble molecules (acetoacetate, beta-hydroxybutyrate, and their spontaneous breakdown product, acetone) that are produced by the liver from fatty acids. Acetoacetic acid is a ketone body, but acetic acid is not. Note that acetic acid is hydrophobic while acetoacetate is water-soluble. -### End" -2063,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spot the diagnosis:, with the following options: A: Stasis dermatitis, B: Seborrheic dermatitis, C: Atopic dermatitis, D: Dyshidrotic eczema - -### Response: -Dyshidrotic eczema Variant of hand eczema Pruritic Vesicles on thenar and hypothenar eminences Affected pas- Palms, soles, sides of fingers and toes crops-crusts-heals Lesion- Deep vesicles Predisposition-atopic diathesis -### End" -2064,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about Ganer cyst ?, with the following options: A: It is remnant of Mesonephric duct in females., B: It is functionally active in females., C: It is remnant of Paramesonephric duct in females., D: In males,it forms excretory system of male reproductive system. - -### Response: -Ganer cyst is basically a remnant of mesonephric or wolffian duct which remains vestigeal and functionally inactive in females. In males it forms collecting pa of male reproductive system. -### End" -2065,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding congenital rubella (CRS) syndrome are all except:, with the following options: A: Infants of congenital rubella syndrome can shed virus in respiratory secretions upto 1 year of age, B: Risk of developing diabetes mellitus is considerably higher in congenital rubella syndrome, C: Cataract in CRS is always bilateral, D: Risk of congenital defects is high when fetus is infected during the first trimester Explanation: - -### Response: -Ans: (c) Cataract in CRS is always bilateralRef: Manual of Neonatal Care, John P. Cloherty, 7th edition, Page 619CONGENITAL RUBELLA SYNDROME (CRS)RNA virus (the toga virus family)Maternal Infection (in gestation)Rate of fetal infectionOccurrence of fetal anomaliesFirst 12 weeks of gestation81%100% of the infected fetuses had cardiac defects and deafnessIn 13 to 16 weeks54%Deafness was found in one-third of fetusesIn 31 to 36 weeks60%No abnormalities were found when fetal infection occurred beyond the 20th week of gestationBeyond 36 weeks100%Clinical Features:Cataracts (can be both unilateral or bilateral), sensory neural hearing loss (single most common finding among the CRS infants), and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis).Common early features - IUGR, retinopathy (salt and pepper retinopathy), microphthalmia, meningo encephalitis, hypotonia, electroencephalographic abnormalities, dermatoglyphic abnormalities, hepatosplenomegaly, thrombocytopenic purpura, radiographic bone , and diabetes mellitus.Rare complications - myocarditis, glaucoma, microcephaly, chronic progressive panencephalitis, hepatitis, anemia, hypogammaglobulinemia, thymic hypoplasia, thyroid abnormalities, cryptorchidism and polycystic kidney disease.Antenatal Diagnosis:1. Determination of specific IgM in fetal blood obtained by PUBS.2. Direct detection of rubella antigen and RNA in a chorionic villus biopsy specimen.Postnatal Diagnosis: The diagnosis of congenital infection is made by one of the following:i. Isolation of rubella virus (oropharynx, urine).ii. Detection of rubella-specific IgM in cord or neonatal blood.iii. Persistent rubella-specific titers over time (i.e., no decline in titer as expected for transplacentally derived maternal IgG).If, in addition, there are congenital defects, the diagnosis of CRS is made.Treatment:No specific therapy for either maternal or congenital rubella infection.Maternal disease is almost always mild and self-limiting.1. Primary maternal infection occurs during the first 5 months of pregnancy-termination options should be discussed with the mother.2. Infection is known to have occurred beyond the 20th week of gestation, its unlikely to develop anomaliesIndividuals with postnatal infection typically shed virus for 1 week before and 1 week after the onset of rash.Infants with congenital infection may shed virus for many months, and contact should be avoided during the first year.Conception also should be avoided for 3 months following immunization.Immunization during pregnancy is not recommended because of the theoretical risk to the fetus. Inadvertent immunizations during pregnancy have occurred - reassurance of little risk to the fetus can be given.Maternal Infection:Symptoms - begin 2 to 3 weeks after exposure and include malaise, low-grade fever, headache, mild coryza, posterior cervical lymphadenopathy, arthralgias and conjunctivitis.Occurring 1 to 5 days before the onset of rash (salmon-pink macular or maculopapular exanthem that begins on the face and behind the ears and spreads downward over 1 to 2 days and disappears in 5 to 7 days from onset).Confirmation - demonstrating a fourfold or higher rise in serum IgG titers when measured at the time of symptoms and approximately 2 weeks later.If a woman exposed to rubella is known to be seropositive, she is immune, and the fetus is considered not to be at risk for infection.If the exposed woman is known to be seronegative, a serum sample should be obtained 3 to 4 weeks after exposure for determination of titer.A negative titer indicates that no infection has occurred, whereas a positive titer indicates infection. -### End" -2066,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following takes place during latent phase of growth curve, with the following options: A: Bacterial cell number increase, B: Bacterial cell size increase, C: Bacterial cell size decrease, D: Sporulation - -### Response: -Sporulation occurs in the latent period of bacterial growth due to potential of growth and multiplication -### End" -2067,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The term 'id' was coined by:, with the following options: A: Freud, B: Skinner, C: Weyker, D: Weyker - -### Response: -A. i.e. Freud -### End" -2068,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diagnostic feature of CRF is -, with the following options: A: Broad casts in urine, B: Elevated blood urea, C: Proteinuria, D: Bleeding diathesis - -### Response: -Ans. is 'a' i.e., Broad casts in urine Casts -o Urinary casts are formed only in the distal convoluted tubuleQ (DCT) or the collecting ductQ (distal nephron),o The proximal convoluted tubule and loop ofhenle are not the locations for cast formation.o Casts are formed through the solidification of materials in the tubules of nephrons.o Later the material is flushed out of the kidney upon the production of more urine leaving a small solidified microscopic cylinder that can also contain what ever other materials that might be within the tubules of the kidneys at the time of cast formation.o The microscopic detection of various types of casts can often be helpful diagnostic tool in the study of various types of renal diseases.Urinarv Casts and their characteristic featuresHyaline castso These are the most common type of casts and they can be found in normal urine samples.o They consists almost entirely of Tamm Horsfall protein,o Zero-to Two hyaline casts per low power field is considered normaLo Increased numbers of Hyaline casts can occur with exercise, heat exposure, dehydration, fever, congestive heart failure and diuretic.Renal tubular epithelial ceil castso These casts results when the epithelial cells o f the renal tubules are being excreted along with the casts.o These are rarer casts, can in theory indicate a serious situation involving the possible breaking down of the lining of the renal tubules themselves.o Renal tubular epithelial casts are most suggestive of tubular injury as in acute tubular necrosis.o They are also found in other disorders including eclampsia, heavy metal poisoning, ethylene glycol intoxication (most of these cases lead to acute tubular necrosis). o These casts are fairly common and occur in both pathological and non pathological condition.o Granular casts can result eitherfrom the breakdown of cellular casts to a point where the cells that once were within them are no longer distinguishable or they can result from the inclusion of aggregates of plasma proteins, fibrinogen or immune complexes within the cast upon formation.Granular castso They can be further divided into coarse gran ular casts andfine gran ular casts,o Fine granular casts can appear in non pathological conditions such as vigorous exercise, but the presence of coarse granular cast is abnormal and presents in wide variety of clinical diseases.o They are common in renal parenchymal disease.Broadcastso These casts originate from dilated chronically damaged tubules or the collecting ducts therefore thev are called renal failure casts.o These are formed in collecting duct as a result of urinary stasis.o Broad casts are two to six times the size of other types of casts.o Broad casts or renal failure casts are usually seen in patients with advanced renal failure.Waxy castso Waxy casts are cylinders of smooth highly refractive material.o Waxy casts are seen in final stages of degeneration offline granular casts. Since the granules need time to degrade, this implies nephron obstruction.o Waxy casts are seen in chronic renal diseases associated with renal failure seen in diabetic nephropathy, malignant hypertension, glomerulonephritis. -### End" -2069,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient is suffering from SLE. On immunofluorescence showed granular deposits at the dermoepidermal junction. What is the constituent in these depostis?, with the following options: A: Anticuclear antibodies, B: Antiepithelial antibodies, C: Antibodies against collagen, D: Immune complex deposits - -### Response: -Immunofluoresence in dermatology Disease IgG IgM IgA C3 Flbrin IF pattern Antigen Pemphigus Vulgaris ++ ++ Intercellular- between epidermal cells Network pattern Desmoglein 3 Ig A pemphigus ++ Do Paraneoplastic pemphigus + + + + Do Desmoplakin Bullous pemphigoid ++ ++ Linear deposits along BMZ BP230 BP180 Epidemolysis bullosa aquisita ++ ++ do Collagen 7 Dermatitis Herpatiformis ++ + Granular papillary tip deposits along BMZ Epidermal transglutaminase SLE ++ ++ ++ Granular deposits along BMZ Lichen planus + + + + ++ Ovoid bodies with ragged fibrin band along BMZ Bollous SLE + ++ Linear BMZ deposits Collagen 7 Porphyria ++ + Perivascular and BMZ deposits Amyloid + ++ ++ ++ Globular deposits in tips of apillary dermis -### End" -2070,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Abnormality seen in ADHD is -, with the following options: A: Hyperactivity, B: Hallucinations, C: Delusion, D: All of the above - -### Response: -Ans is 'a' i.e. Hyperactivity o Characteristic triad of Attention deficit hyperactivity disorder includei. Hyperactivity,ii. Impulsiveness andiii. Inattention (distractibility or lack of concentration). -### End" -2071,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for asymptomatic pseudocyst pancreas is?, with the following options: A: Marsupialisation, B: Conservative, C: Drainage, D: Cystogastrostomy - -### Response: -ANSWER: (B) ConservativeREF: Sabiston 18th ed chapter 56Recent reports have shown that many pseudocysts eventually resolve without complications. Intervention is not mandatory in all cases unless the pseudocysts areSymptomaticEnlargingAssociated with complications.The likelihood that a pseudocyst will resolve spontaneously, however, is dependent on its size. Large pseudocysts (i.e., >6 cm in diameter) are more likely to become symptomatic either because they are tender or because of their mass effect on adjacent organs Symptomatic or enlarging pseudocysts can be treated by several methods:Those in the tail can be treated by excision (i.e., distal pancreatectomy), but excision in the setting of recent acute inflammation maybe hazardous.Most patients who develop symptomatic pseudocysts are best managed by pseudocyst drainage.In poor surgical risk patients, percutaneous catheter drainage can be considered.Internal drainage can be accomplished either endoscopically (by transpapillary drainage, cystogastrostomy, or cystoduodenostomy) or surgically (by cystogastrostomy, cystoduodenostomy, or Roux-en-Y cystojejunostomy).Pseudocysts that are directly adjacent to either the stomach or duodenum can be safely drained endoscopically if there are no intervening vessels. After endoscopic ultrasound and preliminary aspiration of the cyst fluid to confirm the diagnosis and exclude intervening vessels, endoscopic drainage is achieved by making an incision into the pseudocyst through the wrall of the stomach or duodenum.Transpapillary drainage might be more appropriate for patients with pancreatic head pseudocysts -### End" -2072,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which antibiotic acts by inhibiting protein synthesis -, with the following options: A: Cefotetan, B: Doxycycline, C: Ciprofloxacin, D: Oxacillin - -### Response: -Ans. is 'b' i.e., Doxycycline -### End" -2073,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CD marker for cytotoxic T-cells?, with the following options: A: CD 4, B: CD 8, C: CD 21, D: CD 45 - -### Response: -Ans. is 'b' i.e., CD 8 -### End" -2074,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infant moality does not include:, with the following options: A: Early neonatal moality, B: Perinatal moality, C: Post neonatal moality, D: Late neonatal moality - -### Response: -Perinatal moality is not exclusive to infant moality. It includes both late foetal deaths (still bih) and early neonatal deaths. The WHO definition of perinatal moality is all stillbihs (however they are defined) plus all early neonatal deaths up to 28 days per thousand bihs. Ref: Park's Textbook Of Preventive And Social Medicine By K. Park, 19th Edition, Page 449; Park's Textbook Of Preventive And Social Medicine By K. Park, 18th Edition, Page 415; Medical Informatics In Obstetrics And Gynecology By David Parry, Emma Parry, 2009 -### End" -2075,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest symptom of carcinoma bronchus is ?, with the following options: A: Hemoptysis, B: Dyspnoea, C: Cough, D: Wheezing - -### Response: -Ans. is 'c' i.e., Cough -### End" -2076,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following causes bony ankylosis, with the following options: A: TB, B: Septic ahritis, C: Gouty ahritis, D: Behcet's disease - -### Response: -CAUSES OF BONY ANKYLOSIS : TRAUMA HEMAHROSIS SUPPURATIVE AHRITIS RHEUMATOID AHRITIS OSTEOMYLITIS FRACTURE OF CONDYLE REF : MAHESWARI 9TH ED -### End" -2077,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Protein catabolism is increased in, with the following options: A: Starvation, B: Burns, C: Surgery, D: All of the above - -### Response: -During starvation80 to 90 percent of energy requirement will be derived from fats and the remainder 10 to 20 percent from proteins. Utilisation of fats will depend on the ""fat storage"" of the body. Since the adipose tissue represents the largest amount of stored food, the second stage will last for longest period, usually over two weeks. In starvation, tissue proteins are treated as 'food proteins"". They are hydrolysed to amino acids, but to a larger extent and at an increased scale than that occurs normally and constitutes the ""general amino acid pool"". For catabolism of tissue proteins, tissues are not uniformly used. Brain and hea are spared and only lose 3 percent of the bulk. Muscles lose 30 percent, liver 55 percent, and spleen 70 percent. The breakdown of tissue proteins in starvation is controlled possibly through the action of adrenal coex (Glucocoicoids).during an emergency condition such as stress, surgery, dehydration (burns)Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 536 & 538 -### End" -2078,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Casoni's test is used in the diagnosis of which of the following infection?, with the following options: A: Echinococcus granulosus, B: Toxoplasmosis, C: Toxocariasis, D: Syphilis - -### Response: -Casoni's test is an intradermal reaction used for diagnosis of Echinococcus granulosus infection. In this test 0.25ml of fluid is from the hydatid cyst is injected intradermally and the result is noted within half hour to 24 hours. Reaction of 5cm in diameter is considered to be positive. Kveim test: It is used for the diagnosis of sarcoidosis. In this test 0.1ml of sarcoid lesion in the lymph node is injected intradermally and the result is noted in 4-6 weeks. Frei's test: It used for diagnosis of lymphogranuloma inguinale infection. Tuberculin test is used in the diagnosis of tuberculosis. Ref: Clinical Pathology and Clinical Bacteriology By Sachdev page 305. -### End" -2079,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a network analysis technique regarding health management?, with the following options: A: PE, B: Cost benefit analysis, C: Cost effective analysis, D: Systems analysis - -### Response: -Management of health services by quantitative methods include: Cost benefit analysis Cost effective analysis Cost accounting Input output analysis Model Systems analysis Network analysis: the two common techniques of network analysis are: PE: Programme Evaluation and Review Technique CPM: Critical Path Method Ref: Park 21st edition, page 811 -### End" -2080,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the most common malignancy affecting spleen --, with the following options: A: Angiosarcoma, B: Hamaoma, C: Secondaries, D: Lymphoma - -### Response: -Ans. is 'd' i.e., Lymphoma -### End" -2081,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 18-year-old man notices occasional lightheadedness when standing up quickly. He also has difficulty playing sports because of easy fatigue and SOB. Examination shows normal heart sounds, but a loud systolic ejection murmur at the right sternal border. The murmur decreases with elevating the legs and increases in the standing position. Your clinical diagnosis is hypertrophic cardiomyopathy (HOCM).For the above patients, select the characteristic arterial pulse finding., with the following options: A: pulsus tardus, B: pulsus paradoxus, C: hyperkinetic pulse, D: bisferiens pulse - -### Response: -The bisferiens pulse, two systolic peaks, occurs in HOCM and aortic regurgitation. In aortic regurgitation, the bisferiens pulse can occur both in the presence or absence of aortic stenosis. -### End" -2082,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Automatization is:, with the following options: A: Shift of hydrogen, B: Shift of carbon, C: Shift of both, D: None of these - -### Response: -The process of shifting a hydrogen atom from one carbon to another to produce enediols is referred to as automatization. -### End" -2083,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Erythromycin acts on which receptor in GITract -, with the following options: A: Motilin, B: Muscarinic, C: Nicotinic, D: Serotonergic - -### Response: -Ans. is 'a' i.e., Motilin * Erythromycin stimulates motilin (an upper gastrointestinal peptide hormone) receptors in the g.i.t.--thereby induces gastric contractions, hastens gastric emptying and promotes intestinal motility without significant effect on colonic motility.* On the basis of this action erythromycin has been occasionally used to afford short-term symptomatic relief in diabetic gastroparesis. However, tolerance quickly develops to this action (probably due to receptor down- regulation) and undesirable alteration of bacterial flora limit use of erythromycin as a prokinetic agent. Contribution of this action to the g.i. side effects of erythromycin is not known. -### End" -2084,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thrombosthenin is a, with the following options: A: Coagulation factor, B: Contractile protein, C: A thrombosis promoting protein, D: A protein regulating platelet production - -### Response: -Thrombasthenin, platelet contractile proteins contract and help in clot retraction 48 hours after injury. The contractile protein of platelets is, responsible for clot retraction, platelet aggregation, and release of ADP and other biologic amines essential to platelet function. -### End" -2085,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common type of Ca in middle '/3rd of oesophagus?, with the following options: A: Adeno Ca, B: Squamous Ca, C: Adeno squamous Ca, D: Leiomyosarcoma - -### Response: -Ans. is 'b' i.e., Squamous cell carcinomaEsophageal carcinoma is of two common histological types -1.Squamous cell carcinomao Most common type world wide. o Most common type in India.o Occurs in upper and middle 1/3""' of esophagus.2. Adenocarcinomao Most common type in USA.o Located in the lower '/3rd of esophagus. -### End" -2086,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: insulin decreases the activity of:, with the following options: A: c-AMP dependent protein kinase, B: HMG CoA-reductase, C: Phosphodiesterase, D: Acetyl CoA-carboxylase - -### Response: -Ans. A. c-AMP dependent protein kinaseInsulin is a hypoglycemic hormone and is released in hyperglycemia. It helps in the uptake of glucose by the cells thus promoting glycogenesis and inhibiting glycogenolysis. It increases the activity of Phospho diesterase thus decreasing the activity of c-AMP.ATP-c-AMP-3'-5'AMP -### End" -2087,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic of protective epithelium is-, with the following options: A: Regeneration of membrane, B: Microvilli, C: Thinness, D: Pinocytic vesicle - -### Response: -Ans. is 'a' i.e., Regeneration of membraneo The regeneration of epithelium is one of the protective mechnaism of epithelial cells, o There are three mechanism for healing:ResolutionIt is an ideal outcome of healing and occurs in acute inflammatory responses to minor injuriesRegenerationReplacement of lost parenchymal cells by division of adjacent surviving are parenchymal cells (Regeneration) can also restore injured tissue to normal.Whether regeneration occurs depends uponRegenerative capacity of the involved cell (i.e., their ability to divide)The no. of surviving viable cellsPresence of connective tissue framework that will provide the base for restoration ofnormal tissue structure.Repair by scar formation# A scar is a mass of collagen that is the end result of repair by organization and fibrosis. Repair by scar formation occurs when :o Resolution fails to occurs in an acute inflammatory responseo When there is ongoing tissue necrosis in chronic inflammation.o When parenchymal cells necrosis cannot be repaired by regeneration. -### End" -2088,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypolipidemic agents act on:, with the following options: A: HMG CoA synthetase, B: HMG CoA oxygenase, C: HMG CoA reductase, D: HMG CoA hydratase - -### Response: -C i.e. HMG COA reductase -### End" -2089,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Emporiatrics deals with the health of the following group of people:, with the following options: A: Farmers, B: Travellers, C: Industrial workers, D: Mine workers - -### Response: -Emporiatrics is the term coined to describe the science of the health of travellers. Health maintenance recommendations are based not only on the traveler's destination but also on assessment of risk, which is determined by such variables as health status, specific itinerary, purpose of travel, season, and lifestyle during travel. Ref: Park's Textbook of Social and Preventive Medicine, 19th edition, Page 107. -### End" -2090,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Measles rash appearance:, with the following options: A: Along with Koplik spots, B: 1-2 days before Koplik spots, C: 1-2 days after Koplik spots, D: Post measles stage - -### Response: -RASH IN MEASLES Stas 12-24 hours after appearance of Koplik spots. Retro -auricular origin spreads to other pas of body (fades in opposite direction). Takes 1 - 2 days to cover body * Fever is highest and patient is sickest on day of rash. -### End" -2091,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A baby presents with refusal to feed, skin lesions, seizures, ketosis organic acids in urine with normal ammonia; likely diagnosis is:, with the following options: A: Proprionic aciduria, B: Multiple carboxylase deficiency, C: Maple syrup urine disease, D: Urea cycle enzyme deficiency - -### Response: -Baby in the above mentioned case scenario is showing signs and symptoms of multiple carboxylase deficiency such as dermatitis severe metabolic acidosis, organic acid excretion. Ref: Essentials of Pediatrics By Nelson, 16th Edition, Pages 356 ; The Embryo: Scientific Discovery and Medical Ethics By Shraga Blazer, Page 246 ; NORD Guide to Rare Disorders: National Organization for Rare Disorders, Page 483 -### End" -2092,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following vaccines are given at 16 - 24 months according to NIS except:-, with the following options: A: DPT booster, B: OPV booster, C: Japanese encephalitis 2nd dose, D: PCV booster - -### Response: -NIS (National Immunization Schedule, India 2019-20) - At Bih : BCG, OPV0, Hep B - 6 Weeks : DPT1, OPV1, Hep B1, HiB1, Rota V1, fractionated IPV1, PCV1 - 10 Weeks : DPT2, OPV2, Hep B2, HiB2, Rota V2 - 14 Weeks : DPT3, OPV3, Hep B3, HiB3,Rota V3, fractionated IPV2, PCV2 - 9 months : Measles1/MR1, Vitamin A, PCV Booster, live JE1 - Every 6 months : Vitamin A (2 Lacs IU) till 5 years - 16-24 months : DPTB, OPV Booster, Measles2/MR2, live JE2 - 5 Years : DPTB - 10 Years : TT - 16 Years : TT - Pregnancy : TT (In 2020, TT to replaced with Td) -### End" -2093,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mr. C P Patel is having carcinoma colon of left side, comes to emergency depament with obstruction. What will be the best treatment to be given, with the following options: A: Haman's procedure, B: Defunctioning colostomy, C: Lieotransverse anastomosis, D: Transverse colostomy - -### Response: -.Obstruction due to rectosigmoid growth with patient being severely ill--Hamann's operation can be done to save the life of the patient wherein distal stump after removal of the growth is closed, proximal colon is brought out as end colostomy ref:SRB &;s manual of surgery,ed 3,pg no 857. -### End" -2094,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which year did the Kyoto Protocol conic into force?, with the following options: A: 2001, B: 2003, C: 2005, D: 2007 - -### Response: -Ans. is 'c' i.e., 2005 -### End" -2095,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of Golgi apparatus is, with the following options: A: Synthesis of protein, B: Maturation of protein, C: Degradation of protein, D: Sequencing of protein - -### Response: -Organization of the Golgi is directed at proper glycosylation of proteins and lipids. There are more than 200 enzymes that function to add, remove, or modify sugars from proteins and lipids in the Golgi apparatus. Membranous vesicles containing newly synthesized proteins bud off from the granular endoplasmic reticulum and fuse with the cistern on the cis side of the apparatus. The proteins are then passed other vesicles to the middle cisterns and finally to the cistern on the trans side, from which vesicles branch off into the cytoplasm.(REF: GANONG'S REVIEW OF MEDICAL PHYSIOLOGY 23rd EDITION page no.42) -### End" -2096,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minus cylinder lenses are prescribed because of, with the following options: A: Cheaper to produce and distribute, B: Preferred due to meridional aniseikonia, C: Reduces minification, D: Causes less coma and trefoil - -### Response: -Aniseikonia is defined as a condition wherein, images projected to visual coex from the two retinae are abnormally unequal in size and/or shape. Up to 5% aniseikonia is well tolerated. Meridional aniseikonia - refractive differences only occur in one meridian In a plus cylinder the lens is ground on the anterior surface of spectacle and thus there is more scattering and distoion of image as compared to a minus cylinder which is ground on posterior surface. Thus a minus cylinder is more comfoable to the patient and hence all prescriptions are written with a minus cylinder. Extra edge: - In pt with monocular aphakia wearing contact lens, % of aniseikonia is approximately 8% - In aphakia, Aniseikonia is decreased with contact lens than glasses. Hence, IOL implantation is preferred management NOTE- Aneisokonia with IOL- (1-3%) -### End" -2097,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Degloving injury is -, with the following options: A: Surgeon made wound, B: Lacerated wound, C: Blunt injury, D: Avulsion injury - -### Response: -• Degloving occurs when the skin and subcutaneous fat are stripped by avulsion from its underlying fascia, leaving neurovascular structures, tendon or bone exposed. -### End" -2098,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Laproscopic procedure patient develops shoulder pain due to, with the following options: A: Sub phrenic abscess, B: positional pain during surgery, C: Sub diaphragmatic migration of gas, D: Injury to liver - -### Response: -Ans. (c) Sub diaphragmatic migration of gas(Ref: Bailey 26th 100-101)* Shoulder pain after laparoscopy is due to pain referred from diaphragm and due to subdiaphragmatic migration of gas -### End" -2099,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following poisoning gives 'Bitter almond smell'?, with the following options: A: Lead, B: Cyanide, C: Mercury, D: Organophosphorus - -### Response: -Cyanide is having the classic ""bitter almond"" odor. Cyanide is a chemical asphyxiant; binding to cellular cytochrome oxidase, it blocks the aerobic utilization of oxygen. Unbound cyanide is detoxified by metabolism to thiocyanate, a much less toxic compound that is excreted in the urine. Ref: Blanc P.D. (2012). Chapter 57. Cyanide. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e. -### End" -2100,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apoptosis is, with the following options: A: Cell death induced by regulated intracellular program, B: Cell survival by a regulated ultra cellular program, C: Modification and adaptation by the regulated intracellular program, D: Cell death by an extracellular signal - -### Response: -Apoptosis is a pathway of cell death in which cells activate enzymes that degrade the cells' own nuclear DNA and nuclear and cytoplasmic proteins. Fragments of the apoptotic cells then break off, giving the appearance that is responsible for the name (apoptosis, ""falling off"").Apoptosis results from the activation of enzymes called caspases (so named because they are cysteine proteases that cleave proteins after aspaic residues)( Robbins Basic Pathology, 9th edition, page 19 ) -### End" -2101,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not present in dhatura?, with the following options: A: Hyoscine, B: D. Hyoscyamine, C: Muscarine, D: Atropine - -### Response: -Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy. 29th edition. 2010.Explanation:Datura PoisoningDatura contain alkaloids such as Hyoscine (scopolamine), hyoscyamine. and atropine.Datura poisoning symptoms are essentially due to atropine poisoning.The classical description of clinical features in datura poisoning is:Dry as a hone - dryness of mouth and throatRed as a heat - Flushing of faceBlind as a hat - Dilated pupils, sluggish light and accommodation reflexHot as a hare - Raised body temperatureMad as a wet hen - Delirium with gait disturbances.Symptoms of Datura poisoningDryness of mouth and ThroatFlushing of faceDilated pupilsSluggish light and accommodation reflexRaised body temperatureDeliriumGait disturbancesSlurred SpeechDysphagiaDrowsiness- Most of these features are also seen in Alchohol intoxication, (like drowsiness, irrelevant speech, dilated pupils, staggering gait and slurred speech):- Differentiating features are hot skin and dry mouth and lack of alcohol smell in breath.TreatmentGastric lavage and the administration of activated charcoal can be used to reduce the stomach's absorption of the ingested material.The drug physostigniine is used to reverse the effect.Benzodiazepines to decrease patient's agitation, and supportive care with oxygen, hydration, and symptomatic treatment.Muscarine is a natural product found in certain mushrooms, particularly in lnocybe and Clitocybe species. -### End" -2102,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Labour is said to be prolonged when duration of latent stage of labour crosses:, with the following options: A: 12 hours, B: 18 hours, C: 20 hours, D: 36 hours - -### Response: -labour pattern nullipara multipara prolonged latent phase >20 hrs >14 hrs protracted active phase dilatation <1.2 cm/hr <1.5 cm/hr protracted descent <1 cm/hr <2 cm/hr arrest of dilatation >2 hr >2 hr arrest of descent >1 hr >1 hr -### End" -2103,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The average distance of the fovea from the temporal margin of the optic disc is:, with the following options: A: 1 disc diameter, B: 2 disc diameter, C: 3 disc diameter, D: 4 disc diameter - -### Response: -2 disc diameter -### End" -2104,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Osmolarity of plasma is, with the following options: A: 190, B: 290, C: 390, D: 490 - -### Response: -Plasma Osmolarity :it is a measure of hydration status.plasma Osmolarity changes during dehydration and rehydration. Plasma Osmolarity ranges from 280 to 300 mOs/kg Ref:Guyton and Hall textbook of medical physiology 12th edition ,pag number:45 46 -### End" -2105,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After a minor head injury a young patient was unable to close his left eye and had drooling of saliva from left angle of mouth. He is suffering from:, with the following options: A: VIIth nerve injury., B: Vth nerve injury., C: IIIrd nerve injury., D: Combined VIIth and IIIrd nerve injury. - -### Response: -Ans. is 'a' i.e. VII nerve injury [Ref API medicine, 6/e, 730, Dhingra, 3/e p. 123 (2/e, p99) Harrison 17/e p 2584-8516/e p 2436))Inability to close the eye and drooling of saliva from the same side of the mouth is characteristic of VII nerve palsy (U/L)C/F of U/L Facial nerve palsyLower motor neuron (There is loss of muscles of facial expression)Upper motor neuronIpsilateral face is involvedAbsence of furrowing of face on the same sideInability to close the ipsilateral eye (on attempted closure the eyeball rolls upwards- Bell's phenomenon)Flattening of the nasolabial foldsDrooping of the angle of the mouthDeviation of mouth towards opposite side*Contralateral face is involvedThe lower half of the face is involved as in lower motor neuron palsy where as the upper half of the face is spared as it has B/L innervation.* Lets also seeClinical feature of 5th Nerve palsyLoss of corneal reflex*Loss of sensory sensations of face*When one trigeminal N. is paralysed, the jaw deviates to the paralysed side when the pt. attempts opening his mouth (Because of unbalanced action of pterygoid) B/l upper motor neuron lesion of trigeminal N. above the level of pons, causes exaggerated jaw jerk*Clinical feature of 3rd Nerve palsySevere ptosis*Dilated pupil*Divergent squint*Crossed diplopia* -### End" -2106,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child draws circle at, with the following options: A: 12 months, B: 24 months, C: 30 months, D: 36 months - -### Response: -

. Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning.copies circle. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition} -### End" -2107,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Karyotyping is useful in the diagnosis of?, with the following options: A: Autosomal recessive disorders, B: Chromosomal abnormalities, C: X-linked recessive disorders, D: Biochemical abnormalities - -### Response: -Karyotyping is the study of chromosomes and is used in cytogenetics to study the chromosomal abnormalities. After arresting the cells in metaphase the chromosomes are examined to see for: -• Change in Number of chromosomes - To detect abnormalities in chromosome numbers such as aneuploidy (trisomy, tetrasomy), polyploidy. -• For detection of structural chromosomal anomalies such as translocation, deletions, inversion of chromosomes -### End" -2108,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intestinal angiodysplasia involves, with the following options: A: AV malformation, B: Cavernous hemangioma, C: Cavernous hemangioma, D: Malignant tumor - -### Response: -Colonic aeriovenous malformation (AVM) is one of the causes of lower GI bleeding. Unlike small vascular ectasia or angiodysplasia, colonic AVM tends to be solitary, large in size, and identified endoscopically as flat or as an elevated bright red lesion. REFERANCE.MEDSCAP.COM -### End" -2109,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serum sickness is:, with the following options: A: Type 1 hypersensitivity reaction, B: Type 2 hypersensitivity reaction, C: Type 3 hypersensitivity reaction, D: Type 4 hypersensitivity reaction - -### Response: -Ans: C. Type 3 hypersensitivity reaction(Ref: Robbins 9/e p207)Serum sickness is the prototype of a systemic immune complex disease or type III hypersensitivity reaction.Immune Complex--Mediated (Type III) Hypersensitivity:Acute serum sickness is the prototype of a systemic immune complex disease; it was once a frequent sequela to the administration of large amounts of foreign serum (e.g., serum from immunized horses used for protection against diphtheria). -### End" -2110,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Co-administaion of which of the following drug with Zidovudine is not preferred: March 2007, with the following options: A: Indomethacin, B: Aspirin, C: Trimethoprim, D: All of the above - -### Response: -Ans. D: All of the above Common side effects of AZT include nausea, headache, changes in body fat, and discoloration of fingernails and toenails. More severe side effects include anemia and neutropenia. Myopathy, lactic acidosis, hepatomegaly, convulsions and encephalopathy are infrequent. AZT has been shown to work additively or synergistically with many anti-HIV agents; however, acyclovir and ribavirin decrease the antiviral effect of AZT. Drugs that inhibit hepatic glucuronidation, such as indomethacin, acetylsalicylic acid (Aspirin) and trimethoprim, decrease the elimination rate and increase the toxicity. Other nephrotoxic drug and myelosuppressive drugs and probebecid enhances toxicity. Stavudine and zidovudine exhibit mutual antagonism by competing for the same activation pathway. -### End" -2111,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 70-year-old man presents with the deterioration of vision 3 weeks after cataract extraction and lOL implantation. Slit lamp examination shows honeycomb maculopathy and Florescinangiography (Fshows 'flower petal'hyperfluorescence. The most likely diagnosis is -, with the following options: A: Age-related macular degeneration (ARMD), B: Central Serous Retinopathy (CSR), C: Macular Dystrophy, D: Cystoid Macular Edema - -### Response: -Ans-D -### End" -2112,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Totting fence post appearance of femur is seen in:, with the following options: A: Fibrous dysplasia, B: Hyper parathyroidism, C: Pagets disease, D: Fracture neck of femur - -### Response: -Ans: B (Hyperparathyroidism) Ref: Harrison's Principles of Internal Medicine, 18th ed. and Internet Source Explanation: Renal Osteodystrophy CRF leading on to hyperparathyroidism Signs of chronic renal failure Findings of osteomalacia Hyperparathyroidism Bone sclerosis Rugger jersey spine Totting fence post appearance: Due to Rickets + Hyperparathyroidism In children, metaphyseal changes resembling rickets are seen, which together with cortical erosions can give rise to the so-called Totting fence-post' appearance, particularly at the femoral neck. Looser's zone -### End" -2113,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The mechanism of action of EPEC is:, with the following options: A: Adherence to enterocytes, B: Stimulates adenylcyclase, C: Produce secretory diarrhea, D: None of the above - -### Response: -Ans. is 'a' i.e., Adherence to enterocytesENTEROPATHOGENIC E. COLIPathogenesis - Attaching-and-effacing histopathology.Three-stage model of EPEC pathogenesis: (i) Localized adherence(ii) Signal transduction(iii) Intimate adherence.Enteropathogenic E coli (EPEC) are an important cause of diarrhea in infants, especially in developing countries. EPEC adhere to the mucosal cells of the small bowel.Pathogenicity requires two important factors, the bundle forming pilus encoded by a plasmid EPEC adherence factor (EAF) and the chromosomal locus of enterocyte effacement (LEE) pathogenicity island that promote the tight adherence characteristic of EPEC (attachment and effacement). After attachment, there is loss of microvilli (effacement); formation of filamentous actin pedestals or cuplike structures. -### End" -2114,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mitral cells are seen in, with the following options: A: Olfactory bulb, B: Basal ganglia, C: Hippocampus, D: Hypothalamus - -### Response: -Mitral cells are neurons that are pa of the olfactory system. They are located in the olfactory bulb in the mammalian central nervous system. They receive information from the axons of olfactory receptor neurons, forming synapses in glomeruli. Axons of the mitral cells transfer information to a number of areas in the brain, including the piriform coex, entorhinal coex, and amygdala. Mitral cells receive excitatory input from olfactory sensory neurons and external tufted cells on their primary dendrites, whereas inhibitory input arises either from granule cells onto their lateral dendrites and soma or from periglomerular cells onto their dendritic tuft. Mitral cells together with tufted cells from an obligatory relay for all olfactory information entering from the olfactory nerve. -### End" -2115,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On barium swallow Leiomyoma shows following characteristic appearance-, with the following options: A: Rat tail appearance, B: Cork screw appearance, C: Oval mass lined by barium, D: String sign - -### Response: -Ans. is 'c' i.e., Oval mass lined by barium * On barium swallow, leiomyoma may be seen as a discrete round or ovoid submucosal mass that is well outlined by barium. Its borders form slightly obtuse angles with the oesophageal wall.* Oesophageal leiomyoma is a benign smooth-muscle neoplasm of the oesophagus. It is the most common benign tumor of the oesophagus.* They typically involve the mid-to-distal oesophagus. -### End" -2116,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The best suited anticogulant for osmotic fragility test is -, with the following options: A: Heparin, B: EDTA, C: Trisodium citrate, D: Potassium oxalate - -### Response: -Ans. is 'a' i.e., Heparin -### End" -2117,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for thyroglossal cyst is ?, with the following options: A: Suprahyoid, B: Subhyoid, C: Beneath the foramen ceacum, D: Floor of mouth - -### Response: -Ans. is 'b' i.e., Subhyoid -### End" -2118,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Human papillomatosis is caused by?, with the following options: A: INV, B: HPV, C: HIV, D: HBV - -### Response: -Ans. is b i.e., HPV Human upper respiratory papillomatosis is due to infection with human papilloma virus (HPV) type 6 and 11. -### End" -2119,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sumatriptan is a?, with the following options: A: 5HT 1D antagonist, B: 5HT 1 agonist, C: 5HT 1D agonist, D: 5HT 1A antagonist - -### Response: -SUMATRIPTAN *Selective agonist of the 5-HT1B/1D receptor *No interaction with adrenergic, dopaminergic and cholinergic receptors, GABA MOA: *Blockade of 5-HT1D/1B mediated constriction of dilated extracerebral blood vessel *Constriction of the aeriovenous shunt of carotid aery *Inhibition of release of 5-HT and inflammatory neuropeptides around the affected vessels - suppression of neurogenic inflammation *Suppression of impulse transmission in the trigeminovascular system Kinetics: *Poorly absorbed from GIT, bioavailability - 10 - 15% only *Complete absorption after subcutaneous administration *Metabolized by MAO-A and excreted in the urine, t1/2 is 2-3 Hrs *Administration & Doses: -The onset of an acute attack of migraine -Better tolerated than ergotamine -50 to 100 mg as initial dose and repeated after 24 Hrs if required -Should not be given is the first dose fails -SC dose - 12 mg (1 ml) stat and repeated if required *Adverse effects: Dose-related - Tightness of chest, feeling of heat, paresthesia of limbs, dizziness, and weakness (sho lasting) - common with SC route -Risk of MI and seizure and death Contraindications: IHD, epilepsy, hypeension, pregnancy, hepatic and renal impairment -### End" -2120,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A nurse is giving instructions to a client who is receiving Mycophenolate mofetil (CellCept) and Mycophenolic acid (Myfortic) after undergoing a heart transplant. The nurse tells the client to anticipate the following side effects, except?, with the following options: A: Insomnia., B: Vomiting., C: Hypertension., D: Diarrhea. - -### Response: -These medications can cause diarrhea, vomiting, sepsis, back pain, neutropenia and hypertension. -### End" -2121,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type II schizophrenia is characterised by all of the following features, EXCEPT:, with the following options: A: Negative symptoms, B: Poor response to treatment, C: Disorganised behaviour, D: CT scan abnormal - -### Response: -Type II Schizophrenia is characterised by prominent negative symptoms, intellectual deterioration, enlarged cerebral ventricles and poor response to neuroleptics. Type I Schizophrenia is characterised by:Positive symptomsNormal brain structureAbsence of intellectual impairmentGood response to neurolepticsRef: Contemporary Issues in the Treatment of Schizophrenia edited by Christian L. Shriqui, M.D., page 113. -### End" -2122,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior border of ovary is ?, with the following options: A: Attached to suspensory ligament, B: Attached to broad ligament, C: Attached to infundibulopelvic ligament, D: Free of ligament attachment - -### Response: -Ans. is 'd' i.e., Free of ligament attachment OVARY The ovaries are female gonads. Each ovary lies in the ovarian fossa on the lateral pelvic wall which is bound anteriorly by obliterated umblical aery and posteriorly by ureter and internal iliac aery. Each ovary has two poles (upper and lower), two borders (anterior and posterior) and two surfaces (medial and lateral). Upper pole (tubal end) is related to ovarian fimbria of fallopian tube and external iliac aery. Suspensory ligament of ovary (infundibulopelvic ligament) connents it with pelvic brim. Lower pole (uterine end) is connected with lateral angle of uterus by ligament of the ovary, just posteroinferior to the attachment of fallopian tube. Lateral surface is related to ovarian fossa and is covered with peritoneum which separates it from Obturator vessels and nerve. Medial surface is related to fallopian tube and is separated by a peritoneal recess, called ovarian bursa. Anterior border (mesovarian border) is straight and related to fallopian tube and obliterated umblical aery. It is attached to posterior surface of broad ligament of uterus by mesovarium and forms the hilus of ovary. Posterior border (free border) is convex and is related to fallopian tube and ureter. -### End" -2123,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secondary deposits form prostatic carcinoma is commonest in, with the following options: A: Bone, B: Lung, C: Liver, D: Brain - -### Response: -Secondary deposits form prostatic carcinoma is commonest in boneThe prostate is the most common site of origin for skeletal metastases, followed in turn by the breast, the kidney, the bronchus and the thyroid gland. The bones involved most frequently are the pelvic bones and the lower lumbar veebrae. The femoral head, rib cage and skull are other common sites -### End" -2124,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Burden of disease is best detected by:, with the following options: A: DALY, B: Sullivan's index, C: IMR, D: Survival index - -### Response: -Disability adjusted life years: Measures the burden of disease in the population & years lived with disability adjusted for the severity of the disability. One DALY is ""one lost year of healthy life"" Sullivan's index: Expectation of life free from disability, computed by subtracting from life expectancy the probable duration of bed disability & inability to perform major activities according to cross sectional data IMR is universally regarded not only as a most impoant indicator of the health status of a community but also of the level of living of people in general and effectiveness of MCH services in paicular. IMR= No. of deaths of children less than 1 year of age in a year --------------------------------------------------------------------x1000 No. of live bihs in the same year Survival rate: It is the propoion of survivors in a group eg: patients studied and followed over a period (eg: 5-year period). It is a method of describing prognosis in ceain disease conditions. Survival rate can be used as a yardstick for the assessment of standards of therapy. Survival rates have received special attention in cancer studies. Ref : Park's Textbook of Preventive and Social Medicine; 18th edition; Page-24 -### End" -2125,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: all are true about s1 except, with the following options: A: lower frequency than s2, B: caused by closure of mitral valve, C: heard at the end of ventricular systole, D: better heard with diaphragm of stethescope - -### Response: -CHARACTERISTICS OF S1 Normally heard as fused single hea sound Medium to High Frequency Low Pitched Best heard with diaphragm M1 louder than T1 M1 best heard at apex T1 best heard at Left LSB Splitting can be heard in Expiration and L-LSB ref : harrisons 21st ed -### End" -2126,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 46-year-old smoker presents in an ED with a sharp ,left sided chest pain. The pain is not focal. On physical examination , there is no specific finding .Pain is neither aggravated nor relived with change of postural change and with inspiration. On an ECG , anterior ST elevation can be seen.What shall be the next step in management ?, with the following options: A: Activation of the primary angioplastyteam, B: Await troponin tests and give analgesia, C: Non-steroidal anti-inflammatory analgesia, D: Urgent bedside echo to rule out a regional wall motion abnormality - -### Response: -As the patient comes with acute chest pain , and ECG shows anterior MI, pericarditis is ruled out . Ischemia must be urgently ruled out. When ECG is non diagnostic ,abnormalities of wall motion can be seen on echocardiography. It helps in aiding whether patient needs a fibrinolytic therapy or percutaneous coronary intervention ). It can't differentiate acute STEMI and old myocardial scar. It is a screening modality in emergency depament . -### End" -2127,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common parotid gland tumour is, with the following options: A: Pleomorphic adenoma, B: Monomorphic adenoma, C: Primary lymphoma, D: Adeno carcinoma - -### Response: -(A) Pleomorphic adenoma # Parotid tumours> Most common is pleomorphic adenoma (80-90%)> Low-grade malignant tumours cannot be distinguished from benign neoplasms> High-grade tumours grow rapidly are usually painful and often have lymph node involvement of presentation> CT and MRI are useful> Fine-needle aspiration is better than open biopsy> Tumours should be excised, not enucleated -### End" -2128,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are actions of Cytotoxic T-cells except, with the following options: A: They destroy translated & other foreingn cells, B: They display the glycoprotein CDS, C: They can phagocytose cells, D: They act by using perforins and produce lymphotoxins - -### Response: -Phagocytosis is seen in humoral immunity mediated by circulating antibodies produced by B lymphocytes. Cytotoxic T cell destroy transplanted and other foreign cells, with their development, aided and directed by helper T Cell. Cytotoxic T cell displays CD8 and helper T cells display CD4. They kill organisms by inseing perforins into their cell membrane and thus producing holes. Ref: Ganong's Review of medical physiology, 24th edition.Pg no. 69 Textbook of medical physiology by N Geetha, 2nd edition, page no. 96,97 -### End" -2129,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tumor marker of HCC, with the following options: A: AFP, B: Alpha fucosidases, C: DCGP, D: Carbohydrate antigen - -### Response: -Tumor markers of HCC Protein induced by Vitamin K absence (PIVKA; Des-gamma-carboxy prothrombin); glypican-3; AFP fractions Lectin fraction-3 of SFP (AFP-L3) is highly specific to HCC and also indicator of poorly differentiated histology and unourable prognosis Serum AFP level is elevated above 20ng/mp in >70% of patients with HCC Monoclonal antibody HeoPar-1(hepatocyte paraffin-1) identifies a unique antigen on hepatocyte mitochondria and is used to identify hepatocytes or HCC Ref:Sabiston 20th edition 1458-1463 -### End" -2130,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transobturator tape approach in treatment of urinary incontinence is known to, with the following options: A: Increased long term efficacy than TVT., B: Reduce vascular and lower urinary tract injury risks., C: Overlie over proximal tendon of adductor magnus., D: Traverse retropubic space, causing neurovascular injury. - -### Response: -TOT approach was introduced with the intention to reduce vascular and lower urinary tract injury risks that can be associated with traversing retropubic space. -### End" -2131,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which malignancy develops in long standing goiter is, with the following options: A: Follicular, B: Papillary, C: Medullary, D: None - -### Response: -Enlargement of the thyroid, or goiter is caused by impaired synthesis of thyroid hormone, which is most often the result of dietary iodine deficiency. Impairment of thyroid hormone synthesis leads to a compensatory rise in the serum TSH level, which, in turn, causes hyperophy and hyperplasia of thyroid follicular cells and, ultimately, gross enlargement of the thyroid gland. The compensatory increase in functional mass of the gland overcomes the hormone deficiency, ensuring a euthyroid metabolic state in most individuals. If the underlying disorder is sufficiently severe (e.g., a congenital biosynthetic defect or endemic iodine deficiency, discussed later), the compensatory responses may be inadequate, resulting in goitrous hypothy- roidism. The degree of thyroid enlargement is propoional to the level and duration of thyroid hormone deficiency. Goiters can broadly be divided into two types: diffuse non- toxic and multinodular. -### End" -2132,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 58-year-old female employee of a housecleaning business visits the outpatient clinic with a complaint of constant, burning pain in her knees. Clinical examinations reveal a ""housemaid's knee"" condition. Which of the following structures is most likely affected?, with the following options: A: Prepatellar bursa, B: Infrapatellar bursa, C: Posterior cruciate ligament, D: Patellar retinacula - -### Response: -(a) Source: GAS 577, 578; GA 306 Excessive compression of the prepatellar bursa, as in working on bended knees, can result in pain and swelling of the prepatellar bursa, the socalled housemaid's knee. Prepatellar bursitis affects plumbers, carpet layers, and other people who spend a lot of time on their knees. The bursa normally enables the patella to move smoothly under the skin. The constant friction of these occupations irritates this small lubricating sac (bursa) located just in front of the patella, resulting in a deformable tense cushion of fluid. Treatment usually requires simple drainage, but this may need to be repeated and occasionally steroids introduced. Excessive irritation of the infrapatellar bursa in kneeling for frequent and long periods of time (as in prayer) can result in ""parson's knee."" The posterior cruciate ligament of the knee can be injured in sudden, strong flexion of the knee, with posterior displacement of the tibia upon the femur. The patellar retinacula are strong, tendinous bands of tissue that join the quadriceps tendon to the vastus lateralis and medialis muscles. The lateral meniscus is a cartilaginous structure between the lateral condyles of the femur and tibia. -### End" -2133,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organs mostly involved in blast injury ?, with the following options: A: Solid organs, B: Hollow viscus, C: Skeletal system, D: Muscles - -### Response: -Ans. is 'b' i.e., Hollow viscus There is barotrauma to air filled hollow organs. -### End" -2134,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a branch of Cavernous segment of Internal Carotid aery?, with the following options: A: Cavernous Branch, B: Inferior Hypophyseal Branch, C: Meningeal branch, D: Ophthalmic branch - -### Response: -The ophthalmic aery (OA) is the first branch of the internal carotid aery distal to the cavernous sinus. Branches of the OA supply all the structures in the orbit as well as some structures in the nose, face, and meninges. Occlusion of the OA or its branches can produce sight-threatening conditions. -### End" -2135,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following intravenous induction agent is most suitable for day care surgery?, with the following options: A: Morphine, B: Ketamine, C: Propofol, D: Diazepam - -### Response: -ANSWER: (C) PropofolREF: Morgans clinical anesthesiology 3rd edition page 173Repeat in December 2010""Propofol is the most suitable intravenous induction agent for day care surgery"" -### End" -2136,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following conditions affect posterior part of larynx except:, with the following options: A: Contact ulcer, B: Pachydermia laryngis, C: Intubation granuloma, D: Lupus - -### Response: -Lupus affects anterior part of larynx. It starts at the epiglottis and sspreads posteriorly to involve aryepiglottic folds. Slow indolent and symptomless destruction of epiglottis may occur. Lupus of larynx is secondary to lupus of nose and pharynx.Contact ulcer occurs at vocal process of arytenoid when one vocal process hammers against another traumatising the overlying mucosa and formation of a granuloma. It is due to vocal abuse.Pachydermia laryngis is a form of chronic hypertrophic laryngitis. It involves interarytenoid region and both vocal processes of arytenoid where grey or red papilliferous lesions are seen. Biopsy is essential to differentiate from tuberculosis and malignancy.Intubation granuloma is also seen in the area of vocal processes and is due to prolonged rough intubation or using a large tube. Trauma of tube ulcerates mucosa with the formation of a granuloma. -### End" -2137,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement describing innervation of bladder is, with the following options: A: Somatic component of peripheral nervous system innervates smooth muscle., B: Autonomic fibers supplying pelvic viscera course in inferior and superior hypogastric plexus., C: Autonomic component of peripheral nervous system supplies striated muscle., D: β - adrenergic receptors predominate in bladder base. - -### Response: -Sympathetic fibers are carried through superior hypogastric nerve plexus & Inferior hypogastric plexus provides parasympathetic component. -### End" -2138,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which model of DNA was discovered by Watson and Crick, with the following options: A: A- DNA, B: B- DNA, C: C-DNA, D: Z- DNA - -### Response: -Most common form.Right handed double helix.Highly flexible.Watson and Crick model describes the B- form of DNA. -### End" -2139,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Naglers reaction is shown by -, with the following options: A: Cl. tetani, B: Cl. botulinum, C: Cl. perfringens, D: Cl. septicum - -### Response: -Ans. is 'c' i.e., Cl. perfringenes -### End" -2140,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of Metabolism includes all except, with the following options: A: Extraction of nutrients from food, B: Breakdown of substrate, C: Equilibrium of biochemical with intracellular components, D: Using building blocks for synthesis - -### Response: -A i.e. Extraction of nutrients from foodExtraction of nutrients from food is not metabolism. Metabolism is oxidation of nutrients from food to produce energy.QMetabolism is a combination of two processes, namely:Anabolism : synthetic reactions that build up substancesCatabolism : reactions involving breakdown or oxidation of fuel molecules (breakdown of substrate)Both catabolism and anabolism proceed only until equilibrium is achieved. Equilibrium is a mechanism for biological control of rate at which these reactions occur. -### End" -2141,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true during the 12-hour period preceding ovulation?, with the following options: A: A surge of LH is secreted from the pituitary, B: The surge occurs immediately after the formation of the corpus luteum, C: The surge is followed immediately by a fall in the plasma concentration of progesterone, D: The number of developing follicles is increasing - -### Response: -Ovulation will not take place unless a surge of LH precedes it. Immediately prior to ovulation, the number of follicles is decreasing due to normal attrition of all but one follicle, and consequently estrogen synthesis by the ovary is decreasing. Progesterone synthesis is stimulated by the LH surge. -### End" -2142,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has multiple meningiomas, bilateral vestibular schwannomas and early onset cataract. The most likely diagnosis is: -, with the following options: A: Neurofibromatosis type 2, B: Tuberous sclerosis, C: Von Hippel Lindau (VHL) disease, D: Sturge-Weber syndrome - -### Response: -Neurofibromatosis Type 2 Autosomal dominant disorder resulting in a range of tumors, most commonly bilateral eighth nerve schwannomas, multiple meningiomas, and ependymomas of the spinal cord. In addition, a characteristic type of cataract, juvenile posterior subcapsular lenticular opacity, occurs in NF2. This syndrome is caused by mutation of the NF2 gene on chromosome 22q; NF2 encodes a protein called neurofibromin 2/merlin protein. -### End" -2143,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The thyroid inhibitor which produces the fastest response is, with the following options: A: Lugol's iodine, B: Propylthiouracil, C: Radioactive iodine, D: Lithium carbonate - -### Response: -IODINE AND IODIDES Though iodine is a constituent of thyroid hormones, it is the fastest acting thyroid inhibitor. Ref:- kd tripathi; pg num:-254 -### End" -2144,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: LEVOSIMENDAN acts on the all the following mechanism except ?, with the following options: A: phosphodiesterase inhibitor 3, B: neprilysin inhibitor, C: potassium channel opener, D: sensitizes myocardium to calcium channels - -### Response: -Molecular Targets Pharmacological Effects * Calcium sensitisation of the contractile * inotropy without increase of calcium transient and oxygen consumption apparatus by selective binding to calcium * Anti-stunning effect saturated cardiac troponin C * Opening of the ATP-sensitive potassium * Vasodilation (including coronary aeries) channels on the smooth muscle of the vasculature * increase of end-organ perfusion * Opening of the mitochondrial ATP- .Cardioprotection and organ protection Anti-ischaemic effect * sensitive potassium channels REF : KD TRIPATHI 8TH ED -### End" -2145,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 5 days after CBD surgery there is a small leak. What will be the best treatment, with the following options: A: Ultrasound guided aspiration, B: ERCP and stenting, C: Re-exploration and hepaticojejunostomy, D: Re-exploration and primary repair - -### Response: -There is a small leak which can be managed by ultrasound guided aspiration. Many bile leaks resolve with percutaneous drainage alone, and ERCP is probably unnecessary in the absence of radiographic or clinical evidence of ongoing bile drainage Ref: Blumga 5th edition Pgno :627 -### End" -2146,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The gene for Wilson&;s disease is on, with the following options: A: Long arm of Chromosome 13, B: Long arm of Chromosome 6, C: Sho arm of Chromosome 13, D: Sho arm of Chromosome 6 - -### Response: -In Wilson&;s disease,the underlying defect lies in the long arm of chromosome 13 where there is a mutation in ATP7B gene,the normal hepatic copper- excreting gene.Eventually,capacity of hepatocytes to store copper is exceeded and copper is released into circulation which then gets deposited in extrahepatic tissues such as the brain eyes, and others. Reference:Textbook of pathology-Harsh Mohan,6th edition,page no:628 -### End" -2147,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coronary vein is, with the following options: A: Left Gastric vein, B: Right Gastric vein, C: Left Gastroepiploic vein, D: Right Gastroepiploic vein - -### Response: -. -### End" -2148,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Small for date baby is –, with the following options: A: < 10 percentile for the gestational age, B: < 50 percentile for gestational age, C: < 2000 gm, D: < 2500 gm - -### Response: -The expected weight of newborn infants born at a given gestational age is generally estimated from the intrauterine growth charts on observations in live births of mothers delivering at different gestations. - - -Appropriate for gestational age (appropriate for date) - -Babies with birth weight ranging between 10th to 90th percentile on such a chart are considered appropriate for date. - -Small for gestational age (small for date) - -Babies with birth weight less than 10th percentile are categorized as small for dates. - -Large for gestational age (large for date) - -Babies with birth weight more than 90th percentile are categorized as large for date. - -Low birth weight newborn - -Any neonate weighing less than 2500 gm at birth irrespective of the gestational age. - -Very low birth weight newborn - -Any neonate weighing less than 1500 gm at birth irrespective of the gestational age. - -Extremely low birth weight newborn - -Any neonate weighing less than 1000 gm at birth irrespective of the gestational age. -### End" -2149,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following are radiological evidence of Achalasia cardia except not related -radiology, with the following options: A: Smooth narrowing of esophagus, B: Dilated touous esophagus, C: Absence of air in the fundus, D: Exaggerated peristalsis - -### Response: -. -### End" -2150,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fohergill's repair is also known as :, with the following options: A: Khanna's sling operation, B: Manchester operation, C: Le Fo's repair, D: Shirodkar's abdominal sling operation - -### Response: -Manchester operation -### End" -2151,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reading and writing skills of a moderately mental retarded child, with the following options: A: Reasonable, B: Basic, C: Minimal, D: None - -### Response: -Ans. is 'b' i.e., Basic -### End" -2152,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Myositis ossificans is differentiated from other reactive fibroblastic proliferations by the presence of:September 2009, with the following options: A: Dysplastic bone, B: Dystrophic bone, C: Metaplastic bone, D: Hyperophic bone - -### Response: -Ans. C: Metaplastic boneMyositis ossificans usually develops in the athletic adolescents and young adults and follows an episode of trauma in more than 50% of cases.The lesion typically arises in the musculature of proximal extremities.It shows metaplastic bone.It should be differentiated from extraskeletal osteosarcoma. -### End" -2153,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not seen in the first decade -, with the following options: A: Retino blastoma, B: Rhabdomyosarcoma, C: Neuroblastoma, D: Ameloblastoma - -### Response: -Ameloblastoma is not a childhood tumor. -Other three are childhood malignancies. -### End" -2154,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bacterial vaginosis does NOT include:, with the following options: A: Profuse creamy discharge, B: Clue cells present, C: Positive whiff test, D: Absent leucocytes - -### Response: -Gardnerella vaginalis, facultatively anaerobic gram-variable rod, is one of the organismsresponsible for bacterial vaginosis (BV). The vaginal discharge of BV is characteristically described as a thin, gray, homogeneous fluid that is adherent to the vaginal mucosa. A fishy vaginal odour, which is paicularly noticeable following coitusis present. Demonstration of clue cells on a saline smear is the most specific criterion for diagnosing BV. The whiff test may be positive in up to 70% of BV patients. The vaginal discharge of patients with BV is notable for its lack of polymorphonuclear leukocytes (PMNs), typically 1 or less than 1 PMN per vaginal epithelial cell. -### End" -2155,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements regarding dyspnoea are True / False? a) Tripod positioned breathing, characterized by sitting with one's hands braced on the knees is indicative of increased airway resistance b) Paradoxical movement of the abdomen a sign of diaphragmatic weakness c) Left atrial failure should be considered when the patient complains of platypnea d) Raynaud's disease may be an indirect clue to the underlying pulmonary hypeension in a patient with dyspnoea e) If the hea rate is >85% of the predicted maximum an abnormality of the cardiovascular system is likely the explanation for dyspnoea, with the following options: A: c,d,e -True a,b -False, B: a,d,e -True b,c -False, C: a,b,d,e -True c -False, D: a,d -True b,c,e -False - -### Response: -Evidence for increased work of breathing (use of accessory muscles of ventilation, and the tripod position) is indicative of increased airway resistance. Paradoxical movement of the abdomen (inward motion during inspiration), a sign of diaphragmatic weakness. Left atrial myxoma or hepatopulmonary syndrome should be considered when the patient complains of platypnea. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Pages 277-78. -### End" -2156,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AIDS patient with broad budding yeast:-, with the following options: A: Histoplasmosis, B: Blastomycosis, C: Cocidiomycosis, D: Paracocidiomycosis - -### Response: -In AIDS patient fungal infection by dimorphic fungi is very common. All the four options have dimorphic fungi but they have different characteristics. Histoplasma has narrow base budding East whereas blastomycosis have broad based budding yeast whereas in cocidiodimycosis has endospores with spherules are present and in paracocidiomycosis Mickey Mouse kind of arrangement of yeast cells is seen. -### End" -2157,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wilson’s disease is characterised by all except?, with the following options: A: The defective gene is ATP 7A, B: Neurological features include Parkinsonian features and Ataxia, C: Kayser-Fleischer rings and sunflower cataracts are typical eye findings, D: Liver biopsy is confirmatory for the diagnosis - -### Response: -Option 1 - ATP7A gene defect leads to Menke’s disease. -  - Option 2 - Wilson disease leads to copper accumulation leading to reduced concentration of Ceruloplasmin. Copper is deposited mainly in the liver and brain. Parkinsonism, ataxia, dystonia, subcortical dementia, seizures, psychosis and migraine are all neurological features.  -  -Option 3 - Kayser-Fleischer rings (copper in Descemet’s membrane in eye) and sunflower cataracts are typical eye findings.  -  -Option 4 - Eventhough reduced ceruloplasmin and raised urinary copper may suggest the possibility of Wilson’s, the diagnosis is confirmed using a liver biopsy to estimate copper levels. -### End" -2158,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At what value of one hour glucose challenge test will you recommend a standard glucose tolerance test-, with the following options: A: 120 mg\/dl, B: 140 mg\/dl, C: 150 mg\/dl, D: 160 mg\/dl - -### Response: -Answer is option 2 - 140 mg/dl A serum blood glucose value greater than 140mg/dl at one hour in an one hour glucose challenge test (O&; Sullivan test) is termed suspicious and requires a formal/standard glucose tolerance test. Done to detect gestational diabetes Ref manual for laboratory and diagnostic test 8/350 -### End" -2159,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about primary immune response, with the following options: A: Immune response against subsequent antigenic challenge, B: Lag period is longer., C: Slow, Sluggish and short lived, D: All the above - -### Response: -Immune response against primary antigenic challenge - Primary immune response. -### End" -2160,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most important factor for a test to be a good screening test is?, with the following options: A: Specificity, B: Sensitivity, C: Reliability, D: Predictive value - -### Response: -ANSWER: (B) SensitivityREF: Park 20tsi edition page 127, style=""color: rgba(20, 20, 20, 1); font-family: Times New Roman, Times, serif"">ove rview aab6b5The intention of screening is to identify disease in a community early, thus enabling earlier intervention and management in the hope to reduce mortality and suffering from a disease. Although screening may lead to an earlier diagnosis, not all screening tests have been shown to benefit the person being screened; overdiagnosis, misdiagnosis, and creating a false sense of security are some potential adverse effects of screening. For these reasons, a test used in a screening program, especially for a disease with low incidence, must have good sensitivity in addition to acceptable specificity. -### End" -2161,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypopigmented patches may be seen in:, with the following options: A: Becker's nevus, B: Nevus anemicus, C: Nevus of Ota, D: Nevus of Ito - -### Response: -Nevus anaemicus (NA) - Congenital disorder characterized by macules of varying size and shape that are paler than the surrounding skin and cannot be made red by trauma, cold, or heat. Paler area is due to the blood vessels within the area which are more sensitive to body's normal vasoconstricting chemicals. Hyperpigmentary disorders: Nevus of OTA Nevus of ITO Becker's Nevus -### End" -2162,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sistrunks procedure is used for, with the following options: A: Thyroglossal cyst, B: Reidel thyroiditis, C: Thymic aplasia, D: All of the above - -### Response: -Sistrunks procedure is removal of cyst and tract till base of tongue. -### End" -2163,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anaesthetic agent associated with hallucination is:, with the following options: A: Ketamine, B: Halothane, C: Ether, D: Cyclopropane - -### Response: -Ketamine -### End" -2164,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: EAC rosette formation is the property of one of the following type of immune cells -, with the following options: A: T cells, B: B cells, C: Macrophages, D: All of the above - -### Response: -Erythrocyte antibody complement rosetting (EAC-rosetting), occurs when the antibody in the presence of complement is bound to the surface of a red blood cell. The complement binds to the tail region (Fc region) of the antibody. Finally, T-cells with a complement receptor are added and the T-cells bind to the complement on the antibody completing the rosette -### End" -2165,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vital layer in slow sand filter is seen in -, with the following options: A: Top of water, B: On the sand bed, C: Near filter, D: None - -### Response: -Elements of slow sand filter: supernatant or raw water (1-1.5 metre) a bed of graded sand an under-drainage system a system of filter control valves The surface of the sand bed gets covered with a slimy growth known as ""Schmutzdecke"", vital layer, zoological or biological layer. The formation of the vital layer is called ripening. It is the hea of the slow sand filter Park's textbook of preventive and social medicine.K Park. Edition 25. page no:772 -### End" -2166,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false about drugs given in urinary incontinence, with the following options: A: Darifenacin is a selective M3 antagonist, B: Flavoxate, Oxybutynin, Tolterodine are muscarine receptor blockers used to decrease detrusor muscle contraction, C: Tolterodine can be given as tansdermal patch, D: Trospium is a quartenery amine with no CNS side effects - -### Response: -Oxybutynin can be given as transdermal patch, not Tolterodine. -### End" -2167,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Sibson's fascia EXCEPT, with the following options: A: Attached to inner border of first rib, B: Covers supraclavicular pa of lung, C: Modified inner pa of scalenus anterior, D: Attached to transverse process of C7 - -### Response: -Sibson's fascia is a modification of the endothoracic fascia in the supraclavicular region, covering the thoracic inlet. It is a degenerated tendon of scalenus minimus. Attachment : Transverse process of C7 veebra and inner border of 1st rib. It separates the subclan aery and vein ( running on the posterio superior surface of the first rib) from the cervical pleura. -### End" -2168,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A symmetric high-voltage, triphasic slow wave pattern is seen on EEG in the following, with the following options: A: Hepatic encephalopathy, B: Uremic encephalopathy, C: Hypoxic encephalopathy, D: All - -### Response: -Answer is A (Hepatic encephalopathy): Symmetric, high voltage, triphasic slow wave (2-5/second) fattern on Electroencephalogram (EEG) is characteristic (hut non specific) of hepatic encephalopathy- Harrison 16th/1868 The diagnosis of hepatic encephalopathy should be considered when four major factors are present Acute or chronic hepatocellular disease and/or extensive poal systemic collateral shunts Disturbance of awareness and mentation which may progress from forgetfulness and confusion to stupor and finally coma. Shifting combinations of neurological signs including asterixis, rigidity, hyperreflexia, extensor plantar signs and rarely seizures. A characteristic but (nonspecific), symmetric, high voltage, triphasic slow wave (2 or 5/second) pattern on electroencephalogram. -### End" -2169,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The disorder associated with impulse to consume alcohol is called:, with the following options: A: Kleptomania, B: Dipsomania, C: Pyromania, D: Nymphomania - -### Response: -Ans: b (Dipsomania) Ref: Reddy, 27th ed, p. 412Irresistable desire for alcoholic drinks - Dipsomania.Note:Impulse control disordersKleptomania: Irresistable desire to steal.Pyromania: Irresistable desire to set fire.Mutilomania: Irresistable desire to mutilate animals.Trichotillomania: Irresistable desire to pluck hairs.- Erotomania is not an impulse control disorder, it is a delusion of love. -### End" -2170,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common pemphigus is-, with the following options: A: Pemphigus vulgaris, B: Pemphigus vegetans, C: Pemphigus foliaceus, D: Pemphigus erythematosus - -### Response: -The several variant of pemphigous are pemphigous vulgaris, P. foliaceus, P. erythematosus, P. vegetans. In this the most common is pemphigous vulgaris. From illustrated synopsis of dermatology and sexually transmitted diseases neena khanna 5th edition page no 78 -### End" -2171,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dose of Human Rabies Immunoglobulin is:, with the following options: A: 10 IU/kg, B: 20 IU/kg, C: 30 IU/kg, D: 40 IU/kg - -### Response: -b. 20IU/kg(Ref: Nelson's 20/e p 3450, 1642-1644, Ghai 8/e p 202-203)Human rabies immunoglobulin (HRIG--dose is 20U/kg body weight, maximum dose 1500IU); andEquine rabies immunoglobulin (ERIG--dose is 40U/kg, maximum dose 3000IU) -### End" -2172,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for spinal TB, with the following options: A: X-ray, B: CT Scan, C: MRI, D: PET Scan - -### Response: -Answer- C. MRIBest view for Cl-C2 veebrae & junction - open mouth odontoid (pegs) view.Investigation of choice for spinal tuberculosis - MRIInvestigation of choice for traumatic paraplagia - MRI -### End" -2173,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presented with complaints of ipsilateral flushing and sweating with eating and salivation. He had a parotid gland surgery few weeks ago. Frey's syndrome is diagnosed. Frey's syndrome is related to:, with the following options: A: Auriculotemporal nerve, B: Facial nerve, C: Abducens nerve, D: Glossopharyngeal nerve - -### Response: -Frey syndrome: Aberrant nerve regeneration after parotid gland injury or surgery may result in ipsilateral flushing and sweating with eating and salivation. Sweating occurs in the distribution of the auriculotemporal nerve after an injury, abscess, or surgery in the parotid region. Freys syndrome can be seen in infants and children, often following bih trauma with forcep delivery. -### End" -2174,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sleep apnea syndromeFor above situations, select the most likely sleep disturbance., with the following options: A: sleep more than younger adults, B: increased arousals during the night, C: increased slow-wave sleep, D: most common cause of excessive daytime sleepiness in the elderly - -### Response: -Sleep apnea syndrome is the most common cause of daytime sleepiness in the elderly. The prevalence (at least in sleep disorder centers) increases with advancing age. Narcolepsy (usually having started earlier in life) and periodic limb movement disorder (restless legs) are other common causes of excessive daytime sleepiness. -### End" -2175,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coxsackie A virus causes all except, with the following options: A: Aseptic meningitis, B: Herpangina, C: Foot and mouth disease, D: Bornbolm disease - -### Response: -cox sackie virus causes hetpangina,aseptic meningitis,HFMD -### End" -2176,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mastoid process is which type of epiphysis:, with the following options: A: Pressure, B: Aberrant, C: Atavistic, D: Traction - -### Response: -Traction epiphysis are present at the ends of bones and develop due to traction by the attached muscles (and are therefore extracapsular). -Mastoid process is produced due to the traction by the sternocleidomastoid muscle. -### End" -2177,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eugene Blueler's 4As include following except -, with the following options: A: Autism, B: Affect, C: Anhedonia, D: Association - -### Response: -Ans. is 'c' i.e., Anhedoniao Eugen Bleuler renamed dementia precox as Schizophrenia. He recognized that schizophrenia is a group of disorders rather than a distinct entity. Therefore, he used the term, a group of schizophrenias.o Bleuler described the characteristic symptoms (fundamental symptoms) for schizophrenia which are also known as 4 'A's of Bleuler:-1) Ambivalence (coexistence of two opposite feelings and attitude towards the same thing in the same person at the same time).2) Autism (Preoccupation with fantasies, delusions and hallucinations to the exclusion of reality).3) Affect disturbances (e.g., inappropriate affect).4) Association disturbances (e.g., Loosening of association, thought disorder).o He also described accessary syptoms of schizophrenia:- delusions, hallucinations, and negativism. -### End" -2178,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following interactions contributes most in protein folding?, with the following options: A: Covalent Bond, B: Ionic interactions, C: Hydrophobic, D: Vander waal's interaction - -### Response: -Protein folding: The number of distinct combinations of phi and psi angles specifying potential conformations of even a relatively small-- 15 kDa--polypeptide is unbelievably vast, native conformation is specified in the primary sequence. In nature, protein folding takes place in a more orderly and guided fashion.Protein folding generally occurs a stepwise process. In the first stage, as the newly synthesized polypeptide emerges from the ribosome, sho segments fold into secondary structural units that provide local regions of organized structurethe hydrophobic regions segregate into the interior of the protein away from solvent, forming a ""molten globule,"" a paially folded polypeptideCells employ auxiliary proteins to speed the process of folding and to guide it toward a productive conclusionChaperone proteins paicipate in the folding The hsp70 (70 kDa heat shock protein) family of chaperones binds sho sequences ofhydrophobic amino acids- shielding them from solvent.The hsp60 family of chaperones, sometimes called chaperonins, differ in sequence and structure from hsp70 and its homologs. Hsp60 acts later in the folding process, often together with an hsp70 chaperone. The central cavity of the donut-shaped hsp60 chaperone provides a sheltered environment in which a polypeptide can fold until all hydrophobic regions are buried in its interior, thus preempting any tendency toward aggregation. -### End" -2179,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Pre pharyngeal abscess diagnosed as tuberculosis is seen in 44 year old lady with difficulties in deglutition management would be -, with the following options: A: Urgent Drainage, B: Starting of AKT, C: Wait and Eatch, D: Get an MRI of the cervical Spine - -### Response: -Ans. is 'a' i.e., Urgent Drainage Absolute indications of surgery in vertebral tuberculosiso Development of new neurodeficit or its worsening on AKTo Reappearance of previous neurodeficit on AKTo No improvement in neurodeficit for 4-6 weekso Difficulty in deglutition due to a prepharyngeal abscess -### End" -2180,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement about fexofenadine is :, with the following options: A: It undergoes high first pass metabolism in liver, B: Terfenadine is an active metabolite of this drug, C: It does not block cardiac K+ channels, D: It has high affinity for central H1 receptors - -### Response: -Fexofenadine is an active metabolite of terfenadine. It lacks K+ channel blocking property, therefore is devoid of arrhythmogenic potential. It is available as a separate second-generation H1 blocking agent. -### End" -2181,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The main reason behind heating the powdered gold is to ensure complete elimination of:, with the following options: A: Wax, B: Oxide layer, C: Other contaminants, D: None of the above - -### Response: -Powdered gold must be heated in a flame to ensure the complete elimination of the wax. When heating in bulk on a tray, an excessive amount of gold should be avoided because of the difficulties that prolonged and repeated heating can create. Care should be taken to handle pieces with stainless steel wire points or similar instruments that will not contaminate the gold. -Ref:Phillip’s Science of Dental Materials ed 12 pg 414 -### End" -2182,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice in delirium tremens is -, with the following options: A: Diazepalm, B: Phenytoin, C: Chlordiazepoxide, D: Morphine - -### Response: -Chlordiazepoxide is preferred over diazepam. -### End" -2183,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: LCAT activates, with the following options: A: Apo A1, B: Apo B100, C: Apo C-2, D: Apo C-3 - -### Response: -Lipoproteins classes as per apoprotein contents Families: LP A Apolipoproteins: A-I and A-II Density class: HDL Mol. wt. range: 17000 to 28000 Function: LCAT activator, 'Scavenger'Ref: Textbook of Medical Biochemistry, Eighth Edition, Dr (Brig) MN Chatterjea, page no:445, Table 25.11 -### End" -2184,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are known complications of tuberculous meningitis except –, with the following options: A: Cranial nerve palsy, B: Cerebral infarction, C: Ptosis, D: Parkinsonism - -### Response: -Complications of T meningitis - -There may be infarcts in the brain due to vascular occlusion -Various neurological manifestations seen with TBM include : - - -Hemiplegia (20%), quadriplegia (19%), monoplegia (3%)             o Cranial nerve palsies (14%) - - -Hemiballismus (11%)         o Decerebrate Rigidity (3%) -Tremors (6.1%)    o Decorticate Rigidity (3%) - - -Midline cerebellar syndromes (4%)                                                    o Cerebellar Hemispheric Lesions (1.0%) - -Ptosis & Ophthalmoplegia are frequent in Coma stage in tuberculous meningitis -### End" -2185,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are chromosomal trisomies except:, with the following options: A: Down's, B: Patau, C: Turner, D: Edward - -### Response: -Ans: c Turner syndromeTurner's syndrome is due to the absence / defect of second X chromosome and not due to trisomy.All other conditions mentioned are due to trisomies.Down syndrome - trisomy 21Edward syndrome - trisomy 18 (Eighteen)Patau syndrome - trisomy 13 (Pathimunnu)Molecular pathogenesis - Turner syndromeI. Ovaries develop normally early in embryogenesis but, absent 2nd X chromosome - leads to accelerated loss of oocytes II. Ovaries become atrophic fibrous bands devoid of ova and follicles III. Nongonadal abnormalities are due to loss of some genes that reside on the X chromosome Eg, SHOX gene (short stature homeobox gene) on X p22-23. Normally it remains active in both X chromosomes. But haploinsufficiency of this gene (as in turners syndrome) gives rise to short stature.Trinucleotide repeat# Myotonic dystrophy - CTG# Huntingtons disease - CAG# Spinocerebellar ataxia type 1 - CAG# Machado joseph disease - CAG# Spinomuscular atrophy -CAG# Dentate rubral pallidoluysian atrophy - CAG# Fragile X syndrome-CGGDefective splicing of hnRNA# Beta thalassemia# Gaucher disease# Tay sachs disease# Spinomuscular atrophy -### End" -2186,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true regarding PROPOFOL, with the following options: A: It is used in day care anesthesia, B: It is contraindicated in porphyria, C: IT is contraindicated in person allergic to egg, D: It is HIGHLY cardiostable - -### Response: -Only contraindication of propofol is shock being cardiounstable. Intravenous induction agent of choice for day care anesthesia is propofol. It has rapid onset of action and a faster recovery. It also reduces postoperative nausea and vomiting which provide yet another reason for it to be a preferred drug for outpatient anesthesia. Inhalational agent of choice for day care anesthesia issevoflurane. Muscle relaxant of choice for day care anesthesia isrocuronium. -### End" -2187,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following delusion of infidelity is seen?, with the following options: A: De Clerambault' S syndrome, B: Othello syndrome, C: Couvade syndrome, D: Ekbom's syndrome - -### Response: -Ans. B. Othello syndromePathological jealousy, also known as Morbid jealousy, Othello syndrome or delusional jealousy, is a psychological disorder in which a person is preoccupied with the thought that their spouse or sexual partner is being unfaithful without having any real proof, along with socially unacceptable or abnormal behavior related to these thoughts. The most common cited forms of psychopathology in morbid jealousy are delusions. It is considered a subtype of delusional disorder -### End" -2188,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old male suffering from sudden onset of high grade fever. On malarial slide examination all stages of parasites are seen with schizonts of 20 microns size with 14-20 merozoites per cell and yellow brown pigment. The diagnosis is:, with the following options: A: Plasmodium falciparum, B: Plasmodium vivax, C: Plasmodium malariae, D: Plasmodium ovale - -### Response: -Ans. (b) Plasmodium vivax Catch clue of answer from question. In this question clue is 'colour of pigment' which are: Black pigment : P falciparum Brown black : P malariae Dark brown : P ovate Yellow brown : P vivax -### End" -2189,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coaptation is, with the following options: A: Urethral mucosal approximation., B: Adaptation of bladder to large volumes of filtrate., C: Stretch of urethra while voiding., D: Constriction of ureters in response to low volumes of urine. - -### Response: -Submucosal vascular network aids in Urethral mucosal approximation called as coaptation, which improves continence. -### End" -2190,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Invariably involved site in ulcerative colitis;, with the following options: A: Sigmoid colon, B: Transverse colon, C: Ileum, D: Rectum - -### Response: -Most common site involved in ulcerative colitis is the rectum. Rectum is usually spared in Crohn's disease. -### End" -2191,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pyruvate dehydrogenase complex contains all except, with the following options: A: Biotin, B: NAD, C: FAD, D: CoA - -### Response: -Pyruvate dehydrogenase complex--thiamin diphosphate, lipoate, NAD+, FAD, and CoA Reference: Harper; 30th edition; Page no: 163 -### End" -2192,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The management of fat embolism includes all of the following except -, with the following options: A: Oxygen, B: Heparinization, C: Low Molecular weight dextran, D: Pulmonary Emblectomy - -### Response: -Pulmonary embolectomy has not been mentioned  in the treatment of fat embolism syndrome. -All other are used. -### End" -2193,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are mitochondrial disorders except:, with the following options: A: Pearson Syndrome, B: MERRF (Myoclonic Epilepsy Ragged Red Fibre), C: MELAS (Mitochondrial Encephalopathy Lactic Acidosis and Stroke-like episode), D: Fragile X Syndrome - -### Response: -d. Fragile X Syndrome(Ref: Nelson's 20/e p 600-601, Ghai 8/e p 644)Mitochondrial Disorders, include Leber Hereditary Optic Neuropathy, MELAS (Mitochondrial encephalomyopathy, lactic acidosis, and stroke like episodes), MERRF(Myoclonic epilepsy, ragged red fibers) in muscle, & Pearson syndromeExamples of Mitochondrial Disorders (Mnemonic: K-L-M-N-O-P)DiseasePhenotypeKSSKearn-Sayre syndromeExternal ophthalmoplegia, heart block, retinal pigmentation, ataxiaLHONLeber hereditary optic neuropathyBilateral subacute or acute painless optic atrophyMELASMitochondrial encephalomyopathy, lactic acidosis, and stroke like episodes; may manifest only as diabetesMERRFMyoclinic epilepsy, ragged red fibres in muscle, ataxia, increased CSF protein, sensorineural deafness, dementiaNARPNeuropathy, Ataxia, Retinitis Pigmentosa, Leigh diseaseLoss of central vision leading to blindness in young adult lifeCPEOChronic progressive external OphthalmoplegiaBilateral ptosis, ophthalmoplegia & proximal muscle weaknessPearson syndromePancreatic insufficiency, pancytopenia, lactic acidosis -### End" -2194,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Microcephaly is seen in -Beckwith hypoglycaemic syndrome -Fanconi syndrome -Down syndrome -Achondroplasia, with the following options: A: I and iv, B: I and ii, C: ii and iii, D: ii and iv - -### Response: -A condition in which a baby's head is significantly smaller than expected, often due to abnormal brain development. Causes of microcephaly include infections, malnutrition or exposure to toxins. -Symptoms vary and include intellectual disability and speech delay. In severe cases, there may be seizures and abnormal muscle functionality. -### End" -2195,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epidemic conjunctivitis is repoed in a rural area. What is the most probable causative organism?, with the following options: A: Adenovirus, B: Herpes virus, C: EB virus, D: Papilloma virus - -### Response: -Adenovirus infection is often associated with pharyngitis, a follicular reaction and injection of the palpebral conjunctiva, and preauricular adenopathy (pharyngoconjunctival fever). Epidemics of adenoviral keratoconjunctivitis occur. Ref: Braverman R.S. (2012). Chapter 16. Eye. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e. -### End" -2196,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Beta-oxidation is peroxisome is differentiated from that occurring in mitochondria by, with the following options: A: Acetyl CoA, B: H2O2 formed, C: Different enzymes are found in different sites, D: NADH is required - -### Response: -H2O2 formed  - -A modified form of [β -oxidation is found in peroxisomes and leads to formation of acetyl CoA and Hp, (instead of FADH, which is formed in mitochondrial [β -oxidation). -The system facilitates oxidation of very long chain fatty acids. -### End" -2197,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A biopsy of an enlarged salivary gland from an individual with Sjogren's syndrome is most likely to histologically reveal an extensive infiltrate of, with the following options: A: Epithelioid cells, B: Basophils, C: Lymphocytes, D: Neutrophils - -### Response: -Sjogren's syndrome is characterized by dryness of the mouth (xerostomia) and eyes (keratoconjunctivitis sicca). Secondary Sjogren's syndrome is associated with rheumatoid ahritis (RA), SLE, or systemic sclerosis. The primary form shows increased frequency of HLA-DR3, while association with RA shows a positive correlation with HLA-DR4. Anti-SSB antibodies are fairly specific, antiSSA less so, and both may occur in SLE; rheumatoid factor is often present. Glomerular lesions are very rare, but a mild tubulointerstitial nephritis is quite common and may result in renal tubular acidosis. In addition to the usual dense, lymphoplasmacytic infiltrate of salivary glands, the lymph nodes may show a ""pseudolymphomatous"" appearance. True B cell lymphomas have developed with increased frequency in Sjogren's syndrome Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition. -### End" -2198,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Site where endolymph is seen:, with the following options: A: Scala vestibuli, B: Scala media, C: Helicotrema, D: Scala tympani - -### Response: -(b) Scala media(Ref. Scott Brown, 8th ed., Vol 2, page 545)Endolymph is present in the membranous labyrinth, whereas perilymph is present in the bony labyrinth.Hence scala vestibuli, scala tympani and their interconnection helicotrema, which are parts of bony labyrinth, are filled with perilymph.Scala media, utricle, saccule and semicircular canals, which are parts of membranous labyrinth, are filled with endolymph. -### End" -2199,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is seen in cystic fibrosis?, with the following options: A: Low sweat chloride levels, B: Elevated sweat chloride levels, C: Low sweat sodium levels, D: Elevated sweat potassium levels - -### Response: -b. Elevated sweat chloride levels(Ref: Nelson's 20/e p 2100)Because the function of sweat gland duct cells is to absorb rather than secrete chloride, salt is not retrieved from the isotonic primary sweat as it is transported to the skin surface; chloride and sodium levels are consequently elevated. So sweat chloride is usually 60mEq/L in cystic fibrosis. -### End" -2200,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What are the complication (s) of meningitis in a child -, with the following options: A: Arachinioidits, B: Mental retardation, C: Status epilepticus, D: All - -### Response: -Ans is 'a' i.e., Arachinioidits, 'b' i.e., Mental retardation, 'c' i.e., Status epilepticus -### End" -2201,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The sho retroviral regime administration in the peripaum period decreases the risk of veical transmission by :, with the following options: A: 30%, B: 50%, C: 65%, D: 75% - -### Response: -65% -### End" -2202,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Embryonic phase of development is from -, with the following options: A: 1-3 weeks, B: 4th to 8th week, C: 0-4thweek, D: 6th to 9th week - -### Response: -Ans. is 'b' i.e., 4th to 8th week * The development of a new individual in the uterus involves three phasesi) Pre-embro phase or germinal phase (day 0-3 weeks).ii) Embro phase or embryonic period (weeks 4-8).iii) Fetal phase (weeks 8-38). -### End" -2203,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement about female genital tuberculosis :, with the following options: A: Genital tract involvement results only from lymphatic spread, B: Postmenstrual histopathological examination is diagnostic, C: Polymerase chain reaction (PCR) techniques have got higher sensitivity in detection, D: Reproductive outcome following antituberculous chemotherapy is satisfactory - -### Response: -Modes of spread: hematogeneous,lymphatic,ascending Diagnostic uterine curettage done during the week preceding menstruation. Histology detects TB in 10% cases only following chemotherapy pregnancy is rare(5-10%) ,and if occurs ectopic is more D.C.DUTTA'S TEXTBOOK OF GYNAECOLOGY,Pg no:143,6th edition -### End" -2204,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Addition of which of the following agent can help in elimination of 15-20 tablets of 10 mg dextroamphetamine -, with the following options: A: Acetazolamide, B: NH4 CI, C: Penicillamine, D: Na HCO3 - -### Response: -Ans. is 'b' i.e., NH4CI Acidification of urine o Basic drugs are more ionized at acidic pH. So, acidification of urine should be done in poisoning of these drugs. o Examples of such basic drugs are morphine, amphetamine, dexfenfluramine. o Acidification of urine is done by iv infusion of arginine hydrochloride followed by ammonium chloride (NH4CI) by mouth. -### End" -2205,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following nerve involved in-opening inlet of larynx?, with the following options: A: Recurrent laryngeal nerve, B: External laryngeal nerve, C: Internal laryngeal nerve, D: Superficial laryngeal nerve - -### Response: -All intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve except for the cricothyroid which is supplied by the external laryngeal nerve. The cavity of larynx extends from the inlet of the larynx to the lower border of the cricoid cailage.the inlet of the larynx is placed obliquely.it looks backwards and upwards and opens into the laryngopharynx. Ref BDC volume 3;Sixth edition pg 257 -### End" -2206,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HBs Ag positive person may have all of the following associated Renal lesions, Except:, with the following options: A: Membranous Glomerulonephritis (MGN), B: Membrano proliferative Glomerulnephritis (MPGN), C: Mesangiocapillary Glomerulonephritis, D: Focal Segmental Glomerulosclerosis (FSGS) - -### Response: -Answer is D (Focal Segmental Glomerulosclerosis) Focal Segmental Glomerulosclerosis (FSGS) has not been mentioned in association with hepatitis B associated Glomerulonephritis Glomerulonephritis associated with Hepatisis B include, MGN, MPGN and Mesangiocapillaty GN Glomerulonephritis during chronic Hepatitis B infection Membranous Glomerulonephritis (MGN) Membranoproliferatiye Glomerulonephritis (MPGN) Mesanglocapillary glomerulonephritis Note MGN is most commonly seen in childrenQ MPGN is most commonly seen in adultsQ -### End" -2207,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antihelminthic also acting as immunomodulator is:, with the following options: A: Albendazole, B: Levamizole, C: Mebendazole, D: Piperazine - -### Response: -Levamizole -### End" -2208,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is 100 times more potent than morphine?, with the following options: A: Pethidine, B: Fentanyl, C: Pentazocin, D: Meperidine - -### Response: -Fentanyl is 100 times more potent than morphine. Pethidine is 1/10th as potent as morphine. Ref KD Tripathi 8th ed. -### End" -2209,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the indication for Type I thyroplasty?, with the following options: A: Vocal cord medialization, B: Vocal cord lateralization, C: Vocal cord shoening, D: Vocal cord lengthening - -### Response: -Type I thyroplasty is a form of medialization laryngoplasty, in which an implant is placed between the thyroid cailage and the vocalis muscle to medialize the membranous vocal fold. -### End" -2210,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is the marker of HIV infection in blood:, with the following options: A: Reverse transcriptase, B: DNA polymerase, C: RNA polymerase, D: None - -### Response: -Ans. is 'a', i.e., Reverse transcriptase(Ref: Harrison, 18th/e, p. 1539, 1540; 19th/e, p. 1219)* Plasma level HIV RNA can be measured by reverse - transcriptase polymerase chain reaction (RT - PCR) or branched DNA assay (b DNA).* Other markers of HIV infection:-p24 antigen.-Double stranded DNA. -### End" -2211,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ACE inhibitor contraindicated in which of the following condition:, with the following options: A: Bilateral renal artery stenosis, B: Chronic kidney disease, C: Post myocardial infarction, D: Diabetes mellitus - -### Response: -Ans. (a) Bilateral renal artery stenosisRef. Katzung's pharmacology 10th ed. Ch 11* ACEI inhibits the converting enzyme peptidyl dipeptidase that hydrolyzes angiotensin I to angiotensin II and (under the name plasma kininase) inactivates bradykinin, a potent vasodilator, which works at least in part by stimulating release of nitric oxide and prostacyclin.* Drugs under this class are: Captopril, Enalapril, Lisinopril, Benazepril, fosinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril.* ACE inhibitors have a particularly useful role in treating patients with chronic kidney disease because they diminish proteinuria and stabilize renal function (even in the absence of lowering of blood pressure).* ACE inhibitors have also proved to be extremely useful in the treatment of heart failure, and after myocardial infarction, and* There is recent evidence that ACE inhibitors reduce the incidence of diabetes in patients with high cardiovascular risk. -### End" -2212,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Uterus develops from?, with the following options: A: Paramesonephic ducts, B: Sinovaginal bulbs, C: Metanephric blastema, D: Urogenital folds - -### Response: -The epithelium of uterus develops from thr fused paramesonephric ducts .the myometrium is derived from srrounding mesoderm .as thicjnessof myometrium increases the unfused horizontal pas of two paramesonephric ducts comes to form fundus of uterus Human embryology Tenth edition Inderbier singh Page 296 -### End" -2213,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'Disability Limitation' is mode of intervention for:, with the following options: A: Primordial Prevention, B: Primary Prevention, C: Secondary Prevention, D: Tertiary Prevention - -### Response: -Ans. (d) Tertiary PreventionLevels of preventionModes of interventionPrimary LevelHealth Promotion and Specific ProtectionSecondary LevelEarly Diagnosis and TreatmentTertiary LevelDisability Limitation and Rehabilitation -### End" -2214,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Basal exudates, infarcts and hydrocephalus are findings observed in Brain imaging studies. The most likely diagnosis is:, with the following options: A: Tubercular meningitis, B: Viral meningitis, C: Herpes encephalitis, D: Cerebral Malaria - -### Response: -Answer is A (Tubercular meningitis): Basal exudates, hydrocephalus and ischemic infarcts are classical features of Tubercular Meningitis. 'The triad of CT features (Thalamic infarction, Basal cistern enhancement and Hydrocephalus) is diagnostic of Tubercular Meningitis' --Journal of Indian Medical Association Classical Radiological Features (CT/MRI) in Tubercular Meningitis Basal exudates Obliteration of Basal cisterns (Tubercular Exudates are primarily located in the vicinity of basal cisterns) Abnormal Leptomeningeal Enhancement (Usually most pronounced in the basal cisterns) Communicating Hydrocephalus (Usually communicating although non-communicating may also be seen) Ischentic / Vasculitic Infarcts (Basal ganglia and / or Internal capsule) Tuberculomas (Granulomas) -### End" -2215,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common inherited peripheral neuropathy is?, with the following options: A: Refsum's disease, B: Charcot marie tooth 1, C: Farber's disease, D: Fabry disease - -### Response: -Harrison's principles of internal medicine 17th edition. *Charcot-Marie-Tooth neuropathy is the most common heritable neuromuscular disorder with an incidence of 17 -40 cases per 100,000 -### End" -2216,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement about mesenteric vein thrombosis is TRUE?, with the following options: A: Peritoneal signs are always present, B: Invariably involves long length of bowel, C: I.V. heparin is the treatment of choice, D: Surgery can lead to small bowel syndrome - -### Response: -Option 1 Peritoneal signs are present in less than half the cases. Option 2 Any length of bowel may be involved depending on the level and extent of thrombosis. Option 3 Resection of the nonble bowel along with its mesentery is the treatment of choice. heparin is given in all cases and along with bowel rest and fluid resuscitation is sufficient in patient without bowel infarction. Option 4 When extensive resection is done, sho bowel syndrome can occur Ref: Schwaz 9/e, Page 1006; Maingot's 10/e, Page 672; CSDT 13/e, Page 641. -### End" -2217,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement regarding development of drug resistance in MRSA is, with the following options: A: Results due to pencillinase enzyme production, B: Occurs due to change in penicillin -binding proteins, C: Chromosome mediated, D: Treated with amoxicillin +clavulanix acid - -### Response: -Ref Katzung 11/e p776 Methicillin resistance occurs due to altered PBPs6, thus no penicillin (infant no beta lactam antibiotic) is useful against Methicillin -resistant Staphylococcus Audrie infections -### End" -2218,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least priority color code code in triage-, with the following options: A: Red, B: Yellow, C: Black, D: Green - -### Response: -Ans. is 'c' i.e., Black * Dead or moribund patients (color code black) have the lowest priority.* Triage has been explained in previous sessions -### End" -2219,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for sputum positive pulmonary tuberculosis detected in Ist trimester of pregnancy:, with the following options: A: Defer till second trimester, B: Sta cat. I immediately, C: Sta cat. II immediately, D: Sta cat. III immediately - -### Response: -Sta cat. I immediately Repeat May 10 -### End" -2220,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Local Anaesthetic in wound/ulcer management?, with the following options: A: Prilocaine, B: Chlorprocaine, C: Benzocaine, D: Bupivacaine - -### Response: -Ans. is 'c' i.e., Benzocaine For management of wound/ulcer, local anaesthetic with topical anaesthetic action is used. Among the given options, only benzocaine has topical action. -### End" -2221,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Induction agent for Day care Surgery is :, with the following options: A: Ketamine, B: Diazepam, C: Thiopentone, D: Propofol - -### Response: -Ans. is 'd' i.e. . Propofol ""Propofol is used as in inducing agent for day care surgery because residual impairment is less marked and incidence of post-operative nausea and vomiting is Cow."" - KDT, 4/e, p 352Also remember Day care anaesthesia - isoflurane* Day care analgesic - Afentanyl*. -### End" -2222,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice of trachoma is -, with the following options: A: Penicillin, B: Sulfonamide, C: Tetracycline, D: Chloramphenicol - -### Response: -Tetracycline or azithromycin are the drugs of choice for trachoma. Other drugs used are erythromycin, clarithromycin, rifamipicin and sulfonamide. Ref: Parson's 22nd/e p.175 & 21st/e p. 174 -### End" -2223,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Weil felix reaction is -, with the following options: A: Ring test, B: Tube precipitation test, C: Slide agglutination test, D: Tube agglutination test - -### Response: -Ans. is 'd' i.e., Tube agglutination test Precipitationo When a soluble antigen combines with its antibody in the presence of electrolytes (NaCl) at a suitable temperature and pH, the antigen - antibody complex forms an insoluble precipitateo When instead of sedimenting, the precipitate remains suspended as floccules, the reaction is known as flocculation.o It is very sensitive in detection of antigens and as little as 1 g of protein can be detected by precipitation testso Precipitation is relatively less sensitive for the detection of antibodies. Precipitation / flocculation tests | |||||Ring testslide testTube test (Precipitation in gel)ImmunodiffusionElectroimmuno diffusiono Ascoli's thermoprecipitation test for Bacillus anthraxo Grouping of streptococci by the lancefield techniqueoVDRL (flocculation test) for syphiliso Kahn test (flocculation test for syphilis) for detection of alpha- fetoprotein in serum and cryptococcal antigen in the C.S.F.o Elek test for toxigenicity in diphtheria bacillio Most important is countercurrent immunoelectrophoresisAgglutinationo When a particulate antigen is mixed with its antibody in the presence of electrolytes at a suitable temperature and pH, the particles are clumped or agglutinatedo Agglutination is more sensitive than precipitation for the detection of antibodies.Agglutination tests|||||Slide agglutinationTube agglutinationCoombs testPassive agglutination testo Blood grouping and cross - matchingo Widal testo Weil - felix reactiono Paul Bunnell testo Cold agglutination testo Streptococcus MG agglutination testo Anti - Rh antibody test||||| Haemagglutinationo Rose Waaler test for R. A.Latex agglutinationo Detection of: ASO CRP RA factor HOGComplement fixation testo The ability of antigen antibody complexes to 'fix' complement is made use of in the complement fixation testo This is very sensitive test, capable of detecting 0.04 mg of antibody nitrogen and 0.1 mg of antigeno The source of complement is guinea pig serumo Examples# Wassermann CFT for syphilis# Treponema pallidum immobilization test.Antigen - antibody reaction||||Soluble antigenParticulate antigenAntigen+++AntibodyAntibodyAntibody+++ElectrolyteElectrolyteSource of complement|||PrecipitationAgglutinationComplement fixation test -### End" -2224,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for interstitial disease is:, with the following options: A: Chest X-ray, B: HRCT, C: Gallium-67 DTPA scan, D: MRI - -### Response: -Answer is B (NRCT): High Resolution CT (HRCT) is investigation of choice for interstitial lung disease and bronchiectasis as it can delineate the lung parenchyma upto the level of secondary pulmonary lobule. -### End" -2225,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A false belief which is unexplained by reality and is shared by a number of people is:, with the following options: A: lIIusion, B: Delusion, C: Obsession, D: Superstition - -### Response: -There are many beliefs which are false and are shared by whole communities e.g. black magic, witches, etc. These beliefs are considered as superstitions. In comparison, delusions are not shared by members of the same sociocultural background. For example, if a villager stas claiming that he is lord Hanuman, no one in his village will share his beliefs. -### End" -2226,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 13-year-old boy with patchy depigmented skin on the right flank and upper thigh in segmental distribution. The -depigmentation started 1 year back but has been static for last 4 months. Mother reports use of topical steroids which was -ineffective., with the following options: A: Segmental vitiligo, B: Piebaldism, C: Hypomelanosis of Ito, D: Hypopigmented streaks - -### Response: -Segmental vitiligo. - -Vitiligo is an acquired autoimmune condition targeting melanocytes and present with localized or widespread white depigmented patches. Thyroid autoimmune dysfunction is associated. -Piebaldism is an autosomal dominant condition characterized by white forelock and circumscribed depigmented patches affecting the body. It is caused by a defect in proliferation and migration of melanocytes during embryo- genesis. Unlike vitiligo, it is congenital and non-progressive. -In the question the depigmentation started at age of 12 years and patient presented at 13 years. -Nevoid hypomelanosis is characterized by hypopigmented patches or streaks which follow the lines of Blaschko. They are present at birth and may develop in the first 2 years of life. -### End" -2227,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are contents of inguinal canal except ?, with the following options: A: Femoral branch of genitofemoral nerve, B: Ilioinguinal nerve, C: Round ligament of uterus, D: Spermatic cord - -### Response: -Contents of inguinal canal Spermatic cord in male or round ligament of uterus in female. Ilioinguinal nerve : It enters through the interval between external and internal oblique muscles. Note: Genital branch of genitofemoral nerve is a component of spermatic cord (not femoral branch of genitofemoral nerve). -### End" -2228,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Polio is said to be eradicated if no case of polio by wild poliovirus occurs in an area for ?, with the following options: A: 1 year, B: 2 years, C: 3 years, D: 4 years - -### Response: -Ans. is 'c' i.e., 3 years Ceification of polio eradication is conducted an regional bases. Each region can consider ceification only when all countries in the area demonstrate the absence of wild poliovirus transmission for at least three consecutive years. -### End" -2229,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 8 yr old boy presents to casualty with history of diarrhea, followed by decreased urine output. Blood examination shows thrombocytes: 90,000/cm3. Diagnosis is, with the following options: A: Hemolytic Uremic Syndrome, B: Disseminated Intravascular Coagulation, C: Hemophilia, D: Idiopathic Thrombocytopenic Purpura - -### Response: -Thrombotic thrombocytopenic microangiopathies are a group of disorders characterized by thrombocytopenia, a microangiopathic hemolytic anemia evident by fragmented RBCs and laboratory evidence of hemolysis, and microvascular thrombosis. They include thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS).TTP and HUS have common features of thrombocytopenia, hemolytic anemia, fever, renal failure, and neurologic disturbances; When patients, paicularly children, have more evidence of renal injury, their condition tends to be called HUS; In adults with the neurologic disease, it is considered to be TTP; In adults, there is often a mixture of both, hence called TTP/HUS.Renal biopsy showing glomerular capillary endotheliosis associated with platelet thrombi, damage to the capillary wall, and formation of fibrin material in and around glomeruli; similar lesions occur in preeclampsia/HELLP (hemolysis, elevated liver enzymes, and low platelet count syndrome), malignant hypeension, and the antiphospholipid syndromeCauses of TTP/HUS:PregnancyDrugs like oral contraceptives, quinine; in renal transplant patients given OKT3 for rejectionCalcineurin inhibitors, cyclosporine, and tacrolimusAntiplatelet agents, ticlopidine, and clopidogrelHIV infectionIn DIC, while thrombocytopenia and microangiopathy are seen, a coagulopathy predominates - with consumption of clotting factors and fibrinogen resulting in an elevated prothrombin time (PT) & activated paial thromboplastin time (aPTT); The PT and aPTT are characteristically normal in TTP or HUS.Hemolytic Uremic Syndrome (HUS): Characterized by acute renal failure, microangiopathic hemolytic anemia, and thrombocytopeniaIt is seen predominantly in children; most of the cases preceded by an episode of hemorrhagic diarrhea; Escherichia coli O157: H7 is the most frequent etiologic serotype, followed by Shigella dysenteriae This Shiga toxin (verotoxin) inhibits the endothelial production of ADAMTS13(normally ADAMTS13 metalloprotease cleaves large multimers of von Willebrand&;s factor)Absent ADAMTS13, these large multimers cause platelet clumping and intravascular hemolysisSome children with complement protein deficiencies express atypical HUS (aHUS), which can be treated with the liver transplantTreatment of adult TTP/HUS is daily plasmapheresis; Patients with childhood HUS from infectious diarrhea are not given antibiotics, as antibiotics are thought to accelerate the release of the toxin and the diarrhea is usually self-limited. No intervention appears superior to suppoive therapy in children with post-diarrheal HUS.Ref: Harrison's 18/e p970 -### End" -2230,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following medical disorders leads to delayed foetal lung maturity -, with the following options: A: Hea disease, B: Diabetes, C: Thalassemia minor, D: Epilepsy - -### Response: -Ans. is 'b' i.e., Diabetes o Maternal diabetes predisposes to HMD. -### End" -2231,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Property of the material, which describes the resistance to abrasion is:, with the following options: A: Hardness, B: Yield strength, C: Modulus of elasticity, D: None of the above - -### Response: -HARDNESS -Except for comparing one material with another, this term is difficult to define. In mineralogy, the relative hardness of a substance is based on its ability to resist scratching. In metallurgy and most other disciplines, the concept that is most generally accepted is that of “resistance to indentation.” It is on the basis of this process that most modern hardness tests are designed. -Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 63 -### End" -2232,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sexually active male comes with complaints of recurrent ulcers over the glans which heals with hyperpigmentation, probable diagnosis is –, with the following options: A: Aphathous ulcer, B: Fixed drug eruption, C: Herpes genitalis, D: Chlamydial infection - -### Response: -Information provided in this question are not complete with any of the given options. -Anyways, we have to choose one answer. -Informations in this question are :- - - -Sexually active male -Ulcers on genitalia -Recurrent lesion -Healing with hyperpigmentation - - -After reading sexually active male in the question, first thing usually comes in the mind is that it must be a STD. -But this is not the case in this question. -STD in this question are :- - - -Chlamydial infection → does not cause recurrent lesion and does not heal with hyperpigmentation. -Herpes → causes recurrent lesion but does not heal with hyperpigmentation. - - -So, both chlamydial infection and herpes genitalis are excluded. -Recurrent aphthous like ulceration on genitalia can occur in Bechet's syndrome, but these ulcers do not heal with hyperpigmentation and history of sexually active female has nothing to do with it. -Now we are left with one option, i.e.fixed drug eruption and all the given symptoms can occur in fixed drug eruption- - - -Genitalia is most common site -Ulcer is recurrent, occurs every time with the offending drug intake -Heals with hyperpigmentation. - - -However, in this question history of drug intake is not given, which is very important to suggest the diagnosis of fixed drug eruption. -But, I have no point to exclude fixed drug eruption, on the other hand other three options can be excluded easily. -So, best answer in this question is fixed drug eruption. -### End" -2233,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 74-year-old woman is admitted to the hospital in an obtunded condition. Her temperature is 37deg C, pulse is 95/ min, respirations are 22/min, and blood pressure is 90/60 mm Hg. She appears dehydrated and has poor skin turgor. Her serum glucose level is 872 mg/dL. Urinalysis shows 4+ glucosuria, but no ketones, protein, or blood. Which of the following factors is most important in the pathogenesis of this patient's condition?, with the following options: A: Autoimmune insulitis, B: Glucokinase gene mutation, C: HLA-DR3/HLA-DR4 genotype, D: Peripheral insulin resistance - -### Response: -A complication of type 2 diabetes mellitus is hyperosmolar, nonketotic coma. In type 2 diabetes mellitus, the fundamental defect is insulin resistance, leading to an eventual decrease in plasma insulin or a relative lack of insulin, but there is still enough insulin to prevent ketosis. The resulting hyperglycemia tends to produce polyuria, leading to dehydration, which increases the serum glucose level further. If not enough fluids are ingested, dehydration drives the serum glucose to very high levels. Glucokinase gene mutations can be present with maturity-onset diabetes of the young (MODY). The HLA-DR3/HLA-DR4 genotype is a predisposing factor for type 1 diabetes mellitus. Severe loss of beta cells with insulitis, which may be triggered by a viral infection, is a feature of autoimmune, or type 1, diabetes mellitus. -### End" -2234,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clinical feature of minimal change glomerulonephritis are all except -, with the following options: A: Hypeension, B: Edema, C: Non Selective proteinuria, D: Fever - -### Response: -Minimal change disease -clinical features are Abrupt onset of edema Severe Hypoalbuminemia selective proteinuria -urine predominantly contains albumin with minimal amounts of higher molecular weight protiens. Less common clinical features include-hypeension ,microscopic hematuria ,atopic or allergic symptoms and decreased renal function. Ref:Harrison 20th edition pg no. 2142 -### End" -2235,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following region is involved in plummer-vinson syndrome-, with the following options: A: Pyriform sinus, B: Post cricoid region, C: Valleculae, D: Posterior pharyngeal wall - -### Response: -It is associated with an oesophagal web in post cricoid region and 10% patients develops post cricoid carcinoma. -### End" -2236,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bronchus is the site of pathological changes for all of the following diseases, except:, with the following options: A: Chronic bronchitis, B: Asthma, C: Bronchiectasis, D: Emphysema - -### Response: -Emphysema occurs at the site of acinus, the anatomical site for the rest of them is the bronchus. -### End" -2237,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wide fixed split S2 is seen in?, with the following options: A: ASD, B: VSD, C: TOF, D: TAPVC - -### Response: -ASD Examination usually reveals a prominent RV impulse and palpable pulmonary aery pulsation. The first hea sound is normal or split, with accentuation of the tricuspid valve closure sound. Increased flow across the pulmonic valve is responsible for a midsystolic pulmonary outflow murmur. The second hea sound is widely split and is relatively fixed in relation to respiration. A mid-diastolic rumbling murmur, loudest at the fouh intercostal space and along the left sternal border, reflects increased flow across the tricuspid valve. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1921 ) -### End" -2238,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug(s) used in treatment of Attention-Deficit Hyperactivity Disorder :, with the following options: A: Atomoxetine, B: Methylphenidate, C: Dexmethylphenidate, D: All - -### Response: -A. i.e. Atomoxetine; B. i.e. Methylphenidate; C. i.e. Dex methyl phenidate -### End" -2239,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bajaj committee, true is -, with the following options: A: Constituted in 1946, B: Recommends formation of PHC, C: Recommends health manpower policy, D: None - -### Response: -Ans. is 'c' i.e., Recommends health manpower policyBaiai committeeo An ""expert committee for healthpower planning, production and management"" was constituted in 1985 under Dr. J.S. Bajaj. Major recommendations are :-Formulation of National medical & health education policy.Formulation of national health manpower policyEstablishment of an educational commission for health sciences (ECHS) on the lines of UGC .Establishment of health science universities in various states and union territories.Establishment of health manpower cells in centre and states.Vocationalization of education at 10+2 levels.Carrying out a realistic manpower survey. -### End" -2240,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 35-year-old Raymond presents with a painless indurated ulcer on the penis with enlarged genital non-tender lymphnode. What is the diagnosis ?, with the following options: A: Chancroid, B: Herpes genitalis, C: Syphilis, D: LGV - -### Response: -The presence of painless indurated ulcer and a non-tender lymph node is suggestive of primary syphilis. -### End" -2241,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young adult male presented with sudden painless loss of vision. He recovered spontaneously within 3 months Most likely cause of his blindness is –, with the following options: A: Central serous retinopathy, B: Macular hole, C: Myopic crescent, D: Vitreous haemorrhage - -### Response: -Sudden painless loss of vision with full recovery within 4-12 weeks in a young male is characteristic of central serous retinopathy. -### End" -2242,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tissue macrophages are called?, with the following options: A: Monocytes, B: Histiocytes, C: Plasma cells, D: Epitheloid cells - -### Response: -Ans. is 'b' i.e., Histiocytes -### End" -2243,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient with cirrhosis is positive HBs Ag+ and has increased levels of alpha feto protein. What is the most probable diagnosis -, with the following options: A: Submassive hepatic necrosis, B: Hepatocellular carcinoma, C: Massive hepatic necrosis, D: None of the above - -### Response: -Ans. is 'b' i.e., Hepatocellular carcinoma o Cirrhosis, hepatitis B positive and alpha fetoprotein strongly suggests hepatocellular carcinoma.Factors Associated with an Increased Risk of Developing HCCCommonUnusualCirrhosis from any causePrimary- biliary cirrhosisHepatitis B or C chronic infectionHemochromatosisEthanol chronic consumptiona1 Antitrypsin deficiencyNASH'NAFLGlycogen storage diseasesAflatoxin B1 or other mycotoxinsCitrullinemiaProphyria cutanea tardaHerediatry tyrosinemiaWison's disease -### End" -2244,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Angiotensin H causes all of the following, Except:, with the following options: A: Stmulation of Thirst, B: Increased ADH secretion, C: Vasodilatation, D: Aldosterone secretion - -### Response: -C i.e. Vasodilatation Angiotensin II increases secretion of ADH, (Vasopressin), ACTH, Aldosterone, increases thirst and vasoconstriction (most potent or '- 4-8 times more than noradrenaline on weight basis). It decreases rennin secretion. -### End" -2245,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acne vulgaris is caused by-, with the following options: A: Staph aureus, B: Diphtheroids, C: Sweat gland hyperplasia, D: Obstruction to pilosebaceous duct - -### Response: -D i.e. Obstruction to pilosebaceous duct -### End" -2246,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In order to expose the coeliac axis, left renal aery, superior mesenteric aery and abdominal aoa in a case of trauma, which of the following is performed :Left medial visceral rotation, with the following options: A: Left medial visceral rotation, B: Right medial visceral rotation, C: Cranial visceral rotation, D: Caudal visceral rotation - -### Response: -Ans. is 'a' i.e. Left medial visceral rotation The major abdominal vessels are retroperitoneal structures that lie posterior to the contents of peritoneal sac & close to the midline. The vessels which are notoriously difficult to expose are : retrohepatic vena cava, suprarenal aoa; the coeliac axis; the proximal superior mesentric aery; the junction of the superior mesentric, splenic and poal veins and the bifurcation of the vena cava. Rapid exposure of these vessels can be accomplished during abdominal trauma by following maneuvers : - The principle behind visceral rotation is to rotate the viscera of one side towards the midline after freeing their lateral peritoneal attachments so as to expose the vessels of that side A left medial visceral rotation (Mattox maneuver) provides excellent exposure of the aoa, coeliac axis, superior mesentric aery, left renal aery and iliac aeries. A right medial visceral rotation (Catell maneuver) readily exposes the vena cava (with a combined Kocher maneuver), right renal vessels and iliac veins. The infrarenal aoa may be approached a transperitoneal incision at the base of the mesocolon. The junction of the superior mesentric, splenic and poal veins can be readily exposed in trauma surgery by dividing the neck of the pancreas. The bifurcation of the vena cava is obscured by the right common iliac aery. This vessel is to be divided to expose extensive vena caval injuries of this area. -### End" -2247,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 15-year old healthy boy with no major medical problem complaints that he breaks out with blocky areas of erythema that are pruritic over skin of his arm, leg and trunk every time within an hour of eating sea foods. The clinical features are suggestive of:, with the following options: A: Localised immune-complex deposition, B: Cell mediated hypersensitivity, C: Localized anaphylaxis, D: Release of complement C3b - -### Response: -Type I hypersensitivity is also known as immediate or anaphylactic hypersensitivity. The reaction may involve skin (uicaria and eczema), eyes (conjunctivitis), nasopharynx (rhinorrhea, rhinitis), bronchopulmonary tissues (asthma) and gastrointestinal tract (gastroenteritis). The reaction may cause a range of symptoms from minor inconvenience to death. The reaction usually takes 15 - 30 minutes from the time of exposure to the antigen, although sometimes it may have a delayed onset (10 - 12 hours). Ref:Nandini Shetty (2006), Chapter 15, "" Hypersensitivity"", In the book, ""Immunology: Introductory Textbook"", 2nd Edition, New Delhi, Pages 126-128. -### End" -2248,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is derived from both ectoderm and mesoderm?, with the following options: A: Suprarenal gland, B: Kidney, C: Pancreas, D: Spleen - -### Response: -Adrenal The adrenal gland consists of a superficial Coex and a deeper medulla .the cells of the coex arise from the coelomic epithelium(mesoderm). the cells of the medulla are derived from the neural crest(ectoderm) HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:353 -### End" -2249,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For foreign body causing sudden choking, most appropriate first line of management is?, with the following options: A: Tracheostomy, B: Heimlich maneuver, C: Airway insertion, D: Laryngoscopy - -### Response: -ANSWER: (B) Heimlich maneuverREF: Dhingras 4th ed p. 257Management of Laryngeal foreign body:A large bolus of food/ foreign body obstructed above the cords may make the patient totally aphonic, unable to cry for help. He may die of asphyxia unless immediate first aid measures are taken.H eimlichJs maneuvers: S udden thrust dire cte d up wards and backwards, b elo w the epigastrium, squeezes the air from the lungs, sufficient to dislodge a foreign body.Cricothyrotomy or emergency tracheostomy should be done if Heimlich's maneuvers fails.Once acute respiratory emergency is over, foreign body can be removed by direct laryngoscopy or by laryngofissure, if found impactedManagement of Tracheal and bronchial foreign bodies:Bronchoscopy under general anesthesia. Emergency removal of these foreign bodies is not indicated unless there is airway obstruction or they are of the vegetable nature (e.g. seeds) and likely to swell up. Methods to remove tracheobronchial foreign body:Conventional rigid bronchoscopy.Rigid bronchoscopy with telescopic aid.Bronchoscopy with C-arm fluoroscopy.Use of Dormia basket or Fogartys balloon for rounded objects.Tracheostomy first and then bronchoscopy through the tracheostome.Thoracotomy and bronchotomy for peripheral foreign bodies.Flexible fiber optic bronchoscopy in selected adult patients. -### End" -2250,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An investigator wants to study the association between maternal intake of iron supplements (Yes or No) and incidence of low bih weight (< 2500 or 2500 gms). He collects relevant data form 100 pregnant women as to the status of usage of iron supplements and the status of low bih weight in their newborns. The appropriate statistical test of hypothesis advised in this situation is ?, with the following options: A: Paired-t-test, B: Unpaired or independent t-test, C: Analysis of variance, D: Chi-Square test - -### Response: -Ans. is 'd' i.e., Chi-square test Dont get confuse with previous question with this one. o Both are different . Read below. In previous question the attribute used was bih weights of newborn babies, which is a quantitative data (each newborn has a paicular bih weight from a continuous spectrum of weight) --> the answer in that question was student t-test (unpaired or independent). o In this question the attribute used is low bih weight. On the basis of low bih weight newborns can be divided into two groups : - i) Being a LBW ii) Not being a LBW So, It is a qualitative data and the test used should be Chi-square test. -### End" -2251,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Harmonic imaging is used in?, with the following options: A: USG, B: CT, C: MRI, D: MRCP - -### Response: -Harmonic imaging is a technique in ultrasonography that provides images of better quality as compared with conventional ultrasound technique. Advantages over conventional ultrasound Decreased reverberation and side lobe aifacts. Increased axial and lateral resolution. Cyst clearing. Increased signal to noise ratio. Improved resolution in patients with large body habitus. -### End" -2252,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malunion of the supracondylar fracture of the humerus in children results, with the following options: A: Flexion deformity, B: Extension deformity, C: Cubitus varus deformity, D: Cubitus valgus deformity - -### Response: -(Cubitus varus deformity) (599-Apley's 8th)* Malunion is the commonest complication of a supra condylar fracture and results in a cubitus varus deformity (Gun-stock deformity)* This is because the fracture unites with the distal fragment tilted medially and in internal rotation* Cubitus valgus deformity results from fracture lateral condyle of humerus. This may result in late ulnar nerve palsy (Tardy-ulnar nerve palsy) -### End" -2253,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Christmas disease is due to the deficiency of the following clotting factor:, with the following options: A: Factor 8, B: Factor 9, C: Factor 11, D: Factor 12 - -### Response: -Haemophilia B or Christmas disease is due to the deficiency of factor 9. -### End" -2254,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3 week old boy is brought to pediatrics emergency depament with projectile vomiting which is non bilious. On physical examination, firm, olive like mass is noted in the epigastric region post breastfeed and USG revealed thickened pyloric muscle. What is the most likely pathological finding if the pylorus muscle is biopsied?, with the following options: A: , B: , C: , D: - -### Response: -The clinical symptoms, examination with USG findings of thickened pyloric muscle (>3mm) and elongated pyloric canal (>15mm) reveal the diagnosis as CHPS- congenital hyperophic pyloric stenosis which has hyperophy of circular muscle as depicted in option A Hyperophy-Small spindle-shaped (uterine smooth muscle cells) from a normal uterus, compared with large plump cells (the gravid uterus), at the same magnification.A Normal kidney tubules with Early (reversible) ischemic injury showing surface blebs, increased eosinophilia of cytoplasm, and swelling of few cells. Atrophy-Normal brain parenchyma of a young adult compared with Atrophy of the brain. Note made is of loss of brain substance that narrows the gyri and widens the sulci. Apoptosis- The shown cell is reduced in size, contains brightly eosinophilic cytoplasm and a condensed nucleus. -### End" -2255,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Predictive value indicating positive test in a screening modality is calculated by:, with the following options: A: TP/TP+FP*100, B: TN/TN+FN *100, C: TP/TP+FN*100, D: TN/FP+TN*100 - -### Response: -Ans. (a) TP/TP+FP*100SENSITIVITYTP------TP+ FNx 100PREDICTIVE VALU OF A NEGATIVE TESTTN------TN+FNx 100SPECIFICITYTP------FP+ TNx 100% OF FALSE NEGATIVESFN------TP+ FNx 100PREDICTIVE VALU OF A POSITIVE TESTTP------TP+ FPx 100% OF FALSE POSITIVESTN------FP+ TNx 100 -### End" -2256,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 year old female patient diagnosed as a case of -down's syndrome having mosaicism variety. - -Which type of head shape is commonly seen?, with the following options: A: Oligocephaly, B: Dolicocephaly, C: Brachycephaly, D: Mesiocephaly - -### Response: -General manifestations of Down’s Syndrome Skull -a. Brachycepbalic (round) skull resulting in a flattened face and occiput. -b. Presence at birth of third fontanelle. Just anterior to the posterior fontanelle. -c. Flat nasal bridges with a small maxilla. -Eyes -a. Oblique palpebral fissures with prominent epicanthic folds. -b. Brushfield’s spots appear on the iris in a ring concentric with the pupil. -c. Scanty eyelashes.  -d. Cataracts, squint and nystagmus are common. -Ears -a. Dysplastic ears with abnormal pinna. -Neck -Short and broad with excess skin posteriorly. -Hands -a. Broad and short (clinodactyly) with a single transverse palmar crease (simian crease). -b. Short incurved little finger. -c. Multiple loops on finger tips. -Muscles And Joints -Hypotonicity and hyperextensibility. -IQ -Often severely retarded with an IQ of 25-50. -Paediatric Dentistry / Shobha Tandon - 2nd Ed  P: 539,540 -### End" -2257,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minamata Bay disease refers to chronic toxicity with: TN 09, with the following options: A: Ergot, B: Dhatura, C: Organophosphorus, D: Mercury - -### Response: -Ans. Mercury -### End" -2258,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is situated in the upper part of Crista terminaiis -, with the following options: A: AV node, B: Bundle of his, C: Right Bundle branch, D: SA node - -### Response: -Ans. is 'd' i.e., SA node Conducting systemLocation in heartSA nodeUpper end of crista terminal is, near opening of SVCAV nodeTriangle of Koch's (near interatrial septum )Bundle of hisMembranous part of interventricular septumRBBRight surface of interventricular septumLBBLeft surface of interventricular septum -### End" -2259,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Methylphenidate is used for:, with the following options: A: Attention deficit disorder, B: Alzheimer's disease, C: Seizure disorder, D: Obsessive compulsive disorder - -### Response: -Ans. (a) Attention deficit disorderRef.:KDT 6th ed. / 470* Methylphenidate is the preferred drug for the treatment of attention deficit hyperkinetic disorder (ADHD). Other drugs used for this indication are amphetamines, atomoxetine and pemoline. Pemoline has been withdrawn due to life threatening hepatotoxicity.* Abuse of drugs like amphetamine, phencyclidine, methylphenidate, flumazenil etc. causes seizure and is NOT used for seizure disorder.* DOC for alzheimer's disorder- Rivastigmine/ Donepezil* DOC for OCD: Fluoxetine -### End" -2260,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common association in MEN 1 is -, with the following options: A: Gastrinoma, B: Glucagonoma, C: Insulinoma, D: Lipoma - -### Response: -Ans. is 'a' i.e. Gastrinoma ""Gastrinomas are the most common pancreatic islet tumors in MEN1 patients, accounting for over half of all pancreatic islet tumors in these patients."" - Clinical Neuroendocrinology p. 342""The most common islet neoplasm in MEN 1 secret pancreatic polypeptide & is nonfunctional, while gastrinoma is a most frequent functional tumor."" - Essentials of General Surgery""The most common functional islet cell tumor in MEN1 is gastrinoma "" - Oncology: An Evidence-Based Approach MEN-1(Wermer syndrome)o It involves primarily three glands1) Parathyroid (parathyroid hyperplasia/adenoma): Most common manifestation.2) Pituitary: Prolactinoma is the most common type of pituitary tumor in MEN-I.3) Pancreas: There is islet cell hyperplasia/adenoma.o Less common findings are pheochromocytoma, foregut carcinoid, lipomas and dermal angiofibroma -### End" -2261,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are common features of Cushing's syndrome, except?, with the following options: A: Truncal obesity, B: Osteoporosis, C: Distal myopathy, D: Glucose intolerance - -### Response: -Cushing syndrome is characterized with proximal muscle weakness resulting in difficulty in climbing stairs. ""Lemon on sticks"" appearance results in centripetal obesity. The Weight gain leads to insulin resistance coupled with effects of coisol leading to impaired glucose tolerance. -### End" -2262,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Twitch of a single motor unit is called, with the following options: A: Myoclonic jerk, B: Fasciculation, C: Tremor, D: Fibrillation - -### Response: -Contraction of a single muscle fiber is called fibrillation.Involuntary contractions of individual motor units are termed as fasciculations.Ref: Robbin&;s&; 9th edition; Chapter 28 The Central Nervous System -### End" -2263,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of cataract is, with the following options: A: Age related changes, B: Hereditary, C: Diabetes mellitus, D: Trauma induced - -### Response: -Most common cause of acquired cataract is senile cataract Refer: Khurana 6th edition page number 190 -### End" -2264,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anal fissure best diagnosed by:, with the following options: A: Anoscopy, B: History and superficial clinic examination, C: PR examination, D: USG - -### Response: -Fissure-in-Ano- Location of dentate line - usually 2cm below the anal verge.- Longitudinal split in the anoderm from anal verge to the dentate line- Location - In posterior midline at 6'o clock position - Fissure is of two types* Acute fissures* Chronic fissures - Chronic fissures - Characterized by Triad* CANOE- SHAPED ULCER* SENTINEL PILE (aka skin tag)* Hyperophied papilla Pathophysiology- Spasm of Internal Anal sphincter- Patients have constipation- During excessive straining at the time of defecation, the fecal matter passing throughinternal anal sphincter injures the pain sensitive mucosa of anal canal.Tear/ split in the anoderm |Decreased vascularity |Healing of Tear decreases (due to ischemia) - Principle of treatment is based on relaxing the spasm- Fissure in Ano is similar to Achalasia cardia Clinical features- Serve pain during defecation- Streaking of blood over stool- In fissure in Ano - Digital rectal examination is contraindicated.- Examine the gluteal region, find the longitudinal spilt in posterior midline Management- Initially conservative management* Sitz bath* Stool softener- Medical Treatment* CCB - 2% Diltiazem Gel - (Local application)* Nitrates - 0.2% nitroglycerine* Botox injection into sphincters* Lord's procedure - manual dilatation of sphincter (not performed usually).* TOC - NOTARA'S lateral sphincterotomy (divide internal anal sphincter laterally)* Anal advancement flap -### End" -2265,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A four-year-old child is diagnosed with Duchenne muscular dystrophy, an X-linked recessive disorder. Genetic anylysis shows that the patient&;s gene for the muscle protein dystrophin contains a mutation in its promoter region. What would be the most likely effect of this mutation?, with the following options: A: Tailing of dystrophin mRNA will be defective, B: Capping of dystropin mRNA will be defective, C: Termination of dystrophin transcription will be deficient., D: Initiation of dystrophin transcription will be deficient - -### Response: -Because the mutation creates an additional splice acceptor site (the 3'-end) upstream of the normal acceptor site of intron 1, the 19 nucleotides that are usually found at the 3'-end of the excised intron 1 lariat can remain behind as pa of exon 2. Exon 2 can, therefore, have these extra 19 nucleotides at its 5'-end. The presence of these extra nucleotides in the coding region of the mutant mRNA molecule will prevent the ribosome from translating the message into a normal b-globin protein molecule. Those mRNA for which the normal splice site is used to remove the first intron will be normal, and their translation will produce normal b-globin protein.Ref: Lippincott illustrated review, Sixth edition -### End" -2266,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Marker for neuroblastoma among the following is?, with the following options: A: NMP 22, B: Chromogranin A, C: LDH, D: P 2 microglobulin - -### Response: -Ans. is 'b' i.e., Chromogranin-A * Neuroendocrine markers of neuroblastomai) CD-56ii) Chromogranin-Aiii) Synaptophysin -### End" -2267,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Select the most appropriate response of Pill forgotten for 10 continuous days (SELECT 1 RESPONSE), with the following options: A: Stop pills and resume after 7 days, B: Continue pills as usual, C: Continue pills and use an additional form of contraception, D: Take an additional pill - -### Response: -Common side effects of birth control pills include nausea, breakthrough bleeding, bloating, and leg cramps. If these side effects are experienced in the first two or three cycles of pills-when they are most common-the pills may be safely continued, as these effects usually remit spontaneously. On occasion, following correct use of a full cycle of pills, withdrawal bleeding may fail to occur (silent menses). Pregnancy is a very unlikely explanation for this event; therefore, pills should be resumed as usual (after 7 days) just as if bleeding had occurred. However, if a second consecutive period has been missed, pregnancy should be more seriously considered and ruled out by a pregnancy test, medical examination, or both. Women occasionally forget to take pills; however, when only a single pill has been omitted, it can be taken immediately in addition to the usual pill at the usual time. This single-pill omission is associated with little if any loss in effectiveness. If three or more pills are omitted, the pill should be resumed as usual, but an additional contraceptive method (e.g., condoms) should be used through one full cycle. Although most side effects caused by birth control pills can be considered minor, serious side effects do sometimes occur. A painful, swollen calf may signal thrombophlebitis. -### End" -2268,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mid diastolic murmur with presystolic accentuation is seen in?, with the following options: A: Aortic stenosis, B: MVP, C: Mitral regurgitation, D: Mitral Stenosis - -### Response: -ANSWER: (D) Mitral StenosisREF: Harrison 18th ed chapter 13See APPENDIX- 79 below for ""HEART MURMURS""The first heart sound (S1 is usually accentuated and slightly delayed. The pulmonic component of the second heart sound (P2) also is often accentuated, and the two components of the second heart sound (S2) are closely split. The opening snap (OS) of the mitral valve is most readily audible in expiration at, or just medial to the cardiac apex. This sound generally follows the sound of aortic valve closure (A2) by 0.05-0.12 s. The time interval between A2 and OS varies inversely with the severity of the MS. The OS is followed by a low-pitched, rumbling, diastolic murmur, heard best at the apex with the patient in the left lateral recumbent position. APPENDIX- 79HEART MURMURSREF: Harrison 18th ed chapter 8Early diastolicTimeConditionDescriptionEarly diastolicAortic regurgitationThe murmur is low intensity, high-pitched, best heard over the left sternal border or over the right second intercostal space, especially if the patient leans forward and holds breath in full expiration. The radiation is typically toward the apex. The configuration is usually decrescendo and has a blowing character. The presence of this murmur is a good positive predictor for AR and the absence of this murmur strongly suggests the absence of AR. An Austin Flint murmur is usually associated with significant aortic regurgitation.Early diastolicPulmonaryregurgitationPulmonary regurgitation is most commonly due to pulmonaryhypertension (Graham-Steell murmur). It is a high-pitched and blowing murmur with a decrescendo configuration. It may increase in intensity during inspiration and best heard over left second and third intercostal spaces. The murmur usually does not extend to SI.Early diastolicLeft anterior descending artery stenosisThis murmur, also known as Dock s murmur, is similar to that of aortic regurgitation and is heard at the left second or third intercostal space. A Coronary artery bypass surgery can eliminate the murmur.Mid-diastolicTimeConditionDescriptionMid-diastolicMitral stenosisThe first heart sound (S,) is usually accentuated and slightly delayed. The pulmonic component of the second heart sound (P,,) also is often accentuated, and the two components of the second heart sound (S,,) are closely split. The opening snap(OS) of the mitral valve is most readily audible in expiration at, or just medial to the cardiac apex. This sound generally follows the sound of aortic valve closure (A2) by 0.05-0.12 s. The time interval between A2 and OS varies inversely with the severity of the MS. The OS is followed by a low-pitched, rumbling, diastolic murmur, heard best at the apex with the patient in the left lateral recumbent positionMid-diastolicTricuspid stenosisBest heard over the left sternal border with rumbling character and tricuspid opening snap with wide splitting SI. May increase in intensity with inspiration (Carvallos sign). Tricuspid stenosis often occurs in association with mitral stenosis. Isolated TS are often associated with carcinoid disease and right atrial myxoma.Mid-diastolicAtrial myxomaAtrial myxomas are benign tumors of the heart. Left myxomas are far more common than right myxomas and those may cause obstruction of the mitral valve producing a mid-diastolic murmur similar to that of mitral stenosis. An echocardiographic evaluation is necessary.Mid-diastolicIncreased flow across the atrioventricular valveThis can also produce a mid-diastolic murmur, such as in severe mitral regurgitation where a large regurgitant volume in the left atrium can lead to ""functional mitral stenosis.""Mid-diastolicAustin Flint murmurAn apical diastolic rumbling murmur in patients with pure aortic regurgitation. This can be mistaken with the murmur in mitral stenosis and should be noted by the fact that an Austin Flint murmur does not have an opening snap that is found in mitral stenosis.Mid-diastolicCarey-CoombsmurmurA mid-diastolic murmur over the left ventricular impulse due to mitral valvulitis from acute rheumatic fever.Late diastolicTimeConditionDescriptionLate diastolic (presystolic)Complete heart blockA short late diastolic murmur can occasionally be heard (Rytand's murmur).Mid-systolic ejectionTimeConditionDescriptionMid-systolicejectionAortic outflow obstruction (Aortic Stenosis)Can be due to aortic valve stenosis or hypertrophic cardiomyopathy (HCM), with a harsh and rough quality.**Valvular aortic stenosis can produce a harsh, or even a musical murmur over the right second intercostal space which radiates into the neck over the two carotid arteries. The most common cause of AS (Aortic Stenosis) is calcified valves due to aging. The second most common cause is congenital bicuspid aortic valves (normal valve is tricuspid). In aortic stenosis, heaving apical impulse is present. The distinguishing feature between these two causes is that bicuspid AS has little or no radiation. It can be confirmed if it also has an aortic ejection sound, a short early diastolic murmur, and normal carotid pulse. The murmur in valvular AS decreases with standing and straining with Valsalva maneuver.** Supravalvular aortic stenosis is loudest at a point slightly higher than in that of valvular AS and may radiate more to the right carotid artery **Subvalvular aortic stenosis is usually due to hypertrophic cardiomyopathy (HCM), with murmur loudest over the left sternal border or the apex. The murmur in HCM increases in intensity with a standing position as well as straining with Valsalva maneuver.Mid-systolic ejectionPulmonic outflow obstruction (Pulmonary Stenosis)A harsh murmur usually on left second intercostal space radiating to left neck and accompanied by palpable thrill. It can be distinguished from a VSD (Ventricular septal defect) by listening to the S2, which is normal in VSD but it is widely split in pulmonary stenosis. However, VSD is almost always pansystolic where the murmur of pulmonary stenosis is diamond-shaped and ends clearly before S2. Many innocent murmurs also arise from this location but SI and S2 must split normally.Mid-systolicejectionDilation of aortic root or pulmonary arteryProduces an ejection sound, with a short ejection systolic murmur and a relatively wide split S2. There is no hemodynamic abnormality. This is similar to pulmonary hypertension except the latter has hemodynamic instabilities.Mid-systolicejectionIncreased semilunar blood flowThis can occur in situations such as anemia, pregnancy, or hyperthyroidism.Mid-systolicejectionAortic valve sclerosisThis is due to degenerative thickening of the roots of the aortic cusps but produces no obstruction and no hemodynamic instability and thus should be differentiated from aortic stenosis. It is heard over right second intercostal space writh a normal carotid pulse and normal S2.Mid-systolicejectionInnocent midsystolic murmursThese murmurs are not accompanied by other abnormal findings. One example of a benign paediatric heart murmur is Still's murmur in children.Late systolicTimeConditionDescription This is the most common cause of late systolic murmurs. It can be heard best over the apex of the heart, usually preceded by clicks. The most common cause of mitral valve prolapse is ""floppy"" valve (Barlow's) syndrome. If the prolapse becomes severe enough, mitral regurgitation may occur. Any maneuver that decreases leftLate systolicMitral valve prolapseventricular volume -- such as standing, sitting, Valsalva maneuver, and amyl nitrate inhalation -- can produce earlier onset of dicks, longer murmur duration, and decreased murmur intensity'. Any maneuver that increases left ventricular volume -- such as squatting, elevation of legs, hand grip, and phenylephrine -- can delay the onset of clicks, shorten murmur duration, and increase murmur intensity.Late systolicTricuspid valve prolapseUncommon without concomitant mitral valve prolapse. Best heard over left lowrer sternal border.Late systolicPapillary muscle dysfunctionUsually due to acute myocardial infarction or ischemia, which causes mild mitral regurgitation.Holosystolic (pansystolic)TimeConditionDescriptionHolosystolic(pansystolic)TricuspidinsufficiencyIntensifies upon inspiration. Can be best heard over the fourth left sternal border. The intensity can be accentuated following inspiration (Carvallo's sign) due to increased regurgitant floiv in right ventricular volume. Tricuspid regurgitation is most often secondary to pulmonary hypertension. Primary tricuspid regurgitation is less common and can be due to bacterial endocarditis following IV drug use, Ebstein s anomaly, carcinoid disease, or prior right ventricular infarction.Holosystolic(pansystolic)Mitral regurgitationThe S1 is generally absent, soft, or buried in the holosystolic murmur of chronic MR. In patients with severe MR, the aortic valve may close prematurely, resulting in wide but physiologic splitting of S2. A lowT-pitched S.. occurring 0.12-0.17 s after the aortic valve closure sound. It may be followed by a short, rumbling, middiastolic murmur, even in the absence of MS. A fourth heart sound is often audible in patients with acute severe MR who are in sinus rhythm. A presystolic murmur is not ordinarily heard with isolated MR. A systolic murmur of at least grade III/VI intensity is the most characteristic auscultatory finding in chronic severe MR. It is usually holosystolic, but as previously noted it is decrescendo and ceases in mid- to late systole in patients with acute severe MR. The systolic murmur of chronic MR not due to MVP is intensified by isometric exercise (handgrip) but is reduced during the strain phase of the Valsalva maneuver.Holosystolic (pan systolic)Ventricular septal defectNo intensification upon inspiration. VSD is a defect in the ventricular wall, producing a shunt between the left and right ventricles. Since the L ventricle has a higher pressure than the R ventricle, flow during systole occurs from the L to R ventricle, producing the holosystolic murmur. It can be best heard over the left third and fourth intercostal spaces and along the sternal border. It is associated with normal pulmonary artery pressure and thus S2 is normal. This fact can be used to distinguish from pulmonary stenosis, which has a wide splitting S2. When the shunt becomes reversed (""Eisenmenger syndrome7'), the murmur may be absent and S2 can become markedly accentuated and single. Holosvstouc Murmur Differential Diagnosis Onset with S1 terminates at or beyond S2 | | | Maximum intercity over apexRadiation to axilla of bassA2 not Heard ever apexDecreased intensity with amyl nitrate Maximum intensity over left sternal borderRadiation to epigastrium and right sternal borderIncreased intensity during inspirationProminent c-v wave with sharp g descant in jugular venous pulse Maximum intensity over lower left third and lourith nterspareWildespreaed radiation, palpable thrillDecreased intensity with amyl nitrateNo change in intensity during inspirationWide splitting of S2 | | Mitral regurgitation Tricuspid regurgitation|||||Hyperdynamic left ventrioular impulse wide splitting of S2Suitatned left ventricular impulse Single S2 or narrow splitting of S2Prominent left parasternal - diastolic impulseNormal brilet left paraster - nal systolic impulseNormal P2 Rarely paradoxical S2Sustained systolic left parasternal impulseNarrow splitting of S2 wiin marked increase in intensity of P2Favors ventricular septal detect; often difficult todifferentiate from mitral regurgitant mumur |||| Primary mitral regurgitation (e.g,. rheumatic, naptuned chorclae)Secondary mitral regurgitation (dilated cardiomyopathy; papillary muscle dystunetion or late stage of primary mitral regurgitation)PrimarySecondary to pulmonary hypertension CMDT 2009 Table 10-1DIFFERENTIAL DIAGNOSIS OF VALVULAR HEART DISEASE MitralStenosisMitralRegurgitationAorticStenosisAorticRegurgitationTricuspidStenosisTricuspidRegurgitationInspectionMalar flush,precordialbulge, anddiffusepulsation inyoungpatients.Usually prominent and hyperdynamic apical impulse to left of MCL.Sustained PMI, prominent atrial filling wave.Hyperdynamic PMI to left of MCL and downward- Visible carotid pulsations. Pulsating nailbeds (Quincke), head bob (deMusset).Giant a wave in jugular pulse with sinus rhythm. Peripheral edema or ascites, or both.Large v wave in jugular pulse; time with carotid pulsation. Peripheral edema or ascites, or both.Palpation.""Tapping"" sensation over area of expected PMI. Right ventricular pulsation left third toForceful, brisk PMI; systolic thrill over PMI. Pulse normal, small, or slightly collapsing.Powerful, heaving PMI to left and slightly below MCL. Systolic thrill over aortic area, sternal notch, or carotid arteriesApical impulse forceful and displaced significantly to left and downward. Prominent carotid pulses. Rapidly rising and collapsing pulses (Corrigan pulse).Pulsating, enlarged liver in ventricular systole.Right ventricular pulsation. Systolic pulsation of liver. fifth ICSparasternallywhenpulmonary hypertension is present.P2. may be palpable. in severe disease. Small and slowly rising carotid pulse. If bicuspid AS check for delaj at femoral artery to exclude coarctation. Heart sounds, rhythm, and blood pressureS2 loud if valve mobile. Opening snap following S2. The worse the disease, the closer the S2-opening snap intervalS1 normal or buried in early part of murmur (exception is mitral prolapse where murmur may be late). Prominent third heart sound when severe MR.Atrial fibrillation common. Blood pressure normal. Midsystolic clicks may be present and may be multiple.A2 normal, soft, or absent. Prominem S4. Blood pressure normal, or systolic pressure normal with high diastolic pressure.S2 normal or reduced, A., loud. Wide pulse pressure with diastolic pressure < 60 mm Hg. When severe, gentle compression of femoral artery with diaphragm of stethoscope may reveal diastolic flow (Duroziez) and pressure in leg on palpation > 40 mm Hg than arm (Hill).S2 often loud.Atrial fibrillation may be present.MurmursLocationandtrans - missionLocalized at or near apex.Diastolicrumble bestheard inleft Lateralposition;may beaccentuatedby havingpatient dosit-ups.Rarely,shortdiastolicmurmuralonglower leftsternalborder(GrahamSteell) inseverepulmonaryhypertension.Loudest over PMI; posteriorly directed jets (ie, anterior mitral prolapse) transmitted to left axilla, left infrascapular area; anteriorly directed jets (ie, posterior mitral prolapse) heard over anterior precordium. Murmur unchanged after premature beat.Right second ICS parasternally or at apex, heard in carotid arteries and occasionally in upper interscapular area. May sound like MR at apex (Gallaverdin phenomenon), but murmur occurs after S1 and stops before S2. The later the peak in the murmur, the more severe the AS.Diastolic: louder along left sternal border in third to fourth interspace. Heard over aortic area and apex.May be associated with lowr-pitched middiastolic murmur at apex (Austin Flint) due to functional mitral stenosis.If due to an enlarged aorta, murmur may radiate to right sternal border.Third to fifth ICS along left sternal border out to apex. Murmur increases with inspiration.Third to fifth ICS along left sternal border. Murmur hard to hear but increases with inspiration. Sit- ups can increase cardiac output and accentuate.TimingRelation of opening snap to A2.important. The higherPansystolic: begins ivitb S1 and ends at or after A2. May be lateBegins after S1, ends before A2 The more severe the stenosis, the later the murmurBegins immediately after aortic second sound and ends before first sound (blurring both); helpsRumble often follows audible opening snap.At times, hard to hear. Begins with S1 and fills systole. Increases with inspiration. the LA pressure the earlier the opening snap. Presystolic accentuation before if in sinus rhythm. Graham Steel! begins with P2 (early diastole) if associated pulmonary hypertension.systolic in mitral valve prolapse.peaks.distinguish from MR. CharacterLow-pitched, rumbling; presystolic murmur merges with loud S1Blowing, high-pitched; occasionally harsh or musical.Harsh, rough.Blowing, often faint.As for mitral stenosis.Blowing, coarse, or musical.OptimumauscultatoryconditionsAfter exercise, left lateral recumbency. Bell chest piece lightly applied.After exercise; use diaphragm chest piece.In prolapse, findings may be more evident while standing.Use stethoscope diaphragm. Patient resting, leaning forward, breath held in full expiration.Use stethoscope expiration, diaphragm. Patient leaning forward, breath held inUse stethoscope bell. Murmur usually louder and at peak during inspiration. Patient recumbent.Use stethoscope diaphragm. Murmur usually becomes louder during inspiration.RadiographyStraight left heart border fromenlarged LA appendage. Elevation of left mainstem bronchus. Large right ventricle and pulmonary artery if pulmonary hypertension is present. Calcification in mitral valve in rheumatic mitral stenosis or in annulus in calcific mitral stenosis.Enlarged left ventricle and LA.Concentric left ventricular hypertrophy. Prominent ascending aorta. Calcified aortic valve common.Moderate to severe left ventricular enlargement. Aortic root often dilated.Enlarged right atrium with prominent SVC and azygous shadow.Enlarged right atrium and right ventricle.ECGBroad Pwaves in standard leads; broad negativeLeft axis deviation or frank left ventricular hypertrophy-Left ventricular hypertrophy.Left ventricular hypertrophy.Tall, peaked P waves. Possible right ventricular hypertrophy.Right axis usual. phase of diphasic P in V1 Ifpulmonary hypertension is present, tall peaked P waves, right axis deviation, or right ventricular hypertrophy appears.P waves broad, tall, or notched in standard leads. Broad negative phase of diphasic P in V1 EchocardiographyTwo - dimensional echocar - diographyThickened,immobilemitral valvewith anteriorand posteriorleafletsmovingtogether.""Hockeystick"" shapeto openedanteriorleaflet inrheumaticmitralstenosis.Annularcalciumwith thinleaflets incalcificmitralstenosis.LAenlargement, normal to small left ventricle. Orifice can be traced to approximate mitral valve orifice area.Thickened mitral valve in rheumatic disease; mitral valve prolapse; flail leaflet or vegetations may be seen. Dilated left ventricle in volume overload. Operate for left ventricular end- systolic dimension > 4.5 cm.Dense persistent echoes from the aortic valve with poor leaflet excursion. Left ventricular hypertrophy late in the disease. Bicuspid valve in younger patients.Abnormal aortic valve or dilated aortic root. Diastolic vibrations of the anterior leaflet of the mitral valve and septum. In acute aortic insufficiency, premature closure of the mitral valve before the QRS. When severe, dilated left ventricle with normal or decreased contractility. Operate when left ventricular end- systolic dimension > 5.0 cm.In rheumatic disease, tricuspid valve thickening, decreased early diastolic filling slope of the tricuspid valve. In carcinoid, leaflets fixed, but no significant thickening.Enlarged right ventricle with paradoxical septal motion. Tricuspid valve often pulled open by displaced chordae.Continuous and color flow Doppler and TEEProlongedpressurehalf-timeacross mitralvalve allowsestimationof gradient.MVAestimatedfrom pressurehalf-time.Regurgitant flow mapped into LA. Use of PISA helps assess MR severity. TEE important in prosthetic mitral valveregurgitation.Increased transvalvular flow velocity; severe AS when peak jet > 4 m/ sec (64 mm Hg}. Valve area estimate using continuity equation is poorly reproducible.Demonstrates regurgitation and qualitatively estimates severity based on percentage of left ventricular outflow filled with jet and distance jet penetrates into left ventricle.TEE important in aortic valveProlonged pressure half-time across tricuspid valve can be used to estimate mean gradient. Severe tricuspid stenosis present when mean gradient > 5 mm Hg.Regurgitant flow mapped into right atrium and venae cavae. Right ventricular systolic pressure estimated by tricuspid regurgitation jet velocity. Indirectevidence ofpulmonaryhypertensionby notingelevatedrightventricularsystolicpressuremeasuredfrom thetricuspidregurgitationjet. endocarditis to exclude abscess. Mitral inflow pattern describes diastolic dysfunction. MCL, midclavicular line; PMI, point of maximal impulse; ICS, intercostal space; P2, pulmonary second sound; AS, aortic stenosis; SI, first heart sound; S2, second heart sound; MR, mitral regurgitation; A2, aortic second sound; S4, fourth heart sound; LA, left atrial; SVC, superior vena cava; VI, chest ECG lead 1; TEE, transesophageal echocardiography; MVA, measured valve area; PISA, proximal isovelocity surface area.EFFECT OF RESPIRATION:Left-sided murmurs may be best heard at end expiration, when lung volumes are minimized and the heart and great vessels are brought closer to the chest wall. This phenomenon is characteristic of the murmur of AR. Murmurs of right-sided origin, such as tricuspid or pulmonic regurgitation, increase in intensity during inspiration. The intensity of left-sided murmurs either remains constant or decreases with inspiration. Normal Physiologic Splitting Wkide physiologic splittingPhysiologic but wide splitting diving the respiratory cycle implies either premature aortic valve closure, as can occur with severe MR, or delayed pulmonic valve closure due to PS or right bundle branch block.Reversed splittingReversed splitting can be a feature of severe AS, HOCM, left bundle branch block, right ventricular apical pacing, or acute myocardial ischemia.Narrow physiologic splitting (|P2)Narrow physiologic splitting occurs in pulmonary hypertension, and both A2 and P2 are heard during expiration at a narrow splitting interval because of the increased intensity and high - frequency composition of P2Mild Vs Severe MSMild MSIn mild MS, the dtastoiic gradient across the valve is limited to the phases of rapid ventneutar filling in early diastole and presystole. The rumble may occur during either or both periods.In severe MS, a large pressure gradient exists across the valve during the entire diastolic filling, and the rumble persists throughout diastole. As the left atrial pressure becomes greater, the Interval between A2 [or P2) and the opening snap (O.S.) shortens. Secondary pulmonary hypertension develops and results In a loud P? and the splitting Interval usually narrows. -### End" -2269,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The skin overlying the region where a venous ""cut-down"" is made to access the Great saphenous vein is supplied by -, with the following options: A: Femoral nerve, B: Sural nerve, C: Tibial nerve, D: Superficial peroneal nerve - -### Response: -Great saphenous vein on its course is accompanied by saphenous nerve which is a branch of femoral nerve. -### End" -2270,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A inhalation anaesthetic agent was used in a surgery which caused high output renal failure. The agent is:, with the following options: A: Methoxyflurane, B: Diethyl ether, C: Enflurane, D: Halothane - -### Response: -Methoxyflurane was the most potent inhalation agent, but its high solubility and low vapor pressure yielded longer inductions and emergences. Up to 50% of it was metabolized by cytochrome P-450 (CYP) enzymes to free fluoride (F-), oxalic acid, and other nephrotoxic compounds. Prolonged anesthesia with methoxyflurane was associated with a vasopressin-resistant, high-output, renal failure that was most commonly seen when F- levels increased to greater than 50 micro mol/L. Ref: Butterwoh IV J.F., Butterwoh IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C., Wasnick J.D. (2013). Chapter 8. Inhalation Anesthetics. In J.F. Butterwoh IV, J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e. -### End" -2271,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The arrow shows:, with the following options: A: Howell Jolly bodies seen in pernicious anaemia, B: Cabot’s ring seen in pernicious anaemia, C: Rushton bodies seen in IDA, D: None of the above - -### Response: -The image marked with arrow shows Cabot’s rings, punctate basophilia and basophilic stripping.   - -The bald tongue is referred to as Hunter’s glossitis or Moeller’s glossitis (seen in pernicious anaemia). -The Bald tongue of Sandwith is seen in pellagra in niacin deficiency. -Howell – Jolly bodies and Cabot’s rings, punctate basophilia and basophilic stripping is present. -### End" -2272,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Broadest neuroretinal rim is seen in:, with the following options: A: Sup role, B: Inf pole, C: Nasal pole, D: Temporal lobe - -### Response: -Ans. Inf pole -### End" -2273,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Extremely pruritic excoriation & papules on buttocks with autoantibodies against epidermal transglutaminase and IgA deposition in dermis on immunohistological examination of normal perilesional skin. Diagnosis is –, with the following options: A: Pemphigus vulgaris, B: Pemphigoid, C: Linear IgA disease, D: Dermatitis herpetiformis - -### Response: -Following information suggest the diagnosis of dermatitis herpetiformis. - -Extremely pruritic -Paulo - excoriation -Buttock involved -Antibodies against epidermal transglutaminase -IgA deposition in dermis -### End" -2274,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aseptic necrosis is commoner in fractures of: September 2011, with the following options: A: Calcaneum, B: Scaphoid, C: Cuboid, D: Trapezium - -### Response: -Ans. B: Scaphoid The blood supply of the Scaphoid is precarious In fractures through the waist, there is high probability of the proximal fragment becoming avascular -### End" -2275,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old obese woman who denies any history of alcohol abuse presents with severe abdominal pain radiating to the back. Laboratory results indicate an increase in serum amylase and lipase, with a marked decrease in calcium. Which of the following likely has caused this condition?, with the following options: A: Abetalipoproteinemia, B: Alcohol, C: Cholelithiasis, D: Cystic fibrosis - -### Response: -Leading cause of pancreatitis, paicularly in nonalcoholic patients, -Cholelithiasis(gallstones). Gallstones obstruct the pancreatic ducts-Autodigestion of the pancreas by the enzymes it normally secretes into the duodenum (lipases). These lipids then form soaps (saponify) with calcium-Hypocalcemia. Alcohol is another leading cause of pancreatitis. Cystic fibrosis, abetalipoproteinemia, and mumps infection are all less common causes of pancreatitis. -### End" -2276,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady approaches a physician for contraceptive advice. On examination there were two symmetrical ulcers on vulva, which were well defined with firm base. Which of the following is the most Hkely cause :, with the following options: A: Chancre, B: Herpes, C: Syphilis, D: Malignancy - -### Response: -Ans. is a i.e. Chancre Painless well defined ulcers with firm base should raise the suspicion of chancre. (The lesion in the question is thought to be painless as the lady in the question is not coming because of ulcer, but for contraceptive advice. Presence of ulcer is an incidental finding). Chancre is the primary lesion of primary syphilis. It is most commonly found on the labium majus, labium minus, fourchette. clitoris. urethral orifice or cervix but can be found anywhere on the lower genital tract. In 10% cases more than one primary lesion is present. The first manifestation is a small papule which breaks to form an ulcer. Ulcer is firm rainless with raised edges and granulomatous base. Intact any so of discrete relatively painless ulceration on the vulva may be primary syphilitic lesion. Inguinal glands enlarge when the primary is on the vulva or lower vagina. Lymph nodes are hard, shotty, painless and do not suppurate. -### End" -2277,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: As per immunisation schedule, Hepatitis A vaccine is recommended at:, with the following options: A: 1 year, B: 2 year, C: 5 years, D: 10 years - -### Response: -Hepatitis A vaccine is administered intra muscularly in children older than 2 years of age in a two dose schedule, given 6-12 months apa. This vaccine is stored at 2-8 degree celsius. Must know: IAP time schedule of routine vaccination: Bih - 15 days: BCG + OPV + Hep B 1st dose 6 wks - 8 wks: OPV 1 + DPT1 +Hep B 2nd dose 10 wks - 12 wks: OPV 2 + DPT 2 14 Wks - 16 wks: OPV 3 + DPT 3 6-9 months: Hep B 3rd dose 9 months: measles vaccine 15-18 months: 1st booster dose of OPV + DPT, MMR vaccine 4-6 yrs: 2nd booster dose of OPV + DPT 10 yrs: Tetanus toxoid 16 yrs: Tetanus toxoid Ref: Essential Paediatrics By O P Ghai, 6th edn, page 199 -### End" -2278,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2 year old child with purulent nasal discharge,fever and pain since 2 months. His fever is 102-103 F, and leucocyte count is 12000 cu/mm.X ray PNS showed opacification of left ethmoidal air cells.The culture of the eye discharge was negative. which of the following would be most useful fuher step in evaluation of this patient?, with the following options: A: CT Scan, B: Urine culture, C: Blood culture, D: Repeat culture of the eye discharge - -### Response: -The best method to assess the state of ethmoidal air cells and it's complications is CT Scan. ""CT is paicularly useful in ethmoid and sphenoid sinus infections and has replaced studies with contrast material"". Ref Dhingra 5/e,p 209. -### End" -2279,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following doesn't occur during the processing of RNA?, with the following options: A: Terminal addition, B: Nucleoside modification, C: Nucleoside cleavage, D: Chemical hydrolysis - -### Response: -Precursor tRNA is processed to form mature tRNA. Alterations during processing are of three types: nucloelytic reactions, nucleoside modifications, terminal additions of nucleotides. Chemical hydrolysis is not a pa of RNA processing. Poly A tailing and 5'capping occurs in the processing of RNA. Methylation and deamination are known to occur. Introns will be removed after cleavage in the process. -### End" -2280,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glucose transpoer present in the RBC-, with the following options: A: a) GLUT 1, B: b) GLUT 2, C: c) GLUT 3, D: d) GLUT 4 - -### Response: -Highest level of GLUT 1 is present in RBC. -### End" -2281,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 29 year old male patient complains of protruding upper incisors. The incisor relationship can be classified as Class II div 1. This system of classification for incisor relationship was described by:, with the following options: A: E. Angle, B: British Standards Institute, C: Ackerman-Proffit system, D: Dewey - -### Response: -British Standard Classification of Incisor Malocclusion: - -Class I: The lower incisor edges occluded on or lie below the cingulum plateau of the upper incisors.  -Class II, division 1: The lower incisor edges occluded behind the cingulum plateau of the upper incisors and the upper incisors are normally inclined or proclined.  -Class II, division 2: The lower incisor edges occluded behind the cingulum plateau of the upper incisors and the upper incisors are retroclined.  -Class III: The lower incisor edges occlude anterior to the cingulum plateau of the upper incisors. - -Ref: British Standards Institute. Glossary of Dental Terms (BS 4492). London: BSI; 1983. -### End" -2282,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Consider the following statements about Jacuzzi syndrome and mark the true statement ., with the following options: A: It is caused by Pneumococcus ., B: It is also known as hot tub folliculitis ., C: It is progressive illness ., D: It is always a painless condition . - -### Response: -Jacuzzi syndrome :- It is caused by Pseudomonas aeruginosa This condition arises due to inflammation of hair follicles (haiub folliculitis). It is usually self limiting condition . It can be extremely painful or itchy condition . -### End" -2283,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in norma basalis except, with the following options: A: Mental foramen, B: Foramen magnum, C: Foramen ovale, D: Foramen Lacerum - -### Response: -The foramen passing through norma basalis are; 1.Greater palatine foramen 2.Lesser palatine foramen 3.Foramen spinosum 4.Foramen ovale 5.Emissary sphenoidal foramen or foramen of Vesalius 6.Foramen lacerum 7.Jugular foramen 8.Foramen magnum NOTES: Mental foramen is present on the outer surface of the mandible. The mental foramen lies below the interval between the premolar teeth. Ref BDC volume3,Sixth edition pg 13 -### End" -2284,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which aery does not contribute to little&;s area?, with the following options: A: Septal branch of facial aery, B: Anterior ethmoidal aery, C: Sphenopalantine A, D: Posterior ethmoidal A - -### Response: -The anterior pa or vestibule of the septum contains anastomosis Between the septal ramus of superior labial branch of facial aery, branch of sphenopalatine aery, greater palatine and of anterior ethmoidal aery.These form a large capillary network called kiesselbachs plexus and this area is called LITTLE'S AREA. REFER BDC SIXTH EDITION VOL 3 PAGE NO: 241 -### End" -2285,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What lies anterior to transverse sinus, with the following options: A: Aoa, B: Pulmonary aery, C: IVC, D: SVC - -### Response: -Transverse sinus is a horizontal gap between the aerial and venous ends of the hea tube.It is bounded anteriorly by the ascending aoa and pulmonary trunk,and posteriorly by the superior venacava and inferiorly by the left atrium.On each side it opens into the general pericardial cavity. REF:B D CHAURASIA'S HUMAN ANATOMY,VOLUME-1,FIFTH EDITION Page no 242 -### End" -2286,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the least common cause of ambiguous genitalia in a female child?, with the following options: A: Fetal placental steroid sulfatase deficiency, B: Fetal placental aromatase deficiency, C: Congenital adrenal hyperplasia, D: WNT-4 gene mutation - -### Response: -Fetal placental steroid sulfatase deficiency is an X-linked disorder therefore occur only in males. So it's the least common cause of ambiguous genitalia in a female child. Ref: Principles and practice of endocrinology and metabolism, Page 957 By Kenneth L. Becker page1061. -### End" -2287,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following developmental defects of the Urogenital sinuses NEVER occurs in the female?, with the following options: A: Epispadias, B: Hypospadias, C: Ectopia vesicae, D: All these defects can occur - -### Response: -Hypospadias is seen only in males Girls have epispadias, with separation of the 2 halves of the clitoris and wide separation of the labia Ectopia vesicae also occurs in both sexes -### End" -2288,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following doesn't present with bleeding per rectum?, with the following options: A: Ca rectum, B: Sigmoid volvulus, C: Inflammation of Meckel's diveiculum, D: Enteric fever - -### Response: -Sigmoid volvulus presents with features of lower intestinal obstruction not bleeding per rectum. Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. The most common sites of volvulus are the sigmoid colon and cecum. -### End" -2289,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Length of the female urethra -, with the following options: A: 2cm, B: 4cm, C: 6cm, D: 8cm - -### Response: -Urethra --        Length -o   Male - 20 cms -o   Female - 4 cms --        Shortest part of the male urethra - Membranous part --        The longest part of the male urethra - Penile urethra --        Location of sphincter urethrae - Membranous part --        Prostatic urethra -o   Widest part -o   Most dilatable part -o   Concave anteriorly. -o   Route- downwards & forwards. Exit prostate slightly anterior to its apex. -o   Crescentic on the cross section -o    Structures on the posterior wall -§  Urethral crest -§  Colliculus seminalis (verumontanum) -§  Opening of ejaculatory ducts -§  Prostatic sinuses with the opening of prostate glands -o   Lymphatics -§  Membranous part - Internal iliac nodes -§  Prostatic part - Internal iliac nodes -§Penile urethra - Deep inguinal nodes. -### End" -2290,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 31 year old female patient complains of bilateral impairment of hearing for the 5 year. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows As type of curve and acoustic reflexes are absent. All constitute pa of treatment, except:, with the following options: A: Hearing aid, B: Stapedectomy, C: Sodium fluoride, D: Gentamicin - -### Response: -Gentamicin is used to treat Meniere's disease. -### End" -2291,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dental wear caused by tooth-to-tooth contact is, with the following options: A: Abrasion, B: Attrition, C: Erosion, D: Abfraction - -### Response: -Wasting diseases of the teeth include erosion (corrosion; may be caused by acidic beverages), abrasion (caused by mechanical wear as with toothbrushing with abrasive dentifrice), attrition (due to functional contact with opposing teeth), and abfraction (flexure due to occlusal loading) -### End" -2292,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major apolipoprotein of chylomicrons -, with the following options: A: B-100, B: D, C: B-48, D: None - -### Response: -Ans. is 'c' i.e., B-48 TypeFound inSite of synthesisFunctionApo-A AI-IHDL, Chylomicrons QLiver, intestineMajor structural protein of HDL Q, major activator of LCAT Q -A-IIHDL, ChylomicronsLiver, intestineStructural protein of HDL, inhibits lipoprotein lipase (LPL), stimulate hepatic lipase, inhibits LCATA-IVHDL, ChylomicronsIntestine A-VChylomicrons, VLDLLiver lipolysisPromotes lipoprotein lipase (LPL) mediated triglycerideApo-B B-100LDL. VLDL, IDLLiverStructural protien of VLDL, IDL; only apoprotein of LDL Q; mediate uptake of LDL by LDL receptors Q of liverB-48Chylomicrons QIntestineStructural protein of chylomicronsApo-C C-IChylomicrons Q, VLDL, HDLLiverInhibits choiesteryl ester transfer protein (CETP), Activates LCAT and LPL QCIIIChylomicrons, VLDL, HDLLiverActivates lipoprotein lipase Q (major activator)c-inChylomicrons VLDL, HDL Liver Inhibits lipoprotein lipase QApo-DHDLSpleen, brain, testes, adrenal Apo-EChylomicrons Q, VLDL, HDLLiverMediates uptake of chylomicron remnants and IDL by LDL receptors Q in liver -### End" -2293,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not seen in the syndrome associated with the following condition?, with the following options: A: Hypoglycemia, B: Hypeension, C: Frank psychosis, D: Hypokalemia - -### Response: -Cushing syndrome: causes impaired Glucose tolerance and hyperglycemia. The majority of patients also experience psychiatric symptoms, mostly in the form of anxiety or depression, but acute paranoid or depressive psychosis may also occur. Due to paial mineralocoicoid activity of coisol, hypeension and hypokalemia is explained. -### End" -2294,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Immunoflourosence of pemphigus vulgaris shows?, with the following options: A: Linear IgG in BMZ, B: Granular IgG in BMZ, C: Fish net appearance, D: IgA deposition in dermal papillae - -### Response: -ANSWER: (C) Fish net appearanceREF: Fitz Patricks Dermatology, Sixth Edition Page 561, 563, 565 -### End" -2295,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which maneuver generally is not performed early before chest compression in basic life suppo outside the hospital?, with the following options: A: Call for help, B: Obtain airway, C: Electrical cardioversion, D: Ventilation - -### Response: -Basic life suppo does involve calling for help, obtaining an airway, and beginning ventilation before staing chest compression. Electrical cardioversion requires special equipment and trained personnel and thus is pa of the advanced cardiac life suppo. -### End" -2296,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary sclerosing cholangitis is associated with, with the following options: A: Ulcerative cholangitis, B: Retroperitoneal fibrosis, C: Reidel's thyroiditis, D: All of the above - -### Response: -Features of ulcerative colitis in case of PSC(70%).PSC may be associated with retroperitoneal fibrosis,mediastinal fibrosis,Riedel's thyroiditis,orbital pseudotumour. Reference:SRB's manual of surgery,5th edition,page no:658. -### End" -2297,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Estrogen is secreted by -, with the following options: A: Granulosa cells, B: Theca luteal cells, C: Thecainterna, D: Thecaexterna - -### Response: -Ans. is 'a' i.e., Granulosa cells o Ovarian follicle contains two types of cells in preovulatory phase Gramdosa cells :- Secrete mainly estrogen and very minimal amount of progesterone. Theca cells (interna & externa) :- Theca interna cells provide androgen and pregnenolone to granulosa cells to convert them into estrogen and progesterone respectively. o After ovulation, corpus luteum contain two types of cell Granulosa luteal ceils (formed by luteinization of granulosa cells) Produce mainly estrogen and minimal progesterone. Theca luteal cells (formed by luteinization of theca interna cells) Produce mainly progesterone. -### End" -2298,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major pa of cardiac septa development is completed by day:, with the following options: A: 25, B: 27, C: 35, D: 37 - -### Response: -The major septa of the hea are formed between the 27th and 37th days of development, when the embryo grows in length from 5 mm to approximately 16 to 17 mm. Ref: Langman's embryology 11th edition Chapter 12. -### End" -2299,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is false about GIST ?, with the following options: A: Associated with NF 1, B: Most common site is stomach, C: Associated with CD 117, D: Least common mesenchymal neoplasm of gastrointestinal tract - -### Response: -Ans. is 'd' i.e., Least common mesenchymal neoplasm of gastrointestinal tract Gastrointestinal stromal tumors (GISTs) GISTs are the most common mesenchymal neoplasm of gastrointestinal tumor. GIST represents a distinct group of gastrointestinal tumors that originate from the interstial cells of cajal which control gastrointestinal peristalsis. GISTs can occur anywhere in the gastroinstestinal tract; the most common site being the stomach followed by small intestine. -### End" -2300,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mediators of inflammation are all except -, with the following options: A: TNF, B: IFN, C: Myeloperoxidase, D: Prostaglandins/Interleukins - -### Response: -Mediators of inflammation:- -The vascular and cellular reactions of both acute and chronic inflammation are mediated by chemical factors known as a mediator of inflammation. -Mediators originate either: - -1. From plasma -Complement proteins, Bradykinin -2. From cells -Cells derived mediators may be performed and are stored in secretory granules or they may be synthesized de novo in response to a stimulus. -Preformed mediators → Histamine, Serotonin, Lysosomal enzymes. -Newly synthesized → Prostaglandins, Leukotrienes, platelet activating factors, nitric oxide, reactive oxygen species, cytokines (TNF, IL-1). -Myeloperoxidase is not an inflammatory mediator. It is an enzyme of neutrophil which catalyzes the conversion of Cl, Br, and T, and SCN to the corresponding acids (HOCl, HOBr etc.). These acids are potent oxidants and help in destroying the invading organisms. -Mediators of Acute inflammation -### End" -2301,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following immunoglobulins can crosses placenta:, with the following options: A: IgA, B: IgM, C: IgG, D: IgD - -### Response: -Answer is C (IgG): IgG is the only maternal immunoglobulin, that is normally transpoed across the placenta and provides natural passive immunity in the newborn. -### End" -2302,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following arise from the apex of orbit except, with the following options: A: Superior oblique, B: Inferior rectus, C: Superior rectus, D: Medical rectus - -### Response: -Superior oblique rises from under the surface of the lesser wing of sphenoid, superomedial to the optic canal. The four recti arise from a common annular tendon or tendinous ring of Zinn. The ring is attached to the middle pa of the superior orbital fissure.Ref: BD Chaurasia; Volume 3; 6th edition; Page no: 208 -### End" -2303,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pure gonadal dysgenesis will be diagnosed in the presence of, with the following options: A: Bilateral streak gonads, B: Bilateral undescended testes in male, C: One side streak and other side normal gonad, D: One side dysgenetic testis and other side dysgenetic ovary - -### Response: -Pure gonadal dysgenesis is characterised by B/L streak gonads. The external phenotype is female and mullerian structures are present. Usually present with primary amenorrhea (hypergonadotropic hypogonadism) -### End" -2304,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 48 years old female suffering from severe menorrhagia (DUB) underwent hysterectomy. She wishes to take hormone replacement therapy. Physical examination and breast are normal but X-ray shows osteoporosis. The treatment of choice is:, with the following options: A: Progesterone, B: Estrogen progesterone, C: Estrogen, D: None - -### Response: -Osteoporosis in this patient is due to estrogen deficiency. Estrogens are efficacious when administered orally or transdermally. Various types of estrogens (conjugated equine estrogens, estradiol, estrone, esterified estrogens, ethinyl estradiol, and mestranol) reduce bone turnover, prevent bone loss, and induce small increases in bone mass of the spine, hip, and total body. The effects of estrogen are seen in women with natural or surgical menopause and in late postmenopausal women with or without established osteoporosis. Ref: Lindsay R., Cosman F. (2012). Chapter 354. Osteoporosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -2305,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diagnostic feature of RHD is :, with the following options: A: McCallam patch, B: Aschoff nodules, C: Shaggy vegetations, D: Bread butter pericarditis - -### Response: -Ans. is 'b' i.e. Aschoff nodules Aschoff nodules are focal inflammatory lesions found in any of the three Layers of the heart. They are characteristic of acute rheumatic fever.Aschoff nodules consist ofFibrinoid necrosis*Aschoff giant cells *Histiocytes*Plasma cells*Lymphocytes*Fibroblast*Collagen* -### End" -2306,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What will be the treatment of choice for nodules present at the junction of anterior 1/3 & posterior 2/3 of vocal cords, in a 30 year old female singer with a history of gastrooesophageal reflux?, with the following options: A: Microlaryngectomy, B: Microlaryngascopic surgery & C02 laser, C: Speech therapy and Proton Pump Inhibitor (PPI), D: Direct laryngoscopy and biopsy - -### Response: -Vocal nodules typically present at the junction of the anterior one-third and posterior two-third as this is the area which is subjected to maximum trauma. Speech therapy and educating the patient in using their voice is the recommended to prevent its recurrence. The patient also has gastro oesophageal reflux for which proton pump inhibitors should be prescribed. -### End" -2307,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Condition caused by deficiency of fibrillin 1 is?, with the following options: A: Marfan syndrome, B: Ehler Danlos syndrome, C: Osteogenesis imperfecta, D: Angelman syndrome - -### Response: -Ans. is 'a' i.e., Marfan syndrome * Marfan syndrome is an autosomal dominant disorder due to mutation in fibrillin-1 gene on chromosomal 15.About other options* EDS comprises a clinically and genetically heterogenous group of disorders that result from some defect in the synthesis or structure of collegen and characterized by hyperelasticity of skin and hypermobile joints* Osteogenesis imperfecta, also called brittle bone disease or Lobstein syndrome, is an autosomal dominant disorder due to defect in type-1 collagen* Duchenne Muscular Dystrophy (DMD) is an X-linked recessive disorder. It is caused by a mutation in gene responsible for producing dystrophin (a sarcolemmal protein). -### End" -2308,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypersensitivity pneumonitis, all are true except:, with the following options: A: Due to organic dusts/proteins, B: Leads to fibrosis of lung parenchyma (Interstitial lung disease), C: Farmers lung is an example of HP, D: Bronchoalveolar lavage will have increased eosinophils - -### Response: -BAL fluid will have increased neutrophils (NOT EOSINOPHILS). -### End" -2309,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a young patient who had extensive soft tissue and muscle injury, which of these muscle relaxants used for endotracheal intubation might lead to cardiac arrest –, with the following options: A: Atracurium, B: Suxamethonium, C: Vecuronium, D: Pancuronium - -### Response: -Sch can cause dangerous hyperkalemia in patients with extensive soft tissue & muscle injury (crush injury) which may cause cardiac arrest. -### End" -2310,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding anaemia of chronic ds. are --A/E ?, with the following options: A: Decreased TIBC, B: Increased macrophage iron in marrow, C: Decrease serum ferritin level, D: Decreased serum iron levels - -### Response: -Ans. is 'c' i.e., Decreased serum ferritin level -### End" -2311,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anterior spinal Aery thrombosis is characterized by all, except:, with the following options: A: Loss of pain & touch, B: Loss of vibration sense, C: Loss of power in lower limb, D: Sphincter dysfunction - -### Response: -Answer is B (Loss of vibration sense): Anterior spinal aery thrombosis does not involve the posterior column and hence vibration sense and joint positions sense (proprioception) are preserved. -### End" -2312,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metabolism of drugs is mostly done by which enzyme-, with the following options: A: Cytochrome C, B: Cytochrome P450, C: Glucronyl transferase, D: Acetylase - -### Response: -Ans. is 'b' i.e., Cytochrome P450 o Biotransformation reactions (metabolism) of drugs can be classified :A. Non-synthetic (phase I) reactions# Metabolism brings about a change in the drug molecule by:1. Oxidation2. Reduction3. Hydrolysis4. Cyclization5. Decyclization# The new metabolite may retain biological activity or it may be an inactive metabolite.# Oxidation is the most important metabolizing reaction.# The most important enzyme for oxidation reaction is cytochrome P450B.Synthetic (phase II or conjugation) reaction# Metabolism involves union of the drug with one of several polar (water-soluble) endogenous molecules that are products of intermediary metabolism, to form a water-soluble conjugate which is readily eliminated by kidney or, if the molecular weight exceeds 300, in the bile.# Phase II metabolism almost invariably terminates biological activity, i.e. metabolites are usually inactive.# Reactions are:-1. Acetylation2. Glucuronide conjugation3. Glycine conjugation4. Glutathione conjugation5. Sulfate conjugation6. Methylation7. Neucleotide synthesis -### End" -2313,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of lepromatous leprosy except:, with the following options: A: Gynaecomastia, B: Madarosis, C: Saddle nose, D: Perforating Ulcer - -### Response: -D i.e. Perforating Ulcer Leprosy and acquired syphilis are not vesico-bullous disordersQ (i.e. there is no vesicle and bullae formation, which can be seen in congenital syphilis). Neuropathic / Trophic /Perforating / Plantar - ulcer is a frequent complication (not clinical feature) of lepromatous leprosyQ because sensory impaiment appears before motor weakness and patient continues to miisuse his feet and hands. -### End" -2314,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Emotion is controlled by:, with the following options: A: Limbic system, B: Frontal lobe, C: Temporal lobe, D: Occipital lobe - -### Response: -The neuroanatomical substrate for generation of emotions is limbic system (which includes hippocampus, amygdala, hypothalamus, cingulate gyrus and related thalamic and coical areas) The regulation/control of emotions is a function of frontal lobe. -### End" -2315,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trapping parasites using NETs is assisted by, with the following options: A: Neutrophils and Eosinophils, B: Neutrophils and Monocytes, C: Eosinophils and Monocytes, D: Nk cells - -### Response: -NEUTROPHILS AND EOSINOPHILS EMPLOY NETS TO ENTRAP PARASITESIn addition to ingesting small microorganisms such as bacteria by phagocytosis, neutrophils and eosinophils can assist in the elimination of larger invaders by trapping them within webs called neutrophil extracellular traps or NETsRef: Harper&;s Biochemistry; 30th edition; Chapter 54 White Blood Cells -### End" -2316,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Several employees in a veterinary facility experience a mild influenza-like infection after working on six sheep with an undiagnosed illness. The etiologic agent causing the human disease is most often transmitted to humans by which of the following methods?, with the following options: A: Fecal contamination from flea deposits on the skin, B: Inhalation of infected particles or aerosols from the suspected animal urine and feces, C: Lice feces scratched into the broken skin during the louse's blood feeding, D: Tick saliva during feeding on human blood - -### Response: -Coxiella burnetii is a rickettsial organism that causes upper respiratory infections in humans. These can range from sub-clinical infection to influenza-like disease and pneumonia. Transmission to humans occurs from inhalation of dust contaminated with rickettsiae from placenta, dried feces, urine, or milk, or from aerosols in slaughterhouses. Campylobacter burnetii can also be found in ticks, which can transmit the agent to sheep, goats, and cattle. No skin rash occurs in these infections. Treatment includes tetracycline and chloramphenicol. Coxiella burnetii is not transmitted by flea or tick vectors. Since Q fever involves the upper respiratory tract, liver, or CNS, there is no transmission by urethral discharge. -### End" -2317,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Superior gluteal nerve does not supply -, with the following options: A: Tensor fasciae latae, B: Gluteus medius, C: Gluteus minimus, D: Gluteus maximus - -### Response: -Ans. is 'd' i.e.. Gluteus maximus o Nerve supplying muscles of gluteal region areInferior gluteal nerve : Gluteus maximus.Superior gluteal nerve : Gluteus medius and minimus,Nerve to piriformis : PiriformisNerve to obturator intemus : Obturator intemus. Gemellus superior.Nerve to quadrants femoris : Quadratus femoris, Gemellus inferior,o Tensor fascia latae is supplied by superior gluteal nerve. -### End" -2318,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most sensitive method of non invasive monitoring of cardio-vascular ischemia in perioperative period is -, with the following options: A: NIBP, B: BOG, C: Pulse oximeter, D: TEE - -### Response: -Ans. is 'd' i.e., TEE o Two dimensional TEE is the most sensitive method to detect myocardial ischemia and air embolism in peri-operative period.o Detection of regional w all motion abnormality a rapid and more sensitive indicator of myocardial ischemia than is the ECGo Decreased systolic wall thickening may be more reliable index for ischemia than endocardial wall motion abnormality alone. -### End" -2319,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Motor supply to the muscles of the tongue is by:, with the following options: A: Hypoglossal nerve, B: Facial nerve, C: Lingual nerve, D: Glossopharyngeal nerve - -### Response: -All the intrinsic and the extrinsic muscles, except the palatoglossus are supplied by the hypoglossal nerve. The palatoglossus is supplied by the cranial root of the accessory nerve through the pharyngeal plexus Lingual nerve is the nerve of general sensation and the chorda tympani is the nerve of taste for the anterior two thirds of the tongue except vallate papillae -### End" -2320,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neck of fibula fracture leads to which nerve injury?, with the following options: A: Common peroneal nerve, B: Obturator nerve, C: Genitofemoral nerve, D: Posterior tibial nerve - -### Response: -Ans. (a) Common peroneal nerve* Common peroneal nerve originates from the dorsal branches of the fourth and fifth lumbar and the first and second sacral nerves. It descends obliquely along the lateral side of the popliteal fossa to the head of the fibula, close to the medial margin of the biceps femoris muscle. Where the common peroneal nerve winds round the head of the fibula, it is palpable and vulnerable to injury.Remember* Tarsal tunnel syndrome- Posterior tibial nerve* MeralgiaParasthetica- Lateral cutaneous nerve of thigh* Claw hand-ulnar nerve* Mononeuritis multiplex is most commonly caused by Polyarteritis Nodosa.(If asked for India Ans. as leprosy). -### End" -2321,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Keratometry used for?, with the following options: A: Measuring curvature of anterior surface of cornea, B: Calculating Axial length of eyeball, C: Endothelial cell count, D: Intraocular pressure - -### Response: -Ans. is 'a' i.e., Measuring curvature of anterior surface of cornea Ketatometry -o A keratometer, also known as a ophthalmometer, is a diagnostic instrument for measuring the curvature of the anterior surface of cornea. Keratometer reading provide the following information to assist in the overall assessment of the corneai) Radii of curvature of the corneaii) The degree of corneal astigmatismiii) The direction of the principal meridians of the eye, determining whether the astigmatism is with the rule or against the rule a key factor in contact lens fitting.iv) The presence of any corneal distortion. -### End" -2322,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are true about fibronectin nephropathy,except:, with the following options: A: Autosomal recessive inheritance, B: Gomerular enlargement and PAS+ trichrome messangial deposit, C: Glomerulus do not consistently stain for Ig and complement, D: Ultrastructural feature is presence of large electron essangial or subendothelial deposit - -### Response: -. Autosomal recessive inheritance -### End" -2323,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 75-year-old male presented with chief complaint of pain in the right shoulder. CXR is shown below. Which of the following could be the cause of pain in this patient?, with the following options: A: Pancoast tumor, B: Sarcoidosis, C: Subclan aery aneurysm, D: Mesothelioma - -### Response: -CXR shows a mass in the right lung apex and there is associated destruction of the right 2nd and 3rd ribs posteriorly. A combination of an apical mass along with the destruction of the rib is characteristic of Pancoast tumor/ Superior Sulcus Tumor. MRI is a more sensitive investigation in identifying the extension of tumor into adjacent soft tissue and bone. -### End" -2324,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin K carboxylates, with the following options: A: Aspaate, B: Glutamate, C: Tyrosine, D: Tryptophan - -### Response: -The vitamin K-dependent (VKD)3carboxylase is a bifunctional enzyme that catalyzes the oxygenation of vitamin Khydroquinone, resulting in formation of vitamin K epoxide, in parallel with the carboxylation of multipleglutamate (Glu) residues in vitamin K-dependent proteins Ref ganong's review of medical physiology 25e -### End" -2325,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 52 years male present with pain in the lower limbs, on performing Doppler it shows sapheno femoral junction incompetence and dilatation of great saphenous vein, deep veins appear normal, which of the following statement regarding the management of this patient is false?, with the following options: A: Stab avulsion, B: Sclerotherapy, C: Endovascular stripping, D: Saphenofemoral flush ligation with stripping - -### Response: -Ans. (b) Sclerotherapy.Image indicates varicose veins which is further confirmed by doppler. Sclerotherapy is used for telangiectatic vessel and varicose veins less than 3 mm in diameter, involvement of great saphenous vein along with saphenofemoral junction indicates varicosity over 3 mm where sclerotherapy has no role.Image Source- style=""font-family: Times New Roman, Times, serif""> -### End" -2326,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Colour of O2 cylinder, with the following options: A: Gray, B: Orange, C: Blue, D: Black & White - -### Response: -D i.e. Black & White -### End" -2327,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lymphoepithelial change in stomach is seen in -, with the following options: A: Maltoma, B: Coeliac disease, C: Ipsidoma, D: IBS - -### Response: -The stomach is the most common site for extranodal lymphoma. -Nearly all gastric lymphomas are B-Cell Lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma). -The majority are associated with chronic gastritis and H. pylori infection. - -In MALT Lymphoma, monomorphic lymphocytic Infiltrate of the lamina propria surrounds gastric glands massively infiltrated with atypical lymphocytes and undergoing destruction → the lymphoid - epithelial lesion. -### End" -2328,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The stomach motility is inhibited by, with the following options: A: Histamine, B: Angiotensin, C: Acetylcholine, D: Dopamine - -### Response: -The physiologic function of the dopamine in the circulation is unknown. However, injected dopamine produces renal vasodilation, probably by acting on a specific dopaminergic receptor. It also produces vasodilation in the mesentery. Elsewhere, it produces vasoconstriction, probably by releasing norepinephrine, and it has a positive inotropic effect on the hea by an action on b 1 -adrenergic receptors. The net effect of moderate doses of dopamine is an increase in systolic pressure and no change in diastolic pressure. Because of these actions, dopamine is useful in the treatment of traumatic and cardiogenic shock (see Chapter 33). Dopamine is made in the renal coex. It causes natriuresis and may exe this effect by inhibiting renal Na+-K+ ATPase.Ref: Ganong&;s review of medical physiology 23rd edition Page no: 342 -### End" -2329,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CD 4 are associated with -, with the following options: A: Helper T cell, B: Supressor T cell, C: NK cells, D: T cell antigen receptor complex - -### Response: -T cells can differentiate into effector cells. Helper (CD4) T-cell activity, in addition to stimulating B cells to produce antibodies, promotes the development of delayed hypersensitivity and thereby also serves in the defense against intracellular agents, including intracellular bacteria (eg, mycobacteria), fungi, protozoa, and viruses. Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg: 135 -### End" -2330,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proprioception is lost when?, with the following options: A: Posterior pa of spinal cord is injured, B: Lateral pa of spinal cord is injured, C: Anterior pa of spinal cord is injured, D: None - -### Response: -Ans. is'a'i.e., Posterior pa of spinal cord is injuredPosterior pa of spinal cord consists of fasciculus gracilis and fasciculus cuneatus which carry the sensations of and vibration to the brain.They also carry fine touch and kinesthesia. -### End" -2331,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in stage 3 Trachoma except, with the following options: A: Tarsal epitheliofibrosis, B: Herbe pits, C: Disappearance of Bowman's membrane, D: Trichiasis - -### Response: -Stage 3 is scarring stage characterized by Tarsal epitheliofibrosis Herbe pits Disaaperance of Bowman's membrane Refer: Khurana 6th edition page number 65 -### End" -2332,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dark ground microscopy is used for diagnosis of, with the following options: A: Spirochaete, B: Myco-tuberculosis, C: Myco-leprae, D: Mycoplasma - -### Response: -Ans. a (Spirochete). (Ref. Harrison, Principles of Medicine, 18th/Chapter 169. Syphilis)# Dark ground microscopic examination is useful but negative results does not exclude diagnosis of syphilis.# Diagnosis by microscopy is applicable in primary and secondary stages and congenital syphilis.# Wet film prepared with exudates is seen under dark ground microscope.# T.pallidum show slow movement with slender spiral structure.# However, serology remains the best diagnostic test for syphilis.Educational point:# In blood transfusion and in congenital syphilis, no chancre occurs. -### End" -2333,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intraocular muscle supplied by Edinger Westphal nucleus is -, with the following options: A: Superior oblique, B: Ciliary muscle, C: Lateral rectus, D: Medial rectus - -### Response: -Ans - B -### End" -2334,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malaria ?, with the following options: A: Propagative, B: Cyclopropagative, C: Cyclodevelopmental, D: None of the above - -### Response: -Ans. is 'b i.e., Cyclopropagative -### End" -2335,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The pediatric disease that most closely resembles amyotrophic lateral sclerosis (ALS) is, with the following options: A: Schilder disease (adrenoleukodystrophy), B: Tabes dorsalis, C: Werdnig-Hoffmann disease, D: Gauches disease - -### Response: -Werdnig-Hoffmann disease most closely resembles amyotrophic lateral sclerosis (ALS). Both of these diseases involve the degeneration of motor neurons. Presentation Symptoms symmetric flaccid paralysis most affected infants are hypotonic at bih proximal muscle involvement lower extremity greater than upper extremity sparing of upper cranial nerves e.g., normal eye movements Physical exam absent or decreased deep tendon reflexes tongue and finger fasciculatons infants have flaccid ""frog-like"" posture restrictive respiratory insufficiency ALS appears to be increasing in incidence. In 5% to 10% of cases, there is an autosomal dominant pattern with strong age-dependent penetrance. Proposed etiologies include oxidative stress, viral infection, immunologic disease, or some unknown environmental factor. Currently, the oxidative stress theory is ored because a defect in the zinc-copper binding superoxide dismutase (5001) coded on chromosome 21 was discovered. Because SO 01 is an antioxidant that conves the superoxide free radical into peroxide and oxygen, reduced activity causes apoptosis (individual cell necrosis) of spinal motor neurons. Inhibition of glutamate transpo potentiates the toxicity associated with the reduced SODllevels. ALS most commonly presents with both upper motor neuron signs (e.g., spastic paralysis) and, eventually, lower motor neuron signs (e.g., muscle atrophy, fasciculations). Atrophy of the intrinsic muscles of the hand and forearms with hand weakness and spastic changes in the lower legs are early signs. Antioxidant cocktails have now been developed, which offer some symptomatic improvement. Werdnig- Hoffmann disease is a progressive muscular atrophy noted in infants. It often presents as the floppy child syndrome. Reference: GHAI Essential pediatrics, 8th edition -### End" -2336,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mucin is secreted by?, with the following options: A: Skin, B: Lung, C: Stomach, D: Gall bladder - -### Response: -Gall bladderSecretion of Mucin:Secretes mucin adding to bile.During intestinal release of bile, mucin acts as lubricant. Aids in intestinal movement of chyme. -### End" -2337,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fetal scalp blood pH of less than ......................... is abnormal :, with the following options: A: 7.4, B: 7.3, C: 7.2, D: 7.35 - -### Response: -7.2 -### End" -2338,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lamin is present in:, with the following options: A: Basement membrane., B: Inner nuclear membrane., C: Outer nuclear membrane., D: Mitochondria. - -### Response: -Harper – 578 -Lamins for a meshwork in opposition to the inner nuclear membrane. The distribution of intermediate filaments in normal and abnormal (eg, cancer) cells can be studied by the use of immunofluoroscent techniques, using antibodies of appropriate specificities. -### End" -2339,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The principal vector of dengue virus-, with the following options: A: Anopheles culicifacies, B: Aedes aegypti, C: Anopheles stephensi, D: Culex molestus - -### Response: -The principal vector of dengue is the mosquito Aedes aegypti, which breeds in standing water; collections of water in containers, water based air coolers & tyre drumps are a god environment for the vector in large cities. Reference: Harrison20th edition pg 879 -### End" -2340,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most frequent cause of neonatal thrombocytopenic purura is -, with the following options: A: Infection, B: Drug idiosyncrasy, C: Large haemangiomas, D: Erythroblastosis - -### Response: -Ans. is 'a' i.e., Infection o Amongst the given options, only infection causes neonatal thrombocytopenia. -### End" -2341,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about brown sequard syndrome except, with the following options: A: Contralateral loss of joint sensation, B: Ipsilateral loss of pain & temperature, C: Segmental sign are bilateral, D: All of the above - -### Response: -Brown-Sequard syndrome is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection injury of the spinal cord, often in the cervical cord region. The effects of hemisection of the spinal cord can be described in two-stage: - immediate effects Immediate effects following hemisection of the spinal cord are those of 'spinal shock'. - late effects If the patient survives, typical motor and sensory changes develop after recovery from the spinal shock. These changes constitute the Brown-Sequard syndrome and can be described as ~ changes at the level of section, ~ changes below the level of section, ~ changes above the level of section Ref: guyton and hall textbook of medical physiology 12 edition page number:691,692,693 -### End" -2342,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renal calculi associated with proteus infection?, with the following options: A: A.Uric acid, B: B.Triple phosphate, C: C.Calcium oxalate, D: D.Xanthine - -### Response: -Urease producing organisms eg :- proteus ,psuedomonas , and staphylococcus , break down urea to produce ammonia and CO2.The urine becomes alkaline which promotes formation of struvite calculi ( magnesium ammonium phosphate ) which grow to become staghorn calculi.E coli never forms struvite stones. Struvite occupying pelvi-calyceal system:- TYPES:1.Complete- occupancy of > 80%of pelvi- calyceal system. 2.Incomplete:- Occupancy of atleast 2 pelvicalyceal system. ref :- Bailey and Love 27th edition .chapter 72 . pg no 1406 -### End" -2343,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs can cause torsedes points, with the following options: A: Quinidine, B: Lignocaine, C: Esmolol, D: Flecainide - -### Response: -Torsedes'de point is a polymorphic ventricular tachycardia that is usually caused due to blockade of delayed rectifier potassium channels in the hea It manifest in ECG as QTc prolongation Drugs having cardiac potassium channel blocking activity can cause this Arrythymia. These include : Class 1a anti Arrythymics:quinidine,procainamide( Sodium and potassium channel blocker) Class 3 anti arrhythmia:bretylium,sotalol. Other drugs like terfenadine ,cisapride Refer katzung 10e 224, KDT 6/e 510 -### End" -2344,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sexual perversion in which one has desire to see other person/wife having sex with others -, with the following options: A: Sadism, B: Exhibitionism, C: Voyeurism, D: Fetishism - -### Response: -Ans is 'c' i.e. Voyeurism o Watching sexual activity of other people or the body parts of members of opposite sex is k/a Voyeurism Other abnormalities in the sexual actA. Exhibitionism:- Exposure of one's genital organs to strangers or others.B. Sadism:- Sadism involves infliction of pain or humiliation on the partner (e.g., whipping, beating, strangulation, etc.)C. Masochism:- It is opposite to sadism, i.e., sexual excitement is achieved by self-inflicted pain by the sexual partner (e.g., being whipped, beaten, strangulated etc).D. Frotterurism:- Fondling or rubbing against the body of unfamiliar women in public places followed by masturbation.o Fetishism is having sexual pleasure using shoes or clothes of other sex. -### End" -2345,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: the diffusion capacity of lung (DL) is decreased in all of the follow ing conditions except -, with the following options: A: Inerstitial lung disease, B: Goodpasture's syndrome, C: Pneumocystis Jiroveci, D: Primary pulmonary hypertension - -### Response: -Ans. is 'b' i.e., Goodpasture's syndrome Gas diffusion tests:o Gas diffusion tests measure the amount of oxygen and other gases that cross the alveoli into the blood.o These tests evaluate how well gases are being absorbed into the blood from lungs. Gas diffusion tests include.a) Carbon monoxide diffusing capacity (transfer factor DLco)b) Arterial blood gasesCarbon monoxide diffusing capacity (DLco)o This measures how well the lung transfers a small amount of carbon monoxide into the blood(r).o Normally, in the lung; a gas has to cross the alveolar membrane, capillary# membrane to reach the blood where it combines with hemoglobin.So quiet obviously the diffusion capacity of gas depends upon -Driving pressure of the gasSurface area of alveolar capillary: membraneThickness of alveolar capillary1 membraneDiffusion coefficient of the gasRed blood cell volume.Reaction rate with hemoglobin and hemoglobin level of patient.Degree of V/Q mismatching.Decrease value of DLco is seen in -o Emphysema-Due to destruction of alveolar wall, the area of alveolar capillary membrane is decreasedo Interstitial lung disease e.g. SLE,Asbestasis pneumonia, sarcoidosis-Due to scarring of alveolar capillary membrane the area of alveolar capillar membrane is diminished.o Recurrent pulmonary emboli or primary pulmonary hypertension-Due to decrease in cross sectional area and volume of pulmonary: vascular bed. the area of alveolar capillary membrane is diminished.o Anemia-Due to decrease in volume of the blood, reduced hemoglobin is available for transfer of gases.Increased level of DLco is seen in-o Congestive heart failure-Due to increase in pulmonary blood volumeo Alveolar hemorrhage-Due to increase in hemoglobino Polycythemia-Due to increase in hemoglobino Left to right shunts-Due to increase in pulmonary volumeo Asthma -### End" -2346,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: TRUE regarding cholera is -, with the following options: A: Toxin acts on GM 1 receptor, B: Toxin action is cAMP mediated, C: Peritrichate flagella, D: Utilises arginine and lysine - -### Response: -Ans. is 'b' i.e., Toxin action is cAMP mediated V. cholerae produces cholera toxin, the model for enterotoxins, whose action on the mucosal epithelium is responsible for the characteristic diarrhoea of the cholera. -### End" -2347,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Laser capsulotomy is treatment of choice for ?, with the following options: A: POAG, B: Phacolytic glaucoma, C: Posterior capsular after cataract, D: Closed angle glaucoma - -### Response: -Ans. is 'c' i.e., Posterior capsular after cataract Thin membranous after cataract and thickened posterior capsule are best treated by YAG-laser capsulotomy or discission with cystitome or Zeigler's knife. -### End" -2348,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Occurrence of ovulation is indicated by :, with the following options: A: Progesterone, B: LH, C: Estradiol, D: All of the above - -### Response: -All of the above -### End" -2349,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Twin Peak sign is characteristic of, with the following options: A: Dichorionic Diamniotic, B: Monochorionic Diamniotic, C: Monochorionic Monoamniotic, D: Conjoined twins - -### Response: -Determination of ZygositySonographic Determination:ChorionicityDividing inter-twin membrane thicknessSignDichorionicity> 2mmTwin peak sign or Lambda signMonochorionicity< 2mmT signReference: William's Obstetrics; 25th edition; Chapter 45; Multifetal pregnancy -### End" -2350,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mixed lymphocyte culture is used to indentify :, with the following options: A: MHC class I antigen., B: MHC class II antigen., C: B lymphocytes., D: T helper cells. - -### Response: -Ans. is 'b' i.e. MHC class II antigen Mixed lymphocyte culture is used to identify HLAIIHarrison says - ""HLAII genes were first detected by their ability to stimulate lymphocyte proliferation by mixed lymphocyte reaction.""Some more information about Major histocompatibility complex:Human Major histocompatibility complex (commonly called the human leucocyte antigen complex) is a cluster of extensively studied genes located on short arm of chromosome 6*.Some of the important genes in this region are HLA class I and HLA class II genes.The important function of these HLA molecule is that they bind peptide antigens and present them to T cells, thus they are responsible for antigen recognition by the T cell receptor.Important feature of Human MHC gene products. Class IClass IIGenetic lociHLA-A , B & CHLA-DP, D Q & D RCell distributionAll nucleated somatic cells*Antigen presenting cells* (macrophages, B cells etc.) activated human T cells.*Present peptide antigens toCD8T Cells*CD4 T cells* Polypeptide compositionMolecular weight 45,000+ b2 ,M* (MW 12000)a chain (M.W. 33000) b chain (M.W. 29000) Li chain (M.W. 30000)* Other question asked on HLAHLA regulating immune response - Class II antigens*HLA responsible for acceptance or rejection of allografts - Class I antigens*HLA determining Histocompatibility - Class I antigen*HLA which include complements of complement system - Class III antigen* -### End" -2351,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 54-yrs-old woman undergoes a laparotomy because of a pelvic mass. At exploratory laparotomy, a unilateral ovarian neoplasm is discovered that is accompanied by a large omental metastasis. Frozen section confirms metastatic serous cystadenocarcinoma. Most appropriate intraoperative course of action is, with the following options: A: Excision of the omental metastasis and ovarian cystectomy, B: Omentectomy and ovarian cystectomy, C: Excision of the omental metastasis and unilateral oophorectomy, D: Omentectomy, total abdominal hysterectomy, and bilateral salpingo oophorectomy - -### Response: -The survival of women who have ovarian carcinoma varies inversely with the amount of residual tumor left after the initial surgery. At the time of laparotomy a maximum effort should be made to determine the sites of tumor spread and to excise all resectable tumor. Although the uterus and ovaries may appear grossly normal, there is a relatively high incidence of occult metastases to these organs, for this reason, they should be removed during the initial surgery. Ovarian cancer metastasizes outside the peritoneum via the pelvic or paraaortic lymphatics, and from there into the thorax and the remainder of the body. -### End" -2352,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Early cause of death due to burns is :, with the following options: A: Shock, B: Infection, C: Haemorrhage, D: Diabetes - -### Response: -The main causes of early death ( shock and inhalation injury. The Prognostic Burn Index is the sum of the patient's age and percentage of full thickness or deep paial thickness burn. An additional 20% moality is added if inhalation injury is present. The Prognostic Burn Index is most useful at the extremes of age. Ref : Nemer J.A. (2013). Chapter 37. Disorders Related to Environmental Emergencies. In M.A. Papadakis, S.J. McPhee, M.W. Rabow, T.G. Berger (Eds),CURRENT Medical Diagnosis & Treatment 2014. -### End" -2353,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not possess both DNA & RNA -, with the following options: A: Bacteria, B: Fungus, C: Virus, D: Spirochete - -### Response: -Viruses contain only one type of nucleic acid,either DNA or RNA,but never both REF:ANANTHANARAYANAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 8TH EDITION PAGE NO:427 -### End" -2354,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Anti- epileptic of choice shall be:, with the following options: A: Leveteracetam, B: Phenytoin, C: Phenobarbitone, D: Lorazepam - -### Response: -Ans. c. Phenobarbitone (Ref: Nelson 19/e p2037)Phenobarbital:Drug of first choice in neonatal seizuresLoading dose: 20 mg/KgIf this dose is not effective, then additional doses of 5-10 mg/kg can be given until a dose of 40 mg/kg is reached.After 24 hours of loading dose, maintenance dosing can be started at 3-6 mg/Kg/day, usually administered in two separate doses.Treatment of Neonatal SeizuresA mainstay in the therapy of neonatal seizures is the diagnosis and treatment of underlying etiologyQ.Etiologies: HypoglycemiaQ, hypocalcemiaQ, meningitisQ, drug withdrawal and traumaQDrugs used in Neonatal SeizuresPhenobarbital* Drug of first choice in neonatal seizuresQ* Loading dose: 20 mg/Kg* If this dose is not effective, then additional doses of 5-10 mg/kg can be given until a dose of 40 mg/ kg is reached.* After 24 hours of loading dose, maintenance dosing can be started at 3-6 mg/Kg/day, usually administered in two separate doses.* Metabolized by liver, excreted by kidneyPhenytoin/Fosphenytoin* If a total loading dose of 40 mg/kg of Phenobarbital was not effective, then a loading dose of 15-20 mg/Kg of Phenytoin or Fosphenytoin can be administered IV.* Rate should not exceed 0.5-1 mg/Kg/min in order to prevent cardiac problem.* Fosphenytoin, which is phosphate ester prodrug is preferred. It is highly soluble in water and can be administered very safely IV or IM, without causing injury to tissues.Lorazepam* The initial drug used to control acute seizure is usually Lorazepam.* Can be use either as the initial drug or as a 2nd line treatment in a newborn who does not respond to the treatment with Phenobarbital and Phenytoin.* Lorazepam is distributed to brain very quickly and exerts its anticonvulsants action in <5 minutes.Diazepam and Midazolam* Highly lipophilic, so it distributes very rapidly into the brain and then is cleared very quickly out, carrying the risk of recurrence of seizures.* Carries the risk of apnea and hypotension* However, the IV preparation contains sodium benzoate and benzoic acid, it is currently not recommended as a first line agent.Leveteracetam* Dose: 10-30 mg/Kg/day* Drug of 2nd or 3rd choice -### End" -2355,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 20-years old male presents with anterior shoulder dislocation. This injury is usually caused as a combination of which of the following -, with the following options: A: Abduction & external rotation, B: Adduction & external rotation, C: Abduction & internal rotation, D: Adduction & internal rotation - -### Response: -Most common mechanism of injury for anterior dislocation of shoulder is fall on outstretched hand or throwing, with abduction, external rotation, and extension at shoulder. - -Anterior shoulder dislocation - -Indirect force (most common) →  Abduction, external rotation, extension. -Direct force (less common)    →  Blow from the posterior aspect of shoulder. -### End" -2356,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A bactericidal drug would be preferred over a bacteriostatic drug in a patient with:, with the following options: A: Neutropenia, B: Cirrhosis, C: Pneumonia, D: Hea disease - -### Response: -Primarily bacteriostatic:Sulfonamides ,Erythromycin Tetracyclines, Ethambutol Chloramphenicol ,Clindamycin Linezolid. Primarily bactericidal Penicillins Cephalosporins Aminoglycosides Vancomycin Polypeptides Nalidixic acid Rifampin Ciprofloxacin Isoniazid Metronidazole Pyrazinamide Cotrimoxazole Many infections in patients with normal host defence respond equally well to bacteriostatic and bactericidal AMAs. But several acute infections resolve faster with a cidal than a static drug, because the cidal drug directly reduces the number of bacteria at the site of infection, while the static drug only prevents increase in their number. Many bactericidal drugs exe prolonged postantibiotic effect so that maintenance of drug level continuously above the MIC is not essential. With bacteriostatic AMAs the bacteria sta multiplying quickly when drug level falls below the MIC, resulting in relapse of infection. A bactericidal antibiotic is clearly superior to bacteriostatic one in treating patients with impaired host defence, life-threatening infections, infections at less accessible sites (SABE) or when carrier state is possible (typhoid) . ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:676 -### End" -2357,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Creatinine is formed from all except -, with the following options: A: Glycine, B: Arginine, C: Methionine, D: Asparagine - -### Response: -Ans. is 'd' i.e., Asparagine * The three aminoacids used for the synthesis of creatine are Glycine, Arginine and Methionine* In Kidney, Glycine reacts with Arginine in the presence of Arginine Glycine Amido Transferase to for Guanidoacetate and Ornithine* Guanidoacetate through circulation is taken to liver. In liver Guanidoacetate undergoes transmethylation reaction with S- Adenosyl Methionine in the presence of Guanidoacetate Methyl Transferase to form Creatine.* The creatine through circulation reaches tissues.* 90% of creatine is taken up by skeletal muscles and is phosphorylated by creatine Kinase to form creatine Phosphate.* This creatine phosphate acts as the immediate source of energy for skeletal muscle. -### End" -2358,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a complication of fibroid in pregnancy?, with the following options: A: Preterm labour, B: Postpaum hemorrhage, C: Aboion, D: malignant transformation - -### Response: -Complications of fibroid in pregnancy includes miscarriage,preterm labour,abruption,malpresentation,unengaged head at term,uterine ineia,obstructed labour,PPH,difficulties in CS,puerperal infection. Refer page no 221,222 of Text book of obsteics,sheila balakrishnan,2 nd edition. -### End" -2359,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following inhibits Na+-K+2Cl- cotranspo?, with the following options: A: Mannitol, B: Carbonic anhydrase inhibitor, C: Thiazide, D: Loop diuretic - -### Response: -Potassium-sparing diuretics act by either antagonizing the action of aldosterone (spironolactone) or by inhibiting Na+ reabsorption in the distal tubules (amiloride). Mannitol is freely filtered at the glomerulus, but in contrast to glucose is not reabsorbed and produces an osmotic diuresis. Clinically it is used to treat cerebral edema and in prerenal azotemia to conve oliguric acute renal failure to non-oliguric acute renal failure. Thiazides inhibit Na+ and K+ reabsorption in the distal tubule and loop diuretics (furosemide, ethacrynic acid) inhibit the Na+-K+-2Cl+ cotranspoer in the ascending loop of Henle. Ref: Ives H.E. (2012). Chapter 15. Diuretic Agents. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e. -### End" -2360,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are the contraindications for the use of progesterone-only pills except-, with the following options: A: Pregnancy, B: Patient suffering from breast cancer, C: Peripheral vascular disease, D: Diabetes mellitus - -### Response: -Ans. is 'd' i.e., Diabetes mellitus o Contraindications for the use of progesterone-only pills are as follows:PregnancyUnexplained vaginal bleedingRecent breast cancerArterial diseaseThromboembolic disease -### End" -2361,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Giving Benzathine penicillin in RHD is a type of -, with the following options: A: Primary prevention, B: Secondary prevention, C: Teiary prevention, D: Primordial prevention - -### Response: -park's textbook of preventive and social medicine 23rd edition. *in children :Im injection of benzyl pencillin 600000 units. *in adult :1.2 million units. *this must be continued for 5 years or until the child reaches 18 years. -### End" -2362,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All true regarding spitz nevus except:, with the following options: A: Benign tumor, B: Trunk is the most common site involved, C: Tumour cells are spindled and epitheloid melanocytes, D: Treatment is wait and watch - -### Response: -Spitz nevus- Benign tumor- Trunk is the most common site involved and also seen in face and extremities- Tumor cells are spindled and epithelioid melanocytes- Treatment is excision followed by histopathology - spindle melanocytes seen in it. -### End" -2363,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Example of neurohormone: September 2012, with the following options: A: ACTH, B: Coisol, C: Oxytocin, D: Somatostatin - -### Response: -Ans. C i.e. OxytocinNeurohormoneIt is any hormone produced and released by neuroendocrine cells (also called neurosecretory cells) into the blood.By definition of being hormones, they are secreted into the circulation for systemic effect, but they can also have a role of neurotransmitter or other roles as autocrine (self) or paracrine (local) messenger.The hypothalamus produces the hypophysiotropic and neurohypophysial hormones in specialized hypothalamic neurons which extend to the median eminence and posterior pituitary.The adrenal medulla produces adrenomedullary hormones in chromaffin cells, cells which are very similar in structure to post-synaptic sympathetic neurons, even though they are not neurons they are derivatives of the neural crest.Enterochromaffin and enterochromaffin-like cells, both being enteroendocrine cells, are also considered neuroendocrine cells due to their structural and functional similarity to chromaffin cells, although they are not derivatives of the neural crest. -### End" -2364,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic feature of early congenital syphilis is –, with the following options: A: Microcephaly, B: Saddle nose, C: Interstitial keratitis with saber shin, D: Vesicular rash with bulla over palms and soles - -### Response: -Vesicle and bullae are seen in early congenital syphilis. Interstitial keratitis and saddle nose are seen in late congenital syphilis. -### End" -2365,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true regarding Hemophilia?, with the following options: A: Normal platelets, B: Deficient factor VIII, C: Deficient factor IX, D: Increased BT - -### Response: -Since the platelets count and function is normal the bleeding time is normal. The following are the common lab findings of Haemophilia Laboratory findings Results PT Normal APTT Abnormal Bleeding Time Normal Platelet count Normal Factor VIII:C assay (in Hemophilia A) Abnormal Factor IX assay (in Hemophilia B) Abnormal -### End" -2366,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscle is intoer of eye, with the following options: A: Inferior oblique, B: Inferior rectus, C: Superior rectus, D: Medial rectus - -### Response: -Actions of extraocular muscles : Muscle Primary Secondary Teiary action action action LR Abduction -- -- SR Elevation Intorsion Adduction IR Depression Extorsion Adduction SO Intorsion Depression Abduction IO Extorsion Elevation Abduction Ref;A.K.Khurana ; 6th edition; Page no:339 -### End" -2367,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dysphonia plica ventricularis is produced from:, with the following options: A: Vocal cord, B: Ventricular fold, C: Arytenoid, D: Epiglottis - -### Response: -Ans: b (Ventricular fold) Ref: Dhingra, 3rd ed, p. 379 & 4th ed, p. 289In dysphonia plica ventricularis (ventricular dysphonia) voice is produced by ventricular fold which take over the function of true vocal cords. Voice is rough, low pitched and unpleasant.Aetiology:1. Functional2. Secondary to impaired function of vocal cord (paralysis, fixation, surgical excision.tumour)Diagnosis:On direct laryngoscopy false cords are seen to approximate partially or completely and obscure the view of true cords on phonationTreatment:1. VD secondary to laryngeal disorders -- difficult to treat2. Functional VD -- voice therapy & psychological counselling -### End" -2368,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'Safe zone' of the eye ball is:, with the following options: A: At the limbus, B: 3-4 mm behind the limbus, C: 8-9 mm behind the limbus, D: 12 mm behind the limbus - -### Response: -Ans. 8-9 mm behind the limbus -### End" -2369,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following enzyme defect is the most commonly inherited metabolic disorder of glycolysis?, with the following options: A: Glucokinase, B: Hexokinase, C: Phosphofructokinase, D: Pyruvate kinase - -### Response: -Pyruvate kinase is the most commonly inherited metabolic disorder of glycolysis Pyruvate kinase Produces an ATP at the level of substrate level phosphorylation(SLP) Deficiency loss of ATP inability to maintain ion pumps in erythrocytes-Hemolysis Autosomal recessive Presentation Hydrops fetalis, Prolonged neonatal jaundice, Anemia In a glycolytic enzyme deficiency, there is a reduced rate of glycolysis, leading to decreased ATP production. This results in a few alterations in the RBC membrane, thereby leading to changes in cell shape. Such deformed RBCs are later phagocytosed by cells of the reticuloendothelial system, and this results in a state of hemolytic anemia. The most common enzyme deficiency causing hemolytic anemia is glucose-6-phosphate dehydrogenase deficiency(pentose phosphate pathway). The second most common enzyme deficiency causing hemolytic anemia is the pyruvate kinase. Note: Though hemolysis is seen in PFK-1 deficiency, it does not always manifest as anemia. -### End" -2370,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The liver removes LDLs in the blood by the LDLs binding to, with the following options: A: LDL receptors and then internalizing them, B: HDL receptors and then internalizing them, C: The albumin present on LDLs and then internalizing them, D: The transferrin present on LDL and then internalizing them - -### Response: -. -### End" -2371,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about otitic barotrauma except, with the following options: A: Conductive deafness, B: Retracted tympanic membrane, C: Catheterization can be used, D: Occurs during sudden ascent in aircraft - -### Response: -Otitic barotrauma is a nonsuppurative condition resulting from the failure of the eustachian tube to maintain middle ear pressure at ambient atmospheric level. The usual cause is rapid descent during an air flight, underwater diving or compression in the pressure chamber. Severe earache, tinnitus, hearing loss are common complaints. Hearing loss is usually conductive, but the sensorineural type may also be seen. Reference: Diseases of Ear, Nose and Throat, PL Dhingra, Shruti Dhingra,7th edition, pg no.71 -### End" -2372,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: lntra epidermal IgG deposition is seen in:, with the following options: A: Pemphigus, B: Bullous pemphigoid, C: Herpes genitalis, D: Dermatitis herpetiformis - -### Response: -Ans: A (Pemphigus) Ref: Rook, 7th ed. pg. 414, Table 41.3, 41.6 Pemphigus is an immune bullous disorder, characterized by IgG deposition in intercellular area of epidermis. Herpes genitalis is also characterized by intra epidermal blisters, but it is not an immunobullous disorder and not associated with any immune complex deposition. Other two are subepidermal blistering disorders. Examples of intra epidermal blistering disorders Pemphigus vulgaris P. foliaceous P. vegetans paraneoplastic pemphigus Fish net appearance - intercellular IgG deposition on surface of keratinocytes in Pemphigus Bullous pemphigoid- linear IgG and C3 deposition along the basement membrane. Dermatitis herpetiformis - granular deposits of IgA in dermal papillae and papillary tip microabscesses. -### End" -2373,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Delhi boil refers to:, with the following options: A: Solar Keratosis, B: Malignant pustule, C: L. tropica sore, D: Venereal ulcer - -### Response: -Cutaneous leishmaniasis is the most common form of leishmaniasis affecting humans.  -It is a skin infection caused by a single-celled parasite that is transmitted by the bite of a phlebotomine sandfly.  -This disease is considered to be a zoonosis (an infectious disease that is naturally transmissible from animals to humans), with the exception of Leishmania  tropica.  -Other names are Oriental sore, Tropical sore, Chiclero ulcer, Chiclero's ulcer, Aleppo boil, Delhi Boil or Desert boil. - -Ref :https://en.wikipedia.org/wiki/Cutaneous_leishmaniasis -### End" -2374,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which agent is used to prevent synechiae after DCR surgery-, with the following options: A: Mitomycin, B: Tacrolimus, C: Cyclosporine, D: Doxycycline - -### Response: -Ans. is 'a' i.e., Mitomycin o Now, Mitomycin is being increasingly used for this purpose and is proving more usefulo Mitomycin is an anticancer agent that has shown to decrease scar formation after E.N.T. surgeryo It is an antifibroblastic agent and thus prevents the wound healing and subsequent synechae formationo It is useful in preventing synechae formation in following operations :-i) DCRii) Sinus surgery -### End" -2375,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triamterene causes, with the following options: A: Better glucose tolerance, B: Muscle cramps, C: Decrease in urea level, D: Hypokalemia - -### Response: -Inhibitors of renal epithelial Na+ channel Include Triamterene and amiloride. Triamterene:- It is incompletely absorbed orally, paly bound to plasma proteins, largely metabolized in liver to an active metabolite and excreted in urine. Plasma t 1/2 is 4 hours, effect of a single dose lasts 6-8 hours. Side effects:- consist of nausea, dizziness, muscle cramps and rise in blood urea. Impaired glucose tolerance and photosensitivity are repoed, but urate level is not increased. Ref:- kd tripathi; pg num:-590 -### End" -2376,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In venturi mask maximum O2 concentration attained is, with the following options: A: 90%, B: 100%, C: 60%, D: 80% - -### Response: -Maximum concentration delivered by ventimask (venturimask) is 60%. -### End" -2377,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The supinator muscle is supplied by, with the following options: A: Ulnar nerve, B: Anterior interosseous nerve, C: Median nerve, D: Posterior interosseous nerve - -### Response: -SupinatorOrigin1.Lateral epicondyle of the humerus. 2.Radial collateral ligament of the elbow joint. 3.Annular ligament. 4.Supinator crest of the ulna, and the posterior pa of the triangular area in front of it.Inseion: Upper one-third of the lateral surface of the radius.Nerve Supply: Posterior interosseous nerve (C6, C7).Action: Supination of the forearm.Note: The muscles have two layers, superficial and deep. The posterior interosseous nerve runs downwards between these layers.Ref: BD Chaurasia; Volume 1; 6th edition; Page no: 133 -### End" -2378,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs used in CCF are all Except, with the following options: A: Diuretics, B: Vasodilators, C: Dopamine/Dobutamine, D: Amiodarone - -### Response: -There is a significant evidence-practice gap in the treatment of CHF; paicularly the underuse of ACE inhibitors and b-blockers and aldosterone antagonists which have been shown to provide moality benefit.Treatment of CHF aims to relieve symptoms, to maintain a euvolemic state (normal fluid level in the circulatory system), and to improve prognosis by delaying progression of hea failure and reducing cardiovascular risk. drugs used include diuretic agents, vasodilator agents, positive inotropes, ACE inhibitors, beta-blockers, and aldosterone antagonists (e.g.spironolactone).Some drugs which increase hea function, such as the positive inotrope Milrinone, lead to increased moality and are contraindicated -### End" -2379,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest cailage to ossify is, with the following options: A: Hyaline, B: Elastic, C: Fibrous, D: Fibroelastic - -### Response: -The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cailage plate in the metaphysis at each end of a long bone. It is the pa of a long bone where new bone growth takes place; that is, the whole bone is alive, with maintenance remodeling throughout its existing bone tissue, but the growth plate is the place where the long bone grows longer (adds length). The plate is not only found in children and adolescents; in adults, who have stopped growing, the plate is replaced by an epiphyseal line. This replacement is known as epiphyseal closure or growth plate fusion. Complete fusion happens between ages 12-16 for girls and 14-19 for boys. Ref - Medscape.com -### End" -2380,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which myxovirus does not have hemagglutinin and neuraminidase but have membrane fusion protein -, with the following options: A: Measles, B: Parainfluenza, C: RSV, D: Influenza - -### Response: -Ans. is 'c' i.e., RSV RSV does not posses hemagglutinin or neuraminidase. The viral envelope has two glycoproteins? i) G protein - By which virus attaches to cell surface ii) F- protein ( Fusion protein ) - which bring about fusion between viral and host cell membranes. It is also responsible for cell to cell fusion, which leads to characteristic syncytial formation. -### End" -2381,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coronary steal phenomenon shown by, with the following options: A: Pyridoxine, B: Dihydropyridine, C: Dipyridamole, D: Trimetazidine - -### Response: -Ans. is 'c' i.e., Dipyridamole * There are two types of vessels in coronary circulaton -1. Larger conducting arteries which run epicardially and send perforating branches.2. Smaller resistance arterioles - These are perforating branches of conducting arteries. These arterioles supply blood to endocardium.* During ischemia, adenosine (a local mediator) causes dilatation of resistance arterioles in ischemic area only, tone of resistance vessels of nonischemic area does not change - increased flow to ischemic area.* Dipyridamole is a powerful coronary dilator; increases total coronary flow by preventing uptake and degradation of adenosine.* It dilates resistance vessels in nonischemic zone as well - Diverts the already reduced blood flow away from ischemic zone - Coronary steal phenomenon.* It has no effect on larger conducting vessels (contrast nitrates which dilate larger conducting vessels and cause redistribution of blood towards ischemic zone).* Dipyridamole inhibits platelet aggregation by increasing cAMP (by inhibiting phosphodiesterase) which potentiates PGI2 and interferes with aggregation.* It is not useful as an antianginal drug (due to coronary steal phenomenon), but can be used for prophylaxis of coronary and cerebral thrombosis in post MI and post stroke patients as well as to prevent thrombosis in patients with prosthetic heart valve. -### End" -2382,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sereny test is positive for, with the following options: A: ETEC, B: EPEC, C: EIEC, D: EAEC - -### Response: -Sereny's test is positive in EIEC (Enteroinvasive E.coli). Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg: 285 -### End" -2383,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypoparathyroidism following thyroid surgery occurs within, with the following options: A: 24 hours, B: 2-5 days, C: 7-14 days, D: 2-3 weeks - -### Response: -Parathyroid insufficiency is due to the removal of the parathyroid glands or infarction through damage to the parathyroid end aeries; often both factors occur together. Vascular injury is probably far more impoant than inadveent removal. The incidence of permanent hypoparathyroidism should be less than 1% and most cases present dramatically 2-5 days after an operation but, very rarely, the onset is delayed for 2-3 weeks or a patient with marked hypocalcemia may be asymptomatic.Ref: Bailey and Love, page no: 815 -### End" -2384,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 64-year-old male is to undergo an elective laparotomy procedure. The proposed wound is considered as ""clean-contaminated.""The wound characteristic indicates which of the following?, with the following options: A: Entry of intestinal or urinary tract without significant spillage, B: Gross spillage from intestinal tract, C: No entry of intestinal tract, D: Entry into infected tissue - -### Response: -If spillage is substantial or infected tissue has entered, the wound is classified as contaminated. Dirty wounds are used for drainage of an abscess or debridement of infected tissue. -### End" -2385,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 months old baby was brought do difficulty in feeding. '' The child was found to be hypotonic with a weak gag. The child is on breast milk and mother also gives honey to the child during periods of excessive crying. The causative agent is, with the following options: A: Gram positive aerobic COCCUS, B: Gram positive anaerobic spre-suffering bacillus, C: Toxin produced by gram positive anaerobic bacillus, D: Echovirus - -### Response: -Infant botulism is associated with intake of honey, breastmilk etc. The child presents with generalized weakness and hypotonia in addition to bulbar palsies with symptoms like poor feeding, feeble cry,weak suck,drooling and obstructive apnea. Reference: Nelson textbook of pediatrics 19th edition Page 988 -### End" -2386,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A technique of combining reversible and irreversible hydrocolloid that could bond to irreversible hydrocolloid is known as:, with the following options: A: Injecting technique, B: Laminate technique, C: Immersion technique, D: Tempering technique - -### Response: -LAMINATE TECHNIQUE (ALGINATE-AGAR METHOD) -A modification of the traditional agar procedure is the combined agar-alginate technique. The agar in the tray is replaced with a mix of chilled alginate that bonds to the agar expressed from a syringe. The alginate gels by a chemical reaction, whereas the agar gels by means of contact with the cool alginate rather than with the water circulating through the tray.  -Since it is the agar, not the alginate, that contacts the prepared teeth, maximal detail is reproduced. Because only the syringe material needs to be heated, equipment cost is lower and less preparation time is required. -This laminate technique is the most cost-effective way of producing an impression with adequate detail. -Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 176 -### End" -2387,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pancreatic carcinoma most common variety is:, with the following options: A: Adenocarcinoma, B: Neuroendocrine tumour, C: Mucous secreting tumour, D: Acinar cell cystadenocarcinoma - -### Response: -Ans: a (Adenocarcinoma) Ref: Bailey & Love, 24th ed, p. 1128More than 85% of pancreatic carcinoma are duct cell adenocarcinoma.Prolonged natural history - CystadenocarcinomaIncreased survival after resection - Ampullary tumour, neuroendocrine tumourStart as a benign tumour and progress after years into an aggressive malignant lesionMen and women have equal occurrence.}- Intraductal, papillary mucous secreting tumour.Neoplasms of pancreas are of two types1. Those arising from endocrine pancreas i.e., islet cells2. Those arising from exocrine pancreas i.e., ducts and aciniFunctional pancreatic endocrine tumours* Insulinoma - From 6 cells (produce insulin & symptoms of hypoglycemia)* Gastrinoma - From G cells (produce gastrin & Zollinger Ellison syndrome)* Glucagonoma - Arise from a cells & produce glycogen & hyperglycaemia* Somatostatinoma - Arise trom a or D cells* VIPoma* GRFomas & many othersBRIDGEPassaro's triangle - about 70-90% of gastrinoma are located within this triangle 3 points making the Passaro's triangle:- Junction of cystic duct and CBD- Junction of 2nd and 3rd portion of duodenum- Junction of neck and body of pancreasWhipple triad (Insulinoma)* Signs & symptoms of hypoglycaemia during fasting* Relief of symptoms by intravenous administration of glucose* Blood glucose below 2.8 mmol/1 (50 mg/dl) during symptomatic episodesTreatment of Ca head of pancreasWhipple resection -### End" -2388,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not the source of cytosolic NADPH:-, with the following options: A: Isocitrate dehydrogenase, B: ATP citrate lyase, C: Malic enzyme, D: G6PD - -### Response: -SOURCE of Cytosolic NADPH HMP pathway Malic enzyme Isocitrate dehydrogenase Main enzyme - G6PD alternative pathway to glycolysis and TCA cycle for the oxidation of glucose the main pathway for biosynthesis of NADPH and pentoses. Conves malate to pyruvate NADPH and CO2 are generated NADPH mainly utilized for fatty acid synthesis 3 isoenzymes One, which uses (NAD+) in Mitochondria other two use NADP+ in Mitochondria and cytosol -### End" -2389,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serotonin (5-HT) is one of several mediators of the signs and symptoms of carcinoid tumor. When released from this neoplasm, most of the manifestations of 5-HT are the result of activation of the 5-HT2 receptor. These manifestations are therefore likely to include which of the following effects?, with the following options: A: Bronchospasm, B: Constipation, C: Skeletal muscle weakness, D: Tachycardia - -### Response: -- 5-HT2 receptors mediate smooth muscle contraction and thus cause bronchospasm and diarrhea, not constipation.- Skeletal muscle and cardiac muscle are relatively insensitive to 5-HT.- Peptic ulceration is not mediated in pa by 5-HT; the autacoid actually reduces acid secretion. -### End" -2390,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following neurological conditions is not inherited in autosomal dominant pattern, with the following options: A: Neurofibromatosis, B: Friedreich's ataxia, C: Marfan's syndrome, D: None - -### Response: -Friedreich ataxia Gene :FXN,locus:9q21.1 ; protein :frataxin; repeat GAA; normal: 7-34 ; Disease :34-80 (pre); >100 (full) Friedreich ataxia is an inherited condition that affects the nervous system and causes movement problems.This condition is caused by mutations in the FXN gene and is inherited in an autosomal recessive pattern Ref Robbins 9/e pg 168 -### End" -2391,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs are used for treating Mycobacterial Infections except:, with the following options: A: Rifaximin, B: Rifampicin, C: Rifabutin, D: Rifapentine - -### Response: -Rifamycins: include Rifampin or Rifampicin, Rifapentine and Rifabutin. MOA: binds to the b subunit of DNA-dependent RNA polymerase (rpoB) resulting in suppressesion of the chain formation in RNA synthesis. Inhibitsthe growth of most gram-positive bacteria as well as many gram-negative microorganisms, such as Escherichia coli, Pseudomonas,indole-positive and indole-negative Proteus, Klebsiella, Staphylococcus aureus and coagulase-negative staphylococci, Neisseria meningitidis and Haemophilus influenzae, M. tuberculosis, Mycobacterium leprae and other mycobaterial organisms also . Rifampicin should be taken on an empty stomach, whereas Rifapentine should be taken with food ifpossible. Rifaximin: Is a semi-synthetic Rifamycin. Route: Oral It is a non-systemic antibiotic as it doesn't cross the GIT wall (i.e poorly absorbed) USE: Travellers diarrhea, IBS-D: because it stops the growth of the bacteria causing diarrhea . Also used for treatment of Hepatic Encephalopathy: because it stops the growth of the bacteria producing toxins that worsen the liver condition. -### End" -2392,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is true regarding umbilical cord:, with the following options: A: Two aeries, B: Umblical cord pulsation rate corresponds to maternal pulsation rate, C: Covered by amnion and chorion, D: Two veins - -### Response: -Two aeries -### End" -2393,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most malignant type of pustular psoriasis is ?, with the following options: A: Palmo - planter pustolosis, B: Acrodermatitis continua, C: Pustular bacterids, D: Von Zumbusch type - -### Response: -Ans. is'd'i.e., Von Zumbusch typeVon Zumbusch type of pustular psoriasis is the suddenly developing most serious type, characterized by severe systemic upset, swinging pyrexia, ahralgia and high polymorphonuclear lymphocytes.The skin first becomes erythrodermic and then develops sheets of sterile pustules over trunk and limbs.Pustules become confluent to from ""lakes of pus"". -### End" -2394,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40 year old man presented with painless haematuria. Bimunual examination revealed a ballotable mass over the right flank. Subsequently right nephrectomy was done and the mass was seen to be composed of cells with clear cytoplasm. Areas of haemorrhage and necrosis were frequent. Cytogenetic analysis of this mass is likely to reveal the abnormality of-, with the following options: A: Chromosome 1, B: Chromosome 3, C: Chromosome 11, D: Chromosome 17 - -### Response: -Ans. is 'b' i.e., Chromosome 3 -### End" -2395,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The side effects of digitalis are all except -, with the following options: A: Ventricular tachycardia, B: Vasodilatation, C: Nausea and vomiting, D: Ventricular Bigemini - -### Response: -Ans. is 'b' i.e., Vasodilatation o Digitalis causes mild vasoconstriction (not vasodilatation).Manifastations of digitalis intoxicationo Anorexia, nausea, vomiting and abdominal pain are usually reported first.o Later occuring - fatigue, malaise, no desire to walk or lift an arm, headach, mental confusion, restlesness, disorientation, visual disturbances - yellow vision, weight loss, cachexia, gynaecomastia delerium, skin rash,diarrhoea.o Cardiac - Most frequent disturbances of cardiac rhythm are ventricular premature beat, bigeminy, ventricular tachycardia and rarely ventricular fibrillation.o A-V block and non paroxysmal atrial tachcardia with variable A-V block are characteristic of digitalis intoxication.o Severe bradycardia, atrial extrasystoles, AF and AFI may occur. -### End" -2396,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child brought with seizures and impairment of development is diagnosed having phenylketonuria. What is the initial line of treatment in this child?, with the following options: A: Dietary supply of deficient protein, B: Restriction of substrate of the deficient enzyme in the diet, C: Replacing the products, D: Dietary supply of deficient pro enzyme - -### Response: -Phenylketonuria: It is an autosomal recessive metabolic disorder, where the level of hepatic enzyme phenylalanine hydroxylase is low, therefore phenylalanine cannot be conveed to tyrosine. Phenylalanine accumulates in the blood, cerebrospinal fluid and tissues. Accessory metabolic pathways sta operating which conve phenylalanine to phenylpyruvic acid, phenyl-lactic acid and o-hydroxyphenyl-acetic acid. Restriction of phenylalanine in the diet is the mainstay of treatment of phenylketonuria. Ref: Essential Pediatrics by O.P. Ghai, 6th edition, Page 609. -### End" -2397,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 20 year old male goes swimming . After a few days he develops itching with rashes over his body diffusely. He ignores it until several weeks later he develops lancinating pain down his legs and all of his toes. Within a few days he develops paraparesis and problems with bowel and bladder control with resultant urinary retention. What is your approach to this patient, with the following options: A: Initiate anticoagulation, B: Do spinal angiography, C: Order an MRI scan, D: Perform sensory evoked potential testing - -### Response: -MRI is the best emergent test as it will show compressive lesions as well as infections and vascular lesions  .initiating anticoagulation will cause bleeding in case of AV malformations , so it is excluded. -### End" -2398,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When an outcome is compared with intended objectives, it is called as –, with the following options: A: Monitoring, B: Evaluation, C: Input-Output analysis, D: Network analysis - -### Response: -Evaluation - -Evaluation measures the degree to which objectives and targets are fulfilled and the quality of results obtained. -The purpose of evaluation is to assess the achievement of the stated objectives of a programme -While monitoring is confined to day-to-day or on-going operation, evaluation is concerned with the final outcome. -### End" -2399,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anxious,shy, avoidant symptoms come under cluster, with the following options: A: A, B: B, C: C, D: D - -### Response: -Patients with cluster C personality disorders have shy and anxiety features. This cluster contains 3 personality disorders namely Avoidant Dependent Obsessive-compulsive Ref. Kaplan and sadock synopsis of psychiatry, page 742 -### End" -2400,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 72-year-old man is brought to the emergency room after injuring his right knee in a car accident. The pain started soon after the accident. Later that same day he developed swelling and more intense pain making walking difficult. On physical examination, the knee is warm, swollen, and extremely painful to bend. There are clinical signs of an effusion. X-rays of the knee rule out a fracture, and joint fluid aspiration reveals an opaque-colored fluid containing rhomboid crystals with weak-positive birefringence. Which of the following is the most appropriate next step in management?, with the following options: A: oral prednisone, B: intravenous antibiotics, C: oral NSAIDs, D: acetaminophen - -### Response: -In traumatic arthritis, swellings, ecchymoses, muscular spasms, and tenderness tend to be present, but fractures must be excluded. This man has calcium pyrophosphate (CPPD) crystal- induced monoarthritis, so called ""pseudogout."" It is most common in the elderly and can be precipitated by minor trauma. The crystals have a rhomboid shape, and the clinical presentation can mimic that of gout. It can be associated with metabolic abnormalities such as hyperparathyroidism or hemochromatosis. Treatment is with an NSAID for 7-10 days. If there are multiple joints involved, then steroids can be considered. An alternative to oral NSAIDs is intra-articular steroids for single joint disease. Allopurinol is not effective in CPPD. -### End" -2401,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are signs of Cor pumonale except: September 2007, with the following options: A: Feeble pulse, B: Elevated JVP, C: Hepatomegaly, D: Peripheral edema - -### Response: -Ans. A: Feeble pulse Symptoms of cor pulmonate include: Tiredness, weakness, anorexia Lower extremity oedema May have hepatic pain Symptoms of underlying cause Signs include: Warm, cyanosed extremities Bounding pulse Tachypnoea Raised JVP May be functional tricuspid incompetence - systolic 'v' waves seen in JVP Gallop rhythm, loud P2 due to pulmonary hypeension, but overlying emphysema may reduce hea sounds Hepatomegaly, lower extremity oedema -### End" -2402,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In congenital dystrophic variety of epidermolysis bullosa, mutation is seen in the gene conding for, with the following options: A: Laminin 4, B: Co11agen type 7, C: Alpha 6 integerin, D: Keratin 14 - -### Response: -Dystrophic epidermolysis bullosa - collagen type VII Epidermolysis bullosa simplex -keratin 14 Junctional epidermolysis bullosa is an inherited disease affecting laminin and collagen . page no. 287. Reference IADVL's concise textbook of dermatology -### End" -2403,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurofibromatosis true all, except aEUR', with the following options: A: Autosomal recessive, B: Associated with cataract, C: Scoliosis, D: Multiple fibroma - -### Response: -Autosomal recessive Neurofibromatosis is an inherited disorder It is of two types: ? Neurofibromatosis - Neurofibromatois II Genetics of Neurofibromatosis Both the neurofibromas are inherited in an autosomal dominant pattern. The genes for them are located on different chromosome - NF-1--) Neurofibrin gene on chromosome 17 - NF-2 --) Merlin gene on chromosome 22 NEUROFIBROMATOSIS TYPE I ? Neurofibromatosis is a comparatively common hereditary disorder in which the skin, nevous system, bone, endocrine glands and sometimes other organs are at the sites of a variety of congenital abnormalities often taking the fonn of benign tumours. . The main feature of neurofibromatosis I is - (i) Spots of hyperpigmentation and (ii) Cutaneous and subcutaneous neurofibromatous tumours'. Hyperpigmentation in Neurofibromatosis I takes two forms :? a) Cafe - au - lait spots' . These are patches of pigmentation and they appear sholy after bih' and occur anywhere on the body. . They are light brown in colour (cafe - au - lait) and do not change in number as the patient ages but they increase in size during pubey. . Presence of more than six cafe - au - lait spots > 1.5 cm in size is considered diagnostic of Neurofibromatosis. b) Freckles' . Neurofibromatosis I is also characterized by the presence of Freckles like or diffuse pigmentation of the axillae and other interiginous areas (groin, under breast) and small round whitish spots. When coupled with cafe au lait patches they are viually pathogtzomonice of the disease. ii) Neurofibromas a) Cutaneous tumours . They are situated in the dermis and form discrete soft or, firm papules. . They are ,flesh coloured or violaceous and often topped with comedo. When pressed, the soft tumours tend to invaginate through a small opening in the skin giving the feeling of a seedless raisin or a scrotum without a testicle. This phenomenon is spoken of as ""button holding"". b) Subcutaneous tumours . They take two forms ? a) Firm discrete nodules attached to a nerve. b) Plexiform neuromase (overgrowth of subcutaneous tissue sometimes reaching enormous size and occur most often in the face, scalp, neck and chest and may cause hideous disfigurement). Lisch Nodule'? This is another unique .finding of neurofibromatosiso. . It is a small whitish spote present in the iris. Tumours associated with Neurofibromatosis I are 1) Tumours of the CNS a) Optic Nerve Gliomao b) Non-optic Gliomas (usually low grade astrocytomas) c) Nonneoplastic ' hamaomatous"" lesion Osborn writes - ""The common CNS tumor in NF-1 is optic nerve glioma occuring in 5 to 15% of casese"" 2) Other tumours associated with NF-1 a) Pheochromocytoma b) Rhabdomyosarcoma c) leukemia (myeloid leukemia) d) Wilms tumour e) Juvenile Xanthogranuloma -### End" -2404,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a child, non-functioning kidney is best diagnosed by:, with the following options: A: Ultrasonography, B: IVU, C: DTPA renogram, D: Creatinine clearance - -### Response: -In order to assess function of an apparent non-functioning kidney, the best modality would be DTPA renogram. About other options: a. Ultrasonography: initial modality for imaging of the kidney and urinary tract. Good for anatomic details and not functional details of kidneys ureter and bladder. b. IVP (Intravenous pyelography) gives valuable information about renal anatomy and function. But due to the risk of anaphylaxis with the contrast material use of IVP has declined following the availability of radionuclide imaging. d. 24 hrs creatinine clearance can be calculated by collecting a timed urinary specimen and taking a blood sample around the mid-collection period. In children, in addition to problem with urine collection, this overestimates the actual GFR and can't be used to assess isolated kidney function. -### End" -2405,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are typical intercostal nerves except ?, with the following options: A: 2', B: 3"", C: 4th, D: 5th - -### Response: -Ans. is 'a' i.e., 2"" A typical intercostal nerve is the one that is confined to the intercostal space in its distribution.Based on this, the intercostal spaces are also designated as typical or atypical.The typical intercostal space is traversed by a typical intercostal nerve.The first and second thoracic nerves are atypical because they also innervate pa of upper limb brachial plexus (T1) and intercostobrachial nerve (T2). The lower six thoracic nerves (T7-T12) are atypical because they also innervate anterior abdominal wall.Thus only 3""' to 6"" are called typical intercostal nerves, and 3'd to 6' intercostal spaces are called typical intercostal spaces. -### End" -2406,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In apoptosis, permeabilization of the membrane occurs in, with the following options: A: Nuclear membrane, B: Cytoplasmic membrane, C: Lysosome, D: Mitochondrial membrane - -### Response: -Mitochondria contain several proteins that are capable of inducing apoptosis; these proteins include cytochrome c and other proteins that neutralize endogenous inhibitors ofapoptosis. When cells are deprived of growth factors and other survival signals, or are exposed to agents that damage DNA, or accumulate unacceptable amounts of misfolded proteins, a number of sensors are activated. These sensors are members of the Bcl-2 family called ""BH3 proteins"" (because they contain only the third of multiple conserved domains of the Bcl-2 family). They, in turn, activate two pro-apoptotic members of the family called Bax and Bak, which dimerize, inse into the mitochondrial membrane, and form channels through which cytochrome c and other mitochondrial proteins escape into the cytosol.( Robbins Basic Pathology, 9th edition, page 18 ) -### End" -2407,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secondary attack rate of chicken pox is ?, with the following options: A: 60, B: 50, C: 90, D: 40 - -### Response: -Ans. is 'c' i.e., 90 o Secondary attack rate of chicken pox is high, upto 90%. -### End" -2408,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A farmer visiting a orchard gets unconscious, excessive salivation , constricted pupils and fasciculation of muscles, treatment staed with, with the following options: A: Atropine, B: Neostigmine, C: Physostigmine, D: Adrenaline - -### Response: -A i.e. Atropine -### End" -2409,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mesovarium, with the following options: A: Attaches ovary to uterus, B: Attaches ovary to lateral pelvic wall, C: Attaches ovary to broad ligament, D: Attaches ovary to ovarian ligament - -### Response: -Mesovarium attaches ovary to posterior fold of peritoneum of broad ligament and contains vessels, lymphatics and nerves of ovary. -### End" -2410,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dandy walker syndrome- True is -, with the following options: A: Mostly had hydrocephalus, B: Cystic expansion of 4,h ventricle, C: Mid cerebellar hypoplasia, D: All are true - -### Response: -Ans. is 'd' i.e., All are true o The Dandy-Walker malformation consists of a cystic expansion of the 4th ventricle in the posterior fossa and midline cerebellar hypoplasia, which results from a developmental failure of the roof of the 4th ventricle during embryogenesiso Approximately 90% of patients have hydrocephalus, and a significant number of children have associated anomalies, including agenesis of the posterior cerebellar vermis and corpus callosum. Infants present with a rapid increase in head size and a prominent occiput.o Transillumination of the skull may be positive. Most children have evidence of long-tract signs, cerebellar ataxia, and delayed motor and cognitive milestones, probably due to the associated structural anomalies.o The Dandy-Walker malformation is managed by shunting the cystic cavity (and on occasion the ventricles as well) in the presence of hydrocephalus. -### End" -2411,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about vitiligo are all except:, with the following options: A: Surgical treatment is indicated if medical treatment fails, B: Leucotrichia is associated with good prognosis, C: Autoimmune condition, D: Skin biopsy specimen shows abscence of melanocytes. - -### Response: -VITILIGO -Autoimmune disorder -Skin biopsy specimen shows absence of melanocytes. Poor prognostic factors: Leucotrichia Long standing type Lesions over bony prominences Acrofacial -Surgical treatment is indicated if medical treatment fails and disease is stable for >1 year. - Modalities : Skin grafting Non-cultured autologous melanocytic transfer Cultured autologous melanocytic transfer. -### End" -2412,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve emerging through the trapezoid body of pons is, with the following options: A: Trigeminal nerve, B: Abducens nerve, C: Facial nerve, D: Cochlear nerve - -### Response: -The trapezoid body is located in the caudal pons, or more specifically the pontine tegmentum. The trapezoid body is pa of the auditory pathway where some of the axons coming from the cochlear nucleus decussate, or cross over to the other side before traveling on to the superior olivary nucleus. This is believed to help with localization of sound. (Ref: vishram Singh textbook of clinical neuroanatomy second edition pg 80) -### End" -2413,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In couinaud's classification, segment IV of liver is, with the following options: A: Caudate lobe, B: Quadrate lobe, C: Right lobe, D: Left lobe - -### Response: -Segments nomenclature I Caudate lobe (sometimes subdivided into left and right pas called segment IX) II Left lateral superior segment III left lateral Inferior segment IV left medial segment or Quadrate lobe V Right anterior Inferior segment VI Right posterior Inferior segment VII Right posterior superior segment VIII Right anterior superior segment -### End" -2414,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ram Prashad is admitted to Guru Teg Bahadur Hospital with respiratory infection for which antibiotic tobramycin is ordered. The clearance and Vd of tobramycin in him are 160 ml/min and 40 L, respectively. If you wish to give Ram Prashad an intravenous loading dose to achieve the therapeutic plasma concentration of 4 mg/L rapidly, how much should be given?, with the following options: A: 0.1 mg, B: 10 mg, C: 115.2 mg, D: 160 mg - -### Response: -Loading dose = Vd x target plasma cone. -= 40 L x 4 mg/L -= 160 mg -Clearance plays no role in the determination of loading dose. It is given to confuse you. -### End" -2415,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following aery is not a terminal branch of coeliac trunk ?, with the following options: A: common hepatic aery, B: left gastric aery, C: splenic aery, D: gastroduodenal aery - -### Response: -The coeliac trunk arises from the front of the abdominal aoa just below the aoic opening of the diaphragm at the level of the disc between veebrae thoracic twelve and first lumbar. The trunk is only about 1.25 cm long. It ends by dividing into its three terminal branches, namely the left gastric, hepatic and splenic aeries. Ref : B D Chaurasia's Human Anatomy ,seventh edition , volume 2 , pg. no., 302 ( fig. 21.3 to 21.5 ). -### End" -2416,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Red cell volume can be measured by injecting tagged red blood cells. All of the following are used to tag red cell, EXCEPT:, with the following options: A: 51 Cr, B: 59 Fe, C: 32 P, D: 121 I - -### Response: -Red cell volume is the volume occupied by all the circulating red cells in the body. It can be measured by sustracting the plasma volume from total body water. It can also be measured by injecting tagged red blood cells and measuring the fraction of red cells that is tagged.51 Cr radio isotope of chromium is commonly used. Isotopes of iron(59Fe) and phosphate (32P)and antigenic tagging is also used. Ref: Ganong's Reveiw of Medical Physiology, 21st Editon, Page 3 -### End" -2417,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The surgery for hyperophic pyloric stenosis of infancy is, with the following options: A: Ramstedt's operation, B: Truncal vagotomy, C: Heller's operation, D: Delorme's operataion - -### Response: -After laparotomy hyperophied muscle is cut along the whole length adequately until mucosa bulges out, then pyloromyotomy is done. in Heller&;s operation muscle of the cardiac are cut to allow passage of food ,and is done in achalasia cardia Truncal vagotomyis done by denervating the main branch which is supply in pylorus as in cases like peptic ulcerarltion Delorme&;s operation is done for repairing a external rectal prolapse Reference: SRB 5th edition page no. 821 & internet -### End" -2418,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old man has bronchospasm that is exercise induced, paicularly in the cold weather. He takes his medication 15 minutes prior to anticipated exercise, which will help to prevent the asthmatic attack but does not produce bronchodilation. Which drug does he take?, with the following options: A: b-Agonist inhaler, B: Glucocoicoid inhaler, C: Chromone agent, D: IgE inhibitor - -### Response: -MAST CELL STABILIZERS Sodium cromoglycate (Cromolyn sod.) It is a synthetic chromone derivative which inhibits degranulation of mast cells (as well as other inflammatory cells) by trigger stimuli. Release of mediators of asthma like histamine, LTs, PAF, interleukins, etc. is restricted. Bronchospasm induced by allergens, irritants, cold air and exercise may be attenuated. It is also not a bronchodilator and does not antagonize constrictor action of histamine, ACh, LTs, etc. Therefore, it is ineffective if given during an asthmatic attack. Pharmacokinetics Sodium cromoglycate is not absorbed orally It is administered as an aerosol through metered dose inhaler. Uses 1. Bronchial asthma 2. Allergic rhinitis 3. Allergic conjunctivitis Ref:-kd tripathi; pg num:-229 -### End" -2419,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lubipristone is a, with the following options: A: Enkephalinase inhibitor, B: Guanylyl cyclase agonist, C: Chloride channel activator, D: 5HT4 agonist - -### Response: -Lubipristone is a chloride channel activator used in treatment of IBS (Irritable bowel syndrome) with constipation. -### End" -2420,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are associated with MEN-2 except :, with the following options: A: Phoeochromocytoma, B: Islet cell hyperplasia, C: Medullary carcinoma thyroid, D: Parathyroid adenoma - -### Response: -Islet cell hyperplasia /Ref: Harrison 17th/e p 2361 & 16thie p 2231 and Robbins 7th/e p. 12211 MULTIPLE ENDOCRINE NEOPLASIA (MEN) SYNDROMES MEN I MEN 2A MEN 2B Pituitary Adenomas[', Hyperplasia -- Parathyroid Hyperplasia AdenomasQ Hyperplasia or adenomas' Pancreatic islets Hyperplasia AdenoniasQ CarcinomasQ -- ___. Adrenal Coical hyperplasia2 Pheochromocyt omae PheochromocytomaQ Thyroid -- C-cell hyperplasiaQ Medullary carcinoma C-cell hyperplasiao Medullary carcinomaQ Extraendocrine changes . Forcgut carcinoid0 * Subcutaneous or visceral . Dermal angiofibroma or collagenoma Cutaneous lichen amyloidosis Hirschsprung diseaseQ Mucosal and gastro intestinal neuroma, ganglio-neuromas, Marfanoid habitus Mutant gene locus MEN I RET RET -### End" -2421,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following occur in pregnancy EXCEPT, with the following options: A: Increase in Cardiac output, B: Increase in stroke volume, C: Decrease in fibrinogen levels, D: Rise in the venous pressure in the lower limb in supine position - -### Response: -(C) Decrease in fibrinogen levels # PHYSIOLOGICAL CHANGES ASSOCIATED WITH PREGNANCY:> Blood Volume increases progressively from 6-8 weeks gestation (pregnancy) and reaches a maximum at approximately 32-34 weeks with little change thereafter.> Renal plasma flow and glomerular filtration rate begin to increase progressively during the first trimester.> Increases in blood volume and cardiac output.> Elevations in plasma flow and glomerular filtration result in an elevation in creatinine clearance.> Blood urea and serum creatinine are reduced by 40%.> here is also an increase in filtered sodium, but tubular absorption is increased by an increase in aldosterone secretion, via the renin-angiotensin meChanism.There is also a decrease in plasma osmolality.# RBC & Haemoglobin: RBC volume is increased to the extent of 20-30%. Total increase in volume is about 350ml; the amount to be regulated by the increased demand of oxygen transport during pregnancy. Disproportionate increase in plasma and RBC volume produces a state of haemodilution during pregnancy. Thus, even though the total haemoglobin mass increases during pregnancy to the extent of 18-20 percent, there is apparent fall in haemoglobin concentration. At term the fall is about 2 gm5 from the non-pregnant value. There is simultaneous fall in number of red cells by 15-20% and the hematocrit level.# Blood changes in Pregnancy: Blood volume +30-40% Plasma volume + 40-50% RBC volume +20-30% Hb+18-20% Hematocrit Diminished. Changes in blood coagulation factors: Platelets Static or-15% Fibrinogen + 50% ESR 4 times increases -### End" -2422,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phocomelia is best described as:, with the following options: A: Defect in development of long bones, B: Defect in development of flat bones, C: Defect in intramembranous ossification, D: Defect in cartilage replacement by bones - -### Response: -ANSWER: (A) Defect in development of long bonesREF: Goodman Gillman manual of pharmacology and therapeutics 2008 edition page 897, http:// en.wikipedia.org/wiki/PhocomeliaPhocomelia is lack of development of proximal part of limb. The distal part being present is called as seal limb. Phocomelia is an extremely rare congenital disorder involving the limbs. Although various numbers of factors can cause phocomelia, the prominent roots come from the drug use of thalidomide and from genetic inheritance -### End" -2423,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not seen in Tumour lysis Syndrome?, with the following options: A: Hypophosphatemia, B: Hypocalcemia, C: Hyperuricemia, D: Hyperkalemia - -### Response: -TUMOR cells with very high rate ||| of growth - during Chemo Therapy - large no of cells are dyinge TUMOR cell lysis syndrome. i.e. Summary- components of Tumor-Lysis Syndrome HYPERKALEMIA HYPERURICEMIA HYPERPHOSPHATEMIA HYPOCALCEMIA -### End" -2424,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Caries sicca refer to -, with the following options: A: Tuberculosis of shoulder, B: Tuberculosis of wrist, C: Tuberculosis of ankle, D: Tuberculosis of calcaneum - -### Response: -Ans. is 'a' i.e., Tuberculosis of shoulder Tuberculosis of shoulder:* Tuberculosis of the shoulder is uncommon.* It usually starts as an osteitis but is rarely diagnosed until arthritis has supervened. This may proceed to abscess and sinus formation, but in some cases the tendency is to fibrosis and ankylosis.* If there is no exudate the term 'caries sicca' is used.* They may be confused with frozen shoulder clinically. -### End" -2425,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following cardiac chamber forms the base of the hea?, with the following options: A: Right atrium, B: Right ventricle, C: Left atrium, D: Left ventricle - -### Response: -Posterior surface or base of the hea is entirely formed by the left atrium which receives the 4 pulmonary veins. The anterior or sternocostal surface consist of the right atrium, veical atrioventricular groove, and the right ventricle with a narrow strip of left ventricle appearing on the horizon of the left border.The inferior or diaphragmatic surface consist of the right atrium receiving the inferior vena cava, the anteroposterior atrioventricular groove and to the left this the ventricular surface is made up of one third right ventricle and two third left ventricle separated by posterior interventricular branch of right coronary aery.Ref: Waxman S.G. (2010). Chapter 19. The Limbic System. In S.G. Waxman (Ed),Clinical Neuroanatomy, 26e. -### End" -2426,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are involved in sperm pathway, except -, with the following options: A: Efferent tubule, B: Afferent tubule, C: Rete testes, D: Epididymis - -### Response: -Ans. is 'b' i.e., Afferent tubule o The correct sequence of sperm movement from within testis to urethra isSeminiferous tubule - Straight tubule (Tubulirecti) - Rete testes - Efferent tubule - Epididymis - Vas (ductus) deferens - Ejaculatory duct - Prostatic urethrao Testis consists of 200-300 lobules. Each lobules consists of 2-3 seminiferous tubules (where spermatozoa are formed). Seminiferous tubules join at the apex of lobules to form straight tubules, which anastomose with each other to form rete testis. Which emerge from upper pole and enter the epididymis. Each tubule becomes highly coiled to form a lobe of the head of epididymis. All tubules end in a single duct which is coiled on itself to form the body and tail of the epididymis. It is continuous w ith ductus deference.o Epididymis is a firm structure, attached behind the testis. Its upper end is called head. Head is made up of highly coiled efferent ductules coming for upper end of testis. The middle part is called the body and lov/er part is called tail. The body and tail are made up of a single duct, the duct of the epididymis which is highly coiled on itself. At the lower end of tail this duct becomes continuous with the ductus deferens.o Ductus deferens (Vas deferens) is a direct continuation of the canal of the epididymis. It is a thick-walled muscular tube with a narrow7 lumen except at the terminal dilated part called the ampulla. It enters the spermatic cord, passes through the inguinal canal. At the deep inguinal ring, it leaves the spermatic cord and hooks around the lateral side of inferior epigastric artery. In the region of ischeal spine, it crosses ureter and then bends medially to reach the base of bladder. The part lying behind the bladder is dilated to form ampulla, and there is no intervening peritoneum between bladder base and ductus deferens. At the base of prostate it is joined by the duct of seminal vesicle to form ejaculatory duct. -### End" -2427,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Energy requirement in a pregnant lady doing moderate work is?, with the following options: A: 2525/kcal/day, B: 2280 kcal/day, C: 2850 kcal/day, D: 3200 kcal/day - -### Response: -Ans-A -### End" -2428,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following aoic arches regress during development:, with the following options: A: II, B: IV, C: V, D: VI - -### Response: -The aoic sac contributes a branch to each new arch as it forms, giving rise to a total of five pairs of aeries. (The fifth arch either never forms or forms incompletely and then regresses. Consequently, the five arches are numbered I, II, III, IV, and VI Ref: Langman's embryology 11th edition Chapter 12. -### End" -2429,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pemphigus neonatorum is:, with the following options: A: Ritter Disease, B: Epidermolysis bullosa, C: Congenital syphilis, D: Pemphigus - -### Response: -Bullous impetigo Caused by S. aureus S. aureus phage type 2 releases Epidermolytic Toxin (ET). This toxin ruptures desmosomes primarily in subcorneal layer - as the target is desmoglein - 1 (Note : It is a toxin- mediated destruction of Dsg - 1, not autoimmune destruction as in pemphigus foliaceus). The organism can be cultured from blister fluid. The pus settles on lower end of the blister as it is heavier - Hypopyon sign. When the ET causes local skin infection - called bullous impetigo and when it disseminates hematogenously - called Staphylococcus Scalded skin syndrome (SSSS)/Ritter Disease/pemphigus neonatorum. Histopathology- Blister below stratum corneum (within or below the granular layer) with plenty of neutrophils. -### End" -2430,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best mode to control leprosy eradication programme is -, with the following options: A: Mass chemotherapy, B: Early diagnosis and treatment, C: High risk chemotherapy, D: Health education - -### Response: -

Early diagnosis and treatment. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:321. <\p> -### End" -2431,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28 year old female nearing her date of delivery has been admitted following regular contractions. The resident doctor did an examination documents that the head is at +1 station.Where is the exact position of head?, with the following options: A: High up in the FALSE pelvis, B: Just above ischial spine, C: Just below ischial spine, D: At the perineum - -### Response: -Station is leading point of Head. Station 0 = Head at level of Ischial spines + means below Ischial spines - means above Ischial spines Numbers like 1 , 2 denote distance in cm below or above Ischial spine -### End" -2432,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zona hatching occurs, with the following options: A: 4 days after feilisation, B: 5 days after feilisation, C: 6 days after feilisation, D: 8 days after feilisation - -### Response: -Five days after feilisation, blastocyst performs zona hatching and it undergoes degeneration to be replaced by trophoblastic cells -### End" -2433,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following laryngeal muscle is supplied by external laryngeal nerve?, with the following options: A: Cricothyroid, B: Thyroarytenoid, C: Cricoarytenoid, D: Vocalis - -### Response: -External laryngeal nerve is a branch of superior laryngeal nerve and supplies cricothyroid muscle. Superior laryngeal nerve arise from inferior ganglion of the vagus descends behind the internal carotid aery and at the level of greater cornua of hyoid bone, divides into external and internal branches. The internal branch pierces the thyrohyoid membrane and supplies sensory innervation to the larynx and hypopharynx. -### End" -2434,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Human development index includes all of the following, except:, with the following options: A: Adult literacy rate, B: Life expectancy at bih, C: Income, D: Infant moality rate - -### Response: -Infant moality rate -### End" -2435,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Diagnosis of hemolytic anemia except-, with the following options: A: Elevated unconjugated bilirubin in the blood, B: Low LDH in the blood, C: Haptoglobin levels are decreased, D: Direct cooms test is positive - -### Response: -Lab evaluation of hemolysis Tets for increased red cell breakdown serum unconjugated bilirubin is increased urine urobilinogen raised Faecal stercobilinogen raised Serum haptoglobin(alpha globulin binding protein)reduced or absent Plasma LDH raised. Evidenceof intravascular hemolysis Tests for increased red cell production Reticulocytosis Routine blood film B.M shows erythroid hyperplasia X ray bone shows expansion of marrow space Tests of damage to red cells Abnormal morphological appearance of red cell in blood routine Osmotic fragility increased or decreased Coobs antiglobulin test for AIHA Electrophoresis Estimation of HbA2 Estimation of HbF Test for sickling Screening for G6PD deficiency Ref: Harsh Mohan textbook of pathology, 7th edition.Pg no.287 Ref Robbins 9/e pg 416 -### End" -2436,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Extracampine hallucinations term was given by ?, with the following options: A: Eugene Bleuler, B: William Harvey, C: Robe Macinoff, D: Eden Speroff - -### Response: -Ans. A. Eugene BleulerExtracampine hallucinationsThe term extracampine is indebted to Latin words extra - outside and campaneus - field.It was introduced in or sholy before 1903 by Swiss Psychiatrist Eugene Bleuler to denote a hallucination that is experienced by affected individual as being outside the range of normal perception. -### End" -2437,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Formed visual hallucinations are seen in lesion of:, with the following options: A: Frontal, B: Occipital, C: Temporal, D: Arcuate fasciculus - -### Response: -C i.e. Temporal lobe -### End" -2438,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bilateral Cold water irrigation of ears response is seen in, with the following options: A: Upbeat nystagmus and downward movement of eye, B: Down beat nystagmus and upward movement of eye, C: Rotatory nystagmus, D: None - -### Response: -(A) Upbeat nystagmus and downward movement of eye# COLD WATER INDUCES NYSTAGMUS to opposite side and warm water to the same side.> Depending on response to the caloric test, we can find canal paresis or dead labyrinth, directional preponderance, i.e. nystagmus is more in one particular direction than in the other, or both canal paresis and directional preponderance. -### End" -2439,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are components of Meig's syndrome. except :, with the following options: A: Pleural effusion, B: Ovarian tumour, C: Ascites, D: Pericardial effusion - -### Response: -Ans. is d i.e. Pericardial effusion The combination of ovarian fibroma with ascites and hydrothorax usually right sided is known as Meig's syndrome. Apa from fibroma Meig's syndrome like feature can also occur with granulosa cell tumour and Brenner's tumour (Pseudomeig syndrome). -### End" -2440,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are hypercoagulable conditions EXCEPT, with the following options: A: AT III deficiency, B: Protein C deficiency, C: Protein S deficiency, D: Anti Lupus anticoagulant deficiency - -### Response: -(D) Anti Lupus anticoagulant deficiency # Risk of thromboembolic disease increases when IBD becomes active, and patients may present with deep vein thrombosis, pulmonary embolism, cerebrovascular accidents, and arterial emboli.> Factors responsible for the hypercoagulable state include reactive thrombocytosis; increased levels of fibrinopeptide A, factor V, factor VIII, and fibrinogen; accelerated thromboplastin generation; antithrombin III deficiency secondary to increased gut losses or increased catabolism; and free protein S deficiency.> A spectrum of vasculitides involving small, medium, & large vessels has also been observed in IBD patients -### End" -2441,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Autonomic Polyglandular syndrome 2 is associated with Adrenocoical insufficiency and-, with the following options: A: PGAl, B: Hashimata's thyroiditis, C: Islet cell adenoma, D: Type 1 diabetes - -### Response: -Ref 70%, B: Presence of collaterals, C: A systolic pressure gradient >20 mmHg across the lesion, D: Post stenotic dilatation of the renal aery - -### Response: -B i.e. Presence of collaterals -### End" -2460,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Turner's syndrome are all except:, with the following options: A: Long stature, B: Normal gonads, C: Normal intelligence, D: Normal breast - -### Response: -The question is asking about true statement about Turner's syndrome out of all options. Only Normal intelligence is true and while all other options provide a false explanation of Turner's syndrome as explained below: Turner syndrome Genotype is X0 Female is affected Only monosomy compatible with life Have zero Barr bodies (A normal female has one Barr body) Intelligence is normal -### End" -2461,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: While working in a neonatal ICU. Your team delivers a preamature infant at 27 weeks of gestation and weighing 1500gm. How soon will you request fundus examination by an ophthalmologist?, with the following options: A: Immediately, B: 3 – 4 weeks after delivery, C: At 34 weeks gestational age, D: At 40 weeks gestational age - -### Response: -All babies weighing less than 1.5 kg at birth or having a gestation period of less than 32 weeks should be screened with indirect ophthalmoscopy for retinopathy of prenaturity, between 32 and 36 weeks post conception. -### End" -2462,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for diagnosis of Epilepsy is, with the following options: A: EEG, B: CT scan, C: MRI, D: CSF investigations - -### Response: -All patients who have a possible seizure disorder should be evaluated with an EEG as soon as possible. The EEG is most useful in evaluating patients with suspected epilepsy. The presence of electrographic seizure activity - i.e., abnormal, repetitive, rhythmic activity having an abrupt onset and termination and a characteristic evolution - clearly establishes the diagnosis. -### End" -2463,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common benign tumours during infancy is:, with the following options: A: Lymphangioma, B: Hemangioma, C: Cystic hygroma, D: Lipoma - -### Response: -(Hemoangioma) (1726-Nelson 17th) (342-Ghai 7th)* Hemangioma are the most common benign tumours of infancy and occurs in about 10% of term infants.* Lympangioma and cystic hygroma are second most common benign vascular tumours in children.* Hemangiomas are benign vascular lesions that represent the most common benign tumour of infancy -### End" -2464,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The physical half life of radioactive I131 is:, with the following options: A: 8 hrs, B: 8 days, C: 16 days, D: 60 days - -### Response: -Half life of radioactive I131 is 8 days. It can cause irreversible hypothyroidism. It is contra-indicated in pregnancy. -### End" -2465,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gancyclovir is more effective than acyclovir against?, with the following options: A: CMV, B: Influenza, C: Herpes, D: None of the above - -### Response: -Ans. A. CMV. (Ref. H - 17th/pg. 2633; 847; 1092)Harrison's internal medicine 17th/pg. 1092.......GANCICLOVIR is an analogue of acyclovir, ganciclovir is active against HSV and VZV and is markedly more active than acyclovir against CMV.Harrison's internal medicine 17th/pg. 847 .......""With the development of highly effective oral antiviral agents, CMV immune globulin is no longer used. Ganciclovir (valganciclovir) is beneficial when prophylaxis is indicated and for the Rx of serious CMV disease. Acyclovir (Valacyclovir) is less efficacious but also less toxic than ganciclovir (Valganciclovir). The availability of Valganciclovir and Valacyclovir has allowed most centers to move to oral prophylaxis for transplant recipients. Additional oral prophylactic agents, such as maribavir, are in clinical study"".# Ganciclovir, valganciclovir, foscamet, and cidofovir are approved for Rx of CMV retinitis in patients with AIDS. They are also used for colitis, pneumonia, or ""wasting"" syndrome associated with CMV and for prevention of CMV disease in transplant recipients.GANCICLOVIR AND VALGANCICLOVIR# An analogue of acyclovir. ganciclovir is active against HSV and VZV and is markedly more active than acyclovir against CMV.# Ganciclovir is a synthetic nucleoside analogue of 2?-deoxyguanosine. The drug is preferentially phosphorylated by virus-induced cellular kinases.# Ganciclovir triphosphate acts as a competitive inhibitor of the CMV DNA polymerase, and its incorporation into nascent viral DNA results in premature chain termination.# In HSV- and VZV-infected cells, ganciclovir is phosphorylated by virus-encoded thymidine kinases; in CMV-infected cells, it is phosphorylated by a viral kinase encoded by the UL97 gene.# Ganciclovir is approved for the Rx of CMV retinitis in immunosuppressed patients and for the prevention of CMV disease in transplant recipients. It is widely used for the Rx of other CMV-associated syndromes, including pneumonia, esophagoGI infections, hepatitis, and ""wasting"" illness.# Oral ganciclovir has largely been supplanted by valganciclovir, which is the L-valyl ester of ganciclovir & is frequently used in place of IV ganciclovir.- Intraocular ganciclovir, given by either intravitreal injection or intraocular implantation, has also been used to treat CMV retinitis.# Valganciclovir is well absorbed orally, with a bioavailability of 60%, and is rapidly hydrolyzed to ganciclovir in the intestine and liver. The area under the curve for a 900-mg dose of valganciclovir is equivalent to that for 5 mg/kg of ganciclovir given IV, although peak serum concentrations are -40% lower for valganciclovir. The serum half-life is 3.5 h after IV administration of ganciclovir and 4.0 h after PO administration of valganciclovir.# Valganciclovir is an orally bioavailability prodrug that can generate high serum levels of ganciclovir, although studies of its efficacy in treating CMV CNS infections are limited.Foscarnet# is a pyrophosphate analogue that inhibits viral DNA polymerases by binding to the pyrophosphate-binding site.# Foscarnet is poorly soluble and must be administered IV via an in- fusion pump in a dilute solution over 1-2 h.# Foscarnet is approved for the Rx of CMV retinitis in patients with AIDS and of acvclovir-resistant mucocutaneous HSV infections. Intraocular foscamet has been used to treat CMV retinitis.# Foscarnet has also been employed to treat acyclovir-resistant HSV and VZV infections as well as ganciclovir- resistant CMV infections, although resistance to foscarnet has been reported in CMV isolates obtained during therapy. Foscarnet has also been used to treat HHV-6 infections in immunosuppressed patients.# The major form of toxicity associated with foscamet is renal impairment. Thus renal function should be monitored closely, particularly during the initial phase of therapy.# Since foscarnet binds divalent metal ions, hypocalcemia, hypomagnesemia, hypokalemia, and hypo- or hyperphosphatemia can develop. Saline hydration and slow infusion appear to protect the patient against nephrotoxicity and electrolyte disturbances.# Foscarnet is not myelosuppressive and is active against acyclovir- and ganciclovir-resistant herpesviruses.Cidofovir# Cidofovir is a phosphonate nucleotide analogue of cytosine.# Its major use is in CMV infections. particularly retinitis. but it is active against a broad range of herpes viruses. including HSV. human herpesvirus (HHV) type 6. HHV-8. and certain other DNA viruses such as polyomaviruses. papillomaviruses. adenoviruses. and poxviruses. including variola (smallpox) and vaccinia.# Cidofovir is usually active against foscarnet-resistant CMV. although cross-resistance to foscarnet as well as to ganciclovir has been described.# Cidofovir has poor oral availability and is administered IV. It is excreted primarily by the kidney and has a plasma half- life of 2.6 h.# The major toxic effect of cidofovir is proximal renal tubular injury, as manifested by elevated se- rum creatinine levels and proteinuria. The risk of nephrotoxicity can be reduced by vigorous saline hydration and by concomitant oral probenecid. Neutropenia, rashes, and GI intolerance may also occur.# IV cidofovir has been approved for the Rx of CMV retinitis in AIDS patients who are intolerant of ganciclovir or foscarnet or in whom those drugs have failed.AMCICLOVIR AND PENCICLOVIR# Famciclovir is the diacetyl 6-deoxyester of the guanosine analogue penciclovir.# Famciclovir is well absorbed orally, has a bioavailability of 77%, and is rapidly converted to penciclovir by deacetylation and oxidation in the intestine and liver.# Penciclovir's spectrum of activity and mechanism of action are similar to those of acyclovir. Thus, penciclovir is usually not active against acyclovir-resistant viruses.# Famciclovir is effective as therapy for mucocutaneous HSV infections in HIV-infected patients.Ribavirin (Intravenous)# (15-25 mg/kg per day in divided doses given every 8 h) has been reported to be of benefit in isolated cases of severe encephalitis due to California encephalitis (LaCrosse) virus.# Ribavirin might be of benefit for the rare patients, typically infants or young children, with severe adenovirus or rotavirus encephalitis and in patients with encephalitis due to LCMV or other arenaviruses.# However, clinical trials are lacking. Hemolysis, with resulting anemia, has been the major side effect limiting therapy.TRIFLURIDINE# Trifluridine is a pyrimidine nucleoside active against HSV-1, HSV-2, and CMV.VIDARABINE# Vidarabine is a purine nucleoside analogue with activity against HSV- 1, HSV-2, VZV, and EBV.# Vidarabine inhibits viral DNA synthesis through its 5?-triphosphorylated metabolite.# IV-administered vidarabine has been shown to be effective in the Rx of herpes simplex encephalitis, mucocutaneous HSV infections, herpes zoster in immunocompromised patients, and neonatal HSV infections. Its use has been supplanted by that of IV acyclovir, which is more effective and easier to administer. -### End" -2466,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inlet of larynx is formed by:, with the following options: A: Ventricular fold, B: Aryepiglottic fold, C: Glossoepiglottic fold, D: Vocal cord - -### Response: -The laryngeal inlet (laryngeal aditus, laryngeal apeure) is the opening that connects the pharynx and the larynx. Its borders are formed by: the free curved edge of the epiglottis, anteriorly. the arytenoid cailages, the corniculate cailages, and the interarytenoid fold, posteriorly. -### End" -2467,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements is not true of McBurney's incision?, with the following options: A: Most suitable if the diagnosis of appendicitis is definite, B: If it is conveed into a muscle cutting incision it is called Rutherford Morison's incision, C: Inguinal hernia is a sequel of the incision, D: The incision can be extended upwards or downwards - -### Response: -In McBurney's incision, incision is extended upwards and laterally, not downwards. -### End" -2468,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior pa of hypothalamus is concerned with: March 2013, with the following options: A: Regulation of sexual function, B: Role in circadian rhythm, C: Regulation of response to smell, D: Secretion of posterior pituitary hormones - -### Response: -Ans. C i.e. Regulation of response to smell -### End" -2469,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: xylene and toluene ate types of, with the following options: A: inhalants, B: hallicinigens, C: stimulants, D: anabolic androgenic steroids - -### Response: -Inhalants * FAMOUS COMPONDS==Toluene, xylene, trichloroethylene AGE OF ONET-----------Adolescent * Breath only for minutes, * inexpensive, * legal to possess, * easily concealed * COMPLICATIONS * Respiratory depression, * aspiration, * temporal lobe epilepsy, * leukoencephalopathy * LAB INVESTIGATION * Urine.============. Gas chromatography Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.656 -### End" -2470,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Attitude in posterior dislocation of hip, with the following options: A: Flexion, abduction and internal rotation, B: Flexion, adduction and internal rotation, C: Flexion, abduction and external rotation, D: Flexion, adduction and external rotation - -### Response: -Ref: Textbook of ohopaedics, Maheshwari and Mhaskar, 6th edition Pgno:130 -### End" -2471,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements is true about rabies virus?, with the following options: A: It is double stranded RNA virus, B: Contains a DNA - dependent RNA polymerase, C: RNA has a negative polarity, D: Affects motor neurons - -### Response: -Ans. is 'c' i.e., RNA has negative polarity(Ref: Ananthanarayan, 9th/e, p. 510, 532 and 8th/e, p. 525)* It is an enveloped, RNA (negative sense ss RNA) virus.* It has RNA dependent RNA polymerase. Q* Rabies virus multiplies in muscle or connective tissue at the site of inoculation and then enters peripheral nerves at neuromuscular junctions and spreads up the nerves to the central nervous system. It multiplies in the central nervous system and progressive encephalitis develops. The virus then spreads through peripheral nerves to the salivary glands and other tissues. -### End" -2472,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In defining General Fertility Rate, the denominator is:, with the following options: A: Population between 15 and 49 years of age, B: Women between 15 and 49 years of age, C: Mid-year population, D: Live births - -### Response: -Ans. is 'b' i.e. Women between 15 and 49 years of ageRef Park 20th/e, p 419, 18th/e, p. 356 (17th/e p 333)General fertility rate (GFR):It is the number of live births per 1000 women in the reproductive age group (15-44 or 49 years) in a given year _ Number of live births in an area GFR=----------------------------------------- Midyear female population age 15-44 (or 49) in the same area in same yearAlso knowTotal fertility rate :Total fertility rate represents the average number of children a woman would have if she were to pass through her reproductive years bearing children at the same rates as the women now in each age groupThis measure gives the approximate magnitude of ""completed family size ""Gross reproduction rate (GRR):Average number of girls that would be bom to a married woman if she experiences the current fertility pattern throughout her reproductive span (15-44 or 49 year) assuming no mortality Net reproductive rate (NRR):NRR is defined as the number of daughters a newborn girl will bear during her lifetime assuming fixed age specific fertility and mortality rates.NRR is demographic indicator, the present level of NRR in India is 1.5 (1990).NRR of 1 is equivalent to attaining approximately the 2-child normThe govt, of India in 1983 adopted the policy of attaining a NRR of 1 by the year 1996 (now to be achieved by 2006)These types of questions where denominator is asked are one of the most often repeated questions in PG exams. These are the one of the easiest questions but quite often confusing because of the large number of statistical formulas.I have listed down most of the imp. Epidemiological formulas. Have a look at them and stress on the denominators.Birth Rate =(no. of live birth during the yr/mid yr population) x 1000Crude Death Rate =(no. of deaths during the yr/mid yr population) x1000General Fertility Rate =(no. of live birth during the yr/mid yr female population age 15-44) x 1000General Marital Fertility Rate =(no. of live births during the yr/mid yr married female population) x 1000Case Fatality Rate =(No of deaths due to a ds/no of cases due to the same ds) x 100Maternal Mortality Rate =(Total no. of female deaths d/t complication of pregnancy, child birth or within 42 days of delivery from puerperal causes/ total no. of live birth) x 1000Still birth rate =(Foetal deaths weighing over 1000gm i.e. equivalent to 28 wks of gestation)/(total live birth + still births over 1000 gms) x 1000)Perinatal Mortality Rate =(Foetal deaths weighing over 1000 gms i.e. 28 wks gestation or more + early neonatal death within 7 days of birth)/(total no. of live birth) x 1000Infant Mortality Rate =(No. of deaths of infants /no. of live births) x 1000Neonatal Mortality Rate =(no. of deaths of neonate/No. of live births) x 1000Under 5 mortality rate or child mortality rate =(no. of deaths of children less than 5 yrs of age in a given year/no. of live birth) x 10001-4 year mortality rate =(No. of deaths of children aged 1-4 yrs during a year/ total no. of children aged 1-4 yrs at the middle of the year) x 1000 -### End" -2473,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the total dose of Vitamin - A given under national immunisation schedule, with the following options: A: 16 Lac IV, B: 17 Lac IV, C: 18 Lac IV, D: 20 Lac IV - -### Response: -1 lac IU @ 9 months age. -2 lac IU every 6 months therefter, till the age of 5 years. -### End" -2474,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tracheostomy done at which level-, with the following options: A: T1, B: T3, C: T4, D: T5 - -### Response: -Ans. is 'b' i.e., ""The T3 vertebral level defines the ideal position of the tracheostomy site"". --Critical care medicineSites of Tracheostomyo Depending on the position of tracheostome, tracheostomy can be classified as :High tracheostomy: Performed above the level of thyroid isthmus which lies against II, III and IV tracheal rings:Indicated in carcinoma larynx when laryngectomy is anticipated.Drawback : tracheostomy at this point violates the I51 ring of trachea and causes perichondritis of the cricoid cartilage and subglottic stenosis, so it is better avoided.Mid tracheostomy: Performed at the level of thyroid isthmusThe opening is made at the level of II, III ringsIt is the preferred site for tracheostomyLow tracheostomy: Performed below the level of thyroid isthmusIndicated in laryngeal papillomatosis to avoid implantationDrawback: At this level trachea lies close to several large vessels which can get injured and the tracheostomy tube impinges on suprasternal notch at this level. -### End" -2475,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are not intermediate acting non depolarizing NMB -, with the following options: A: Pancuronium, B: Vecuronium, C: Rocuronium, D: Atracurium - -### Response: -Non depolarizing muscle relaxants are classified according to their structure and duration of action as: Stucture Clinical duration Long acting (>50 min) Intermediate (20-50 min) Sho (15-20 min) Ultra-sho (<10-12 min) Steroidal Pancuronium Pipecuronium Vecuronium Rocuronium Benzyliso- quinolinium d-Tubocurarine Metacurine Doxacurium Atracurium Cis-atracurium Mivacurium Onium chlorofumarate Gantacurium Phenolic ether Gallamine -### End" -2476,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person developed seizures on the railway station while waiting for the train. A wristband was found showing that he is a patient of epilepsy and has a medicine in his pocket. What will you do next?, with the following options: A: Put a handkerchief in his mouth and restrain him by holding hands and legs, B: Take him away from the train, give him medicine with small sips of water and wait for seizure to resolve, C: Take him away from the train, give him medicine with small sips of water and raise his legs and wait for seizure to resolve, D: Take him away from the train, make him lie down and refer to the hospita - -### Response: -Ans. c. Take him away from the train, give him medicine with small sips of water and raise his legs and wait for seizure to resolve -### End" -2477,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pentameric structure -, with the following options: A: IgM, B: IgG, C: IgA, D: IgD - -### Response: -Ans. is 'a' i.e., Ig M o IgM is a pentameric immunoglobulin with five, four - peptide subunits.o The subunits are joined together by J chain.IgMo IgM is the earliest immunoglobulin class to be synthesized by the fetus. begining at 20 weeks of age.o As it is not transported across the placenta, the presence of IgM in the fetus or newborn indicates intrauterine infection and its detection is useful in the diagnosis of congenital infections such as syphilis, rubella and toxoplasmosis.o It normally circulates as pentamer.o It is the oldest immunoglobulin class.o It is the predominant antibody in primary antibody response.o It is short lived, disappearing earlier than IgGL. Hence, its demonstration in serum indicates recent infection.o Treatment with 2-mercaptoethanol selectively destroys IgM wdthout affecting IgG. This is a simple method for the differential estimation of IgG and IgM.o The isohemagglutinins (blood group anti A, anti B) are usually IgMo Being largely confined to the intravascular space, IgM is believed to be responsible for protection against blood invasion by microorganisms.o Monomeric IgM is the major antibody receptor on the surface of B lymphocytes for antigen recognition.o IgM is an important component of immune complexes in autoimmune diseases e.g. IgM antibodies against IgG in Rheumatoid arthritis. -### End" -2478,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Neuroblasotmas the most common presentation is ?, with the following options: A: Lytic lesion in skull with suture diastasis, B: Lung metastasis, C: Renal invasion, D: Secondaries in brain - -### Response: -Ans. is 'a' i.e., Lytic lesion in skull with suture diastasis Although the most common presentation of neuroblastoma is an abd. mass, option 'a' is most common among the given options. Sutton writes - ""Neuroblastoma frequently metastasizes to the skull. Lesions may involve the suture margins, paicularly the coronal suture, which becomes widened (diastasis) and irregular"". -### End" -2479,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is NOT the feature of secondary ACTH deficiency?, with the following options: A: Hypotension, B: Fatigue, C: Hyperpigmentation, D: Anorexia - -### Response: -Clinical feature of secondary ACTH deficiency: Mineralocoicoid secretion is intact. Manifests more insidiously with lack of skin hyperpigmentation. Hypotension is seen with gluco-coicoid deficiency because of loss of control of inhibition of vasopressin. Fatigue, hyponatremia, and hypoglycaemia is also seen -### End" -2480,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with peripheral circulatory failure. The arterial pH is 7.0, pCO2 of 15 mmHg, pO2 76 mmHg. Which of the following will be the immediate therapy-, with the following options: A: Sodium bicarbonate infusion, B: A bolus of Ringers lactate, C: A bolus of hydroxyethyl starch, D: Dopamine infusion - -### Response: -Ans- B Volume replacement by RL or normal saline is the first step in the management of shock (peripheral circulatory failure). Giving Sod bicarb without fluids increases mortality by cardio-depressant action -### End" -2481,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A obese female having hirsutism on laboratory investigation has high level of LH and androgens. Likely cause is-, with the following options: A: PCOS, B: Exogenous steroid ingestion, C: Turner syndrome, D: Kleinfelter syndrome - -### Response: -Ans. is 'a' i.e., PCOS o The clinical and laboratory features of the patient described in the question match with those of PCOS as depicted in the table. So the most appropriate answer is PCOS.Clinical features of polycystic ovarian diseaseClinical featureHannonalSequelaeo Young womano | E2. levelo Diabaetes (15%)o Central obesityo | FSH | LH > 10 IU/mlo CVS disorder# SMI > 30kg/cm2o | FSK/LH ratioo Lipidaemia# Waist line > 35o | Androgenso Hypertensiono Gligomenorrhoea, amenorrhoeao Testosterone,epiandrostenedione. |dehydropepiandrosterone |o Endometrial cancero Infertility (20%)o Breast cancero Hirsutismo Premature ovariano Acanthosis nigra due to insulin resistance, Thick pigmented skin over the nape of neck, inner thigh and axillao 17-alpha-hvdroxy progesterone> 800 ng.'dLfailure following surgeryo Testosterone > 2 ng/mlo Most androgens from ovaryo | fasting insulin > l0mlu/Lo Protactin |o Sex hormone binding globulin (SHBG)o | E2/oestrone (E1) ratioo F glucose,'insulin ratio <4-5 (normal 2-4-4-5) -### End" -2482,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Allergic bronchopulmonary aspergillosis, with the following options: A: Aspergillus fumigatus is M/C cause, B: History of asthma, C: Elevated serum IgE levels, D: Distal bronchiectasis is primary diagnostic Criteria - -### Response: -Central / Proximal bronchiectasis is a Primary diagnostic Criteria. -### End" -2483,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All known effects of cyclic AMP in eukaryotic cells results from ?, with the following options: A: Activation of the catalytic unit of adenylate cyclase, B: Activation of synthetase, C: Activation of protein kinase, D: Phosphorylation of G protein - -### Response: -Ans. 'c' i.e., Activation of protein kinase o Cyclic AMP exes most of its effects by stimulating cAMP-dependent protein kinases. These kinases are composed of a cAMP-binding regulatory (R) dimer and two catalytic (C) chains. When cAMP binds to the R dimer, active C chains are released to diffuse through the cytoplasm and nucleus, where they transfer phosphate from ATP to appropriate substrate proteins, often enzymes. The specificity of cAMP's regulatory effects resides in the distinct protein substrates of the kinases that are expressed in different cells. For example, liver is rich in phosphorylase kinase and glycogen synthase, enzymes whose reciprocal regulation by cAMP-dependent phosphorylation gov erns carbohydrate storage and release. -### End" -2484,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following type of joint is found in the small joints of the veebrae?, with the following options: A: Hinge joint, B: Saddle joint, C: Gliding joint, D: Condyloid joint - -### Response: -Plane joint or gliding joint allows gliding movements of the plane joint surfaces and is found in the small joints of the veebrae.Hinge joint: In this type of joint a cylindrical bone end is applied to a gutterlike depression in a hollow skeletal cylinder. Because of its shape this type of joint have only one axis of movement and two main movements.Saddle joint: It consist of two concave curved surfaces with two main axes of movement that are perpendicular to each other and allow four main movements. Condyloid joint: It has an elliptical head fitted into a convex and concave socket. They have two main axes perpendicular to each other and allow four main movements.Ref: The Human Body: An Introduction to Structure and Function By Adolf Faller page 122. -### End" -2485,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The fibers from contralateral nasal retina project to the following layers of lateral geniculate nucleus, with the following options: A: 2,3,5, B: 1,4,6, C: 1,2,3, D: 4,5,6 - -### Response: -On each side, layers 1,4 and 6 of the lateral geniculate nucleus receive input from the contralateral eye, whereas layers 2,3 and 5 receive input from the ipsilateral eye. Illustration showing ganglion cell projections from retina to lateral geniculate nucleus Ref: Ganong&;s review of Medical Physiology 26th edition Pgno: 198 -### End" -2486,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bimodal distribution is represented by:, with the following options: A: Mode = 3 median - 2 mean, B: Mode = 3 median + 2 mean, C: Mode = 2 median +2 mean, D: Mode = 3 mode - 3 mean - -### Response: -Bimodal distribution = Mode = 3 median - 2 mean -### End" -2487,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is most commonly implicated in genital (vulval) warts?, with the following options: A: HPV 16, B: HPV 18, C: HPV 31, D: HPV 6 - -### Response: -Ans. is d, i.e. HPV 6Ref: Williams Gynae 1st/ed, p619""Low Risk HPV types 6 and 11 cause nearly all genital warts."" - Williams Gynae 1st/ed, p67Genital Warts:* Genital warts are lesions created from productive infection with HPV (most common type 6 and 11).* They display various morphologies and appearances ranging from flat papules to the classic verrucous, polyphytic lesions, termed ""condyloma acuminata"".* Sites: External genital warts may develop at sites in the lower reproductive tract, urethra, anus, or mouth.* Diagnosis: They are typically diagnosed by clinical infection, and biopsy is not required unless co-existing neoplasia is suspected. HPV serotyping is not required for routine diagnosis.Treatment:* Condyloma acuminata may remain unchanged or resolve spontaneously.* Effect of treatment on future viral transmission is unclear. However, many women prefer removal, and lesions can be destroyed with sharp or electrosurgical excision, cryotherapy, or laser ablation. In addition, very large, bulky lesions may be managed with cavitational ultrasonic surgical aspiration.Medical Management of Genital Warts:* Topical 5-percent imiquimod cream (immunomodulator)* Podophyllin (antimitotic agent)* Trichloroacetic acid (proteolytic agent)* Bichloroacetic acid (proteolytic agent)* Intralesion injection of interferonNote: Intralesion injection of interferon has high cost, is painful and is inconvenient to administer, So this therapy is not recommended as a primary modality and is best reserved for recalcitrant cases.Therapy of choice: No data suggest the superiority of one treatment. Thus in general treatment should be selected based on clinical circumstances and patient and provider preferences. -### End" -2488,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cough is an adverse reaction seen with intake of, with the following options: A: Thiazide, B: Nifedipine, C: Enalapril, D: Prazosin - -### Response: -Refer kDT 6/e p984 ACE inhibitor cause adverse reaction like cough. The CAPTOPRIL mnemonic can be used to remember the side effects of ACE inhibitors: cough, angioedema, potassium changes, taste change, hyp-O-tension, pregnancy changes, rash, increased renin, and lower angiotensin II. Another side effect is hyperkalemia. -### End" -2489,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Systolic murmur in TOF is due to?, with the following options: A: VSD, B: Pulmonary stenosis, C: ASD, D: None - -### Response: -b. Pulmonary stenosis(Ref: Nelson's 20/e p 2223-2225, Ghai 8/e p 424-426)Ejection systolic murmur in TOF is due to pulmonary stenosis.The intensity and duration of this systolic murmur is inversely proportional to the severity of TOF. -### End" -2490,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Irreversible change staing in MI in myocardium is seen in:, with the following options: A: Few seconds, B: 10 minutes, C: 20 minutes, D: 40 minutes - -### Response: -Change in myocardium in MI:- Few seconds: onset of ATP depletion 10 min : ATP | to 50% 20 min : Irreversible changes stas 40 min -### End" -2491,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A hypeensive primigravida developed Sheehan's syndrome after the delivery. All of the following are seen with Sheehan's syndrome, EXCEPT:, with the following options: A: Obesity, B: Amenorrhoea, C: Failure to lactate, D: Absence of secondary sexual characteristics - -### Response: -Severe intrapaum or early postpaum hemorrhage and associated hypotension is followed by pituitary failure or Sheehan syndrome. It refers to panhypopituitarism. Abrupt, severe hypotension leads to pituitary ischemia and necrosis. It is characterized by failure of lactation, amenorrhea, breast atrophy, loss of pubic and axillary hair, hypothyroidism, and adrenal coical insufficiency. Also know: The pituitary cell types are differentially sensitive to damage. For this reason, prolactin secretion deficiency is the most common, followed by loss of gonadotropin and growth hormone release, loss of ACTH production, and least commonly, by decreases in thyroid-stimulating hormone (TSH) secretion. Ref: Leveno K.J., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 35. Obstetrical Hemorrhage. In K.J. Leveno, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. -### End" -2492,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The ECG change seen in hyperkalemia is, with the following options: A: Narrowing of the QRS complex, B: Increased amplitude of P waves, C: Narrowing and peaking of T waves, D: Ventricular arrhythmias - -### Response: -Hyperkalemia (plasma K+ +-7.0 meq/L). The PR and QRS intervals are within normal limits. Very tall, slender peaked T waves are now present. Hyperkalemia (plasma K+ +-8.5 meq/L). The QRS complex is broad and slurred and the QRS interval has widened to 0.2 s. The T waves remain tall and slender Fuher elevation of the plasma K+ level may result in ventricular tachycardia and ventricular fibrillation. Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No: 504 -### End" -2493,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Number of teeth present in the oral cavity at the age between 8-9 years:, with the following options: A: 12 teeth., B: 20 teeth., C: 24 teeth., D: 28 teeth. - -### Response: -24 teeth are present that is 12 primary and12 permanent teeth. -### End" -2494,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Testosterone inhibitor is-, with the following options: A: Spironolactone, B: Clomiphene, C: Bremelanotide, D: Sildenafil - -### Response: -Ans. is 'a' i.e., Spironolactone -### End" -2495,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Study useful for rare disease -, with the following options: A: Cohort study, B: Case-control study, C: cross sectional study, D: Field trial - -### Response: -Ans. is 'b' i.e., Case control study Advantages & Disadvantages of Case-contral studyADVANTAGES1. Relatively easy to carry out.2. Rapid and inexpensive (compared with cohort studies)3. Require comparatively few subjects.4. Particularly suitable to investigate rare diseases or diseases about which little is known.5. No risk to subjects6. Allows the study of several different aetiological factors (e.g., smoking, physical activity and personality characteristic in myocardial infarction).7. Risk factors can be identified. Rational prevention and control programmes can be established.8. No attrition problems, because case control studies do not require follow-up of individuals into the future.9. Ethical problems minimal.DISADVANTAGES1. Problems of bias relies on memory or past records, the accuracy of which may be uncertain; validation of information obtained is difficult or sometimes impossible.2. Selection of an appropriate control group may be difficult.3. We cannot measure incidence, and can only estimate the relative risk (odds ratio) but not the actual relative risk..4. Do not distinguish between causes and associated factors.5. Not suited to the evaluation of therapy or prophylaxis of disease.6. Another major concern is the representativeness of cases and controls. -### End" -2496,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Attacks of flushing and cyanosis occur in which type of ovarian tumors?, with the following options: A: Struma ovarii, B: Krukenberg's tumor, C: Arrhenoblastoma, D: Carcinoid tumors of ovary - -### Response: -Ans. is d, i.e. Carcinoid Tumors of ovaryRef: Shaw 15th/ed, p378Carcinoid tumor of Ovary:* It is sometimes primary and sometimes metastatic.* Also called Argentaffinoma.* Occurs as a malignant change in benign dermoid cyst.* Presence of solid yellow tumor with histological property of reducing silver salts derived from specialized Kulchitsky cells of intestine.* It produced 5 - HT which causes attacks of flushing and cyanosis.Q -### End" -2497,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 year old male presents with irreducible hernia. He had a dnoron seducible hernia for 5 years prior to this. He had bowel movement while examination at surgery, a Richter's hernia was found which of the following is true, with the following options: A: It contains meckel's diverticulam, B: It presents lateral to the rectus sheath, C: It may allow normal passage & stools, D: It present through obturator tomamen. - -### Response: -Richter's hernia is part of bowl wall entrapped in the hernial sac. -Leads to partial occlusion of lumen. -Bowel movements. -### End" -2498,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Steroid causes all except -, with the following options: A: Decreased healing of the wound, B: Water retention, C: |ed bone matrix formation, D: None of the above - -### Response: -Ans. is 'c' i.e., |ed bone matrix formation o Steroid causes Decreased healing of the wound Water retention | bone-matrix formation o Glucocorticoids cause decreased osteoid formation and increased resorption of bone, o They decrease intestinal Ca' absorption, o There is decalcification (not calcification) of bones. GLUCOCORTICOID ACTIONS Carbohydrate and protein metabolism Glucose - There is hyperglycemia o | Glycogen synthesis o | Peripheral utilization of glucose, o | Gluconeogenesis o | release of glucose from the liver. Protein - Glucocorticoids are catabolic o | protein breakdown and aminoacid mobilization from peripheral tissues - negative nitrogen balance. Uricosuric action - Glucocorticoids increase uric acid excretion. Fat metabolism - Action is permissive in nature o T Lipolysis due to glucagon, GH, Adr & thyroxine o Redistribution of body fat - Extremities lose fat which is deposited over face* neck and shoulder - moon face, fish mouth, buffalo h ump. o Mechanism of redistribution - # Peripheral adipocytes are less sensitive to insulin, corticosteroid enhanced lipolytic action fo GH and Adr predominates, whereas truncal adipocytes respond mainly to enhanced insulin level under the influence of glucocorticoids. Calcium metabolism o |intestinal absorption & | renal excretion. o | loss of calcium from bone especially from spongy bone (vertebrae, ribs). Water excretion o Glucocorticoids maintain normal GFR (not aldosterone). CVS o Restrict capillary permeability, maintain the tone of arterioles and myocardial contractility', o They have a permissive effect on presser action of Adr and agiotensin --> Hypertension may occur. CNS o Have a mild euphoric effect Stomach o t gastric acid and pepsin secretion --> may aggravate a peptic ulcer. Skeletal muscles o Optimum level of corticosteroids is needed for normal muscular activity, o Both hypo & hypercorticism cause weakness. 9. Blood cells o | in numbers of RBCs, platelets and neutrophils. o | in lymphocytes, eosinophils and basophils - not due to destruction, but due to their sequestration in tissues. 10. Inflammatory responce o All components and stages are suppressed. o The most important overall mechanism is the limitation of recuitment of inflammatory cells at the local site (chemotaxis) and production of proinflam mat ory mediators like PGs, LTs, PAF through inhibition of phospholipase A2. o This is through the production of lipocortins that are responsible for the inhibition phospholipase A2 11. Immunological response o Glucocorticoids suppress all type of hypersensitivity and allergic reactions. o They cause greater suppression of cell mediated immunity (delayed hypersensitivity and graft rejection) - basis of use in autoimmune diseases and organ transplantation, o Effect is due to suppression of recruitment of leukocytes at the site of contact with antigen and of inflammatory response to immunologic injury. o Antibody production and complement function is not impaired. Note - o Corticoids have some direct and some permissive actions. Direct - Corticoids themselves produce an effect. Permissive - Corticoids do not themselves produce an effect, their presence facilitates the action of other hormones. -### End" -2499,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Esophageal carcinoma what is the most important prognostic indicator?, with the following options: A: Length of involvement, B: Depth of invasion, C: Histological grading, D: Immunohistochemistry - -### Response: -Ans. is 'b' i.e., Depth of invasion Prognostic indicators in esophageal carcinoma:* The depth of invasion of the tumor through the wall of esophagus, is the most important prognostic indicator, with considerable independent prognostic significance.* Presence or absence of lymph nodal metastases is a significant and independent indicator of prognosis.Other prognostic indicators:* Presence or absence of distant metastases* Resection margins* Serosal or peritoneal involvement* T1 subclassification* Vascular invasion -### End" -2500,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of umblicus does not separate at age of 2 years., with the following options: A: Raspbery tumour, B: Leukocyte adhesion deficiency, C: Patent urachus, D: Umbilici granuloma - -### Response: -(Leukocyte adhesion deficiency) (1289- B & L 24th) (61-62-Basis pathology 7th) (985-Baily & Love 25th)* Leukocyte adhesion deficiency (LAD-1)- Defects in b chain of CD 11 /CD 18 integrins- Characterised by recurrent bacterial infections and impaired wound healing* Leukocyte adhesion deficiency (LAD-2)- Defect in fucosyl transferase required for synthesis of sialylated oligosaccharide- Characterised by recurrent bacterial infections* Raspberry tumour - (Umbilical adenoma) - due to a partially (occasionally completely) unobliterated vitellointestinal duct. Mucosa prolapsing through the umbilicus gives rise to a raspberry like tumour, which is moist and tends to bleed - Treatment umbilectomy -### End" -2501,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Syndrome of inappropriate ADH secretion is commonly associated with: March 2012, with the following options: A: Breast carcinoma, B: Ovarian carcinoma, C: Lung carcinoma, D: Hepatocellular carcinoma - -### Response: -Ans: C i.e. Lung carcinomaParaneoplastic syndromeParaneoplastic syndromes associated with breast carcinoma are hypercalcemia, dermatomyositis etc.Paraneoplastic syndrome associated with ovarian carcinoma is hypoglycaemiaThe most frequent causes of SIADH include the secretion of ectopic ADH by malignant neoplasms (paicularly small cell carcinomas of the lung), drugs that increase ADH secretion etc.Other paraneoplastic syndromes associated with lungs carcinoma are hypercalcemia (squamous cell carcinoma), cushings syndrome (small cell carcinoma), acanthosis nigricansParaneoplastic syndromes associated with hepatocellular carcinoma are carcinoid syndrome and polycythemia -### End" -2502,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Internal podalic version is done in, with the following options: A: Complete breech delivery, B: Frank breech delivery, C: Delivery of aftercoming twin, D: Preterm breech delivery - -### Response: -Internal podalic version is done for only delivery of second twin (Transverse lie). -### End" -2503,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Single hea sound (S2) is heard in:, with the following options: A: Transposition of great vessels, B: Ebstein's anomaly, C: Tetralogy of Fallot, D: TAPVC - -### Response: ---> Single second hea sound: It is either A2 / P2/ combination of both. Decision whether it is aoic / pulmonic / combination depends on location, intensity of S2 & clinical profile of pt Seen in: *Tetralogy of fallot --> S2 represents A2 component since pulmonic component is delayed, soft & inaudible. *Eisenmenger complex --> S2 represents combination of A2 & P2 - Thus, based on auscultation alone, it might be difficult to differentiate b/w TOF & Eisenmenger complex. History & chest X-ray can distinguish these conditions. -### End" -2504,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Banana sign on USG is seen in :, with the following options: A: Arnold Chiari malformation, B: Holoprosencephaly, C: Dandy walker malformation, D: Anencephaly - -### Response: -Compression or flattening of the posterior cerebellar surface making a crescentic appearance (banana sign) is seen in open spina bifida and Arnols Chairi's malformation. Reference: Dutta's Textbook of Obstetrics 7th edition page no 647 -### End" -2505,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A pharma agent wants to introduce vaccine for 1 yr old and see its efficacy. The study design should be ?, with the following options: A: Coho study, B: Clinical trial, C: Field trial, D: None - -### Response: -Ans. is 'c' i.e., Field trial Experimental epidemiology (Epidemiological Experiments) Experimental epidemiology is also called trial. Broadly speaking, a trial refers to putting something to a test. This allows the term to be used in reference to a test of a treatment for the sick or a test of a preventive measure intended to ave illness, injury or disease. Therefore, the defining feature of an experimental study is its ability to allocate or assign interventions or treatment to experiment unit. In simple words, the study of a treatment (Drugs, surgical intervention) or preventive measure (e.g. vaccination) on living subjects is known as experimental study or trial. Assignment of treatments may be based on Randamization - In randomized controlled trials Non-randmization trails There are following types of experimental trials Clinical trials: Used to evaluate treatment for people who are ill (e.g. a clinical trial of a chemotherapeutic agent) Field trails: Used to evaluate interventions to prevent disease in healthy people (e.g. a field trial of a vaccine). Community trial: Used to evaluate community-wide intervention (e.g. a community trail of the effects of fluoridation of public water supply). Animal Study: When clincial trails are done on animals (instead of human) is called animal study. In an experimental study, the investigator assign individuals in experimental group and reference group and then follows the two groups for the outcome of interests. Therefore, experimental study is prospective study. Before staing any experimental study the approval of ethics committee is required. The poocol of study is submitted to ethics committee and ethics committee gives approval to the studies which are ethical. So, all experimental studies are considered ethical (after taking approval of ethics committee). There are fewer ethical restrains on experimental study in animals than in human. -### End" -2506,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are autoimmune diseases, EXCEPT:, with the following options: A: SLE, B: Grave's disease, C: Myaesthenia gravis, D: Sickle Cell Disease - -### Response: -Sickle cell diease is not an autoimmune disease. Sickle Cell Disease is a structural hemoglobinopathy caused by a mutation in the f3-globin gene that changes the sixth ammoacid from glutamic acid to valine (HBS a2 B2 6Glu?Val), The mode of inheritance is autosomal recessive. Ref: Harrison 16th Edition, Page 678 ; Robbins Pathologic basis of disease 6th Edition, Page 611. -### End" -2507,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about pachydermia laryngitis except, with the following options: A: Hoarseness of voice, B: Premalignant condition, C: Involves posterior pa of larynx, D: Biopsy shows acanthosis and hyperkeratosis - -### Response: -PACHYDERMIA LARYNGIS It is a form of chronic hyperophic laryngitis affecting posterior pa of larynx in the region of interarytenoid and posterior pa of the vocal cords. Clinically, patient presents with hoarseness or husky voice and irritation in the throat. Indirect laryngoscopy reveals heaping up of red or grey granulation tissue in the interarytenoid region and posterior thirds of vocal cords; the latter sometimes showing ulceration due to constant hammering of vocal processes as in talking, forming what is called ""contact ulcer."" The condition is bilateral and symmetrical. It does not undergo malignant change. However, biopsy of the lesion is essential to differentiate the lesionfrom carcinoma and tuberculosis. Aetiology is unceain. It is mostly seen in men who indulge in excessive alcohol and smoking. Other factors are excessive forceful talking and gastro-oesophageal reflux disease where posterior pa of larynx is being constantly bathed with acid juices from the stomach. Treatment is removal of granulation tissue under operating microscope which may require repetition, control of acid reflux and speech therapy. Ref:- Dhingra; pg num:-292,293 -### End" -2508,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female child presents with vaginal bleeding for 4 days after birth, what is to be done?, with the following options: A: Wait and watch, B: Estrogen, C: Bleeding time, D: Factor deficiency screening - -### Response: -ANSWER: (A) Wait and watchREF: Shaw 13th ed p. 48Repeat from December 2009""Vaginal bleed may be noticed in neonates in first week, it is due to withdrawal of maternal estrogen circulating in the newborn circulation. No treatment is needed except for reassurance"" -### End" -2509,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following form the floor of third ventricle, except, with the following options: A: Infundibulum, B: Occulomotor nerve, C: Mammillary body, D: Optic chiasma - -### Response: -Floor of third ventricle is formed from before backward by :Optic chiasmaTuber cinerum & infundibulumMammillary bodiesPosterior perforated substanceTegmentum of midbrain(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 137) -### End" -2510,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Protein quality assessment is best done by –, with the following options: A: NPU, B: Biological value, C: Digestibillity coefficient, D: Amino acid score - -### Response: -Net protein utilization is considered to be most practile because it is the product of biological value and digestibility coefficient divided by 100. -### End" -2511,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Prerenal Azotemia, Except:, with the following options: A: Urinary Cr/Plasma Cr >40, B: FENa < 1, C: Urinary output < 400m1/day, D: Plasma BUN/Creatinine ratio <20 - -### Response: -Answer is D (Plasma BUN/Creatinine ratio <20): Prereanl Azotemia is characterized by, Plasma BUN/creatinine ratio of>20: I Oliguria (urine output that cannot be used to differentiate Prerenal Azotemia from Intrinsic Renal failure (ATN) Urine output Decreased urine output represents oliguric renal failure and may be seen in both prerenal and renal azotemia. Ucr/Pcr >40; FENa < I and UNA < 20 meci/1 are features of Prerenal Azotemia that may be used to distinguish Prerenal Azotemia from Intrinsic Renal Azotemia. -### End" -2512,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Range of kuppu swami scale for upper middle class:, with the following options: A: 26-29, B: 16-25, C: 16-26, D: 26-30 - -### Response: -Ans. (b) 16-25Ref: K. Park 23rd ed. / 690MODIFIED KUPPUSWAMI SCALE: Scale of socio- economic status of urban families, includes Education status of head, occupation status of head, Income per capita.Total score of 3 componentsSocioeconomic class* 26-29* 16-25* 11-15* 05-10* 03-04UpperUpper-middleLower-middleUpper-lowerLower -### End" -2513,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following are true about Rheumatoid ahritis except:, with the following options: A: Positive for Anti-IgG antibody, B: Juxta-aicular osteoporosis, C: Morning stiffness, D: C Reactive protein indicates better prognosis - -### Response: -Answer is D (C Reactive protein indicates better prognosis) Persons who present with high titers of Rheumatoid factor, C Reactive protein and Haptoglobin have a worse prognosis than the individuals who present with Subcutaneous nodules or Radiographic evidence of erosions -### End" -2514,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mamillary body receive afferent fibers, with the following options: A: Corpus callosum, B: Thalamus, C: Pituitary gland, D: Fornix - -### Response: -Mammillary body receive afferent fibers Fornix C - shaped bundle of nerve fibers which acts as major output tract of hippocampus They are association fibers(connects one brain center to another) It is pa of limbic system (Papez circuit) Papez circuit - for memory consolidation, emotions & behavior -### End" -2515,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are seen in the Horner's syndrome, Except, with the following options: A: Drooping of upper eyelid, B: Enophthalmos, C: Dilated pupil, D: Loss of sweating on same side of face - -### Response: -Horner&;s syndromeClinical featuresLess common featuresPtosisHyperactive accommodationMiosis Hypochromic heterochromiaAnhydrosisHypotonyEnophthalmosHyperemiaLoss of ciliospinal reflexes -### End" -2516,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: R-factor in bacteria is transfered by ?, with the following options: A: Transduction, B: Transformation, C: Conjugation, D: Veical transmission - -### Response: -Ans. is 'c' i.e., Conjugation Conjugation Bacterial conjugation is the transfer of genetic material between bacteria through direct cell to cell contact or through a bridge- like connection between two cells. Conjugation is process where by a donor (male) bacterium makes physical contact with a recipient (female) bacterium. Donor status is determined by the presence of plasmid. This plasmid codes for specialized fimbria (sex pilus) and for self transfer. Sex pilus (conjugation tube) helps in transfer of genetic material from male bacterium to female bacterium. The plasmid is known as transfer factor (sex factor or feility factor). Plasmid may be R factor, which codes for transferrable multiple drug resistance. The DNA of the plasmid replicates during transfer so that each bacterium receives a copy Recipient becomes donor and the donor retains its donor status. -### End" -2517,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In obstruction of second part of axillay artery, the anostomosis between the following artery will maintain the blood supply of upper limb:, with the following options: A: Deep branch of transverse cervical artery & subscapular artery, B: Anterior & posterior circumflex humeral, C: Posterior circumflex humeral & circumflex scapular artery, D: Suprascapular & anterior circumflex humeral artery - -### Response: -Ans. is 'a' i.e. Deep branch of transverse cervical artery & subscapular artery Axillary artery is the continuation of the subclavian artery. It is crossed by pectoralis minor muscle which divides it into three parts.A rich anastomosis exists around the scapula between branches of subclavian artery (first part) & the axillary artery (third part).This anastomosis provides a collateral circulation through which blood can flow to the limb when the distal part of subclavian artery or theproximal part of axillary artery is blocked. Anastomosis around the scapula :Formed by branches of- * Subclavian artery - first partSuprascapular arteryDeep branch of transverse cervical artery *Axillary artery - third partSubscapular artery & its circumflex scapular branchThere are other smaller anastomoses over the acromion process, which also helps to maintain flow to arm. (BDC Vol 1, 4/e, p 82) Anastomoses over the acromion process: Formed by -Acromial br. of thoraco-acromial arteryAcromial br. of suprascapular arteryAcromial br. of posterior circumflex humeral arteryThe subscapular artery also forms anastomoses with intercostal arteries. -### End" -2518,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The shortest part of the colon is-, with the following options: A: Transverse colon, B: Ascending colon, C: Descending colon, D: Sigmoid colon - -### Response: -Among given options, ascending colon is shortest. -### End" -2519,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cranial nerve involved in CSOM is -, with the following options: A: V, B: VII, C: IX, D: XI - -### Response: -Ans. is 'b' i.e., VII Complications of otitis mediaa. Extracranial complicationsb. Intracranial complicationso Mastoiditiso Petrositis/Gradenigo syndromeo Facial paralysiso Labyrinthitiso Osteomyelitis of temporal boneo Septicaemia or pyaemiao Meningitiso Extradural abscesso Subdural abscesso Otogenic Brain Abscesso Lateral sinus thrombophlebitiso Otitic hydrocephalus -### End" -2520,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ribosomes has following enzymatic activity?, with the following options: A: Peptidyl transferase, B: Peptidase, C: Aminoacyl tRNA synthetase, D: GTPase - -### Response: -The formation of peptide bonds is catalysed by peptidyl transferase, an activity intrinsic to the 23 S r-RNA of 50 S subunit in prokaryotes and 28 S r-RNA of 60 S subunit in eukaryotes. So, it is referred to as ribozyme & indicates a direct role of r-RNA in protein synthesis. -### End" -2521,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gas used in rapid airbag inflation, with the following options: A: Sodium azide, B: Nitrocellulose, C: Mercuric nitrate, D: Potassium nitrate - -### Response: -Chemistry of airbagsThe inclusion of airbags in the modern automobiles has led to decrease in the automobile injuries The term airbag is a misnomer as air is not involved in the inflation processRather an airbag inflates rapidly (in about 30ms) due to explosive production of N2 gas. Sodium azide is used which rapidly decomposed to nitrogen gas(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition) -### End" -2522,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is the MOST common site of salivary gland calculi formation?, with the following options: A: Parotid, B: Submandibular, C: Sublingual, D: Minor salivary glands - -### Response: -Submandibular salivary glands are the most common site for calculus formation. followed in frequency by parotid gland. Sublingual glands and minor salivary glands are rarely affected. Physiologic factors which contribute to stone formation are: Alkaline pH High calcium concentration Mucin content of saliva Submandibular salivary glands are the most common site for calculus formation. followed in frequency by parotid gland. Sublingual glands and minor salivary glands are rarely affected. Physiologic factors which contribute to stone formation are: Alkaline pH High calcium concentration Mucin content of saliva -### End" -2523,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a male after laparoscopic cholecystectomy, specimen is sent for histopathology which shows carcinoma Gallbladder stage IB. Appropriate management, with the following options: A: Conservative and follow up, B: Extended cholecystectomy, C: Excision of all po sites, D: Radiotherapy - -### Response: -Treatment of carcinoma Gallbladder Gallbladder cancer: Incidental pathological finding after laparoscopic cholecystectomy T1a with negative cystic duct margin : No fuher therapy T1a with postive cystic duct margin : Reresection of cystic duct or CBD to negative margin T1b, T2, T3 tumor with no evidence of metastasis : Reresection, extended cholecystectomy (possible CBD or extended hepatic resection) T4: Extended cholecystectomy with extended right hepatectomy N2 or M1 disease : Clinical trial (Chemoradiation or chemotherapy) in good performance status. Laparoscopic trocar site scars are excised for staging purpose to identify M1 disease than for any potential therapeutic benefit Ref: Sabiston 20th edition Pgno : 1512-1514 -### End" -2524,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: steven johnsons syndrome is a side effect of, with the following options: A: carbamezepine, B: lithium, C: clozapine, D: clonazepam - -### Response: -- SIDE EFFECTS OF THE DRUG - APLASTIC ANEMIA - AGRANULOCYTOSIS - Hyponatremia - Steven Johnson's syndrome - Liver enzyme elevation - It has teratogenic potential Ref.kaplon and sadock, synopsis of psychiaty, 11 th edition, pg no.923 -### End" -2525,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Multibacillary leprosy follow up for -, with the following options: A: 12-18 months, B: 2 years, C: 5 years, D: 10 years - -### Response: -It is recommended that multibacillary cases be examined clinically atleast once a year for a minimum period of 5 years after the completion of therapy. Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 344 -### End" -2526,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The protective effects off breast milk are known to be associated with –, with the following options: A: IgM antibodies, B: Lysozyme, C: Mast cells, D: IgA antibodies - -### Response: -Although antibodies and Lysozyme, both are important for the protective effects of breast milk, antibodies play a major role. Out of IgM and IgA antibodies, breast milk is especially rich in secretory IgA which is the single best answer here. -Protective role of breastfeeding against infection - -Breast milk provides protection against infection because of the following facts - - -1. The breast milk is clean and uncontaminated -2. Breast milk contains several antiinfective factors - - -Antibodies → secretory IgA, IgM -Lysozyme -Antistaphylococcal factor -Specific inhibitory substances against viral infections. -Lactoferrin → Inhibits growth of E. coli. -Bile stimulated lipase → kills Entamoeba histolytica and Giardia lamblia. -Bifidus factor → Inhibits growth of E. coli -Para-amino-benzoic acid (PABA) → Provides protection against malaria -Phagocytic macrophages and lymphoid cells - -3. Lower pH of the stool of breastfed infants contributes to the favourable intestinal flora more bifidobacteria and lactobacilli, fewer E. coli. -### End" -2527,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Longest fetal skull diameter is:, with the following options: A: Mentovertical, B: Submentovertical, C: Submentobregmatic, D: Occipito-frontal - -### Response: -Ans-A -### End" -2528,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presented with painful ophthalmoplegia. On CT scan, there was enlargement of the cavernous sinus on one side. The most likely diagnosis is:, with the following options: A: Cavernous sinus thrombosis, B: Gradeniego's syndrome, C: Tolosa- Hunt syndrome, D: Orbital Pseudotumor - -### Response: -C i.e. Tolosa Hunt Syndrome Painful opthalmoplegia can be seen in cavernous sinus thrombosis, Tolosa Hunt syndrome & orbital pseudotumor. These are differentiated by? Orbital pseudotumor There is enlargement of extraocular muscles (not cavernous sinus)Q Gradeniego's syndrome CT scan show - enhancement of cavernous sinusQ (not enlargement) - petrous apicitis of temporal bone including opacification of mastoid air cells - bony erosion with in petrous apex Idiopathic orbital inflammatory disease (Pseudo tumor) It is non neoplastic, non infectious, non specific space occupying orbital lesion (a diagnosis of exclusion). Unilateral disease is the rule in adults, although may be bilateral in children. It usually presents in 30-60 years male with acute unilateral periorbital (lid) redness, swelling and pain with proptosis. Rarely opthalmoplegia and optic nerve dysfunction may occur in severe cases. It may 1/t intermittent episodes with spontaneous recovery without sequelae or prolonged course resulting in frozen orbit characterized by opthalmoplegia, ptosis & visual impairment. USG shows diffuse infiltration of hetrogenous consistency CT scan shows ill defined orbital opacification & loss of definition of contents, diffuse thickening of the extraocular muscles including their tendinous inseion, which differentiates it from thyroid eye disease where the muscle enlargement is confined to the muscle belly and spares the terminal tendinous poionQ. Steroids, radiotherapy (in unresponsive cases) and cyclophosphamide are used to treat. Tolosa-Hunt Syndrome It is a rare diagnosis of excision, caused by non specific granulomatous inflammation of the cavernous sinus, superior orbital fissure and /or orbital apexQ. The clinical course is characterized by remissions and recurrences. It is characterized by acute, painful, opthalmoplegia, with or without involvement of optic nerve and ophthalmic division of trigeminal nerve and it responds promptly to steroid treatment (in 24-48 hrs). It presents with diplopia a/w ipsilateral periorbital or hemicranial pain, mild proptosis, ocular motor nerve palsies often with involvement of pupil and sensory loss along the distribution of 1st & division of trigeminal nerve. Original cases had granulation around carotid aery in cavernous sinus. Full investigation to exclude diagnosis of carotid- cavernous fistula, infraclinoid aneurysm, pituitary tumor, meningioma & orbital tumor. Other lesions may be responsive to steroids but neither is the remission complete nor it occurs so rapidlyQ. THS should not be diagnosed with out aeriography and venography or when there are atypical features (clinical /radiological/in resonse to treatment). Thin slice high magnetic field MRI of cavernous sinus including coronal sections with & without contrast and fat suppressed cuts of orbital regions is modality of choice Inflammatory changes in cavernous sinus, superior orbital fissure & /or orbital apex are observed on high resolution contrast enhanced imaging. Enlargement of optic nerve &/or extra ocular muscles. -### End" -2529,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The vaginal smear shows presence of?, with the following options: A: Bacterial Vaginosis, B: Candidiasis, C: Human papilloma Virus, D: Trichomonas Vaginalis - -### Response: -Ans. (a) Bacterial VaginosisThe image shows presence of clue cells which are vaginal epithelial cells, coated with bacteria. The patient presents with whitish vaginal discharge with a fishy odor. -### End" -2530,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least pregnancy failure rate in, with the following options: A: IUCD, B: Oestrogen + Progesterone, C: Oestrogen alone, D: Progesterone alone - -### Response: -(Oestrogen + Progesterone) (547-Dutta 6th)Pregnancy Failure Rate (H,W,Y) (PEARL - INDEX)**Number of accidental pregnancies x 1200Number of patients in 100 year1200 = Number of months in 100 years* Condome = 14 * IUCD = 2* Diaphragm = 20 LNG- IUS (0.2 H.W.Y)]* Rhythm method = 20-30 = 1-2 H.W.Y* Coitus interruptus = 20 * OCP = * Progesterone alone [0.5-2 H.W.Y -### End" -2531,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sex ratio as per 2011 census-, with the following options: A: 970, B: 940, C: 921, D: 915 - -### Response: -Ans. is 'b' i.e., 940 * Important findings of census 2011# Total population-1210 millions# Annual average growth rate-164%# Decadal growth rate-17-64%# Sex ratio-940# Birth rate-22-1%# Death rate-7-2# Literacy rate-74%# Life expectancy-64 5 years# Density of population-382 -### End" -2532,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infantile polycythemia is seen in, with the following options: A: Cerebellar hemangioma, B: Retinoblastoma, C: Hepatoblastoma, D: Nesidioblastosis - -### Response: -Other clinical features include lethargy, tachypnea, cyanosis, jitteriness, poor feeding, feeding intolerance, hypoglycemia. Most common presentation: The majority of newborn infants withpolycythemia are asymptomatic. They can only be identified by performance of a hematocrit. Reference: GHAI Essential pediatrics, 8th edition -### End" -2533,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Absolute contraindication for IUCD are all except, with the following options: A: Pregnancy, B: Undiagnosed vaginal bleeding, C: Pelvic inflammatory disease, D: Uterine malformation - -### Response: -Absolute contraindications Suspected pregnancy Undiagnosed vaginal bleeding Cancer cervix Previous ectopic pregnancy Relative contraindications Distoions of the uterine cavity due to Congenital malformations Fibroids Anaemia Menorrhagia Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 497 -### End" -2534,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of Obstructive Jaundice resulting in Cholestasis which of the following enzymes are elevated?, with the following options: A: Alkaline phosphatase, B: 5' Nucleotidase, C: GGT, D: All the above - -### Response: -Ans. (d) All the aboveRef: Bailey And Love Page 1155* Elevated Bilirubin- Direct in Obstructive Jaundice* Elevated Alkaline Phosphatase- Cholestatic Liver disease or Partial Obstruction.* AST and ALT are elevated in Acute hepatocellular Damage* GGT is elevated in Liver injury due to alcohol -### End" -2535,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Verapamil acts by -, with the following options: A: Blocking membrane depolarisation, B: Calcium channel blockers, C: Membrane stabilising, D: Blocking membrane repolarisation - -### Response: -Ans. is 'b' i.e., Calcium channel blocker o Calcium channel blockers delay the recovery of `L' type calcium channel from inactivated state to resting state --> depression of pacemaker activity and conduction - negative ionotropic, chronotropic and dromotropic effect. o Amongst CCBs, recovery of Ca' channel is delayed maximally by verapamil and to a lesser extent diltiazem. o DHPs do not delay the recovery - no negative chronotropic, ionotropic or bathantotropic effect, infact sho acting DHPs like nifedipine can cause tachycardia and paradoxically increase the frequency of angina sho acting DHPs should not be used in angina. -### End" -2536,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most probable diagnosis in a newborn baby with regurgitation of feeds and continuous drooling of saliva is:, with the following options: A: Esophageal atresia, B: Diffuse esophageal spasm, C: Achalasia cardia, D: Zenker's diveiculum - -### Response: -Continuous drooling of saliva indicates no communication of Esophagus distally - esophageal atresia. Type E is also known as H shaped Fistula Least Common- Type D Classification of TEF Type A: Atresia only (6%) Type B: Atresia with proximal TEF (2%) Type C: Atresia with distal TEF (85%): Most common Type D: Atresia with both proximal and distal TEF (rare) Type E: TEF only (1%) Clinical Features The diagnosis of EA is enteained in an infant with excessive salivation along with coughing or choking during the first oral feeding. A maternal history of polyhydramnios is often present. The newborn baby with atresia regurgitates all of its first and subsequent feeds0. Saliva pours continuously from its mouth . Repeated episodes of coughing, choking and cyanosis occur on feeding in TEF. Associated Anomalies MC anomaly associated with TEF is CVS (VSD). Esophageal atresia may occur as pa of VACTERL group of anomalies: -V: Veebral body segmentation defects0 -A: Anal atresia0 -C: Cardiovascular (PDA, VSD) -TE: Tracheoesophageal fistula -R: Renal (unilateral renal agenesis) -L: Limb anomalies (radial ray hyplasia) -### End" -2537,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Health assistant should make repos of bihs and deaths occurring in their area every: September 2011, with the following options: A: Day, B: Week, C: Month, D: Year - -### Response: -Ans. B: Week Common job functions for the health assistants (male and female) include collecting and compiling the weekly repos of bihs and deaths occurring in their areas and submitting them to the MO PHC. -### End" -2538,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DNA double helix is maintained by:, with the following options: A: Hydrogen bond, B: Vanderwaal forces, C: Disulfide linkage, D: Covalent bond - -### Response: -In a DNA double helix, two polynucleotide strands come together through complementary pairing of the bases, which occurs by hydrogen bonding.Each base forms hydrogen bonds readily to only one other -- A to T and C to G -- so that the identity of the base on one strand dictates what base must face it on the opposing strand.Thus the entire nucleotide sequence of each strand is complementary to that of the other, and when separated, each may act as a template with which to replicate the other. -### End" -2539,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Charas is, with the following options: A: Leaves of Cannabis Indica, B: Flowers of Cannabis Indica, C: Stem of Cannabis Indica, D: Resin exudate of Cannabis Indica - -### Response: -Resin exudates of cannabis Indica Ref ; Narayana reddy 33rd ed. -### End" -2540,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following antiepileptic drugs acts by affecting the levels of GABA?, with the following options: A: Sodium valproate, B: Ethosuximide, C: Phenytoin sodium, D: Carbamazepine - -### Response: -Ans. (A) Sodium valproate(Ref: KDT 8/e p444)It acts by various mechanisms like increase in GABA, blockade of Na+ channels and inhibition of T-type Ca2+ currents. Valproate increases the formation of GABA (by stimulating glutamic acid decarboxylase) and inhibits the degradation of GABA (by inhibiting GABA transaminase and succinic semialdehyde dehydrogenase).Phenytoin and carbamazepine acts by affecting neuronal Na+ channels.Ethosuximide acts by affecting T-type Ca2+ currents. -### End" -2541,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of hypoglycemia due to insulin is all except, with the following options: A: Glucagon, B: Glucose IV, C: Adrenaline, D: Candy - -### Response: -Adrenaline is a counter-regulatory hormone. Hypoglycemia is managed by glucose or oral carbohydrates or oral juices or Glucagon other counter regulatory hormones are growth hormone,steroids. Ref: Harrison16th ed. Pg 2185 -### End" -2542,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a scotochromogen?, with the following options: A: M.fouitum, B: M.kansasii, C: M.ulcerans, D: M.scrofulaceum - -### Response: -The organisms which produce the pigment chiefly in the dark are called scotochromogens. M. scrofulaceum causes scrofula, a granulomatous cervical adenitis, usually in children. (M. tuberculosis also causes scrofula.) The organism enters through the oropharynx and infects the draining lymph nodes. Its natural habitat is environmental water sources, but it has also been isolated as a saprophyte from the human respiratory tract. Scrofula can often be cured by surgical excision of the affected lymph nodes. Mycobacterium fouitum-chelonae complex is composed of two similar species, M. fouitum and M. chelonei. They are saprophytes, found chiefly in soil and water, and rarely cause human disease. Infections occur chiefly in two populations: (1) immunocompromised patients and (2) individuals with prosthetic hip joints and indwelling catheters. It is a rapidly growing mycobacteria. M. kansasii causes lung disease clinically resembling tuberculosis. It is a photochromogen. Do You Know: Mycobacterium marinum causes ""swimming pool granuloma,"" also known as ""fish tank granuloma"". Ref - Levinson W. (2012). Chapter 21. Mycobacteria. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e. -### End" -2543,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Slit lamp examination helps in the examination of, with the following options: A: Anterior 2/3rd of choroid, B: Anterior 1/3rd of choroid, C: Posterior 1/3rd of choroid, D: Posterior capsule - -### Response: -Structures examined in Slit lamp: *Eyelids *Conjunctiva *Cornea *Anterior chamber *Iris and Pupil *Lens - Anterior and Posterior surface *Retina ( with +78D or +90D lens ) Choroid can be examined with Indirect Ophthalmoscopy only. Reference : Khurana's Theory and Practice of Optics and Refraction; 2nd Ed; Pg. 350-360 -### End" -2544,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thickness of cornea is best measured by:, with the following options: A: Keratometer, B: Pachymeter, C: Optometer, D: Pentoscope - -### Response: -Ans. Pachymeter -### End" -2545,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During which of the following sleep stages shows sleep spindles in ECG?, with the following options: A: Stage 1, B: Stage 2, C: Stage 3, D: Stage 4 - -### Response: -Ans. B. Stage 2Stage 1 (sleep)presence of theta waves 4-HzStage 2 (sleep)Sleep spindles appears as sinusoidal waves occurring at a frequency of 12-14 Hz. Presence of sleep spindles and K complexes. K complexes are occasional high voltage biphasic waves.stage 3A high-amplitude delta rhythm (0.5-4 Hz) are seen.Stage 4presence of slow waves. -### End" -2546,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common Molluscum virus:, with the following options: A: 1, B: 2, C: 3, D: 4 - -### Response: -Ans. a. 1 -### End" -2547,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Schizophrenia is characterized by: Kerala 06, with the following options: A: Delusion and hallucination, B: Tremor and delusion, C: Obsession and delusion, D: Autonomic disturbance - -### Response: -Ans. Delusion and hallucination -### End" -2548,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is true about halothane except?, with the following options: A: Volatile liquid with sweet odour, B: Sensitises hea to adrenaline, C: Constricts bronchii, D: Causes malignant hypehermia - -### Response: -Ans. is 'c' i.e., Constricts bronchii Halothane It is a volatile liquid with sweet odour, nonirritating and noninflammable. It is a potent anaesthetic with poor analgesic and muscle relaxant propeies. Halothane causes direct depression of myocardial contractility by reducing intracellular Ca. It causes fall in BP and CO. Hea rate decreases due to vagal stimulation. It tends to sensitize the hea to arrhythmogenic action of adrenaline - contraindicated in pheochromocytoma. It causes greater depression of respiration and ventilation perfusion mismatch. It dilates the bronchi - inhalation agent of choice in asthmatics (intravaneous anaesthetic of choice in asthmatics is ketamine). It is a hepatotoxic drug and can also cause malignant hypehermia (Succinylcholine accentuate it). Recovery is smooth and reasonably quick. It causes postanaesthetic shivering and chills. It inhibits intestinal and uterine contractions - agent of choice for assisting external or internal version during late pregnancy. Because its uterine relaxant action it is contraindicated during labour. It is paicularly suitable for induction and maintenance in children and as maintenance anaesthetic in adults. -### End" -2549,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inability to perform physical activity without discomfo falls under, with the following options: A: NYHA class 1, B: NYHA class 2, C: NYHA class 3, D: NYHA class 4 - -### Response: -Ans. d. NYHA class 4 -### End" -2550,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pipkin fracture is defined as, with the following options: A: Head of radius fracture, B: Head of femur fracture, C: Fracture dislocation of ankle, D: Fracture neck of femur - -### Response: -Pipkin fracture is defined as head of femur fracture. * pipkin types ( dislocation of hip with fracture of femoral head) type 1 : femoral dislocation of the hip with fracture of femoral head caudad to fovea centralis type 2: posterior dislocation of the hip with fracture of the femoral head cephalad to the fovea centralis type 3: type 1 & type2 with associated fracture of femoral neck type 4 : type1,2,3 with associated fracture of acetabulum Ref: Textbook of Ohopaedics, John Ebenezer, 6th edition, page no 214 -### End" -2551,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In VIPoma, which of the following is not seen?, with the following options: A: Watery diarrhea, B: Hypokalemia, C: Hypercalcemia & hyperglycemia, D: Increased acid secretion - -### Response: -VIPoma / Verner - Morrison syndrome / pancreatic cholera / WDHA syndrome M.C in tail of pancreas. C/F Watery diarrhea (4-6L) Hypokalemia Achlorhydria Hypovolemia Dyselectrolytemia. Medical emergency Management - IV fluids + correction of dyselectrolytemia RX of choice - Distal pancreatectomy -### End" -2552,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The best marker to diagnose thyroid related order is-, with the following options: A: T3, B: T4, C: TSH, D: Thyroglobulin - -### Response: -Answer is option 3 - TSH The enhanced sensitivity and specificity of TSH assays have greatly improved laboratory assessment of thyroid function. Normal TSH excludes primary abnormalities of thyroid mostly Harrison 19 /2283 -### End" -2553,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about neuropeptide Y except :, with the following options: A: Consist of 36 amino acids, B: Decreased in starvation, C: Decrease thermogenesis, D: Regulated by melanocortin - -### Response: -Neuropeptide secretion increases during starvation, the other actions are true regarding neuropeptide Y. -Neuropeptide Y is a polypeptide containing 36 amino acid residues that are closely related to the pancreatic polypeptide. It is present in many parts of the brain and the autonomic nervous system. In the autonomic nervous system, although not in the brain, much of it is located in noradrenergic neurons, from which it is released by high-frequency stimulation. It augments the vasoconstrictor effects of norepinephrine. Circulating neuropeptide Y from sympathetic nerves increases with severe exercise in humans. In the hypothalamus, it mediates increased appetite. Y1, Y2 Y4, Y5, and Y6 receptors for this polypeptide have been cloned. -### End" -2554,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Health status of a child under 5 years of age will be adversely affected by all of the following, EXCEPT:, with the following options: A: Malnutrition, B: Low bih weight, C: Maternal Hb of 11gm%, D: Infections - -### Response: -Out of all the options given, maternal Hb of 11gm% is the best answer as although maternal undernutrition and anemia (Hb As per Federation of Obstetrics and Gynaecological Society Hb ICMR grading of severity of anemia: Mild - 10.0 - 10.9g/dl Moderate - 7 - 7.9g/dl Severe - <7g/dl Very Severe - <4g/dl Ref: Essential of Pediatrics By O P Ghai, 6TH Edition, Pages 1-2; Clinical Obstretics By S. Gopalan, Sarala and Jain, Vanita, 10th Edition, Page 147; Management of High Risk Pregnancy : A Practical Approach By S. S. Trivedi, SS Trivedi, MS FICOG and Manju Puri, M. Puri, Page 274 -### End" -2555,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is supplied by the third crania] nerve ?, with the following options: A: Superior oblique, B: Inferior oblique, C: Lateral rectus, D: Dilator papillae - -### Response: -Ans. is 'b' i.e., Inferior oblique NerveMuscles suppliedGcculomotorSuperior, Inferior and medial RectusInferior obliqueLevator palpebrae superiorisSphincter pupillaeCiliary' muscleTrochlearSuperior obliqueAbducensLateral rectus -### End" -2556,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient admitted at 29 weeks of pregnancy with jaundice and severe pre eclampsia, BP 170/110, urine albumin 3+. Blood investigations reveal Hb=7gm%, platelet count=70,000, TLC=13,000, SGOT=230, bilirubin=2 mg/dL, INR=2. Diagnosis is?, with the following options: A: Acute Cholecystitis, B: HELLP syndrome, C: Hepatic rupture, D: IHCP - -### Response: -HELLP syndrome Complication of pre eclampsia Characterized by Hemolytic anemia, Elevated Liver enzymes, Low Platelets Management: platelet transfusion, management of pre eclampsia and termination of pregnancy Presence of HELLP classifies pre eclampsia as severe pre eclampsia Hepatic rupture is a rapid catastrophic event which frequently results in a moality -### End" -2557,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In ductus venous, the fetal blood from the placenta reaches to the liver through, with the following options: A: Poal vein, B: Right umbilical vein, C: Inferior vena cava, D: Left umbilical vein - -### Response: -when there is an increase in placental circulation, to facilitate the rapid transpo of blood through the liver ,a large passage is formed between left umbilical vein and right hepato cardiac channel.This passage is called ductus venosus REFERENCE: TEXTBOOK OF CLINICAL EMBRYOLOGY... VISHRAM SINGH SECOND EDITION....PAGE NO:241 -### End" -2558,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A rough / chalky surface of the cast is due to all of the following except:, with the following options: A: Not waiting for 20 min before pouring, B: Excess wetting agent left on impression, C: Air incorporation in the mix, D: Improper powder/water ratio of stone - -### Response: -Air incorporation in the mix leads to bubbles. -### End" -2559,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about complete mole:a) Presence of foetal parts and cardiac activityb) Normal uterine sizec) Beta hCG doubling time is 7-10 daysd) Pre eclampsia at < 24 weekse) Per vaginal bleeding is commonest presentation, with the following options: A: bde, B: ade, C: ace, D: bce - -### Response: -Complete Mole – Is that variety of H. mole in which no evidence of fetal tissue is seen. (i.e. option a is incorrect) M/C presenting symptom in H. mole is vaginal bleeding. -“Vaginal bleeding is the most-common symptom causing patient to seek treatment for complete mole pregnancy.” Novak 14/e, p 1585 (i.e. option ‘e’ is correct) -Early onset preeclampsia – if features of precampsia are present in < 24 weeks, complete mole should always be suspected (i.e. option ‘d’ is correct) -On P/A examination in molar pregnancy –size of the uterus in more than the expected period of amenorrhea in 70%,it corresponds with the period of amenorrhea in 20% and is smaller than the period of amenorrhea in 10% cases Thus normal size uterus may be seen in case of H. mole. -“Excessive uterine enlargement relative to gestational age is one of the classic signs signs of complete mole, although it is present in only about one half of the patients. -Novak 14/e, p 1585. -The clinical presentation of a complete mole has changed considerably over the past few decades. -“More than half of the patients diagnosed in the 1960’s and 1970’s had anemia and uterine size in excess of that predicted for gestational age. Complete moles, however, present infrequently today with these traditional signs and symptoms.” -Willimams Gynae 1/e, p757 -So from above lines, it is clear that uterine size more than the period of amenorrhea, was earlier a more common and typical presentation of complete H. moles. These days more common picture is uterine size corresponding of the period of amenorrhea. Thus, I am including option ‘b’ in correct answers. -As far as hCG levels are concerned : -In case of molar pregnancy, levels of b-hCG are higher than that which are expected for that gestational age (due to trophoblastic proliferation), but the doubling time is same i.e. 1.4-2 days -### End" -2560,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Esterase inhibitor deficiency causes:, with the following options: A: SLE, B: MPGN, C: Hereditary angioneurotic edema, D: Omen syndrome - -### Response: -Ans. (c) Hereditary angioneurotic edema(Ref: Harrison 18:2666-67, 17th ed 2030, 2031)Deficiency of complement componentDisease/Syndrome1. C1 esterase InhibitorHereditary angioneurotic edema -### End" -2561,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Material causing minimum tissue distortion is:, with the following options: A: Polysulphide, B: Silicone, C: Impression plaster, D: Zinc oxide eugenol paste - -### Response: -Impression plaster is a β-calcium sulfate hemihydrate used at a water/powder ratio of approximately 0.5 to 0.6. Its fluidity makes it suitable for making impressions of soft tissues in the uncompressed state, a characteristic of mucostatic impression material. -Ref: Phillip’s Science of Dental Materials ed 12 pg 177 -### End" -2562,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A two year old child presents with persistent diarrhoea acidic stools and presence of one per cent of reducing substance in the fresh stools. What is the most probable diagnosis ?, with the following options: A: Cystic fibrosis, B: Lactose intolerance, C: Rotavirus induced diarrhoea, D: Intestinal tuberculosis - -### Response: -Ans. is 'b' i.e., Lactose intolerance -### End" -2563,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Retinoblastoma gene regulates-, with the following options: A: Gi - S phase, B: G2 - M phase, C: Go - S1 phase, D: S - G1 phase - -### Response: -Ans. is 'a' i.e., G1- S phaseo Phosphorylation of RB is a molecular ""On-off' switch for cell cycle.o It regulates cell cycle at G,- S phase (has been explained in details in previous explanations). -### End" -2564,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Reynold's pentad of fever, jaundice, right upper quadrant pain, septic shock and mental status change in typical of:, with the following options: A: Cholangitis, B: Hepatitis, C: Cholecystitis, D: Pancreatitis - -### Response: -Cholangitis is one of the two main complications of choledochal stones, the other being gallstone pancreatitis. The most common presentation is fever, epigastric or right upper quadrant pain, and jaundice. These classic symptoms, well known as Charcot's triad, are present in about two thirds of patients. The illness may progress rapidly with septicemia and disorientation, known as Reynolds pentad (e.g., fever, jaundice, right upper quadrant pain, septic shock, and mental status changes). Ref: Oddsdottir M., Pham T.H., Hunter J.G. (2010). Chapter 32. Gallbladder and the Extrahepatic Biliary System. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e. -### End" -2565,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reservoir for scrub typhus -, with the following options: A: Mite, B: Humans, C: Rodents, D: Dogs - -### Response: -Ans. is 'c' i.e., Rodents DiseaseAgentInsect vectorMammalian reservoir1. Typhus group a. Epidemic typhusR. prowazekiiLouseHumansb. Murine typhus (Endemic typhus)R. typhiFleaRodentsc. Scrub typhusR. tsutsugamushiMiteRodents2. Spotted fever group a. Indian tick typhusR.conoriiTickRodents, dogsb. Rocky mountain spotted feverR.rickettsiiTickRodents, dogsc. Rickettsial poxR. akariMiteMice3. Others a. Q feverC.burnetiiNilCattle, sheep, goats.b. Trench feverRocholimaca quintanaLouseHumans -### End" -2566,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug being given is ?, with the following options: A: Ethacrydine lactate (0.1%), B: 20% mannitol, C: 50% Urea, D: Misoprostol - -### Response: -Ethacrydine lactate (0.1%) is used only extra – amniotically. -### End" -2567,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are indicators for the assessment of the nutritional programm except -, with the following options: A: Weight and height of the preschool child, B: Prevalence of low Bih weight (less than 2.5 kg) in community, C: Nutritional assessment of the preschool child, D: Prevalence of pregnant mothers having Hb<11.5g % in the 3rd trimester - -### Response: -Infant and preschool children and school children are the phenomenon indicating nutritional statusREF.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.Editon-21.Page no.-602. -### End" -2568,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common toxin causing Dilated Cardiomyopathy is:, with the following options: A: Alcohol, B: Chemotherapeutic agents, C: Heavy metal, D: Occupational exposure - -### Response: -Answer is A (Alcohol) Chronic Alcohol Consumption is the most common cause of Toxic Dilated Cardiomyopathy. Alcohol is the most common toxin implicated in chronic dilated cardiomyopathy' Note : Dilated cardiomyopathy is the most common type of cardiomyopathy The most common cause of dilated cardiomyopathy is Idiopathic (Two-Thirds) Alcohol Consumption is the most common cause of Toxic Dilated Cardiomyopathy -### End" -2569,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about branchial cysts except -, with the following options: A: They are commonly located in the posterior triangle of neck, B: They are lined by squamous epithelium, C: They are remnants of branchial apparatus that is persistent, D: It may contain granulation tissue - -### Response: -Ans. is 'A' i.e., They are commonly located in the posterior triangle of neck MASSSITEBranchial cystAnterior border of sternocleidomastoidThyroglossal cystMedian neckCystic HygromaPosterior triangleCarotid Body TumourAnterior TriangleBranchial Cleft Cystso Branchial cleft cysts are congenical cysts that are located in the lateral aspect of the neck. They are the result of developmental anomalies of the branchial clefts. Apel et al (1994) reported branchial cleft cysts located within the thyroid. The cysts may remain occult until middle or older age and may appear suddenly. The branchial cysts may become inflamed and clinically painful. The cysts are usually lined by mature squamous epithelium supported by a stroma rich in lymphoid tissue, sometimes forming mature lymph follicles. Occasionally, the squamous epitheilium is less mature and is composed of smaller squamous cells of parabasal type with large nuclei. On rare occasions, part of the cyst lining will be composed of mucus-producing columnar cellso Aspiration usually yields thick, very turbid, white or yellow fluid. The cysts may disappear after complete aspiration of the contents, resulting in cure. However, some cysts may recur and the fluid can reaccumulate. Microscopically, the fluid contains a variable number of mature squamous cells and acellular squames, proteinaceous material, cellular debris, and lymphocytes, Less often, and particularly in the presence of inflammation, the squamous cells may be smaller, of a parabasal or even basal type, and may show nuclear enlargement, some hyperchromasia, or even pyknosis. The smear background may show evidence of acute or subacure inflammation and sometimes may contain granulation tissue, characterized by numerous capillaries, fibroblasts and mono and multinucleated macrophages (Koss et al, 1992). -### End" -2570,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NK cells are -, with the following options: A: Activated macrophages, B: Antibody-activated T cells, C: Null cells activated by complement, D: Independent of antibody - -### Response: -NK cells are unique, however, as they have the ability to recognize stressed cells in the absence of antibodies and MHC, allowing for a much faster immune reaction. They were named ""natural killers"" because of the initial notion that they do not require activation to kill cells that are missing ""self"" markers of MHC class 1. Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg:137 -### End" -2571,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements regarding the schilling test for vitamin B|2 malabsorption is most accurate?, with the following options: A: The schilling test results are abnormal in patients with dietary vitamin B,,deficiency, B: In patients with pernicious anemia, the results of the schilling test normalize after oral administration of intrinsic factor, C: In patients with ileal disease, the results of the schilling test normalize after oral administration of intrinsic factor, D: Pancreatic exocrine insufficiency does not cause schilling test results to be abnormal - -### Response: -Ans. is 'b' i.e., In patients with pernicious anemia, the results of the schilling test normalize after oral administration of intrinsic factor An abnormal Schilling Is test that corrects or normalizes after administration of intrinsicfactor suggests a diagnosis of Pernicious Anemia (Intrinsic Factor Deficiency).Shilling '.s' test corrects after the administration ofo Intrinsic factor-Pernicious anemiao Pancreatic enzyme-Exocrine pancreatic deficiencyo Five day antibiotic-Bacterial overgrowth syndromeso Does not correct after administration of any of the above-Ileal dysfunction -### End" -2572,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dehydrogenase in HMP shunt act in oxidative phase to generate which of the following?, with the following options: A: NADP+, B: NADPH, C: FAD+, D: FADH - -### Response: -. -### End" -2573,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The study for correlation of genetic disease to consanguinity -, with the following options: A: Case Contral Study, B: Cohort study, C: Cross-sectional study, D: Case report - -### Response: -Ans. is 'a' i.e., Case Control Study "" The association of consanguinity with complex disorders can be studied using different approaches. For example, epidemialogial surveys could compare the frequency of a disorder in the progeny offirst cousin parents with that of unrelated parents, whereas case-control studies could compare the rates of first cousins among affected individuals and controls"". -### End" -2574,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presented with complaints of dysphagia. On UGI Endoscopy a diagnosis of esophageal candidiasis was made. The organism obtained from the sample was cultured on a specialized media and the below findings were visible on microscopy of the culture. What phenomenon is shown below?, with the following options: A: Germ tube formation, B: Spore formation, C: Mould to yeast formation, D: Budding - -### Response: -(a) Germ tube formationCandidiasis* Candidiasis MC fungal infection in humans both in HIV and non-HIV infected people.* Caused by Candida, a yeast like fungus that produces pseudohyphae.Various species of Candida include:* Candida albicans: The most common and most pathogenic species* Other rare species are C. tropicalis, C. Glabrata, C. Krusei, C. parapsilosis, C. dubliniensis, C. kejyr, and C. viswanathii.Predisposing factors that are associated with increased risk of infection with Candida include-* Physiological state: Extremes of age (infancy, old age), pregnancy* Low immunity: Patients on steroid or immunosuppressive drugs, post transplantation, malignancy, HIV* Patients on broad spectrum antibiotics suppresses the normal flora* Diabetes mellitus, febrile neutropenia and zinc or iron deficiency.Clinical ManifestationsCandida species are a part of normal flora of the skin and mucosa including gut flora. In presence of opportunistic conditions, they can cause various infections.1. Mucosal candidiasis:* Oropharyngeal candidiasis (oral thrush) presents as white, adherent, painless patches in the mouth* Candidal vulvovaginitis thin whitish curd like vaginal discharge* Balanitis and balanoposthitis (occurring in uncircumcised males)* Esophageal candidiasis* Angular stomatitis and denture stomatitis* Chronic mucocutaneous candidiasis: Seen in infants with deficient CMI, resistant to treatment.2. Cutaneous candidiasis:* Intertrigo, Paronychia and onychomycosis (fungal infection of nail)* Diaper candidiasis in infants, Perianal candidiasis* Erosio interdigitalis blastomycetica, an infection between the digits of the hands or toes* Generalized disseminated cutaneous candidiasis, seen in infants.3. Invasive candidiasis: Results from hematogenous or local spread of the fungi. Various forms are:* UTI, Pulmonary candidiasis, meningitis, osteomyelitis and Hepatosplenic and disseminated candidiasis* Septicemia (C.albicans and C.glabrate).* Ocular: Keratoconjunctivitis and endophthalmitis* Nosocomial candidiasis (mainly by C. glabrata)4. Allergic candidiasis include:* Candida Vesicular lesions in the web space of hands, similar to that of dermatophytid reaction (both conditions are together called 7D' reaction)* Other allergic reactions include: Gastritis, irritable bowel syndrome and eczema.Laboratory Diagnosis* Direct microscopy: Gram-positive oval budding yeast cells (4-6 pm size) with pseudohyphae.* Culture on SDA: Colonies are described as creamy white, smooth, and pasty with typical yeasty odor.Tests for species identification:* Germ tube test: It is also called Reynolds Braude phenomenon, specific test for C. albicans.* It is differentiated from pseudohyphae as there is no constriction at the origin.* Though the test is specific for C.albicans, it may also be positive for C. dubliniensis.Note from Author: ""The germ tube formation of Candida albicans was shown in the AIIMS Question PseudohyphaeTrue hyphaeSeptaConstrictedNo constrictionOrigin of branchesConstricted and SeptateNo constriction, No septum presentGrows byBuddingApical elongationTreatment* Cutaneous candidiasis or oral thrush- DOC is topical azole* Esophageal and vulvovaginal candidiasis- DOC is oral flucconazole* Disseminated candidiasis- DOC is Amphotericin B* C.glabrata and C.krusei exhibit intrinsic resistance to azoles and are refractory to treatment with azoles. -### End" -2575,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Olecranon process of ulna helps in formation of?, with the following options: A: Radial notch, B: Trochlear notch, C: Olecranon fossa, D: Coronoid fossa. - -### Response: -Ans. is 'b' i.e., Trochlear notch Inner surface of olecranon process forms trochlear notch for aiculation of trochlea of humerus. Radial notch is seen in lateral pa of upper end of shaft (not on olecronon). Olecranon fossa and coronoid fossa are pa of lower end of humerus. -### End" -2576,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following thalamic nuclei do not project to neocoex?, with the following options: A: Reticular, B: Pulvinar, C: Interlaminar, D: Anterior thalamic - -### Response: -Except reticular nuclei every other thalamic nuclei project to neocoex. The output of reticular nuclei is mainly to other thalamic nuclei -### End" -2577,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common malignancy found in Marjolin&;s ulcer is, with the following options: A: Basal cell carcinoma, B: Squamous cell carcinoma, C: Malignant fibrous histiocytoma, D: Neutrophic malignant melanoma - -### Response: -Marjolin's Ulcer Low grade SCC, which develops on a chronic benign ulcer or a long standing scar tissue Arises from the edge of the ulcer. Marjolin's ulcer may develop in Post burn scar Long standing venous ulcer Chronic ulcer due to trauma. Chronically discharging osteomyelitis sinus Post - radiation ulcer Ref: schwaz's principle of surgery 10th edition Pgno :259 -### End" -2578,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which condition is associated with S-100 marker?, with the following options: A: Multiple myeloma, B: Malignant melanoma, C: Prostate carcinoma, D: Medullary carcinoma thyroid - -### Response: -Ans is 'b' i.e. Malignant melanoma Markers for melanocytes1) S-100 - 90% of tumors are positive2) HMB-45 - More specific but less sensitive than S-1003) TA-904) Tyrosinase5) Microphthalmia transcription factor 6) Melan-A -### End" -2579,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A non ventilated Preterm baby in incubator is under observation. Which is the best way to monitor the baby&;s breathing and detect Apnaea ?, with the following options: A: Infrared throraric movement study, B: Capnography, C: Nasal digital temperature monitoring, D: Impedence technique - -### Response: -Electrical impedance tomography (EIT) is a noninvasive type of medical imaging in which the electrical conductivity, permittivity, and impedance of a pa of the body is inferred from surface electrodemeasurements and used to form a tomographic image of that pa. Electrical conductivity varies considerably among various biological tissues (absolute EIT) or the movement of fluids and gases within tissues (difference EIT). The majority of EIT systems apply small alternating currents at a single frequency, however, some EIT systems use multiple frequencies to better differentiate between normal and suspected abnormal tissue within the same organ (multifrequency-EIT or electrical impedance spectroscopy). Figure : A cross section of a human thorax from an X-ray CT showing current stream lines and equi-potentials from drive electrodes. Note how lines are bent by the change in conductivity between different organs. Reference: GHAI Essential pediatrics, 8th edition -### End" -2580,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The below abnormality in x-ray skull can be seen in the following conditions except, with the following options: A: Multiple Myeloma, B: Histiocytosis X, C: Hyperparathyroidism, D: Paget's disease - -### Response: -. -### End" -2581,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Three point bony relationship Of the elbow is disturbed, with the following options: A: Supracondylar fracture of humerus, B: Fracture lateral Condyleof humerus, C: Monteggia fracture dislocation, D: Fracture of proximal radius - -### Response: -Fracture lateral condyle of the humerus Three point bony relation ship of elbow Fracture of medial or lateral and condyke/epicondyle/intercanglylar area Fracture of olecranon Elbow dislocation Refer Kenneth A Evil 4th p 609 -### End" -2582,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During inspiration the main current of air flow in a normal nasal cavity is through:, with the following options: A: Middle part of the cavity in a parabolic curve, B: Lower part of the cavity in a parabolic curve, C: Superior part of the cavity in a parabolic curve, D: Through olfactory area - -### Response: -(a) Middle part of the cavity in a parabolic curve(Ref. Cummings, 6th ed., 626)The main current of airflow passes through the middle part of the nose in a parabolic curve both during inspiration and expiration. -### End" -2583,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about gastrointestinal carcinoid tumor?, with the following options: A: Alcohol has no effect on the flushing attacks, B: Occur most commonly in jejunum, C: Tumors most commonly produce histamine, D: Preoperative octreotide scanning can detect extent of the disease - -### Response: -Answer- D. Preoperative octreotide scanning can detect extent of the diseaseThese neuroendocrine tumours occur throughout the gastrointestinal tract, most commonly in the appendix, ileum and rectum in decreasing order of frequency. Appendicular carcinoid tumours are most commonly noted as an incidental finding at appendicectomy.Carcinoid tumours arise from Kulchitsky cells at the base of intestinal crypts (of Lieberkuhn)The tumours can produce a number of vasoactive peptides, most commonly S-hydroxytryptamine (serotonin), but also histamine, prostaglandins and kallikrein.Classically, the flushing attack are induced by alcohol.The extent of disease can be assessed preoperatively using octreotide scanning, which may detect otheise clinically apparent primary and secondary tumour. -### End" -2584,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a property of viscoelastic material?, with the following options: A: Strain instantaneously during rapid stretching, B: Strain linearly over time when a stress is applied slowly, C: Both, D: None - -### Response: -Viscoelasticity — The ability of a material to strain instantaneously like an elastic solid during rapid stretching or to resist shear flow and to strain linearly over time (like honey) when a stress is applied slowly. -Ref: Phillip’s Science of Dental Materials ed 12 page no. 152 -### End" -2585,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Functional analysis of kidney is best done by, with the following options: A: Radionuclide scanning, B: IVP, C: Ultrasound, D: MRI - -### Response: -A i.e. Radionuclide scanning -### End" -2586,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oxigen are used as specific antidotes in, with the following options: A: Alcohol poisoning, B: Mercury poisoning, C: OP poisoning, D: Cyanide poisoning - -### Response: -Oximes These are specific antidotes. The available oxigen are Diacetyl monoxime. 2- pyridine Aldoxime Methiodide Pralidoxime chloride Action: Oximes react with phosphate moiety of organophosphate- AchE complex and get phosphorilated. So AchE is released from the complex and thus reactivated. The oximes decreases the muscarinic, nicotine and CNS effects of organophosphates within 10-40 minutes Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 450 -### End" -2587,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year-old female previous case history of fever, weight loss polyahralgia. Morning stiffness and bilateral hand pain the radiological finding is given below, what may be your diagnosis?, with the following options: A: Osteoahritis, B: Rheumatoid ahritis, C: Gout, D: Psoriatic Ahritis - -### Response: -X-ray image shows destruction of proximal interphylangeal joints RA - Typically in a female of 30-40 years with complain of polyahralgia, swelling and loss of weight. It usually involves the proximal joints of the fingers and has bilateral involvement. Another classic feature is generalized stiffness after periods of inactivity, especially in the early morning. Gout - 70% of acute gout affects the 1st metatarsal phalangeal joints.in joint aspiration needle shaped negatively biferingent mono sodiaum urate crystals are seen Psoriatic ahritis - It presents with ahritis of DIP joints. Psoriasis of skin and nails usually precedes the ahritis. * Osteoahritis - It commonly affects DIP and the thumb base in the hand. But it will not present with severely deformed hand. -### End" -2588,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Central sulcus is an example of, with the following options: A: Limiting sulcus, B: Axial sulcus, C: Operculated sulcus, D: Complete sulcus - -### Response: -Limiting sulcus develops along the plane of the coical areas, which differ in the function they primarily subserve. Central sulcus (of Rolando) forms the boundary between the motor area of cerebral coex in front and sensory area behind. Calcarine sulcus is also a limiting sulcus. Axial sulci develop along the long axis of rapidly growing homogenous areas. Operculated sulcus is similar to limiting sulcus in that it separates functionally different areas but transition occurs in the lip and not on the floor. Complete sulcus is deep enough to produce an elevation in the wall of ventricle.(Ref: Vishram Singh textbook of clinical neuroanatomy, second edition pg- 142) -### End" -2589,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is a neural tube defect?, with the following options: A: Spina bifida occulta, B: Encephalocele, C: Dermal sinus, D: All of these are NTD - -### Response: -Ans. D. All of these are NTDNeural tube defects are failure of closure of the neural tube between 3rd-4th weeks of intrauterine life. Important neural tube defects include spina bifida occulta, meningocele, meningomyelocele, dermal sinus, encephalocele, anencephaly, syringomyelia and diastematomyelia. -### End" -2590,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Man is definitive host for -, with the following options: A: Echinococcus, B: Malaria, C: Filariasis, D: Rabies - -### Response: -W.bancrofti passes its life cycle in two host Man -definite host Mosquito-intermediate host The adult worms are harboured in the lymphatic system of man. The lymph provides nutrition to adult worms (refer pgno:166 baveja 3 rd edition) -### End" -2591,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Parathyroid auto-transplantation is done in which of the following muscle?, with the following options: A: Brachioradialis, B: Biceps, C: Triceps, D: Saorius - -### Response: -Hypoparathyroidism Surgical cause of hypoparathyroidism is Auto thyroidectomy (whole of thyroid is removed) MCC of hypoparathyroidism: Autoimmune Post thyroid surgery, > 72 hours tetany develops leading to laryngospasm. So, to prevent this, auto-transplantation in Brachioradialis is done -### End" -2592,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kupffer cells are found in:, with the following options: A: Hea, B: Lungs, C: Liver, D: Spleen - -### Response: -Lungs -### End" -2593,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How many days after ovulation is placental circulation established :, with the following options: A: 18-21, B: 11-Sep, C: 9-Jul, D: 30-33 - -### Response: -18-21 -### End" -2594,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice in whole body imaging in metastasis is -, with the following options: A: Magnetic Resonance Imaging, B: Radiography, C: Bone scan, D: CT Scan - -### Response: -Best investigation for bony metastasis is MRI. MRI has almost 100% sensitivity in detecting bony metastasis Investigation of choice for whole body screening for bony metastasis is Bone scan Intial investigation in symptomatic bone pain is Radiography CT is used in evaluation of focal abnormalities of bone scan and also for guided needle biopsy. -### End" -2595,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pungent volatile anaesthetic agents are – a) Halothaneb) Isofluranec) Sevofluraned) Desfluranee) N2O, with the following options: A: c, B: d, C: bd, D: ac - -### Response: -Pungent volatile anaesthetics :- Desflurane, isoflurane, enflurane, ether. -""Desflurane is the most pungent of the volatile anaesthetic"". -Non pungent volatile anaesthetics N2O, Halothane, Sevoflurane. -### End" -2596,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: WHO grade I tumour is located in Cerebellum On histological examination Rosenthal fibres seen what is the most probable diagnosis?, with the following options: A: Medulloblastoma, B: Crainopharyngioma, C: Pilocytic astrocytoma, D: Ependymoma - -### Response: -Pilocytic astrocytoma : - -WHO grade I tumour. -Usually occurs in Cerebellum. -Biphasic tumour. -Rosenthal fibres seen. -### End" -2597,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a specimen of kidney, fibrinoid necrosis is seen and onion peel appearance is also present. Most probable pathology is:, with the following options: A: Hyaline degeneration, B: Hyperplastic aeriosclerosis, C: Glomerulosclerosis, D: Fibrillary glomerulonephritis - -### Response: -Histological alterations characterizing blood vessels in malignant hypeension. ? Hyperplastic aeriosclerosis Fibrinoid necrosis of aerioles: Onion-skinning (concentrically arranged smooth muscle with collagen). -### End" -2598,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NDPS act does not include -, with the following options: A: Poppy, B: Paracetamol, C: Cannabis, D: Coca - -### Response: -The Narcotic Drugs and Psychoactive Substances Act 1985 (NDPS) This Act repeals and renders obsolete three Acts namely - 1. The Opium Act 1857 2. The Opium Act 1878 3. The Dangerous Drugs Act 1930 * According to this Act, a narcotic drug refers to the cocoa leaf, cannabis (hemp), opium, poppy straw and includes all manufactured drugs. A manufactured drug means all the cocoa derivatives, medicinal cannabis, opium derivatives and poppy straw concentrate and any other narcotic substance preparation, which the Central Government may by notification, declare to be manufactured drug. * The Act defines psychotropic substance as any substance, natural or synthetic, included in the list of psychotropic substances specified in a Schedule to the Act. The Schedule lists 77 psychotropic substances. * Under section 27 of the Act, if a person possess in a small quantity, any narcotic drug or psychotropic substance intended for personal use and not for sale or distribution, or consumes any narcotic or psychotropic substance, he shall be punished with imprisonment for a term, which may extend to one year or with fine or with both. The small quantity as quoted in the definition means: 1. 5 gm of hashish 2. 250 mg of heroin, smack and brown sugar 3. 5 gm of opium 4. 125 mg of cocaine 5. 500 gm of ganja * NDPS Act prohibits the cultivation of poppy, cannabis and coca plants, however restricted cultivation is allowed for medicinal or scientific purpose. * The minimum punishment for any offense committed under the Act is 10 years rigorous imprisonment and fine of Rs. 1 lakh while maximum punishment is 20 years rigorous imprisonment and fine of Rs. 2 lakh. REF:THE SYNOPSIS OF FORENSIC MEDICINE AND TOXICOLOGY:K S NARAYANA REDDY;PAGE NO 277 -### End" -2599,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Veical transmission is by-, with the following options: A: Mosquitoes, B: Direct contact, C: Droplet, D: Placenta - -### Response: -When the infectious agent is transmitted veically from infected female to her progeny in the vector is known as transovarial transmission.Transmission of the disease agent from one stage of the life cycle to another as for example nymph to adult is known as transstadial transmission (refer pgno:98 park 23rd edition) -### End" -2600,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Smallest Virus is ?, with the following options: A: Herpes virus, B: Adenovirus, C: Parvovirus, D: Poxvirus - -### Response: -Ans. is `c' i.e. Parvovirus -### End" -2601,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood culture is positive in which infection of Staphylococcus aureus is, with the following options: A: TSS, B: SSSS, C: Infective endocarditis, D: Impetigo - -### Response: -Infections caused by methicillin-sensitive S aureus, high-magnitude bacteremia (defined as >4 positive blood cultures ), and endocarditis. The most impoant test is a blood culture used to identify bacteria in the bloodstream. REFERENCE: www.mayoclinic.org -### End" -2602,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement is not true about Gout?, with the following options: A: Alcohol is a risk factor for the disease, B: Tophi is characteristic of gout, C: Great toe is most commonly affected, D: Aspiration shows urate crystals which are needle shaped and positively birefringent - -### Response: -Aspiration in acute gout shows  diagnostic finding of needle shaped negatively-birefringent uric acid crystals(yellow when parallel to the axis ) -### End" -2603,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 34-year-old man is admitted to the emergency department after a traumatic landing into a swimming pool from a high diving platform. The patient has multiple traumas in his abdominal cavity. After a reconstructive operation of his abdominal organs the patient develops a high fever. Radiographic examination reveals that the lower portion of the descending colon and rectum has become septic and must be excised. Six months postoperatively the patient complains of impotence. Which of the following structures was most likely injured during the second operation?, with the following options: A: Pudendal nerve, B: Sacral splanchnic nerves, C: Pelvic splanchnic nerves, D: Sympathetic chain - -### Response: -The pelvic splanchnic nerves contain parasympathetic efferent fibers that mediate erection. These same nerves innervate the hindgut, the portions of the large intestine that were removed in this patient. -### End" -2604,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dumping syndrome is due to all except:, with the following options: A: Motilin, B: Small stomach, C: Hypeonic fluid contents in bowel, D: Neurotensin - -### Response: -Dumping syndrome Signs and symptoms arise from the rapid emptying of hyperosmolar gastric contents into the small intestine, resulting in a fluid shift into the gut lumen with plasma volume contraction and acute intestinal distention. Release of vasoactive GI hormones -vasoactive intestinal polypeptide, neurotensin, motilin play a role in early dumping. Early dumping takes place 15-30 minutes after meals and consists of crampy abdominal discomfo, nausea, diarrhea, belching, tachycardia, palpitations, diaphoresis, lightheadedness, and, rarely, syncope. -### End" -2605,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child 4 month old has 10 episodes of vomiting and 2-3 episodes of loose stools and crying since the last 24 hours, best line of management will be ?, with the following options: A: Intravenous fluids, B: ORS, C: Intravenous fluids then ORS, D: Hospitalise and treat - -### Response: -In the given case baby is crying(irritable,restless state)it denotes some dehydration. so we opt for treatment plan B:patients with some dehydration need to be treated in a health centre .however, oral fluid therapy must be commenced promptly, Rehydration therapy :give 75 ml/kg of ORS in the first 4 hours. Maintainance flulid therapy:when signs of dehydration begins to disappear ,usually within 4 hours, ORS is administered in volume equal to diarrhoea loses. Approximately 10-20 ml /kg bw for each liquid stool Ref : ESSENTIAL PEDIATRICS, O.P.GHAI, 7 th edition PG NO:264,265 -### End" -2606,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for lactating female with a painful lump?, with the following options: A: USG, B: CT, C: MRI, D: Mammogram - -### Response: -Ans. A. USGPainful lump in a lactating female is suggestive of breast abscess. Ultrasound is the investigation of choice for differentiating cystic vs solid swelling. -### End" -2607,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Screening of neonatal thyroid disease is done by, with the following options: A: T4, B: T3, C: TSH, D: TPO antibodies - -### Response: -Since the neonates are asymptomatic at bih all newborns are screened for neonatal hypothyroidism. TSH is estimated either in cord blood at the time of bih (preferred) or blood obtained from heel prick after 2 days of bih.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2669 - 2773) -### End" -2608,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reverse head gear is used mainly, with the following options: A: To retract maxilla, B: To induce the growth of maxilla in skeletal retrusion, C: To inhibit growth of mandible in class-III malocclusion, D: To induce growth of mandible in class-III - -### Response: -Headgears that cause a forward pull. on maxilla are called reverse pull headgear. Facemask is one of the most common reverse pull headgears in use today. -### End" -2609,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PGE2 cervical gel for cervical ripening maximum dose in 24 hrs is ?, with the following options: A: 2 mg, B: 1 mg, C: 1-5 mg, D: 4 mg - -### Response: -Ans. is'c'i.e., 1.5 mgPGE2 (dinsprcslsas) is used for cervical ripening.Cervical gel 0.5 mg is used, which may be repeated 6 hours later, if necessary.Maximum dose which can be given in 24 hours is 1.5 mg. -### End" -2610,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HMG-CoA can be directly conveed to all except?, with the following options: A: Acetoacetate, B: Acetyl-CoA, C: Mevalonate, D: Aceto-acetyl CoA - -### Response: -Ans. is 'd' i.e., Aceto-acetyl CoA Acetoacetate & Acetyl - CoA are derived from HMG-CoA during ketogenesis by HMG-CoA lyase which breaks the HMG-CoA into acetoacetate and acetyl-CoA during ketogenesis.Mevalonate is formed directly from HMG-CoA in cholesterol synthesis.HMG-CoA is conveed to mevalonate by HMG-CoA reductase, the key regulatory enzyme of cholesterol synthesis. -### End" -2611,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following vessel does not cross the midline of the body:, with the following options: A: Left gonadal vein, B: Left renal vein, C: Left brachiocephalic vein, D: Hemiazygous vein - -### Response: -The left gonadal vein drains into the left renal vein which crosses the midline to join inferior vena cava. All the other options (Left renal vein, left brachiocephalic vein and hemiazygous vein) cross the midline.Ref: Human Anatomy, B D Chaurasia, 4th Edition, Volume 2, Chapter 24, Page 297, 307, 316; Clinical Anatomy by Systems, Richard S. Snell, 2007 Edition, Page 166, 167, 840. -### End" -2612,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urate crystals are deposited in small joints of the hands & feets in: September 2003, with the following options: A: Gout, B: Still's disease, C: Retropharyngeal abscess, D: Ankylosing spondylitis - -### Response: -Ans. A i.e. Gout -### End" -2613,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On biopsy, characteristic finding of malignant mesothelioma is -, with the following options: A: Myelin, B: Desmosin, C: Weibel-palade bodies, D: Branching microvilli - -### Response: -Ref:Textbook of pathology (Harsh mohan)6th edition, page no.506 Malignant (Diffuse) Mesothelioma Malignant or diffuse mesothelioma is rare. It is a highly malignant tumour associated with high moality. The tumour is significant in view of its recognised association with occupational exposure to asbestos (paicularly crocidolite) for a number of years, usually 20 to 40 years . About 90% of malignant mesotheliomas are asbestos-related. Mechanism of carcinogenicity by asbestos is not quite clear but it appears that prolonged exposure of amphibole type of asbestos is capable of inducing oncogenic mutation in the mesothelium. However, prolonged asbestos-exposure is considered more significant rather than heavy exposure as documented by occurrence of malignant mesothelioma in the family members of asbestos workers. Although combination of cigarette smoking and asbestos exposure greatly increases risk to develop bronchogenic carcinoma, there is no such extra increased risk of developing mesothelioma in asbestos workers who smoke. Recently, SV40 (simian vacuolating virus) antigen has also been implicated in the etiology of mesothelioma. Grossly, the tumour is characteristically diffuse, forming a thick, white, fleshy coating over the parietal and visceral Grossly Microscopically, malignant mesothelioma may have epithelial, sarcomatoid or biphasic patterns. SECTION III Systemic Pathology Malignant (diffuse) mesothelioma, gross appearance. The tumour is seen to form a thick, white, fleshy coat over the parietal and visceral surfaces. osteoahropathy or hypoglycaemia. Removal of the tumour is generally curative. Malignant (Diffuse) Mesothelioma Malignant or diffuse mesothelioma is rare. It is a highly malignant tumour associated with high moality. The tumour is significant in view of its recognised association with occupational exposure to asbestos (paicularly crocidolite) for a number of years, usually 20 to 40 years (page 492). About 90% of malignant mesotheliomas are asbestos-related. Mechanism of carcinogenicity by asbestos is not quite clear but it appears that prolonged exposure of amphibole type of asbestos is capable of inducing oncogenic mutation in the mesothelium. However, prolonged asbestos-exposure is considered more significant rather than heavy exposure as documented by occurrence of malignant mesothelioma in the family members of asbestos workers. Although combination of cigarette smoking and asbestos exposure greatly increases risk to develop bronchogenic carcinoma, there is no such extra increased risk of developing mesothelioma in asbestos workers who smoke. Recently, SV40 (simian vacuolating virus) antigen has also been implicated in the etiology of mesothelioma. Grossly, the tumour is characteristically diffuse, forming a thick, white, fleshy coating over the parietal and visceral surfaces . i)Epithelial pattern resembles an adenocarcinoma, consisting of tubular and tubulo-papillary formations. The tumour cells are usually well-differentiated, cuboidal, flattened or columnar cells. ii)Sarcomatoid pattern consists of spindle cell sarcoma resembling fibrosarcoma. The tumour cells are arranged in a storiform pattern with abundant collagen between them. iii)Biphasic pattern shows mixed growth having epithelial as well as sarcomatoid pattern. Usually, there are slit-like or gland-like spaces lined by neoplastic mesothelial cells separated by proliferating spindleshaped tumour cells . Asbestos bodies are found in the lungs of most patients with malignant mesothelioma of any histologic type On biopsy, mesothelioma is seen as branching microvilli like appearance. -### End" -2614,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 5HT1 paial agonists are used as, with the following options: A: Anti anxiety drugs, B: Antipsychotic drugs, C: Anti reflux medications, D: Anti emetic - -### Response: -Buspirone, gepirone, spiperone - atypical anti-anxiety agents they do not affect GABA levels- so atypical they are serotonin paial agonists Ref: KD Tripathi 8th ed -### End" -2615,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs have activity against hepatitis B virus EXCEPT:, with the following options: A: Lamivudine, B: Zidovudine, C: Emtricitabine, D: Telbivudine - -### Response: -Lamivudine (3TC) :This deoxycytidine analogue IS phosphorylated intracellularly and inhibits HIV reverse transcriptase as well as hepatitis B virus (HBV) DNA polymerase. Zidovudine: It is a thymidine analogue (azidothymidine, AZT), the prototype NI. After phosphorylation in the host cell-zidovudine triphosphate selectively inhibits viral reverse transcriptase (RNA-dependent DNA polymerase) in preference to cellular DNA polymerase. Zidovudine is used in HIV infected patients only in combination with at least 2 other ARV drugs. However, its efficacy as monotherapy in AIDS has been confirmed in the past. HIV-RNA titer is reduced to undetectable levels and CD4 count increases progressively. Emtricitabine:It exhibits clinical activity against the HBV. Among individuals with chronic HBV infection, emtricitabine treatment results in significant histologic, virologic, and biochemical improvement. The safety profile of emtricitabine during treatment is similar to that of a placebo. Telbivudine is an antiviral used in the treatment of hepatitis B infection.Telbivudine impairs hepatitis B virus (HBV) DNA replication by leading to chain termination. It differs from the natural nucleotide only with respect to the location of the sugar and base moieties, taking on an levorotatory configuration versus a dextrorotatory configuration as do the natural deoxynucleosides. It is taken orally in a dose of 600 mg once daily with or without food. ESSENTIALS OF MEDICAL PHARMACOLOGY,en.wikipedia.org K.D.TRIPATHI SIXTH EDITION PAGE NO:770,771 -### End" -2616,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At 30 days of intrauterine life, with the following options: A: Hea stas beating, B: Cerebellum develops, C: Optical vesicle appears, D: Pinna appears - -### Response: -*Optical vesicle come in contact with surface ectoderm and lens place is forming by the 4th week of IUL - the eyes begin to develop as a pair of diveicula from the lateral aspects of the forebrain. These diveicula make their appearance before the closure of the anterior end of the neural tube; after the closure of the tube, they are known as the optic vesicles. *Ear pinna or auricle stas forming by the 5th week of IUL *Cerebellum stas forming by the 8th week of IUL *The baby's heabeat stas as the blood flow begins by 22nd day of IUL (Reference: I B Singh's Embryology, 10th edition, pg 374, 281) -### End" -2617,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In cell death, myelin bodies are derived from, with the following options: A: RER, B: Cell Membrane, C: Cytoplasm, D: Lysosome - -### Response: -Myelin bodies are membrane bounded myelin figures. These are derived from the plasma membrane and represent the whorls of phospholipids. -### End" -2618,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common complication associated with 'Total Parenteral Nutrition' is, with the following options: A: Catheter related infection, B: Hyperglycemia, C: Pneumothorax, D: Hyperkalemia - -### Response: -The most common complication associated with TPN is a Catheter-related infectionTotal parenteral nutrition (TPN) is defined as the provision of all nutritional requirements by means of the intravenous route and without the use of the gastrointestinal tract.Parenteral nutrition is indicated when energy and protein needs cannot be met by the enteral administration of these substrates. The most frequent clinical indications relate to those patients who have undergone massive resection of the small intestine, who have an intestinal fistula or who have prolonged intestinal failure for other reasons.TPN can be administered either by a catheter inseed in the central vein or peripherally inseed central venous catheter (PICC) line or a conventional cannula (not preferred).Catheter-related sepsis occurs in 3-14% of patients. It may occur at the time of line inseion or afterwards by migration of skin bacteria along the external catheter surface. -### End" -2619,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cephalic Index of 80-85 is seen in:, with the following options: A: Mongols, B: Chinese, C: European, D: Negroid - -### Response: -Ans: A (Mongols) Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy. 29th edition. 2010. Pg: 54Explanation:Cephalic Index =Maximum breadth of skull Maximum length of skttllx 100The length and breadth are measured by calipers between both parietal eminences, between glabella and external occipital protuberance, and not by measuring tapeThe skull of an Indian is Caucasian with a few Negroid charactersWith skull measurements, race can be determined in 85% = 90% of casesRacial difference in the skullRaceType of SkullCephalic IndexPure AryansAboriginesNegroesDolicocephalic (long headed)70 - 75EuropeansChineseMesati-cephalic (Medium headed)75 - 80MongolianBrachy-cephalic (Short headed)80-85 -### End" -2620,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following would be the best treatment for a 2 cm thyroid nodule in a 50 year old man with FNAC revealing it to be a papillary carcinoma, with the following options: A: Hemithyroidectomy, B: Subtotal thyroidectomy with modified neck dissection, C: Near total thyroidectomy with central neck dissection, D: Hemithyroidectomy with modified neck dissection - -### Response: -For a patient with a unilateral thyroid malignancy and no evidence of metastatic disease, there are several rationales to consider total thyroidectomy, including facilitation of RAI ablation, which is much less effective and requires a larger dosage if residual thyroid exists the frequent presence of occult multifocal disease and facilitating the use of Tg as a tumor marker, which is most useful if there is no remaining normal thyroid. In the setting of clinically negative central compament nodes, a prophylactic level VI dissection dissection is more clearly indicated in higher risk situations (age greater than 45 is high risk) Source : Sabiston 20th edition Pg : 907 -### End" -2621,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common fungus causing corneal ulcer is, with the following options: A: Aspergillus, B: Mucor, C: Fusarium, D: Sprothrix - -### Response: -Aspergillus causes respiratory diseases, disseminated aspergillosis in brain, kidney and hea, and superficial infection like sinusitis, otomycosis and mycotic keratitis. Sporothrix causes sporotrichosis - nodular ulcerative disease of the skin and subcutaneous tissue. Mucor causes pulmonary and gastrointestinal mucormycosis. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition -### End" -2622,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3- year- old child comes with hydrocele of the hernia sac. Management will include:, with the following options: A: Herniotomy, B: Herniorrhapy, C: Observation only, D: Operated after 5 years of age - -### Response: -Management of hydrocele of the hernia sac (congenital hydrocele) in a 3 years old child is Herniotomy. Mesh is not used because there will be growth in body compared to mesh. -### End" -2623,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bispectral index is used in?, with the following options: A: To know the potency of general anesthesia, B: To know the speed of induction, C: To monitor the depth of general anesthesia, D: None of the above - -### Response: -Ans. is 'c' i.e., To monitor the depth of general anesthesia Bispectal Index* It is the first scientifically validated and commercially available monitor to check depth of anesthesia.* It utilizes many parameters like EEG signals, eye blinks etc to calculate a score.* A score of 45-60 is considered as adequate depth (score of 100 is for fully awake state and O for completely silent brain).BIS valueInterpretation80-100Awake60-80Moderate sedation40-60General anesthesia (no awareness)<40Deep anesthesia -### End" -2624,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary sclerosing cholangitis is likely to be associated with, with the following options: A: Adenocarcinoma of pancreas, B: Cholangiocarcinoma, C: Hepatocellular carcinoma, D: Adenocarcinoma of gallbladder - -### Response: -Diseases associated with PSC Chronic ulcerative colitis. Crohn's disease Autoimmune hepatitis Chronic pancreatitis Hypereosinophilia Riedel's thyroiditis Celiac disease Auto immune hemolytic anemia Sicca syndrome Sarcoidosis Glomerulonephritis Retro peritoneal fibrosis Systemic sclerosis Ref: Sabiston 20th edition Pgno : 1508-1509 -### End" -2625,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A distinctive clinical manifestation of a successful Rapid Maxillary Expansion is:, with the following options: A: Anterior crossbite, B: Posterior crossbite, C: Midline diastema, D: Open bite - -### Response: -Rapid maxillary expansion (RME) results in rapid correction of the cross-bite occurring in 2–6 weeks. A midline diastema may appear which is suggestive of the mid-palatal split. This diastema would close spontaneously due to the recoil of the stretched trans-septal group of gingival fibres. -Reference: Orthodontics: Diagnosis and Management of Malocclusion and Dentofacial Deformities 3rd O P Kharbanda, pdf no 2403 -### End" -2626,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The antibiotic causing pseudomembrane colitis is-Clindamycin, with the following options: A: Clindamycin, B: Garamycin, C: Erythromycin, D: Vancomycin - -### Response: -Ans. is 'c' i.e., Clindamycin o Pseudomembranous enterocolitis is caused most commonly by 2nd generation cephalosporins, clindamycin ampicillin, and fluoroquinolones. -### End" -2627,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following names are associated with tests/operations around the hip joint except, with the following options: A: Bryant, B: Shenton, C: Mc Murray, D: Salter - -### Response: -D i.e. Salter Shenton's line is an imeginary semicircular line joining the medial coex of femoral neck to the lower border of superior pubic ramus. It is breeched in fracture neck femur, head femur, superior pubic ranii and dislocation of hip. -### End" -2628,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Opium is derived from: NEET 13, with the following options: A: Leaf, B: Root, C: Poppy seed, D: Unripe capsule - -### Response: -Ans. Unripe capsule -### End" -2629,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Under the national TB programme, for a PHC to be called a PHC–R, requisite is –, with the following options: A: Microscopy, B: Microscopy plus radiology, C: Radiology, D: None of the above - -### Response: -District tuberculosis centre (DTC) is the nucleus of DTP -The function of DTC is to plan, organize and implement the DTP in the entire district, in association with general Health services. -When DTP activities (Sputum microscopy, chest X-ray, Anti-TB treatment) are introduced in an organized manner in a peripheral health institution (PHI), it is considered to be implemented PHI. -It is important that only such PHIs are selected for implementation of the programme, which are under the charge of qualified Medical officers. -### End" -2630,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following statements are true regarding Chlamydia except:, with the following options: A: Erthromycin is effective for therapy of Chamydial infections, B: Their cell wall lacks a peptidoglycan layer, C: They can grow in cell free culture media, D: They are obligate intracellular bacteria - -### Response: -Unique properties of Chlamydia are -Chlamydia is an obligate intracellular parasite. This means they can survive only by establishing residence inside -Animal cells -They need their host's ATP as an energy source for their own cellular activity. They are energy parasites using a -Cell membrane transport system that uses ATP from the host system and gives out ADP. -This obligate intracellular existence makes it impossible to culture these organisms on nonliving artibacterial media. -Due to their small size and failure to grow in cell - free media they were considered to be viruses. -Chlamydiae grows in cultures of a variety of eukaryotic cell lines Me Coy or HeLa cells. It may be necessary to -Treat cells with poly anionic compounds such as DEAD-dextran to reduce the electrostatic barrier to infection. -Antimetabolite such as cycloheximide is added to favour competition for host cell amino acid pools. All types of -Chlamydiae proliferate in embryonated eggs particularly in the yolk sac. -The special features in structure and chemical composition of chlamydiae are -The outer cell wall resembles the cell wall of gram negative bacteria It has a relatively high lipid content -It is rigid but it does not contain typical bacterial peptidoglycan; perhaps it contains a Tetrapeptide linked matrix. -N Acetyl muramic acid also appears to be absent from chlamydiae cell wall -Antibiotic susceptibility of chlamydiae. -Penicillin binding proteins occur in chlamydiae cell wall and chlamydiae cell wall formation is inhibited by penicillins -And other drugs that inhibit transpeptidation of bacterial peptidoglycan. But remember the important point about t/t, -That cell wall inhibitors result in the production of morphologically defective forms but are not effective in clinical -Disease. -• Inhibitors of protein synthesis (tetracyclines, erythromycins) are effective in most clinical infections. Erythromycin -Or tetracyclines are considered the drug of choice for chlamydiae infections. -### End" -2631,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about warfarin except, with the following options: A: It inhibits the activation of vitamin K dependent clotting factors, B: It's half life is 36hrs, C: It can cross placenta, D: It's dose is increased in liver disease - -### Response: -Refer Katzung 11/e p595 Warfarin is an oral anticoagulant that acts by inhibiting the gamma carboxylation of glutamate residues in vitamin K dependent clotting factors It has a long half life It readily crosses the placenta Liver disease reduces the synthesis of clotting factors thus increases the effect of warfarin -### End" -2632,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Of the following groups of amino acids produce common component of the TCA cycle is, with the following options: A: Alanine, isoleucine, leucine, lysine, B: Serine, asparagine, glycine, glutamate, C: Isoleucine, valine, methionine, D: Proline, leucine, tryptophan - -### Response: -Isoleucine, valine, methionine -### End" -2633,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Postmortem caloricity is not seen in?, with the following options: A: Strychnine poisoning, B: Typhoid, C: Organophosphorus poisoning, D: Septicemia - -### Response: -Ans. is 'c' i.e., Organophosphorus poisoning o Normally, temperature falls after death. But in some situations, for initial 2-3 hours the dead body may gain heat, i.e. postmortem caloricity.o Postmortem caloricity is seen in:-1) Due to disturbed heat regulation: Sun-stroke (heat stroke), pontine hemorrhage.2) Due to heat production by muscular activity: Tetanus, strychnine poisoning, asphyxial death.3) Acute bacterial or viral infections: Pneumonia, septicemia, liver abscess, peritonitis, typhoid, nephritis, meningitis, cholera etc.4) Very high atmosphere temperature. -### End" -2634,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For which malignancy, Intensity Modulated Radiotherapy (IM) is the most suitable:, with the following options: A: Lung, B: Prostate, C: Leukemias, D: Stomach - -### Response: -B i.e. Prostate -### End" -2635,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major basic protein is secreted by?, with the following options: A: Neutrophil, B: Basophil, C: Platelet, D: Eosinophil - -### Response: -Eosinophil REF: Harrison's 17th ed chapter 61 The distinctive feature of the red-staining (Wright's stain) eosinophil granule is its crystalline core consisting of an arginine-rich protein (major basic protein) with histaminase activity, impoant in host defense against parasites -### End" -2636,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient wants to scratch for itching in his amputated limb is an example of, with the following options: A: Illusion, B: Pseudohallucination, C: Phantom limb hallucination, D: Autoscopic hallucination - -### Response: -The phantom limb is the most common organic somatic hallucination of psychiatric origin. In this case the patient feels that they have a limb from which in fact they are not receiving any sensations either because it has been amputated or because the sensory pathways from it have been destroyed. Reference: Fish's Clinical Psychopathology, page 29. -### End" -2637,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CT scan of a mentally retarded child with recurrent seizures and hemangioma. Diagnosis is?0, with the following options: A: Epiloias, B: Encephalofacial angiomatosis, C: Louis Bar syndrome, D: Neuronal ceroid lipofuscinoses - -### Response: -Ans. (b) Encephalofacial angiomatosis.* The CT scan shows extensive intracranial calcification which will lead to seizures, paralysis and hemiatrophy. The presence of hemangioma shows presence of Sturge-Weber syndrome called as encephalofacial angiomatosis.* Epilolia is alternative term for tuberous sclerosis.* Louis bar syndrome is alternative term for phakomatosis by name of ataxia telangiectasia.* Neuronal ceroid lipofuscinosis includes leukodystrophy like Krabbe's disease and adrenoleukodystrophy. Image source; style=""font-size: 1.04761904761905em; color: rgba(0, 0, 0, 1); font-family: Times New Roman, Times, serif; margin: 0 0 8pt""> -### End" -2638,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dehydration in a child with diarrhea thirst present -, with the following options: A: Mild, B: Moderate, C: Sever, D: None - -### Response: -- in acute diarrhoeal disease,dehydration is assessed on the basis of patient's appearance, radial pulse, blood pressure, skin elasticity. - patient is thirsty, ale and restless in mild dehydration. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:225 <\p> -### End" -2639,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of chronic pancreatitis, with the following options: A: Gall stones, B: Tropical pancreatitics, C: Pancreas divisium, D: Alcohol - -### Response: -.high alcohol consumption is the most frequent cause of chronic pancreatitis accounting for 60 to 70 percent of cases but only 5 to 10 percent of people with alcoholism develop chronic pancreatitis. Bailey and Love 26 th ed:pg 1134 -### End" -2640,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: It is true regarding normal microbial flora present on skin and mucous membrane that, with the following options: A: It cannot be eradicated by antimicrobial agents, B: It is absent in the stomach due to acidic pH, C: It establishes in the body only after the neonatal period, D: The flora in the small bronchi is similar to that of the trachea - -### Response: -It is present in stomach soon after food. It establishes on body during labour and not after neonatal period. Lower respiratory tract ie below trachea is sterile. -### End" -2641,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 55 years male presented with dry mouth, & rheumatoid ahritis with high titre of anti SS-A and SS-B antibodies, diagnosed a case of minor salivary gland tumour. The earliest histologic finding in -, with the following options: A: Endothelial cells, B: Basophils, C: Lymphocyte, D: Eosinophils - -### Response: -Harshmohan textbook of pathology 7th edition. *sjogren's syndrome is characterised by triad of dry eyes ,dry mouth and rheumatoid ahritis. In early stage the lacrimal and salivary gland shows periductal infiltration by lymphocytes and plasma cells which at times may form lymphoid follicles. -### End" -2642,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which vitamin is required for glucose 6 phosphate dehydrogenase?, with the following options: A: Riboflavin, B: Thiamine, C: Niacin, D: Biotin - -### Response: -Niacin - pyridine derivative. Coenzyme forms - NADP+, NAD+ The coenzymes NAD+ and NADP+ are involved in a variety of oxidation-reduction reactions Selected example of NAD+ & NADP+ dependent enzyme NAD+ Enzyme Coenzyme Isocitrate dehydrogenase NAD+ a- Ketoglutarate dehydrogenase NAD+ Glucose 6-phosphate dehydrogenase NADP+ Malate dehydrogenase NAD+ Glutamate dehydrogenase NAD+ Glyceraldehyde 3-phosphate dehydrogenase NAD+ or NADP+ Lactate dehydrogenase NAD+ Alcohol dehydrogenase NAD+ NOTE: Niacin causes hyperglycemia. Niacin induces pancreatic islet dysfunction through activation of the islet beta-cell G-coupled protein receptors that mediate peroxisome proliferation and increase reactive oxygen species. It also decreases glucose-stimulated insulin secretion. Thus, it increases the blood glucose level and is contraindicated in diabetics. -### End" -2643,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Impetigo is characterized by all except, with the following options: A: Superficial bacterial infection commonly due to staph. Aureus, B: Microscopic feature is accumulation of lymphocyte beneath the stratum corneum, C: Blister formation is due to bacterial production of a toxin that cleaves Desmoglein 1, D: Typically involves exposed skin mainly hands and face - -### Response: -Characteristic microscopic feature in impetigo is accumulation of neutrophils beneath the stratum corneum producing a subcorneal pustule. -### End" -2644,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a long term adverse effect of proton pump inhibitors?, with the following options: A: Pelvic fracture, B: Pneumonia, C: Vitamin -B12 deficiency, D: Hypothyroidism - -### Response: -Proton pump inhibitors (PPI) - They are the strongest acid inhibiting drugs. - All PPI are prodrugs. - They are enteric coated - They are irreversible inhibitors of the proton pump. So, they work like hit &run drugs. - They inhibit CYP2C19. - Adverse effects o Osteoporosis (calcium deficiency) o Megaloblastic anaemia (Vitamin B12 deficiency) o Increased infection (like pneumonia) o Carcinoid tumor (seen in rats and mice) o hypergatrinemia following withdrawal of drug -### End" -2645,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following are included in Malaria Vector Indices in pre-eradication era ? a)Spleen ratio b)Human blood index c) Slide positivity rate d)Parasite density index, with the following options: A: 1,3, B: 1,4, C: 1, 2, 3, D: 4,3,1 - -### Response: -Malaria vector indices are divided into 3 groups. 1.Pre-eradication era 2.Eradication ERA 3. Malaria vector indices Spleen ratio AV. Enlarged spleen Parasite rate Parasite density index IPR PCR API ABER AFI SPR SFR Human blood index Sporozoite rate Mosquito Density Biting density Inoculation rate -### End" -2646,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the established biological therapy for Crohn's disease?, with the following options: A: Anti TNF a antibody, B: IL - I antagonist, C: IL - 6 antagonist, D: IL - 8 antagonist - -### Response: -Tumor Necrosis Factor (TNF) is a key inflammatory cytokine and mediator of intestinal inflammation. The expression of TNF is increased in IBD. Infliximab is a chimeric human monoclonal antibody against TNF that is extremely effective in Crohn's disease. Recently adalimumab has also been approved for treatment of moderate to severe crohn disease. Newer Immunosuppressive Agents for IBD Tacrolimus Mycophenolate mofetil 6-Thioguanine Thalidomide -### End" -2647,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following factors causes endometrial hyperplasia?, with the following options: A: Estrogen, B: Danazole, C: Perimenopausal age, D: None of the above - -### Response: -Most cases of endometrial hyperplasia result from high levels of estrogens, combined with insufficient levels of the progesterone-like hormones. This may occur in conditions including obesity, polycystic ovary syndrome, estrogen producing tumours (e.g. granulosa cell tumour) and ceain formulations of estrogen replacement therapy. Endometrial hyperplasia is a significant risk factor for the development or even co-existence of endometrial cancer. Hyper estrogenic state is associated with marked endothelial hyperplasia which regress with progestins. -### End" -2648,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About Pneumocystis pneumonia the true statement is:, with the following options: A: The causative organism is a protozoan, B: Drug of choice is Trimethoprim-Sulfamethoxazole (Cotrimoxazole), C: Most common radiological appearance is a bat wing distribution of infiltrates with pneumocysts in peripheral fields, D: Steroids have no role in the therapy of Pneumocystis pneumonia - -### Response: -Pneumocystis jirovecii is a fungus responding to Cotrimoxazole. It causes opportunistic pneumonia in patients with HIV infection.  -The most common radiology finding is a normal X-ray chest.  However, the most typical X-ray is  a bat wing distribution of infiltrates with pneumocysts in peripheral fields.  -Steroids are combined with Cotrimoxazole in treatment of severe Pneumocystis jirovecii pneumonia. -### End" -2649,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brain dead individuals have all of the following features EXCEPT (* NIMHANS March-2017 Post-MBBS, NIMHANS - Feb. 2008), with the following options: A: Dolls eye movement is absent, B: Oculo-vestibular reflex is absent, C: Only pain is preserved, D: Corneal reflex is absent - -### Response: -(C) Only pain is preserved# BRAIN-DEAD> individual has no clinical evidence of brain function upon physical examination.> No response to pain and no cranial nerve reflexes.> Reflexes include pupillary response (fixed pupils), oculocephalic reflex, corneal reflex, no response to the caloric reflex test, and no spontaneous respirations.> In comatose patients, once it has been determined that the cervical spine is intact, a test of the vestibulo-ocular reflex (VOR), also known as the oculocephalic reflex or doll's eye reflex can be performed by turning the head to one side.> Positive response occurs when the eyes rotate to the opposite side to the direction of head rotation, thus indicating that the brain- stem (CN3,6,8) is intact.> Vertical oculo-vestibular eye responses can be assessed by irrigating both ears simultaneously.> If the brainstem is intact, cold water causes the eyes to deviate downwards and warm water causes the eyes to deviate upwards. -### End" -2650,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CASPAR criteria is used in diagnosis of :, with the following options: A: Psoriatic ahritis, B: Rheumatoid ahritis, C: Ankyosing spondylitis, D: Reactive synovitis - -### Response: -CASPAR Criterion for Psoriatic Ahritis To be classified as having PsA, a patient must have inflammatory joint disease (joint, spine, enthesitis) with >= 3 of the following 5 criteria. 1. Evidence of psoriasis (One of these) a. Current psoriasis b. Personal history c. Family history 2. Psoriatic nail dystrophy 3. Negative RF 4. Dactylitis (One of a, b) a. Current b. History 5. Radiological evidence of Juxta-aicular new bone formation. -### End" -2651,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gall bladder adenocarcinoma is only involving lamina propria. What is the preferred treatment, with the following options: A: Simple cholecystectomy, B: Radical cholecystectomy, C: Chemotherapy alone, D: Radiotherapy - -### Response: -Only invading lamina propria is T1a stage -simple cholecystectomy. -### End" -2652,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Convergent muscle among the following is, with the following options: A: Subscapularis, B: Deltoid, C: Temporalis, D: Pectoralis minor - -### Response: -Convergent muscle is one where all the fibres converge at the insertion (Fan shaped) -Eg - Temporalis -### End" -2653,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most indicative test for prostate cancer is:, with the following options: A: A thorough digital rectal examination, B: Magnetic resonance imaging (MRI), C: Excretory urography, D: Prostate-specific antigen - -### Response: -An elevated prostate-specific antigen level indicates prostate cancer, but it can be falsely elevated if done after the prostate gland is manipulated. - -Option A: A digital rectal examination should be done as part of the yearly screening, and then the antigen test is done if the digital exam suggests cancer. -Option B: MRI is used in staging the cancer. -### End" -2654,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin E is -, with the following options: A: Anticoagulant, B: Coagulant, C: Antioxidant, D: Antiinflammatory - -### Response: -Ans. is 'c' i.e., Antioxidant o Vitamin E is sometimes described as anti-sterility vitamin.o However, its anti-sterility function is seen only in some animals and not in human beings,o Vitamin E activiy is present in several tocopherols Q, the most important being a-, b-, g- and d- tocopherol,o a-Tocopherol is the most abundant and is taken as the standard,o The most important function of vitamin E in human beings is to act as an anti-oxidant Q.o It prevents the oxidation of other antioxidants, .e.g, carotenes, vitamin A Q and vitamin C Q.o Vitamin E is the lipid-soluble antixodant in cell membranes and plasma lipoproteins.o The main function of vitamin E is as a chain-breaking, free radical-trapping antioxidant in cell membranes and plasma lipoproteins by reacting with lipid peroxide radicals formed by peroxidation of polyunsatured fatty acid Q,o Vitamin E prevents rancidity of fats due to its antioxidant action Q.o Deficiency of vitamin E is rare. Deficiency may occur in severely undernourished children and in premature infants fed on artificial milk.o The clinical manifestations are edema, hemolytic anemia Q (due to fragile red cell's membrane as a result of lipid peroxidation) and thrombocytosis,o Nerve and muscle membrane damage may occur. -### End" -2655,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Immunostimulant used for the treatment of malignant Melanoma Norma is, with the following options: A: Levamisol, B: BCG, C: Aldesleukin, D: Methotrexate - -### Response: -Ref-Katzung 10/e p906 It is a recombinant IL-2 used for the treatment of renal cell carcinoma and malignant melanoma -### End" -2656,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest of death in ARDS is, with the following options: A: Hypoxemia, B: Hypotension, C: Non-pulmonary organ failure, D: Respiratory failure - -### Response: -Moality estimates for ARDS range from 26 to 44%.Moality in ARDS is largely attributable to nonpulmonary causes,with sepsis and nonpulmonary organ failure accounting for >80% of deaths.Increasing age,chronic liver disease,cirrhosis,chronic alcohol abuse,chronic immunosuppression,sepsis,chronic renal disease,any nonpulmonary Organ failure have been linked to increased ARDS moality. Ref:Harrison's disease-18th edition,page no:2209/ -### End" -2657,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Raygat's test is used for ?, with the following options: A: Weight of lung, B: Specific gravity of lung, C: Consistency of lung, D: None - -### Response: -Ans. is 'b' i.e., Specific gravity of lung Hydrostatic test (Raygat's test, 1"" life test) : The specific gravity of a non-respired lung is 1040-1050 and of a respired lung is 940-950, so, after respiration lung floats on water (specific gravity of water is 1000). False positive hydrostatic test may occur (i.e.non-respired lung may float) in decomposition and in attempted aificial respiration. False negative hydrostatic test (i.e. respired lung may sink down) may occur in atelectasis, pulmonary oedema, bronchopneumonia, and congenital syphylis. -### End" -2658,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renal vein thrombosis is/are not caused by -, with the following options: A: Nephrotic syndrome, B: Invasive renal cell carcinoma, C: CKD, D: DehydrationPregnancy - -### Response: -Nephrotic syndrome Nephrotic syndrome is characterised by very heavy proteinuria (>3.5 g/24 hrs), hypoalbuminaemia and oedema (see below). Blood volume may be normal, reduced or increased. Renal sodium and causes venous thrombosis retention is an early and universal feature;. The diseases that cause nephrotic syndrome all affect the glomerulus (see Fig. 15.9), either directly, by damaging podocytes, or indirectly, by causing scarring or deposition of exogenous material such as amyloid into the glomerulus. Investigation of nephrotic syndrome usually involves renal biopsy, although non-invasive tests may also be helpful in suggesting the underlying cause . In children, minimal change disease is by far the most common cause of nephrotic syndrome and therefore renal biopsy is not usually required unless the patient fails to respond to high-dose glucocoicoid therapy. Similarly, most patients with diabetes presenting with nephrotic syndrome will have diabetic nephropathy, and so renal biopsy is usually not performed unless the course of the disease is atypical (rapidly increasing proteinuria or rapid decline in renal function;). Management of nephrotic syndrome should be directed at the underlying cause. In addition, nephrotic syndrome is associated with a number of complications , which may require suppoive management unless the nephrosis is expected to resolve rapidly, such as in glucocoicoid-responsive minimal change disease. Ref Harrison20th edition pg 287 -### End" -2659,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Green stick fracture is, with the following options: A: Fracture in adults, B: Complete fracture, C: Incomplete fracture, D: Fracture spine - -### Response: -green stick fracture is an incomplete fracture. In which bone is incompletely divided &periosteum remain in continuity . -Bone is buckled /bent.Seen in children whose bones are more springy than those of adults. -Children also sustain injuries where bone is partially deformed (misshapen) without any crack visible. -In complete fracture bone is split into 2 or more fragments . -compression fracture occur when cancellous bone is crumpled happen in adult & typically where this type of bone -structure is present eg;vertebral bodies ,calcaneum,tibial plateau. -### End" -2660,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common route of spread of puerperal sepsis, with the following options: A: Lymphatic, B: Direct invasion, C: Skip lesion, D: Hematogenous - -### Response: -Puerperal pyrexia – is defined as a rise of temperature reaching 100.4° F (38° C) or more (measured orally) on 2 separate occasions at 24 hours apart (excluding first 24 hours) within first 10 days following delivery. -Any infection of genital tract which occurs as a complication of delivery is called as Puerperal sepsis. -Most common site of Puerperal infection – Placental site. In vaginal delivery and uterine incision in cesarean section. -Most common manifestation of Puerperal infection – Endometritis. -Most common cause of Puerperal sepsis – Streptococcus. -Most common route of infection – Direct spread. -Single most significant risk factor for development of puerperal sepsis (uterine infection) = Route of delivery (It is M/C in cesarean delivery than vaginal delivery) -Mgt: Clindamycin + Gentamycin ± Ampicillin -### End" -2661,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the best management of contaminated wound with necrotic material?, with the following options: A: Tetanus toxoid, B: Gas gangrene serum, C: Debridement, D: Broad spectrum antibiotics - -### Response: -Contaminated wound with necrotic material is best treated by debridement to prevent development of tetanus. -### End" -2662,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chicken pox vaccine is-, with the following options: A: Live vaccine, B: Killed vaccine, C: Conjugated vaccine, D: None - -### Response: -

chicken pox vaccine:- Live attenuated vaccine Recommended for children between 12-18 months of age who do not have had chicken pox. Monovalent vaccine-0.5 ml one/two doses each by subcutaneous injection. 2 dose schedule adviced for all persons aged> 13 yrs with a minimum interval of 6weeks/3months for children and 4/6 weeks for adults. Combination vaccine- 9-12 months old children. 2doses. Minimum interval being 4 weeks. Duration of immunity-10yrs. Adverse reactions- tenderness , erythema,fever, maculopapular/vesicular rash. Contraindicated in persons allergic to neomycin. Following vaccination,salicylates should be avoided for 6 weeks to prevent Reye&;s syndrome. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.146}

-### End" -2663,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 52-year-old man has suffered with chronic diarrhea for several years, but has refused to see a doctor. He finally comes because he is having trouble driving at night, because of difficulty seeing. Physical examination reveals a slender, pale, unwell-looking man. He has a microcytic anemia, slight elevation in the INR, low ionized calcium, and albumin levels. Which of the following is the most likely cause for his diarrhea?, with the following options: A: malabsorption, B: osmotic diarrhea, C: secretory diarrhea, D: inflammatory bowel disease - -### Response: -His night blindness suggests vitamin A deficiency, which is more likely to occur with malabsorption. His anemia and general appearance are compatible with chronic inflammatory bowel disease as well, but the clinical and biochemical features of fat-soluble vitamin deficiency (in this case vitamin A, D, and K) suggest malabsorption. -### End" -2664,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug which is used for long-term maintenance in opioid addiction -, with the following options: A: Naloxone, B: Nalorphine, C: Butarphanol, D: Methadone - -### Response: -Drugs for long-term maintenance for opioid dependence (addiction) :- Methadone is the DOC. Alternatives are buprenorphine, LAAM, opioid antagonists (naltrexone). -### End" -2665,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common heart disease in pregnancy is-, with the following options: A: ASD, B: Eisenmenger's, C: MS, D: AS - -### Response: -Ans: C -### End" -2666,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cytotoxic drugs are treated/disposed by ?, with the following options: A: Autoclaving, B: Chemical disinfection, C: Incineration, D: Microwaving - -### Response: -Ans. is 'c' i.e., Incineration Cytotoxic drugs are category No. 5 wastes which are destroyed by incineration and disposed by secured landfills. -### End" -2667,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45-year-old man who is a heavy smoker complains of sudden onset of high fever and chills, nonproductive cough, and chest pain. An X-ray film of the chest shows bilateral, diffuse, patchy infiltrates. The patient reports that a number of similar cases have occurred recently in the building where he works. He responds to antibiotics and recovers. Which of the following is the most likely a reservoir for the microorganism that is responsible for this patient's respiratory tract infection?, with the following options: A: Cooling towers, B: Elevator shafts, C: Floor cleaners, D: Heat pumps - -### Response: -Legionella pneumophila causes a pneumonia that ranges from mild to a severe life-threatening, necrotizing pneumonia referred to as ""Legionnaire disease."" The bacterium is found in natural bodies of fresh water and survives chlorination, allowing it to proliferate in cooling towers, water heaters, humidifiers, and ventilation systems. Legionella pneumonia begins when microorganisms enter alveoli, where they are phagocytized by resident macrophages. Bacteria multiply within macrophages and are released to infect new macrophages. The disease presents as an acute bronchopneumonia, with a diffuse and patchy pattern of infiltration. None of the other situations creates suitable conditions for bacteria to multiply.Diagnosis: Legionnaire disease -### End" -2668,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve supply of deltoid is, with the following options: A: Axillary, B: Musculocutaneous, C: Median, D: Radial - -### Response: -Anterior division of axillary nerve supplies most pa of the deltoid muscle.Posterior division of axillary nerve supplies the posterior fibres of deltoid muscle.B D Chaurasia 7th edition Page no: 180 -### End" -2669,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A male 25 years old presents to the dental clinic due to food lodgement in lower back region tooth. He also gives the history of previous dental treatments of other teeth as well. On examination it is revealed that interproximal caries is present between right mandibular molars. The clinician restores the tooth with amalgam. -The carving of the restoration can be done by which of the following ?, with the following options: A: Discoid–cleoid instrument, B: Hollenback carver, C: Thin explorer tip, D: Two of the above - -### Response: -A discoid–cleoid instrument may be used to carve the occlusal surface of an amalgam restoration. The rounded end (discoid) is positioned on the unprepared enamel adjacent to the amalgam margin and pulled parallel to the margin. This removes any excess at the margin while not allowing the marginal amalgam to be carved below the preparation margins (i.e., “submarginated”). -The pointed end (cleoid) of the instrument may be used to define the primary grooves, fossae, and cuspal inclines. The Hollenback carver is also useful for carving these areas.The reproduction of grooves and fossae is necessary to provide appropriate mastication and sluiceways for the escape of food from the occlusal table. The mesial and distal fossae are carved to be inferior to the marginal ridge height, helping limit the potential for food to be wedged into the occlusal embrasure. Having rounded and relatively shallow occlusal anatomy also helps achieve a 90-degree amalgam margin on the occlusal surface and to ensure adequate occlusogingival dimension of the final amalgam restoration for strength. -Occlusal embrasure areas are developed with a thin explorer tip or carving instrument by mirroring the contours of the adjacent tooth. The explorer tip is pulled along the inside of the matrix band, creating the occlusal embrasure form. -### End" -2670,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: SARS most common in ?, with the following options: A: Coal miners, B: School kids, C: Pregnancy, D: Health care workers - -### Response: -Ans. is 'd' i.e., Health care workers Health care workers, especially those involved in procedures generating aerosols, accounted for 21 per cent of all cases. Maximum virus excretion from the respiratory tract occurs on about day 10 of illness and then declines. The efficiency of transmission appears to be greatest following exposure to severely ill patients or those experiencing rapid clinical deterioration, usually during the second week of illness. When symptomatic cases were isolated within 5 days of the onset of illness, few cases of secondary transmission occured. There was no evidence that patient transmits infection 10 days after fever has resolved. Children are rarely affected by SARS. To date, there have been two repoed cases of transmission from children to adults and no repo of transmission from child to child. Three separate epidemiological investigations have not found any evidence of SARS transmission in schools. Fuhermore, no evidence of SARS has been found in infants of mothers who were infected during pregnancy. -### End" -2671,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 18 year old patient presents with acute abdominal pain, vomiting and on clinical examination loin tenderness is present. History of pyrexia is absent. The diagnosis is, with the following options: A: Acute testicular torsion, B: Acute appendicitis, C: Acute pyelonephritis, D: Acute diverticulitis - -### Response: -(A) Acute testicular torsion# TESTICULAR TORSION Usually presents with sudden, severe, testicular pain (in groin and lower abdomen) and tenderness. There is often associated nausea and vomiting. Testis may be higher than its normal position. Mild pyrexia and redness of overlying area may be found. Presentation of acute appendicitis includes abdominal pain, nausea, vomiting, and fever. Appendix becomes more swollen and inflamed, it begins to irritate the adjoining abdominal wall. Leads to the localization of the pain to the right lower quadrant. Classic migration of pain may not be seen in children under three years. Pain can be elicited through signs and can be severe. Signs include localized findings in the right iliac fossa. Abdominal wall becomes very sensitive to gentle pressure (palpation). There is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness). If appendix is retrocecal (localized behind the cecum), even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix). This is because the cecum, distended with gas, protects the inflamed appendix from pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. Digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point).> Acute pyelonephritis develop rapidly over a few hours or a day & it can cause high fever, pain on passing urine, and abdominal pain that radiates along the flank towards the back. There is often associated vomiting.> Chronic pyelonephritis causes persistent flank or abdominal pain, signs of infection (fever, unintentional weight loss, malaise, decreased appetite), lower urinary tract symptoms and blood in the urine.> Diverticulitis symptoms may include: Tenderness, cramps, or pain in the abdomen (usually in the lower left side but may occur on the right) that is sometimes worse with movement. Fever and chills. Bloated feeling, abdominal swelling, or gas. Diarrhea or constipation. Nausea and sometimes vomiting. Loss of appetite. -### End" -2672,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deficiency of which vitamin causes spinocerebellar ataxia:, with the following options: A: B12, B: E, C: C, D: A - -### Response: -Ans: b (Vit E) Ref:Harrison, 16th ed, p. 409Vitamin E deficiency is a cause of spinocerebellar ataxia.Spinocerebellar ataxiaIt is an autosomal dominant condition. It includes spinocerebellar ataxia type 1 to type 22.They are caused by CAG triplet repeat expansions.CAG encodes glutamine and these expandedCAG triplet expansions result in expanded polyglutamine protein, termed 'ataxin'.Clinical featuresAtaxia, ophthalmoparesis, pyramidal and extra pyramidal signs.Vitamin dependant statesVitamin A- Darrier diseaseVitamin B: (thiamine)- Leigh's disease - Maple syrup diseaseNiacin- Hartnup diseasePyridoxine-- HomocystinuriaCystathionuriaXanthinuriaOxaluriaGyrate atrophy of choroidVitaminB12- Methyl malonic aciduriaVitamin C-Chediak Higashi syndrome, alkaptonuriaFolic acid-HomocystinuriaFolate reductase deficiencyFormimino transferase deficiency -### End" -2673,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following nail changes are associated with psoriasis, EXCEPT:, with the following options: A: Pitting, B: Onycholysis, C: Pterygium formation, D: Subungual hyperkeratosis - -### Response: -Pterygium formation is seen in severe cases of lichen planus. Nail changes in Psoriasis includes: Pitting: It is the most frequent change. Subungual hyperkeratosis Onycholysis Thickening and yellowish discoloration of nail plate Oil spots 10% of patients with Lichen planus have nail changes. Thinning of nail plate along with discoloration and irregular longitudinal grooves and ridges is the commonest change. Pterygium formation is seen in severe cases. Ref: Illustrated Synopsis Of Dermatology & Sexually Transmitted Diseases By Khanna page 123. -### End" -2674,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sweaty feet smelling urine is seen in A characteristic feature of isovaleric acidemia is a distinctive odor of sweaty feet. This odor is caused by the buildup of a compound called isovaleric acid in affected individuals. Reference: GHAI Essential pediatrics, 8th edition, with the following options: A: Maple Syrup, B: Gaucher, C: Isovaleric acidemia, D: Phenyl Ketonuria - -### Response: -A characteristic feature of isovaleric acidemia is a distinctive odor of sweaty feet. This odor is caused by the buildup of a compound called isovaleric acid in affected individuals. Reference: GHAI Essential pediatrics, 8th edition -### End" -2675,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not need treatment, with the following options: A: Neuroblastoma, B: Burkitt's lymphoma, C: T cell lymphoblastic leukemia, D: AML - -### Response: -Ans. a. Neuroblastoma Though all of the four malignancies in the given options should be treated, but spontaneous regression might be seen in neuroblastoma. So, the Ans. of exclusion is neuroblastoma Tumors with Spontaneous Regression (NCR MR) NeuroblastomaQ Malignant melanomaQ ChoriocarcinomaQ RetinoblastomaQ Renal cell carcinomaQ Leukemia Treatment AML Cytarabine + Anthracycline +/- Etoposideoside CML Imatinib mesylate (DOC), Hydroxyurea, Interferon-y ALL Induction: Vincristine, prednisone, Daunorubicin, asparaginase, intrathecal Methotrexate Consolidation: Cyclophosphamide, aspraginase Maintenance: 6-mercaptopurine, Methotrexate CLL Fludarabine and Chlorambucil Burkitt's Lymphoma Treatment of Burkitt's Lymphoma in both children and adults should begin within 48 hours of diagnosis andinvolves the use of intensive combination chemotherapy regimens incorporating high doses of cyclophosphamide. Prophylactic therapy to the CNS is mandatory. Today, cure can be expected in 70-80% of both children and young adults when effective therapy is -### End" -2676,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tonsillectomy following peritonsillar abscess is done after weeks:, with the following options: A: 1-3 weeks, B: 6-8 weeks, C: 4-6 weeks, D: 8-12 weeks - -### Response: -The tonsils should be removed 6-8 weeks following a Quinsy. - Turner 10th/ed p 86 Tonsils are removed 4-6 weeks following an attack of Quinsy. - Dhingra 6th/ed Most people would practise interval tonsillectomy for these patients, deferring surgery for 6 weeks following resolution of an attack. - Head and Neck Surgery by Chris de Souza -### End" -2677,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paraganglioma seen in -a) Carotid body tumorb) Thoraxc) Para-vertebral locationd) Para-aortic lymph nodes, with the following options: A: ab, B: bc, C: acd, D: abc - -### Response: -Paraganglioma are clusters of neuroendocrine cells associated with the sympathetic and parasympathetic nervous system. -Paraganglioma is the tumor of neuroendocrine cells of these paraganglia that occurs at various body sites including head, neck, thorax and abdomen. -Most common location of paragangliomas is adrenal medulla, where they are referred to as pheochromocytomas. -Other locations are - - -Paravertebral ganglion (organs of zuckerkandl and rarely bladder) -Paraganglia related to the great vessels of head and neck, so called aorticopulmonary chain, including carotid bodies (most common); ganglion nodosum of vagus nerve; and clusters located about the oral cavity, nose nasopharynx, larynx, and orbit. - - -Microscopic features of Paraganglioma are: - - -Composed of nests (zellballen) of round to oval chief cells (neuroectodermal origin) that are surrounded by delicate vascular septa. -Chief cells stain strongly for neuroendocrine markers such as chromogronin, synaptophysin, neuron specific enolase, CD56 and CD57. -There is a supporting stroma of spindle-shaped cells (sustentacular cells), that are positive for S-100 protein. -Neuroendocrine granules -### End" -2678,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not cause mydriasis?, with the following options: A: Atropine, B: Phenylephrine, C: Tropicamide, D: Pilocarpine - -### Response: -Pilocarpine cause miosis, not mydriasis Sympathomimetic drugs cause contraction of dilator pupillae and thus result in active mydriasis whereas parasympathomimetic drugs contract sphincter pupillae leading to active miosis. Parasympatholytic drugs like atropine stop the action of ACh on sphincter pupillae resulting in passive mydriasis. Effect Mechanism Drug Group Responsible Examples Active mydriasis Contraction of dilator pupillae Sympathomimetic drugs Phenylephrine ,Cocaine, Amphetamines Passive mydriasis Relaxation of sphincter pupillae Anti-cholinergic drugs Atropine ,Homatropine, Tropicamide Cyclopentolate Active miosis Contraction of sphincter pupillae Cholinergic drugs Pilocarpine, Physostigmine Passive miosis Relaxation of dilator pupillae Anti-adrenergic drugs Clonidine -### End" -2679,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Subtrochanteric fractures of femur can be treated by all of the following methods, EXCEPT:, with the following options: A: Skeletal traction on Thomas' splint, B: Smith Petersen Nail, C: Condylar blade plate, D: Ender'snail - -### Response: -Smith Petersen Nail -### End" -2680,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Waldeyer&;s ring consists of all of the following except, with the following options: A: Palatine tonsils, B: Pharyngeal tonsils, C: Tubal tonsils, D: Post. auricular nodes - -### Response: -In relation to the Naso - oropharyngeal isthmus, there are several aggregations of lymphoid tissue that constitute waldeyer' s lymphatic ring. the most impoant aggregations are the right and left palatine tonsils usually referred to simply as the tonsils. posteriorly and above there is the nasopharyngeal tonsil; laterally and above there are the tubal tonsils, and inferiorly there is the lingual tonsil over the posterior pa of the dorsum of the tongue. Waldeyer's lymphatic ring Nasopharyngeal tonsil Tubal tonsil Intratonsillar cleft Palatine tonsil Lingual tonsil Ref BDC volume;3 Sixth edition -### End" -2681,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In an epidemiological study, the first case which comes to the attention of the investigator is -, with the following options: A: Reference case, B: Index case, C: Primary case, D: Secondary case - -### Response: -Primary case refers to the first case of a communicable disease introduced into the first unit being studied. Index case is the first case which comes to the attention of the investigator. They may not always be the same. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 103 -### End" -2682,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corpulence index is a measure of:, with the following options: A: Copper level in the serum, B: Iron loss in faeces, C: Obesity, D: Income inequality - -### Response: -Corpulence index= actual weight/ desirable weight A value above 1.2 indicates obesity Ref: Park 21st edition, page 178. -### End" -2683,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The glomus tumor invasion of jugular bulb is diagnosed by, with the following options: A: Carotid angiography, B: Veebral venousvenography, C: X-ray, D: Jugular venography - -### Response: -MRI - gives soft tissue extent of tumor; Magnetic Resonance Angiography (MRA) shows compression of the carotid aery whereas magnetic resonance venography shows invasion of jugular bulb by the tumor. -### End" -2684,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a child ,Self-feeding develops at the age of __________, with the following options: A: 12 months, B: 15 months, C: 18 months, D: 24 months - -### Response: -Emerging patterns of social behaviour from 1-5years of age 15months Indicates some desires or needs by pointing Hugs parents 18months Feeds self Seeks help when in trouble May complain when wet or soiled Kisses parent with pucker 24months Handles spoon well Often tells about immediate experiences Helps to undress Listens to stories when shown pictures 30months Helps put things away Pretends in play 36months Plays simple games (in ""parallel"" with other children) Helps in dressing (unbuttons clothing and puts on shoes) Washes hands 48months Plays with several children, with the beginning of social interaction and role-playing Goes to the toilet alone 60months Dresses and undresses Asks questions about the meaning of words Engages in domestic role-playing Ref: Nelson paediatrics; Table 11-1 -### End" -2685,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which Couinaud segment of liver has independent supply?, with the following options: A: I, B: II, C: III, D: IV - -### Response: -Ans. is 'a' i.e., I * Caudate lobe (Couinaud Segment I) (anatomical part of right lobe) belongs physiologically to both right and left lobes because it receives blood from right and left hepatic arteries; right and left branches of portal vein; and drains bile into both right and left hepatic duct. Thus it is considered as physiological independent lobe of the liver. -### End" -2686,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diuresis produced by alcohol is due to, with the following options: A: Decreased tubular reabsorption, B: Increased glomerular filtration rate, C: Osmotic diuresis, D: Inhibition of ADH secretion - -### Response: -Diuresis- increased formation and secretion of urine. Diuresis occurs in conditions such as diabetes mellitus, diabetes insipidus, and acute renal failure.Vasopressin is a peptide hormone that increases water permeability of the kidney&;s collecting duct and distal convoluted tubule by inducing translocation of aquaporin-CD water channels in the plasma membrane of collecting duct cells. It also increases peripheral vascular resistance, which in turn increases aerial blood pressure. It plays a key role in homeostasis, by the regulation of water, glucose, and salts in the blood.Ref: Ganong&;s review of medical physiology; 24th edition; page no:- 311 -### End" -2687,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pain relief in chronic pancreatitis can be obtained by destruction of, with the following options: A: Celiac ganglia, B: Vagus nerve, C: Anterolateral column of spinal cord, D: None of the above - -### Response: -Chronic pancreatitis Pain from the pancreas is carried in sympathetic fibres that traverse the Celiac ganglion, reach the sympathetic chain through the splanchnic nerves, and then ascend to the coex Celiac plexus nerve blocks performed either percutaneously or endoscopically have been employed to abolish this pain with inconsistent results Ref: Sabiston 20th edition Pgno :1534 -### End" -2688,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ALL THE FOLLOWING ARE STRUCTURES PRESENT OUT SIDE BLOOD BRAIN BARRIER EXCEPT ?, with the following options: A: TUBERUS CINERIUM, B: AREA OF PROSTREMA, C: LAMINA TERMINALIS, D: NEUROHYPOPHYSIS - -### Response: -TUBERUS CINERIUM IS PA OF FLOOR OF 3RD VENTRICLE REMAINING ALL ARE THE ONLY STRUCTURES OUTSIDE BBB REF :bd chaurasia -### End" -2689,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blastomycosis may involve any of the following organs except(NOT RELATED), with the following options: A: Skin, B: Lungs, C: Lymphatics, D: Intestinal tract - -### Response: -Blastomycosis does not involve intestinal tract -### End" -2690,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about fibronectin nephropathy are all except?, with the following options: A: Autosomal recessive inheritance, B: Gomerular enlargement and PAS+ trichrome mesangial deposit, C: Glomerulus do not consistently stain for Ig and complement, D: Ultrastructural feature is presence of large electron mesangial or subendothelial deposit - -### Response: -Ans. is 'a' i.e., Autosomal recessiveFibronectin nephropathy o Fibronectin nephropathy a disease of autosomal dominant mode of inheritance is characterized by massive glomerular accumulation of plasma fibronectin.o Fibronectin is a multifunctional, extracellular matrix glycoprotein that is active in cellular adhesion and migration. It is produced : -(i) Locally in the glomerulus by mesangial cells (cellular fibronectin).(ii) Liver synthesizes fibronectin that circulates (plasma fibronectin).o In fibronectin nephropathy, plasma fibronectin is accumulated.Pathological findingso The principal light microscopic change is glomerular enlargement and lobulation resulting from PAS and trichrome-positive mesangial deposits and mild mesangial proliferation. this process displaces the glomerular capillaries to the periphery of the lobule and decreases their luminal diameter. With Jones stain, the preserved GBM is usually at the periphery of the thickened capillary wall. There are no specific changes in renal tubules, interstitium or blood vessels.o By immunofluresence microscopy, the glomeruli do not consistently stain for immunoglobulin or complement components.o Immunohistological stain for fibronectin is strongly positive in the mesangial and subendothelial location.o The most consistent ultrastructural finding is large (giant), mesangial and subendothelial electron dense deposits that mirror the location of the PAS - positive fibronectin deposits. -### End" -2691,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following statements are true about pityriasis versicolor except, with the following options: A: Caused by Malasezzia globosa, B: Sphagetti & meat ball appearance on koh mou, C: Fried egg appearance of colonies on SDA, D: Steroids are used - -### Response: -Steroids are contraindicated in pityriasis versicolor -Treatment include:- - -Selenium sulfide shampoo, ketoconazole shampoo or cream. -### End" -2692,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Left ventricular hyperophy is caused by all except-, with the following options: A: MS, B: MR, C: AS, D: AR - -### Response: -Left ventricular hyperophy is enlargement and thickening (hyperophy) of the walls of your hea's main pumping chamber (left ventricle). Left ventricular hyperophy can develop in response to some factor -- such as high blood pressure or a hea condition -- that causes the left ventricle to work harder. The most common cause of LVH is high blood pressure (hypeension). Other causes include athletic hyperophy (a condition related to exercise), valve disease, hyperophic cardiomyopathy (HOCM), and congenital hea disease. Ref Davidson 23rd edition pg 472 -### End" -2693,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NALGONDA technique' is used in -, with the following options: A: Enedmic-fluorosis, B: Epidemic-dropsy, C: Endemic-ascites, D: Neurolathyrism - -### Response: -The National Environmental Engineering Research Institute Nagpur developed a techniwue for removing flouride by chemical treatment. it is called Nalgonda techniqueREF.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.Editon-21.Page no.-596 -### End" -2694,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lutein and theca lutein cysts may be associated with all the following except, with the following options: A: Mole, B: Choriocarcinoma, C: Stein-leventhal syndrome(PCOS), D: Pregnancy - -### Response: -- Theca lutein cysts are present because of high HCG. - These are seen in : Molar pregnancy, Choriocarcinoma, Twin pregnancies, Chronic renal failure (due to decreased hCG clearance) Hypehyroidism (due to structural homoly between hCG and TSH) - PCOS is not associated with theca lutein cysts. In fact, PCOS has NO CYSTS. - PCOS is associated with anovulation and hyperandrogenesim. -### End" -2695,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Liver synthesises all except, with the following options: A: C3 complement component, B: Haptoglobin, C: Fibrinogen, D: Immunoglobulin - -### Response: -Immunoglobulins are synthesized by the B-lymphocytes. -### End" -2696,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following are NOT features of Coicospinal tract lesion? 1. Spasticity 2. Resting tremor 3. Exaggerated tendon reflexes 4. Extensor plantar response 5. Cogwheel rigidity, with the following options: A: 1,2 & 3, B: 2 & 5, C: 4 & 5, D: None - -### Response: -""Resting tremors are present in parkinsons disease and in extrapyramidal disorder, not in coicospinal tract disorder"". ""Rigidity is increased tone that is present throughout the range of motion (a ""lead pipe""or ""plastic"" stiffness) and affects flexors and extensors equally; it sometime has a cogwheel quality that is enhanced by voluntary movement of the contralateral limbs(reinforcement). Rigidity occurs with ceain extrapyramidal disorders such as parkinson's disease "". Coicospinal tract lesions: Axons of the pyramidal or coicospinal system descends through the brainstem in the cerebral peduncle of the midbrain, the basis points, and the medullary pyramids. At the cervicomedullary junction, most pyramidal axons decussate into the contralateral coicospinal tract of the lateral spinal cord, but 10-30% remain ipsilateral in the anterior spinal cord. Muscle stretch (tendon) reflexes are usually increased with upper motor neuron lesions, although they may be decreased or absent for a variable period immediately after onset of an acute lesion. This is usually -but not invariably -accompanied by abnormalities of cutaneous reflexes (such as superficial abdominals) and in paicular, by an extensor plantar (Babinski) response. Ref: Harrison 17/e, page 147 ; Ganong 23/e, page 253 -### End" -2697,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following doesn't come under section 320 of IPC?, with the following options: A: Dislocation of a tooth, B: Emasculation, C: Any hu which endangers life, D: Any hu which leaves the person bed ridden for 5 days - -### Response: -If a person is unable to follow his ordinary pursuits for a period of 20 days as a result of the injury it becomes grievous hu (Section 320 IPC). Ref: Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 21st Edition, Page 244. -### End" -2698,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Defect most commonly occuring in congenital rubella is -, with the following options: A: Cataract, B: Deafness, C: Microcephaly, D: Blindness - -### Response: -A cataract is the most common defect in congenital rubella REF:ANATHANARAYANAN MICROBIOLOGY NINTH EDITION PAGE.555 -### End" -2699,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Black colour code is used in four code system of triage management in disaster for -, with the following options: A: Ambulatory pateints, B: Low priority pateints, C: Dead patients, D: High priority patients - -### Response: --triage consists of rapidly classifying the injured on the basis of severity of their injuries and the likelihood of their survival with prompt medical intervention. - black colour triage is for moribund and dead patients Reference: Park's textbook of preventive and social medicine, 23rd edition, pg no: 796 <\p> -### End" -2700,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: spinal nerve is related to, with the following options: A: Glossopharyngeal, B: Vagus, C: Hypoglossal, D: Facial - -### Response: -The anterior primary ramus of C1 joins with hypoglossal nerve, which distributes the motor fibres to the geniohyoid and thyroid muscles. C1 is the first spinal nerve which is unique in that it contains only motor fibres. -### End" -2701,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About dermatophytes all are true execpt, with the following options: A: Candida albicans usually cause systemic infection, B: Dermatophytes involve superficial layers of skin, C: Microsporum doesn't involve nail, D: Epidermophyte doesn't involve hair - -### Response: -A i.e. Candida albicans usually cause systemic infection Candidiasis may present as buccal creamy curd like pseudomembrane (thrush) or thickness, erosion & discoloration of web space (erosio interdigitalis blastomycetica)Q. It is most common fungal infection of female genital tract. Amphotericin B is drug of choice in systemic candidiasisQ. -### End" -2702,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fixation is a concept related to, with the following options: A: Psychosocial stages of development, B: Psychosexual stages of development, C: Cognitive stages of development, D: Hierarchy of needs - -### Response: -Fixation is concept introduced by Sigmund Freud, he explains this in his each stage of Psychosexual stages of development. Ref: Synopsis of Psychiatry, 11e, pg 157. -### End" -2703,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about the Serratus anterior muscle is, with the following options: A: Originates from the lower four ribs, B: Bipennate muscle, C: Supplied by the subscapular nerve, D: Helps in forced inspiration - -### Response: -Serratus anterior helps in veical overhead abductionQ (assisted by trapezius), forward punchQ (assisted by pectoralis minor) & forced inspirationQ; it's paralysis leads to winging of scapulaQ -### End" -2704,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Macula involvement is common in:, with the following options: A: Toxoplasma, B: Malaria, C: CMV, D: Syphilis - -### Response: -C i.e. CMV -### End" -2705,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an automsomal dominant metabolic disorder?, with the following options: A: Cystic fibrosis, B: Phenyl ketonuria, C: a-I antitrypsin deficiency, D: Familial hyper cholestrolemia - -### Response: -Answer is D (Familial hypercholesterolemia): -### End" -2706,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has a miotic pupil, IOP = 25, normal anterior chamber, hazy cornea and a shallow anterior chamber in fellow eye. Diagnosis is:, with the following options: A: Acute anterior uveitis, B: Acute angle closure glaucoma, C: Acute open angle glaucoma, D: Senile cataract - -### Response: -In this scenario patient present with signs of acute anterior uveitis, which is an inflammation of iris and ciliary body. Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Pages 141-44 ; Textbook of Ophthalmology By Neema, 3rd Edition, Page 160 -### End" -2707,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meningococcal vaccine is available for all of the following, except -, with the following options: A: Group A, B: Group B, C: Group C, D: Group Y - -### Response: -Ans. is 'b' i.e., Group B o Vaccines are available for group A, C, Y and W-125. There is no group B vaccine available at present. -### End" -2708,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bupivacaine poisoning is treated with:, with the following options: A: Esmolol, B: Sotalol, C: Lignocaine, D: 5% dextrose - -### Response: -Bupivacaine causes more toxicity than other drugs in its therapeutic dosage. Hence in poisoning cardiovascular side effect would be profound and is treated with a cardio selective beta blocker that is esmolol. Sotalol is no a cardio selective beta blocker. Lignocaine is a local anesthetic that can fuher aggravate cardio toxicity. From padmaja 4th edition Page no 202 -### End" -2709,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 44-year-old woman suffers a fall while rock climbing, landing on her but tocks and falling forward. Despite prolonged airlift to the ED, she is hemodynamically stable. She complains of bilateral pain in her legs, distal to her knees. She has profound weakness in her bilaterally extensor hallucis longi and gastrocsoleus complexes and has marked saddle anesthesia. MRI shows a large, midline herniated disc, compressing each of the traversing nerve roots and entire cauda equina below its level, but sparing the exiting nerve roots. Which disc is most likely involved in this injuryinjury, with the following options: A: L2-3, B: L3-4, C: L4-5, D: L5-S1 - -### Response: -This patient has weak extensor hallucis longi (L5 nerve root), weak gas trocsoleus complexes (S1), and saddle anesthesia (S2-4). She has normal function above this level, suggesting that the L5 nerve roots and those below are affected. An injury at L4-5 that spares the exiting roots (L4) but affects the traversing roots (L5) and those below (S1-5) would be most consistent with these symptoms. Remember the sacral spine does not have interbody discs, as it is fused. -### End" -2710,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyperphagia, weight gain and hypersexuality is seen in ?, with the following options: A: Kluver-Bucy syndrome, B: Sein-leventhal syndrome, C: Bulemia nervosa, D: None - -### Response: -Ans. is 'a' i.e., Kluver-Bucy syndrome Kluver - Bucy syndrome may present with hyperphagia, hypersexuality, oral tendencies, and visual agnosia. Kluver-Bucy syndrome is a neuro-behavioural syndrome associated with bilateral lesions in the anterior temporal horn or amygdala. Heinrich kluver and Paul Bucy first described the syndrome in 1937 after experimental work where they removed rhesus monkey's temporal lobes. They found that the monkeys developed. Visual agnosia : They could see, but were unable to recognise familiar objects or their use. Oral tendencies : They would examine their surroundings with their mouths instead of their eyes. Hypermetamorphosis : A desire to explore everything. Emotional changes : Emotion was dulled and facial movements and vocalisations were far less expressive. They lost fear where it would normally occur. Even after being attacked by a snake, they would casually approach it again. This was called ""placidity"". Hypersexuality : A dramatic inc rease in ove sexual behaviour, including masturbation, and homosexual and heterosexual acts. They may even attempt copulation with inanimate objects. The syndrome in humans is due to bilateral destruction of the amygdaloid body and inferior temporal coex, most commonly due to herpes simplex encephalitis (HSE). It shares visual agnosia and loss of normal fear and anger responses in common with the monkey model but one also seen loss of memory with dementia, distractibility and seizures. The hypersexuality tends to be less ove than in the monkeys but may be public and unacceptable. -### End" -2711,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vicarious responsibility peains to: Delhi 06; NIMHAS 14, with the following options: A: Patient's, contribution towards negligence, B: Hospitals contribution towards patient's damage, C: Responsibility for actions of a colleague, D: Responsibility of senior for actions of junior - -### Response: -Ans. Responsibility of senior for actions of junior -### End" -2712,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following statements are related to obstetric inversion :, with the following options: A: It is usually insidious in onset, B: It is usually acute, C: It is usually incomplete, D: In majority, it is spontaneous in nature - -### Response: -Uterine inversion is a condition in which there is a inside out turning of the uterus. It is a rare cause of postpaum collapse but collapse occurs suddenly after labour It is acute in onset Mostly uterine inversion is complete, i.e, third degree Most common cause of uterine inversion is mismanagement of third stage of labour Ref: Datta Obs 9e pg 395. -### End" -2713,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 54 year old woman presents with complaints of abdominal fullness and early satiety. She denies a change in bowel habits and says that constipation is her normal state. A radiographic bowel series shows an ""apple core"" lesion in her sigmoid colon. Which of the following markers is expected to be elevated in this patient?, with the following options: A: Alpha-fetoprotein (AFP), B: Carcinoembryonic antigen (CEA), C: Human chorionic gonadotropin (hCG), D: actate dehydrogenase (LDH) - -### Response: -CEA is a glycoprotein (200,000 daltons) that is found in the gastrointestinal mucosal cells and pancreatobiliary system secretions. It becomes elevated when breaks in the mucosal basement membrane occur due to tumor growth. Some other conditions can also cause elevations of CEA (e.g., cirrhosis, pancreatitis). The patient described above has colonic carcinoma, and the ""apple core"" lesion is the classic radiographic finding of this tumor. Although CEA is not used for screening because of the large number of false positives, it can be used to guide treatment in known cases. It returns to normal levels 30-45 days after tumor resection. If it begins to rise again, tumor recurrence is likely. AFP, or alpha-fetoprotein, is an alpha globulin (70,000 daltons) made by the liver and yolk sac of the human fetus. It is elevated with hepatocellular carcinoma and germ cell neoplasms. It is not paicularly specific. hCG, or human chorionic gonadotropin, is a glycoprotein secreted by trophoblastic epithelium of the placenta. It is useful (sensitive and specific) for germ cell tumors of the testis and ovary. LDH, or lactate dehydrogenase, is a very non-specific test that can be elevated in many conditions, including malignancy. Ref: Meric-Bernstam F., Pollock R.E. (2010). Chapter 10. Oncology. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e. -### End" -2714,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Superficial inguinal ring in the female transmits:, with the following options: A: Broad ligament of uterus, B: Round ligament of the uterus, C: Cardinal ligament, D: None of the above - -### Response: -The superficial inguinal ring is a triangular apeure in the aponeurosis of the external oblique muscle and is situated above and medial to the pubic tubercle. In the female, the superficial inguinal ring is smaller and difficult to palpate; it transmits the round ligament of the uterus. -### End" -2715,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypercalcemia is seen in all, except-, with the following options: A: Acute pancreatitis, B: Hypervitaminosis D, C: Addison's disease, D: Hyperparathyroidism - -### Response: -

Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of PTH. The elevation of circulating hormone usually leads to hypercalcemia and hypophosphatemia. There is great variation in the manifestations. Patients may present with multiple signs and symptoms, including recurrent nephrolithiasis, peptic ulcers, mental changes, and, less frequently, extensive bone resorptionHypercalcemia in vitamin D intoxication is due to an excessive biologic action of the vitamin, perhaps the consequence of increased levels of 25(OH)D rather than merely increased levels of the active metabolite 1,25(OH) 2 D (the latter may not be elevated in vitamin D intoxication). 25(OH)D has definite, if low, biologic activity in the intestine and bone. The production of 25(OH)D is less tightly regulated than is the production of 1,25(OH) 2 D. Hence concentrations of 25(OH)D are elevated severalfold in patients with excess vitamin D intake.In secondary adrenal insufficiency, only glucocoicoid deficiency is present, as the adrenal itself is intact and thus still amenable to regulation by the RAA system. Adrenal androgen secretion is disrupted in both primary and secondary adrenal insufficiency . Hypothalamic-pituitary disease can lead to additional clinical manifestations due to involvement of other endocrine axes (thyroid, gonads, growth hormone, prolactin) Causes of Secondary Adrenal Insufficiency Diagnosis Gene Associated Features Pituitary tumors (endocrine active and inactive adenomas, very rare: carcinoma)(harrison 18 pg 2956)

-### End" -2716,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acculturation is defined as –, with the following options: A: Loss of culture sense, B: Isolation of two cultures, C: Fading away of culture, D: Mixing of two cultures when coming in contact - -### Response: -Acculturation - -Acculturation means ""Culture contact"", when there is contact between two peoples with different types of culture. There is diffusion of culture in both ways. -Various ways of culture contact are : -Trade and commerce -Industrialization -Propagation of religion -Education -Conquest -### End" -2717,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: TRUE regarding human hea, with the following options: A: Conduction of impulse from endocardium to inwards, B: During exercise duration of systole is reduced more than diastole, C: HR increases with parasympathetic denervation, D: Vagal stimulation decreases force of contraction - -### Response: -C i.e. Hea rate increases with parasympathetic denervationThe duration of systole is much more fixed than that of diastole and when the hea rate is increased (eg. in exercise), diastole is shoened to a much greater degree.QSympathetic & parasympathetic innervationVagal (parasympathetic) fibres are mainly distributed to atria & not much to ventricles. This explains the fact that the main effect of vagal stimulation is to decrease hea rate rather than to decrease the strength of hea contraction greatly (which is dependent on ventricle)Sympathetic (noradrenergic) fibres are distributed to both atria & ventricle. So its stimulation has a strong effect on both hea rate (chronotropic) & force of contraction(ionotropic)FeatureSympathetic(adrenergic)stimulationParasympathetic(cholinergic)stimulationHea rate(chronotropic)IncreasedDecreased (main)ConductionIncreasedDecreasedForce ofcontraction(lonotropic)IncreasedDecreased (to alesser extent)Denervation- At rest, there is a moderate amount of tonic discharge in cardiac sympathetic nerves, whereas vagal tone (tonic discharge) is of good amount.- So when vagi are cut (or parasympatholytic drug eg atropine is given) the normal resting hea rate rises (from 70) to 150-180 beats/min due to unopposed sympathetic tone. Q- If both noradrenergic & cholinergic systems are blocked, the hea rate is -100 beats / min. -### End" -2718,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An asymptomatic patient has proteinuria and hematuria that is glomerular in origin on a routine urinalysis. Which of the following is the most likely diagnosis?, with the following options: A: diabetes mellitus (DM), B: amyloidosis, C: immunoglobulin A (IgA) nephropathy (Berger's disease), D: focal glomerulosclerosis - -### Response: -Other causes of asymptomatic hematuria, with or without proteinuria, include sickle cell disease, Alport's syndrome, resolving glomerulonephritis, and thin basement disease. Berger's disease is characterized by immunoglobulin A (IgA) deposits in the mesangium. It most commonly affects older children and young adults, and is more common in Blacks than Whites. Macroscopic hematuria may occur with inter-current illness or vigorous exercise. The prognosis is variable but tends to progress slowly. Spontaneous remissions are more common in children than in adults. About 20-50% of patients develop end-stage renal disease within 20 years of diagnosis. -### End" -2719,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of anthrax is, with the following options: A: Cutaneous, B: Gastrointestinal, C: Pulmonary, D: Pneumonic - -### Response: -Ans. a (Cutaneous). (Ref. Harrison, Medicine, 18th/Chapter 221. Microbial Bioterrorism)Bacillus anthrax causes anthrax and disease may be seen in three forms;# Cutaneous, Pulmonary, and Intestinal- Cutaneous is the most common form (malignant pustule, Hide porter's disease)- Pulmonary is wool sorter's disease.Also Remember:Cultural characteristics of B.anthrax are:# M'fadyeans reaction# Frosted glass appearance# Medusa head sign# Inverted tree appearance# PLET media used -### End" -2720,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Person experiencing fear when he travels by bus alone is a case of, with the following options: A: Generalized anxiety disorder, B: Panic disorder, C: Agoraphobia, D: All the above - -### Response: -(A) Generalized anxiety disorder # Symptoms of ANXIETY:# Physical Symptoms:> Motor Symptoms: Tremors; Restlessness; Muscle twitches; Fearful facial expression> Autonomic and Visceral Symptoms: Palpitations; Tachycardia; Sweating; Flushes; Dyspnea; Hyperventilation; Constriction in the Chest; Dry mouth; Frequency and hesitancy of micturition; Dizziness; Diarrhea; Mydriasis# Psychological Symptoms:> Cognitive Symptoms: Poor concentration; Distractibility; Hyperarousal; Vigilance or scanning; Negative automatic thoughts> Perceptual Symptoms: Derealization; Depersonalization.> Affective Symptoms: Diffuse, unpleasant, and vague sense of apprehension; Fearfulness; Inability to relax; Irritability; Feeling of impending doom (when severe)> Other Symptoms: Insomnia (initial); Increased sensitivity to noise Exaggerated startle response -### End" -2721,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In testicular tumours, with the following options: A: Only 10% are malignant, B: Maldescent of testes leads to malignancy, C: Extremely painful, D: Excoriation of the superficial skin - -### Response: -(Maldescent of testis leads to malignancy) (1411-LB) (1385-B & L 25th)Tumours of the Testes* About 99% of testicular neoplasm are malignant and although they make up only about 1 -2% of malignant tumours (MC tumours in young males)* **Maldescent undoubtedly predisposes to malignancy.* Tumours of testis = Seminoma (40%) Teratoma (32%) combined (14%) interstitial tumours (1.5%) lymphoma (71%).* Malignant teratoma intermediate teratocarcinoma is the most common histologic variants of teratoma.* Clinical features(i) First noticing that he has a testicular lump. A sensation of heaviness.(ii) Only 30% of patients experience pain (Normally painless)(iii) There is a history of trauma to the affected side in over 10%(iv) 10% of patients have lax secondary hydroceleEssentials of Diagnosis (1070-CSDT 11th)* Painless firm mass within the testicle in a man aged 18-40* Elevated serum levels of the beta subunit of(i) Human chorionic gonadotropin (P-hCG) (ii) Alpha fetoprotein (AFP) (iii) Lactic dehydrogenase (LDH) or all three* Enlarged retroperitoneal nodes on abdominal CT scan* Palpable abdominal mass in advanced cases. -### End" -2722,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best scan for assessing myocardial viability:, with the following options: A: Thallium, B: B. MIB1, C: Tc99 pyrophosphate scan, D: FDG PET - -### Response: -Ref: Harrison's Principles of Internal Medicine, 18th edition,, pg 1846Explanation:* Nuclear (or radionuclide) imaging requires intravenous administration of radiopharmaceutical s which undergoes uptake in specific organs & radiation is emitted in the form of photons (gamma rays). The two most commonly used technologies in clinical nuclear cardiology are single- photon emission computed tomography (SPECT) and positron emission tomography (PET). (See the following table)The PET FDG (positron emitting tracer F-18 flurodeoxyglucose) asseses myocardial viabilityUses Rubidium 82, N-13 ammoniaIt measures myocardial glucose metabolism after oral glucoseIschemic/hibernating myocardium show increased FDG uptake - 'flow/metabolism mismatchIdentifies areas of myocardium likely to improve after revascularizationCan calculate LV systolic function & volumesBetter image quality compared to SPECT (Single photon emission computed tomography)SPECT with ThaI201/ Tc99m needs viable myocardial cells for uptake, does not identify hibernating myocardium.' -### End" -2723,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 14 year old boy having lost his father a year ago, is caught shoplifting. The boy will be sent to, with the following options: A: An orphanage, B: An anganwari, C: A prison, D: A remand home - -### Response: -Ans. is 'd' i.e., A remand home -### End" -2724,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication of splenectomy is ?, with the following options: A: Pancreatic leak, B: Pulmonary complications, C: Pneumococcal peritonitis, D: Hemorrhage - -### Response: -Ans. is 'b' i.e., Pulmonary complications -### End" -2725,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Complications of cholera are all of the following except: September 2007, with the following options: A: Metabolic alkalosis, B: Metabolic acidosis, C: Acute renal failure, D: Hypovolemic shock - -### Response: -Ans. A: Metabolic alkalosis The loss of sodium and water causes severe diarrhea, called ""ricewater stool"". Acute dehydration, hypovolemic shock, and metabolic acidosis follow quickly. The patient exhibits dry skin, sunken eyes, lethargy, cyanosis, a weak pulse, faint hea sounds, hemoconcentration, and elevation of serum proteins. Patients are usually afebrile, body temperature may be subnormal. The fluid in diarrhoea contains large amounts of sodium, chloride, bicarbonate, and potassium, as well as mucus; the loss of these electrolytes causes blood volume depletion, low blood pressure, and shock. -### End" -2726,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Angular conjunctivitis is caused by -, with the following options: A: H. influenza, B: Adenovirus type 32, C: Moraxella axenfield bacillus, D: Brahnmella - -### Response: -Moraxella axenfeld (moraxella lacunata) is the most common causative organism for angular conjunctivitis. Ref: Parson's 21st/e p.168 -### End" -2727,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of Cheyne-Stokes breathing is?, with the following options: A: Diabetic ketoacidosis, B: CHF, C: Bulbar polio, D: Pontine hemorrhage - -### Response: -Ans. is'b'i.e., CHF(Ref Clinicalmedicine p. 713)Cause of Cheyne-Stokes respiration,Normally occurs during sleep at high altitudeCongestive cardiac failureDamage to respiratory centers -### End" -2728,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypoxiema independent of, with the following options: A: Fi02, B: altitude, C: Hb, D: PaCO2 - -### Response: -Hb [Ref: Ganong 23/e p617; http://en.wikipedia.org/wiki/Hypoxemiaj Hypoxemia is decreased paial pressure of oxygen in blood. It is the oxygen that is dissolved in the blood not attached with hemoglobin; thus it does not depend on Hemoglobin. Hypoxemia is one of the types of Hypoxia kla Hypoxic Hypoxia. The Hypoxia dependent on hemoglobin is anemic Hypoxia. Hypoxia is defined as 0, deficiency at the tissue level. Hypoxia has been divided into four types. (1) Hypoxic hypoxia, in which the P02 of the aerial blood is reduced; (2) Anemic hypoxia, in which the aerial P02 is normal but the amount of hemoglobin available to carry 02 is reduced; (3) Stagnant or Ischemic hypoxia, in which the blood .flow to a tissue is so low that adequate 02 is not delivered to it despite a normal P02 and hemoglobin concentration; and (4) Histotoxic hypoxia, in which the amount of 02 delivered to a tissue is adequate but, because of the action of a toxic agent, the tissue cells cannot make use of the 02 supplied to them. Hypoxic Hypoxia (Hypoxemia) Hypoxic Hypoxia is the most common form of hypoxia seen clinically. Causes: 1.Low inspired paial pressure of oxygen (low Pi02) 2. Alveolar hypoventilation 3.Impairment of diffusion across blood-gas membrane 4.Ventilation-perfusion inequality 5. Shunt In contrast, primary hemoglobin deficiency, e.g. anemia is not a cause, since it doesn't decrease the paial pressure of oxygen in blood. Low inspired oxygen paial pressure (low PiO2) If the paial pressure of oxygen in the inspired gas is low, then a reduced amount of oxygen is delivered to the alveoli of the lung. The reduced oxygen paial pressure can be a result of reduced fractional oxygen content (low Fi02) or simply a result of low barometric pressure, as can occur at high altitudes. This reduced Pi02 can result in hypoxemia even if the lungs are normal. Alveolar hypoventilation If the alverolar ventilation is low, there may be insufficient oxygen delivered to the alveoli each minute. (e.g., airway obstruction, depression of the brain's respiratory center, or muscular weakness). Impaired diffusion Impaired diffusion across the blood-gas membrane in the lung can cause hypoxemia, e.g. pneumonia, pulmonary fibrosis Shunt Shunting of blood from the right side to the left side of the circulation (right-to-left shunt) is a powerful cause of hypoxemia. The shunt may be intracardiac (tong. cyanotic hea disease) or may be intrapulmonary.(Note that Left-toright shunting does not cause hypoxemia.) Ventilation-perfusion inequality Ventilation-perfusion inequality (or ventilation-perfusion mismatch) is a common cause of hypoxemia in people with lung disease. It is the areas of the lung with ventilation/perfusion ratios that are less than one (but not zero) that cause hypoxemia by this mechanism. A ventilation/perfusion ratio of zero is considered a shunt. (Not sure how PCO\\ is linked with hypoxemia or PaO2 ; possibl! hypoxemia causes lryperventilation which leads todecreased alveolar and aeial PCO2) -### End" -2729,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common accepted theory for antibody production is, with the following options: A: Direct template, B: Indirect template, C: Natural selection, D: Clonal selection - -### Response: -(Clonal selection theory) (149-150-AN 7th)Clonal selection theory proposed this theory which shifted immunological specificity to the cellular level According to the clonal selection hypothesis, during immunological development, cells capable of reacting with different antigens were formed by a process of somatic mutation, clones of cells that has immunological reactivity with self antigens were eliminated during embryonic life. Such clones are called forbidden clones. Their persistence or development in later life by somatic mutation could lead to autoimmune process.* The clonal selection theory is more widely accepted than the other theories, though it is unable to account for all the features of the immune response. -### End" -2730,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Measles vaccine given to contact of measles case exes protective effect within -, with the following options: A: 1 day, B: 3 days, C: 7 days, D: 10 days - -### Response: -Ans. is 'c' i.e., 7 days o Normally the incubation period of measles is 10 days from exposure to appearance of first symptom (fever). o But, when infection is induced aificially by injecting the live measles vaccine, the incubation period is somewhat shoened, averaging 7 days. Why is it so ? Lets see o In natural infection, virus enters through respiratory tract and then it gains entry to blood stream. o In contrast, measles vaccine is injected subcutaneously it immediatly enters into circulation. So, measles vaccine has incubation period less (3 days) than natural infection. o For this reason, measles vaccine should be given within 2-3 days after exposure, so that vaccine virus can induce immunity before the natural virus can cause clinical illness. -### End" -2731,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5-year-old boy presents to the hospital with bleeding wound from bite of his pet dog which was fully vaccinated. He previously had completed anti rabies immunization on December 2018. What post exposure prophylaxis against rabies is recommended for the patient now?, with the following options: A: No ARV required, B: Single site 2 doses on day 0 and 3, C: Single site 4 doses on day 0, 3 7 and 28, D: Rig and 4 doses regime - -### Response: -Ans. (B) Single site 2 doses on day 0 and 3(Refer: WHO vaccination 2018)As it is difficult to know whether the vaccinated dog is adequately seroconverted/protected against rabies. Hence, even in such individuals it is recommended to start the PEPThis case is classified under WHO- Category-III.Individuals with WHO category II or III exposures should receive PEP without delay.One ID dose is 0.1 mL of vaccine and one IM dose is an entire vial of vaccine, irrespective of the vial size.Should a vaccine dose be delayed for any reason, the PEP schedule should be resumed (not restarted)Rabies Immunoglobulin (RIG)RIG provides a passive immunization and is administered only once, as soon as possible after the initiation of PEP and not beyond 7 days after the first dose of vaccine.Vaccines should never be withheld regardless of the availability of RIG.Max dose: hRIG- 20IU/kg, eRIG- 40IU/kgAll of the rabies immunoglobulin, or as much as anatomically possible (but avoiding possible compartment syndrome), should be administered into or around the wound site or sites. The remaining immunoglobulin, if any, should be injected intramuscularly at a site distant from the site of vaccine administration. Rabies immunoglobulin may be diluted to a volume, sufficient for all wounds to be effectively and safely infiltrated.Prioritization of RIG allocation:#Multiple bites > Deep wounds > Bites to head, neck and hands > Patients with severe immunodeficiency > The biting animal is confirmed or probable rabies > Bites, scratches, and exposure of mucous membranes caused by a bat.Immunodeficient individuals: In the event of exposure a complete PEP course, including RIG is recommended irrespective of the PrEP status.(PrEP) Pre-exposure prophylaxis:#PrEP considered in remote, rabies- endemic areas where access to PEP is difficult, the dog bite incidence is 5% per year or vampire bat rabies is known to be present.#2 sites ID or a 1-site IM vaccine administration on days 0 and 7.#A routine PrEP booster or serology for neutralizing antibody titers is recommended only if a continued, high risk of rabies exposure remains.#Individuals with documented immunodeficiency should be evaluated on a case-by-case basis and best receive an ID or IM PrEP schedule as above, plus a third vaccine administration between days 21 to 28. -### End" -2732,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antihypeensive specially suited for physically, intellectually and sexually active young patients:, with the following options: A: Calcium channel blockers, B: ACE inhibitors, C: b adrenergic blocker, D: Diuretics - -### Response: -ACE inhibitors -### End" -2733,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gateway of tears is:, with the following options: A: Rathke pouch, B: Sinus of morgagni, C: Killians dehiscence, D: Pharyngeal bursa - -### Response: -Killians dehiscence is also called 'gateway of tears' -### End" -2734,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Operational efficiency of malaria control programme?, with the following options: A: Infant parasite rate, B: Slide positivity rate, C: Mosquito bite rate, D: Annual blood examination rate - -### Response: -Ans. is 'd' i.e., Annual blood examination rate MEASUREMENTOFMALAR1A In the pre-eradication era, the magnitude of the malaria problem in a country used to be determined mostly from the repos of the clinically diagnosed malaria cases and the classical malariometric measures, e.g., spleen rate, parasite rate etc. On the other hand, during eradication era, the microscopic diagnosis of malaria cases became the main method of diagnosis and the parameters used are mostly parasitological in nature e.g., API, ABER, SPR and SFR. Measurements of malaria in the pre eradication era Spleen rate: Defined as the percentage of children between 2 & 10 years of age showing enlargement of spleen. Spleen rate is widely used for measuring the endemicity of malaria in a community. Av. enlarged spleen : A refinement of spleen rate , denoting the average size of spleen. Parasite rate Defined as on the percentage of children between the ages of 2 & 10 yrs showing malarial parsites in their blood films. Parasite density index Average degree of parasitimia Infant parasite rate Percentage of infants showing malarial parasites in their blood films. It is the most sensitive index of recent transmission of malaria in a locality. If the infant parasite rate is zero for three consecutive years in a locality, it is regarded as absence of malaria transmission even though, the Anopheline vectors responsible for previous transmissions may remain. Eradication Era Annual Parasite Incidence (API)* = (Confirmed cases during one year / population under surveillance) x 1000 Annual Blood Examination Rate = (No. of slides examined/population) x 100 ABER is an index of operational efficiency. In the modified plan of operation, the minimum prescribed is 10 percent of the population in a year. Annual falciparum index Slide positivity rate Slide positivity rate is the percentage of slides found positive for malarial parasite, irrespective of the type of species. Slide falciparum rate It is the percentage of slides positive for P. falciparum. -### End" -2735,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clinical features of anicteric Leptospirosis are all EXCEPT: March 2013, with the following options: A: Influenza like illness like fever, hepatosplenomegaly, nausea, headache etc., B: Muscle pain, C: High moality, D: Conjuctival suffusion is MC finding on physical examination - -### Response: -Ans. C i.e. High moality Leptospira Leptospirosis is transmitted by: Rat urine Leptospirosis is associated with: Rat, Ricefields, Rain Weils disease is caused by: L. icterio-hemorrhagica -### End" -2736,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient died after a blunt trauma to chest, most common cause of death in blunt trauma to chest is, with the following options: A: Oesophageal rupture, B: Tracheo bronchial rupture, C: Pulmonary laceration, D: Pneumothorax - -### Response: -Answer is pneumothorax. The common life threatening conditions due to blunt trauma are Tension pneumothorax, Massive haemothorax, Flail chest etc, out of which Tension pneumothorax is most common cause. Pericardial tamponade needs to be differentiated from a tension pneumothorax. It is most commonly the result of penetrating trauma. Reference: Bailey & love, 27th Edition, page no = 367 -### End" -2737,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyperpigmentation is seen with which hormone?, with the following options: A: FSH, B: LH, C: TSH, D: ACTH - -### Response: -Ans. (d) ACTHRef: Harrison 19th ed. / 401e-4 -### End" -2738,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preoperative medication for thyrotoxicosis are all except, with the following options: A: Propranolol, B: Carbimazole, C: Lugol's Iodine, D: Nifedipine - -### Response: -Ans. (d) NifedipineRef: Bailey and Love 27th edition, Page 813Preoperative preparation of Thyrotoxic patient:* Aim of thyrotoxic patient is to make the patient euthyroid:# Carbimazole 30-40mg per day is the drug of choice for preparation# For pregnant patients and patient's with leucopenia we prefer propyl thiouracil# Last dose of carbimazole is given on the day before surgery in evening# Propranolol 40mg, three times daily or Nadolol 160mgOD is added for fast preparation for surgery# Propranolol is given on day of surgery and continued for 7 days postoperative.# Lugol's Iodine (Iodide) is given last 10 days to make gland firmer and reduce the vascularity of gland -### End" -2739,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fetal growth restriction is defined as estimated fetal weight is below the ------ for their Gestational age, with the following options: A: 3rd percentile, B: 5th percentile, C: 10th percentile, D: 15th percentile - -### Response: -IUGR is replaced by fetal growth restriction, which was designed to identify fetuses with estimated weight below the 10th percentile for their gestational ages.Reference: Practical guide to High-risk pregnancy and delivery; Chapter 4; Fetal growth restriction -### End" -2740,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nodular scabies is found in –, with the following options: A: Web space of finger, B: Axilla, C: Abdomen, D: Scrotum - -### Response: -Nodular scabies is an atypical form of scabies that presents as itchy nodules over scrotum & penis. -### End" -2741,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Sub mucosal"" glands are present in which one of the following organs:, with the following options: A: Duodenum, B: Colon, C: Anal canal, D: Stomach - -### Response: -Duodenum -### End" -2742,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A hernia which presents through the space of Larry is, with the following options: A: Retrosternal Hernia, B: Posterolateral Hernia, C: Posterior Hernia, D: Central Hernia - -### Response: -The superior epigastric vessels and some lymphatics pass between the origins of the diaphragm from the xiphoid process and the 7th costal cailage. This gap is known as Larry&;s space or foramen of Morgagni.Morgagni hernias are one of the congenital diaphragmatic hernias (CDH) and are characterized by herniation through the foramen of Morgagni. Morgagni hernias are:Anterior (a retrosternal or a parasternal hernia)More often right-sided (~90%)SmallRare (~2% of CDH)Reference: Chaurasia Volume II; 7th edition; Page no: 364 -### End" -2743,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A woman whose blood type is A, Rh positive and a man whose blood type is B, Rh positive come to the clinic with a 3-year-old girl whose blood type is O, Rh negative. What can be said about the relationship of these two adults to this child?, with the following options: A: The woman can be the child's natural mother, but the man cannot be the natural father, B: The man can be the child's natural father, but the woman cannot be the natural mother, C: Neither adult can be the natural parent of this child, D: This couple can be the natural parents of this child - -### Response: -Each parent needs only a single allele for either the A or B antigen or the Rh(D) antigen to express these antigens on their blood cells and other cell types. Thus, if each parent also carries an allele for blood type O, as well as a null allele for the Rh(D) antigen, then the child can be homozygous for the recessive O allele and the Rh(D)-negative allele. -### End" -2744,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 12 year old, presents with a severely damaged nail on his index finger, after accidentally crushing the finger while closing a door. A decision is made to excise the injured nail. In preparation for the procedure, the physician would most likely anesthetize a branch of which of the following nerves?, with the following options: A: Anterior interosseous nerve, B: Median nerve, C: Musculocutaneous nerve, D: Radial nerve - -### Response: -The median nerve supplies the surface of the lateral palm, the palmar surface of the first three digits and the distal dorsal surface of the index and middle fingers (including the nail beds). Therefore, prior to performing surgery in this area, it is essential to anesthetize a branch of this nerve (possibly a proper digital branch) to eliminate pain sensation around the nail bed of the index finger.Neither the anterior interosseous nor the musculocutaneous nerves supplies the hand. The anterior interosseous nerve supplies the flexor pollicis longus, the lateral half of flexor digitorum profundus, and pronator quadratus. The musculocutaneous nerve supplies the coracobrachialis, biceps, and most of the brachialis muscle, then becomes the lateral cutaneous nerve of the forearm. The radial nerve supplies skin on the radial side of the dorsal surface of the hand, but not the fingeips. -### End" -2745,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ketamine contraindicated in all Except, with the following options: A: Head injury, B: Hypeension, C: Asthma, D: Glaucoma - -### Response: -(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.294) -### End" -2746,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An adult hypeensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely d/t, with the following options: A: Intracerebral parenchymal hemorrhage, B: Ischemic stroke, C: Meningitis, D: Subarachnoid hemorrhage - -### Response: -Harrison's principles of internal medicine 17 th edition. *SAH characterised by headache ,which is generalised and sudden onset ,neckstiffness,vomiting is common *Althoughsudden headache without focal neurological deficit may occur as hallmark feature of aneurysmal rupure ,but focal neurological deficit may occur . -### End" -2747,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a ""Fenestrated hip prosthesis""?, with the following options: A: Bipolar prosthesis, B: Austin Moore prosthesi, C: Thompson prosthesis, D: All - -### Response: -ANSWER: (B) Austin Moore prosthesisREF: Essential Handbook of Practical Orthopedic Examination, By Dr. Kaushik Banerjee, page 146Bipolar prosthesis is used for total hip replacement (THR) while the Austin Moore and Thompson both are used for hemiarthroplasty. Bipolar prosthesis can be both fenestrated and non-fenestratedAustin Moore is always fenestratedThompson is always non fenestrated Austin mooreThompsonPartsHead, neck, collar, shoulder, stemHead, neck, collar, stem (no shoulder)FixingWithout bone cementWith bone cementExtractionEasierVery difficultStem fenestrationsTwo in numberNilCollar holePresent (to check position)AbsentSelf-lockingPresentAbsentWeightLight weightHeavierUsed whenCalcar femorale > 1.25 cmCalcar femorale <1.25 cm -### End" -2748,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Position of wrist in cast of colle's fracture is:, with the following options: A: Palmar detion & pronation, B: Palmar detion & supination, C: Dorsal detion & pronation, D: Dorsal detion & supination - -### Response: -A . i.e. Palmar detion & pronation -### End" -2749,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stain with parasite having charcot-laden crystals but no pus cells, with the following options: A: Giardia, B: Tenia, C: E. histolytica, D: Trichomonas - -### Response: -Ans. is 'c' i.e., E. histolytica Fecal finding in amoebiasis are :- i) Positive test for heme. ii) Paucity (lack) of neutrophils (pus cells). iii) Presence of amebic cysts or trophozoites iv) Charcot-leyden crystals. Remember Charcot leyden crystals are seen in E. histolytica 3. Ascaris pneumonia Whip worm (Trichuris) 4. Bronchial asthma -### End" -2750,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the normal human right eye, the peripheral field of vision is usually least:, with the following options: A: On the left side (nasally), B: In the downward direction, C: In the upward direction, D: On the right side (temporally) - -### Response: -The field of vision is 50 degree superiorly, 60 degree nasally, 70 degree inferiorly and 90 degree temporally. Ref: Textbook of Ophthalmology By Nema, 3rd Edition, Page 73; Comprehensive Ophthalmology By AK Khurana, 2nd Edition, Page 37 -### End" -2751,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is NOT a dietary anti-oxidant:March 2013 (g), with the following options: A: Beta-carotene, B: Vitamin D, C: Vitamin E, D: Vitamin C - -### Response: -Ans. B i.e. Vitamin DThe vitamins that are considered antioxidants include vitamin A, vitamin C, vitamin E and beta carotene, but many minerals like selenium, lycopine and zeaxanthin are also antioxidants. -### End" -2752,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transposition of the great aeries is a cardiac malformation that involves which of the following septa?, with the following options: A: Aoicopulmonary septum, B: Atrial septum, C: Atrioventricular septum, D: Interventricular septum - -### Response: -Transposition of great vessels involves the Aoicopulmonary septum due to improper spiraling of AP septum fig;- transposition of great aeries Other AP septum disease:- 1.PTA(persistent truncus aeriosus) - due to absence of migration of NCC to truncus aeriosus. 2. TOF( tetrology of fallot):- due to anterior migration of AP septum. Defect in atrial septum lead to ASD. Defect in interventricular septum lead to VSD. -### End" -2753,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old fire fighter emerges from a burning house with third-degree burns over 70% of his body. The patient expires 24 hours later. Which of the following was the most likely cause of death?, with the following options: A: Congestive heart failure, B: Disseminated intravascular coagulation, C: Hypovolemic shock, D: Pulmonary saddle embolism - -### Response: -Hypovolemic shock may be caused by hemorrhage, fluid loss from severe burns, diarrhea, excessive urine formation, perspiration, or trauma. In the case of burns or trauma, direct damage to the micro-circulation increases vascular permeability. Persons with third-degree burns weep large amounts of plasma. The other choices are unlikely causes of death in an acute burn victim.Diagnosis: Hyperthermia, hypovolemic shock -### End" -2754,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A test was considered for diagnosing a disease. Out of 80 positive cases with this test, 40 actually had no disease. Out of 9920 tested negative cases 9840 actually had no disease. Calculate the sensitivity of the test-, with the following options: A: 13%, B: 33%, C: 50%, D: 99% - -### Response: -Ref :Parks 23rd edition pg 139 Sensitivity = TP / (TP + FP) = 40 / (40+80)=. 33 -### End" -2755,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The deficit in weight for height in a 3-year-old child indicates, with the following options: A: Concomitant acute and chronic, B: Chronic malnutrition, C: Acute malnutrition, D: Under weight - -### Response: -Low weight for height is wasting which suggests acute malnutrition, the result of more recent food deficit or illness. -### End" -2756,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzymes involved in Base-excision repair are:-, with the following options: A: DNA helicase II, B: ABC excinuclease, C: DNA polymerase I, D: DNA photolyase - -### Response: -Type Proteins & Enzymes involved Mismatch repair Dam methylase MutH, MutL, MutS proteins DNA helicase II DNA polymerase III DNA ligase Base-excision repair DNA glycosylases AP endonucleases DNA polymerase I DNA ligase Nucleotide-Excision repair Helicase DNA polymerase I DNA ligase ABC excinuclease Direct repair (Photoreactivation) DNA photolyase -### End" -2757,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Branch of ulnar nerve in Arm ?, with the following options: A: To FCU, B: To FDP, C: To FCP, D: No branch - -### Response: -Ans. is 'd' i.e., No branch -### End" -2758,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug used for treatment of methicillin resistant staphylococcus aureus is:, with the following options: A: Teicoplanin, B: Vancomycin, C: Both, D: None - -### Response: -Vancomycin is a glycopeptide antibiotic discovered in 1956 as a penicillin substitute which has assumed special significance due to efficacy against MRSA Strep. viridans, Enterococcus and Cl. difficile. It is bactericidal to gram-positive cocci, Neisseria, Clostridia and diphtheroids. However, in hospitals where it has been extensively used for surgical prophylaxis, etc., vancomycin-resistant Staph. aureus (VRSA) and vancomycin-resistant Enterococcus (VRE) have emerged. These nosocomial bacteria are resistant to methicillin and most other antibiotics as well. Vancomycin acts by inhibiting bacterial cell wall synthesis. It binds to the terminal dipeptide 'D-ala-D-ala' sequence of peptidoglycan unitsprevents its release from the bactoprenol lipid carrier so that assembly of the units at the cell membrane and their cross linking to form the cell wall cannot take place Enterococcal resistance to vancomycin is due to a plasmid mediated alteration of the dipeptide target site, reducing its affinity for vancomycin. Systemic use (500 mg 6 hourly or 1 g 12 hourly infused i.v. over 1 hr) is restricted to serious MRSA infections for which it is the most effective drug. and as a penicillin substitute (in allergic patients 1 for enterococcal endocarditis along with gentamicin. For empirical therapy of bacterial meningitis, i.v. vancomycin is usually combined with i.v. ceftriaxone/ cefotaxime. It is also used in dialysis patients and those undergoing cancer chemotherapy. Penicillin-resistant pneumococca: infections and infection caused by diphtheroids respond very well to vancomycin. It is the preferred surgical prophylactic in MRSA prevalent areas and in penicillin allergic patients. Essentials of medical pharmacology K D Tripathi Sixth edition Pg 732 -### End" -2759,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fanconi's anemia is a -, with the following options: A: Constitutional anemia, B: Hemolytic anemia, C: Iron deficiency anemia, D: Auto - immune anemia - -### Response: -Ans. is 'a' i.e., Constitutional anemia Constitutional pancytopenia o Constitutional pancytopenia is defined as decreased marrow production of the 3 major hematopoietic lineages on an inherited basis, resulting in anemia, neutropenia and thrombocytopenia. o Impoant causes are : - Fanconi anemia Amegakaryocytic thrombocytopenia Shwachman-Diamond syndrome Down syndrome Dyskeratosis congenita Noonan syndrome -### End" -2760,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following completely blocks oxidation and phosphorylation by blocking the flow of protons through ATP synthase?, with the following options: A: Oligomycin, B: Cyanide, C: BAL, D: Carboxin - -### Response: -The antibiotic oligomycin completely blocks oxidation and phosphorylation by blocking the flow of protons through ATP synthase. Reference: Harper; 30th edition; Page no: 132 -### End" -2761,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ROME III criteria for Irritable bowel syndrome AE, with the following options: A: Improvement with defection, B: Rectal bleeding, C: Onset associated with change in frequency of stool, D: Onset associated with change in form of stool - -### Response: -Answer- B. Rectal bleedingROME II Diagnostic Criteria for Functional Bowel Disorders-Irritable Bowel SyndromeFunctional Abdominal BloatingFunctional ConstipationFunctional DiarrheaUnspecifed Functional Bowel Disorder -### End" -2762,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Side-effects of captopril are all except -, with the following options: A: Cough, B: Hyperkalemia, C: Renal dysfunction, D: Hemolytic anemia - -### Response: -Ans. is 'd' i.e., Hemolytic Anemia -### End" -2763,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HypertriglyceridemiaFor the above dyslipidemias, select the most characteristic finding., with the following options: A: palmar plane xanthomas, B: triglycerides > 1000, C: subcutaneous extensor tendon xanthomas, D: low serum cholesterol - -### Response: -Hypertriglyceridemia is usually secondary to diabetes mellitus (DM) or drugs, rather than a genetic disorder. It can be a normal response to caloric excess or alcohol ingestion and is common in the third trimester of pregnancy. -### End" -2764,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Umbilical cord has?, with the following options: A: 2 aery and 1 vein, B: 1 aery and 2 vein, C: 2 aery and 2 vein, D: Only one aery - -### Response: -A i.e. 2 aery and 1 veinInitially in embryo there are 4 vessels - 2 umbilical aeries & 2 umbilical vein. The aeries carry venous blood from fetus to placenta & veins carry oxygenated blood from placenta to embryo.At 4 months right umbilican vein disappears i.e. left umbilical vein is leftQ. So after 4 months umbilical cord contains 2 aeries & left umbilical veinQA Single umbilical aery is present in 1% cases; more commonly in twins & babies born to diabetic mothersQ. It is frequently associated with congenital malformation of fetus (renal abnormalities)QAfter bih left umbilical vein forms ligamentum teres hepatisQ & ductus venosus form ligamentum venosum. -### End" -2765,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Test based on the principle of suspect's reaction, if he witnesses an event then he behaves in a ceain way is, with the following options: A: Truth serum testing, B: Narcoanalysis, C: Polygraph, D: Brain mapping - -### Response: -* Narcoanalysis is a test carried out on a patient or suspect when he/she, after administering truth serum, comes in a sleep like state, and his/her repressed feelings are released. * Truth serum are drugs used in narcoanalysis. Two most common drugs used in narcoanalysis are Sodium amytal, which is also known as amobarbital or amylobarbition, and Sodium Pentothal commonly known as thiopental or thiopentone * Polygraph measures and records physiological actions of human body especially autonomic nervous system while the subject is asked questions relating to the crime and he answers them. * It is based on the principle that autonomic nervous system changes are beyond reasonable control of an individual and hence autonomic nervous system response changes transpires when the subject tries to tell a lie. * Brain mapping measures the P300 evoked potential. In this test the suspect is made to sit in evoked potential recording machine and is shown objects relating to crime scene or is made to hear sounds peaining to crime site. The sensors from his head pick the event related potentials in the form of Brain Mapping only if the person has been at the site of crime. The accuracy of Brain Mapping is almost 100%. -### End" -2766,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meconium should be excreted by a newborn by ... days?, with the following options: A: 2, B: 3, C: 6, D: 4 - -### Response: -Most of the newborns pass urine by 24hrs and Meconium by 48hrs. If not, it requires observation and investigations. Refer page no 420 of Text book of obstetrics,DC DUTTA'S ,9thedition. -### End" -2767,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an autosomal dominant metabolic disorder-, with the following options: A: Cystic fibrosis, B: Phenylketonuria, C: Alpha-I anti-trypsin deficiency, D: Familial hypercholesterolemia - -### Response: -Ans. is 'd' i.e., Familial hypercholesterolemia -### End" -2768,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following conditions the only means of sexual excitement are in inanimate objects:, with the following options: A: Exhibitionism, B: Fetishism, C: Voyeurism, D: Sadism - -### Response: -B ref: Ahuja, 4th/e p. 118 and 5th/e p. 130 -### End" -2769,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Denver shunt used in?, with the following options: A: Ascites, B: Dialysis, C: Raised ICP, D: Raised IOP - -### Response: -Denver shunt is a one way valve peritoneo-venous shunt done in order to drain ascitic fluid from peritoneal cavity to internal jugular vein with additional facility of having a chamber to evacuate the debris by digital pressure. Reference : page 626 SRB's manual of surgery 5th edition -### End" -2770,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a feature of Hartnup's disease, with the following options: A: Cerebellar ataxia, B: Cutaneous photosensitivity, C: Mental retardation, D: Psychological disturbance - -### Response: -In hartnup's disease, mental development is normal. -### End" -2771,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of chronic pancreatitis is, with the following options: A: Alcohol, B: Gallstones, C: Tropical pancreatitis, D: ERCP - -### Response: -Etiology of Chronic Pancreatitis Heavy alcohol consumption is most common cause of CP (70-80%) Smoking increases the risk of alcohol induced CP Other causes : Chronic duct obstruction, trauma, pancreas divisum, cystic dystrophy of the duodenal wall, Hyperparathyroidism, hyperiglyceridemia, autoimmune pancreatitis, tropical pancreatitis&hereditary pancreatitis (accounts for <10 %of all cases) Ref:Sabiston 20th edition Pgno :1531 -### End" -2772,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Staph. aureus causes vomiting in 16-18 hours. The mechanism of action is, with the following options: A: Stimulation of cy AMP, B: Vagal stimulation, C: Stimulation of cy GMP, D: Acts through ganglioside GM receptor - -### Response: -""The mechanism by which the staphylococcus aureus causes vomiting is uncertain but may involve direct neural stimulation of the autonomic nervous system rather than a local effect on G.I.T mucosa"". -### End" -2773,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Frontal lobe syndrome involves, with the following options: A: Impaired recent memory, B: Emotional instability, C: Attention deficit, D: All of the above - -### Response: -Frontal lobe syndrome : - -Euphoria  -Impaired recent memory -Flight of ideas -Attention deficit -### End" -2774,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about 'secondary apnea' in a neonate EXCEPT:, with the following options: A: The baby is not breathing, B: HR may become < 100/min, C: It may be present even at bih, D: Baby may respond to tactile stimulation - -### Response: -Primary apnea Secondary apnea Baby is not breathing Baby is not breathing HR may become < 100/min HR may become < 100/min Baby may respond to tactile stimulation Infant is unresponsive to stimulation & does not spontaneously resume respiratory effos unless PPV is initiated. -### End" -2775,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Michaelis Guttmannn bodies are present in, with the following options: A: Analgesic nephropathy, B: Him and ulcer, C: Malacoplakia, D: Erythroplasia - -### Response: -Ref Robbins 9/e p693 Michaelis-Gutmann bodies are concentrically layered basophilic inclusions found in the urinary tract. They are 2 to 10 mm in diameter, and are thought to represent remnants of phagosomes mineralized by iron and calcium deposits. -### End" -2776,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Headquaers of FAO is located in, with the following options: A: New York, B: Rome, C: Geneva, D: New Delhi - -### Response: -Food and Agriculture Organization (FAO) established in October 1945 with the objective of eliminating hunger and improving nutrition and standards of living by increasing agricultural productivity. The FAO coordinates the effos of governments and technical agencies in programs for developing agriculture, forestry, fisheries, and land and water resources. Headquaered in Rome, Italy, the FAO maintains offices throughout the world. The organization, which has more than 180 members, is governed by the biennial FAO conference, in which each member country, as well as the European Union, is represented. The conference elects a 49-member Council. Ref: 25th edition Park&;s Textbook of Preventive and Social Medicine, Page no. 986 -### End" -2777,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Toynbee's muscle is, with the following options: A: Tensor tympani, B: Stapedius, C: Levator ani, D: Scalenus minimus - -### Response: -Tensor tympani is called as Toynbee muscle origin, the cailaginous pa of the pharyngotympanic (auditory) tube and the walls of its hemicanal just above the bony poion of the pharyngotympanic tube; inseion, handle of malleus; action, draws the handle of the malleus medially tensing the tympanic membrane to protect it from excessive vibration by loud sounds. nerve supply, branches of trigeminal through the otic ganglion Ref - Pubmed.com -### End" -2778,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Motility disorders of the oesophagus are best diagnosed by -, with the following options: A: Barium meal, B: Manometry, C: Radiography, D: Endoscopy - -### Response: -

Davidson&;s principles and practice of medicine 22nd edition. *Manometry confirms the high pressure ,non relaxing lower oesophageal sphincter with poor contractility of the oesophageal body .

-### End" -2779,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corneal epithelium develops from -, with the following options: A: Surface ectoderm, B: Mesoderm, C: Endoderm, D: Neural crest - -### Response: -Ans. is 'a' i.e., Surface ectoderm PrecursorDerivativesNeural ectodermSmooth muscle of the iris, opticle vesicle and cup, iris epithelium, ciliary epithelium, Part of the vitreous, Retina, Retinal pigment epithelium, fibres of the optic nerve.Surface ectodermConjunctival epithelium, Corneal epithelium, Lacrimal glands, Tarsal glands, Lens.MesodermExtraocular muscles, corneal stroma, sclera, iris, Vascular endothelium, Choroid, Partof the vitreous.Neural crestCorneal stroma, keratocytes and endothelium, Sclera, Trabecular meshwork endothelium, Iris stroma, Ciliary muscles, Choroidal stroma, Part of the vitreous, Uveal and conjunctival melanocytes, Meningeal sheaths of the optic nerve, Ciliary ganglion, Schwann cells, orbital bones, Orbital connective tissue, Connective tissue sheath and muscular layer of the ocular and orbital blood vessels. -### End" -2780,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Where is the local anaesthetic introduced in spinal anaesthesia?, with the following options: A: Dura and pia, B: Pia and arachnoid, C: Between ligamentum flavum and dura, D: Directly into cord - -### Response: -The injection of a relatively small dose of local anesthetic into the subarachnoid space (between pia and arachnoid) that produces profound motor and sensory blockade is known as spinal anesthesia. The spinal subarachnoid space extends from the foramen magnum to the S2 in adults and S3 in children. Injection of local anesthetic below L1 in adults and L3 (below the termination of the conus medullaris) in children helps to avoid direct trauma to the spinal cord. Ref: Butterwoh IV J.F., Mackey D.C., Wasnick J.D. (2013). Chapter 45. Spinal, Epidural, & Caudal Blocks. In J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e. -### End" -2781,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inhalational halogenated anesthetics may cause malignant hyperthermia in(372- KDT 6th) (Lippincott's 3rd pharmacology), with the following options: A: Patients with poor renal function, B: Patients allergic to the anesthetics, C: Alcoholics, D: Genetic defect in calcium channel at sarcoplasmic reticulum of the skeletal muscle - -### Response: -D. i.e. (Genetic defect in calcium channel at sarcoplasmic reticulum of the skeletal muscle) (372-KDT 6th)Malignant Hyperthermia - occurs in small population who have a genetic defect in the muscle (ryanodine receptor) calcium channel at the sarcoplasmic reticulum of the skeletal muscle.Which is triggered by halothane** to release massive Ca++ intracellularly causing persistent muscle contraction and increase heat production**. Succinylcholine** - accentuates the conditions.Treatment* Rapid external cooling* Bicarbonate infusion* 100% O2 inhalation* IV Dantrolene** 1. Thiopental** is a potent anesthetic but weak analgesic2. Nitrous oxide* - is potent analgesic but weak general anesthetic* Propofol is agent of choice for induction in susceptible individuals for malignant hyperthermia -### End" -2782,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year-old woman presents with progressive palmoplantar pigmentation. X-ray spine shows calcification of IV disc. On adding benedicts reagent to urine, it gives greenish brown precipitate and blue-black supernatant fluid. What is the diagnosis?, with the following options: A: Phenyl ketonuria, B: Alkaptonuria, C: Tyrosinemia type 2, D: Argininosuccinic aciduria - -### Response: -Ans. B. AlkaptonuriaAlkaptonuriaAutosomal Recessive disorder is due to a deficiency of Homogentisic Acid Oxidase1st inborn error detectedBelongs to Garrod's Tetrad Biochemical DefectHomogentisate Oxidase deficiency leads to accumulation of Homogentisic Acid (Homogentisate) which polymerises to form Alkaptone bodies.Clinical PresentationNormal Life till 3rd or 4th decade.Urine Darkens on standing is the only manifestation in children.In adults Ochronosis-Alkaptone Bodies in Intervertebral Disc, cartilage of nose, pinna, etc.Laboratory DiagnosisAlkalanisation increase darkening of urine.Benedicts test positive in urine because homogentisic acid is reducing agent.Ferric Chloride test positiveSilver Nitrate Test positive.No Mental RetardationTreatmentNew Drug is Nitisinone which inhibit para Hydroxyl Phenyl Pyruvate hydroxylase which prevent the accumulation of homogentisic acid.Symptomatic Treatment. -### End" -2783,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pink’s disease is due to toxicity of:, with the following options: A: Silver, B: Mercury, C: Lead, D: Tetracycline - -### Response: -ACRODYNIA (Pink disease, Swift's disease) - -Cause of the disease has been established as a mercurial toxicity reaction, either actual mercury poisoning or more likely, an idiosyncrasy to the metal. -The source of the mercury is usually a teething powder, ammoniated mercury ointment, calomel lotion, or bichloride of mercury disinfectant. -Occurs most frequently in young infants before the age of two years, although children are occasionally affected upto the age of five or six years. -The skin, particularly of the hands, feet, nose, ears and cheeks becomes red or pink and has a cold ""clammy feeling"". -The appearance has been described as resembling raw beef. -The skin over the affected areas peels frequently. -Severe sweating is an almost constant feature of acrodynia. -Other features are a state of extreme irritability, photophobia with lacrimation, muscular weakness, tachycardia, hypertension, insomnia, gastrointestinal upset and stomatitis. -The children will frequently tear their hair out in patches. - -Ref: Shafer's textbook of oral pathology 7th edition page 559 -### End" -2784,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are added to PCR, except:, with the following options: A: Deoxynucleotide, B: Dideoxynucleotide, C: Thermostat DNAP, D: Template DNA - -### Response: -Ans. B. Dideoxynucleotide(Ref: Tietz Textbook of Clinical Chemistry 4fe page1446)Pre requisites of PCRSample DNA to be amplifiedDeoxynucleotides.Thermostable Polymerase--Taq Polymerase obtained from Thermus Aquaticus found in hot springs.Primer.Mgcl2 , KCl -### End" -2785,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A man with diabetes insipidus has a glomerular filtration of 155 L/day. Which range most likely represents the upper limit for urine flow rate in this individual if he were not receiving treatment but had free access to water?, with the following options: A: 1 to 3 L/day, B: 5 to 10 L/day, C: 15 to 20 L/day, D: 30 to 35 L/day - -### Response: -Ans. C. 15 to 20 L/dayUrine flow rate in the absence of antidiuretic hormone (ADH) can approach approximately 10% to 13% of the glomerular filtration therefore, for a glomerular filtration of 155 L/day, urine flow could be as much as 15 to 20 L/ day. To maintain this level of urine flow, the individual must consume an equivalent amount of water per day. -### End" -2786,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Lesch Nyhan Syndrome:, with the following options: A: Patient have normal intellectual capacity, B: Pyrimidine overproduction is the cause, C: Uric acid stones are frequently formed, D: X- Linked dominant - -### Response: -Ans. (c) Uric acid stones are frequently formedRef: Harper's Biochemistry, 30th ed. pg. 354-55, 26th ed.pg. 300LESCH-NYHAN SYNDROME* It is a X- linked recessive disorder which is characterized by:# An overproduction hyperuricemia# Frequent episodes of uric acid lithiasis# Self-mutilative behavior,# Mental retardation.* It reflects a defect in hypoxanthine-guanine phospho- ribosyl transferase, an enzyme of purine salvage. The accompanying rise in intracellular PRPP results in purine overproduction. Mutations that decrease or abolish hypoxanthine-guanine phosphoribosyl transferase activity include deletions, frameshift mutations, base substitutions, and aberrant mRNA splicing. -### End" -2787,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Management of RCC less than 4 cm in size:, with the following options: A: Radical nephrectomy, B: Paial nephrectomy, C: Chemotherapy, D: Surgery followed by chemotherapy - -### Response: -Indications of Paial nephrectomy/Nephron sparing surgery For stage T1a RCC size up to 4cm also for most of patients with T1b 4-7 cm RCC in solitary kidney Bilateral RCC RCC with diseased contralateral kidney like Renal aery stenosis -### End" -2788,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Main MOA brimonidine in glaucoma ?, with the following options: A: Decreased aqueous secretion, B: Increased trabecular outflow, C: Increased uveoscleral outflow, D: Reduce vitreous volume - -### Response: -Ans. is 'a' i.e., Decreased aqueous secretion -### End" -2789,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DIC in association with giant hemangiomas is seen in, with the following options: A: Waterhouse-Friderichsen syndrome, B: Kasabach-Merritt syndrome, C: Hemolytic Uremic Syndrome, D: Type 2 von Willebrand disease - -### Response: -An unusual form of DIC occurs in association with giant hemangiomas (Kasabach-Merritt syndrome), in which thrombi form within the neoplasm because of stasis and recurrent trauma to fragile blood vessels.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 14; Red Blood Cell and Bleeding Disorders; Page no: 664 -### End" -2790,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication of mumps is:, with the following options: A: Orchitis and Oophritis, B: Encephalitis, C: Pneumonia, D: Myocardium - -### Response: -Ans. is 'a' i.e., Orchitis and OophoritisComplications of mumps: Meningoencephalitis is the most frequent complication of mumps in childhood. Other rare complications include oophoritis, mastitis, pancreatitis, thyroiditis, arteritis, thrombocytopenia and pneumonia. Death due to mumps is rare. -### End" -2791,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old woman complains of slowly progressive dyspnea. Her history is otherwise negative, and there is no cough, sputum production, pleuritic chest pain, or thrombophlebitis. She has taken appetite suppressants at different times. Physical examination reveals jugular venous distention, a palpable right ventricular lift, and a loud P2 heart sound. Chest x-ray shows clear lung fields. Oxygen saturation is 94%. ECG shows right axis deviation. A perfusion lung scan is normal, with no segmental deficits. Which of the following is the most likely diagnosis?, with the following options: A: Pulmonary arterial hypertension, B: Recurrent pulmonary emboli, C: Right-to-left cardiac shunt, D: Interstitial lung disease - -### Response: -Although a difficult diagnosis to make, pulmonary arterial hypertension (PAH) is the most likely diagnosis in this young woman who has used appetite suppressants. Pulmonary arterial hypertension (also known as primary pulmonary hypertension) has been associated with fenfluramine-type appetite suppressants. The predominant symptom is dyspnea, which is usually not apparent until the disease has advanced. When physical findings, chest x-ray, or echocardiography suggest pulmonary hypertension, recurrent pulmonary emboli must be ruled out. In this case, a normal perfusion lung scan makes pulmonary angiography unnecessary. Right-to-left cardiac shunts cause hypoxia (oxygen desaturation) that characteristically does not improve with oxygen supplementation. Restrictive lung disease should be ruled out with pulmonary function testing but is unlikely with a normal chest x-ray. An echocardiogram will show right ventricular enlargement and a reduction in the left ventricle size consistent with right ventricular pressure overload. Left ventricular dysfunction can cause pulmonary edema but not pulmonary hypertension. -### End" -2792,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 month old child presents with congenital inguinal hernia. Next step would be: March 2012, September 2012, with the following options: A: Observation, B: Wait for 3 years & operate, C: Operate immediately, D: Truss - -### Response: -Ans: C i.e. Operate immediately -### End" -2793,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Predominant blood supply to the supraduodenal bile duct is derrived from:, with the following options: A: Vessels that run upward along the bile duct from the duodenal end of the duct such as the retroduodenal and the gastroduodenal aeries, B: Vessels that run downward along the bile duct from the hepatic end of the duct such as the right hepatic aery, C: Vessels that arise from the hepatic aery proper as it runs up along the common bile duct and supplies it with twigs in a non-axial distribution, D: Vessels that arise from the cystic aery - -### Response: -A i.e. Vessels that run upward along the bile duct from the duodenal end of the duct such as the retroduodenal and the gastroduodenal aeriesPredominant (60%) blood supply to supraduodenal bile duct is derived from ascending (running upward) branches from retroduodenal branch of gastroduodenal aery. These branches run upwards from caudal (duodenal) end of CBD. -### End" -2794,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How many lactiferous ducts open in nipple ?, with the following options: A: 0 -10, B: 15 -20, C: 25 -50, D: 50 -75 - -### Response: -The nipple is pierced by 15-20 lectiferous ducts. -### End" -2795,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Levo–bupivacaine is administered by which of the following route –, with the following options: A: Nasogastric, B: Epidural, C: Intravenous, D: Intra-theccal - -### Response: -Bupivacaine & levo-bupivacaine can be used for spinal, epidural, infiltration and peripheral nerve block. -### End" -2796,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 12 year old boy presents with recurrent attacks of conjunctivitis during warm season for the last 2 years with intense itching and ropy discharge. Horner-Trantas dots are seen on the limbal region. The diagnosis is:, with the following options: A: Vernal conjunctivitis, B: Phlyctenular conjunctivitis, C: Trachoma, D: Viral conjunctivitis - -### Response: -Vernal conjunctivitis characteristically affects children and adolescents; the incidence decreases sharply after the second decade of life. Vernal conjunctivitis occurs only in the warm months of the year. The disease characteristically produces giant (""cobblestone"") papillae of the tarsal conjunctiva. The keratinized epithelium from these papillae may abrade the underlying cornea, giving rise to complaints of foreign body sensation or even producing frank epithelial loss (""shield ulcer""). This disease affects the limbal region, producing a characteristic gelatinous thickening of the limbal conjunctiva, often associated with white accumulations of eosinophils and desquamated epithelial cells (""Horner-Trantas dots""). Ref: Chan T.Y., Hodge W.G. (2011). Chapter 16. Immunologic Diseases of the Eye. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. -### End" -2797,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following inhibits oxidative phosphorylation by inhibiting the transpo of ADP into and ATP out of the mitochondrion?, with the following options: A: Atractyloside, B: 2,4-dinitrophenol, C: Carbon monoxide, D: Rotenone - -### Response: -Atractyloside inhibits oxidative phosphorylation by inhibiting the transpoer of ADP into and ATP out of the mitochondrion. Reference: Harper; 30th edition; Page no: 132 -### End" -2798,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cancer in liver is, with the following options: A: Papilloma, B: Hepatic adenoma, C: Metastasis, D: Cavernous Hemangioma - -### Response: -Answer- C. MetastasisMost commonhqtatic neoplasm is metastasis.Most common primary benig nlesion of liver is cavernous hemangioma.Most common primary malignant lesion of liver is hepatocellular carcinoma.Most common primary hepatic tumor of children is hepatoblastoma. -### End" -2799,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about benzodiazepines ?, with the following options: A: Increased release of GABA, B: Antagonzing release of GABA, C: Lorazepam is shoer acting than temazepam, D: Atropine is its antagonist - -### Response: -Ans. is 'c' i.e., Lorazepam is shoer acting than temazepam Lorazepam has VA 10-20 hours, while Temazepam has VA 10-40 hours. About other options BZDs do not increase or decrease the release of GABA, they bind on GABAA receptors and increase Cl- conductance - GABA facilitatory action. Flumazenil (not atropine) is the antagonist of BZDs. -### End" -2800,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tibial fracture with >1 cm wound, slight conjunction and moderate crushing is -, with the following options: A: Grade I, B: Grade II, C: Grade III A, D: Grade III B - -### Response: -Compound fracture - -Compound fracture also called open fracture, in which fracture communicates with the external environment, i.e., overlying soft tissue coverage (skin and muscles) is breached. -Open fractures are typically caused by high energy injuries such as car crashes, falls, or sports injuries. -Gustila and Anderson classified open fracture into following types. -### End" -2801,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fracture of the proximal humerus in an elderly patient is best treated by?, with the following options: A: K-wire fixation, B: Open reduction internal fixation, C: Cuff and sling only, D: Manual reduction and Slab application - -### Response: -Fracture Proximal Humerus MC fracture in osteoporotic postmenopausal women Classification of fracture - Neer classification Complications - Axillary nerve injury, Shoulder stiffness & Malunion, AVN of the humeral head Treatment Undisplaced - Immobilization in a sling (Cuff & Collar or Triangular sling) x 4 weeksDisplaced & Unstable - Closed reduction & internal fixation with percutaneous pinning or nailing(Refer: Watson Jones Textbook of Ohopedics & Trauma, 6thedition, pg no: 536-538) -### End" -2802,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Iron and folic acid supplementation forms -, with the following options: A: Health promotion, B: Specific protection, C: Primordial prevention, D: Primary prevention - -### Response: -Ans. is 'b' i.e., Specific protection o Option 'c' is also correct because specific protection is a type of primary prevention. o But we will have to choose one option for All India enterance examination. o Option 'b' (specific protection) is the best answer (unlike previous question where more than one option can be correct for PGI). -### End" -2803,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Large pituitary tumour results in, with the following options: A: Unilateral quadrantanopia, B: Increase in blind spot only, C: Bitemporal hemianopia, D: Binasal hemianopia - -### Response: -(C) Bitemporal hemianopia # Visual field defects are caused by tumor compression on the optic nerve or chiasm leading to axonal damage.> Depending on the size and location of the tumor, as well as the anatomical relationship of the chiasm to the pituitary stalk, the severity and symmetry of the visual field defect may vary.> Monocular Visual Field Deficits: Asymmetric tumors may preferentially involve one side of the chiasm or an optic nerve, and most commonly presents as a supertemporal quadrantanopia. The incidence of pituitary adenomas presenting as monocular visual field defects was reported to be 9% (in a series of 1,000 patients). If the presenting symptom is sudden monocular visual loss, a pituitary adenoma may be acutely missed, as other more common etiologies are evaluated. Another consideration for sudden monocular visual loss is pituitary apoplexy, though visual field evaluation is often deferred due to the emergent nature of this condition. Monocular temporal hemianopia are not always indicative of a pituitary tumor. These defects, especially in the setting of no Relative afferent pupillary defect or optic atrophy, may suggest functional (non-organic) vision loss. Functional vision loss in the setting of a monocular temporal hemianopsia can be confirmed by the persistence of the temporal hemianopia on binocular visual field testing.> Chiasmal Field Deficits: Characteristically lesions at the level of the optic chiasm produce a bitemporal hemianopia. Pituitary adenomas, which grow upward from the pituitary stalk, compress the chiasm from below, which preferentially involves the inferior, nasal, and macular nerve fibers. This corresponds to superior, bitemporal, and central vision loss. While these field defects typically respect the vertical midline, pituitary adenomas large enough to cause compression tend to also reduce visual acuity and cause diffuse central depression on automated and Goldmann perimetry. In prefixed chiasms or tumors that preferentially grow posteriorly, selective compression of macular fibers may cause a bitemporal hemianopsia involving the central visual field while sparing the peripheral field.> Junctional Field Deficits:- Phenomenon of a central scotoma in one eye with temporal visual field loss in the other eye has been termed a junctional scotoma. Anatomical correlate to this visual field pattern has been suggested by some as compression to an anterior loop to the decus- sating nasal fibers within the posterior optic nerve.> This explanation, called ""Wilbrand's knee,"" is debated within the literature; regardless of the cause, multiple studies nave proven that this visual field phenomenon localizes the lesion to the anterior chiasm and posterior optic nerve.> While junctional field defects have been the presenting sign of pituitary adenomas, it is more commonly seen in other etiologies (meningioma, aneurysm, inflammation). -### End" -2804,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are advantages of LMA except-, with the following options: A: More reliable than face mask, B: Prevent aspiration, C: Alternative to Endotracheal intubation, D: Does not require laryngoscope & visualization - -### Response: -Ans. is 'b' i.e., Prevent aspiration o LMA is intermediate between the face mask and Endotracheal intubation in terms of reliability, invasiveness and facilitation of gas exchance (face mask has minimum and endotracheal intubation has maximum)o LMA does not prevent aspiration - should not be used in full stomach patients.o LMA can be used as an alternative to endotracheal intubation for minor surgeries, where anaesthetist wants to avoid intubation.o LMA is introduced blindly (without laryngoscopy)Laryngeal Mask Airwayo The LMA is a supraglottic airway. It is also referred as Brain mask as it was invented by Dr. Archies Brain. LMA provides an airway intermediate between the face mask and tracheal tube in terms of anatomic position (face mask is on the face, LMA is in the larynx around inlet and tracheal tube is in the trachea), invasiveness, security to protect airway, and facilitate gas exchange. The principle of LMA is that it provides an effective gas tight seal around the laryngeal inlet without anything having to pass through vocal cord.o LMA is very effective in maintaining a patent airway in spontaneously breathing patient. Positive pressure ventilation may be applied if necessory without tracheal intubation.o LMA is available in 8 different sizes (Lee 13th/e 206).Mask sizePatient weight & ageMaximum inflation volume1< 5 Kg, neonates & infants4 ml1[?]55 - 10 kg, Infants7 ml210 -20 kg, Infants & children10ml2.520 - 30 kg, Children14330 - 50, Children & Small adults14450 - 70 kg, Adults30570-100 kg Adult406> 100 kg, Adult o After induction of anaesthesia with propofal (which depresses laryngeal reflexes) LMA is introduced blindly (without laryngoscopy) into the hypopharynx. One of the major disadvantage of LMA is that its seal around laryngeal inlet does not always prevent aspiration. Therefore, LMA should not be used where there is an increased risk of aspiration of stomach contents, e.g., full stomach patient.Indications of LMA1. As an alternative to intubation where difficult intubation is anticipated (difficult airway).2. To facilitate endo-tracheal intubation in a patient with difficult airways.3. Situations involving a difficult mask fit.4. Securing airway (as cardiopulmonary resuscitation) in emergency where intubation and mask ventilation is not possible.5. For minor surgeries (short surgeries), where anaesthetist wants to avoid intubation.6. As a conduit for bronchoscopes, small size tubes, gum elastic bougies.7. For extra and intra-ocular surgeries including retinopathy surgery in premature infants - LMA is particularly useful in ophthalmic surgery as problems created by other two airways are eliminated:-i) Face mask creates problem in surgical field access due to its size (LMA provides a better access).ii) Endotracheal intubation may cause raised IOT (LMA has no effect). -### End" -2805,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the true statement regarding post-dural anesthetic headache:, with the following options: A: Blood patch is the first line of treatment, B: Occurs due to low CSF pressure, C: Increased incidence with early mobilization of patient, D: All - -### Response: -B i.e. Occurs due to low CSF pressure Post Dural Puncture Headache (PDPH) Any breach of dura may result in PDPH. This may follow a lumber puncture, myelogram, spinal anesthesiaQ, wet epidural tapQ (in which epidural needle pierced dura) or uncomplicated epidural (dlt scratching of dura). It result from decreased intracranial pressure as CSF leaks from dural defect at a greater rate than it is being produced.Q The headache is BIL, frontal Or retro-orbital, occipital & extending into neck. It may be throbbing & associated with photophobia & nausea. The onset is usually 12-72 hoursQ following procedure (in first 3 days) may last for 1-2 weeksQ. The hallmark is its association with body positionQ (i.e. aggravated by sitting or standing & relieved by lying down)0 The incidence increases with ? 1. Larger needleQ 2. Cutting point (in comparision to pencil point) needle. 3. Young age, Female sex, PregnancyQ So, max incidence is expected in a wet epidural tap with a large epidural needle in an obstetric patient. Lowest incidence would be expected with an elderly male using 27 gauge pencil point needle. Management of PDPH Prevention by thinner needleQ (whitacre needle) Supine position, intravenous fluids & caffeine and analgesia. Epidural blood Patch is most effective treatment. -### End" -2806,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thyrocervical trunk is branch of which part of subclavian artery-, with the following options: A: 1st, B: 2nd, C: 3rd, D: None - -### Response: -Ans. is 'a' i.e., 1st Branches of subclavian arteryFirst partVertebral arteryInternal thoracic arteryThyrocervical trunk ; Branches of thyrocervical trunk are :Inferior thyroid arterySuprascapular arterySuperficial cervicalSecond parto Costocervical trunk : It gives following branches :Deep cervical arterySuperior intercostal arteryThird parto Dorsal scapular artery. -### End" -2807,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The chromosomal karyotype in Patau syndrome is -, with the following options: A: 47)0C,+21, B: 46XX/47)0C+18, C: 45XX,der(14;21), D: 47XX,+13 - -### Response: -Ans. is 'd' i.e., 47XX +13 -### End" -2808,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum cones are seen in: March 2005, with the following options: A: Limbus, B: Fovea centralis, C: Macula lutea, D: Blind spot - -### Response: -Ans. B: Fovea centralis There are two basic types of retinal photo-receptors: Cones, responding to bright-light conditions, and Rods, responding to low-intensity light Depending on their spectral sensitivity, the former belong to either L (long-wavelengths sensitive), M (mid-wavelengths sensitive) or S (sho-wavelengths sensitive) cones. By combining their separate inputs, the brain creates colors. The cones are concentrated in the center of retina (fovea). Cones become larger up to about four times (of their size at fovea) toward outer areas of the retina. Fovea is the most sensitive pa of retina. It contains only cones and no rods. Since the fovea does not have rods, it is not sensitive to dim lights. Macula does not have a blood supply so the fovea receives oxygen from the vessels in the choroid. -### End" -2809,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a cause of point mutation?, with the following options: A: Paracentric inversion, B: Deletion, C: Substitution, D: Insertion - -### Response: -Ans. a. Paracentric inversion (Ref: Robbins 9/e p138, 160, 8/e p138, 160; Lippincot 5/e p433-434)""Inversion refers to a rearrangement that involves two breaks within a single chromosome with reincorporation of the inverted, intervening segment. An inversion involving only one arm of the chromosome is known as paracentric. If the breaks are on opposite sides of the centromere, it is known as pericentric. Inversions are often fully compatible with normal development.""- Robbins 9/e p160, 8/e p160 Point MutationsReplacement or changes in single baseQTransitionTransversionPurine - PurineQ Pyrimidine - PyrimidineQPurine PyrimidineQ Pyrimidine - PurineQ Effects of point mutationSilent Mutations:No apparent effect due to change in 3rd nucleotide of genetic code (Wobble hypothesis)QThe codon containing the changed base codes for the same amino acidQExample: 67th position of B chain of HbAQNormalValineMilwaukeeQGlutamateBristolQAspartateSydneyQAlanineMissense mutations:The codon containing the changed base codes for different amino acidQAcceptable: Change in amino acid does not alter function of protein, Ex: Hb Hikari b-61: Asparaginase for lysineQPartially acceptable: Change in amino acid interferes with normal function. Ex: HbS/Sickle cell anemia b-6: Valine for glutamic acidQUnacceptable: Result in totally non-functional protein, Ex: HbM (Boston) a-58: Tyrosine for histidineQNonsense mutations:The codon containing changed base may become the termination codonFrame-shift muations:Addition or deletion of a base can cause aleration in the frame of m-RNA. -### End" -2810,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The vector which transmits trench fever -, with the following options: A: Tick, B: Mite, C: Flea, D: Louse - -### Response: -Trench fever is caused by Rickettsia quintana. The vector being lice. Other diseases transmitted by lice include epidemic typhus, dermatitis, relapsing fever. REFERENCE: PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE, 25TH EDITION, PG NO. 837 -### End" -2811,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common genital prolapse is :, with the following options: A: Cystocoele, B: Procidentia, C: Rectocoele, D: Enterocoele - -### Response: -Ans. is a i.e. Cystocoele Genital prolapse : refers to protusion of the pelvic organ into or out of the vaginal wall. Classification of prolapse Anterior vaginal wall : upper two thirds - cystocoele Cytourethrocoele lower one third - urethrocoele Posterior vaginal wall : upper one third - enterocoele (pouch of Douglas Hernia) Grade I = Descent halfway to the hymen Grade II = Descent to the hymen Grade IIt = Descent halfway past the hymen Grade IV = Maximum possible descent for site Bader walker Halfway system : 11, Grade 0 = Normal postion for each reproesentative site Uterine descent : Shaw's classification (old classification) : 1deg- descent of the cervix to the vagina 2deg - descent of the cervix to the introitus 3deg - descent of the cervix outside the introitus. Procidentia : all of the uterus outside the introitus. Utero vaginal Prolapse : It is the commonest type of prolapse. Cystocoele occurs first followed by traction on the cervix causing retroversion of the uterus and then uterus is pushed into the vagina. Vault prolapse : it follows vaginal or abdominal hysterectomy, symptoms are-coital difficulty and difficulty in walking. Congenital Prolapse : There is no cystocoele. ""Data from Women's Health Initiative revealed anterior pelvic organ prolapse in 34.3%, posterior wall prolapse in 18.6% and uterine prolapse in 14.3% of women in the study."" Therefore, from the above data it is clear that cystocele (anterior organ prolapse) is the most common type of prolapse. Friends, according to latest trends, prolapse is not classified as above, but compamental classification is done. (It might be asked in fohcoming PGME exams). Newer classification Prolapse Uterine Prolapse Vaginal prolapse 10 descent of the uterus but the cervix remains within the introitus. 2o degree Descent to the extent that the cervix projects through the vulva, when the woman is straining or standing 3o degree i.e. complete Procidentia. Anterior compamentdefectLeads to cystocoeleUrethrocele of vagina Middle compamentdefectLeads to Enterocele& massive eversion Posterior compamentdefectRectocoele and Perinealbody descent Note:Sometimes the term apical prolapse is used - It includes : Uterine prolapse Vaginal vault prolapse (post hysterectomy) Enterocele -### End" -2812,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest cause of periumbilical pain after 30 min. of TURP done under spinal anesthesia with Bupivacaine, with the following options: A: Meteorism, B: Perforation of bladder, C: Recovery from bupivacaine anaesthesia, D: Mesentery aery i schemia - -### Response: -Ans is 'b' ie Perforation of the bladder Perforation of bladder is one of the complications of TURP. It can present with periumblical pain. This pt. experiences pain 30 minutes after TURP. This is because he is under spinal anesthesia. In this pt. the effect of spinal anesthesia terminates 30 min. after the operation. Now he is able to perceive the pain of bladder perforation. Meteorism - is distention of the abdomen or intestines by gas. This is seen in Renal injury but not in TURP. -### End" -2813,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The hea to the activated sludge process is ?, with the following options: A: Primary sedimentation tank, B: Sludge digester, C: Aeration tank, D: Final settling tank - -### Response: -Ans. is 'c' i.e., Aeration tank o The hea of the activated sludge process is aeration tank. -### End" -2814,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 18 y.o. student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student’s health history?, with the following options: A: Renal calculi, B: Renal trauma, C: Recent sore throat, D: Family history of acute glomerulonephritis - -### Response: -The most common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body. -### End" -2815,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement about cleft palate repair is: March 2011, with the following options: A: Hemoglobin should be 10 gram%, B: Weight should be 10 pounds, C: Repaired immediately after bih, D: 2 stage procedure if associated with cleft lip - -### Response: -Ans. C: Repaired immediately after bih Timing of primary cleft palate procedures: Soft palate alone: One operation at 6 months Soft and hard palate: 2 operations; Soft palate at 6 months and hard palate at 15-18 months -### End" -2816,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about is / are :, with the following options: A: MS surgery better avoided in pregnancy, B: MR with PHT-definite indication for termination of pregnancy, C: Aoic stenosis in young age is due to Bicuspid valve, D: All - -### Response: -Ans. a, b and c i.e. MS surgery better avoided in pregnancy; MR with PHT- definite indication for termination of pregnancy; and Aoic stenosis in young age is due to Bicuspid valve -### End" -2817,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are the criteria for medical management of ectopic pregnancy except:, with the following options: A: Asymptomatic patient., B: Serum r3-hCG level <2000 IU/L., C: Pregnancy diameter <5 cm., D: Unruptured tube. - -### Response: -Ans. C. Pregnancy diameter <5cmCriteria are:a. Asymptomatic patient.b. Serum b-hCGlevel<2000IU/L.c. Pregnancy diameter <2cm.d. Unruptured tube.e. Non-active bleeding.f. No fetal cardiac activity on USG.g. <100ml blood in the pouch of Douglas. -### End" -2818,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which condition, postpaum hemorrhage will not occur :, with the following options: A: Preterm labour, B: Cervical laceration, C: Prolonged labour, D: Over distension of uterus - -### Response: -Preterm labour -### End" -2819,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following provisions are included in the Primary health care according to the Alma Ata declaration except:, with the following options: A: Adequate supply of safe drinking water, B: Nutrition, C: Provision of free medicines, D: Basic sanitation - -### Response: -ALMA - ATA CONFERENCE: Called for WHO Goal of ""Health for All"" by 2000 India is a signatory Provisions included under Primary Health Care according to Alma Ata conference: E- Essential drugs ; 33-38 essential drugs are included in PHC. Most essential drug is Paracetamol L - Locally endemic disease prevention & control E - Education M - Maternal & child health E - EPI 1978; UIP- 1985 N- Nutrition T - Treatment of common ailments S - Safe water supply & sanitation -### End" -2820,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 42 year old man is preoccupied with his health being not in good shape. He feared that his irregular bowel functions mean he has cancer. Now he is preoccupied about having a serious heart disease, despite his physician's assurance that he has no heart disease. What is his most likely diagnosis?, with the following options: A: Pain disorder, B: Hypochondriasis, C: Delusional disorder, D: Somatization disorder - -### Response: -Ans. B. Hypochondriasis* Hypochondriasis is characterized by fear of developing or having a serious disease, based on the patient's distorted interpretation of normal physical sensations or signs.* The patient continues worrying even though physical exams and diagnostic tests fail to reveal any pathological process.* The fears do not have the absolute certainty of delusions.* Hypochondriasis can develop in every age group, but onset is most common between 20 and 30 years of age.* Both genders are equally represented, and there are no differences in prevalence based on social, educational, or marital status. The disorder tends to have a chronic, relapsing course. -### End" -2821,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true regarding bleaching powder-, with the following options: A: Contact period is one hour, B: Volume of water is estimated, C: lmmediatly dissolved in water, D: Chlorine demand is estimated - -### Response: -Ans. is 'c' i.e., Immediatly dissolved in water -### End" -2822,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nil per oral orders for an 8 year old child posted for elective nasal polyp surgery at 8 AM is all except, with the following options: A: Milk can be taken at 7 AM in morning, B: Apple juice can be taken at 10 PM previous night, C: Rice can be consumed at 11 PM previous night, D: Can take sips of water up to 6 AM in morning - -### Response: -For children, nil per oral orders are upto 8 hrs for solid food, 6 hours for formula milk, 4 hours for breast milk and 2 hours for clear fluid. -### End" -2823,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ceain obligations on the pa of doctor who undeakes postmoem examination are following except :, with the following options: A: The examination should be meticulus and complete, B: Routinely record all positive findings and impoant negative ones, C: He must keep the police informed about the findings, D: He must preserve viscera and send for toxi-cology examination in case of poisoning - -### Response: -C i.e. He must keep the police informed about the findings It is not obligatory on the pa of doctor to keep the police infonned about the findingsQ -### End" -2824,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tennis elbow is characterized by, with the following options: A: Tenderness over the medial epicondyle, B: Tendinits of common extensor origin, C: Tendinitis of common flexor origin, D: Painful flexion and extension - -### Response: -Tennis elbow is extraaicular affection characterized by pain and acute tenderness at the origin of the extensor muscles of the forearm from the lateral epicondyleIt is believed to be caused by strain of the forearm extensor muscles, paicularly the extensor carpi radialisbrevis, at the point of their origin from lateral epicondyle(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 175, 497) -### End" -2825,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Class IV Kennedy Classification is:, with the following options: A: Bilateral edentulous area located posterior to the remaining natural teeth., B: Unilateral edentulous area located posterior to the remaining natural teeth., C: Unilateral edentulous area with natural teeth remaining both anterior to the remaining natural teeth and posterior to it., D: A single but bilateral (crossing the midline) edentulous area located anterior to the remaining natural teeth. - -### Response: -The following is the Kennedy classification: -Class I: Bilateral edentulous areas located posterior to the natural teeth. -Class II: A unilateral edentulous area located posterior to the remaining natural teeth. -Class III: A unilateral edentulous are with natural teeth remaining both anterior and posterior to it. -Class IV: A single, but bilateral (crossing the midline), edentulous area located anterior to the remaining natural teeth. -Ref: McCrackens Removable Partial Denture Ed 13th Pg 17 -### End" -2826,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are used to improve attention deficit in children except -, with the following options: A: Cognitive enhancement therapy, B: Cognitive behavioural therapy, C: Cognitive remeditation therapy, D: Flooding - -### Response: -Ans. is 'd' i.e., Floodingo In attentention deficit following can be used :Cognitive enhancement therapy (also called cognitive remeditation therapy)Cognitive behavioral therapyClinical behavior therapyDirect contingency managementIntensive, packaged behavioral treatment -### End" -2827,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady undergoes total radical hysterectomy for stage Ib Ca cervix. It was found that Ca extends to lower pail of body of uterus and upper pa of cervix. Next step of management will be, with the following options: A: Chemotherapy, B: Radiotherapy, C: Chemoradiation, D: Follow-up - -### Response: -Follow up This patient has stage Ib Ca cervix (i.e. clinical lesion confined to cervix). Management of Ca cervix consists of Primary management and Post-op management. Primary Mx of Ib Radical hysterectomy + lymphadenectomy (detailed Mx of Ib described ahead) Post surgical management depends on presence or absence of risk factors. So here this patient has stage Ib Ca cervix - She has undergone total radical hysterectomy, which is the appropriate primary management. Post-op it is found that carcinoma is extending to lower pa of body of uterus. This is the tricky pa of the question. - an extension to uterus is given no consideration in FIGO clinical staging of Ca Cervix. Fuhermore Novak writes - ""After a clinical stage is assigned and treatment has been initiated the stage must not be changed because of subsequent findings of either extended clinical staging or surgical staging"". So a finding of uterus involvement is not going to change the stage or the management. Post op. management (i.e. either follow up, radiotherapy or chemoradiation) is going to be determined by presence or absence of risk factors. In the question, no risk factor has been mentioned (uterine involvement is not a risk factor). So we assume that none are present and hence fuher management would be -> 'follow up' Management of Ca Cervix Primary Management of Note - Radiotherapy can also be used for stages la to Ila if patient is medically inooperable. Trachelectomy or cervicectomy refers to surgical removal of cervix. In radical trachelectomy parametria and vaginal cuff are also excised along with removal of cervix. This is a feility preserving alternative to radical hysterectomy in younger patients with early stage carcinoma. Types of hysterectomy Type I - Simple (extrafascial) hysterectomy routinely done for benign conditions for e.g. fibroid. Type II - (Weheim's or modified radical hysterectomy) In type II along with hysterectomy, medial half of the cardinal and uterosacral ligaments and proximal 1-2 cm of vagina are also removed. Type III - (Meigs radical hysterectomy) It includes removal of most of the uterosacral and cardinal ligaments and the upper one third of the vagina. Both type II & type III hysterectomy includes pelvic lymph node dissection. Type IV - (extended radical hysterectomy) In type IV, the periureteral tissue, superior vesical aery, and as much as 3/4th of vagina in addition are removed. Type V (paial exenteration) - Poions of the distal ureter and bladder are resected. Type IV & V are rarely performed because radiotherapy is more adequate treatment in extensive disease. These factors are seen during histopathological examination of specimens (uterus, cervix, parametria, vaginal cuff, lymph nodes etc.) of radical hysterectomy and lymphadenectomy. Let's also have a revision of Ca Cx staging FIGO Staging of Carcinoma of the Cervix Preinvasive Carcinoma 0 Carcinoma in situ Invasive Carcinoma I Carcinoma is strictly confined to the cervix lA Invasive cancer identified only microscopically. All gross lesions even with superficial invasion are stage lB cancers. Invasion is limited to measured stromal invasion = 5 mm deep and < 7 mm wide. IA1 Measured invasion of stroma <3 mm deep and <7 mm wide IA2 Measured invasion of stroma >3-5 mm deep and <7 mm wide IB Clinical lesions confined to the cervix or microscopic lesions greater than stage IA M1 Clinical lesions <4 cm in size 1B2 Clinical >4 cm in size II Carcinoma extends beyond the cervix but has not extended to the pelvic wall or lower third of the vagina. IIA No obvious parametrial involvement IIB Obvious parametrial involvement III Carcinoma has extended to the pelvic wall. On rectal examination, there is no cancer free space between the tumor and the pelvic wall. The tumor involves the lower third of the vagina. All cases of hydronephrosis or nonfunctioning kidney are included unless known to be due to another cause. IIIA No extension to the pelvic wall IIII3 Extension to the pelvic wall, hydronephrosis, or nonfunctioning kidney IV Carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum. Bullous edema does permit a case to be allocated to stage IV. IVA Spread of growth to adjacent organs IVB Spread to distant organs -### End" -2828,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 27-year-old mountain climber falls from a steep rock wall and is brought to the emergency depament. His physical examination and computed tomography (CT) scan reveal dislocation fracture of the upper thoracic veebrae. The fractured body of the T4 veebra aiculates with which of the following pas of the ribs, with the following options: A: Head of the third rib, B: Head of the fifth rib, C: Neck of the fouh rib, D: Tubercle of the fouh - -### Response: -The body of veebra T4 aiculates with the heads of the fouh and fifth ribs. The body of the T3 veebra aiculates with the head of the third and fouh ribs. The neck of a rib does not aiculate with any pa of the veebra. The transverse process of the veebra aiculates with the tubercle of the corresponding rib. Therefore, the transverse process of veebra T4 aiculates with the tubercle of the fouh rib. -### End" -2829,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the pathogen responsible for blindness in advanced HIV infections? (NOT RELATED), with the following options: A: Cytomegalovirus, B: Epstein-Barr virus, C: Fungus, D: Toxoplasma - -### Response: -. -### End" -2830,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The least radio sensitive tissue is, with the following options: A: Nervous tissue, B: Bone, C: Kidney, D: Thyroid - -### Response: -Ans. is 'b' i.e., Bone -### End" -2831,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4-year child presents with a history of hoarseness, croupy cough and aphonia, the child has dyspnoea with wheezing. The most probable diagnosis is ?, with the following options: A: Asthmatic bronchitis, B: Laryngeal foreign body, C: Bronchopneumonia, D: Retropharyngeal abscess - -### Response: -Ans. is 'b' i.e., Laryngeal foreign body -### End" -2832,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In chronic arsenic poisoning, greatest amount found in -, with the following options: A: Muscle, B: Kidney, C: Liver, D: Keratin tissue - -### Response: -Chronic Arsenic Poisoning Skin - generalized or localized fine mottled brown pigmentation of skin (Rain drop pigmentation) Nails - become brittle and show Mees' line. Mees' line are white transverse lines over nails Hairs - dry and may fall off; patchy or diffuse alopecia Arsenic dust - flexor eczema, painless perforationof nasal septum. Liver enlarged (hepatomegaly) and cirrhotic Weakness of muscle and atrophy - extensor muscles more commonly affected resulting in wrist drop and foot drop CNS-polyneuritis,optic neuritis Eyes-congestion,watering of eyes,photophobia GIT-cirrhosis of liver,nausea,vomiting,abd cramp,diarrhoea,salivation CVS-cardiac failure,dependent edema Hematologic-* Leukopenia * Thrombocytopenia * Mild eosinophilia * Karyorrhexis - manifested by bizarre nuclear forms * Megaloblastic anemia * Basophilic stippling RS-cough,hemoptysis REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 305 -### End" -2833,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All form the boundaries of the ovarian fossa, except -, with the following options: A: Ureter, B: Internal pudendal artery, C: Obliterated umbilical artery, D: Internal iliac artery - -### Response: -Ans. is 'b' i.e., Internal pudendal arteryo Each ovary lies in ovarian fossa and the lateral pelvic wall which is boundedAnteriorly: Obliterated umbilical arteryPosteriorly: Ureter and internal iliac artery -### End" -2834,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Smooth induction is seen by -, with the following options: A: Ether, B: Halothane, C: Isoflurane, D: Enflurane - -### Response: -Ans. is 'c' i.e., Isoflurane Induction by inhalation agents Unpleasant Intermediate Smooth Ether Halothane Isoflurane En flurane Desflurane Sevoflurane Nitrous oxide -### End" -2835,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bile acid has a detergent action due to ?, with the following options: A: Formation of soap, B: Formation of zwitter ion, C: Amphipathic nature of bile salts, D: Formation of medium chain triglycerides - -### Response: -Ans. is c i.e., Amphipathic nature of bile acids Bile-salts help in digestion of fat by emulsification of fat in small intestine by detergent action of bile salts. The detergent action of bile salts is due to their amphipathic propey. Emulsification increases the surface to volume ratio of the lipid droplets facilitating the action of lipases. Bile salts also help in formation of micelles. Micellar formation solubilizes the digested fats and provides a mechanism of their absorption into the enterocytes. -### End" -2836,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ectopic ACTH production is seen in -, with the following options: A: Small cell carcinoma is lung, B: Anaplastic carcinoma of lung, C: Squamous cell carcinoma of lung, D: Adenocarcinoma of cerebellum - -### Response: -Ans. is 'a' i.e, Small cell carcinoma of lung Ectopic ACTH is produced byo Small cell carcinoma of lung (most common)o Carcinoid tumorso Medullary Carcinoma of thyroido Islet cell tumors of pancrease -### End" -2837,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ther technique of laproscopic cholecystectomy was first described by?, with the following options: A: Erich Muhe, B: Philip Moure, C: Ku semm, D: Eddie Reddick - -### Response: -Erich Muhe is a German surgeon who performed the first laparoscopic surgery in 1985. -### End" -2838,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 12-year-old boy, who had been camping in the mountains with his family, was brought to the emergency depament because of headache, rash, and the abrupt onset of a high fever. The rash began on his palms and soles but spread up to his ankles and arms. On physical examination he was found to have palpable purpura on his wrists and lower legs. The infection is likely caused by?, with the following options: A: Rickettsia rickettsii, B: Treponema pallidum, C: Coxsackievirus, D: Dissiminated histoplasma infection - -### Response: -Infections with Rickettsia rickettsii, Treponema pallidum, and coxsackievirus all can cause a rash on the palms and soles. This patient is most likely infected with R rickettsii. The clinical course is typical for Rocky Mountain spotted fever, which is characterized by fever with abrupt onset and a rash that spreads from the extremities toward the trunk. Palpable purpura is a poor prognostic sign, as it indicates active vasculitis and leakage of blood into the skin. The rash in syphilis and coxsackievirus is typically more gradual. -### End" -2839,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prausnitz kustner reaction is which type of hypersensitivity -, with the following options: A: Type 1, B: Type 2, C: Type 3, D: Type 4 - -### Response: -Ans. is 'a' i.e., Type 1HYPERSENSITIVITYType I (IgE mediated)Type II (IgG, IgM and complement mediated)* Eczema* Blood transfusion reactions* Hay fever* Erythroblastosis fetalis* Asthma* Autoimmune hemolytic anemia or thrombocytopenia or agrnulocytosis* Atopy* Urticaria* Pemphigus vulgaris* Anaphylactic shock* Good pasture syndrome* Acute dermatitis* Bullous pemphigoid* Theobald smith phenomenon* Pernicious anemia* Prausnitz Kusnter (PK) reaction* Acute rheumatic fever* Casonis test* Diabetes mellitus* Schultz-Dale phenomenon* Graves disease * Myasthenia gravisType III (IgG, IgM, complement and leucocyte mediated)Type IV (Cell mediated)* Local-Arthus reaction* Tuberculin test* Systemic-serum sickness* Lepromin test* Schick test* Sarcoidosis* Polyarteritis nodosa (PAN)* Tuberculosis* Rheumatoid arthritis* Contact dermatitis* SLE* Granulomatous inflammation* Acute viral hepatitis* Type I lepra reaction* Penicillamine toxicity* Patch test* Hyperacute graft rejection* Temporal arteritis* Type 2 lepra reaction (ENL)* Jones mote reaction (cutaneous basophilic HSN)* Hypersensitivity pneumonitis* Graft rejection* R.A.* Fairleys test* Infective endocarditis* Frie's test* Henoch schonlein purpura * Glomerulonephritis -### End" -2840,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A man presents 6 hrs after head injury complaining of mild proptosis and scleral hyperemia:, with the following options: A: Pneumo-orbit, B: Caroticocavernous fistula, C: Retro-orbital hematoma, D: Orbital cellulitis - -### Response: -Ans. Retro-orbital hematoma -### End" -2841,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Subacute combined degeneration of spinal cord is due to deficiency of, with the following options: A: VitaminA, B: Vitamin C, C: Vitamin B12, D: Vitamin B3(Niacin) - -### Response: -Ans. is 'c' i.e., Vitamin B12 -### End" -2842,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice in Neonatal ITP is -, with the following options: A: Platelet transfusion, B: Prednisolone, C: Dexamethasone, D: Gammaglobulin - -### Response: -Ans. is 'd' i.e., Gammaglobulin Treatment of neonatal ITP o Prenatal administration of coicosteroids to mother. o IV immunoglobulin or sometime coicosteroids to the infant after delivery. Treatment of ITP in children IV immunoglobulin is the treatment of choice. Glucocoicoids are often used in combination. -### End" -2843,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HPV triage strategy includes all except, with the following options: A: Conventional pap smear, B: Liquid based cytology, C: Hybrid capture 2 for HPV DNA, D: Colposcopy - -### Response: -HPV Triage strategy Liquid based thin layer cytology: atypical squamous cells Hybrid capture 2 for HPV DNA HPV DNA POSITIVE: If high risk strains proceed with colposcopy and directed biopsy NEGATIVE: Repeat smear after one year Ref: D.C.DUTTA&;S TEXTBOOK OF GYNECOLOGY; 6th edition; Pg no:324 -### End" -2844,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renauld Braud phenomenon is seen is:, with the following options: A: Candida albicans, B: Candida pscitasi, C: Histoplasma, D: Cryptococcus - -### Response: -Ans. a. Candida albicans -### End" -2845,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most commonly lesion associated with pathological fracture in hand is -, with the following options: A: Enchondroma, B: Metastases, C: Osteoid osteoma, D: Osteochondroma - -### Response: -Ans. is 'a' i.e., Enchondroma Pathological fractures in hand* In hand pathological fractures are most commonly associated with benign bone tumors.* About 23 % of the bone tumors in hand present with pathological fractures.* The average age of presentation is 37 years.* The most common bone affected is the proximal phalynx, the fifth ray was involved in 44% of the patients.* Majority (approximately 88%) of the pathological fractures are caused by enchondromas. -### End" -2846,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady with 3 living children comes with 8 wks pregnancy with Cu T inutero, treatment suitable is :, with the following options: A: Continue pregnancy and Remove Cu T during delivery, B: Remove Cu T and permanent sterilization, C: Remove Cu T, D: None - -### Response: -Remove Cu T and permanent sterilization -### End" -2847,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cell surface receptors are used by which hormone-, with the following options: A: Thyroxine, B: Testosterone, C: Glucagon, D: Cortisol - -### Response: -Ans. is 'c'i.e., Glucagon Type of receptorso All hormones act through specific receptors present inside the cell (intracellular) or on the surface of cells (membrane receptors).A. Membrane receptorso Present on the cell membrane.o Their drug/hormone binding domain is extracellular and effector domain is intracellular.These are:1. G protein coupled receptors - It may act through.a) Adenylyl cyclase| cAMP - TSH, FSH, LH, ACTH, glucagon, PTH, adrenaline, calcitonin, vasopressin (V2).| cAM P - PRIH (Dopamine)b) IP3-DAG (Ca2+ and protein kinase 'c') -Vasopressin (V1), oxytocin.c) Channel regulation (Ca+2, K+ Na+)2. Receptor with Intrinsic ion channels - (Na+, K+, Ca+2 or C1-)3. Enzyme linked receptorsa) Intrinsic enzyme receptors (tyrosine kinase receptors) - Insulin.b) JAK-STAT kinase binding receptors - Growth hormone, Prolactin.B. Intracellular receptors (transcription factors)o Present inside the cell and induce synthesis of specific protein by increasing the expression of specific gene.1. Cytoplasmic - Glucocorticoids, Mineralocorticoids, Androgens, Progestins.2. Nuclear - Thyroxine, Triiodothyronine, Estrogen, retinoic acid, Vit D. -### End" -2848,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following moves rapidly across the membrane?, with the following options: A: CO2, B: Water, C: Glucose, D: Urea - -### Response: -Hydrophobic molecules move rapidly across the membrane -### End" -2849,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infundibulo pelvic ligament is also called as ?, with the following options: A: round ligament of ovary, B: round ligament of uterus, C: mackenrodt's ligament, D: suspensory ligament of ovary - -### Response: -The pa of the broad ligament that stretches from the upper pole of the ovary and the infundibulum of the uterine tube to the lateral pelvic wall is called the suspensory ligament of the ovary or the infundibulopelvic ligament. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 2 , pg. no., 415. -### End" -2850,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 37-year-old man is brought to the emergency depament complaining of severe chest pain. His angiogram reveals thromboses of both brachiocephalic veins just before entering the superior vena cava. This condition would most likely cause a dilation of which of the following veins?, with the following options: A: Azygos, B: Hemiazygos, C: Right superior intercostal, D: Left superior intercostal - -### Response: -The left superior intercostal vein is formed by the second, third, and fouh posterior intercostal veins and drains into the left brachiocephalic vein, so its thrombosis leads to dilatation of left superior intercostal vein. The right superior intercostal vein drains into the azygos vein, which in turn drains into the SVC. The hemiazygos vein drains into the azygos vein, whereas the internal thoracic vein empties into the brachiocephalic vein. -### End" -2851,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements regarding the oculomotor nerve are true except, with the following options: A: It accommodates the eyes, B: It raises the upper eyelid, C: It innervates lateral rectus, D: It constricts the pupil - -### Response: -Ref:BDC 6th edition pg 361 & 208Oculomotor nerve is the 3rd cranial nerve. It is distributed to extraocular as well as intraocular muscles.It is a somatic motor nerveIt innervates all the extraocular muscles except superior oblique & lateral rectus.The superior oblique is supplied by the Trochlear nerve(4th cranial nerve)The lateral rectus is supplied by Abducent nerve(6th cranial nerve)NOTE:MNEMONICS: Extraocular muscles innervation:""LR6SO4 REST 3"" -### End" -2852,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with acute diarrhea with signs of dehydration; On investigation, Na+ 125 mEq/L, K+ 3 meq/L, HCO3- 16 mEq/L and pH is 7.23. IV Fluid to be given is?, with the following options: A: Normal saline, B: 3% saline, C: N/2 saline + 10% dextrose, D: N/3 saline + 5% dextrose - -### Response: -* Hyponatremic dehydration is treated by correction of intravascular volume with isotonic fluid (NS or LR). * An overly rapid (>12 mEq/L over the first 24 hr) or overcorrection of serum sodium concentration (>135 mEq/L) is associated with an increased risk of central pontine myelinolysis. -### End" -2853,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following are causes for cholecystitis wxcept?, with the following options: A: Estrogen, B: OCP, C: Diabetes mellitus, D: Obesity - -### Response: -acalculous cholecystitis is not an uncommon entity, but can be commonly missed.* It is common in patients who have undergone major surgeries, trauma, burns, or any other stress or in cases of cholecystoses. * Common in ICU patients. ACUTE CHOLECYSTITIS * Commonly it occurs in a patient with pre-existing chronic cholecystitis but often also can occur as a first presentation. * Usual cause is impacted gallstone in the Hamann's pouch, obstructing cystic duct. ref : SRB&;s manual of surgery,3 rd ed,pg no 576 -### End" -2854,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs are used as immunosuppressants in organ transplantation, EXCEPT:, with the following options: A: Glucocoicoids, B: Cyclosporine, C: Cephalosporin, D: Azathioprine - -### Response: -Cephalosporins are similar to penicillins, but more stable to many bacterial Beta-lactamases and therefore have a broader spectrum of activity. Immunosuppressive drugs are used to dampen the immune response in organ transplantation and autoimmune disease. In transplantation, the major classes of immunosuppressive drugs used today are: Glucocoicoids Calcineurin inhibitors Anti-proliferative/antimetabolic agents Biologicals (antibodies) Azathioprine was first introduced as an immunosuppressive agent in 1961, helping to make allogeneic kidney transplantation possible. It is indicated as an adjunct for prevention of organ transplant rejection and in severe rheumatoid ahritis. The calcineurin inhibitor cyclosporine is a potent immunomodulator used most frequently after organ transplantation. It is effective in specific clinical settings in IBD, but the high frequency of significant adverse effects limits its use as a first-line medication. Ref: Krensky A.M., Bennett W.M., Vincenti F. (2011). Chapter 35. Immunosuppressants, Tolerogens, and Immunostimulants. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -2855,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Splenic macrophages in Gaucher's disease differ from those in ceroid histiocytosis by staining positive for for, with the following options: A: Lipids, B: Phospholipids, C: Acid fast stain, D: Iron - -### Response: -Gaucher disease results from mutation in the gene that encodes glucocerebrosidase. This deficit leads to an accumulation of glucocerebroside, an intermediate in glycolipid metabolism, in the mononuclear phagocytic cells and their transformation into so-called Gaucher cells. Gaucher cells contain abundant lipid-laden granular cytoplasm. (Robbins Basic Pathology, 9 th edition. page : 231) -### End" -2856,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice in lignocaine toxicity -, with the following options: A: Bretylium, B: Amiodarone, C: Isoprenaline, D: Diazepan - -### Response: -Ans. is `d' i.e., Diazepan o If lignocaine toxicity is suspected, stop the injection immediately. o Ensure adequate oxygenation, whether by face mask or by intubation. o Anticonvulsants such as benzodiazepines and barbiturates are the drug of choice for seizure control. o Succinylcholine is sometimes also used to terminate the neuromuscular effects of seizures. o If CVS symptoms occur (cardiac depression and hypotension), IV fluid and vasopressor agents may be required. o If metabolic acidosis develops, use of sodium bicarbonate can be considered, although, as in other instances of acute metabolic acidosis, this is controversial. -### End" -2857,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: As per Anderson and D'Alonzo classification the most dangerous type of odontoid fracture is, with the following options: A: Type I, B: Type II, C: Type III, D: Type IV - -### Response: -Anderson and D'Alonzo classification for odontoid fracture  -Type I : Avulsion of tip . -Type II : Fracture at junction of odontoid process and axis. -Type III : Fracture through the body of axis. -Treatment according to classification  -Type I : Conservatively -Type II : Most dangerous type, treated with screw fixation -Type III : Conservatively -### End" -2858,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a feature of cocaine poisoning:September 2011, with the following options: A: Hallucination, B: Agitation, C: Hypothermia, D: Stimulation of libido - -### Response: -Ans. C: HypothermiaCocaine when ingested results in hypehermia, hallucinations, euphoria and stimulation of libido Cocaine intoxicationWith excessive or prolonged use, the drug can cause itching, tachcardia, hallucinations and paranoid delusions.Overdoses cause tachyarrythmias and a marked elevation of blood pressure, which can be life-threatening.Toxicity results in seizures, followed by respiratory and circulatory depression of medullar origin.This may lead to death from respiratory failure, stroke, or hea-failure.Cocaine is also highly pyrogenic, because the stimulation and increased muscular activity cause greater heat production.Heat loss is inhibited by the intense vasoconstriction.Cocaine-induced hypehermia may cause muscle cell destruction and myoglobinuria resulting in renal failure.Emergency treatment often consists of administering a benzodiazepine sedation agent, such as diazepam to decrease the elevated hea rate and blood pressure.Physical cooling (ice, cold blankets, etc.) and paracetamol (acetaminophen) may be used to treat hypehermiaThere is no officially approved specific antodote for cocaine overdoseCocaine's primary acute effect on brain chemistry is to raise the amount of dopamine and serotonin in the nucleus accumbens (the pleasure center in the brain); this effect ceases, due to metabolism of cocaine to inactive compounds and paicularly due to the depletion of the transmitter resources (tachyplaxis).This can be experienced acutely as feelings of depression, as a ""crash"" after the initial high. -### End" -2859,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hepatotoxic agent is, with the following options: A: Ketamine, B: Ether, C: N2O, D: Halothane - -### Response: -The first modern halogenated volatile anesthetic, halothane, was introduced in 1955. Clinical exposure to halothane is associated with two distinct types of hepatic injury. Subclinical hepatotoxicity occurs in 20% of adults who receive halothane. It is characterized by mild postoperative elevations in alanine aminotransferase and aspaate aminotransferase, but is reversible and innocuous. Anaerobic halothane reduction by CYP2A6 to a 2-chloro-1,1,1-trifluoroethyl radical is thought to mediate this mild hepatic injury. The fulminant form of hepatotoxicity, commonly known as halothane hepatitis, It is characterized by elevated alanine aminotransferase, aspaate aminotransferase, bilirubin, and alkaline phosphatase levels, and massive hepatic necrosis following the administration of halothane. Halothane hepatitis is rare (1 in 5000 to 35,000 administrations in adults), but is fatal in 50% to 75% of these cases. Because of the potential for fatal hepatitis, halothane is no longer used in adult patients in many countries. Halothane hepatitis is caused by a hypersensitivity reaction associated with the oxidative metabolism of halothane. The highly reactive trifluoroacetyl chloride metabolite of halothane oxidation can react with nearby liver proteins. In most patients who developed hepatic necrosis after halothane anesthesia, antibodies against TFA-modified proteins were detected, suggesting that the hepatic damage is linked to an immune response against the modified protein, which acts as a neoantigen. Accordingly, patients who develop halothane hepatitis often have a history of prior exposures to halothane or other volatile anesthetics, together with symptoms suggestive of immune reactivity, such as fever, rash, ahralgia, and eosinophilia. A current hypothesis is that TFA-protein adducts induce a cytotoxic T cell reaction in sensitized individuals, which leads to liver damage. However, the immune responses observed in halothane hepatitis might not mediate liver injury. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e -### End" -2860,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Steroid ingested for long time leads to all of the following except -, with the following options: A: Avascular necrosis of head of femur, B: Cataract, C: Glaucoma, D: Growth retardation - -### Response: -Ans. is 'c' i.e., Glaucoma Glaucoma occurs after topical therapy (not systemic) -### End" -2861,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of obstructive jaundice is-, with the following options: A: Cystic duct stone, B: CBD stone, C: Hepatitis, D: Liver cirrhosis - -### Response: -Ans. is 'b' i.e., CBD stone -### End" -2862,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deficiency of vasopressin results in:, with the following options: A: Inability of the kidney to concentrating urine, B: Increased Na+ loss, C: Hyperkalemia, D: Decreased urine output - -### Response: -Inability of the kidney to concentrating urine -### End" -2863,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about folic acid except ?, with the following options: A: Foification of wheat products (flour) is done with folic acid in India as well as in USA, B: It is present in the green leafy vegetables, C: It is proven to decrease the occurence of neural tube defects when taken before conception, D: Methyl-folate trap is because of methionine synthase defect - -### Response: -FOLIC ACID India has not yet adopted recommendation of foification of all wheat products in India with folic acid Preconceptionally given for prevention of neural tube defects It is present in leafy vegetables spinach, paneer Requirement perday in pregnancy is 500 mcg Ref: Park 25th edition Pgno : 658 -### End" -2864,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The minimum recommended conecntration of free chlorine (mg/L) in drinking water at the end of 1 hour is -, with the following options: A: 0.1, B: 0.5, C: 1, D: 1.5 - -### Response: -Recommended contact period of free residual Chlorine in water : 1 hour Level of free residual chlorine (FRC) recommended : Water type Residual chlorine level (Recommended) Contact period Drinking water >0.5 mg per litre (ppm) 1 hour Water bodies, post disaster >0.7 mg per litre (ppm) 1 hour Swimming pool sanitation >1.0 mg per litre (ppm) 1 hour Ref: Park 25th edition Pgno : 752 -### End" -2865,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: General anaesthetic agent causing sympathetic stimulation: September 2011, with the following options: A: Thiopental, B: Ketamine, C: Midazolam, D: Etomidate - -### Response: -Ans. B: Ketamine Ketamine stimulates sympathetic system causing tachycardia and hypeension so it is intravenous anaesthetic of choice for shock Disadvantages of Midazolam: Incidence of apnea, respiratory depression and hypotension are higher and more profound than diazepam Thiopentone causes hypotension which is more because of venodilatation Ketamine: It is phencyclidine Causes dissociative anaesthesia Increases all pressures (BP, intraocular tension, intracranial tension) Causes profound analgesia Causes hallucinations, illusions and delusions Contraindicated in: Intracerebral mass or hemorrhage Causes bronchodilation (used in asthmatics) and increases cardiac output (used in hypovolumic shock) -### End" -2866,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Burkitt's lymphoma is characterized by elevated ""early antigen"" tests with a restricted pattern of fluorescence. This disease is caused by, with the following options: A: Cytomegalovirus, B: B. burgdorferi, C: Epstein-Barr virus, D: Lymphogranuloma venereum - -### Response: -Epstein-Barr virus (EBV) is a herpesvirus that causes a number of syndromes; the most common is infectious mononucleosis. It is a ubiquitous enveloped DNA virus. Only one serotype of EBV has been recognized, although molecular methods have reorganized a number of genotypes of EBV.Infectious mononucleosis is an acute disease most commonly seen in younger people. It is characterized by a proliferation of lymphocytes, lymph node enlargement, pharyngitis, fatigue, and fever. Infection in young children is usually either asymptomatic or characteristic of an acute upper respiratory infection. Diagnosis is usually made by a positive heterophil test. Heterophil antibodies are those that occur in one species (human) and react with antigens of a different species. The heterophil test may be insensitive (30 to 60%) in children. Definitive diagnosis is made by detection of antibodies to EBV components.EBV causes a variety of other syndromes including Burkitt's lymphoma, the most common childhood cancer in Africa, and nasopharyngeal carcinoma, commonly seen in China.Similar mononucleosis-like diseases are caused by cytomegalovirus (CMV) and Toxoplasma gondii, a parasite. CMV causes fewer than 10% of infectious mononucleosis-like diseases. CMV ""mono"" is primarily characterized by fatigue. Congenital infection with CMV almost always causes serious sequelae, such as retardation and hearing loss. T. gondii also causes a variety of clinical problems, among them encephalitis in AIDS patients and food poisoning from the ingestion of raw meat. Although CMV and T. gondii are relatively rare causes of infectious mononucleosis, they must be ruled out, particularly when EBV tests are nonreactive. -### End" -2867,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of cervical insufficiency is, with the following options: A: Idiopathic, B: Previous dilatation, C: Exposure to DES, D: Conization - -### Response: -The most common cause of cervical insufficiency is idiopathicCervical incompetence may be congenital due to the following:Mullerian anomaliesCollagen disordersExposure to DES or the causes may be acquiredObstetric trauma like cervical laceration during deliveryMechanical dilatationCervical Conization -### End" -2868,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The vitamin A supplement administered in ""Prevention of nutritional blindness in children programme"" contain -, with the following options: A: 25,000 i.u\/ml, B: 1 lakh i.u\/ml, C: 3 lakh i.u\/ml, D: 5 lakh i.u\/ml - -### Response: -parks textbook of preventive and social medicine 23rd edition. * under national programme for prevention od nutritional blindness,beneficiaries were preschol children (1-5years ) it focussed on administration of massive dose vitamin A upto five years .first dose of 100,000 IU with measles vaccination at nine months and subsequent doses of 200,000 IU each,every six months upto the age of five years . -### End" -2869,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic pathologic feature in malignant hypertension is:(1988), with the following options: A: Fibrinoid necrosis, B: Papillary necrosis, C: Glomerulosclerosis, D: Focal glomerulonephritis - -### Response: -Ans: a (Fibrinoid necrosis)Ref: Robbin's, 7thed, p. 530 & 6,hed, p. 515 -### End" -2870,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patch on tonsil is not caused by:, with the following options: A: Vincent's angina, B: Candida, C: Staphylococcus, D: Ludwig's angina - -### Response: -(d) Ludwig's angina(Ref. Scott Brown, 8th ed., Vol 3; 550)Ludwig's angina does not involve tonsil. The other options can lead to patch/pseudomembrane on the tonsil. -### End" -2871,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organ of rosenmullar is remnant of, with the following options: A: Endodermal sinus, B: Mulleria duct, C: Mesonerphric tuble, D: Paramesonephric duct - -### Response: -The epoophoron or epoophoron (also called organ of Rosenmuller or the parovarium) is a remnant of the mesonephric tubules that can be found next to the ovary and fallopian tube -### End" -2872,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For Contralateral weakness and sensory loss, worse in face and arm; homonymous hemianopsia; aphasia or neglect syndrome select the site of the lesion of cerebrovascular disease,, with the following options: A: Internal carotid aery, B: Middle cerebral aery, C: Midbasilar aery, D: Penetrating branch, middle cerebral aery - -### Response: -Sudden, painless monocular blindness is a sign of carotid disease. The symptom is also called amaurosis fugax . The patient may describe a shade dropping in front of the eye or describe vision like looking through ground glass. If a thrombus propagates up the carotid to the middle cerebral aery, then symptoms seen in middle cerebral aery occlusion or embolization (hemiparesis with sensory symptoms, aphasia depending on hemispheric dominance) will also occur. Midbasilar aery disease produces weakness and sensory loss with diplopia, loss of facial sensation or movement, and ataxia. Branches of the basilar aery supply the base of the pons and superior cerebellum. The symptoms described suggest disease in the posterior circulation, whichincludes paired veebral aeries, the basilar aery, and the paired posterior cerebral aeries. The basilar aery divides into two posterior cerebral aeries that provide branches to the cerebellum, medulla, pons, midbrain, thalamus, and temporal and occipital lobes. A midbasilar aery occlusion could cause ataxia of limbs by involving pontine nuclei; paralysis of the face, arm, and leg by involving coicospinal tracts; and impairment of facial sensation by involvement of fifth nerve nucleus. Occlusion of the entire middle cerebral aery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a penetrating branch of the middle cerebral aery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct). -### End" -2873,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At the end of a balanced anaesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received., with the following options: A: Pancuronium, B: Gallamine, C: Atracurium, D: Vecuronium - -### Response: -C i.e. Atracurium -### End" -2874,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement about congenital adrenal hyperplasia is not true -, with the following options: A: 21-alpha hydroxylase deficiency is the most common cause, B: Males present with precocious puberty, C: Females present with ambiguous genitalia, D: Hypokalemic alkalosis is seen - -### Response: -Deficiency of 21α hydroxylase is the most common cause of congenital adrenal hyperplasia. -Due to the deficiency of this enzyme there is no synthesis of mineralocorticoid and glucocorticoids in the adrenal cortex. -Decreased mineralocorticoid causes marked sodium loss in the urine resulting in hyponatremia, hyperkalemia acidosis and hypotension. -Due to deficiency of 21α hydroxylase there is increased formation of 17 hydroxyprogesterone which is then shunted into the production of testosterone. -This causes virilisation in females and precocious puberty in males. -### End" -2875,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of oxytocin, with the following options: A: Milk ejection, B: Milk secretion, C: Ovulation, D: Maintenance of pregnancy - -### Response: -Oxytocin - a hypothalamic hormone stored in and released from the posterior pituitary; it may also be prepared synthetically or obtained from the posterior pituitary of domestic animals. It acts as a powerful stimulant to the pregnant uterus, especially toward the end of gestation, and also causes milk to be expressed from the alveoli into the lactiferous ducts during breastfeeding.Ref: Ganong&;s review of medical physiology;24th edition; page no:-311 -### End" -2876,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Herbe's pits are seen in -, with the following options: A: Trachoma, B: Phlyctenular conjunctivitis, C: Sarcoidosis, D: Molluscum contagiosum - -### Response: -Herbe pits are the oval or circular pitted scar, left after healing of herbe follicles in the limbal area. Ref: Parson's 22nd/e p.173 & 21st/e p.173 -### End" -2877,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an oxidoreductase -, with the following options: A: Catalase, B: Glucokinase, C: Alcohol dehydrogenase, D: Peroxidase - -### Response: -Ans. is 'b' i.e., Glucokinase Oxidoreductases are oxidases, dehydrogenases, hydroperoxidases (Catalase, peroxidase), oxygenases.Glucokinase is a transferase. -### End" -2878,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cell shape and motility are provided by -, with the following options: A: Microfilaments, B: Microtubules, C: Golgi apparatus, D: Mitochondria - -### Response: -Functions of Microtubules include determination of cell shape and various cell movements. -### End" -2879,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dysthymia is, with the following options: A: Chronic mild depression, B: Chronic severe depression, C: Bipolar disorder, D: Personality disorder - -### Response: -Persistent mood disorders are characterised by persistent mood symptoms which last for more than 2 years but are not severe enough to be labelled as even hypomania or mild depressive episode. If the symptom consists of persistent mild depression, the disorder is called as dysthymia (Ref: A sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no73) -### End" -2880,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Water-hammer pulse is seen in?, with the following options: A: Mitral stenosis, B: Aoic regurgitation, C: Aoic stenosis, D: Pulmonary stenosis - -### Response: -Corrigan's pulse /Water hammer pulse/Collapsing pulse | According to Frank Starling law, as end diastolic volume of LV increases, the force of contraction of LV increases. Seen on arm elevation above level of head. Collapsing pulse/Watson's water hammer pulse: Pulse is a bounding, forceful pulse with a rapid upstroke and descent. It is seen in the following situations: Physiological Fever Pregnancy Cardiac lesions Aoic regurgitation Patent ductus aeriosus Systolic hypeension Bradycardia Aoopulmonary window Aneurysm of sinus of Valsalva High-output states Anemia Cor pulmonale Cirrhosis of liver Beriberi Thyrotoxicosis Aeriovenous fistula Paget's disease Other causes Chronic alcoholism -### End" -2881,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hind milk is richer in –, with the following options: A: Carbohydrate, B: Protein, C: Fat, D: Minerals - -### Response: -The composition of breastmilk varies at different stages after birth to suit the needs of the baby. -According to the postnatal period the breast milk is divided into - - -1. Clostrum - -Is the milk secreted during the first three days after delivery. -It is yellow and thick. -It contains more antibodies and cells and high amounts of vitamins A,D,E and K. - -2. Transitional milk - -Is secreted during the following two weeks (after clostrum). -The immunoglobulin and protein content decreases while the fat and sugar content increases. - -3. Mature milk - -Follows transitional milk. -It is thin and watery but contains all the nutrients essential for optimal growth of the body. - - -According to feed the breast milk is divided into - -1. Fore milk - - -It is watery and is rich in protein, sugar, vitamins, minerals and water that satisfy the baby's thirst. - -​​2.Hind milk - -Comes towards the end of feed -Rich in fat content and provides more energy, and satisfies the baby's hunger. -The milk of mother who delivers prematurely differs from the milk of a mother who delivers at term - - -Preterm milk - -Contains more protein S, sodium, iron, immunoglobins and calories as they are needed by the preterm baby. -### End" -2882,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acclimatization to a high altitude is associated with which of the following changes?, with the following options: A: Hyperventilation, B: Polycythemia, C: O2 dissociation curve shifts to right, D: Decreased concentration of systemic capillaries - -### Response: -Oxygen hemoglobin dissociation curve, is the curve relating percentage saturation of the oxygen carrying power of hemoglobin to the PO2. It has a characteristic sigmoid shape due to the T-R interconversion. In deoxyhemoglobin, globin units are tightly bound in a tense (T) configuration which reduces the affinity of the molecule for oxygen. When the first oxygen is bound, the bonds holding the globin units are released, producing a relaxed (R) configuration which exposes more oxygen binding sites. Thus, binding of one oxygen molecule increases the affinity of hemoglobin to bind other O2 molecules. Ascent to high altitude triggers a substantial rise in 2,3 DPG concentration in red blood cells. Factors causing shift of the curve to right includes: Fall in pH Rise in temperature Increase in 2, 3 BPG pH of the blood falls as its CO2 content increases, so that when PCO2 rises the curve shifts to right. Ref: Textbook of Medical Physiology By Guyton, 10th Edition, Page 466 ; Ganong's Review of Medical Physiology, 23rd Edition, Page 667-9 -### End" -2883,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When can a child kick a ball?, with the following options: A: 12 months, B: 18 months, C: 24 months, D: 36 months - -### Response: -c. 24 months(Ref: Illingworth's normal and abnormal child)A child can run and kick a ball at 2 years age and can go upstairs and downstairs 2 feet/step. -### End" -2884,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 56-year-old woman with diabetes, hypertension, and hyperlipidemia is found to have an A1C of 11 despite her best attempts at diet and faithfully taking her metformin and glyburide. The patient mentions that she has been unable to exercise much, partially due to severe fatigue and sleepiness in the daytime. On examination she is obese, has a full appearing posterior pharynx, clear lungs, a normal heart examination, and trace bilateral edema. Reflexes and skin are normal. Her TSH is 2.0 m/L (normal). The patient asks if there is anything else that can be done before adding another oral agent or switching to insulin. What is the best next step?, with the following options: A: Educate the patient on sleep hygiene to ensure better rest and more energy., B: Prescribe zolpidem as a sleep aid to help her sleep and increase her energy to exercise during the day., C: Explore for possible depression as a contributor to the fatigue which is keeping her from exercising., D: Arrange for a sleep study to check the patient for obstructive sleep apnea. - -### Response: -Obstructive sleep apnea (OSA) that has gone untreated contributes to increased insulin resistance. This appears to have an additional effect even beyond the common cooccurrence of obesity as in this patient. Treatment of OSA can lead to improvement in glucose control. This patient is obese, has a crowded oropharynx on examination, and has daytime somnolence. Although overnight oxygen saturation monitor may be performed at home as screening, this patient is at high risk of complications of OSA should proceed directly to formal overnight polysomnography. Sleep hygiene is important for patients with sleep disturbance but is not likely to help in this patient with probable severe OSA. Similarly, sedative hypnotic agents such as zolpidem are widely prescribed for sleep but could exacerbate the OSA. Depression should always be explored but there are no clues beyond fatigue to suggest this diagnosis. Low vitamin D levels are generally asymptomatic unless the condition is severe and prolonged and would not affect sleep apnea or glucose control specifically. -### End" -2885,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lateral Pterygoid muscle is attached to-, with the following options: A: Articular disc of temporomandibular joint, B: Angle of mandible, C: Floor of temporal fossa, D: Maxillary tuberosity - -### Response: -Ans. is 'a' i.e., Articular disc of temporomandibular joint Muscles of masticationMusclesOriginInsertionNerve supplyActionSpecial remarksMasseterLower border of zygomatic arch & its deep surface.Lateral surface of ramus and angle of mandible.Anterior division of mandibularnerve.Elevates the mandible, clenches teeth. Protrusion.Effector of the jaw jerk reflex. It is hypertrophied in bruxism.TemporalisFloor of temporal fossa and temporal fascia.Coronoid process and anterior border of ramus of mandible.Anterior division of mandibularnerve.Elevates the mandible, Retracts the mandible.Side to side movement.Fan shaped muscle.Lateral pterygoidUpper head: Infra temporal surface & crest of greater wing of sphenoid. Lower head:Lateral surface of lateralpterygoid plate.Pterygoid fovea on the neck of mandible, articular disc and capsule of temporoman- dibular joint.Anterior division of mandibularnerve.Depresses the mandible.Protrusion and side to side movement.Most important muscle for opening of mouth along with suprahyoid muscles.Medial pterygoidSuperficial head:Tuberosity of maxilla.Deep head: Medial surface of lateral pterygoid plate & pyramidal process of palatine bone.Medial surface of angle mandible & adjoining ramus.Branch from trunk of mandibularnerve.Elevates the mandible. Protrusion & side to side movement.Nerve to medial pterygoid suppliestensor palati & tensor tympani through otic ganglion. -### End" -2886,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In priapism, cavernous blood study will reveal:, with the following options: A: pO2 < 30%, pCO2>60%, B: pCO2>60%, C: pCO2<60%, D: pO2<60% - -### Response: -Blood Gas Values in Priapism Source pO2 (mmHg) pCO2 (mmHg) pH Normal aerial blood (room air) >90 <40 7.40 Normal mixed venous blood (room air) 40 50 7.35 Ischemic Priapism (First corporal aspirate) <30 >60 <7.25 Ref: Campbell 11th edition Pgno: 678 -### End" -2887,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wavelength of carbon dioxide laser is?, with the following options: A: 10600 nm, B: 1082nm, C: 2940 nm, D: 1064 nm - -### Response: -Ans- A 10600 nm Ref- CO2 Lasers Definition: infrared lasers based on a gas mixture in which light is amplified by carbon dioxide molecules The CO2 laser (carbon dioxide laser) is a molecular gas laser based on a gas mixture as the gain medium, which contains carbon dioxide (CO2), helium (He), nitrogen (N2), and possibly some hydrogen (H2), water vapor and/or xenon (Xe). Such a laser is electrically pumped via a gas discharge, which can be operated with DC current, with AC current (e.g. 20-50 kHz) or in the radio frequency (RF) domain. Nitrogen molecules are excited by the discharge into a metastable vibrational level and transfer their excitation energy to the CO2 molecules when colliding with them. Helium serves to depopulate the lower laser level and to remove the heat. Other constituents such as hydrogen or water vapor can help (particularly in sealed-tube lasers) to reoxidize carbon monoxide (formed in the discharge) to carbon dioxide. Figure 1: Schematic setup of a sealed-tube carbon dioxide laser. The gas tube has Brewster windows and is water-cooled. CO2 lasers typically emit at a wavelength of 10.6 mm, but there are other lines in the region of 9-11 mm (particularly at 9.6 mm). In most cases, average powers are between some tens of watts and many kilowatts. The power conversion efficiency can be well above 10%, i.e., it is higher than for most gas lasers (due to a particularly favorable excitation pathway), also higher than for lamp-pumped solid-state lasers, but lower than for many diode-pumped lasers. - Laser Types The family of CO2 lasers is very diverse: For laser powers between a few watts and a several hundred watts, it is common to use sealed-tube or no-flow lasers, where the laser bore and gas supply are contained in a sealed tube. Such lasers are compact and rugged, and reach operation lifetimes of several thousands of hours. High-power diffusion-cooled slab lasers (not to be confused with solid-state slab lasers) have the gas in a gap between a pair of planar water-cooled RF electrodes. The excess heat is efficiently transferred to the electrodes by diffusion, if the electrode spacing is made small compared with the electrode width. Several kilowatts of output are possible. Fast axial flow lasers and fast transverse flow lasers are also suitable for multi-kilowatt continuous-wave output powers. The excess heat is removed by the fast-flowing gas mixture, which passes an external cooler before being used again in the discharge. Transverse excited atmosphere (TEA) lasers have a very high (about atmospheric) gas pressure. As the voltage required for a longitudinal discharge would be too high, transverse excitation is done with a series of electrodes along the tube. TEA lasers are operated in pulsed mode only, as the gas discharge would not be stable at high pressures. They often produce average output powers below 100 W, but can also be made for powers of tens of kilowatts (combined with high pulse repetition rates). There are gas dynamic CO2 lasers for multi-megawatt powers (e.g. for anti-missile weapons), where the energy is not provided by a gas discharge but by a chemical reaction in a kind of rocket engine. The concepts differ mainly in the technique of heat extraction, but also in the gas pressure and electrode geometry used. In low-power sealed-tube lasers (used e.g. for laser marking), waste heat is transported to the tube walls by diffusion or a slow gas flow. The beam quality can be very high. High-power CO2 lasers utilize a fast forced gas convection, which may be in the axial direction (i.e., along the beam direction) or in the transverse direction (for the highest powers). - Applications CO2 lasers are widely used for material processing, in particular for cutting plastic materials, wood, die boards, etc., exhibiting high absorption at 10.6 mm, and requiring moderate power levels of 20-200 W cutting and welding metals such as stainless steel, aluminum or copper, applying multi-kilowatt powers laser marking of various materials. Other applications include laser surgery (including ophthalmology) and range finding. CO2 lasers used for material processing (e.g. welding and cutting of metals, or laser marking) are in competition with solid-state lasers (particularly YAG lasers and fiber lasers) operating in the 1-mm wavelength regime. These shorter wavelengths have the advantages of more efficient absorption in a metallic workpiece, and the potential for beam delivery via fiber cables. (There are no optical fibers for high-power 10-mm laser beams.) The potentially smaller beam parameter product of 1-mm lasers can also be advantageous. However, the latter potential normally cannot be realized with high-power lamp-pumped lasers, and diode-pumped lasers tend to be more expensive. For these reasons, CO2 lasers are still widely used in the cutting and welding business, particularly for parts with a thickness greater than a few millimeters, and their sales make more than 10% of all global laser sales (as of 2013). This may to some extent change in the future due to the development of high-power thin-disk lasers and advanced fiber cables in combination with techniques which exploit the high beam quality of such lasers. Due to their high powers and high drive voltages, CO2 lasers raise serious issues of laser safety. However, their long operation wavelength makes them relatively eye-safe at low intensities. - Bibliography C. K. N. Patel, ""Continuous-wave laser action on vibrational-rotational transitions of CO2"", Phys. Rev. 136 (5A), A1187 (1964) C. K. N. Patel, ""Interpretation of CO2 optical maser experiments"", Phys. Rev. Lett. 12 (21), 588 (1964) A. Robinson and D. Johnson, ""A carbon dioxide laser bibliography, 1964-1969"", IEEE J. Quantum Electron. 6 (10), 590 (1970) P. T. Woods et al., ""Stable single-frequency carbon dioxide lasers"", J. Phys. E: Sci. Instrum. 9, 395 (1976) A. L. S. Smith and J. Mellis, ""Operating efficiencies in pulsed carbon dioxide lasers"", Appl. Phys. Lett. 41, 1037 (1982) K. M. Abramski et al., ""Power scaling of large-area transverse radiofrequency discharge CO2 lasers"", Appl. Phys. Lett. 54, 1833 (1989) O. Svelto, Principles of Lasers, Plenum Press, New York (1998) -### End" -2888,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following causative factors is not involved in the pathogenesis of Diabetic gangrene, with the following options: A: Infection, B: Myelopathy, C: Atherosclerosis, D: Osteoahropathy - -### Response: -Others Are Neuropathy, Microangiopathy, Glycosylation Of Hb And Proteins, Hyperglycemia . ref - Srb's manual of surgery , Harriosns internal medicine 20edition -### End" -2889,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest feature in Poncet's disease is?, with the following options: A: Joint pains, B: Hemoptysis, C: Headache, D: Vascular collapse - -### Response: -Ans. A. Joint painsPoncet's disease, is a reactive symmetric form of polyarthritis that affects persons with visceral or disseminated tuberculosis. No mycobacteria are found in the joints, and symptoms resolve with antituberculous therapy. -### End" -2890,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A peripheral smear with increased neutrophils, basophils, eosinophils and platelets is highly suggestive of:, with the following options: A: Actute myeloid leukemia, B: Acute lymphoblastic leukemia, C: Chronic myelogenous leukemia, D: Myelodysplastic syndrome - -### Response: -. Chronic myelogenous leukemia -### End" -2891,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Munchausen's syndrome by proxy involves-, with the following options: A: Drug abuse, B: Toxin-mediated neuropsychiatric, C: Illness caused by care giver, D: All of the above - -### Response: -Munchausen's syndrome by proxy is a form of child abuse in which a patent, usually the mother, or a caretaker repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought, often in an emergency setting. -### End" -2892,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about sphincter urethrae except, with the following options: A: Voluntary, B: Supplied by Pudendal nerve, C: Originates from the ischiopubic rami, D: Located at bladder neck - -### Response: -The urethral sphincter is two muscles used to control the exit of urine in the urinary bladder through the urethra. Two muscles either the female or male, external urethral sphincter and internal urethral sphincter. ref - BDC vol2 pg376,380 -### End" -2893,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proposed number of female health workers at subcenter according to IPHS norms., with the following options: A: 1, B: 2, C: 3, D: 4 - -### Response: -IPHS subcenter norms - - - -  - -Existing - - -Proposed - - - -Female health workers - Male health workers - Voluntary workers - -1 - 1 - 1 - (optional) - - -2 - 1 - 1 - (optional) - - - -  -2/3 -3/4 -### End" -2894,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organism associated with fish consumption which causes carcinoma gallbladder, with the following options: A: Clonorchis sinensis, B: Gnathosoma, C: Stronglyoidosiscantonensis, D: H. diminuta - -### Response: -Ans. (a) Clonorchis sinensisRef: Bailey & Love 26th ed. /1115Clonorchis sinensis is liver fluke acquired by ingestion of raw or inadequately cooked fresh water fish. In human body it lives within bile ducts and causes inflammatory reaction leading to cholangitis, cholangio-hepatitis and biliary obstruction. It is well known to be a risk factor for Cholangio-carcinoma. -### End" -2895,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incidence of scar rupture in a subsequent pregnancy in case of Lower Segment Cesarean Section (LSCS) is:, with the following options: A: 2%, B: 4%, C: 5%, D: 8% - -### Response: -The risk of lower segment scar - rupture is low (0.2-1.5%) and even if it does occur, maternal death is much less and the perinatal moality is about 1 in 8. REF : Dutta book of obstetrics 8th Ed. -### End" -2896,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a provitamin -, with the following options: A: Ascorbicacid, B: Vitamin-E, C: b-carotene, D: Vitamin-K - -### Response: -Ans. is 'c' i.e., b-carotene o Two group of compounds have vitamin A activity -Vitamin 'A': - Vitamin 'A' refers to three biologically active Vitamers (i.e.. isomers of vitamin): - RetinolQ (an alcohol), retinalQ (an aldehyde), and retinoic acidQ (an acid). All of these are found only in animai They are polyisoprenoid compounds comprising two distinct components : (i) a cyclohexenyl ring and (ii) A side chain of several isoprene units attached to cyclohexenyl ring. The term 'Retinoids' is used to define these three compounds (retinol, retinal, and retinoic acid) and other synthetic compounds with vitamin A activity.Carotenoids : - These are provitamins of vitamin A which are present in plants. These are precursors of vitamin A which are cleaved to yield retinal (retinaldehyde) and then retinol and retinoic acid. The most important carotenoid is b-carotene, which consists of two molecules of vitamin A (retinal) joined end to end. -### End" -2897,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice in thyrotoxicosis in pregnancy is :, with the following options: A: Carbimazole, B: Lugol's iodine, C: Propranolol, D: Radioactive iodine - -### Response: -Carbimazole -### End" -2898,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is Masochistic habit, with the following options: A: Nail biting, B: Digit Sucking, C: Lip biting, D: Gingival stripping - -### Response: -Classification of Habits -### End" -2899,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a fetus highest oxygen concentration is found in?, with the following options: A: Inferior vena cava, B: Superior vena cava, C: Left ventricle, D: Ascending aoa - -### Response: -Among the following options, highest oxygen conc is found in IVC Saturation of Oxygen in fetal structures - Umbilical vein - 80% (PO2 of 30-35 mm Hg ) ( Max. in entire body of fetus ) Inferior vena cava - 70% (PO2 of 26-28 mm Hg) Left ventricle - 65% Right Ventricle - 55-60% Umbilical aery - very low SVC - (PO2 of 12-14 mm Hg) -### End" -2900,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an immediate cause of death?, with the following options: A: Thromboembolism, B: Shock, C: Septicemia, D: Ventricular fibrillation - -### Response: -ANSWER: (C) SepticemiaREF: Harrisons 18:h edchapter 233, 270, http://en.wikipedia.org/wiki/SepsisApproximately 20-35% of patients with severe sepsis and 40-60% of patients with septic shock die within 30 days. Others die within the ensuing 6 monthsVentricular fibrillation can lead to sudden cardiac deathAcute hemmorrhagic shock, neurogenic shock can lead to immediate deathThromboembolism leading to stroke or pulmonary dysfunction, or a large embolus causing MI can lead to sudden cardiac death. -### End" -2901,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following side effects are seen with etomidate-, with the following options: A: Myoclonus, Adrenal suppression, Haemodynomic imbalance(HI), B: Myoclonus, adrenal suppression, pain on IV injection, C: Pain on IV injection, Adrenal suppression, HI, D: Pain on IV injection, HI ,Myoclonus. - -### Response: -Etomidate a intravenous anaesthetic agent is Milky white in colour , imidazolone derivative, causes pain on iv injection. Major advantages over other intravenous agents is cardiovascular stability thus use cardiac compromised patients Routinely not in clinical use since it is adrenal suppressant. Other side effects myoclonus and increased nausea and vomiting. -### End" -2902,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lysozymes are found in, with the following options: A: Eukaryotes, B: Prokaryotes, C: Plants, D: Bacteriophage - -### Response: -Lysosomes are membrane-enclosed vesicles formed from Golgi complex. They are released at the site of inflammation to digest cellular debris. (REF: GANONG&;S REVIEW OF MEDICAL PHYSIOLOGY) -### End" -2903,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A gardener has multiple vesicles on hand and multiple eruptions along the lymphatics. Most common fungus responsible is, with the following options: A: Sporothrix schenckii, B: Cladosporium, C: Histoplasma, D: Candida - -### Response: -Sporotrichosis is a chronic infection involving cutaneous, subcutaneous and lymphatic tissue. It is caused by Sporothrix schenckii. pathogenesis- 1. lesion on the exposed pa of skin follow minor trauma. Nodules are first formed, followed by ulceration and necrosis of nodules. 2. From lesions on the skin and subcutaneous tissue, infection spread by lymphatic channels to the lymph node, and lymphatics are hardened and cord-like. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition -### End" -2904,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About p53 all are true except -, with the following options: A: Encodes 53k Da protein, B: Located on Chr. 17, C: Arrests cell cycle at G1 phase, D: Wild type p53 is associated with childhood tumors - -### Response: -. Wild type p53 is associated with childhood tumors -### End" -2905,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cod fish vertebrae seen in, with the following options: A: Osteomalacia, B: Osteoporosis, C: Hyperparathyroidism, D: All the above - -### Response: -Cod fish vertebrae - -Osteomalaria -Osteoporosis -Hyperparathyroidism. -### End" -2906,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following drugs is most likely to be associated with elevations of pancreatic enzymes, including amylase and lipase?, with the following options: A: Erythromycin, B: Didanosine, C: Isoniazid, D: Azidothymidine - -### Response: -Pancreatic dysfunction, heralded by large increases in serum amylase and lipase, is associated with the use of several reverse-transcriptase inhibitors (RTIs). Didanosine appears to be the worst offender, and pancreatitis is the most characteristic adverse effect of this particular NRTI. Conditions enhancing susceptibility to drug induced pancreatic dysfunction include hypertriglyceridemia, hypercalcemia, and history of excessive ethanol use. Liver dysfunction including hepatitis may occur with the antitubercular drugs, isoniazid, and pyrazinamide. Cholestasis is associated with the estolate form of erythromycin. -### End" -2907,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following can not be diagnosed on direct ophthalmoscopy, with the following options: A: Diabetic retinopathy, B: Retinitis pigmentosa, C: Angle recession, D: papilledema - -### Response: -Angle recession cannot be diagnosed by direct ophthalmoscopy Diseases that can be diagnosed by Direct Ophthalmoscope Location of cataract (distant direct ophthalmoscopy) Diabetic retinopathy Hypeensive retinopathy Age-related macular degeneration Fundus dystrophies Optic neuritis Papilledema Glaucoma Comprehensive Ophthalmology, 6th edition, A K Khurana, Pg 590 -### End" -2908,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A fetus born to a mother with history of fever with rash in first trimester of pregnancy shows chorioretinitis, cerebral coical atrophy, cutaneous scarring and bone leg defects. Most probable cause is?, with the following options: A: Maternal rubella, B: Maternal varicella, C: Maternal CMV, D: Maternal toxoplasma - -### Response: -Maternal varicella during the first half of pregnancy may cause congenital malformations by transplacental infection called congenital varicella syndrome Eye defects: Microphthalmia, chorioretinitis, cataracts Neurological: microcephaly, cerebral coical atrophy, neurological dysfunction of bladder and bowel sphincters Cutaneous: scarring in dermatomal origin Bony defects: limb hypoplasia -### End" -2909,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 22-year-old woman is admitted to the hospital with an injury to her eye. The corneal reflex is tested and found to be present. Which of the following nerves is responsible for the afferent limb of this reflex?, with the following options: A: Frontal, B: Lacrimal, C: Nasociliary, D: Oculomotor - -### Response: -The afferent/sensory limb of the corneal (blink) reflex is carried by the nasociliary nerve. It is a branch of the ophthalmic division of the trigeminal nerve. The frontal and lacrimal nerves provide cutaneous supply to parts of the orbit and face, but they do not innervate the cornea. The facial nerve is the efferent limb of the corneal reflex and mediates the closing of both eyes in response to irritation of the cornea. The oculomotor nerve mediates the reopening of the eyes by contraction of the levator palpebrae superioris. The optic nerve also innervates the eye for the sense of vision and is the afferent limb of the pupillary light reflex. -### End" -2910,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme deficiency in galactosemia -, with the following options: A: Glucokinase, B: Aloblase - B, C: Galactokinase, D: All of the above - -### Response: -Ans. is 'c' i.e., Galacto kinase o Galactosemia is a group of metabolic disorders which results from inborn errors due to deficiency of the enzymes of galactose metabolism.o The classical galactosemia is caused by deficiency of galactose-1-phosphate uridyl transferase. The less common types of galactosemia occur due to deficiency of galactokinase and UDP - galactose-4-epimerase.o Urine of the patient shows reducing sugar (galactose) which can be detected by Benedicts reagent. Glucose oxidase test is negative as it is specific for glucose. Thus, presence of reducing material (galactose) in urine with a negative glucose oxidase test suggests diagnosis of galactosemia. -### End" -2911,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient comes with gravida 4, living 1 with 22 weeks of pregnancy with carcinoma Insitu. The treatment of choice is :, with the following options: A: Conisation of the cervix, B: MTP and hysterectomy, C: MTP and radiotherapy, D: Allow the baby to be born and then hysterectomy is done - -### Response: -Allow the baby to be born and then hysterectomy is done -### End" -2912,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for laryngeal cailagenous tumors is, with the following options: A: Cricoid cailage, B: Thyroid cailage, C: Arytenoid cailage, D: Corniculate cailage - -### Response: -Laryngeal cailaginous tumors- Cricoid cailage is the most common site of laryngeal cailaginous tumor. Ref:- Essentials of ENT Mohan Bansal; pg num:- 372 -### End" -2913,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paul bunnel reaction is a ty pe of -, with the following options: A: Agglutination, B: CF, C: Precipitation, D: Flocculation test - -### Response: -Ans. is 'a' i.e., Agglutination test Precipitationo When a soluble antigen combines with its antibody in the presence of electrolytes (NaCI) at a suitable temperature and pH, the antigen - antibody complex forms an insoluble precipitate,o When instead of sedimenting, the precipitate remains suspended as floccules, the reaction is knowm as flocculation.o It is very sensitive in detection of antigens and as little as 1 g of protein can be detected by precipitation tests,o Precipitation is relatively less sensitive for the detection of antibodies.Precipitation / flocculation testsRing testslide testTube testImmunodiffusionElectroimmuno- (Precipitation in gel)diffusion o Ascoli's thermo-o VDRLo Kahn testo Elek test foro Most important isprecipitation(flocculation test)(flocculation testtoxigenicity incountercurrenttest forfor syphilisfor syphilis)diphtheria bacilliimmunoelectrophoresisBacillus anthraxfor detection of alpha- o Grouping offetoprotein in serum streptococci byand cryptococcai the lancefieldantigen in the C.S.F. technique Agglutinationo When a particulate antigen is mixed with its antibody in the presence of electrolytes at a suitable temperature and pH, the particles are clumped or agglutinated,o Agglutination is more sensitive than precipitation for the detection of antibodies.Complement fixation testo The ability of antigen antibody complexes to 'fix' complement is made use of in the complement fixation test,o This is very sensitive test, capable of detecting 0.04 mg of antibody nitrogen and 0. i mg of antigen,o The source of complement is guinea pig serumo Exampleso Wassermann CFT for syphiliso Treponema pallidum immobilization test.Antigen - antibody reactionSoluble antigenParticulate antigenAntigen+++AntibodyAntibodyAntibody+++ElectrolyteElectrolyteSource of complement|||PrecipitationAgglutinationComplement fixation test -### End" -2914,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The liver biopsy in acute hepatitis due to hepatitis ? virus is likely to show all of the following, EXCEPT:, with the following options: A: Ballooning change of hepatocytes, B: Ground glass hepatocytes, C: Focal or spotty necrosis, D: Acidophil bodies - -### Response: -. Ground glass hepatocytes -### End" -2915,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skeletal metastasis is common in:, with the following options: A: Cancer stomach, B: Cancer pancreas, C: Hepatoma, D: Cancer breast - -### Response: -Ans: d (Cancer breast)Ref: Maheshwari Ortho, 3rd ed, p. 224 -### End" -2916,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are hallucinogens, except -, with the following options: A: LSD, B: Phenylcyclidine, C: Mescaline, D: Methylphenidate - -### Response: -Ans. is 'd' i.e., Methylphenidate -### End" -2917,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: QT depression is seen in ?, with the following options: A: Hypokalaemia, B: Hyperkalaemia, C: Hypocalcaemia, D: Hypercalcaemia - -### Response: -In vitro, hypokalemia not only prolongs the QT interval in the absence of drug but also potentiates drug block of ion channels that results in QT prolongation. Drugs (i.e., certain antiarrhythmics and erythromycin) and electrolyte disorders (i.e., hypokalemia, hypocalcemia, hypomagnesemia) can prolong the QT' interval and predispose to torsades de pointes. -Hypercalcemia can result  in significant electrocardiographic changes, including bradycardia, AV block, and short QT interval; changes in serum calcium can be monitored by following the QT interval -Hyperkalemia, or drugs such as flecainide) tend to increase QRS duration. Conditions that prolong phase 2 (use of amiodarone, hypocalcemia) increase the QT interval. -Hypocalcemia typically prolongs the QT interval (ST portion), while hypercalcemia shortens it -### End" -2918,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The type of synechiae in iris bombe is, with the following options: A: Ring, B: Total, C: Goniform, D: Filiform - -### Response: -A. i.e. Ring -### End" -2919,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congenital toxoplasmosis false is aEUR', with the following options: A: IgA is better than IgM in detection, B: Diagnosed by detection of IgM in cord blood, C: IgG is diagnostic, D: Not recalled - -### Response: -IgG is diagnostic Repeat .from May 10 Q no.122 -### End" -2920,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood flow in hemodialysis machine, with the following options: A: 100-200 ml/min, B: 300-500 ml/min, C: 700-800 ml/min, D: >1000 ml/min - -### Response: -Blood flow - 300-500 ml/min. -Dialysate - 500-800 ml/min in opposite direction. -### End" -2921,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In PCOD, which is true, with the following options: A: Increase FSH, decrease LH, B: Increase LH, decrease estrogen, C: Increase FSH/LH ratio, decrease estrogen, D: Increase LH, increase estrogen - -### Response: -(D) Increase LH, increase estrogen > The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone) is greater than 1:1, as tested on Day 3 of the menstrual cycle due to increase in LH.Oestrogen levels are incresed. -### End" -2922,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Duration of TIA:, with the following options: A: 12 hours, B: 24 hours, C: 48 hours, D: 36 hours - -### Response: -Ans. (b) 24 hoursRef.: Harrison 19th ed. / 2568, 17th ed. Ch. 364* The standard definition of TLA requires that all neurologic signs and symptoms resolve within 24 hours regardless of whether there is imaging evidence of new permanent brain injury; stroke has occurred if the neurologic signs and symptoms last for >24 hours. -### End" -2923,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incidentally findings, in CT scan, a 3cm adrenal mass, which of the following is NOT- done, with the following options: A: Adrenalectomy, B: Dexamethasone suppression test, C: Measurment of catecholamines, D: Midnight plasma cortisol - -### Response: -(Adrenalectomy) (816- B&L 24th) (812-Baily &Love 25th)* A unilateral non functioning adrenal mass greater than 4cm in diameter is an indication for adrenalectomy. The patient with a mass smaller than 4cm in diameter should undergo repeat CT/MR1 -4-6 months after the previous examinationINVESTIGATIONSFunctioning adrenal tumourA malignant adrenal mass1. 2 x 24 hour urine collection for catecholamines and metanephrines** FNAC* Primary adrenocortical carcinoma -2. Plasma urea and electrolytes, plasma aldosterone and reninIncidentalomas of 4cm or more in diameter carry an increased risk of malignancy3. Basal a-m and midnight plasma cortisol, blood glucose, DHEAS4. 1 mg overnight dexamethasone suppression test* -### End" -2924,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a feature of brain death, with the following options: A: Complete apnea, B: Absent Pupillary reflex, C: Absence deep tendon reflex, D: Hea rate un-responsive to atropine - -### Response: -The structural and functional damage of brain-stem may be diagnosed depending upon the following observations: Dilated fixed pupils, not responding to sharp changes in intensity of incident light. Absence of motor responses within the cranial nerve distribution on painful stimulation. Absence of corneal reflexes. Absence of vestibulo-ocular reflexes. Absence of gag reflex or reflex response to bronchial stimulation by a suction-catheter passed down the trachea. Absence of spontaneous breathing. Ref : Krishnan vij Textbook of Forensic medicine and Toxicology 5th edtion ; pg no - 75 -### End" -2925,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood testes barrier is formed by -, with the following options: A: Sertoli cells, B: Ependymal cells, C: Mesenchymal cells, D: Spermatozoa - -### Response: -Ans. is 'a' i.e., Sertoli cells Blood testes barrier* The blood-testis barrier is a physical barrier between the blood vessels and the seminiferous tubules of the testes.* The walls of seminiferous tubules are lined with primitive germ layer cells and by Sertoli cells. The barrier is formed by tight junctions, adherens junctions and gap junctions between the Sertoli cells.* The presence this allows Sertoli cells to control the environment in which germ cells (spermatocytes, spermatids and sperm) develop by influencing the chemical composition of the luminal fluid. The barrier also prevents passage of cytotoxic agents (bodies or substances that are toxic to cells) into the seminiferous tubules. -### End" -2926,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 7 year old boy presented with generalized edema. Urine examination revealed marked albuminuria. Serum biochemical examinations showed hypoalbuminaemia with hyperlipidemia. Kidney biopsy was undeaken. On light microscopic examination, the kidney appeared normal. Electron microscopic examination is most likely to reveal, with the following options: A: Fusion of foot processes of the glomerular epithelial cells, B: Rarefaction of glomerular basement membrane, C: Deposition of electron dense material in the basement membrane, D: Thin basement membrane - -### Response: -Answer is A (Fusion of foot processes of the glomerular epithelial cells): The presence of generalized edema is a 7 year old boy with proteinuria suggests a diagnosis of Nephrotic syndrome. This child is likely to have. Minimal change disease as this is the most common cause of Nephrotic syndrome in children and is associated with normal findings on Light microscopy Generalized edema May develop Pleural effusion, pulmonary edema, ascitis Patients with minimal change disease characteristically show fusion of foot processes of the glomerular epethelial cells on electron microscopy. Minimal change Disease: Review Most common cause of Nephrotic syndrome in children (80% in children; 20% in adults) Peak Age of onset is between 6-8 years of Age (usually < 10 years) Type of onset : Insiduous Clinical features Peripheral Edema: Presenting Feature Nephrotic syndrome is the typical presentation Peripheral edema is the hallmark of Nephrotic syndrome occurring when serum albumin levels become less than 3g/dl Initially dependent Edema > Generalized edema May develop Pleural effusion, pulmonary edema, ascitis Hematuria : 20-30% Hypeension : V. Rare Renal failure : Does not usually progress to renal failure Laboratory (Features of Nephrotic syndrome) Proteinuria Hypoalbuminemia Hyperlipidemia/Hyper cholesterolemia (Increased hepatic prduction of lipids) Hypercoagulability Renal pathology (Biopsy) Investigation Light microscopy Q Electron microscopy Q Immunofluorescence Q Observation No abnormality hence the term minimal change Fusion of foot processes Absence of immunoglobulin or complement Prognosis Prognosis is Good Response to steroids is Excellent Does not progress to Renal Failure Treatments Coicosteroids form the mainstay for treatment of MCD -### End" -2927,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Burn patient EXCEPT:, with the following options: A: Hematemesis, B: For Head and neck burn exposure treatment done, C: Stridor can be present, D: Most common infection is by pseudomonas - -### Response: -Ans. (a) HematemesisRef: Sabiston 19th ed./529-32Management of burn wound Exposure MethodClosed method* Application of the agent to the wound 2-3 times a day. No dressings are applied over wound* Generally closed method is preferred.* Exposure method is commonly used for face and head* Occlusive dressing is applied over the agent and changed twice daily* Disadvantage:Increased pain, heat lossRisk of cross-contamination* Advantage: Less pain, less heat loss Less risk of cross -contamination * Disadvantages:If dressing is not changed twice daily, there is risk of contamination.* Pseudomonas is the most common infection in burn patients.* Due to inhalation of burn particles, stridor can be present. -### End" -2928,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Under FSS act, non-vegetarian Foods containing only eggs are labeled with What color mark ?, with the following options: A: Green, B: Yellow, C: Orange, D: Brown - -### Response: -As per act, any food containing egg is treated as non-vegetarian food ""Non- Vegetarian Food"" means an aicle of food which contains whole or pa of any animal including birds, fresh water or marine animals or eggs or products of any animal origin, but excluding milk or milk products, as an ingredient; Every package of ""Non-Vegetarian"" food shall bear a declaration to this effect made by a symbol and colour code as stipulated below to indicate that the product is Non-Vegetarian Food. The symbol shall consist of a brown colour filled circle inside a square with brown outline Ref - Follicular bronchitis, D: >Bronchiolitis obliterans - -### Response: -Bronchiolitis obliterans Repeat from Nov 08 Q no.130 -### End" -2933,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased calcium levels lead to, with the following options: A: Increased 1,25 dihydroxycholecalciferol, B: Increased 24,25 dihydroxycholecalciferol, C: Decreased calcitonin, D: Increased parathormone - -### Response: -24,25-dihydroxycholecalciferol; a metabolite in calcium metabolism, formed in the kidney from 25-hydroxycholecalciferol by the activation of a 24-hydroxylase.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-379 -### End" -2934,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lichtenberg flowers are seen in: CMC (Vellore) 14, with the following options: A: Thermal bums, B: Electrocution, C: Vitriolage, D: Lightning - -### Response: -Ans/. Electrocution -### End" -2935,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following poison retards putrefaction-, with the following options: A: Organophosphorus, B: Carbolic acid, C: Oxalic acid, D: Hydrogen chloride - -### Response: -Carbolic acid retards putrefaction. Poisons which retard putrefaction are carbolic acid, arsenic, strychnine and zinc chloride. -### End" -2936,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fick's principle is used to calculate:, with the following options: A: Cardiac output, B: Pulse pressure, C: Cardiac axis, D: LVET - -### Response: -Ans: A (Cardiac output) Ref: Pal GK, Cardiac Output. In: Textbook of Medical Physiology, 2nd ed, Ahuja Publishing House 2011: 74: 608Explanation:In Fick's method, the following variables are measured:Oxygen consumption in ml of pure gaseous oxygen per minuteOxygen concentration of blood taken from the pulmonary arteryOxygen concentration of blood from a cannula in a peripheral arteryCardiac Output =Oxygen consumption-------------Arteriovenous oxygen differencex 100Fick's principle can also be used in renal physiology to calculate renal blood flow.Pulse pressure is the difference between systolic and diastolic pressureCardiac axis is measured using ECGLeft ventricular ejection time is estimated with carotid pulse tracing -### End" -2937,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following symptoms are seen in cystitis Except, with the following options: A: Fever, B: Hematuria, C: Dysuria, D: Nocturia - -### Response: -In cystitis there will be increased frequency, pain, haematuria and pyuria. Pyrexia and rigors are not associated with simple UTI but are signs of upper tract infection or septicemia. Reference : Bailey &Love, 27th Edition, page no = 1442. -### End" -2938,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nicotine deaddiction uses all except, with the following options: A: Nicotine Patch, B: Nicotine Spray, C: Nicotine Inhaler, D: Nicotine subcutaneous Injection - -### Response: -(D) Nicotine subcutaneous Injection # CLINICAL PRACTICE GUIDELINES> Physician actions: Ask: Systematically identify all tobacco users at every visit Advise: Strongly urge all smokers to quit Identify smokers willing to quit Assist the patient in quitting Arrange follow-up contact> Pharmacologic interventions -- First-line therapies: Nicotine gum (1.5) Nicotine 24-h patch: 21-mg patch for 4 weeks, 14-mg patch for 2 weeks & 7-mg patch for 2 weeks (1.9) Nicotine nasal inhaler: one spray to each nostril 1-2 times/h for 3-6 months (2.7) Nicotine oral inhaler: 6-16 puffs per day for up to 6 months (2.5) Bupropion: 150 mg/d PO for 3 days followed by 150 mg bid for 7-12 weeks (2.1)> Pharmacologic interventions -- Second-line therapies: Clonidine: Initial dose 0.1 mg bid PO, or 0.1-mg transdermal patch, increasing to 0.15-0.75 mg/d PO or 0.2-mg patch for 3-10 weeks (2.1) Nortriptyline: Initial dose 25 mg/d PO, increasing to 75-100 mg/d for 12 weeks (3.2)> Other interventions: Physician or other medical personnel counseling, 10 minutes Intensive smoking cessation program Clinic-based smoking status identification system Counseling by nonclinicians and social support by family and friends Telephone counseling -### End" -2939,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following has autosomal dominant inheritance -, with the following options: A: Best's disease, B: Gyrate atrophy, C: Laurence Moon Biedl syndrome, D: Bassen-Kornzweig's disease - -### Response: -Vitelliform macular dystrophy or vitelliform dystrophy is an irregular autosomal dominant eye disorder which can cause progressive vision loss. This disorder affects the retina, specifically cells in a small area near the center of the retina called the macula Vitelliform macular dystrophy causes a fatty yellow pigment (lipofuscin) to build up in cells underlying the macula. The retinal pigment epithelium also degenerates. Over time, the abnormal accumulation of this substance can damage the cells that are critical for clear central vision. As a result, people with this disorder often lose their central vision and may experience blurry or distoed vision, and loss is rarely symmetric. Scotomata appear, first with red light and then for green; finally, relative (or in more serious cases, absolute) scotomata occur with white light. Vitelliform macular dystrophy does not affect side (peripheral) vision or the ability to see at night. Researchers have described two forms of vitelliform macular dystrophy with similar features. The early-onset form (known as Best disease) usually appears in childhood; however, the onset of symptoms and the severity of vision loss vary widely. The adult-onset form begins later, usually in middle age, and tends to cause relatively mild vision loss. The two forms of vitelliform macular dystrophy each have characteristic changes in the macula that can be detected during an eye examination. -### End" -2940,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Facial nerve lies with which nerve in internal auditory meatus -, with the following options: A: Trigeminal nerve, B: Abducent nerve, C: Vestibulocochlear nerve, D: Hypoglossal nerve - -### Response: -Ans. is 'c' i.e., Vestibulocochlear nerve FORAMENSTRUCTURES PASSINGInternal accoustic meatusFacial N.Auditory N.Nervus intermedius(wrisberg) Labyrynthine vessels -### End" -2941,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The joint that permits nodding of head while saying yes is:, with the following options: A: Atlanto-axial joint, B: Atlanto-occipital joint, C: C2- C3 joint, D: C3- C4 joint - -### Response: -Atlanto-occipital joint is a synol between skull and C1 veebrae. It permits nodding of head such as flexison and extension (YES movement) and lateral flexion. Atlanto-axial joint is a pivot joint between C1 and C 2 veebrae. It permits rotation of head that is side to side movement (NO movement). Ref: Keith moore clinical anatomy, 4th Edition, Page 459. -### End" -2942,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is Autosomal dominant with an expression during adolescence?, with the following options: A: Duchenne's dystrophy, B: Becker's dystrophy, C: Facioscapulohumeral dystrophy, D: Congenital muscular dystrophy - -### Response: -Facioscapulohumeral dystrophy is an autosomal dominant condition with onset during adolescence. It involves face, shoulder and upper arm. The speed of progression of the disease is variable. Ref: O P Ghai, 5th Edition, Page 424. -### End" -2943,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Risk of the damage of fetus by maternal rubella is maximum if mother gets infected in, with the following options: A: 20-24 weeks of pregnancy, B: 24-28 weeks of pregnancy, C: 32-36 weeks of pregnancy, D: 6-12 weeks of pregnancy - -### Response: -Congenital Rubella Syndrome (CRS): - -CRS is said to have occurred if: - -– Infant has IgM rubella antibodies shortly after birth, or -– IgG antibodies persist for more than 6 months - -Major determinant of extent of fetal infection in CRS: Gestational age at which fetal transmission occurs, - -– Infection in I trimester: MOST DISASTROUS TIME -1. Abortions -2. Still births -3. Skin lesions: blueberry muffin lesions -4. ‘Triad of Congenital Rubella Syndrome’ -i. Sensorineural deafness -ii. Congenital heart defects (MC is PDA) -iii. Cataracts -– Infection in early part of II Trimester: Deafness (only) -– Infection after 16 weeks POG: No major abnormalities -Risk of fetal damage in CRS: -### End" -2944,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following complications is most likely to occur after recieving several units of blood transfusion?, with the following options: A: Metabolic alkalosis, B: Metabolic acidosis, C: Respiratory alkalosis, D: Respiratory acidosis - -### Response: -Banked blood has a pH of 6.8 and is acidotic. After massive transfusion citrate in the stored blood is conveed into bicarbonate resulting in metabolic alkalosis. Ref: Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects By Christopher D. Hillye, Page 291 ; Yao and Ausio's Anesthesiology: Problem-Oriented Patient Management By Fun-Sun F. Yao, 6th Edition, Page 1148 -### End" -2945,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First step to be done in case of variceal bleeding-, with the following options: A: Blood transfusion, B: IV Crystal]oides, C: Endoscopy, D: Somatostatin - -### Response: -Ans. is 'b' i.e., iv crystalloides Initial resuscitation is usually with isotonic crystalloid solutions. A minimum of 6 units of blood are typed and crossmatched for most patients. If PT is prolonged more than 3 seconds, fresh frozen plasma is a component of the resuscitation volume.Endoscopy to determine cause of bleeding - endoscopic sclerotherapy or endoscopoic variceal ligation and injection with cynoacrylate.iv antibiotics.Somatostatin/Octreotide.Balloon tamponade. -### End" -2946,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ECT in depressive phase of MDP (bipolar disorder) is useful because it:, with the following options: A: Produces recurrence, B: Reduces recurrence, C: Shoens duration, D: Increases drug effects - -### Response: -ECT shoens the duration of depressive episode. It does not prevent the recurrence unless given as a maintenance treatment. -### End" -2947,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adduction at wrist is caused by ?, with the following options: A: Flexor carpi radialis, B: Extensor pollics longus, C: Extensor carpi ulnaris, D: Flexor digitorum profundus - -### Response: -Extensor carpi ulnaris -### End" -2948,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 62-year-old man is evaluated in the ER for drowsiness and generalized weakness for the past 4 weeks. He is brought to the hospital by EMS after he experienced a tonic clonic seizure in a local restaurant. His medical history is positive for HTN and gout, for which he takes metoprolol and allopurinol. He has smoked 1 pack per day for nearly 40 years, with no alcohol or recreational drug abuse. He noticed nearly 20 lb weight loss in past 2 months. Physical examination is normal. Laboratory tests reveal hemoglobin 10.2 gm/dL, leukocyte count 9500/mL, and platelet 171,000/mL. Serum sodium is 122 mEq/L, potassium 3.8 mEq/L, blood urea nitrogen (BUN) 26 mg/dL, and creatinine 0.9 mg/dL. Additional laboratory findings include serum osmolality 258 mOsm/kg, urine osmolality 300 mOsm/kg, and urine sodium 48 mmol/L. TSH and cortisol levels are normal., with the following options: A: Trousseau syndrome, B: Sezary syndrome, C: Syndrome of inappropriate antidiuretic hormone, D: Tumor lysis syndrome - -### Response: -Syndrome of inappropriate of antidiuretic hormone (SIADH) is a disorder of impaired water excretion due to excessive secretion of ADH hormone, often by neoplastic cells. Antidiuretic hormone makes the urine concentrated, thereby preventing free water excretion. This leads to water retention and hyponatremia. As total body water increases, the serum osmolality decreases. In normal person, when serum osmolality decreases, the kidneys produce dilute urine to excrete excess water. In SIADH, however, continued ADH release from the tumor prevents urinary dilution, and urine osmolality remains inappropriately high. Urine osmolality more than 100 mOsm/kg in face of hyponatremia is highly suspicious of SIADH. Urine Na value is also higher than 40 mEq/L in SIADH. It is most commonly seen in small cell cancer of the lung.Tumor lysis syndrome (TLS) is an oncologic emergency resulting from breakdown of tumor cells with subsequent release of potassium, phosphate, and uric acid into the circulation. It is most commonly seen in hematologic malignancy such as non-Hodgkin lymphoma or Burkitt lymphoma. Diagnostic criteria (the Cairo-Bishop criteria) for TLS include both laboratory and clinical features. Laboratory TLS includes two or more of the following values: uric acid >= 8 mg/dL, calcium <= 7 mg/dL, potassium >=6 mEq/L, and phosphorus >= 6.5 mg/dL for children or 4.5 mg/dL for adults. Clinical TLS is laboratory TLS plus one of the following: increased serum creatinine concentration (>=1.5 times the upper limit of normal, cardiac arrhythmia, sudden death, or seizure).The classic Trousseau syndrome consists of migratory superficial thrombophlebitis. A single episode of tenderness and inflammation in a superficial vein is common and usually benign, but recurrent unprovoked episodes should prompt a search for an underlying neoplasm Cancer of the pancreas is the most common tumor, but any mucin-producing carcinoma can produce this syndrome. Sezary syndrome is skin infiltration by malignant T-cells in cutaneous T-cell lymphoma. Lambert- Eaton myasthenic syndrome is a disorder of the neuromuscular junction due to antibodies directed against the voltage-gated calcium channel. The antibody prevents normal calcium flux required for the release of acetylcholine, resulting in neuromuscular weakness. It is often a paraneoplastic syndrome associated with small cell carcinoma of the lung -### End" -2949,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aldosterone acts at:, with the following options: A: Collecting duct, B: Glomerulus, C: Proximal convoluted tubule, D: Loop of Henle - -### Response: -Ans. A Collecting ductRef: Ganong, 23rd ed. pg. 648* Aldosterone is secreted from adrenal cortex.* Action of aldosterone is localized to distal tubule are collecting duct.* Mechanism: Stimulates Na+K+ ATPase at basolateral end which generate gradient for movement of sodium ion from apical membrane causing an increase in sodium: reabsorption. -### End" -2950,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most commonly used local anaesthetics ?, with the following options: A: Dibucaine, B: Bupivacaine, C: Prilocaine, D: Tetracaine - -### Response: -Ans. is 'b' i.e., Bupivacaine Bupivacaine Bupivacaine is 2nd most commonly used local anaesthetic (after lidocaine). Bupivacaine has the highest local tissue irritancy amongst local anaesthetics. It is the most cardiotoxic local anaesthetic. Levobupivacaine (The S(-) enantiomer of bupivacaine) is less cardiotoxic and less prone to cause seizure. Concentrations used for bupivacaine are : - Nerve block : 0.5%, Epidural : 0.25 - 0.5 %, and spinal : 0.5%. Maximum safe dose is 2 mg/kg without adrenaline and 3mg/kg with epinephrine -### End" -2951,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In HIV infected patients, smear from oral lesions will show which organism -, with the following options: A: Candida, B: Cryptococcosis, C: Histoplasma, D: Trichophyton - -### Response: -Ans. is 'a' i.e., Candida * Amongst the given options, only Candida causes oral lesion in AIDS patient.* Oral lesions in AIDS include1. Hairy leukoplakia (caused by EBV)2. Thrush (caused by Candida)3. Aphthous ulcer -### End" -2952,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The development of cells of immune system in the individual is called as:, with the following options: A: Ontogeny, B: Phylogeny, C: Allogeny, D: Heterogeny - -### Response: -Immunological ontogeny: -The origin and development (=ontogeny) of the lymphocyte system, from its earliest stages to the two major populations of mature lymphocytes: the thymus dependent or T lymphocytes, and the thymus-independent or B lymphocytes. -### End" -2953,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient is admitted with severe pain in the abdomen, nausea, vomiting and fever. The most likely diagnosis, with the following options: A: Perforated peptic ulcer, B: Intestinal obstruction, C: Acute pancreatitis, D: Acute cholecystitis - -### Response: -Clinical features of acute pancreatitis Cardinal symptoms : Epigastric and /or peri umbilical pain that radiates to the back, relieved by sitting & leaning forward Upto 90% of patients have nausea and/or vomiting that typically does not releive on pain Nature of the pain is constant Dehydration, poor skin turgor, tachycardia, hypotension & dry mucous membranes are commonly seen in patients with AP Mild-pancreatitis: Abdomen may be normal of reveal only mild epigastric tenderness Severe pancreatitis : Significant abdominal distension, associated with generalised rebound tenderness and abdominal rigidity Flank (Grey Turner), peri umbilical (cullen's sign) & inguinal ecchymosis (Fox sign) are indicative of retro peritoneal bleeding associated with severe pancreatitis Dullness to percussion and decreased breathing sounds in left or less commonly, in the right hemithorax suggest pleural effusion Ref: Sabiston 20th edition Pgno :1524-1528 -### End" -2954,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common presentation of nasopharyngeal carcinoma., with the following options: A: Neck lymph node, B: Blockage of nose, C: Loss of smell, D: Blood tinged discharge - -### Response: -Painless cervical lymphadenopathyis the most common presenting feature of nasopharyngeal carcinoma. Presence ofunilateral serous otitis media in an adult should raise suspicion of nasopharyngeal growth. (Eustachian tube obstruction leads to serous otitis media which causes deafness). Commonest site of origin for nasopharyngeal carcinoma is thefossa of Rosenmuller. EXTRA EDGE: Nasopharyngeal cancer can causeTrotter's triadof Conductive deafness(eustachian tube blockage), Ipsilateral temporoparietal neuralgia (involvement ofCN V) and Palatal paralysis (CN X) -### End" -2955,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of metastatic disease in retinoblastoma is –, with the following options: A: Chemotherapy, B: Enucleation, C: Radiotherapy, D: Cryo - -### Response: -Treatment of choice for metastasis is chemotherapy. -### End" -2956,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Oliguric ARF, with the following options: A: Anemia, B: Metabolic Acidosis, C: Uremia, D: Hypercalcemia - -### Response: -Answer is D (Hypercalcemia): Oliguric ARF is associated with hypocalcemia and not hypercalcemia. Hypocalcemia is caused by metastatic deposition of calcium phosphate, tissue resistance to PTH and reduced levels of active vitamin D. -### End" -2957,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 1–month–old boy is referred for failure to thrive. On examination, he shows feature of congestive failure. The femoral pulses are feeble as compared to brachial pulses. The most likely clinical diagnosis is –, with the following options: A: Congenital aortic stenosis, B: Coarctation of aorta, C: Patent ductus arteriosus, D: Congenital aortoiliac disease - -### Response: -Feeble femoral pulsations compared to strong brachial pulsations suggests the diagnosis of coarctation of aorta. Hypertension and strong pulsations in the upper extremities and absence, marked dimunition or delay in pulsations in the femoral artery are characteristic in coarctation. Also failure to thrive and congestive heart failure are consistent with the diagnosis of congestive heart failure. -Remember: - -Differential cyanosis is a manifestation of PDA -Differential pulses/Blood pressure is a manifestation of Coarctation -### End" -2958,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proteins are absorbed from GIT as:, with the following options: A: Amino acids, B: Peptides, C: Peptones, D: All of the above - -### Response: -Ans. A. Amino acidsAmino acids are end product of protein digestion. Glycerol and fatty acids are end products of lipid digestion. Monosaccharides are end product of carbohydrate digestion. -### End" -2959,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reids index is increased in: March 2007, with the following options: A: Bronchial asthma, B: Bronchiectasis, C: Chronic bronchitis, D: Pneumonia - -### Response: -Ans. C: Chronic bronchitisThe Reid Index is a mathematical relationship that exists in a human bronchus section observed under the microscope. It is defined as ratio between the thickness of the submucosal mucus secreting glands and the thickness between the epithelium and cailage that covers the bronchi.It isn't of diagnostic use in vivo since it requires a dissection of the airway tube, but it has value in post moem evaluations and for research.RI = gland/wallRI is the Reid IndexWall is the thickness of the airway wall between the epithelium and the cailage's perichondriumGland is the thickness of the mucous producing gland at the location of inspection.A normal Reid Index should be smaller than 0.4, the thickness of the wall always more than double the thickness of the glands it contains.Hyperplasia and hyperophy of mucous glands as in chronic bronchitis causes them to be present at deeper levels in the bronchial wall and thicker in size, thus increasing the Reid Index beyond the normal value. -### End" -2960,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A baby boy is brought to the hospital because of convulsion. In the course of work up his body temperature & plasma glucose are normal but his CSF glucose is 12 mg/ dl. A possible explanation is, with the following options: A: SGLT 1 deficiency in astrocytes, B: GLUT 5 deficiency in cerebral capillaries, C: GLUT-1 55 K deficiency in capillaries, D: GLUT-1 45 K deficiency in microglia - -### Response: -Ans: c (GLUT 1 55K deficiency in capillaries) Ref: Ganong, 22nd ed, p. 615It is a direct pick from self study MCQs in Ganong.According to the given parameters there is deficient transport of glucose across brain capillaries.The predominant GLUT in the brain is GLUT-1 55 K (Ganong p. 615). GLUT-1 45 K is also present in brain capillaries and not in microglia.GLUT 1 - RBC, brain, kidney, placenta, retinaGLUT 2 - Liver, B cells of pancreasGLUT 3 - BrainGLUT 4 - Skin, cardiac muscle, adipose tissueGLUT 5 - Testes, spermsGLUT 7 - Liver, endoplasmic reticulumNote:GLUT 4 is mediated by insulin.GLUT 5 is used as a fructose transporter (semen). -### End" -2961,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of secondary PPH is, with the following options: A: Atonic uterus, B: Retained placental bits, C: Ruptured uterus, D: Cervical laceration - -### Response: -Causes of secondary PPH: Retained bits of cotyledon or membranes Infection and separation of slough over a deep cervicovaginal laceration Endometritis Hemorrhage from cesarean section wound Withdrawal bleeding following estrogen therapy for suppression of lactation Ref: Dutta Obs 9e pg 392. -### End" -2962,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal vaginal anaerobe is:, with the following options: A: Lactobacillus, B: Corynebacterium, C: Gardenella, D: E. coli - -### Response: -Lactobacillus are gram positive bacilli, nonspore forming anaerobes. Normally they are present in mouth, intestines and vagina. They rarely cause disease, though L.catenaforme is associated with bronchopulmonary infections. Most of them are vancomycin resistant. Lactobacillus forms the predominat bacterial flora of vagina. They ferment glycogen deposited in the vaginal epithelium and forms lactic acid which helps to maintain a acidic pH. Good to know: Albe Dorderlein in 1891 described the cultural and physiological characters of organism,""Lactobacilus acidophillus"", which has since born its name as ""Dorderlein bacillus"" . Ref: Jawetz, 'Medical microbiology', 23rd Edition, Page 244 ; A textbook of microbiology, By P.Chakraboy, 2nd Edition, Page 309. -### End" -2963,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ketone bodies are synthesized -, with the following options: A: Cytosol, B: ER, C: Miochondria, D: Peroxisomes - -### Response: -Ans. is 'c' i.e., Miochondria o Ketone body synthesis (ketogenesis) occurs in mitochondria,SiteCycle/ReactionsCytosolQGlycolysis Q (EMP Cycle Q), HMP shunt, fatty' acid synthesisQ glycogenesis, glycogenolysis, Bile acid/Salt synthesis, cholesterol synthesisMitochondria QKreb's cycle (citric acid cycle) Q. Electron transport chain (ECT) Q, Fatty' acid oxidationQ, KetogenesisBoth cytosol and mitochondriaGluconeogenesisQ, Urea cycleQPeroxisomesOxidation of very' long chain fatty' acidsSmooth endoplasmic reticulumTriglyceride synthesisQ, Steroid synthesisQ, cholesterol synthesis, phospholipid synthesisRough endoplasmic reticulum (ribosomes)Protein synthesisNucleusDMA and RNA synthesiso They are called essential fatty acids because human beings require these fatty acids but cannot synthesize themQ,o Humans lack the enzymes to introduce double bonds at carbon atom beyond C9 in the fatty' acid chain,o Hence, human cannot synthesize linolenic acid0and linolenic acid having double bonds beyond C9.o Arachidonic acid can be synthesized from linoleic acid.o Therefore, in deficiency of linoleic acid, arachidonic acid also becomes essential fatty' acids,o Therefore linoleic acid is the most important essential fatty acid0 as it senes as a basis for the production of other EFA. -### End" -2964,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glanzmann thrombasthenia is-, with the following options: A: Autosomal dominant disorder, B: Autosomal recessive disorder, C: None, D: Both - -### Response: -Glanzmann thrombasthenia is an autosomal recessive disorder. -### End" -2965,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is contraindicated in a patient with raised intracranial pressure?, with the following options: A: Thiopentone, B: Propofol, C: Midazolam, D: Ketamine - -### Response: -ketamine increases all the pressures - blood pressure intracranial pressure intragastric pressure intraocular pressure In patients with increased ICP who are breathing spontaneously, ketamine should be used with caution because it can increase ICP and has been repoed to cause apnea. It is contraindicated. Ref: Miller's anesthesia 8th edition. -### End" -2966,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Typhoid Vi polysaccharide vaccine is usually administered in children above the age of :, with the following options: A: 6 months, B: 1 year, C: 2 years, D: 1 year 6 months - -### Response: -The Vi polysacchiride vaccine is licensed for individuals aged 2 years because it does not elicit immune response in children less than 2 years. -### End" -2967,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patterns of inter relationships between persons in a society is -, with the following options: A: Social structure, B: Social psychology, C: Herd structure, D: Social science - -### Response: -Social structure refers to the pattern of inter relationships between persons.Every society has a social structure - a complex of major institutions ,groups,power structure and status hierarchy. Ref:(p.727) 25 th edition Park's textbook of Preventive and Social Medicine. -### End" -2968,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Interstitial nephritis is seen with all except, with the following options: A: Beta lactam inhibitors, B: INH, C: Diuretics, D: Allopurinol - -### Response: -Acute interstitial nephritis Acute interstitial nephritis (AIN) is an immune-mediated disorder, characterised by acute inflammation affecting the tubulointerstitium of the kidney. It is commonly drug-induced, with proton pump inhibitors (PPIs) fast becoming the most common cause, but can be caused by other toxins, and can complicate a variety of systemic diseases and infections . Clinical features The clinical presentation is typically with renal impairment but, in some patients with drug-induced AIN, there may be signs of a generalised drug hypersensitivity reaction with fever, rash and eosinophilia. Proteinuria is generally modest (PCR < 100 mg/mmol) and tubular in type . The urine may contain white blood cells and white cell casts but is sterile on culture. Eosinophils are present in up to 70% of patients but this is a non-specific finding. AIN should always be considered in patients with non-oliguric AKI. There may be a rapid deterioration of renal function in some cases of drug-induced AIN, causing the condition to be mistaken for RPGN. Investigations Renal biopsy is usually required to confirm the diagnosis . This typically shows evidence of intense inflammation, with infiltration of the tubules and interstitium by polymorphonuclear leucocytes and lymphocytes. Eosinophils may also be observed, especially in drug-induced AIN. Often granulomas may be evident, especially in drug-induced AIN or sarcoidosis . The degree of chronic inflammation in a biopsy is a useful predictor of long-term renal function. Eosinophiluria may be present but is not a good discriminator for AIN. Management Some patients with drug-induced AIN recover following withdrawal of the drug alone, but high-dose glucocoicoids (prednisolone1 mg/kg/day) may accelerate recovery and prevent long-term scarring. Other specific causes should be treated, if possible. Chronic interstitial nephritis Chronic interstitial nephritis (CIN) is characterised by renal dysfunction with fibrosis and infiltration of the renal parenchyma by lymphocytes, plasma cells and macrophages, in association with tubular damage Pathophysiology This disease may follow on from AIN that does not resolve, or may be associated with ingestion of various toxins and drugs, or with metabolic and chronic inflammatory diseases . In many patients, CIN presents at a late stage and no underlying cause can be identified. Genetic causes may underlie many of these cases . Toxins that have been associated with CIN include those contained within the plant Aristolochia clematitis (bihwo). These are probably responsible for the severe nephrotoxicity that can be associated with treatment with herbal medicines in Asia and for Balkan nephropathy, which affects isolated rural communities in Bosnia, Bulgaria, Croatia, Romania and Serbia, possibly through contaminated flour. The nephropathy is commonly linked with tumours of the collecting system and is probably due to the mutagenic effects of the plant toxin on the urothelial epithelium. Ingestion of mushrooms within the Coinarius genus can cause a devastating and irreversible renal tubular toxicity. It is encountered occasionally in Scandina and Scotland. Ref Harrison20th edition pg 278 -### End" -2969,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To which patient would the MMR be safe to administer?, with the following options: A: A 15-month-old HIV-infected child with a CD4 cell count of 700, B: A 25-year-old pregnant woman, C: A 12-year-old asthmatic on 20 mg of oral prednisone daily for the last 20 days, D: An 18-year-old with leukemia in remission whose chemotherapy was terminated 1 month ago - -### Response: -Unusual or serious adverse events following the administration of the MMR have not been documented in HIV-infected children who were not severely immunocompromised. Because measles may cause a severe infection in HIV-infected persons, vaccination is recommended if noimmunosupression is present. Live vaccines should be avoided during pregnancy. Patients with leukemia in remission may receive live vaccines only if chemotherapy has been terminated for at least three months. An oral dose of 2 mg/kg or 20 mg of prednisone for two weeks or more is considered sufficient to induce immunosuppression and warrants concern about the safety of administration of a live vaccine. -### End" -2970,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding fetal RBC&;s Except -, with the following options: A: Elevated 2,3 DPG, B: Decreased carbonic anhydrase activity, C: Decreased life span, D: High RBC volume - -### Response: -

The difference in physiochemical propeies when compared with Hb A are: increased solubility of deoxy HbF,slower electrophoretic mobility for HbF,increased resistance of UnFounately to alkali denaturation,HbF has decreased interaction with 2,3-BPG.Thus increase in oxygen affinity is physiologically advantageous in facilitating transplacental oxygen transpo due to diminished binding of 2,3-BPG.

Reference :DM Vasudevan textbook of biochemistry sixth edition pg no 259

-### End" -2971,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true regarding ETC?, with the following options: A: Occurs in mitochondria, B: Generates ATP, C: No role of inorganic phosphate, D: Involves transpo of reducing equivalent - -### Response: -Ans. is 'c' i.e., No role of inorganic phosphate -### End" -2972,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Capillary fill fast in which of the following type of shock: March 2013 (d, e, g), with the following options: A: Septic, B: Hypovolumic, C: Hemorrhagic, D: Obstructive - -### Response: -Ans. A i.e. Septic shock Harrison's Medicine, 16th ed., p-1604 states that capillary refill time is prolonged in hypovolemic shock Capillary refill It is the rate at which blood refills empty capillaries. It can be measured by holding a hand higher than hea-level (prevents venous reflux), pressing the soft pad of a finger or toe until it turns white, and taking note of the time needed for the color to return once pressure is released. Normal refill time is less than 2 seconds. In newborn infants, capillary refill can be measured by pressing on the sternum for five seconds with a finger or thumb, and noting the time needed for the colour to return once the pressure is released. The upper normal limit for capillary refill in newborns is 3 seconds. The capillary refill time (C) is a common indication of dehydration and decreased peripheral perfusion. It is very useful as suppoing evidence for a positive sign of poor perfusion to the extremities. The C test is often referred to as the Nail blanch test. Septic shock In early stages of septic shock (the hyperdynamic phase), patients may show dark red mucous membranes with a sho capillary refill time (C In more advanced stages mucous membranes may seem grey and dry and there will be an increased C and weak pulses. -### End" -2973,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MC cause of Puberty' Menorrhagia:, with the following options: A: Anovulation, B: Malignancy, C: Endometriosis, D: Bleeding disorder - -### Response: -Ans-A (Anovulation) [Ref Shaw 14th/ 271; Novak 14th/447- 449 ; COGDT 10th/ 557)Puberty Menorrhagia# Puberty'menorrhagia is a threshold of bleeding of adolescence caused by:* Excess or unopposed estrogen & absence of progesterone in the anovulatory cycles- most common.* Coagulation disorders (20%)# Menorrhagia may be noticed from the very start of menarche, but often, the initial few periods are normal""Puberty menorrhagia is excessive cyclical regular bleeding occurring in adolescents. Most common cause of puberty menorrhagia is anovulation which results in excess of estrogen or unopposed estrogen in absence of progesterone, and the most common cause is- Bleeding disorders- blood dyscrasias and coagulation disorders""- Shaw 14th/ 271Other Cause of Abnormal Bleeding in Adolescents. Novak 14th /447- 449# Pregnancy-related bleeding# Sexually transmitted- Infections - particularly chlamydia# Sexual abuse# Hepatic dysfunction# Hyperprolactinemia (it can cause either amenorrhea or irregular bleeding)# PCOS- It can occur during adolescence also# Hypothyroidism# Anatomical cause - Partially obstructive genetic anomalies.Table: Shaw 14th/271DUB is of two type1. Anovulatory (80%)2. Ovulatory (20%)Anovulatory (80%)1. Threshold bleeding of puberty menorrhagia2. Metropathia hemorrhagia'-'/ cystic glandular hyperplasia3. Premenopausal DUB (Atrophy of endometrium).Ovulatory (20%)1. Irregular ripening2. Irregular shedding3. IUCD insertion4. Following the sterilization operation.Anovulatory Bleeding Treatment Novak 14th /451-54, COGDT 10th/557Mild bleedingHematinicsReassuranceHormone therapy = lowDose OCFS or cyclical progesterone therapy (Medroxyprogesterone acetate 5- 10mg/day for 10-13 days).Moderate bleedingCombination monophask OC P every 6 hrs. for 4-7 days and then stop | followed byWithdrawl bleeding| followed byLow dose OCP for 3 to 6 by cycles Acute severe bleedingEmergency management:Admit the patientStabilize the vitalsConjugated estrogen 25 -40mg LV every 6 hrs or 2.5mg oral estrogen every 6hrs.Once bleeding stops medroxy progesterone l0mg for 10 days if above regime is not effectively assessed the patient for any local cause. USG should be done to rule out fibroid/endometrial hyperplasia or clots.It intrauterine clots are detected D & C should be done. -### End" -2974,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: caldwell view is done for:, with the following options: A: Sphenoid sinus, B: Maxillary sinus, C: Ethmoid sinus, D: Frontal sinus - -### Response: -Lateral view is best for the sphenoid sinus. Caldwell view is the occipito frontal view. The frontal sinuses are seen clearly in this view. Ref Dhingra 6/e,p 434. -### End" -2975,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs inhibit thromboxane A2 synthase?, with the following options: A: Dazoxiben, B: Daltroban, C: Sultroban, D: Lamifiban - -### Response: -Ans. is 'a' i.e., Dazoxiben * Dazoxiben is an orally active thromboxane synthase inhibitor. It has shown a significant clinical improvement in patients with Raynaud's syndrome.* Daltroban and sultroban are TXA2 receptor antagonists. -### End" -2976,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the stage of ovarian Ca with superficial liver metastasis with B/kovarian mass :, with the following options: A: Stage I, B: Stage II, C: Stage III, D: Stage IV - -### Response: -Ans. is c i.e. Stage III Superficial liver metastasis is included in Stage Ill. Metastasis to liver parenchyma is included in Stage 1V. -### End" -2977,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dexmedetomidine acts on which receptor for its analgesic action ?, with the following options: A: 5HT2A, B: D2, C: a2A, D: D5 - -### Response: -Ans. is'c' i.e., a2ADexmeditomidine is centrally active selective alpha (a2) agonist that has been introduced for sedating critically iil ventilated patients in intensive care units. -### End" -2978,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of Esophageal perforation, with the following options: A: Mallory Weiss syndrome, B: Borehave syndrome, C: Iatrogenic, D: Esophageal varices - -### Response: -- Most common cause of esophageal perforation is Iatrogenic . - Most common esophageal lacerations are Mallory- Weiss tears, which are often induced by severe retching or vomiting -### End" -2979,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Person having cerebellar signs on the same side with hearing loss. Site of damage is, with the following options: A: Left cerebellopontine angle, B: Left pons, C: Left medulla, D: Middle ear - -### Response: -(A) Left cerebellopontine angle # CEREBELLOPONTINE ANGLE TUMORS:> Tumors within the nerve canaliculi initially present with unilateral sensorineural hearing loss, unilateral tinnitus, or disequilibrium (vertigo is rare, on account of the slow growth of neuromas).> Speech discrimination out of proportion to hearing loss, difficulty talking on the telephone are frequent accompaniments.> Tumors extending into the CPA will likely present with disequilibrium or ataxia depending on the amount of extension on the brainstem.> With brainstem extension, midfacial and corneal hypesthesia, hydrocephalus, and other cranial neuropathies become more prevalent.> Cerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors.> Most CPA tumors are benign, with over 85% being vestibular Schwannomas (acoustic neuromas), lipomas, vascular malformations, & hemangiomas.> Most frequent non acoustic CPA tumors are meningiomas, epidermoids (primary cholesteatomas), and facial or lower cranial nerve Schwannomas.> Primary malignancies or metastatic lesions account for less than 2% of neoplasms in the CPA.> Presenting symptoms of CPA tumors (including acoustic neuromas) include the following: Hearing loss - 95% Tinnitus - 80% Vertigo/unsteadiness - 50-75% Headache - 25% Facial hypesthesia - 35-50% Diplopia-10%> Presenting symptoms can vary according to the size and location of the lesion. -### End" -2980,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cyclophosphamide is?, with the following options: A: Alkylating agent, B: Antitumor antibiotic, C: Monoclonal antibody, D: Antimetabolites - -### Response: -ANSWER: (A) Alkylating agentREF: Harrison's 17th edition chapter 8, KDT, Goodman GillmanSee APPENDIX-37 for ""CLASSIFICATION OF CANCER CHEMOTHERAPY AGENTS"" -### End" -2981,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serum testosterone levels exceeding 200ng /dL is suggestive of, with the following options: A: PCOD, B: Adrenal tumor, C: Metabolic syndrome, D: Ovarian Atresia - -### Response: -Very high testosterone levels are suggestive of ovarian or adrenal androgen-producing tumor. -### End" -2982,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fluconazole differs from ketoconazole in that:, with the following options: A: It is not active by the oral route, B: It is a more potent inhibitor of drug metabolism, C: It is not effective in cryptococcal meningitis, D: It is unlikely to produce anti-androgenic side effects - -### Response: -Fluconazole does not have anti-androgenic side effects. Ketoconazole is rarely used now a days because of several limitations like: Poor oral bioavailability Limited CNS penetration Powerful inhibition of microsomal enzymes Used in treatment of Cushing Syndrome Anti-androgenic adverse effects like gynaecomastia Fluconazole is preferred agent because it has: Very good oral absorption Maximum CNS penetration (therefore effective in cryptococcal meningitis). No inhibitory action on microsomal enzymes No anti-androgenic propey. -### End" -2983,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True for Vi polysaccharide vaccine, with the following options: A: Local side effects are common, B: Severe systemic side effect, C: Contra indicated in HIV, D: Can be given with other vaccines like Hepatitis B & Yellow fever - -### Response: -Vi polysaccharide vaccine can be given with other vaccines like Hepatitis B & Yellow fever. Option 1, 2, 3, 4 -Typhim Vi is a subunit vaccine containing the cell surface Vi polysaccharide extracted from Salmonella enterica serovar Typhi, S. typhi Ty2 strain. -Typhim Vi vaccine is indicated for active immunization against typhoid fever for persons two years of age or older. -The antibody response may be inadequate in children under 2 years of age. - Dose for adults and children is a single injection of 0.5 mL given intramuscularly in the deltoid. - Reimmunization every two years under conditions of repeated or continued exposure to the S typhi organism is recommended at this time. - Typhim Vi vaccine has efficacy against typhoid fever caused by S.typhi infection only. =The adverse reactions are predominately minor and transient local reactions:- -Local reactions such as injection site pain, erythema and induration almost always resolve within 48 hours of vaccination. -Though the antibody response in immunodeficiency states are often suboptimal, it should be given in HIV patients. -TYPHIm Vi may be administered during the same vaccination session with other common vaccines (yellow fever, diphtheria, tetanus, poliomyelitis, rabies prepared on Vero cells, meningitis A+C, hepatitis A and hepatitis B.) -Other vaccines for prophylaxis against enteric fever are:- Mono/di/trivalent heat- killed phenol preserved parenteral vaccines. Live attenuated Typhoid vaccine. -### End" -2984,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not safe in pregnancy?, with the following options: A: USG, B: Doppler, C: MRI, D: CT - -### Response: -CT uses X-rays so it is not safe during pregnancy. CT scan while pregnant first trimester has the highest risk to the developing foetus due to the carcinogenic and teratogenic effects of the ionizing radiation. -### End" -2985,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atomoxetine is a new drug being used in which of the following condition?, with the following options: A: Bipolar disorder, B: Schizophrenia, C: ADHD, D: OCN - -### Response: -ADHD Psychostimulant are regarded as first-line pharmacologic treatment for children and adolescents with attention deficit hyperkinetic disorder (ADHD), as the efficacy and safety of these agents have been well established based on clinical trials and extensive naturalistic use. Adverse effects in some patients and abuse potential have led to the search for new treatments. -### End" -2986,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are microsomal enzyme inhibitors except, with the following options: A: Glucocoicoids, B: Cimetidine, C: Ciprofloxacin, D: INH - -### Response: -Other inhibitors- Ketoconazole, Metronidazole, Allopurinol, Erythromycin, OCPs, Omeprazole -### End" -2987,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common organism causing laryngotracheobrochitis -, with the following options: A: RSV, B: Parainfluenzavirus, C: Influenza virus, D: H. influenzae - -### Response: -Ans. is 'b' i.e., Parainfluenza virusLaryngotracheobronchitis (Croup)o Laryngotracheobronchitis is the most common infectious cause of obstruction in children usually occurring between the ages of 6 months and 3 years.o Male children (boys) are characteristically more frequently involved than females (girls).Etiologyo It is a viral infection most frequently caused by Parainfluenza virus Pathologyo The most characteristic pathological feature is edema formation in the subglottic area.o The loose areolar tissue in the subglottic area swells up and causes predominant signs of upper airway obstruction.Presentationo Gradual onset with a prodrome of upper respiratory symptomso Hoarseness and barking cough (croupy cough)o Stridor (initially inspiratory than biphasic)o Fever is usually low grade (or absent) although may occasionally be high gradeo Droolings is characteristically absent and there is no dysphagia (seen in epiglottitis)Imaging (X ray)o Symmetric 'steeple' or 'funnel shaped' narrowing of the subglottic region (steeple sign)o Hypopharyngeal widening or distensiono Normal epiglottis and aryepiglottic foldsTreatmento Mild symptoms (barking cough but no stridor at rest) Supportive therapy alone with humified oxygen, oral hydration and minimal handlingo Moderate symptoms (barking cough with stridor at rest) Active intervention with humified oxygen, Nebulized racemic epinephrine and glucocorticoids (steroids)o Severe symptoms (impending respiratory failure) Require an artificial airway (Intubation with endotracheal tube or tracheostomy may be required) -### End" -2988,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Impedance audiometry is done in?, with the following options: A: Otomycosis, B: Meniere's disease, C: Pressure changes in middle ear, D: Cholesteatoma - -### Response: -It is an objective test, widely used in clinical practice and is paicularly useful in children. It consists of: Tympanometry Acoustic reflex measurements By changing the pressure in a sealed external auditory canal and then measuring the reflected sound energy, it is possible to find the compliance or stiffness of the tympano-ossicular system and thus find the healthy or diseased status of the middle ear. -### End" -2989,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following conditions do the ovaries functions normally?, with the following options: A: Turner's syndrome, B: Rokitansky-Kuster-Hauser syndrome, C: Androgen insensitivity syndrome, D: Swyer's syndrome - -### Response: -Ans. is b, i.e. Rokitansky-Kuster-Hauser syndromeRef: Jeffcoates 7th/ed, p197-198; Shaw 14th/ed, p82; COGDT 10th/ed, p549* Ovaries develop from genital ridge, whereas fallopian tubes, uterus, cervix and upper part of vagina are formed by Mullerian duct.* In Mullerian agenesis which is also called as Mayer-Rokitansky-Kuster-Hauser syndrome, fallopian tube, uterus, cervix and upper part of vagina are absent and not ovaries.* Ovaries are normally functioning. -### End" -2990,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 37-year-old woman is suffering from carcinoma of the uterus(fundus area) . Cancer cells are likely to metastasize directly to which of the following lymph nodes?,, with the following options: A: External iliac nodes, B: Internal iliac nodes, C: Superficial inguinal nodes, D: Aoic (lumbar) nodes - -### Response: -The superficial inguinal nodes receive lymph from the buttocks, labium majora, upper uterus and the lower pas of the vagina and anal canal. These nodes have efferent vessels that drain primarily into the external iliac and common iliac nodes and ultimately to the lumbar (aoic) nodes. The internal iliac nodes receive lymph from the upper pa of the rectum, vagina, uterus, and other pelvic organs, and they drain into the common iliac nodes and then into the lumbar (aoic) nodes. Pa of uterus Draining lymph nodes Fundus Pre and para aoic lymph nodes Isthmus Round ligament lymphatics- superficial ingiunal LN Mid uterus External iliac LN lower uterus(cervix) everywhere except inguinal LN -### End" -2991,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For pancreatic injury true is, with the following options: A: Most are iatrogenic, B: Blunt trauma most common, C: Urine amylase is diagnostic, D: HRCT is investigation of choice - -### Response: -Answer- D. HRCT is investigation of choicePancreatic injuries are mostly due to penetrating injuries.Moderate injuries usually require operative exploration, debridement, and the placement of external drains. -### End" -2992,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A four-year-old child with exercise intolerance. On investigation Blood pH 7.3, FBS 60 mg%, hypertriglyceridemia, ketosis and lactic acidosis. The child had hepatomegaly and renomegaly. Biopsy of liver and kidney showed increased glycogen content. What is the diagnosis?, with the following options: A: McCardle's disease, B: Cori's disease, C: Von Gierke's disease, D: Pompe's disease - -### Response: -Ans. C. Von Gierke's Disease(Ref: Nelson 20/e page 715, Defects in metabolism of Carbohydrates)Clinical Picture of Von Gierke's Disaese Clinical presentationMost commonly present at 3-4 months of ageDoll like facies with fat cheeksRelatively thin extremitiesShort stature, Protuberant abdomenMassive HepatomegalyKidneys are also enlargedNo SplenomegalyPlasma may be milky due to associated hypertriglyceridemia -### End" -2993,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In TRIAGE system for disaster management, Red colour code indicates?, with the following options: A: About to die patients, B: Uninjured patients, C: High priority or transferable cases, D: Dead or moribund cases - -### Response: -Ans. c (High priority or transferable cases) (Ref. Park Textbook of PSM 22nd/pg.741)TRIAGEIt consists of rapidly classifying the injured on the basis of the severities of their injuries and the likelihood of their survival with prompt medical intervention.Four colour coding# Red - High priority or transferable cases# Yellow - medium priority# Green - ambulatory patients# Black - dead or moribund patients. -### End" -2994,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following are included in criteria for diagnosing acute pancreatitis except, with the following options: A: Typical abdominal pain in the epigastrium, B: Three fold elevation in enzymes (amylase), C: Cullen sign, D: Imaging findings suggestive of pancreatitis - -### Response: -DIAGNOSISAny severe acute pain in the abdomen or back should suggest the possibility of acute pancreatitis. The diagnosis is established by two of the following three criteria: (1) typical abdominal pain in the epigastrium that may radiate to the back, (2) threefold or greater elevation in serum lipase and/or amylase, and (3) confirmatory findings of acute pancreatitis on cross-sectional abdominal imaging.Patients also have associated nausea, emesis, fever, tachycardia, and abnormal findings on abdominal examination. Laboratory studies may reveal leukocytosis, hypocalcemia, and hyperglycemia.Computed tomography (CT) is the best imaging study for initial evaluation of a suspected pancreatic disorder and for the assessment of complications of acute and chronic pancreatitis. It is especially useful for the detection of pancreatic and peripancreatic acute fluid collections, fluid-containing lesions such as pseudocysts, walled-off necrosis, calcium deposits and pancreatic neoplasms. Acute pancreatitis is characterized by (1) enlargement of the pancreatic outline, (2) distoion of the pancreatic contour, and/or (3) a pancreatic fluid that has a different attenuation coefficient than normal pancreas.Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 370; Approach to the Patient with Pancreatic Disease; Page no: 2093 -### End" -2995,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Monosymptomatic hypochondriasis means, with the following options: A: paranoid type delusional disorder, B: Declerambault syndrome, C: somatic type delusional disorder, D: othello syndrome - -### Response: -* Somatic o ALSO KNOWN AS * Monosymptomatic hypochondriacal psychosis * Delusional parasitosis * Olfactory reference syndrome o DIFFERENTIAL DIAGNOSIS * HYPOCHONDRIASIS====NOT REASSURED as in hypochondriasis Ref.Kaplon and sadock, synopsis of psychiatry,11 th edition, pg no.333 -### End" -2996,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following may cause Parkinson's, with the following options: A: Manganese, B: Iron, C: Copper, D: Lead - -### Response: -Manganese causes Parkinson's disease. Other drugs and toxins which causes parkinson's are : Antipsychotic drugs, Metoclopramide, tetrabenazine, sodium valproate, lithium and MPTP.In the human body, manganese aids blood sugar regulation, bone formation, and immunity. However, exposure to excessive levels of manganese may trigger Parkinson's-like neurological symptoms. Manganese builds up in the basal ganglia area of the brain Reference : Harrison20th edition pg 2456 -### End" -2997,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ulnar injury in the arm leads to all except:, with the following options: A: Sensory loss of the medial 1/3rd of the hand, B: Weakness of the hypothenar muscles, C: Claw hand, D: Adducted thumb - -### Response: -D i.e., Adducted thumb Adductor pollicis, which is supplied by ulnar nerve, is paralysed in ulnar nerve injury. This results in loss of thumb adduction & Froment's signQ (i.e., use of FPL in place of adductors to hold paper/book between thumb & index finger) -### End" -2998,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Functional unit for implementation of National Mental Health Programme is at which level?, with the following options: A: District, B: Subcentre, C: PHC, D: State - -### Response: -The Government of India has launched theNational Mental Health Programme(NMHP) in 1982, keeping in view the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care infrastructure in the country to deal with it. Principal unit of Health administration in India is District under a collector. All National health programmes in India are implemented district wise. -### End" -2999,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the following is a absolute contra indication for ECT, with the following options: A: pediatric, B: pregnacy, C: geriatric, D: nil - -### Response: -HISTORY * Medunna ====IM injection of camphor to induce seizures * Ugo cerletti and lucio bini==== ECT in a catatonic patient INDICATIONS * DEPRESSION SUICIDAL IDEAS-------------- first choice * CATATONIC SCHIZOPHRENIA * SCHIZOPHRENIA * MANIA * ELECTRODE PLACEMENT * Most commonly used=== bi fronto temporal * More cognitive side effects==bi fronto temporal * Less cognitive side effect======bi frontal * SIDE EFFECTS * RETROGRADE AMNESIA * BODY ACHE * MEDICATIONS USED IN THE PROCEDURE * ANAESTHETIC======Thiopentone / ethosuximide * MUSCLE RELAXANT====Succynyl choline CURARE IN PSEUDOCHOLINEESTERASE DEFICIENCY * ANTICHOLINERGIC=====Atropine CONTRA INDICATIONS * NO ABSOLUTE Contra indication * RELATIVE -----------------Brain tumour / arrythmia Ref. kaplon and saock, synopsis of psychiatry, 11 th edition, pg no. 1065 -### End" -3000,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fetal position refers to, with the following options: A: The relationship of an arbitrarily chosen poion of the fetal presenting pa to the right or left side of the bih canal, B: That poion of the fetal body that is either foremost within the bih canal or in closest proximity to it, C: The relation of the fetal long axis to that of the mother, D: The form of an ovoid mass that corresponds roughly to the shape of the uterine cavity - -### Response: -Fetal Lie: The relation of the fetal long axis to that of the mother is termed fetal lie and is either longitudinal or transverse. The presenting pa is that poion of the fetal body that is either foremost within the bih canal or in closest proximity to it.In the later months of pregnancy, the fetus assumes a characteristic posture described as attitude or habitus. As a rule, the fetus forms an ovoid mass that corresponds roughly to the shape of the uterine cavity.Position refers to the relationship of an arbitrarily chosen poion of the fetal presenting pa to the right or left side of the bih canal.(Ref: William's Obstetrics; 25th edition) -### End" -3001,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: While doing excision of cervical lymph nodes, inadveent injury to which nerve causes drooping of shoulder, with the following options: A: Supraclavicular nerve, B: Suprascapular nerve, C: Spinal accessory nerve, D: Nerve to serratus anterior - -### Response: -If Cervical lymph node excision is done (may be in posterior triangle of Neck), Most common iatrogenically damaged nerve which is most superficial is spinal accessory Nerve Spinal accessory Nerve is coming from cranial cavity, passing through jugular foramen & supplies : Sternocleidomastoid - contracts while turning head to one side & Trapezius muscle - Causes elevation of the shoulder Damage to this nerve leads to paralysis of trapezius muscle & there would be drooping of shoulder (Difficulty in shrugging the shoulder & overhead abduction) -### End" -3002,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In salmonella infection, true statement is:, with the following options: A: Flagellar antigen forms chalky granular clumps, B: Somatic antigen is a protein, C: Absence of Vi antibody indicate poor prognosis, D: Serological classification is by Craige's scheme - -### Response: -Absence of Vi antibody indicate poor prognosis in salmonella infection is the true statement among the options given above. Option 1 Option 2 Somatic antigen (O Ag): Pa of cell wall lipopolysaccharide (LPS). Flagellar antigen (H Ag): Made-up of proteins: flagellin, confers motility. Option 3 The complete absence of the Vi antibody in a proven case of typhoid fever indicates poor prognosis Option 4 Phase variation: Conversion of isolates from one phase to another is achieved by using Craigie's tube method. Note: Vi Antibodies are not seen in normal population. -### End" -3003,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The age of a 16 years old female is best determined by the radiograph of :, with the following options: A: Lower end of radius and Ulna, B: Upper end of humerus, C: Upper end of radius and Ulna, D: Xiphisternum - -### Response: -A i.e. Lower end of radius & ulna -### End" -3004,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following muscle is not supplied by the marked nerve?, with the following options: A: Superior rectus, B: Superior oblique, C: Medial rectus, D: Levator palpebrae superioris (LPS) - -### Response: -Ans. (b) Superior obliqueRef: Grays Anatomy 41st Ed; Page No- 232* Superior oblique muscles supplied by trochlear nerve.* The marked nerve is Oculomotor Nerve.* Oculomotor Nerve emerges at the midbrain on the medial side of the crus of the cerebral peduncle and passes between the superior cerebellar and posterior cerebral arteries and run forward in the interpeduncular cistern on the lateral side of the posterior communicating artery to reach cavernous sinus.* It enters the cavernous sinus by piercing the posterior part of the roof on the lateral side of the posterior clinoid process, descends along the lateral dural wall of the cavernous sinus, dividing into superior and inferior divisions which run beneath the trochlear and ophthalmic nerve.Nerve supplies of the eyes musclesOculomotorSuperior divisionSuperior rectus and levator palpebrae superioris muscles (LPS)NerveInferior divisionMedial rectus, inferior rectus, and inferior oblique musclesTrochlear Nerve* It passes through the lateral wall of the cavernous sinus, and enters the orbit through the superior orbital fissure.* Nerve supplies the superior oblique muscle.Abducens Nerve* It enters the orbit through the superior orbital fissure.* Nerve supplies the lateral rectus muscle.Cranial Nerves - Components & FunctionNumberNameComponentsFunctionOpening in skullIOlfactory nerveSensory (SVA)Smell sensationOpenings in cribriform plate of ethmoidIIOptic nerveSensory (SSA)VisionOptic canalIIIOculomotorMotor (GSE, GVE)Turns eyeball upward, downward, and medially; Raises upper eyelid, also constricts pupil; accommodates eyeSuperior orbital fissureIVTrochlear nerveMotor (GSE)It helps in turning eyeball downward and laterallySuperior orbital fissureVTrigeminalMaxillary divisionSensory (GSA)Supplies dura mater of anterior part of middle cranial fossa, conjunctiva of inferior eyelid, Skin of face over maxilla; teeth of upper jaw; mucous membrane of nose, the maxillary sinus, and palatePasses through foramen Rotundum to enter pterygopalatine fossa. Ophthalmic divisionSensory (GSA) onlySupplies Cornea, superior conjunctiva, skin of dorsum of external nose, forehead, scalp, Superior eyelids, and also mucous nasal cavity, ethmoid, frontal and sphenoid sinusesSuperior orbital fissure Mandibular divisionSensory (GSA)Skin of lower lip, buccal, parotid and temporal regions of face, external ear (Auricle, tympanic membrane and acoustic meatus), mucous membrane of mouth and anterior two-third part of tongue. Supplies 4 muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani and tensor veli palatiniPasses THROUGH Foramen Ovale into infratemporal fossa. VIAbducent Motor (GSE)Lateral rectus muscle turns eyeball laterallySuperior orbital fissureVIIFacial Sensory (SVA)Taste from anterior two-thirds of tongue, from floor of mouth and palate Motor (SVE)Muscles of face and scalp, stapedius muscle, posterior belly of digastric and stylohyoid musclesInternal acoustic meatus, facial canal, stylomastoid foramen Secretomotor (GVE) parasympatheticSubmandibular and sublingual salivary glands, the lacrimal gland, and glands of nose and palate VIIIVestibulo-CochlearSensory (SSA)Organ of Corti-- hearing cochlearVestibularSensory (SSA)From utricle and saccule and semicircular canals--position and movement of headInternal acoustic meatusIXGlossopharyngealSensory (GVA, SVA, GSA)General sensation and taste from posterior one-third of tongue and pharynx; carotid sinus (baroreceptor); and carotid body (chemoreceptor) Motor (SVE)Stylopharyngeus muscle--assists swallowingJugular foramen Secretomotor (GVE)parasympathetic Parotid salivary gland XVagus Motor (GVE, SVE)Sensory (GVA, SVA, GSA)Heart and great thoracic blood vessels; larynx, trachea, bronchi, and lungs; alimentary tract from pharynx to splenic flexure of colon; liver, kidneys, and pancreasJugular foramenXISpinal accessorySpinal rootMotor (SVE)Sternocleidomastoid and trapezius muscles Cranial rootMotor (SVE)Muscles of soft palate (except tensor veli palatini), pharynx (except stylopharyngeal, and larynx (except cricothyroid in branches of vagusJugular foramenXIIHypoglossal Motor (GSE)Muscles of tongue (except palatoglossus) controlling its shape and movementHypoglossal canal -### End" -3005,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young female on antidepressants presents to the emergency with altered sensorium and hypotension. ECG reveals wide QRS complexes and right axis detion. What is the next best step?, with the following options: A: Sodium bicarbonate, B: Hemodialysis, C: Fomepizole, D: Flumazenil - -### Response: -This patient was most likely on Tricyclic antidepressants and it appears to be a case of Tricyclic antidepressants overdosage as the patient is experiencing arrhythmias, hypotension and has also developed altered sensorium. The mainstay of treatment in TCA induced cardio toxicity is intravenous sodium bicarbonate. It is used if the QRS interval is prolonged (usually more than 100 milliseconds) and can reverse the toxic effects of TCAs. Because of large volume of distribution and high protein binding of TCAs, Hemodialysis is not effective. Fuher flumazenil and fomepizole have no role. -### End" -3006,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about pheochromocytoma except?, with the following options: A: Urinary V.M.A is most specific, B: Paraganglioma occurs at skull base, C: 10% extra adrenal, D: Organ of Zuckerkandl is most common extra adrenal site - -### Response: -Paraganglioma is a term used to describe catecholamine producing tumors in the skull base and neck. The classic rule of tens is valid for pheochromocytoma. Organ of Zuckerkandl is a collection of chromaffin cells near the origin of the inferior mesenteric aery or near the aoic bifurcation. It is the most common extra-adrenal site of pheochromocytoma. Urinary VMA is used for diagnosis of neuroblastoma and not pheochromocytoma. The most sensitive test for pheochromocytoma is urinary fractionated metanephrine -### End" -3007,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Endothelial cells synthesize which of the following:, with the following options: A: Fibrinogen, B: Factor-VIII, C: Factor-X, D: Factor-XII - -### Response: -The major site of factor VIII synthesis is in the hepatic endothelial cells. Liver is the major site of fibrinogen and factor X synthesis. Factor VIII circulates in a noncovalent complex with VWF. When associated with VWF the normal half-life of factor VIII is 8 to 12 hours. And the half-life is markedly reduced in the absence of VWF. Factor VIII has six tyrosine residues that are modified by sulfation. Sulfation of these residues is required for optimal activation by thrombin, maximal activity in complex with factor IXa, and maximal affinity of factor VIIIa for VWF. Ref: Monroe D.M., Hoffman M., Robes H.R. (2010). Chapter 115. Molecular Biology and Biochemistry of the Coagulation Factors and Pathways of Hemostasis. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e. -### End" -3008,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 57 year old woman presents to her family physician complaining of numbness and tingling in her right thumb, index and long finger for the past four weeks. She repos that she wakes up in the middle of the night with these symptoms and needs to shake her hands to ""wake"" them up. She denies numbness or tingling in her other hand or either leg. She has no neck or upper arm pain. On physical examination, her symptoms are reproduced by Tinel testing. Her symptoms are also exacerbated by hyperflexion of the wrist. There is decreased sensation over the palmar aspects of the thumb, index and middle fingers. There is no apparent motor weakness. Which of the following is the most likely diagnosis?, with the following options: A: C5 cervical nerve root compression, B: Carpal tunnel syndrome, C: Cubital tunnel syndrome, D: Radial tunnel syndrome - -### Response: -The patient's symptoms are classic for carpal tunnel syndrome. Carpal tunnel syndrome is the most common compressive neuropathy in the upper extremity. It is caused by compression of the median nerve in the carpal tunnel. The median nerve provides sensation to the palmar side of the thumb, index finger, long finger and radial half of the ring finger. The floor of the tunnel is formed by the carpal bones; the roof is formed by the transverse carpal ligament.A patient with a C5 nerve cervical nerve root compression would have weakness in their deltoids and biceps with sensory changes in the lateral arm.Cubital tunnel syndrome is compression of the ulnar nerve at the elbow. Symptoms include pain and paresthesias over the medial forearm and hand as well as weakness in the ulnar nerve distribution.Radial tunnel syndrome is compression of a branch of the radial nerve at the forearm. It is a pain-only problem without motor or sensory changes. -### End" -3009,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about myxoma is -, with the following options: A: Mostly seen in left atrium, B: Can metastasize to other sites, C: Rarely recurs after removal, D: Most often seen in right atrium - -### Response: -Cardiac myxomas -o Most common primary tumor of the adult heart. -o Benign neoplasms thought to arise from primitive multipotentmesenchymal cells. -o Familial syndromes associated with myxomas have activating mutations in the GNAS1 gene, encoding a subunit of G protein (Gsa) (in association with McCune-Albright syndrome) or null mutations in PRKARIA, encoding a regulatory subunit of a cyclic-AMP- dependent protein kinase (Carney complex). -o About 90% of myxomas arise in the atria, with a left-to-right ratio of approximately 4:1. -### End" -3010,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are used in the treatment of postmenopausal osteoporosis except:-, with the following options: A: Calcitonin, B: Vitamin D, C: Glucocoicoid, D: Bisphosphonates - -### Response: -Glucocoicoids can cause osteoporosis on long term use. DRUGS FOR OSTEOPOROSIS DRUGS Inhibits resorption Stimulates formation Both actions Bisphosphonates Donesumab Cinacalcet Calcitonin Estrogen SERMs Gallium nitrate Teriparatide Calcium Calcitriol Fluoride Strontium renelate -### End" -3011,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements regarding ACE inhibitors is true?, with the following options: A: These inhibit the conversion of angiotensinogen to angiotensin-1, B: Omission of prior diuretic dose decreases the risk of postural hypotension, C: Lisinopril is shorter acting than enalapril, D: These are contra-indicated in diabetic patients. - -### Response: -Ans. (B) Omission of prior diuretic dose decreases the risk of postural hypotension(Ref: KDT 8th/e p531)Angiotensin Converting Enzyme Inhibitors (ACEI)*This group of drugs inhibits the enzyme kininase II or ACE. So, these drugs decrease the activity of RAAS and also potentiate the vasodilatory action of bradykinin. Because these are preventing the conversion of angiotensin I to angiotensin II, so these can decrease the action of the former but not the latter.*ACEI are used for the treatment of hypertension, CHF, evolving MI, diabetic nephropathy, diabetic retinopathy, non-diabetic renal disease and also in scleroderma crisis. These drugs reduce proteinuria in diabetic as well as non-diabetic renal disease and also prevent the manifestations of scleroderma crisis which are mediated by angiotensin II.*This group of drugs is more effective in sodium depleted states (like diuretic use) because activity of RAAS is more in such cases (to compensate for salt loss). These drugs may cause postural hypotension in diuretic treated patients, which otherwise is a relatively rare adverse effect.*Lisinopril is longer acting than enalapril. Former can be given once daily whereas latter is required twice a day. -### End" -3012,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Side chain of which amino acid contains sulfhydryl group -, with the following options: A: Aspargine, B: Cysteine, C: Isoleucine, D: Threonine - -### Response: -Ans. is 'b'' i.e., Cysteine o There are two sulfur containing amino acidsCysteineMethionineo The side chain of cysteine contains sulfhydryl group that has a pKa of approximately 8.4 for dissociation of its hydrogen sulfhydryl groups of two cvstein molecules can form covalent disulfide bond to form cystine,o Methionine although it contains sulfur group, does not containt sulfhydryl group and cannot form disulfide bond. -### End" -3013,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: B cells are induced to produce IgE by which of the following, with the following options: A: IL-2, B: IL-4, C: IL-1, D: IL-6 - -### Response: -ref : robbins 10th ed -### End" -3014,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is anti inflammatory, with the following options: A: Lipoxins, B: Thromboxane, C: Prostaglandins, D: Interleukins - -### Response: -IL-10 and TGF-β have anti inflammatory action -### End" -3015,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alkalinization of urine is done in poisoning with all except -, with the following options: A: Mrophine, B: Salicylates, C: Methotrexate, D: Barbiturates - -### Response: -Ans. is 'a' i.e., Mrophineo By manipulation of the pH of glomerular filtrate, a drug can be made to ionize, become less lipid-soluble, remain in the renal tubular fluid, and so be eliminated in urine.Alkanization of urineo Acidic drugs are more ionized (lipid insoluble / polar / water soluble) at alkaline pH.o So, they cannot be absorbed from tubular lumen, i.e. their excretion by kidney is enhanced by alkanization of urine,o Such acidic drugs are Barbiturates and Salicylate.o Alkanization of urine is done by Lv. infusion of sodium bicarbonate.o Urine alkalinization by NaHCO3 enhances the elimination of weak acids, e.g. Salicylates, Phenobarbitone,Chlorpropamide, formic acid and methotrexate.Acidification of urineo Basic drugs are more ionized at acidic pH.o So, acidification of urine should be done in poisoning of these drugs,o Examples of such basic drugs are morphine, amphetamine, dexfenfluramine.o Acidification of urine is done by iv infusion of arginine hydrochloride followed by ammonium chloride (NH4Cl) by mouth. -- Laurence 9th/e 156 -### End" -3016,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest presentation of Friedrich's ataxia is?, with the following options: A: Ataxia, B: Seizures, C: Optic atrophy, D: Stuttering - -### Response: -Answer is A (Ataxia): In most patients ataxia of gait and stance is the first manifestation of the disease.- Clinical Neurology by Goetz 2""d/742 Friedreich's ataxia presents with progressive staggering gait, frequent falling and titubation- Harrison Note: The first pathological changes in Friendreich's Ataxia are thought to occur is dorsal root ganglia with loss of large sensory neurons. -### End" -3017,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bacillary angiomatosis caused by:, with the following options: A: Bartonella henselae, B: Bartonella quintana, C: Bartonella bacilliformis, D: Coxiella burnetii - -### Response: -Ans. A. Bartonella henselae and B.Bartonella quintanaExplanationBoth can cause:B. henselae causes hepatosplenic lesions.B. quintana cause subcutaneous and lytic bony lesions.In case question do not specify answer B. henselae.Features of Bartonella species are given in the table below:BartonellaDiseasesReservoirTransmissionB. henselaeCat scratch disease Bacillary angiomatosis Bacillary peliosis Bacteremia EndocarditisCats, other felinesExposure to cat bite/scratchB. quintanaTrench fever Chronic bacteremia Endocarditis Bacillary angiomatosisHumansLouse (Pediculus humanus corporis)B. baciliformisBartonellosis (Carrion's disease) Oroya fever Verruga peruanaHumansSandfly (Lutzomyia verrucarum) -### End" -3018,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the follow ing act through ty rosine kinase receptor-, with the following options: A: Insulin, B: Glucagons, C: GH, D: FSH - -### Response: -Ans. is 'a' i.e., Insulin TYPES OF RECEPTORSMembrane receptorso Present on the cell membrane.o Their drug.;hormone binding domain is extracellular and effector domain is intracellular,o These are:G protein coupled receptors - It may act through.Adenylyl cyclase| cAMP - TSH, FSH, LH, ACTH, glucagon, PTH, adrenaline, calcitonin, vasopressin (V2).| cAMP - PR1H (Dopamine)IP.-DAG (Ca2+ and protein kinase 'c') - Vasopressin (V1), oxytocin.Channel regulation (Ca+2, K+, Na+)Receptor with Intrinsic ion channels - (Nay K+, Ca-2 or Cl-)Enzyme linked receptorsIntrinsic enzyme receptors (tyrosine kinase receptors) - Insulin.JAK-STAT kinase binding receptors - Growth hormone, Prolactin.Intracellular receptors (transcription factors)o Present inside the cell and induce synthesis of specific protein by increasing the expression of specific gene.Cytoplasmic - Glucocorticoids. Mineralocorticoids, Androgens, Progestins. Nuclear - Thyroxine, Triiodothyronine, Estrogen, retinoic acid, Vit D. -### End" -3019,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute retropharyngeal abscess, not true ?, with the following options: A: Due to lymphadenitis, B: Common in adults, C: Swelling on one side of midline, D: Incision & drainage - -### Response: -Ans. is 'b' i.e., Common in adults Retropharyngeal abscess Retropharyngeal space lies behind the pharynx, i.e. between buccopharyngeal fascia covering pharyngeal constrictor muscles (anteriorly) and preveebral fascia covering the preveebral muscles (posteriorly). So, retropharyngeal space lies behind the pharyngeal constrictor muscles and anterior to preveebral fascia covering the preveebral muscles. Abscess in this space may present differently depending upon the age :? Abscess in infants (acute Retropharyngeal abscess) It is commonly seen in infants and children below 3 years of age. Most commonly it results from retropharyngeal lymphadenitis due to an upper respiratory tract infection. The presention is acute, i.e. child has high temperature and sore throat. There is smooth swelling (bulge) in posterior pharyngeal wall on one side of the midline. There is dysphagia, difficulty in breathing, stridor, croupy cough and toicollis. Swelling can be palpable per orally on the posterior pharyngeal wall. Treatment is incision and drainage. Abscess in adults (chronic retropharyngeal abscess) If an adult or an older child has a retropharyngeal infection it is likely to be due to a tuberculous infection of the cervical spine (caries of cervical spine). Sometime it may be secondary to tuberculous infection of retropharyngeal lymph nodes. It is of slow onset and gives rise to pharyngeal discomfo, rather than pain. There is fluctuant swelling in posterior pharyngeal wall, centrally in the midline (if it is secondary to caries of cervical spine) or on one side of midline (if it is secondary to tuberculosis of retropharyngeal nodes). Treatment includes incision and drainage of abscess along with full course of antitubercular treatment. -### End" -3020,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: maximum absorption of IRON is seen in?, with the following options: A: duodenum, B: ileum, C: colon, D: jejunum - -### Response: -absorption of iron is maximum in duodenum. vit b12 absorption is maximum in ileum ref: guyton and hall -### End" -3021,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a contraindication to DPT vaccination?, with the following options: A: History of anaphylaxis to previous dose, B: Progressive neurologic illness, C: Fever, D: Encephalopathy within 7 days of previous dose - -### Response: -DPT Adverse effects - Persistent crying (mc) - Hypotonic Hypo-responsive episodes - Fever - Seizures - Encephalopathy C/l in - H/o anaphylaxis to previous dose - Any progressive neurological illness (static illness like CP not a c/l) - Encephalopathy within 7 days of vaccination -### End" -3022,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person having the habit of repeated self inflicted injuries, what is the type of personality, with the following options: A: Borderline personality disorder, B: Schizoid personality disorder, C: Histrionic personality disorder, D: Narcissistic personality disorder - -### Response: -A i.e. Border line personality disorderHabit or repeated self inflicted injuries (ex. suicidal tendencies) is characteristic feature of Borderline personality disorder. -### End" -3023,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for prophylaxis of Pneumocystis jiroveci pneumonia in immunocompromised patients is:, with the following options: A: Cotrimoxazole, B: Amoxycillin, C: Dexamethasone, D: Cefotetan - -### Response: -Ans (A) Cotrimoxazole(Ref: Harrison 19/e p1361)Cotrimoxazole is drug of choice forPneumocystis jiroveciNocardiaBurkholderia cepacia -### End" -3024,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Left anterior descending aery is a branch of, with the following options: A: Ascending aoa, B: Right coronary aery, C: Left coronary aery, D: Circumflex aery - -### Response: -Ascending aoa Right coronary aery Left coronary aery SA Nodal aery AV Nodal Aery Posterior Interventricular Aery (PIVA) Anterior Interventricular Aery (AIVA) OR Left anterior descending aery Circumflex Aery AIVA supplies the anterior 2/3rd of interventricular septum PIVA supplies the posterior 1/3rd of interventricular septum -### End" -3025,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most impoant hormone that increases gallbladder contraction after a fatty meal is:, with the following options: A: Gastrin, B: Secretin, C: CCK, D: GIP - -### Response: -Ans. c. CCK -### End" -3026,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are the benzodiazepines of choice in elderly and those with liver disease, except -, with the following options: A: Lorazepam, B: Oxazepam, C: Temazepam, D: Diazepam - -### Response: -Ans. is 'd' i.e., Diazepam Diazepam generates active metabolites, has slow elemination and tends to accumulate with regular use. Lorazepam, Oxazepam and Temazepam do not produce active metabolites and are relatively safer in elderly patients and in those with liver disease. These agents should be used in preference to diazepam. -### End" -3027,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acntholysis is characteristic of-, with the following options: A: pemphigus vulgaris, B: Pemphigoid, C: Erythema multoforme, D: Dermatitis herpctiforrnis - -### Response: -HP of pemphigus vulgaris shows a suprabasal cleft with bulla formation just above the basal layer with a tomb stone appearance and with blister cavity containing acantholytic cells and inflammatory cells.Page no 282. Reference IADVL's concise textbook of dermatology -### End" -3028,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Selective medium for Pseudomonas:, with the following options: A: Skirrow's medium, B: Regan Lowe medium, C: Cetrimide agar, D: Ashdown's medium - -### Response: -Pseudomonas Resistant to many common antiseptics like quaternary ammonium compounds, chloroxylenol and hexachlorophene. Indeed selective media have been devised incorporating Dettol or cetrimide. Skirrow's medium is selective for Campylobacter. Regan Lowe medium is selective for Bordetella peussis. Ashdown's medium is selective for Burkholderia pseudomallei. -### End" -3029,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transition mutation of GATCCT is:, with the following options: A: GGTCCT, B: GTTCCT, C: GABCCT, D: GrUGGT - -### Response: -A i.e. G G T C C T -### End" -3030,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Legal age of consent is -, with the following options: A: 10 Years, B: 18 Years, C: 14 Years, D: 16 Years - -### Response: -legal age for consent in india 18 yrs Sec 89 IPC. Act done in good faith for benefit of child or insane person, by or by consent of guardian.--Nothing which is done in good faith for the benefit of a person under twelve years of age, or of unsound mind, by or by consent, either express or implied, of the guardian or other person having lawful charge of that person, is an offence by reason of any harm which it may cause, or be intended by the doer to cause or be known by the doer to be likely to cause to that person. Ref: K.S.Narayan Reddy&;s synopsis of Forensic Medicine and Toxicology, 29 th edition, Chapter 4 page 30. -### End" -3031,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Too much false positives in a test is due to which of the following-, with the following options: A: High prevalence, B: Tests with high specificity, C: Tests with high sensitivity, D: High incidence - -### Response: -Ref :Parks 25th edition pg 152 Tests with high sensitivity gives too much false positives. Note Specificity and sensitivity are inversely related. High sensitivity means low specificity. Specificity = TN/ (TN+ FP).. low specificity means low TN, meaning high FP -### End" -3032,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Graft for myringoplasty is taken from, with the following options: A: Temporalis fascia, B: Iliacus fascia, C: Colles fascia, D: Iliotibial band - -### Response: -Graft material used for myringoplasty are:Temporalis fascia (most common)Tragal cailagePerichondrium from the tragusVeinRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 463 -### End" -3033,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: RSV causes all EXCEPT:, with the following options: A: Coryza in kids, B: ARDS, C: Bronchitis, D: Common cold - -### Response: -ARDS REF: Harrison's 18th ed chapter 186 The most common clinical manifestations of rhinovirus infections are those of the common cold. Illness usually begins with rhinorrhea and sneezing accompanied by nasal congestion. The throat is frequently sore, and in some cases sore throat is the initial complaint. Systemic signs and symptoms, such as malaise and headache, are mild or absent, and fever is unusual. Illness generally lasts for 4-9 days and resolves spontaneously without sequelae. In children, bronchitis, bronchiolitis, and bronchopneumonia have been repoed; neveheless, it appears that rhinoviruses are not major causes of lower respiratory tract disease in children. Rhinoviruses may cause exacerbations of asthma and chronic pulmonary disease in adults. The vast majority of rhinovirus infections resolve without sequelae, but complications related to obstruction of the eustachian tubes or sinus ostia, including otitis media or acute sinusitis, can develop. In immunosuppressed patients, paicularly bone marrow transplant recipients, severe and even fatal pneumonias have been associated with rhinovirus infections. -### End" -3034,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true regarding tubercular osteomyelitis, with the following options: A: It is secondary to TB, B: Periosteal reaction is seen, C: Sequestrum is uncommon, D: inflammation is minimum - -### Response: -peiosteal reaction is usually not seen in tubercular osteomyelitis. Tuberculous osteomyelitis * Bone Tuberculosis * Hematogenous spread of organisms from an active focus of tuberculosis : -- lung (common) -- mediastinal or aoic lymph nodes -- kidney -- bowel * Most common in children&youngs * The veebrae and the long bones of the extremities are most frequently involved * In many cases the infection also spreads to contiguous joints such as the hip, knee, and interveebral joints Pathology * The onset of tuberculous osteomyelitis is usually insidious. * The infection is unrelenting, necrotizing, and destructive of bone, cailage, and soft tissue. * The tuberculous exudation and the inflammatory necrosis may extend through the medullary and coical bone, penetrate through the periosteum, and progress through the epiphysial and aicular , cailage. * Tunneling sinuses may extend into the adjoining soft tissue and drain to the skin surface. * Sequestration and the formation of an involucrum are uncommon . Tuberculosis of the spine (Potts disease)* * The thoracic and lumbar veebrae * The infection often begins in the anterior pa of the veebral body and extends into the interveebral disc: 7- - Destruction and collapse of the veebral bodies and discs -- Kyphosis -- Kyphoscoliosis xray of tb osteomylitis ref : maheswari 9th ed -### End" -3035,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coombs test is, with the following options: A: Precipitation test, B: Agglutination test, C: CFT, D: Neutrilization test - -### Response: -Agglutination test:-insoluble antigen +antibody=clumps. Principle-When sera containingantibodies are mixed with antigen coated red cells, the antibody globulin coats the surface of the erythrocytes,though they are not agglutinated. When such erythrocytes coated with the antibody globulin are washednfree of all unattached protein and treated with a rabbitantiserum against human gamma globulin (antiglobulin or Coombs serum), the cells are agglutinated example:- 1. Coombs test (antiglobulin test or anti-Rh antibody test) is an agglutination test. The direct Coombs test is used to detect antibodies that are stuck to the surface of red blood cells. this. These antibodies sometimes destroy red blood cells and cause anemia. this in done for fetal ab(in vivo test) The indirect Coombs test looks for free-flowing antibodies against ceain red blood cells. It is is most often done to determine if you may have a reaction to a blood transfusion. done for detecting Maternal Ab(in vitro test) -### End" -3036,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thrombocytosis may be seen in the following conditions except -, with the following options: A: Idiopathic myelofibrosis, B: Chronic myeloid leukemia, C: Essential thrombocythemia, D: Hypersplenism - -### Response: -Reactive thrombocytosis is seen in chronic inflammatory disorders ,hemolytic anemia , malignant disease , tissue damage, post-splenectomy,post-hemorrhage . Clonal thrombocytosis is seen in primary thrombocythemia,polycythaemia rubra vera,chronic myeloid leukaemia ,myelofibrosis,myelodysplastic syndromes .Reference:Davidson's principles & practice of medicine 22nd edition pg no 1008 -### End" -3037,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Difference between Dispensary and PlIC is that a PHC-, with the following options: A: Gives integrated services, B: Is confined to paicular area, C: Is managed by medical officer, D: Is located in rural areas - -### Response: -Ans. is 'a' i.e., Gives integrated services o Primary health centres provide, as close to the people as possible, an integrated, curative and preventive health care to the rural population, with emphasis on preventive and promotive aspects of health care. The functions of a PlIC are integrated in such a way so as to provde a variety of ""Essential"" elements of primary health care which are not provided by a dispensary. -### End" -3038,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which statement is TRUE about Standard normal distribution curve :, with the following options: A: Mean -1, standard deviation - zero, B: Standard deviation 1, mean-zero, C: Curve skews towards left, D: Curve skews towards right - -### Response: -Ans. is 'b' ie Standard deviation = 1 & mean is 0 Standard Normal Curve*is based on infinitely large no of observationsit is smooth, bell shaped, perfectly symmetrical curve, it does not skew either to the right or left side.the total area of the curve is 1*Mean is O, *Standard deviation is 1*Mean, median, mode all coincide* -### End" -3039,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement about penicillin G is?, with the following options: A: It is administered orally, B: It has a wide spectrum, C: It can be used for rate bite fever, D: Co-administration of probenecid decreases its duration of action - -### Response: -PnG is a narrow spectrum antibiotic; activity is limited primarily to gram-positive bacteria and few others. Penicillin G is acid labile-destroyed by gastric acid. As such, less than 1 /3rd of an oral dose is absorbed in the active form. Absorption of sod. PnG from i.m. site is rapid and complete; peak plasma level is attained in 30 min. Uses Penicillin G is the drug of choice for infection caused by organisms susceptible to it, unless tho: patient is allergic to this antibiotic. However, use has declined very much due to fear of causing anaphylaxis.Topical use of penicillin is highly sensitizing (contact dermatitis and other reactions). Therefore, all topical preparations of penicillin (including eye ointment) have been banned, except for use in eye as freshly prepared solution in case of gonococcal ophthalmia. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:696 -### End" -3040,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs that can be used for out patient treatment of community acquired pneumonia are:, with the following options: A: Ceftriaxone, B: Cefazolin, C: Imipenem, D: Azithromycin - -### Response: -Azithromycin This new azalide congener of erythromycin has an expanded spectrum, improved pharmacokinetics, better tolerability and drug interaction profiles. It is more active than other macrolides against H. influenzae, but less active against gram-positive cocci. High activity is exeed on respiratory pathogens-Mycoplasma, Chlamydia pneumoniae, Legionella, Moraxella and on others like Campylobacter, Ch. trachomatis,H. ducreyi, Calymm, granulomatis, N. gonorrhoea However, it is not active against erythromycin.resistant bacteria. Penicillinase producing Staph aureus are inhibited but not MRSA. Good activity is noted against MAC. Because of higher efficacy, better gastric tolerance and convenient once a day dosing azithromycin is now preferred over erythromycin as first choice drug for infections such as: (a) Legionnaires&; pneumonia: 500 mg OD oral/ i.v. for 2 weeks. Erythromycin or a FQ are the alternatives. (b) Chlamydia trachomatis: nonspecific urethritis and genital infections in both men and women- 1 g single dose is curative, while 3 weekly doses are required for lymphogranuloma venereum. It is also the drug of choice for chlamydia! pneumonia and is being preferred over tetracycline for trachoma in the eye. (c). Donovanosis caused by Calymmatobacterium granulomatis: 500 mg OD for 7 days or 1.0 g weekly for 4 weeks is as effective as doxycycline. (d) Chancroid and PPNG urethritis: single 1 .0 g dose is highly curative. The other indications of azithromycin are pharyngitis, tonsillitis, sinusitis, otitis media, pneumonias, acute exacerbations of chronic bronchitis, streptococcal and some staphylococcal skin and soft tissue infections. In combination with at least one other drug it is effective in the prophylaxis and treatment of MAC in AIDS patients. Other potential uses are in typhoid, toxoplasmosis and malaria. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:730,731 -### End" -3041,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which infection is not common in HIV patients ?, with the following options: A: Cryptosporidiosis, B: Atypical mycobacterial infection, C: Aspergillosis, D: Candidiasis - -### Response: -Ans. is 'c' i.e., Aspergillosis ""Invasive Aspergillosis is not an AIDS defining illness and is generally not seen in patients with AIDS in the absence of neutropenia or administration of glucocoicoids"" Ans. is 'c' i.e., Aspergillosis -### End" -3042,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest tumour at inner canthus of eye -, with the following options: A: Rodent ulcer, B: Dermoid cyst, C: Malignant melanoma, D: Buruli ulcer - -### Response: -Ans. is 'a' i.e., Rodent ulcer -### End" -3043,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Telescopic test is useful to diagnose, with the following options: A: Pehe's disease, B: Intracapsular fracture neck of femur, C: Malunited Trochanteric fracture, D: Ankylosis of hip joint - -### Response: -Positive Telescopy test indicates instability of hip joint such as: old unreduced posterior dislocation, loss of neck and or head in old fractures neck femur and paralytic hip. Telescoping digits is seen in psoriatic ahritis -### End" -3044,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What are telomerases which plays a role in DNA replication?, with the following options: A: DNA dependent DNA polymerase, B: RNA dependent DNA polymerase, C: DNA dependent RNA polymerase, D: RNA dependent RNA polymerase - -### Response: -Telomerase is a RNA dependent DNA polymerase that is expressed in stem cells and most cancer cells, but not in somatic cells. Using an RNA template, telomerase adds GT-rich hexanucleotide repeat sequences ranging from a few hundred (yeast) to several thousand (humans) nucleotides in length to the ends of linear DNA molecules to restore their telomeres to full length. Must know: Telomeres are composed of long strings of GT-rich hexanucleotide repeats that cap the ends of eukaryotic chromosomes. The telomeres at the ends of eukaryotic chromosomes progressively shoen with each cycle of replication. Ref: Kennelly P.J. (2011). Chapter 54. The Biochemistry of Aging. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. -### End" -3045,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If the axial length of the eyeball is changed by limn then the power changes by:, with the following options: A: 1 dioptre, B: 2 D, C: 3 D, D: 4 D - -### Response: -C i.e. 3 Dioptres A decrease in 1 mm in curvature of cornea leads to hypermetropia of 6D while 1 mm decrease in length leads to hypermetropia of 3D.Q -### End" -3046,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is bactericidal?, with the following options: A: Sulfonamides, B: Erythromycin, C: Chloramphenicol, D: Cotrimoxazole - -### Response: -Primarily bactericidal: Penicillins Cephalosporins Aminoglycosides Vancomycin Polypeptides Nalidixic acid Rifampin Ciprofloxacin Isoniazid Metronidazole Pyrazinamide Cotrimoxazole ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:669 -### End" -3047,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: felon most commonly present at -, with the following options: A: Index finger, B: Ring finger, C: Little finger, D: Middle finger - -### Response: -Ans. is 'a' i.e., Index finger Felono Infection of the terminal pulp space is known as 'Felon', which is common and potentially serious,o Dull pain and swelling are the first symptoms, and if untreated by the third day there are severe nocturnal exacerbations of throbbing pain, interfering with sleep, o Light pressure over the affected pulp increases the pain,o In the early acute phase antibiotic treatment is often successful.o If localization of the pus has occured, which is indicated by persistent pain, localized tenderness, then it should be drained by a lateral incision which opens all compartments and avoids damage to the tactile tissue in front of the finger.o If neglected, it may lead to necrosis of distal 4/5 of the terminal phalanx due to occlusion of the vessels by- tension. The proximal 1/5 (epiphysis) escapes because its artery does not transverse the fibrous septa. -### End" -3048,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19 year old patient presents with primary amenorrhoea. She has well developed breasts and axillary and pubic hair. Uterus and vagina are absent. The diagnosis is most likely:, with the following options: A: XYY syndrome, B: Gonadal dysgenesis, C: Mullerian agenesis, D: Klinefelter's syndrome - -### Response: -Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) is the second most common cause of primary amenorrhea. Clinical features: Normal ovarian development Normal endocrine function Normal female sexual development Shoened or absent vagina in addition to absence of the uterus Individuals have 46,XX karyotype Ref: Rosen M.P., Cedars M.I. (2011). Chapter 13. Female Reproductive Endocrinology and Infeility. In D.G. Gardner, D. Shoback (Eds),Greenspan's Basic & Clinical Endocrinology, 9e. -### End" -3049,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dot and blot (round) retinal haemorrhages are situated at the level of:, with the following options: A: Ganglion cell layer, B: Nerve fibre layer, C: Inner nuclear layer, D: Outer plexiform layer - -### Response: -Ans. Outer plexiform layer -### End" -3050,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anterior cerebral artery supplies which part of brain?, with the following options: A: Anterior, B: Lateral, C: Medial, D: Posterior - -### Response: -Most of the medial surface is supplied by the anterior cerebral artery. It also supplies the medial part of the orbital surface of the frontal lobe -Middle cerebral artery supplies most of the superolateral surface of brain. It also supplies the temporal lobe and the lateral part of the orbital surface of the frontal lobe -Most of the inferior surface(except the temporal pole )and occipital lobe is supplied by the posterior cerebral artery. -### End" -3051,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congestive hea failure in an infant is characterized by all except, with the following options: A: Pedal edema, B: Tachypnea, C: Sweating, D: Poor weight gain - -### Response: -Congestive Cardiac Failure in InfantsSymptomsSignsuFeeding difficultyuTakes less volume per feeduDiaphoretic while suckinguForehead sweating.uSuck-rest-suck cycle.uPoor weight gainuPeriorbital edema uClothes no longer fituIncreasing cloth sizeuRapid breathing/nasal flaring/cyanosis/chest retractions.uTachycardia.uHepatomegaly.uOccasionally Splenomegaly.uPeriorbital edemauEdema in flanks. uDependent edema (Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:1530) -### End" -3052,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A two-month-old infant is brought to emergency depament with marked respiratory distress. On examination, the infant has cyanosis and bilateral crepitations. Hea rate is 180/min, respiratory rate 56/min and the liver span 7.5 cm. The child had repeated episodes of fever, cough and respiratory distress since the time of bih. Cardiovascular examination reveals a grade III ejection systolic murmur in left para-sternal area and the chest X-ray reveals cardiomegaly with a narrow base and plethoric lung fields. What is the most likely diagnosis?, with the following options: A: Congenital methemoglobinemia, B: Transposition of great aeries, C: Cystic fibrosis, D: Tetralogy of Fallot - -### Response: -- In the given case scenario, infant has features of hea failure, cyanosis with repeated episodes of pneumonia suggesting increased pulmonary blood flow. - These clinical features along with the chest X ray findings are suggestive of Transposition of great aeries. - ON X-RAY : 'Egg on side' or 'Egg on string' appearance is characteristic of transposition of great aeries Other options: Congenital methemoglobinemia: Inherited in autosomal recessive pattern Diagnosed by genetic testing/ blood tests CYSTIC FIBROSIS: Mutation in gene encoding for CFTR - Located on long arm of chromosome 7 Presents with recurrent bronchiolitis in infancy, recurrent lower resp tract infections, bronchiectasis, steatorrhea, pancreatitis & azoospermia Diagnosed by presence of typical phenotype/ family history & confirmed by high sweat chloride on atleast 2 occasions/ by identifying mutation in both copies of CFTR TOF: Doesn't present with cyanosis at bih. X-ray shows Boot shaped hea. -### End" -3053,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Premalignant lesion of the vulva is -, with the following options: A: Kraurosis, B: Leucoplakia, C: Condyloma accuminata, D: Localised scleroderma - -### Response: -Ans. is 'b' i.e., Leukoplakiao Leukoplakia of vulva means white plaque which may indicate : ?Benign lesionsPremalignant lesionsMalignant lesions -### End" -3054,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior ethmoidal sinus drains into (JIPMER May 2019), with the following options: A: Spheno-ethmoidal recess, B: Superior meatus, C: Middle meatus, D: Inferior meatus - -### Response: -- There are 3 groups of ethmoidal air sinuses Anterior Middle Posterior - Posterior ethmoidal sinus is opening in lateral wall of the nose. - Lateral wall of the nose has 3 elevations called superior, middle & inferior turbinates / conchae - Under each turbinate, there is space called meatus called superior, middle & inferior meatus - Posterior ethmoidal sinus is opening in superior meatus - Anterior & middle sinus is opening in middle meatus - Middle meatus have hiatus semilunaris At front of hiatus semilunaris frontal air sinus opens The anterior, middle ethmoidal sinus respectively Maxillary sinus opens slightly posterior; In the region of hiatus semilunaris in middle meatus - Naso-lacrimal duct opens in the inferior meatus on Anterior aspect - Inferior turbinate is largest turbinate & its meatus is largest meatus - Eustachian tube opens behind inferior turbinate in lateral wall of nasopharynx -### End" -3055,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following imaging modality is most sensitive to detect early renal tuberculosis –, with the following options: A: Intravenous urography, B: Ultrasound, C: Computed tomography, D: Magnetic resonance imaging - -### Response: -Essentially, early findings are best detected on IVP while USG and CT are useful for late or chronic changes. -### End" -3056,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: a 32-year-old female, from rural background presented with a h/o chronic tobacco chewing since 14 years of age. Now she has difficulty in opening her mouth. On oral examination, no ulcers are seen - Most probable diagnosis is, with the following options: A: Submucosal oral fibrosis, B: Carcinoma of tongue, C: Trigeminal nerve paralysis, D: Carcinoma of buccal mucosa - -### Response: -Submucous oral fibrosis is a progressive ds. in which fibrous bands form beneath the oral mucosa. These bands progressively contract so that ultimately mouth opening is severely limited. Tongue movements may also be limited. This condition is almost entirely confined to Asians. Histological it is characterized by juxtaepithelial fibrosis with atrophy or hyperplasia of the overlying epithelium which also shows areas of epithelial dysplasias. The etiology is obscure. Hypersensitivity to chilli; betel nut, tobacco and vitamin deficiencies have been implicated. The scar bands of submucous fibrosis, which result in difficulty in opening can be treated either by intralesional injection of steroids or by surgical excision and grafting, but this has little effect in preventing the onset of squamous cell Ca in the generally atrophic oral mucosa (Submucous oral fibrosis is a precancerous condition for squamous cell Ca)."" - Ref : Bailey & Love 25/e p737 -### End" -3057,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true regarding vessels in the umbilical cord :, with the following options: A: Two aeries & two vein, B: One a & one vein, C: Two a & the left vein, D: Two a & the left vein - -### Response: -C. i.e. Two aeries and the left vein; -### End" -3058,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 year old female presented with post coital bleeding. Next step of management is:, with the following options: A: Pap smear and colposcopy, B: Visual inspection with acetowhite, C: Visual inspection with lugol's iodine, D: Colposcopy directed biopsy - -### Response: -Postcoital bleeding (PCB) has many causes, including vaginitis, cervicitis, cervical dysplasia and malignancy, uterine lesions, and pregnancy. Some women with postcoital bleeding may have pathologic lesions identified at colposcopic evaluation that had been missed by Pap smear screening. Thus, colposcopic examination is considered for women with unexplained postcoital bleeding. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 8. Abnormal Uterine Bleeding. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e. -### End" -3059,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The diagnosis of diabetes mellitus is ceain in which of the following situations?, with the following options: A: Abnormal oral glucose tolerance in a 24-yrs-old woman who has been dieting, B: Successive fasting plasma glucose concentrations of 8, 9, and 8.5 mmol/L in an asymptomatic, otherwise healthy businesswoman, C: A serum glucose level >7.8 mmol/L in a woman in her twenty-fifth week of gestation after a 50-g oral glucose load, D: Persistent asymptomatic glycosuria in a 30-yrs-old woman - -### Response: -The occurrence of hyperglycemic ketoacidosis or hyperglycemic hyperosmolar coma is diagnostic of diabetes mellitus. Similarly, persistent fasting hyperglycemia , even if it is asymptomatic, has been recommended by the National Diabetes Data Group as a criterion for the diagnosis of diabetes. However, abnormal glucose tolerance-whether after eating or after a standard ""glucose tolerance test"" -can be caused by many factors (e.g., anxiety, infection or other illness, lack of exercise, or inadequate diet). Similarly, glycosuria may have renal as well as endocrinologic causes. Therefore, these two conditions cannot be considered diagnostic of diabetes. Gestational diabetes is diagnosed in women between the twenty-fouh and twenty-eighth weeks of gestation, first using a 50-g oral glucose load if the I-h glucose level >7.8 mmol/L (140 mg/dL); a 100-g oral glucose test is performed after an overnight fast. Gestational diabetes is initially treated with dietary measures; if the postprandial glucose level remains elevated, insulin therapy is often staed. About 30% of women with gestational diabetes will eventually develop true diabetes mellitus. -### End" -3060,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about osteoclasts is not TRUE?, with the following options: A: They have acidophilic cytoplasm, B: They stain strongly with alkaline phosphatase, C: The cytoplasmic surface that abuts the bone being resorbed is characterized by a clear zone and a ruffled border, D: They are found in Howship's lacunae - -### Response: -Osteoclasts are of monocytic (hematopoietic) origin. They differ histologically from osteoblasts because they are multinucleate cells with acidophilic cytoplasm, whereas osteoblasts have basophilic cytoplasm and only one nucleus. Osteoblasts stain well with alkaline phosphatase; osteoclasts stain with acid phosphatase. Osteoclasts are found in indentations in the bone they are resorbing. These indentations are called Howship's lacunae. The cytoplasmic surface that abuts the Howship's lacuna has many projections, somewhat like microvilli, that are referred to as ruffles. Next to the ruffled border is a clear zone that delimits the outer edge of bone resorption. An electron microscopy, the only organelles found in the clear zone are actin filaments, which are thought to attach the osteoclast to bone and create a seal around the resorptive. -### End" -3061,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not used for treating acute iron poisoning: March 2009, with the following options: A: Desferrioxamine, B: BAL, C: Magnesium hydroxide, D: Hemodialysis - -### Response: -Ans. B: BAL Chelation with desferrioxamine is the mainstay of therapy. It is indicated for serum iron levels >350 mcg/ dL with evidence of toxicity or >500 mcg/ dL regardless of signs or symptoms. Because adsorption to activated charcoal is minimal, whole bowel irrigation is the GI decontamination (polyethylene glycol) is the method of choice. 1 percent Magnesium hydroxide solution orally Hemodialysis/exchange transfusion in severe cases. -### End" -3062,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serum gamma glutamyl transpeptidase maximum increased in, with the following options: A: Alcoholism, B: Pancreatitis, C: Myocardial infarction, D: Hepatitis - -### Response: -A. i.e. (Alcoholism) (107- U. Satyanarayan 3rd) (600- Rana -Shinde 7th)Important enzymes in the diagnosis of disease* SGPT / ALT- Liver disease (Hepatitis)* SGOT/AST- MI & Liver disease* LDH- MI, Infective hepatitis* CPK- Myocardial infarction* Aldolase- Muscular dystrophy* 5 - Nucleotidase- Hepatitis* Y- Glutamyl- transpeptidase (GGT)- Alcoholism* Y- GT is the most sensitive indicator in alcoholism* Useful test for MI in later stages* Increase serum activity seen with pancreatic disease* It is a valuable parameter in differentiating between skeletal (bone) and hepatic dysfunction associated withincreased serum ALP -### End" -3063,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gene encoding which protein is defective in Dubin Johnson syndrome?, with the following options: A: JAG1, B: MRP2, C: ATP7A, D: ATP 7B - -### Response: -B. MRP2(Ref: Nelson's 20/e p 1931, 1938)In Dubin Johnson syndrome, ABCC2 gene is affected, that codes for MRP2 protein. Absent function of multiple drug-resistant protein 2 (MRP2), an adenosine triphosphate-dependent canalicular transporter, is the responsible defect, that leads to defective conjugated bilirubin excretion. -### End" -3064,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mrs AR G3 P1LIA a full term pregnant female is admitted in labor. On examination, she has uterine contractions 2 in 10 minutes, lasting for 30-35 seconds.On P/A examination 3/5th of the head is palpable per abdomen.On P/V examination-cervix is 4 cms dilated, membranes intact.On repeat examination 4 hours later, cervix is 5 cms dilated, station is unchanged, and cervicograph remains to the right of the alert line. Which of the following statements is true?, with the following options: A: The head was engaged at the time a of presentation, B: Her cervicographical progress is satisfactory, C: Her cervicographical status suggests intervention, D: On repeat examination, her cervicograph should have touched the action line. - -### Response: -In this patient at the beginning of the labor, three fifths of the head was palpable , which indicates head is not engaged as head is said to be engaged only if 1/5th is palpable per abdomen… -### End" -3065,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common location of peptic ulcer is -, with the following options: A: 1st part of duodenum, B: Lesser curvature of stomac, C: Gastric antrum, D: At gastro-esophagal junction - -### Response: -Ans. is 'a' i.e., 1st part of duodenum Peptic ulcers are located in the following sites, in order of decreasing frequency (Robbins 7/e)1. Duodenum, 1st portion2. Stomach, usually antrum3. At the gastro - esophageal junction, in the setting of gastroesophageal reflux or Barrett's esophagus4. Within the margins of a gastrojejunostomy5. In the duodenum, stomach or jejunum of patients with Zollinger-Ellison Syndrome6. Within or adjacent to Meckels diverticulum that contains ectopic gastric mucosa -### End" -3066,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epimer combination (s) is/are :, with the following options: A: D-glucose & D-fructose, B: D-mannose & D-talose, C: D-glucose & D-mannose, D: None of these - -### Response: -C, i.e. D-glucose - Carbohydrate isomers that differ in configuration around only one carbon atom are called epimers. D-glucose and Dmannose are C2 epimers whereas D- glucose and D- galactose differ only at C4. However, D-mannose & D- galactose are not epimersQ as they differ at 2 carbons (2 & 4). Enantiomers (optical isomers or stereoisomers) are pairs of structures that are mirror images of each other but not identical , similar to left and right hand which are the same but opposite. These are non super imposable and are designated as D and L-sugar. Each enantiomer often shows different chemical reactions with other enantiomers. Because of presence of many enantiomers in living beings, there is usually a marked difference in effects of two stereoisomers. For example only one of drug stereoisomer produces desired effect while the other does not. -### End" -3067,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spalding's ring is seen in :, with the following options: A: Still born, B: Live born, C: Premature, D: Dead born - -### Response: -Spalding sign : It is the irregular overlapping of the cranial bones on one another, due to liquefication of brain matter and softening of the ligamentous structures suppoing the vault. Appears 7 days after death. Ref: Datta Obs 9e pg 303. -### End" -3068,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In acute tubular necrosis, all are true except, with the following options: A: Specific gravity of urine < 1.020, B: Urine Osmolatlity > 500, C: Blood urea: creatinine ratio < 20, D: Urine sodium < 20mmol/l - -### Response: -Acute tubular necrosis: - Muddy brown granular or tubular epithelial cell casts- FENa > 1%- UNa > 20 mmol/L- SG < 1.015 Ref: Harrison's 17/e p1757 table 273-2 -### End" -3069,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute silicosis clinical manifestation is, with the following options: A: Pulmonary alveolar proteinosis, B: Hypersensitivity penumonitis, C: Hypersensitivity pneumonia, D: Forms nodules and causes pneumoconiosis - -### Response: -Ans. is 'a' i.e., Pulmonary alveolar proteinosis Silicosis Silicosis is a lung disease caused by inhalation of cystalline silicon diaoxide (silica). o currently, it is the most prevalent occupational disease in the world. o There are three types of silicosis - i) Acute silicosis Results from sho-term exposure to a very large amounts of silica. A subset of acute silicosis is silicoproteinosis the chest radiographic appearance of which mimic pulmonary alveolar proteinosis. A miliary picture with very small round opacities may also occur in lower lung fields. ii) Accelerated silicosis Occurs after exposure to large amounts of silica over a shoer period of time (4-8 years). Inflammation, scarring and symptoms progress faster than chronic silicosis. iii) Chronic silicosis Results from long term exposure (more than 20 years) of low amounts of silica dust. Nodules in upper zones of lung. Fibrotic lesions in hilar lymph node & pleura Progressive massive fibrosis increased susceptibility of TB --> silicotuberculosis -### End" -3070,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about management of PDPH except-, with the following options: A: Early ambulation, B: Hydration, C: Cerebral vasoconstriction - caffeine, D: Analgesic - -### Response: -Ambulation causes aggravation of PDPH. Bed rest is advised. PDPH- Post Dural Puncture headache. May follow lumbar puncture, spinal anesthesia, wet epidural tap (in which epidural needle pierced dura). Onset 12-72hrs and last for 1-2 weeks. Aggravated by sitting and relieved by lying down. Incidence increases with the larger needle, cutting point (in comparison to pencil point) needle, young age, females, pregnancy. Prevention by thinner needle Management: Supine position IV fluids Caffeine and analgesia Epidural blood patch -### End" -3071,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sterilization & disinfection of blood spills is done by-, with the following options: A: Fordaldehyde, B: Sodium Hypochlorite, C: Tincture iodine, D: Phenols - -### Response: -.

hypochlorites are the most widely used chlorine disinfectants.sodium hypochlorite is available as a liquid.aqueous solutions of this of 5.25 to 6.15 percent is called ""house bleach"".they have a broad spectrum of antimicrobial activity.do not leave toxic residues,are unaffected by hardness of water are inexpensive and fast acting remove driede or fixed organisms and biofilms from surfaces.

ref;park&;s textbook of preventive and social medicine,22 nd edition,pg no 120

-### End" -3072,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Double stranded RNA exists in:, with the following options: A: A-DNA like conformation, B: B-DNA like conformation, C: Z-DNA like conformation, D: None of these - -### Response: -Double stranded RNA exists in A- DNA like conformation Usually RNA is single stranded, DNA is double stranded. But in few species, double stranded RNA is found e.g. Rotavirus. B-DNA A-DNA Z-DNA Base pairs/turn 10 11 12 Right/left handed Right Right Left with zigzag sugar-phosphate backbone Function Major DNA in cells Dehydrated DNA or in DNA-RNA regions or in Double stranded RNA Regulation of gene expression, paicularly in GC sequence (alternating Purine-Pyrimidine) -### End" -3073,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Effect of Thiazides on calcium, with the following options: A: Increase excretion, B: Decrease excretion, C: Counterregulatory, D: None - -### Response: -Thiazides spare calcium by inhibiting their excretion.Ref: Goodman Gilman 12/e p 678 -### End" -3074,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apatient who is at risk of estrogen dependent carcinoma andhence estrogen is contraindicate d. So in order to prevent vasomotor symptoms, which drug is given?, with the following options: A: Tamoxifen, B: Conjugated estrogen, C: Clonidine, D: Yombinine - -### Response: -ANSWER: (C) ClonidineREF: Novak's gynecology 13th edition page 455In women for whom hormone replacement is contraindicated, multiple alternative treatments for hot flashes have been developed. Somewhat effective alternatives may be progestins such as medroxyprogesterone (10 to 30 mg daily orally) or megestrol acetate (20 to 40 mg daily orally). If either of these progestins results in intolerable side effects, the use of alternative progestins may be considered, although few data exist regarding their efficacy.In addition to the progestins, other nonsteroidal treatments for hot flashes have been developed. One of the best studied is the b 2-adrenergic agonist, clonidine. This drug probably works through both central and peripheral mechanisms and can be given either orally (0.05 mg twice daily) or by transdermal patch. -### End" -3075,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most esthetic restorative option for carious primary incisors is:, with the following options: A: Unbonded strip crown, B: Dura crown, C: Nu-Smile Crown, D: Bonded strip crown - -### Response: -The most esthetic restorative option for carious primary incisors is the bonded strip crown. - -This is the first choice of many clinicians due to the superior esthetics and the ease of repair, if the crown should subsequently chip or fracture. -This is, however, the most technique-sensitive option. -Hemorrhage or saliva on the tooth will interfere with the bond, and hemorrhage can interfere with the shade or color of the material. -Adequate tooth structure must remain after caries removal to ensure sufficient surface area for bonding. - -Classification -a) Crowns that are luted to the tooth -1) Resin veneered stainless steel crown -2) Facial cut out crown -3) Polycarbonate crown -4) Pedo pearls -b) Crowns that are bonded to the tooth -1) Strip crowns -2) Pedo jacket crowns -3) New millennium crowns -### End" -3076,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause (s) of secondary brain injury is/are-, with the following options: A: Pyrexia and hypotension, B: Seizures and metabolic disturbance, C: Low cerebral perfusion pressure, D: All of the above - -### Response: -Secondary brain injury refers to the changes that evolve over a period of time (from hours to days) after the primary brain injury. Primary and secondary brain injury are ways to classify the injury processes that occur in brain injury. Examples in traumatic brain injury Primary Secondary Intracerebral hemorrhage Subdural hemorrhage Subarachnoid hemorrhage Epidural hemorrhage Cerebral contusion Cerebral laceration Axonal stretch injury. Cerebral edema Impaired metabolism Altered cerebral blood flow Free radicalformation Excitotoxicity -### End" -3077,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Right shift of oxygen dissociation curve is caused by?, with the following options: A: Hypothermia, B: Hypoxia, C: Alkalosis, D: HbF - -### Response: -Ans. is `b' i.e., Hypoxia -### End" -3078,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A middle aged person is rushed to emergency depament with history of loss of motor power on left upper and lower limb since last 30 minutes. Imaging modality of choice to plan appropriate treatment will be, with the following options: A: CT scan of the head, B: MRI of the brain, C: Carotid doppler study, D: EEG - -### Response: -Hemiparesis, or unilateral paresis, is weakness of one entire side of the body (hemi- means ""half""). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke Depending on the type of hemiparesis diagnosed, different bodily functions can be affected. Some effects are expected (e.g., paial paralysis of a limb on the affected side). Other impairments, though, can at first seem completely non-related to the limb weakness but are, in fact, a direct result of the damage to the affected side of the brain. Loss of motor skills Edit People with hemiparesis often have difficulties maintaining their balance due to limb weaknesses leading to an inability to properly shift body weight. This makes performing everyday activities such as dressing, eating, grabbing objects, or using the bathroom more difficult. Hemiparesis with origin in the lower section of the brain creates a condition known as ataxia, a loss of both gross and fine motor skills, often manifesting as staggering and stumbling. Pure Motor Hemiparesis, a form of hemiparesis characterized by sided weakness in the leg, arm, and face, is the most commonly diagnosed form of hemiparesis Ref Harrison20th edition pg 2234 -### End" -3079,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest cancer in which metastasis is seen in the brain is -, with the following options: A: Breast, B: Lung, C: Kidney, D: Intestines - -### Response: -Lung cancer(commonest metastasis to brain) and melanomas are most likely to present with multiple metastasis, whereas breast, colon, and renal cancers are more likely to present with a single metastasis. Ref Harrison 20th edition pg 539 -### End" -3080,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most frequent trace mineral deficiency developing in a patient receiving parenteral alimentation is a deficiency of, with the following options: A: Ca, B: Chromium, C: Cobalt, D: Zinc - -### Response: -Zinc deficiency is marked by an eczematoid rash either diffusely or in interiginous areas. A microcytic anemia can develop from a lack of copper and glucose intolerance and may be associated with a lack of chromium. Daily administration of trace metal supplements obtes these problems. -### End" -3081,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If a doctor gives a -false medical certificate to a patient, he is liable to be prosecuted under which section of the IPC -, with the following options: A: 137, B: 147, C: 167, D: 197 - -### Response: -197 IPC: Issuing or signing (attesting) false certificate by a doctor is a criminal offence. -### End" -3082,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Combination hormone contraceptive are began after how many weeks following delivery ideally, with the following options: A: 4 weeks, B: 6 weeks, C: 10 weeks, D: 12 weeks - -### Response: -Combination hormonal contraceptives are started 6 weeks after delivery if breast feeding is well established and infant's nutritional status is surveiled. -### End" -3083,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recommendation of daily moderate exercise for an adult is, with the following options: A: 15 mins, B: 30 mins, C: 45 mins, D: 60 mins - -### Response: -Physical activity for all These recommendations are relevant to all healthy adults aged 18-64 years unless specific medical conditions indicate to the contrary. They are applicable for all adults irrespective of gender, race, ethnicity or income level. They also apply to individuals in this age range with chronic noncommunicable conditions not related to mobility such as hypeension or diabetes. These recommendations can be valid for adults with disabilities. However adjustments for each individual based on their exercise capacity and specific health risks or limitations may be needed. There are multiple ways of accumulating the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shoer bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week. Pregnant, postpaum women and persons with cardiac events may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for this age group. Inactive adults or adults with disease limitations will have added health benefits if moving from the category of ""no activity"" to ""some levels"" of activity. Adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them. Ref: World Health Organisation -### End" -3084,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fracture-a-la signature is: Al 11; MAHE 12; AIIMS 13, with the following options: A: Gutter fracture, B: Depressed fracture, C: Ring fracture, D: Sutural separation - -### Response: -Ans. Depressed fracture -### End" -3085,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 9-year-old child with high arched palate has shoulders meeting in front of his chest. He has:, with the following options: A: Erb's palsy, B: Cleidocranial dysostosis, C: Chondro-osteodystrophy, D: Coical hyperostosis - -### Response: -CLEIDOCRANIAL DYSOSTOSIS-AD Clinical and Radiological Features: Skull Involvement- Elfin faces- skull is wider but the face appears small and flat looking (hypoplastic bones) Eyes are wide set Deciduous teeth erupt normally,permanent teeth are delayed and maldeveloped. Clavicles maybe underdeveloped or absent. M/C defect is loss of lateral 1/3rd > loss of middle third of clavicle Bilateral clavicle hypoplasia, child can touch the shoulders together in front of the chest. Limbs- Coxa vara is seen, 2nd metacarpal is usually long -### End" -3086,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is TRUE regarding vascularity of lung?, with the following options: A: Hypoxia causes vasodilation, B: Ratio of pulmonary to systemic vascular resistance is usually more than 0.3, C: Perfusion is more in the apical lobe than in base, D: The blood flow is less in the upper pa of the lungs - -### Response: -Gravity has a relatively marked effect on the pulmonary circulation. In the upper pa of the lungs, the blood flow is less, the alveoli are larger, and ventilation is less than at the base. The O2 deficiency apparently acts directly on vascular smooth muscle in the area to produce constriction, shunting blood away from the hypoxic area. The ratio of pulmonary to systemic vascular resistance is usually less than 0.3. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 34. Introduction to Pulmonary Structure and Mechanics. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e. -### End" -3087,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is true regarding site of Meckel's diveiculum:, with the following options: A: 2 feet proximal to ileocaecal valve on mesentric border, B: 2 feet distal to duodenojejunal flexure on antimesentric border, C: 2 feet distal to D-3 flexure on mesentric border, D: 2 feet proximal to ileococcal valve on antimesentric border - -### Response: -Ans. is 'd' i.e. 2 feet proximal to ileococcal valve on antimesentric border -### End" -3088,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true about the autistic specific disorder, with the following options: A: Impaired communication, B: Impaired imagination, C: Language developmental delay, D: Vision problems - -### Response: -Core symptoms of Autism are 1. Persistent deficts in social communication and interaction, 2. Restricted, repititive patterns of behaviour, interests and activities, 3. Associated physical characteristics. Associated behavioural symptoms include- Disturbance in language development and usage, Intellectual disability, Irritability, Instability of mood and affect, Response to sensory stimuli, Hyperactivity and Inattetnion, Precocious skills, Insomnia, Minor infections and GI symptoms. Marked impairment in reciprocal social and interpersonal interaction:i. Absent social smile.ii. Lack of eye-to-eye-contact.iii. Lack of awareness of others existence or feelings; treats people as furniture.iv. Lack of attachment to parents and absence of separation anxiety.v. No or abnormal social play; prefers solitary games.vi. Marked impairment in making friends.vii. Lack of imitative behaviour.viii. An absence of fear in presence of danger.2. Marked impairment in language and non-verbal communicationi. Lack of verbal or facial response to sounds or voices; might be thought as deaf initially.ii. In infancy, an absence of communicative sounds like babbling.iii. Absent or delayed speech (about half of autistic children never develop useful speech).iv. Abnormal speech patterns and content. Presence of echolalia, perseveration, poor aiculation and pronominal reversal (I-You) is common.v. Rote memory is usually good.vi. Abstract thinking is impaired.3. Abnormal behavioural characteristicsi. Mannerisms.ii. Stereotyped behaviours such as head-banging, body-spinning, hand-flicking, lining-up objects, rocking, clapping, twirling, etc.iii. Ritualistic and compulsive behaviour.iv. Resistance to even the slightest change in the environment.v. The attachment may develop to inanimate objects.vi. Hyperkinesis is commonly associated.4. Mental retardation Only about 25% of all children with autism have an IQ of more than 70.5. Other featuresi. Many children with autism paicularly enjoy music.ii. In spite of the pervasive impairment of functions, ceain islets of precocity or splinter functions may remain (called as Idiot savant syndrome). Examples of such splinter functions are prodigious rote memory or calculating ability, and musical abilities.iii. Epilepsy is common in children with an IQ of less than 50. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.164 -### End" -3089,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is anaerobic non - acid fast bacilli:, with the following options: A: Tuberculosis, B: Listeria, C: Nocardia, D: Actinomyces - -### Response: -Actinomyces is an obligate anaerobe & Non acid fast Tuberculosis- it is Gram positive acid fast 20% (depends on mycolic acid content) Listeria-it is Gram positive coccobacilli Nocardia -it is Obligate aerobe , acid fast (1%) -### End" -3090,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cystosarcoma phylloides is tumor of, with the following options: A: Breast, B: Liver, C: Colon, D: Uterus - -### Response: -Ans. a (Breast). (Ref. Baily & Love, Surgery, 22nd/pg.552)CYSTOSARCOMA PHYLLOIDES# is benign tumor of the breast.# It presents as a huge mass in breast.# Its histological pattern is variegated.# Its a misnomer as its relatively benign, but potentially malignant tumor. -### End" -3091,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mauriac's syndrome is characterized by all except, with the following options: A: Diabetes, B: Obesity, C: Dwarfism, D: Cardiomegaly - -### Response: -Ans. is 'd' i.e., Cardiomegaly Mauriac Sydrome Children with poorly controlled type I diabetes may develop Mauriac syndrome. It is characterized by : - Growth attenuation Delayed pubey Hepatomegaly Abnormal glycogen storage and steatosis Cushingoid features Rare in modern era of insuling therapy but is occasionlly repoed. -### End" -3092,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Protein C activation causes, with the following options: A: Promotion of clothing, B: Inactivation of factor II, C: Activation of factor X, D: Inactivation of factor V - -### Response: -Binding of thrombin with thrombomodulin slow the clotting process by removing thrombin, the thrombomodulin-thrombin complex also activates a plasma protein, protein C, that actssnanticoagulant by inactivating activated Factors V and VIII.Ref: Guyton and Hall textbook of medical physiology 13th edition. Page: 489 -### End" -3093,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gallow's traction is used for, with the following options: A: Shaft of femur, B: Neck of femur, C: Shaft of tibia, D: Tibial tuberosity - -### Response: -Gallow's traction Used in fractures of shaft of femur From bih to 2 years In this the legs of the child are tied to a overhead beam. The hips are kept a little raised from the bed so that the weight of the body provides counter traction and the fracture is reduced This is continued till sufficient callus forms(3-6 weeks) Ref: Textbook of ohopaedics Maheshwari and Mhaskar 6th edition pgno:143 -### End" -3094,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Radium paint causes:, with the following options: A: Squamous cell carcinoma, B: Osteogenic sarcoma, C: Rodent ulcer, D: Adenocarcinoma stomach - -### Response: -Ans. Osteogenic sarcoma -### End" -3095,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heterophile antibody is found in -, with the following options: A: Weil Felix test, B: Widal test, C: VDRL, D: All - -### Response: -Weil- Felix reaction for the diagnosis of typhus fever is a hetrophile agglutination test. Based in the sharing of common antigen between typhus rickettsiae and some strains of proteus bacilli. Hetrophile antigen is the same or closely related antigens occurring in different species, classes or kingdoms. Reference : Anathanarayan & paniker's 9th edition, pg no: 109,89 <\p> -### End" -3096,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs are used for detrussor instability except, with the following options: A: Solefenacin, B: Tolterodine, C: Flavoxate, D: Duloxetine - -### Response: -Refer kDT 6/e p 111 Anticholinergic drugs decrease the mobility of urinary tract and thus result in urinary retention (hence contraindicated in BPH) Dicyclomine, flavoxate and oxybutynin are useful for the treatment of urinary incontinence due to detrussor instability Duloxetine is an SSRI used for the treatment of depression -### End" -3097,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about hemorrhoids?, with the following options: A: Hemorrhoids diagnosed by DRE, B: External hemorrhoids are proximal to dentate line, C: Internal hemorrhoids bleed profusely and painless, D: Internal hemorrhoids are covered by anoderm - -### Response: -Hemorrhoids- Are Normal anatomical cushions- Made of* Venules* Aerioles* Smooth muscle fibers* Elastic tissuesLocation of hemorrhoids- 3' o clock- 7'O clock- 11'0 clockPathophysiology- On constipation due to Excessive straining |Abnormal descent of anatomical cushions |Injury by hard fecal matter |Bleeding PR* Mc cause of bleeding PR - Hemorrhoids* Mc cause of significant lower GI bleed - Colonic diveicula* Mc cause of occult lower GI bleed - Angiodysplasia/ Vascular ectasia Clinical Presentation- Painless bleeding- Amount of bleeding - 3 to 5 ml to a max of 10 mlDiagnosis- They Cannot be palpated, therefore hemorrhoids cannot be diagnosed by DRE- Diagnosis of hemorrhoids - by proctoscopy Internal Hemorrhoids External Hemorrhoids - Location - above dentate line (Pain insensitive region)- Painless bleeding- Treatment - depends on the degree - Location - below dentate line(pain sensitive region)- Painful bleeding- Aka 5- days painful self-curing lesion- Recurrent thrombosis in externalhemorrhoids leads to semi- RIPE blackcurrant- Treatment - Excision -### End" -3098,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Comedones are characteristics of -, with the following options: A: Acne vulgaris, B: Acne rosasea, C: SLE, D: Adenoma sebaeceum - -### Response: -A. i.e. Acne Vulgaris -### End" -3099,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a contraindication for extra corporeal -shockwave lithotripsy for renal calculi, with the following options: A: Pregnancy, B: Bleeding disorder, C: Stone >2 cm, D: Stone in a calyceal diverticulum - -### Response: -C/I for ESWL are -absoulete - -Pregnancy -Bleeding disorder - -Relative - -Stone > 2cm -Cystine stone -Children -Obstructed stone. -### End" -3100,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glass blowers cataract is caused due to -, with the following options: A: Wilson's Disease, B: Myotonic Dystrophy, C: Infrared radiation, D: Congenital Rubella - -### Response: -Ans. is 'c' i.e. Infrared radiation o Glassblower's cataracts is formed by many years or decades of exposure to infrared radiaiton while working in the occupation of glass blowing, or working close to hot or molten metals such with metal foundry workers or blacksmiths.o Glassblower's cataracts are due to chronic exposure to infrared radiation emitted due to heating of glass or molten metal. The infrared radiation is absorbed by the iris and lens of the eye. This causes cataracts after decades of exposure. This condition may be pre vented by wearing protective glasses while practicing these occupations. -### End" -3101,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How many gram of protein is given in mid day meal scheme: March 2010, March 2013 (c), with the following options: A: 4-8 gram, B: 8-12 gram, C: 12-16 gram, D: 16-20 gram - -### Response: -Ans. B: 8-12 gram Park's PSM,21st ed., p-612 states: The central assistance provided to states under the mid-day meal is by way of free supply of food grain from nearest Food Corporation of India godown at the rate of 100 g per student per day and subsidy for transpo of food grain. To achieve the objective, a cooked mid-day meal with maximum 300 calories and 8-12 grammes of protein content will be provided to all the children in class Ito V. -### End" -3102,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cobalt 60 is:, with the following options: A: Naturally occurring radioisotope, B: Aificial radioisotope, C: Product of plutonium, D: Product of uranium - -### Response: -Ans. Aificial radioisotope -### End" -3103,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most accurate tool for gestational age assignment is, with the following options: A: Menstrual history, B: Clinical assessment, C: First trimester Crown-Rump length, D: Femur length - -### Response: -A first-trimester crown rump length is the most accurate tool for gestational age assignment and is performed as clinically indicated. (Ref: William's Obstetrics; 25th edition) -### End" -3104,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The main action of muscle ""GameIlius"" is:, with the following options: A: Medial rotation of thigh, B: Lateral rotation of thigh, C: Flexion of hip, D: Extension of hip - -### Response: -Lateral rotation of thigh -### End" -3105,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true regarding Haemophilus influenzae except, with the following options: A: It can be a part of the normal flora in some persons, B: The serotyping is based on the bacterial outer membrane proteins, C: It requires Haemin and NAD for growth in culture medium, D: Type b is responsible for invasive disease - -### Response: -(B) The serotyping is based on the bacterial outer membrane proteins# Characteristics of Hemophilus influenzae: Hemophilus is a pleomorphic gram negative bacilli Hemophilus influenzae describes some of its properties Hemophilus means blood loving. This organism requires a blood containing medium for growth. Factor X and Factor V present in blood are essential for its growth (factor X acts physiologically as haemin and factor V is nicotinamide nucleotide) One important features of H. influenzae is that it does not grow properly on blood agar, because factor V is not available in blood agar as it is located inside red blood cells but when agar is heated to convert it into chocolate agar the factor V is released from R.B.C.'s> Hence H. influenzae grows better on chocolate agar> Antigenic structure: Encapsulated H. influenzae contains polysaccharide capsule. This polysaccharide capsule confers virulence Of these types of H. influenzae type b is commonly associated with invasive H. influenzae diseases such as Meningitis; Epiglottitis; Septic arthritis> Non capsulated strains of H. influenzae can colonize the upper respiratory tract of children and adults.> They lack the virulent invasiveness of encapsulated bacteria and can only cause local infection. -### End" -3106,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Psycho Social stages/ Eight-stage ego development across the life cycle is the centre piece of whose life work?, with the following options: A: Sigmund freud, B: Pavel, C: Strauss, D: Erik H Erikson - -### Response: -The eight stages of ego development are Stage1- trust vs mistrust Stage2- autonomy vs shame and doubt Stage3- initiative vs guilt Stage4- industry vs inferiority Stage5- identity vs role confusion Stage6- intimacy vs isolation Stage7- generativity vs stagnation Stage8- intgrity vs despair. Ref: Synopsis of Psychiatry, 11e, pg 169. -### End" -3107,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Southern blotting is used for:, with the following options: A: RNA, B: DNA, C: Protein, D: Antibody - -### Response: -Ans. b. DNA -### End" -3108,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transpo of two substances across the cell membrane in the same direction is known as?, with the following options: A: Sympo, B: Antipo, C: Exocytosis, D: Pinocytosis - -### Response: -When a carrier protein transpos two or more substances in the same direction, it constitutes a sympo e.g. Na- glucose sympo. When a carrier protein transpos two substances in opposite direction, it is known as antipo. e.g.Na+-H+ antipo in proximal convoluted tubules in the kidney or Na+-K+ ATPase pump. Exocytosis is a type of vesicular transpo. Vesicles with contents are transpoed to the cell membrane. Then they fuse with the cell membrane with the discharge of their contents outside the cell. Pinocytosis is basically endocytosis and the ingested material is liquid. In endocytosis, the sequence of events proceeds in almost the opposite direction of exocytosis. Ref: Principles of Physiology By D. Pramanik, 2007, Page 23; Guyton's physiology 22nd edition, Page 54- 55, Ganong's physiology, 22nd chapter -### End" -3109,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An eight-months-old child had history of unusual crying, altered sensorium & convulsions following previous vaccination after BCG, DPT & OPV (first dose) & Hepatitis B. Now parents have brought child for next doses of vaccination. Which vaccine is contraindicated in this situation?, with the following options: A: Measles, B: DPT, C: Hepatitis B, D: DT - -### Response: -Absolute contraindications to any peussis vaccination (including DTwP vaccine) are: - Anaphylaxis after previous dose. - Development of encephalopathy within 7 days following previous DTwP vaccination. - Progressive neurological disease - Relative contraindication . - Precautions: Previous dose associated with Persistent inconsolable crying of > 3 hrs, < 48hrs Hyperpyrexia (fever > 40.5degC) hypotonic hyporesponsive episodes (HHE) within 48 hours of DTwP administration seizures with or without fever within 72 hours of administration of DTwP - These are considered as precautions but not contraindications to future doses of DTwP because these events generally do not reoccur with the next dose and they haven't been proven to cause permanent sequelae. But in case an event recurs with a subsequent dose, then fuher doses are contraindicated. -### End" -3110,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: SLE mitral and tricuspid valve vegetations are -, with the following options: A: Salmon patch, B: Libman sacs disease, C: Janeway lesions, D: Osiers nodes - -### Response: -Ans. is 'b' i.e., Libmann sach's disease Endocarditis of Systemic Lupus Erythematosus (Libman-Sach's Disease)o Mitral and tricuspid valvulitis with small, sterile vegetations, called Libman-Sach's endocarditis, is occasionally encountered in systemic lupus erythematosus,o Due to the use of steriods, the incidence of this complication has been greatly reduced.o The lesions are small (1 to 4 mm in diameter), single or multiple, sterile, pink vegetations with a warty (verrucous) appearance located on the undersurfaces of the atrioventricular valves, on the valvuar endocardium, on the chords, or on the mural endocardium of atria or ventricles. -### End" -3111,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: High affinity of HbF with O2 due to:, with the following options: A: Decrease binding with 2,3 DPG, B: Decrease concentration of Hb, C: Increase in the Ph, D: Double Bohr effect - -### Response: -Ans. A. Decrease binding with 2,3 DPGa. The affinity of fetal hemoglobin (hemoglobin F) for O2 , which is greater than that for adult hemoglobin (hemoglobin A), facilitates the movement of O2 from the mother to the fetus.b. The cause of this greater affinity is the poor binding of 2,3-BPG by the polypeptide chains that replace chains in fetal hemoglobin.c. Some abnormal hemoglobins in adults have low P50 values, and the resulting high O2 affinity of the hemoglobin causes enough tissue hypoxia to stimulate increased red cell formation, with resulting polycythemia.d. It is interesting to speculate that these hemoglobins may not bind 2,3-BPG.e. Factors affecting the concentration of 2,3-BPG in the red cells includei. pH (acidosis inhibits red cell glycolysis, the 2,3-BPG concentration falls when the pH is low).ii. Thyroid hormones, growth hormone, and androgens increase the concentration of 2,3-BPG and the P50.iii. Exercise has been reported to produce an increase in 2,3-BPGiv. Ascent to high altitude triggers a substantial rise in 2,3-BPG concentration in red cells,v. The affinity of fetal hemoglobin (hemoglobin F) for O2 . The cause of this greater affinity is the poor binding of 2,3-BPG by the polypeptide chains that replace chains in fetal hemoglobin.vi. Red cell 2,3-BPG concentration is increased in anemia and in a variety of diseases in which there is chronic hypoxiavii. In bank blood that is stored, the 2,3-BPG level falls. This decrease, is less if the blood is stored in citrate- phosphate-dextrose solution rather than the usual acid-citrate-dextrose solution .viii. Inosine increases 2,3 DPG in red blood cells. -### End" -3112,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The after coming head of breech, chin to pubis is delivered by :, with the following options: A: Marcelli technique, B: Burns-Marshall method, C: Lovset's method, D: Manual rotation and extraction by Piper's forceps - -### Response: -Sometimes in Breech presentation, the after coming head rotates posteriorly so that face is behind pubis, this condition is difficult to deliver and is called Chin to pubis rotation In this situation, manual rotation of fetal head and trunk is done as in malar flexion and shoulder traction and then head is delivered with forceps. In case of premature baby, the delivery of head may be completed as face to pubis by reversed malar flexion and shoulder traction or by forceps. Ref: Datta Obs 9e pg 363,Williams Obs 23e pg 537. -### End" -3113,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disinfective action of chlorine is due to which of the following?, with the following options: A: Hypochlorite, B: Hypochlorine, C: Hypochlorous acid, D: None - -### Response: -Ans. c (Hypochlorous acid) (Ref. Park Textbook of PSM 22nd/pg. 663).CHLORINATION: Disinfective action of chlorine is mainly due to Hypochlorous acid and to a small extent due to theHypochlorous ions.# H2O + Cl2 (r) HCI + HOCI.# HOCI (r) H = OCI# Chlorine acts best when pH of water is 7.Principles of chlorination are:# Water should be clear & free from turbidity.# Chlorine demand of water should be estimated (done by Horrock's apparatus).# Contact period of at least one hour is essential.# Minimum recommended concentration of free chlorine is 0.5 mg/lit for one hour.BREAK POINT CHLORINATION - the point at which the residual chlorine appears and when all combined chlorine has been completely destroyed. 33% available chlorine should be there in bleaching powder. -### End" -3114,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What does priapism in a polytrauma patient signify-, with the following options: A: Penile injury, B: Spinal Injury, C: Significant head injury, D: Pelvic injury - -### Response: -Ans. is 'b' i.e., Spinal Injury ""Priapism may be a feature of spinal cord injury"" -### End" -3115,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mad Cow disease (Spongiform disease) occurs due to, with the following options: A: C J virus, B: Arena Virus, C: Kuru Virus, D: Parvo Virus - -### Response: -Mad cow disease or bovine spongiform encephalopathy i.e. Caused by “prions” -“PRIONS” are unconventional transmissible agents, proteinaceous in nature.” -Diseases caused by prions are -Kuru -Creutzfeldt Jakob Disease. -Gerstmann Straussler Scheinker Syndrome -Fatal Familial Insomnia. -Scrapie Of Sheep -Transmissible Encephalopathy of Mink. -Bovine Spongiform Encephalopathy (Mad Cow Disease) -### End" -3116,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sho acting glucocoicoid is ?, with the following options: A: Fludrocoisones, B: Dexamethasone, C: Hydrocoisone, D: Aldostrone - -### Response: -Ans. is 'c' i.e., Hydrocoisone Sho-acting: Coisol 8-12 hours Intermediate-acting: Prednisolone 18-36 hours Long-acting: 36-54 hours -### End" -3117,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Negro body is seen in:, with the following options: A: CMV, B: Rabies, C: Inclusion of herpes simplex, D: EBV - -### Response: -Ans. (b) Rabies Negri bodies are the intracytoplasmic inclusions of rabies virus in the CNS. Negri bodies are distributed throughout the brain paicularly in Ammon's horn, the cerebral coex, the brain stem, the hypothalamus, purkinje cells of cerebellum and the dorsal root spinal ganglia. They are not seen in about 20% cases of rabies and their absence does not rule out the diagnosis. Inclusion Bodies It is of following types: Intracytoplasmic eosinophilic inclusions: Negri bodies rabies Guarnieri bodies variola (small pox), vaccinia Bollinger bodies fowlpox Henderson - Peterson bodies molluscum contagiosum Intranuclear acidophilic inclusion bodies: Cowdry type A herpes, chicken pox, CMV, yellow fever Torres bodies yellow fever Cowdry type B polio virus Both Nuclear and cytoplasmic: Wahin Finkeldey measles Intranuclear basophilic inclusion bodies: Cowdry type B adenovirus -### End" -3118,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the opioids has maximum plasma protein binding capacity ?, with the following options: A: Morphine, B: Sufentanil, C: Fentanyl, D: Pethidine - -### Response: -Ans. is 'b' i.e., Sufentanil -### End" -3119,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Punishment for sexual intercourse not amounting to rape by attendant in a hospital is under: Punjab 10, with the following options: A: Sec. 376-A IPC, B: Sec. 376-B IPC, C: Sec. 376-C IPC, D: Sec. 376-D IPC - -### Response: -Ans. Sec. 376-C IPC -### End" -3120,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following should be monitored if linezolid is given for more than 14 days?, with the following options: A: Liver function tests, B: Kidney function test, C: Platelet count, D: Audiometry - -### Response: -Because of the increase in multi-drug-resistant strains of gram-positive bacteria, the development of new and novel-acting antimicrobial agents is at the forefront of pharmaceutical research. Currently, the prevalence of methicillin-resistant staphylococci (MRSA) and vancomycin-resistant enterococci (VRE) is a major clinical problem. Linezolid (Zyvox(r)-Pfizer) is an antimicrobial agent of the oxazolidinone class that possesses a wide spectrum of activity against gram-positive organisms, including MRSA and VRE. Because of linezolid's novel mechanism of action, cross-resistance with other antimicrobial agents is not expected. Linezolid is therefore a ble option for ceain types of infectious disease. Linezolid should not be used for empiric therapy, except under unusual circumstances, or to treat mild gram-positive infections where other antimicrobial agents would be effective. Thrombocytopenia has been repoed in patients treated with linezolid. Platelet levels in most patients returned to normal during the follow-up period. The risk of thrombocytopenia appears to be related to duration of therapy. Platelet counts should be monitored at baseline and at least every 7 days during treatment. -### End" -3121,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice in nocturnal enuresis is, with the following options: A: Imipramine, B: Diazepam, C: Amoxapine, D: Reboxetine - -### Response: -(Imipramine) (449-KDT 6th)Enuresis - In children above 5years, imipramine at bed time is effective, but bed wetting may again start when the drug is stopped* Elderely subjects with bed wetting have also benefittcd* Imipramine is most likely and nortriptyline is least likely to cause orthostatic hypotension (145-LP3rd) -### End" -3122,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Flexion extension in neck occurs at -, with the following options: A: Atlanto-axial joint, B: Atlanto-occipital joint, C: C6-C7 joint, D: C7-T1 joint - -### Response: -Ans. is 'b' i.e., Atlanto-occipital joint o Atlantoaxial joint - Rotatory movement around vertical axis (Right to left and left to right movements).o Atlanto-occipitai joint - (i) Flexion-extension around transverse axis, (ii) Slight lateral flexion around antero-posterior axis.Also knowo Atlanto-occipital joint:- Median........................ Pivot joint.- Lateral .........................Plane synovial joint.o Atlantoaxial joint ............Ellipsoid joint. -### End" -3123,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with Myeloproliferative syndrome presents with decreased while cell count and decreased platelets. The most likely diagnosis is:, with the following options: A: Chronic myeloid leukemia, B: Myelofibrosis, C: Polycythemias vera, D: Essential thrombocytosis - -### Response: -Answer is B (Myelofibrosis) Myelofibrosis may be associated with decreased white cell count and decreased platlet counts. Myelofibrosis is an established cause for panyctopenia with cellular marrow. Condition WBCount Hematocrit/ Red cell mass Platelet count Red cell morphology Splenomegaly Philadelphia chromosome CML || N N or | N Massive Present Myelofibrosis N or | or | N or | | or N or | Abnormal Massive Absent Polycythemia N or |' | N or | N Moderate (Massive in late stages) Absent Essential Thrombocytosis N or | N || N Mild Absent -### End" -3124,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a predisposing factor for Preeclampsia?, with the following options: A: Anti-phospholipid antibody, B: Smoking, C: Gestational diabetes, D: Molar pregnancy - -### Response: -Ans:B.) Smoking REF: William's obstetrics 22nd edition Although smoking during pregnancy causes a variety of adverse pregnancy outcomes, ironically, smoking has consistently been associated with a reduced risk of hypeension during pregnancy (Bainbridge and associates, 2005; Zhang and colleagues, 1999). Placenta pre has also been repoed to reduce the risk of hypeensive disorders in pregnancy (Ananth and colleagues, 1997). Underlying Causes of Chronic Hypeensive Disorders: Essential familial hypeension (hypeensive vascular disease) Obesity Aerial abnormalities Renovascular hypeension Coarctation of the aoa Endocrine disorders Diabetes mellitus Cushing syndrome Primary aldosteronism Pheochromocytoma Thyrotoxicosis Glomerulonephritis (acute and chronic) Renoprival hypeension Chronic glomerulonephritis Chronic renal insufficiency Diabetic nephropathy Connective tissue diseases Lupus erythematosus Systemic sclerosis Periaeritis nodosa Polycystic kidney disease Acute renal failure -### End" -3125,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reynolds number is related to, with the following options: A: Laminar flow, B: Ventimask, C: Dissolved oxygen in blood, D: Intraalveolar tension - -### Response: -Flow through a tube can be described by the modified Bernoulli Equation, which states: Po = P + 1/2 r*U^2 Where Po is a constant called the ""stagnation pressure,"" P is pressure, r is density, U and is equal to fluid velocity. Pressure does not always decrease in the direction of flow - if one assumes friction is negligible (and thus the total energy of the system remains constant), any change in the kinetic energy of a fluid (ex. a reduction as U^2 falls) must be accompanied by an oppositional change in potential energy increases(P rises) Whether flow is laminar or turbulent is dependent on the Reynolds Number (Re), defined as: Re = rUL/u Where r is density, U is equal to fluid velocity, L is the length of the tubing, and u is the viscosity of the fluid. Note that the modified Bernoulli Equation applies to laminar flow (ReD < 2300, parabolic flow profile), but not to turbulent flow (ReD > 4000, blunted flow profile) Flowmeters based on a Venturi tube (circular tube with a gradual contraction and expansion in diameter, ex. those used in aircraft) maintain laminar flow at normal flow rates - since conservation of mass and energy is assumed to apply, restriction of the diameter leads to increased speed of gas flow and a corresponding decrease in the pressure on the walls The floating bobbin rotameter that is familiar to anesthesiologists is known as the Thorpe tube - the sudden restriction caused by the bobbin leads to a propoional increase in velocity and the Bernoulli equation does not apply (flow is propoionate to the square root of the pressure drop). Because the pressure drop across the orifice is inversely propoional to orifice area squared, the pressure change across the bobbin will decrease as the bobbin rises (and the area of the tube increases). The bobbin reaches a steady state when the pressure drop exactly opposes the gravitational force on the bobbin - at this steady state the pressure drop is always the same (because gravitational forces are constant), however as flow rates increase, the bobbin will move higher because this critical pressure drop will occur over a larger cross-sectional area (since velocity is higher) -### End" -3126,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is commonly responsible for toxic shock syndrome in female patient: September 2008, with the following options: A: Streptococcus-group B, B: Pseudomonas, C: H.influenzae, D: Staphylococcus aureus - -### Response: -Ans. D: Staphylococcus aureus Toxic shock syndrome is a severe systemic illness characterised by shock, pyrexia, an erythematous rash, gastrointestinal disturbance and central nervous system signs including lethargy or irritability. It is mediated by toxins produced by some strains of bacteria, most commonly Staphylococcus aureus or Group A Streptococcus. It has a high associated moality of up to 50% if untreated. Children under 4 years of age with skin loss are paicularly at risk, having not developed antibodies to the toxins produced by the bacteria. -### End" -3127,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 42 year old female has palpable purpura with rash over buttocks, pain in abdomen, and arthropathy diagnosis is -, with the following options: A: Sweet syndrome, B: HSP, C: Purpura fulminans, D: Meningococcemia - -### Response: -Typical HSP Henoch Schonlein Purpura (HSP) rash: -### End" -3128,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NADPH is used in:, with the following options: A: Fatty acid synthesis, B: Ketone synthesis, C: Gluconeogenesis, D: Glycolysis - -### Response: -A i.e. Fatty acid synthesis -### End" -3129,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lung granuloma with necrosis are seen in -a) PANb) TBc) Histoplasmosisd) Cryptococcosise) Wegener's granulomatosis, with the following options: A: bce, B: bc, C: acd, D: ace - -### Response: -Granuloma with necrosis -TB    → caseous necrosis -Syphilis    → caseous necrosis -Coccidiodomycosis   →  caseous necrosis -Histoplasmosis   →  caseous necrosis -Wegner’s granulomatosis – Non-caseous necrosis -### End" -3130,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sperm doesn't contain:, with the following options: A: Golgi apparatus, B: Mitochondria, C: Endoplasmic reticulum, D: Lysosome - -### Response: -Endoplasmic reticulum is a better answer than Golgi apparatus.To maximize transpo efficiency, the mature sperm has no ribosomes, endoplasmic reticulum, or Golgi apparatus. Golgi apparatus are present in spermatids but during the process of spermiogenesis, it gets conveed into a cap-like structure, acrosome over the anterior half of the head. Acrosome contains Lysosomal enzymes. -### End" -3131,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Osteoblastic secondaries occurs with, with the following options: A: Carcinoma prostate, B: Carcinoma rectum, C: Carcinoma endometrium, D: Wilm's tumour - -### Response: -(Carcinoma prostate) (1086-CSDT 13th)* Although some tumours may produce mainly osteolytic lesions (eg Kidney cancers) and others mainly osteoblastic lesions (eg prostate cancers), most metastatic lesion produce both types of lesion and may go through stages where one or the other predominates - 613- Harrison 17th* Osteolytic lesions are associated with hypercalcemia* and hydroxyproline - containing peptides* Osteoblastic lesions are associated with increased levels of serum alkaline phosphatase** Most common cause of osteolytic metastasis- In males - lung cancer- In female - Breast cancer Most common cause of Osteoblastic metastasis- In male - Prostate cancer- In female - Breast cancer* Lytic expansile metastasis seen in Thyroid, Renal carcinomaCarcinoma of prostate - 90% tumours are adeno carcinoma the tumour arises primarily in the peripheral zone (70%)**Periurethral (Tansition) zone - site for benign prostatic hyperplasia**Screening by transrectal Ultrasound TRUS / and PSATRUS - most useful for Taking guided biopsy*** Most common cause of sclerotic skeletal metastasis in a female patients is - Carcinoma breast -### End" -3132,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Retrobulbar injection is given in, with the following options: A: Inside muscle cone, B: Outside muscle cone, C: Subtenon space, D: Subperiosteum - -### Response: -(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 444) *Retrobulbar injection:- Injection in retrobulbar space inside the muscle cone *Peribulbar injection:- Injection in peribulbar/retrobulbar space outside the muscle cone *Sub-tenon injection:- Injection beneath the tenon capsule, i.e. in subtenon space. It is also called parabulbar block Retrobulbar block involves depositing local anesthetic inside the muscle cone. It aims to block the ciliary nerves, the ciliary ganglion, and cranial nerves III, IV, and VI. -### End" -3133,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The transmembrane region of protein is likely to have:, with the following options: A: A stretch of hydrophilic amino acids, B: A stretch of hydrophobic amino acids, C: A disulphide loop, D: Alternating hydrophilic and hydrophobic amino acids - -### Response: -Ans. (b) A stretch of hydrophobic amino acids(Ref: Ganong, 25th ed/p.)Integral membrane proteins are also called as Transmembrane proteins because they are present in both inside and outside of membrane. They have both hydrophilic and hydrophobic regions (Amphipathic)Hydrophobic region is present inside and hydrophilic region is present at the ends of bilayer -### End" -3134,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epiglottis is Embryologically developed from, with the following options: A: 2nd pharyngeal arch, B: Hypobranchial eminence, C: 4th pharyngeal arch, D: None of the above - -### Response: -EMBRYOLOGICAL DEVELOPMENT Laryngeal mucosa develops from the endoderm of the cephalic pa of foregut. Laryngeal cailages and muscles develop from the mesenchyme. Development of other structures is as follows: Epiglottis:- Hypobranchial eminence. Upper pa of thyroid cailage:- 4th arch . Lower pa of thyroid cailage , Cricoid cailage , Corniculate cailage, Cuneiform cailage, Intrinsic muscles of larynx:- 6th arch. Upper pa of body of hyoid bone , Lesser cornua of hyoid bone ,Stylohyoid ligament :- 2nd arch. Lower pa of body of hyoid bone and greater cornua:- 3rd arch. Ref:- Dhingra; pg num:-285 -### End" -3135,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person is diagnosed to be a diabetic on his 45th birthday. You will recommend a dilated fundoscopic examination:, with the following options: A: Immediately, B: Before his 50th birthday, C: When he turns 50 years of age, D: When he complains dimness of vision - -### Response: -165. Ans. a. Immediately (Ref. Harrison 19/e p2408, 18/e p3000; Kanski's 5/e p439, 455, Parsons 20/e p294-299)If a person is diagnosed to be a diabetic on his 45th birthday, dilatedfundoscopic examination should be recommended immediately.'Ophthalmoscopic examination should be done in patients of non-insulin dependent DM (Formerly Type II DM) at the time of diagnosis. ""FeatureInsulin Dependent DM (Formerly Type 1 DM)Non-Insulin Dependent DM (Formerly Type II DM)Usual Age at Diagnosis10-20 yearsQ50-70 yearsQPeriod of Latent diseaseLessQMoreQIncidence of diabetic retinopathyMore (40%)QLess (20%)QIncidence of proliferative diabetic retinopathyMoreQLessQOnsetDiabetic retinopathy rarely develops within 5 years of the onset of diabetes or before pubertyQ All most all patients with Type I diabetes (IDDM) develop retinopathy in about 15 years.About 5% of type 2 (NIDDM) diabetics have diabetic retinopathy at presentationRisk factorDuration of diabetes is most important risk factorQRisk of retinopathy increase with the duration of diabetes, accompanying hypertension and smokingQInitial examinationOphthalmoscopic examination within 5 years of diagnosisQOphthalmoscopic examination at the time of diagnosisQFollow-upThen recommendations for periodic fundus examination are as follows:* Every yearly, till there is no diabetic retinopathy or there is mild non proliferative DR (NPDR)* Every 6 monthly, in moderate NPDR* Every 3 monthly, in severe NPDR* Every 2 monthly, in PDR with no high risk characteristic* Involvement of fovea by edema and hard exudates or ischemia (diabetic maculopathy) is the MC cause of visual impairment in diabetic patientsQ particularly those with type 2 diabetes (NIDDM). Ocular Involvement in Diabetes MellitusComplications of Diabetic retinopathyOthers* Exudative maculopathy and macular edema- MC cause of visual loss in diabetic patients (specially in NPDR)Q- Manifest as metamorphopsia* Vitreous hemorrhage- Manifest as floatersQ- MC cause of visual loss in patients with PDRQ* Tractional Retinal detachmentQ- Usually asymptomatic (no photopsia and floaters) unless macula is involved* Neovascular glaucoma - rubeosis iridisQ* Early onset of senile cataract* True diabetic cataract/snowflake/snow storm cataractQ* Nerve palsy MC 3rd nerveQ* MyopiaQ because of fluid imbibitions and swelling of lens induced by hyperglycemia* Index hypermetropiaQ' (in undertreated)Management of Diabetic RetinopathyGeneral MeasuresStrict control of blood glucose may delay the onsetControl of hypertension when associated is essentialAntioxidants are also useful for diabeticsScreeningYearlyTill there is no diabetic retinopathy (DR) or there is mild NPDR (non proliferative diabetic retinopathy)Q 6 monthlyIn moderate NPDRQ3 monthlyIn severe NPDRQ2 monthlyIn PDR with no high risk characteristicsQPhotocoagulationIt is the main stay of treatmentQDouble frequency YAG (532) laser, Argon laser or diode laser is usedMacula is treated by laser only if there is clinically significant macular edemaLaser is contraindicated in ischemic diabetic maculopathyQPan retinal or Scatter laser photocoagu laiionFocal argon laser bumGrid pattern laser burns* It consists of 1200-1600 spots, each 500 pm and 0.1 sec duration* It is applied 2-3 disc areas from the centre of macula extending peripherally to equator* It Is indicated in PDR (proliferative diabetic retinopathy) with one of the high risk characteristicsQ* It is applied to individual mtcrovascular formations in the centre of hard exudates ring in focal exudative maculopathyQ* It is applied in macular area for diffuse macular edemaQPars plana vitrectomy is indicated for dense persistent vitreous hemorrhage, fractional retinal detachment and epiretinal membranes. -### End" -3136,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of Plummer-Vinson syndrome Except, with the following options: A: Oesophageal web, B: Iron deficiency, C: Achalasia cardia, D: Dysphagia - -### Response: -Dysphagia is said to occur because of the presence of post-cricoid web that is associated with iron deficiency anaemia, glossitis and koilonychia Bailey and Love&;s sho practice of surgery,26 th ed. -### End" -3137,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: May thurner or cockett syndrome involves, with the following options: A: Common iliac aery obstruction, B: Internal iliac aery obstruction, C: Internal iliac vein obstruction, D: Left iliac vein compression - -### Response: -May-Thurner syndrome -- also called iliocaval compression syndrome and Cockett syndrome or iliac vein compression syndrome -- occurs secondary to compression of the left iliac vein by the overriding right iliac aery.The sustained compression and trauma caused by the pulsatile force of the aery on the vein damage the intima and lead to the formation of membranes or bands in the vascular lumen that hinder or obstruct the flow of blood in the vein, oring thrombus formation. The current treatment strategy of choice is endovascular vein patch angioplasty and stenting with the aim of improving the caliber of the lumen and enabling normal venous drainage -### End" -3138,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are included in NRHM except:, with the following options: A: Strengthening of JSY (Janani Suraksha Yojna), B: Formation of health & family welfare societies, C: State & district health mission, D: Recruitment & training of ASHA - -### Response: -Formation of health & family welfare societies [Ref: Park 20/e, p 379-380; National Health programmes of India by J. Kishore 7/e, p 78-92; ASHA is one of the core strategies of NRHM Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission being implemented with the objective of reducing maternal & neo-natal moality by promoting institutional delivery among the poor pregnant women. One of the components of plan of action for NRHM is District health plan. Under this plan all veical Health and Family Welfare Programmes at district & state level merge into one common ""District Health Mission"" at the district level and the ""State Health Mission"" at the state level. So under NRHM it is the intergration not .formation of veical Health &.family welfare programmes. NATIONAL RURAL HEALTH MISSION - THE VISION The National Rural Health Mission (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators . These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh. The Mission is an aiculation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP. Key components: provision of a female health activist in each village a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards(IPHS) integration of veical Health & Family Welfare Programmes Funds for optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare. Aim Effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through a District Plan for Health. GOALS Reduction in Infant Moality Rate (IMR) and Maternal Moality Ratio (MMR)by 50% from existing levels in 7 years. Universal access to public health services such as Women's health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of communicable and non-communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH(Indian system of medicine) Promotion of healthy life styles 4. STRATEGIES (a) Core Strategies: Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services. Promote access to improved healthcare at household level through the .female health activist (ASHA). Health Plan for each village through Village Health Committee of the Panchayat. Strengthening sub-centre through an untied fund to enable local planning and action and more Multi Purpose Workers (MPWs). Strengthening existing PHCs and CHCs, and provision of 30-50 bedded CHC per lakh population Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition. Integrating veical Health and Family Welfare programmes at National, State, Block, and District levels. Technical Suppo to National, State and District Health Missions, for Public Health Management. Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision. Formulation of transparent policies. Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc. Promoting non-profit sector paicularly in under served areas. (b) Supplementary Strategies: Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost. Promotion of Public Private Panerships for achieving public health goals. Mainstreaming AYUSH - revitalizing local health traditions. Reorienting medical education to suppo rural health issues including regulation of Medical care and Medical Ethics. Effective and ble risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care. PLAN OF ACTION Accredited Social HealthActivist(ASHA) .Strengthening sub centers Strengthening CHC's for first referral care Strengthening PHC for quality preventive, promotive,curative, supervisory and Outreach services District Health Plan Total Sanitation Campaign (TSC) National Disease Control Programmes for Malaria, TB, Kala Azar, Filaria,Blindness & Iodine Deficiency and Integrated Disease SurveillanceProgramme shall be integrated under the Mission Public-private panership for publichealth goals, including regulation of private sector New health financing mechanism Reorienting health/medical education to suppo rural health issuers Details of the above are available on website & book by J. Kishore mentioned in reference -### End" -3139,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Duration of Oseltamivir treatment for influenza?, with the following options: A: 5 days, B: 7 days, C: 9 days, D: 14 days - -### Response: -Ans. A. 5 daysa. Oseltamivir (oral tablet) - 75 mg BD for 5 days for treatment; 75 mg OD for prophylaxisb. Zanamivir (inhalation)-10 mg BD for 5 days for treatment; 10 mg OD for prophylaxisc. Zanamivir may exacerbate bronchospasm in asthmatic patients.d. Oseltamivir has been associated with neuropsychiatric side effects in children. -### End" -3140,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bile salts act as all except, with the following options: A: Emulsifying agent, B: Detergent, C: Surface tension lowering agents, D: Help in fat digestion - -### Response: -The bile salts have a number of impoant actions: They reduce surface tension and have detergent effects.In conjunction with phospholipids and monoglycerides, are responsible for the emulsification of fat preparatory to its digestion and absorption in the small intestine.They are amphipathic, that is, they have both hydrophilic and hydrophobic domain, therefore, the bile salts tend to form micelles.REF: GANONG&;S REVIEW OF MEDICAL PHYSIOLOGY PAGE NO:439,440 -### End" -3141,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding Oxytocin, true statements are, with the following options: A: Acts on myoepyhelial cells, B: Causes contraction of uterus during labour, C: May cause retention of water, D: All of the above - -### Response: -Refer KDT 6/e p 319 Oxytocin is an octapeptide secreted by the posterior Pituatory along with ADH. Both Oxytocin and ADH are synthesized within the nerve cells bodies in supraoptic and paraventricular nuclei of hypothalamus are transpoed down the axon and stored in the nerve endings within the neuro hypoohysis Oxytocin increases the force and frequency of uterine contractions Oxytocin causes myoepthelium of mammary alveoli and forces milk into the bigger milk sinusoids -### End" -3142,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The scatter plot is used to display, with the following options: A: Causality, B: Correlation, C: Power, D: Type II error - -### Response: -STATISTICAL MAPS When statistical data refer to geographic or administrative areas, it is presented either as ""Shaded Maps"" or ""Dot maps"" according to suitability. The shaded maps are used to present data of varying size. The areas are shaded with different colours, or different intensities of the same colour, which is indicated in the key. Scatter diagram shows the relationship between two variables, e.g., Fig. 10 shows a positive correlation between the intakes of fat and sugar in the average diets of 41 countries. Populations with more income are known to consume more protein, fat and also sugar If the dots cluster round a straight line, it shows evidence of a relationship of a linear nature. If there is no such cluster, it is probable that there is no relationship between the variables. Ref : Park 23rd edition Pgno : 846 -### End" -3143,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inducing agent of choice in DIC, with the following options: A: Thiopentone, B: Ketamine, C: Methohexitone, D: Propofol - -### Response: -The cardiovascular stimulatory effects make ketamine a desirable drug for the induction of anesthesia in unstable cardiovascular patients suffering from hypovolemia, hemorrhagic shock, or cardiovascular depression in sepsis. Ketamine bronchodilation and profound analgesia allowing the use of high oxygen concentrations make ketamine an excellent choice for induction of anesthesia in patients with reactive airway disease. Patients who have sustained trauma with extensive blood loss are typical candidates for rapid-sequence anesthesia induction with ketamine. Patients with septic shock also may benefit from ketamine. The intrinsic myocardial depressant effect of ketamine may manifest in this situation if trauma or sepsis has caused depletion of catecholamine stores before the patient's arrival in the operating room. The use of ketamine in these patients does not obte the need for appropriate preoperative preparation, including restoration of intravascular blood volume. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e -### End" -3144,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 62 years old man with carcinoma of lung presented to emergency depament with respiratory distress. His ECG showed electrical alternans. The most likely diagnosis is, with the following options: A: Pneumothorax, B: Pleural effusion, C: Cardiac tamponade, D: Constrictive pericarditis - -### Response: -Ref Harrison 19 th ed pg 1759-60 Electrical alternans refers to beat-to-beat alteration in one or more components of the ECG signal. Total electrical alternans with sinus tachycardia is a relatively specific sign for pericardial effusion, often with cardiac tamponade. -### End" -3145,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lovibond profile sign is seen in -, with the following options: A: Koilonychias, B: Platynochia, C: Clubbing, D: Onycholysis - -### Response: -Ans. is 'c' i.e., Clubbing ""Clinical indicators of clubbing are Lovibond profile sign and curth s modified profile sign""o Lovibond angle is the angle located at the junction between the nail plate and proximal nail fold. It is normally less than 160deg. In clubbing, the angle exceeds 180deg (Lovibond profile sign). -### End" -3146,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hunner's ulcer is seen in:, with the following options: A: Ureter, B: Bladder, C: Urethra, D: Kidney - -### Response: -Ans: b (Bladder) Ref: Bailey & Love, 24th ed, p. 1357HUNNER'S ULCER (Interstitial cystitis)* Confined to women* 40's age.* Chronic pancystitis with marked infiltration with lymphocytes and macraphages.* Asa result of pancystitis, fibrosis of the vesicular musculature results leading to contracture of the bladder and areas of avascular atrophy of the epithelium. Ulceration of the mucosa occurs in the fundus of the bladder.INVESTIGATION - Cystoscopy.TREATMENTAppearance of the bladder in interstitial cystitis is similar to CA insitu and may be misdiagnosed. It is important to check urine cytology and biopsy of the bladder. Hydrostatic dialation under anaesthesia may give some relief. Light diathermy fixlgration may help -### End" -3147,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lines of Blaschko&;s represent, with the following options: A: Lines along lymphatics, B: Lines along blood vessels, C: Lines along nerves, D: Lines of development - -### Response: -Blaschkos lines are linear patterns of migration of epidermal cells and other nevus cells they do not correspond to vascular lymphatic or neural distribution iadvl textbook of dermatology page 174 -### End" -3148,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Siuin is associated with ?, with the following options: A: Cancer, B: Diabetes, C: Ageing, D: All of the above - -### Response: -Calorie restriction prolongs lifespan and this longevity appears to be mediated by a family of proteins known as siuin.They have histone deacetylase activity.Red wine can activate siuins and thus increase lifespan. Actions of siuins:- Siuins promote the expression of many genes which increase longevity. The proteins products of these genes increase metabolic activity, reduce apoptosis, stimulate protein folding and inhibit the damaging effects of oxygen-free radicals. Siuins also increase insulin sensitivity and glucose metabolism. -### End" -3149,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inversion / Eversion movements occurs at, with the following options: A: Ankle joints, B: Subtalar joints, C: Tibiotalar joints, D: Transverse tarsal joints - -### Response: -(Subtalar joints) (154- BDC-2 4th edition)* Inversion and Eversion of foot occurs at - Subtalar (Talocalcaneum) & Talocalcaneonavicular joints* Principal muscles involved in Inversion are - Tibialis anterior, Tibialis posterior* Principal muscles involved in Eversion are Peroneus longus, Peroneus brevis* Pronation and Supination of the foot - takes place chiefly at the Transverse tarsal joints** and partly at smaller intertarsal, tarsometatarsal and inter metatarsal joints -### End" -3150,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common allergic manifestation of tuberculosis is :, with the following options: A: Phlyctenular conjunctivitis, B: Koeppe's nodule, C: Retinopathy, D: Scleritis - -### Response: -B i.e. Koeppe's nodule -### End" -3151,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Features of false virginity are, with the following options: A: Fleshy and elastic labia majora, B: Cutaneous labia minora, C: Crescentic fourchette, D: All - -### Response: -Ans. d (All). (Ref. Synopsis of FMT by N. Reddy, 23rd ed., 323)Difference between Virginity and deflorationTraitVirginityDefloration1.HymenIt is intact, rigid and inelastic; edges are distinct and regular with a narrow opening hardly allowing small finger to pass .It may be torn or intact; in the latter case it is loose elastic, with a wide opening allowing passage of two or more fingers.2.Labia majoraThey are adjacent to each other, fully developed and completely close the vaginal orifice.They are not apposed to each other, not prominent and at the lower end vaginal orifice may be seen.3.Labia minoraThey are in contact and are covered by labia majoraThey are not in contact and are exposed and separated from labia majora.4.FourchetteIntactTorn or intact5.Fossa navicularisIntactDisappears6.VaginaIt is narrow, the rugae more folded, and the vault more conical.After repeated intercourse it usually grows in length, and the rugae are less obvious.False virginity is characterized by cutaneous labia minora, fleshy and elastic labia majora and crescentic fourchette -### End" -3152,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following treatment options are useful in the management of Guiilain-Barre Syndrome except, with the following options: A: Intra-venous immunoglobulin, B: Intra-venous methotrexate, C: Plasmapheresis, D: Physical medical rehabilitation - -### Response: -. *Either high dose IV Ig or plasmapheresis can be initiated * IV Ig - 5 daily infusions for a total dose of 2g/kg body weight *Plasmapheresis -40-50ml/kg plasma exchange 4 times over a week. We describe an adolescent case of Guillain-Barre syndrome (GBS) mimicking acute methotrexate-associated encephalopathy during chemotherapy for lymphoblastic lymphoma. Although initial presentations of hemiparesis and irritability were suggestive of acute encephalopathy, the diminished deep tendon reflexes and subsequent rapid progression to flaccid triparesis with bulbar palsy were consistent with GBS. After the initiation of intravenous immunoglobulin therapy her symptoms improved rapidly, and the diagnosis of GBS was confirmed by nerve conduction studies and cerebrospinal fluid examination in recovery phase. GBS should be considered in the differential diagnosis of acute methotrexate-associated encephalopathy, although GBS is a rare neurologic complication Methotrexate is contraindicated in Gillian barre syndrome Ref Harrison20th edition pg 2245 -### End" -3153,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Elasticity of hea muscle mainly depends on, with the following options: A: Myosin, B: Acitn, C: Titin, D: Troponin - -### Response: -Titin, the largest known protein (with a molecular mass near 3,000,000 Da), connects the Z lines to the M lines and provides scaffolding for the sarcomere. It contains two kinds of folded domains that provide muscle with its elasticity.Ref: Ganong&;s Review of medical physiology 25th edition. Page: 101 -### End" -3154,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common ovarian tumour in less than 20 year old is:, with the following options: A: Epithelial tumour, B: Germ cell tumour, C: Metastatic tumour, D: Sex cord stromal tumour - -### Response: -Below 20 years, 60% ovarian tumours are of germ cell origin and in girls less than 105, 85% tumours are of germ cell origin. Ref: Shaw 15th edition: page; 376. -### End" -3155,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old male with bilateral asymmetrical ptosis and diplopia on watching TV or working on a laptop.Which test will be useful for diagnosis?, with the following options: A: Nerve conduction velocity, B: Ice pack test, C: Muscle biopsy, D: CPK- MM Levels - -### Response: -Ans. (b) Ice pack test.The image shows presence of asymmetrical droopy eyelids with history of development of this finding on repeated working of eye muscles. The possible diagnosis is myasthenia gravis which can be identified by Ice pack test.Image source - style=""font-family: Times New Roman, Times, serif""> -### End" -3156,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Exposure of left subclan aery by supraclavicular approach does NOT require cutting of?, with the following options: A: Sternocleidomastoid, B: Scalenus anterior, C: Scalenus medius, D: Omohyoid - -### Response: -Exposure of left subclan aery by supraclavicular approach require incision of sternomastoid, omohyoid and scalenus anterior muscle. Supraclavicular incision one finger breadth above the clavicle allows excellent exposure of the middle and distal subclan aery.Right subclan aery is a branch of the brachiocephalic trunk and begins behind the right sternoclavicular joint. Left subclan aery is a direct branch of aoa. The subclan aery is divided into three pas in relation to the anterior scalene muscle: proximal, middle and distal. Proximal subclan aery gives rise to veebral, internal thoracic and thyrocervical trunk. Middle subclan aery contains costocervical trunk and the dorsal scapular aery. Distal subclan aery has no branches. -### End" -3157,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Action of a buffer is maximum when its pH is, with the following options: A: pKa, B: pKI, C: p log(h+), D: pI - -### Response: -Ans: a (pKa)Ref: Vasudevan & Sreekumari, 6th edi., Pg. 340BUFFERS - are solutions which can resist changes in pH when acid or alkali is added.Composition of buffers - two typesMixtures of weak acid with their salt with a strong base. Mixture of weak bases with their salt with strong acid.Example-Carbonic acid and sodium bicarbonate (bicarbonate buffer)Acetic acid and sodium acetate (acetate buffer)HENDERSON -HASSELBALCH EQUATIONpH = pKa + log / pH= negative log of hydrogen ion concentration pKa = pH at which the acid is half ionized is called pKa of an acid When base or salt =acid, then pH= pKa Therefore, when the concentrations of bases and acid are same, then pH is equal to pKa. Strong acids will have a low pKa and weak acids have a higher pKa.A buffer is most effective when the concentration of salt and acid are equal or when pH = pKa. When the ratio between salt and acid is 10:1, the pH will be 1 unit higher than the pKa. -### End" -3158,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Frame shift mutation:, with the following options: A: Substitution of amino acid, B: Changed mRNA base at 3rd nucleotide of codon, C: Due to stop codon, D: Deletion of 2 bases - -### Response: -Ans. (d) Deletion of 2 basesRef: Harper's Biochemistry, 30th ed. pg. 417-18 Somatic Mutation Include* Point mutation- (mutation of single nucleotide)# Silent mutation: If the changed base in the mRNA molecule at the third nucleotide of a codon, leads to no detectable effect.# Mis-sense mutation: Substitution of amino acid# Non sense mutation: Appearance of stop codon due to mutation* Frame shift mutation-due to deletion/insertion, of one or two bases, which causes shift in reading frame. Whole reading frame is changed leading to entirely different protein molecule synthesis, called garbled protein.* Trinucleotide repeat mutation-repeat more than 55 times. -### End" -3159,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vital bleaching temperature, with the following options: A: 100-115℉, B: 115-140℉, C: 140-160℉, D: 160℉ - till patient tolerates - -### Response: -The temperature safely tolerated by pulp is 115-140 °F -### End" -3160,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Psychosis is NOT associated with: DNB 08; TN 08, with the following options: A: Delusion, B: Depression, C: Phobia, D: Mania - -### Response: -Ans. Phobia -### End" -3161,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presented with a history of unilateral purulent nasal discharge with occasional bloody discharge from the same side, The diagnosis is?, with the following options: A: Antrochoanal polyp, B: Foreign body, C: Angiofibroma, D: Rhinosporidiosis - -### Response: -In case of foreign body in the nasal cavity, the child presents with unilateral nasal discharge which is often foul smelling and occasionally bloodstained. It is a dictum that ""if a child presents with unilateral, foul-smelling, nasal discharge, the foreign body must be excluded. If it is radiopaque,a radiograph of the nose is useful to confirm Ref: Dhingra 7e pg 181. -### End" -3162,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child presents after trauma to head with hyponatremia, volume depletion and increased excretion of urinary Na . What is the probable diagnosis?, with the following options: A: Cerebral salt wasting syndrome, B: SIADH, C: Adrenal hemorrhage, D: Autonomic failure - -### Response: -Answer- A. Cerebral salt wasting syndromeElectrolyte imbalance is common in traumatic brain injury (TBI), and contributes to brain swelling and to causing seizures.Cerebral salt wasting, a poorly understood form of excretory dysregulation in association with brain insult, leads to volume depletion and hlponatraemia. -### End" -3163,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle strained in athletic pubaigia is -, with the following options: A: Rectus abdominis, B: Gluteus, C: Retus femoris, D: Quadriceps - -### Response: -Ans-A -### End" -3164,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The standard sutureless cataract surgery done with phaco-emulsificaton and foldable IOL has an incision of:, with the following options: A: lmm-1.5mm, B: 2mm-2.5mm, C: 3mm-3.5mm, D: 3.5mm-4.5mm - -### Response: -C i.e. 3 mm-3.5 nun Cataract Sur eries - Intracaspular cataract extraction (ICCE) Extracapsular cataract extraction (ECCE) Phacoemulsification Definition Whole lens removed with intact capsuleQ Lens nucleus and coex removed leaving the capsular bag behindQ Same as ECCE Incision Large, 180deg, 10-12mm Larger Incision Medium, 120deg, 7-8 mm Smaller Incision Small, 30deg, 3.2-3.5mm Smallest Incision * Phacoemulsion with rollable lens require an incision o , 1mm per se. Micro-incision Cataract Surgery (MICS) using the same lens needs an incision of -3.5mm. -### End" -3165,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the follow ing is not a major criteria for rheumatic fever-, with the following options: A: Carditis, B: Arthralgia, C: Erythema marginatum, D: Subcutaneous nodule - -### Response: -Ans. is 'b' i.e., Arthralgia Guidelines for the Diagnosis of Initial Attack of Rheumatic Fever (Jones Criteria, Updated 1992)Major manfestationsMinor manfestationsSupporting evidence of antecedent group A Streptococal infectionCarditisClinical features:Positive throat culture or rapid streptococcal antigen testPolyarthritisArthralgia FeverElevated or increasing streptococcal antibody titerErythema marginatumLaboratory features: Subcutaneous nodulesElevated acute phase reactants : Erythrocyte sedimentation rate C-reactive protein Prolonged PR interval Chorea o From Jones criteria, updated 1992. JAMA 1992;268:2069-2073. Copyright American Medical Association.o The presence of 2 major or of 1 major and 2 minor manifestations indicates a high probability of acute rheumatic fever if supported by evidence of preceding group A streptococcal infection. -### End" -3166,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The ideal place to record body temperature in dead body is: AIIMS 06; BHU 10; NEET 14, with the following options: A: Rectum, B: Axilla, C: Mouth, D: Groin - -### Response: -Ans. Rectum -### End" -3167,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Indicator used in autoclave is ?, with the following options: A: Clostridium tetani, B: Bacillus stereothermophilus, C: Bacillus pumilis, D: Bacillus subtilis Var Niger - -### Response: -Ans. is 'b' i.e., Bacillus stereothermophilus Biological indicators . Biological indicators are standardised preparations of microorganisms used to assess the effectiveness of a sterilization process. . They usually consist of a population of bacterial spores placed on an ine carrier, for example a strip of filter paper, a glass slide or a plastic tube. . Most commonly, spores of Bacillus stereothermophilus (Geobacillus stearothermophilus) are used. Spores of Bacillus subtilis and Bacillus pumilis are alse used. . For various methods of sterilization following biological indicators are used :- Type of Sterilization Spore used Moist heat (autoclave) Bacillus stearothermophilus Dry heat (hot air oven) Bacillius subtilis Ionizing radiation Bacillus pumilis Gas sterilization (ethylene oxide) Bacillus subtilis Plasma sterilization Bacillus stearothemophilus -### End" -3168,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recording centric relation is important for all of the following reasons except:, with the following options: A: Its required for stability of denture, B: It’s a starting point for developing occlusion, C: It serves as a reference point, D: Centric relation should always coincide with centric occlusion in natural dentition - -### Response: -Centric Relation: “The maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective discs with the complex in the anterior-superior position against the slopes of the articular eminences. This position is independent of tooth contact. This position is clinically discernible when the mandible is directed superior and anteriorly. It is restricted to a purely rotary movement about the transverse horizontal axis” (GPT-5) (most accepted definition). Centric Occlusion: It is the maximum intercuspation between the upper and lower teeth. The latest terminology for centric occlusion is inter-cuspal position (ICP) or maximal intercuspal position. -Key Concept: -​Centric relation serves as a reference point and is used as a starting point for developing occlusion. In  natural dentition centric relation is a little behind the centric occlusion. -### End" -3169,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rx of choice for 'after cataract':, with the following options: A: Repeat ECCE, B: Holmium laser, C: Argon Laser, D: Nd-YAG Laser - -### Response: -Ans. d (Nd- YAG Laser). (Ref: Ophthalmology by A K Khurana 2nd ed: 209)LASERNd-YAG USER# Thin membranous after cataract and thickened posterior capsule are best treated by YAG laser capsulotomy or discission with cystotome or Ziegler's knife.# Nd-YAG produces an infrared radiation with a wavelength of 1064nm.He-Ne LASER# is used to produce the red aiming beam. Doubling its frequency makes it suitable for photocoagulation.# It is usually Q-switched when used to treat the eye.# It is used to treat posterior capsular thickening following cataract surgery and iridotomy for narrow angle glaucomaARGON LASER# can produce both blue and green light.# The new argon laser limits the emission to green light which is not absorbed by the macular xanthophylls and therefore less damaging to the macula of both the patients and the doctors.# During photocoagulation, the laser should just blanch the retina instead of heavy or white burn which increases the risk of visual field loss and reduced dark vision.# Argon laser is well-absorbed by melanin and a pigmented fundus requires less power than a light fundus. -### End" -3170,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In glomerulus subendothelial deposits are seen in ?, with the following options: A: Good pasture syndrome, B: IgA nephropathy, C: MPGN type I, D: MPGN type II - -### Response: -Ans. is 'c' i.e., MPGN type I -### End" -3171,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cholinomimetic is contraindicated in:, with the following options: A: Glaucoma, B: Myasthenia gravis, C: Postoperative ileus, D: Partial heart block - -### Response: -Ans. D. Partial heart blocka. Cholinergic system has Inhibitory effect on heart mediated by M2 receptors.b. Cholinomimetics can convert a partial heart block into a complete heart block due to negative chronotropic,c. Dromotropic properties. -### End" -3172,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of stridor in infants is:, with the following options: A: Laryngomalacia, B: Laryngeal cysts, C: Vocal cord polyp, D: None of the above - -### Response: -Laryngomalacia is the most common cause of stridor in infants and is also the most common congenital laryngeal abnormality, accounting for approximately 60% of cases. -### End" -3173,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pecentage of dose given as Basal insulin in bolus basal regimen in children is ?, with the following options: A: 0-25%, B: 25-50%, C: 50-75%, D: 75-100% - -### Response: -A basal-bolus injection regimen involves taking a number of injections through the day. A basal-bolus regimen, which includes an injection at each meal, attempts to roughly emulate how a non-diabetic person&;s body delivers insulin. Intensive therapy includes the administration of insulin 3 times daily by multiple daily injections (MDI) or pen, or an external pump. Every dose of insulin is adjusted according to the pre-meal blood glucose performed at least four times daily, dietary intake, and anticipated exercise. It does not refer to the type of insulin. Total daily dose is divided as follows: * Basal dose: 25-30% of the total dose in toddlers and 40-50% in older children, given at bedtime. This suppresses the glucose production between meals and overnight. * Bolus doses: Remaining dose is divided into 3 pre-meal doses. The meal time (prandial) doses limit post-prandial hyperglycemia. Every bolus dose of insulin is adjusted as per the scale in Table I. Intensive therapy includes the administration of insulin 3 times daily by multiple daily injections (MDI) or pen, or an external pump. Every dose of insulin is adjusted according to the pre-meal blood glucose performed at least four times daily, dietary intake, and anticipated exercise. It does not refer to the type of insulin .Total daily dose is divided as follows: * Basal dose: 25-30% of the total dose in toddlers and 40-50% in older children, given at bedtime. This suppresses the glucose production between meals and overnight. * Bolus doses: Remaining dose is divided into 3 pre-meal doses. The meal time (prandial) doses limit post-prandial hyperglycemia. Every bolus dose of insulin is adjusted as per the scale in Table I. TABLE I Subcutaneous Basal-Bolus Insulin Dosing and Glycemic Targets Age group (years) Target pre-meal blood sugar* Target HbA 1c (mg%) Dose** (U/kg/d) 0-6 100-180 7.5-8.5%+ 0.6-0.7 6-12 90-180 <8% 0.7-1.0 13-19 80-130 <7.5% 1.0-1.2 Reference: GHAI Essential pediatrics, 8th edition -### End" -3174,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stomach completes its rotation by, with the following options: A: 4 weeks, B: 6 weeks, C: 7 weeks, D: 8 weeks - -### Response: -At 5 weeks Stomach rotates and dilates. The intestinal loop begins to form.At 6 weeks Intestinal loop is well formed.Stomach completes rotation At 7 weeks Intestinal loop herniates out of the abdominal cavityAt 8 weeks Intestinal loop rotates counterclockwiseAt 3 months Herniated coils of intestine return to the abdominal cavity.Reference: Inderbir Singh Embryology; 10th edition; Page no: 200 -### End" -3175,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is an Abnormal finding in a neonate ?, with the following options: A: Glycosuria, B: Bacteriuria, C: WBCs in urine, D: Hyperbilirubinemia - -### Response: -Bacteriuria is the abnormal finding in neonates. Glycosuria, hyperbilirubinemia and wbc in urine can be seen as a physiologic and pathological finding and can be spontaneously resolved Reference: GHAI Essential pediatrics, 8th edition -### End" -3176,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In infant most sensitive audiometric screening is ?, with the following options: A: Electrocochleography, B: BERA, C: Coical evoked response, D: Tympanometry - -### Response: -Ans. is 'b' i.e., BERARef: Logan turner Ltr/e p. 416, 417; Anirban biswas clinical audio vestibulometry 3'd/e p. 68, 99BERA (brain stem evoked response audiometry) is now the most widely used method to estimate hearing threshold in infants. -### End" -3177,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The impression material that is mainly composed of sodium or potassium salts of alginic acid is _____., with the following options: A: Polyether, B: Irreversible hydrocolloid, C: Polyvinyl siloxane, D: Polysulfide - -### Response: -Irreversible hydrocolloid (IH) or alginate is the material of choice to produce diagnostic casts. Its composition is mainly sodium or potassium salts of alginic acid. They react chemically with calcium sulfate to produce insoluble calcium alginate. -### End" -3178,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 1-week-old previously healthy infant presents to the emergency room with the acute onset of bilious vomiting. The abdominal plain film in the emergency department (A) and the barium enema done after admission (B) are shown. Which of the following is the most likely diagnosis for this patient?, with the following options: A: Jejunal atresia, B: Hypertrophic pyloric stenosis, C: Malrotation with volvulus, D: Acute appendicitis - -### Response: -The plain films demonstrate dilated stomach and proximal loops of bowel. The cross-table upper GI demonstrates a ""curly Q"" twist of barium as it passes through the malrotated portion of bowel. Malrotation results when incomplete rotation of the intestines occurs during embryologic development. The most common type of malrotation is failure of the cecum to move to its correct location in the right lower quadrant. Most patients present in the first weeks of life with bilious vomiting indicative of bowel obstruction and/or intermittent abdominal pain. Acute presentation, similar to that in the question, is caused by a volvulus of the intestines. The diagnosis is confirmed by radiographs; barium contrast studies (upper GI and/or enema) demonstrate malposition of the cecum in the vast majority of cases. Treatment is surgical. Appendicitis is rare at this age and presents as an acute, rigid abdomen and signs of sepsis. Pyloric stenosis usually does not occur until after 3 weeks of life and presents with nonbilious vomiting. If the child were 6 months or older, intussusception would be higher on the differential, but it is an unusual condition for this age. Jejunal atresia would have been noted on the first day of life, as the patient would not have tolerated any feeds prior to newborn discharge. -### End" -3179,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A competitive inhibitor of an enzyme will?, with the following options: A: Alter the Vmax of the reaction, B: Bind to the same site as the substrate, C: Decrease the apparent Km for the substrate, D: Decrease the turnover number - -### Response: -Substances that reduce the activity of an enzyme are called inhibitors. Reversible inhibitors bind to an enzyme but rapidly dissociate from it . There are several types of reversible inhibitors: Competitive inhibitors usually resemble the substrate and compete with it for binding at the active site. Thus, increasing the concentration of substrate will decrease the percent inhibition of the enzyme. The Vmax is unchanged, but the Km is increased. A noncompetitive inhibitor binds with equal affinity to both enzyme and enzyme-substrate complex. This binding leads to a distoion of the substrate binding site, so new substrate cannot bind and/or the product cannot be released. In this kind of inhibition, the Vmax is decreased (choice A), but the Km is not altered. Adding more substrate will not reverse this type of inhibition. This is the equivalent of decreasing the turnover number. An uncompetitive inhibitor does not bind to free enzyme, but binds to the enzyme-substrate complex at a site other than the catalytic site. Once bound by the inhibitor, the enzyme is trapped in the enzyme-substrate complex state until the inhibitor dissociates. In this kind of inhibition, the slope of the reaction (which is the ratio Km/Vmax) remains the same, but both Vmax and Km are reduced. Ref: Janson L.W., Tischler M.E. (2012). Chapter 5. Enzymes and Amino Acid/Protein Metabolism. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry. -### End" -3180,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During a laboratory exercise on coagulation testing, a 23-year-old medical student is found to have a prolonged bleeding time. She has had a long history of ""easy bleeding,"" with frequent bleeding of the gums, epistaxis, cutaneous bleeding, and menorrhagia. Fuher testing revealed a deficiency of Von Willebrand factor. Which of the following thrombogenic processes involving platelets is most directly impaired?, with the following options: A: Adhesion, B: Conformational change with activation of phospholipid surface, C: Formation of fibrinogen bridges, D: Release reaction - -### Response: -Disruption of the endothelium exposes subendothelial von Willebrand factor (vWF) and collagen, which promote platelet adherence and activation. Deficiency of Von willebrand factor (VWF) causes | platelet adhesion ( |BT) and | Intrinsic pathway activity ( | aPTT) . -### End" -3181,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Presence of spiral grooves in the barrel of weapon is referred to as -, with the following options: A: Rifling, B: Incendiary, C: Cocking, D: None of the above - -### Response: -The synopsis of forensic medicine & toxicology ; Dr k.s narayan reddy ; 28th edition ; pg.no 123 & 124 The bore is cut internally with number of shallow ,spiral "" grooves"" varying from two to more than twenty ,the most common being six ,which run parallel to each other but twisted spirally ,from breech to muzzle . The groove are called rifling and the projecting ridges between these grooves are called ""lands"". -### End" -3182,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Term gestation patient with critical aortic stenosis presents to the labor, and her cervix is 6cm dilated. Your approach in treatment of patient includes all except, with the following options: A: Provide opiod epidural analgesia., B: Limit activity., C: Do pulmonary artery catheterization., D: Restrict i.v fluids to decrease cardiac preload. - -### Response: -Pregnant woman with critical aortic stenosis needs intensive monitoring during labor. So pulmonary artery catheterization is helpful. -Maintaining intravascular volume and cardiac output is important to decrease chances of hypotension and hemorrhage. -### End" -3183,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True in mitral regurgitation (MR) is, with the following options: A: Pansystolic murmur at the apex, B: Loud S1, C: Functional or Secondary MR is caused by papillary muscle rupture after myocardial infarction, D: ECG commonly reveals 'P' pulmonale - -### Response: -S1 is soft in MR unlike MS.  -Functional or Secondary MR is caused by dilation of the left ventricle causing leakage at the mitral annulus.  -ECG in MR shows 'P' mitrale due to dilation of the Left atrium. -### End" -3184,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ACRTI-RADS scan for thyroid nodule characteristics include all except:, with the following options: A: Margin, B: Echogenicity, C: Vascularity, D: Shape - -### Response: -Ans: (c) VascularityColl Radiol 2017 May, 14(5), Page 587-595ACR TI-RADS is a reporting system for thyroid nodules on ultrasound proposed by the American College of Radiology.It is based on the following characteristic of the lesion:CompositionEchogenicityShapeMarginEchogenic fociRecommendationsTR1: No FNAC requiredTR2: No FNAC requiredTR3: >=1.5 cm follow up, >=2.5 cm FNACFollow up: 1, 3 and 5 yearsTR4: >=1.0 cm follow up, >=1.5 cm FNACFollow up: 1,2,3 and 5 yearsTR5: >=0.5 cm follow up, >=1.0 cm FNACAnnual follow up for up to 5 years -### End" -3185,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recommended minimum per capita space for every worker under The Factory Act 1948 is:-, with the following options: A: 100 cu.ft., B: 300 cu.ft., C: 500 cu.ft., D: 1000 cu.ft. - -### Response: -Factory act 1948: Employment of <14 years child is not allowed 15-18 years Adolescents are allowed to work only between 6 am and 7 pm Work hour duration: Max. working hours (Adults) - 48hrs /week (not exceeding 9 hrs/day) Total no. of hours including oveime should not exceed - 60hrs /week Per capita space - 500 cu.ft 1 safety officer / 1000 worker 1 Welfare officer / 500 worker 1 canteen - 250 workers 1 creche - 30 female workers. -### End" -3186,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incised looking lacerated wounds are seen in:, with the following options: A: Hand, B: Thorax, C: Abdomen, D: Forehead - -### Response: -Ans: D (Forehead) Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy. 29th edition. 2010. Pg: 171Explanation:Incised- like or Incised- looking woundsLacerations produced without excessive skin crushing may have relatively sharp marginsBlunt force on areas where the skin is close to bone, and the subcutaneous tissues are scantyProduces a wound which by linear splitting of the tissues, may look like a incised woundThe sites are:Scalp & ForeheadEyebrowsCheek bonesLower jawIliac crestPerineumShin -### End" -3187,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about adrenals are true except :, with the following options: A: Chromoffin granules are seen in pheochromocytoma, B: Adrenal medulla normally secretes epinephrine & in excess of norepinephrine, C: Tumours of adrenal medulla secrete epinephrine in excess of norepinephrine, D: Adrenal medulla is not essential for life - -### Response: -B i.e. Adrenal medulla normally secretes epinephrine & in excess of norepinephrine -### End" -3188,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest site of Maltoma is, with the following options: A: Neck, B: Mediastinum, C: Stomach, D: Vertebra - -### Response: -Stomach is commonest site of Maltoma. -### End" -3189,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reaction due to lysis of bacterial cell wall & necrotic cell product -, with the following options: A: Arthus reaction, B: Serum sickness, C: Jerish herheximer reaction, D: Infectious mononucleosis-ampicillin reaction - -### Response: -Ans. is 'c' i.e., Jerish herheximer reaction o Certain cell wall acting antibiotics cause rapid cell lysis and release of proinflammatory and/or toxic bacterial components, which induce inflammatory response in host.o This produces a clinical syndrome known as Jarish-hersheimer reaction.o The typical example is treatment of primary and secondary syphilis with penicillin, which may produce fever, malaise and exacerbation of symptoms due to Jarish -hersheimer reaction.o The reaction can be managed with antipyretics and antihistaminics.About other optionso Arthus reaction and serum sickness are type III hypersensitivity reactions due to formation of antigen- antibody complex.o In IMN, ampicillin causes rash but this is due to allergic reaction against ampicillin. -### End" -3190,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: cDNA from RNA is synthesized by -, with the following options: A: Helicase, B: DNA dependent DNA polymeraze, C: Topoisomerase, D: Reverse transcriptase - -### Response: -Ans. is 'd' i.e., Reverse transcriptase o The enzyme RNA dependent DNA polymerase (reverse transcriptase) is responsible for the formation of DNA from RNA.o This DNA is complementory (c DNA) to viral RNA and can be transmitted into host DNA. -### End" -3191,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not vit K dependent clotting factor is -, with the following options: A: II, B: VII, C: VIII, D: IX - -### Response: -Ans. is 'c' i.e.. VIII o Vit K acts as a cofactor at a late stage in the synthasis of coagulation factors by liver - Prothrombin (factor II), Factor VII, IX and X (also protein 'C' & Protein 'S').Vitamin-Ko It is a fat soluble vitamin.o It is the major coagulant of human body (coagulants are substances which promote coagulation),o It is of three types -K1 (from plants) - PhytonadioneK2 (Produced by bacteria) - MenaquinonesK3 (Synthetic) - Menadioneo Half life of vit K is 72 hours - Mahenderbhan Singh 5th/e - 348o l it K acts as a cofactor at a late stage in the synthasis of coagulation factors by liver - Prothrombin (factor II), Factor VII, IX and X (also protein & Protein 'S')o It catalyzes the final step in activation of these factors i.e. gamma carboxylation of glutamate residues which confers on them the capacity to bind Ca+2 and to get bound to phospholipids surfaces - properties essential for participation in the coagulation cascade.Uses1. Deficiency stateDietry deficiency, prolonged antimicrobial therapy, obstructive jaundice or malabsorption syndrome.2. Liver diseaseVit K is usually ineffective because synthesis of clotting factor in liver is impaired.It may be helpful if there is deficiency due to decreased absorption because of lack of bile salts (bile salts promote absorption of fat soluble vitamin).3. NewbornsNewborns have deficiency of vit K as well as has limited capacity to synthesize clotting factors.Haemorrhagic disease of newborn can be prevented and treated with Vit K.4. Overdose of oral anticoagulantsThis is the most important indication of lit K.Oral anticoagulant interfere with the synthesis of Vit K dependent clotting factor - Vit K can be used to reverse the effect.o Phytonadione (Kj) is the preparation of choice for these indications, because it acts most rapidly.o lit Kj (Menadione) can cause hemolysis-contraindicated in G-6-PD deficiency and neonates.o In the newborn menadione can precipitate kemicterus by -Inducing hemolysis.Competitively inhibiting glucronidation of bilirubin. -### End" -3192,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle spindle detects ?, with the following options: A: Tension, B: Length, C: Proprioception, D: Pressure - -### Response: -Ans. is 'b' i.e., Length -### End" -3193,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 8 year old boy has itchy rash all over the body, all family members are affected. What is the drug of choice-, with the following options: A: Ivermectin, B: Topic permethrin, C: Prednisolone, D: Antibiotics - -### Response: -Ans. is 'b' i.e., Topic permethrin This boy is having scabies. Topical permethrin is the DOC for scabies Treatment of scabies Scabicide Method of use Topical Permethrin (5%) - Drug of choice Single aplication of 12 hour. Gamma benzen hexachloride BHC 1% Single application for a hour Benzyl-Bezoate (25%) Three applications at 12 hourly intervals Crotamiton (10%) Two application daily 14 days o Malathion (0.5%) Oral Ivermectin Single dose 200 mg/kg body-weight, repeat after 2 weeks Note : BHC is not safe in pregnancy and children (< 2 years) as it can cause neurotoxicity -### End" -3194,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug treatment for laryngeal stenosis is, with the following options: A: Adriamycin, B: Mitomycin C, C: Cyclophosphamide, D: Doxorubicin - -### Response: -Mitomycin-C is an antineoplastic antibiotic that acts as an alkylating agent by inhibiting DNA and protein synthesis. ... Topical application of mitomycin-C (0.4 mg/mL) was used as an adjuvant treatment in the endoscopic laser management of laryngeal and tracheal stenosis Ref: Internet sources -### End" -3195,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Red velvety appearance of the gastric mucosa is seen in poisoning with:, with the following options: A: Abrus precatorius, B: Lead, C: Arsenic, D: Copper - -### Response: -Red velvety appearance of mucosa of stomach is seen in Arsenic poisoning. -### End" -3196,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are causes of hypercalcemia except, with the following options: A: Hyperparathyroidism, B: Thyrotoxicosis, C: Vitamin A deficiency, D: Lithium - -### Response: -Causes of hypercalcaemia.EndocrinePrimary hyperparathyroidismThyrotoxicosisPhaeochromocytomaRenal failureSecondary hyperparathyroidismTeiary hyperparathyroidismMalignant diseaseSkeletal metastatic diseaseMultiple myeloma, lymphoma, leukaemiaSolid tumours (PTH-related peptidemediated): lung, renal, squamouscell carcinoma of the head and neck,oesophagus, genital tractNutritionalExcessive vitamin D ingestionVitamin A intoxicationMilk-alkali syndromeAluminum intoxicationGranulomatousSarcoidosisTuberculosisInherited diseaseHypercalciuric hypercalcaemiaImmobilisationPaget's diseaseDrug-relatedLithiumRef: Bailey and Love 27e pg: 826 -### End" -3197,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs binds to albumin ?, with the following options: A: Penicillin, B: Lidocaine, C: Propranolol, D: Verapamil - -### Response: -Acidic drug bind to albumin whereas basic drugs; bind to ∝ acid glycoprotein. -Penicillin is an acidic drug, so it binds to albumin -### End" -3198,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the commonest complication of Mumps in adults ?, with the following options: A: Encephalitis, B: Orchitis, C: Pancreatitis, D: Carditis - -### Response: -Meningoencephalitis is common in children. Unilateral deafness and thyroiditis are also known complication. -### End" -3199,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 48 year old diabetic with orbital cellulitis presented with a corneal ulcer. An aqueous tap showed branched hyphae. Diagnosis is -, with the following options: A: Herpetic ulcer, B: Mycotic Ulcer, C: Bacterial Ulcer, D: Anterior staphyloma - -### Response: -Ans. is 'b' i.e., Mycotic Ulcer Mycotic (fungal) corneal ulcero The incidence of corneal ulceration due to fungi has increased significantly due to long-term unwarranted use of antibiotic and steroid. The most common mode of infection is injury by vegetative material such as crop leaf, horn, wooden stick. The causative fungus are Aspergillus fumigatus (most common), Candida albicans and fusarium.Clinical featureso Symptoms are similar to bacterial comeal ulcers but in general they are less marked than the equal size bacterialulcer.On the other hand signs are very prominent, i.e. signs are more prominent than symptoms, o Following signs can be seen: -i) Greyish-white dry looking ulcer with the elevated rolled out feathery & hyphate margins.ii) Feathery finger like extension into surrounding stroma under intact epithelium.iii) A sterile immune ring (yellow line) of Wesseley.iv) Multiple small satellite lesions.v) Non-sterile (infected) hypopyon (Pseudohypopyon-Hence penetrated the endothelium)vi) Perforation is rare and comeal vascularization is conspicuously absent.Diagnosiso Examination of wet KOH will show:-i) Flamentous fungi (branched septate hyphae ):- Aspergillus fumigatus, Fusarium.ii) Non-filamentous (yeast like fungi): - Candida.Treatment of fungal corneal ulcero Treatment of comeal fungal ulcer involves:- 1) Specific (definitive) treatment, and 2) Adjunctive (concurrent) treatment.1) Definitive treatment: - It includes antifungal drugs: -A) Topical antifungals -i) For filamentous fungi (Aspergillus,fusarium):- Natamycin (5%) eye drops (drug of choice), Miconazole ointment, Amphotericin B drops.ii) For yeast (Candida): - Amphotericin B (Drug of choice), nystatin, flucytocine.B) Systemic antifungals: - May be required in severe cases. Fluconazole or ketoconazole may be used.2) Adjunctive/Concurrent therapy: - This follows the same principles as in any other infectious comeal diseases.# Cycloplegic (1% atropine ointment or drop is the DOC) should be used to: - i) Reduce pain from ciliary spasm; ii) Prevent posterior synaechiae; iii) Reduce uveal inflammation.# Topical steroids enhance fungal replication and comeal invasion and are contraindicated during early therapy of a fungal comeal ulcer. -### End" -3200,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adenosine deaminase In CSF Is significantly higher In, with the following options: A: Tuberculous meningitis, B: BacteriaI meningitis, C: Viral meningitis, D: Syphilitic meningitis - -### Response: -Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis (TB) and has very high morbidity and moality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis Ref Harrison20th edition pg 2456 -### End" -3201,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gene of Wilsons disease is:, with the following options: A: ATP 7A, B: ATP 7B, C: ADP 7A, D: ADP 7B - -### Response: -Gene Disease ATP 7Agene Menke disease ATP 7B gene Wilson's disease -### End" -3202,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Peak incidence of osteosarcoma occurs at:-, with the following options: A: 2nd decade, B: 3rd decade, C: 5th decade, D: 6th decade - -### Response: -* The most common bone tumor of 1st decade is Ewing's sarcoma.* The most common bone tumor of 2nd decade is osteosarcoma.* Both osteosarcoma and Ewing's sarcoma peak in 2nd decade (10-20 years of age). -### End" -3203,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pizza pie appearance is seen in -, with the following options: A: Toxoplasmosis, B: Congenital rubella, C: Dyug toxicity, D: CMV retinitis - -### Response: -CYTOMEGALIC INCLUSION DISEASE It is a multisystem disease caused by cytomegalo-virus (CMV). It occurs in two forms: congenital and acquired. 1. Congenital cytomegalic inclusion disease. It affects the neonates. The infection is acquired eitheransplacentally in utero or during bih from the infected cervix of mother. Its common systemic features are sensory deafness, mental retardation and convulsions. Ocular involvement occurs in the form of peripheral,central or total necrotizing chorioretinitis with associated vitreous haze. Posterior pole is involved more commonly and the lesions may be similar to Those found in congenital toxoplasmosis. Secondary involvement of anterior uvea may occur rarely. 2. Acquired cytomegalic inclusion disease. It occurs only in the immunosuppressed patients (due to any cause). The infection may be acquired by droplet infection or by transfusion of fresh blood containing infected white cells. Ocular involvement is in the form of 'CMV retinitis' characterised by presence of yellow-white exudates (areas of retinal necrosis) associated with areas of vasculitis and retinal haemorrhages. Some eyes may develop exudative retinal detachment. Ultimately, there occurs total retinal atrophy. Treatment. There is no specific treatment of CID. Recently treatment with intravenous dihydroxy- propylmethyl guanine has been shown to cause regression in some cases. Ref comprehensive ophthalmology Ak Khurana 4/e page no 159. -### End" -3204,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The bone matrix has the following crystals, with the following options: A: Calcium hydroxyapatite, B: Calcium pyrophosphate, C: Calcium phosphate, D: Calcium sulphate - -### Response: -The bone is made up of bone cells and extracellular matrix.The matrix consists oftwo types of materials,organic and inorganic. The organic matrix is formed by the collagen,which forms 30-35% of dry weight of a bone. The inorganic matrix is primarily calcium and phophorus salts,especially hydroxyapatite .It constitutes about 65-70% of dry weight of a bone. ref:maheswari,5th edition page no.9 -### End" -3205,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Longest acting local anaesthetic is: March 2013 (e, h), with the following options: A: Procaine, B: Lignocaine, C: Bupivacaine, D: All of the above - -### Response: -Ans. C i.e. Bupivacaine Bupivacaine Amide with duration of action more than 2 hours, C/I for: Bier's block/Intravenous regional anaesthesia/IVRA It is highly cardiotoxic Cardiotoxicity is not easily reversible, Levo-bupivacaine is used by epidural/intrathecal route -### End" -3206,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cardiomyopathy is not a feature of -, with the following options: A: Duchenne's Muscular Dystrophy, B: Friedriech's ataxia, C: Pompe disease, D: Lowe's syndrome - -### Response: -Ans. is 'd' i.e., Lowe's Syndrome -### End" -3207,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Causes of antepaum hemorrhage are all except, with the following options: A: Placenta pre, B: Atonic uterus, C: Abruptio placenta, D: Circumvallate placenta - -### Response: -Atonic uterus -### End" -3208,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rokitansky-Aschoff sinuses are seen in which of the following conditions?, with the following options: A: Acute cholecystitis, B: Chronic cholecystitis, C: Xanthogranulomatous cholecystitis, D: Gallbladder carcinoma - -### Response: -Rokitansky-Aschoff sinuses are seen in Chronic cholecystitis. It is due to outpouchings of mucosal epithelium through the wall of the gallbladder forming these sinuses. Can contain fragmented bill pigment stones. -### End" -3209,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Generalized necrotising lymphadenopathy is-, with the following options: A: Kimura disease, B: Kukuchi disease, C: Non--Hodgkin's lymphoma, D: Castleman's disease - -### Response: -Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limited disease that mainly affects young women. Patients present with localized lymphadenopathy, fever, and leukopenia in up to half of the cases. -### End" -3210,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following muscles of thumb is not supplied by median nerve, with the following options: A: Adductor pollicis brevis, B: Flexor pollicis brevis, C: Opponens pollicis, D: Abductor pollicis brevis - -### Response: --in the palm, the median nerve flattens at the distal border of the flexor retinaculum and divides into lateral and medial divisions. The lateral division gives a recurrent branch that curls upwards to supply the thenar muscles except for the deep head of flexor pollicis brevis. Thenar muscles are abductor pollicis brevis, flexor pollicis brevis and opponents policies Mnemonic Median nerve innervates hand muscles like The LOAF muscles Lumbricals 1 & 2 Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis -Reference: Textbook of anatomy, Upper limb and thorax, Vishram Singh, 2nd edition, page no.144,177 Figure: 9.41,page no: 126- BD chaurasia , 6th edition -### End" -3211,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which cyclooxygenase plays a role in maintaining GI mucosal integrity?, with the following options: A: Cyclooxygenase 1, B: Cyclooxygenase 2, C: Cyclooxygenase 3, D: Cyclooxygenase 4 - -### Response: -Cyclooxygenase 1- plays a role in maintaining GI mucosal integrity The beneficial effects of NSAIDs on tissue inflammation are due to inhibition of COX-2 S/E of NSAIDs: GI mucosal ulceration and renal dysfunction- due to inhibition of the COX-1 isoform. Highly COX-2-selective NSAIDs- provide the beneficial effect of decreasing tissue inflammation & minimizing toxicity in the GI tract. Selective COX-2 inhibitors have had adverse effects on CVS, leading to increased risk of myocardial infarction. -### End" -3212,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Middle 1.5 cm of anal canal is lined by, with the following options: A: Keratinized stratified squamous epithelium, B: Non keratinized stratified squamous epithelium, C: Columnar epithelium, D: Psudocolumnar epithelium - -### Response: -The anal canal is divided into three pas. The zona columnaris is the upper half of the canal and is lined by simple columnar epithelium. The lower half of the anal canal, below the pectinate line, is divided into two zones separated by Hilton's white line. The two pas are the zona hemorrhagic and zona cutanea, lined by atratified squamous non keratinized and stratified squamous keratinized. ref - BDC vol2 pg416 -### End" -3213,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type I hypersensitivity, the mediator is -, with the following options: A: IgE, B: IgD, C: IgM, D: IgC - -### Response: -Type I hypersensitivity reaction is IgE dependent. Cytotoxic IgE antibodies are fixed on the surface of tissue cells ( mast cells and basophils) in sensitized individuals. The antigen combines with the cell fixed antibody, leading to release of pharmacologically active substance that produces the clinical reaction. Reference : Anathanarayan & paniker's 9th edition, pg: 162 <\p> -### End" -3214,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infectivity period of measles is:, with the following options: A: 2 days before and 4 days after appearance of rash, B: 4 days before and 5 days after appearance of rash, C: 4 days before and 1 days after appearance of rash, D: Entire incubation period - -### Response: -Infectivity period :-:Period of communicability is the time during which an infectious agent may be transferred directly or indirectly from an infected person to another person Measles patients are infectious from 4 days before to 5 days after the onset of rash. Infectivity period of other diseases:- Chicken pox patients are infectious from 2 days before 5 days after the onset of rash. Mumps patients are infectious from 1 week before to 2 weeks after the onset of parotitis. Rubella patients are infectious from 1 week before to 1 week after the onset of rash. -### End" -3215,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the screening test for evaluation of mineralocoicoid excess?, with the following options: A: Saline infusion test, B: Salt loading test, C: Cosyntropin test, D: Aldosterone renin ratio - -### Response: -The accepted screening test for mineralocoicoid excess is aldosterone renin ratio. Since the leading cause is Adrenal Adenoma, the autonomous aldosterone values will rise and renin values will be low due to feedback. ARR screening is positive if ratio is > 750pmol/L per ng/ml. Spironolactone should be discontinued for at-least 4 weeks before performing this test for obvious reasons. This is followed by performance of investigation of choice for mineralocoicoid excess which is Saline infusion test. -### End" -3216,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 8 days old neonate with extensor posture–a) Cerebral palsyb) Hypoxic ischemic encephalopathyc) Malnutritiond) Infection, with the following options: A: ac, B: a, C: ab, D: bc - -### Response: -Normal posture of a full term neonate is flexor posture. -Extensor posture may be seen when there is brain damage as in hypoxia -3 hypoxic ischemic encephalopathy and cerebral palsy. -### End" -3217,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child suffering from acute diarrhoea is brought to the casualty and is diagnosed as having severe dehydration with pH of 7.23. Serum Na– 125, Serum K– 3, HCO3– 16. The best I.V. fluid of choice is –, with the following options: A: 3% Saline, B: N/3 Saline + 10% dextrose, C: Normal saline, D: N/3 saline + 5% dextrose - -### Response: -The fluid used in severe dehydration - -Best IV fluid for severe dehydration is Ringer's lactate. -An ideal preparation would be Ringer's lactate with 5% added dextrose, However, it is not available. -If Ringer's lactate is not available, normal saline solution (0.9% NaCl ) can be used. -### End" -3218,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mondor&;s disease is, with the following options: A: Superficial thrombophlebitis of breast, B: Fat necrosis in breast, C: Postradiation breast and arm edema, D: Skin infection over the breast - -### Response: -Mondor&;s disease is spontaneous thrombophlebitis of the superficial veins of the breast and anterior chest wall cause is unknown it is often self limited it often mimics the lymhatic permeation of the carcinoma of breast ref ;(page no;525) 5th edition of SRB&;S Manual of SURGERY -### End" -3219,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 42-year-old woman presents with a diffuse swelling in front of the neck. Thyroid function tests are within normal limits. A fine-needle biopsy reveals malignant cells. The tumor is excised and examined. The tumour cells are positive for calcitonin on immunohistochemistry. What is the appropriate pathologic diagnosis?, with the following options: A: Anaplastic carcinoma, B: Follicular carcinoma, C: Medullary carcinoma, D: Papillary carcinoma - -### Response: -Medullary carcinoma thyroid microscopic features: Composed of polygonal to spindle-shaped cells, which may form nests, trabeculae, and even follicles. Small, more anaplastic cells are present in some tumors and may be the predominant cell type. Amyloid deposits derived from calcitonin polypeptides are present in the stroma in many cases. Calcitonin is readily demonstrable within the cytoplasm of the tumor cells as well as in the stromal amyloid by immunohistochemical methods. Electron microscopy reveals variable numbers of membrane-bound electron-dense granules within the cytoplasm of the neoplastic cell. -### End" -3220,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common orbital cyst in children is, with the following options: A: Neuroenteric cyst, B: Dermoid cyst, C: Lymphoma, D: Clobomatous cyst - -### Response: -(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 417) Epidermal dermoid cyst (dermoid) is the most common orbital cystic lesion in children, accounting for over 40% of all orbital lesions of childhood and for 89% of all orbital cystic lesions of childhood that come to biopsy or surgical removal.the most impoant secondary cyst is a mucocele that can occur in children with cystic fibrosis Orbital dermoid cysts are benign congenital choristomas. They are common in pediatric population, developing adjacent to suture lines, most commonly located in antero-lateral fronto-zygomatic suture, and are slowly progressive. Complete surgical excision without rupture of cyst is the standard of care -### End" -3221,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Feto maternal transfusion is detected by:, with the following options: A: Kleihauer test, B: Spectrophotometry, C: Benzidine test, D: None of the above - -### Response: -Kleihauer-Betke test may be performed on maternal blood to assess the amount of fetomaternal bleed.The maternal blood is subjected to an acid solution.Acid will elute the adult hemoglobin,but not the fetal hemoglobin from the red cells.Hence fetal red cells appear dark red,adult red cells appear pale(ghost cells). TEXT BOOK OF OBSTETRICS,Sheila Balakrishnan,2nd edition,page no.311 -### End" -3222,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of cyst in jaw, with the following options: A: Radicular, B: Dentigerous cyst, C: Solitary bone cyst, D: Nasolabial cyst - -### Response: -Radicular Radicular Cyst 1. Also known as dental cyst or periodontal cyst or periapical granulomaQ 2 Most common cyst of jaw 3 It usually develops due to continuous irritation of infected tooth which stimulate the nests of cell to proliferate. 4 Occur more frequently in upper jaw. Presentation * Cyst present at the apexQ of the affected tooth * Expansion of jaw * Painless (unless infected) * Bone in thinned out with eggshell crackling. X- ray- well circumscribed radiolucency at the apex of the affected tooth. The margin of the cyst may be sclerosed. Treatment- Extraction of the carious tooth with curettage (intra oral approach) -### End" -3223,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Interstitial nephritis is most commonly seen with -, with the following options: A: Methicillin, B: Ampicillin, C: Amoxycillin, D: Cloxacillin - -### Response: -Ans. is 'a' i.e., Methicillin o Hematuria, Albuminuria and reversible interstitial nephritis are the specific adverse effect of methicillin. Remember o Methicillin - Intestitial nephritis o Oxacillin - Hepatitis o Nafcillin - Neutropenia o Ampicillin - Diarrhea -### End" -3224,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The coagulation profile in a 13-year old girl with menorrhagia having von Willebrand's disease is ?, with the following options: A: Isolated prolonged PTT with a normal PT, B: Isolated prolonged PT with a normal PTT, C: Prolongation of both PT and PTT, D: Prolongation of thrombin time - -### Response: -Ans. is 'a' i.e., Isolated prolonged PTT with a normal PT -### End" -3225,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is NOT effective in controlling the hot flushes of menopause in a woman?, with the following options: A: Hormone replacement therapy, B: Tibolone, C: Raloxifene, D: Isoflavones - -### Response: -Ans is 'c' i.e., RaloxifeneHot Flushes : They are the 'hallmark' of menopause. Hot flushes are described as recurrent transient period of flushing, sweating and a sensation of heat often accompanied by palpitations. feelings of anxiety. and sometimes followed by chills.The entire episode lasts no more than 1-3 minutes and recurs 5-10 times / day (can occur upto 30 times a day). Sho term estrogen therapy results in resolution of hot flushes.Hormone therapyEstrogen therapy (most effective)Combined estrogen and progestin therapyProgestin therapy (to be given in those women in whom estrogen is contraindicated)TiboloneNon hormonal prescription medicines :Not FDA approvedClonidineSelective serotonin reuptake inhibitor : paroxetine, fluoxetineSerotonin and nor epinephrine reuptake inhibitor : venlafaxineDopamine antagonist : VeraliprideGabapentinBellergal (combination of ergotamines, phenobarbital and belladona, approved for the treatment of migrain).)MeazapineTrazodoneNon prescription medicines :Isoflavones (100 mg/day)Soy products (60 g/d)Vitamin E (800 IU/day)Life style changes :Reducing body temperatureMaintaining a healthy weightSmoking cessationPaced respiration -### End" -3226,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Social Mobility is -, with the following options: A: From rural to urban areas for work, B: Industrialization, C: Interaction between cultures, D: Movement in socio-economic stratas - -### Response: -Ans. is 'd' i.e., Movement in socio-economic status Social mobilityo Social mobility is the degree to which an individual's is family or group's social status can change throughout the course of their life through a system of social hierarchy or stratification.o The individual or family can move up or down the social classes based on achievements or factors beyond their control.o If such mobility involves a change in position, especially in occupation, but no change in social class, it is called ""horizontal mobility "". Example - a person who moves from a managerial position in one company to a similar position in another.o If the move involves a change in social class it is called ""vertical mobilityExample - An industrial worker who becomes a wealthy businessman moves upward in the class system. -### End" -3227,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 82-year-old female presented with history of loss of vision in right eye for about 15 minutes and it cleared up. She has a history of diabetes and hypertension. She had which showed old infarct on right side. Carotid duplex showed that patient had 99% carotid artery stenosis. Which one of the following statements is TRUE?, with the following options: A: 60%chance that extra cranial carotid artery stenosis is the cause of transient ischemic attack (TIA), B: It is always due to platelet emboli., C: 25% may be intracranial bleed., D: 0.5 to 10% may have cardiac and other causes of TIA. - -### Response: -Neurological events are associated with extracranial carotid artery in about 60%. Forty percent may have extracranial/intracranial cause for neurological events, which includes cardiac emboli, arch of aorta as source of emboli; intracranial bleed may be more than just a TIA. It is not always that platelet emboli are the cause of TIA, it could be due to atheroma. It is not always attributed to thrombus. -### End" -3228,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inverted papilloma arises from -, with the following options: A: Roof, B: Medial wall, C: Lateral wall, D: None - -### Response: -Ans. is 'c' i.e., Lateral wall Inverted Papilloma (Transitional ceil papilloma'Schneiderion papilloma)o Inverted papilloma is a benign neoplasm occurs mostly between 40-70years with male preponderance (5 : 1).o It arises from the lateral wall of nose and is always unilateral. Rarely, it may arise from nasal septum,o Features of inverted papilloma are : -It shows finger like epithelial invasions into the underlying stroma of the epithelium rather than on surface so called inverted papilloma.It is usually unilateral and is a locally aggressive tumour.Patients complain of nasal obstruction, rhinorrhea & unilateral epistaxis.In 10-15% cases there may be associated squamous cell carcinoma.o Treatment is adequate local excision. If it arises in maxillary sinus, then a radical antrostomy is carried out. If it arises in the ethmoidal sinus, an external eihmoidectomy is done. If it arises from nose, treatment is wide surgical excision by lateral rhinotomy.o Has a tendency to recur even after removal. -### End" -3229,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dawson disease is:, with the following options: A: SSPE, B: Acute disseminated encephalomyelitis, C: Neuromyelitis optica, D: Multiple Sclerosis - -### Response: -Dawson disease SSPE (Subacute Sclerosing pan encephalitis) Late complication of measle virus which can causes myoclonus at 8 years of age Multiple Sclerosis- Dawson Fingers: MRI head Neuromyelitis Optica- Anti aquaporin - 4 A/b - T. Myelitis + Optic neuritis -### End" -3230,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antihelminthic which acts by flaccid paralysis of worms is-, with the following options: A: Piperazine, B: Bephenium, C: Pyrantel, D: None - -### Response: -Ans. is 'a' i.e., Piperazine Piperazine o It causes hyperpolarization of ascaris muscle by a GABA agonistic action opening Cl-channels --> flaccid paralysis. o Piperazine safe and well tolerated drug, it is also safe in pregnancy. Remember o Drugs causing flaccid paralysis Ivermectin, piperazine. o Drugs causing spastic paralysis --> Pyrantel pamoate, levamisole. -### End" -3231,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following characteristics is not of much impoance in a screening test, with the following options: A: Low cost, B: High safety margin, C: High sensitivity, D: High specificity - -### Response: -High specificity All are impoant attributes of screening test but among them high specificity is less impoant as Park states -'Screening test is not intended to be a diagnostic test. It is only an initial examination. Those who are found to have positive test results are refen-ed to a physician for fuher diagnostic work-up & treatment. High specificity is a necessary attribute for a diagnostic test. Below are given the differences between screening and diagnostic tests. Screening test Diagnostic test * Done on apparently healthy Done on those with indications or sick (asymptomatic) * Applied to groups Applied to single patients, all diseases are considered * Test results are arbitrary and final Diagnosis is not final but modified in light of new evidence, diagnosis is the sum of all evidence 4. Based on one criterion or cut-off Based on evaluation of a number of symptoms, signs and point (e.g., diabetes) laboratory findings Less accurate More accurate 6. Less expensive More expensive 7. Not a basis for treatment Used as a basis for treatment 8 The initiative comes from the investigator or agency providing care The initiative comes from a patient with a complaint Criteria for Screening test Screening test must satisfy the criteria of - acceptability - repeatability - validity - simplicity - safety - rapidity - ease of administration - low cost 1. Acceptability - Considering that screening tests are applied on asymptomatic people in large numbers, a high rate of people cooperation is needed. Thus the tests should be acceptable to the people. In general, tests that are painful, discomfoing or embarrasing (eg. rectal or vaginal examinations) are not likely to be acceptable to the population in mass campaigns. 2. Repeatability (Precision or reproducibility) - means that the test must give consistent results when repeated more than once on the same individual or material under the same conditions. 3.Low cost - A screening should be inexpensive. As a screening test has to be applied on millions of people to identify a small percentage who have early disease or its precursors, an expensive test however good, cannot justify use of restricted financial resources that has to be used for fuher diagnostic workup and t/t of those screened on positives. 4. High safety margin - This is an attribute of any test, whether diagnostic or screening. Moresoever for screening as screening tests are to be applied on millions of asymptomatic people and any adverse effect would bring whole process into disrepute. iims IN/nee answers & explanations -- May 2007 5. Validity - It expresses the ability of a test to separate or distinguish those who have the disease from those who do not - Validity has two components - sensitivity & specificity - An ideal screening test should be both highly sensitive and highly specific. But this is seldom possible and a compromise has always to be made. -### End" -3232,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A tumor has the following characteristics - retrobulbar location within the muscle cone, well defined capsule, presents with slowly progressive proptosis, easily resectable, occurs most commonly in the 2nd to 4th decade. Most likely diagnosis is -, with the following options: A: Capillary hemangioma, B: Cavernous hemangioma, C: Lymhangioma, D: Hemangiopericytoma - -### Response: -Ans. (b) Cavernuos hemangiomaRef: Kanski's 7/e, p. 105* Cavernous hemangioma is the most common benign, intraconal tumour in adults.* Presents with slowly progressive unilateral proptosis* CT - well circumscribed oval lesion, encapsulated -### End" -3233,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication of Shigellosis, with the following options: A: HUS, B: Reactive arthritis, C: Pneumonia, D: Meningitis - -### Response: -(A) HUS # EXTRAINTESTINAL COMPLICATIONS OF SHIGELLOSIS:> Common complications: Bacteremia HUS: occur with S. dysenteriae type 1 infection. Manifestations of HUS usually develop at end of first week of shigellosis. Oliguria, marked drop in hematocrit are the first signs & progress to anuria with renal failure & to severe anemia with congestive heart failure.> Less common complications: Reactive arthritis> Rare complications: Pneumonia; Meningitis; Vaginitis (in prepubertal girls); Keratoconjunctivitis & ""rose spot"" rashes. -### End" -3234,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Z score measures the bone mineral density compared to, with the following options: A: Age, Race and sex matched individuals, B: Race and sex matched individuals, C: Sex matched individuals, D: None of the above - -### Response: -T Score and Z score are the measures of bone mineral densityZ score: measures the bone mineral density in terms of standard detion from the mean bone mineral density of age, race, and sex-matched individualsT score: measures the bone mineral density in terms of standard detion from the mean bone mineral density of race and sex-matched individuals or normal younger age group(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 400 - 412) -### End" -3235,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adult worm of Echinococcus is found in:, with the following options: A: Dog, B: Humans, C: Domestic animals, D: Felines - -### Response: -Ref. Textbook of Microbiology and Immunology BY Parija. – Compiled from Various chapters -### End" -3236,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following condition is treated with, with the following options: A: Systemic antifungal therapy, B: Systemic antiviral therapy, C: Systemic corticosteroids, D: Systemic antibiotics - -### Response: -The picture and the description are characteristic features of Pyostomatitis vegetans . It is usually treated by corticosteroids -### End" -3237,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is false about the hormonal changes in pregnancy -, with the following options: A: Level of progesterone is more in third trimester compared to first trimester, B: Level of hCG is more in third trimester compared to first trimester, C: Level of estriol is less in first trimester compared to third trimester, D: Level of human placental lactogen is less in the first trimester compared to third trimester - -### Response: -Ans is 'b' i.e., Level of hCG is more in third trimester o hCG level is maximum at the end of 1 st trimester (9-12 weeks). After that it starts decreasing.hCG levels in weeks from the last normal menstrual period :3 weeks LMP5-50mlU/ml4 weeks LMP5-426mlU/ml5 weeks LMP18-7,340mlU/ml6 weeks LMP1,080 -56,500 mlU/ml7-8 weeks LMP7,650-229,000 mlU/ml9-12 weeks LMP25,700-288,000 mlU/ml13-16 weeks LMP13,300-254,000 mlU/ml17-24 weeks LMP4,060-165,400 mlU/ml25-40 weeks LMP3,640 -117,000 mlU/mlo Estrogen, progesterone and human placental lactogen gradually increase from 1st trimester to third trimester. -### End" -3238,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following cells are responsible for acid secretion in kidney:, with the following options: A: I cells, B: P cells, C: Mesangial cell, D: Pericytes - -### Response: -Two types of cells in CD & DCT: -P (Principal) cell is responsible for: - -Na+ reabsorption -K+ secretion -H2O Absorption - -I (Intercalated) cell: two types - -Alpha: acid secretion -Beta: HCO-2 secretion -### End" -3239,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alpha particle is similar to, with the following options: A: Electron, B: Proton, C: Neutron, D: Helium nucleus - -### Response: -Ans: d (Helium nucleus) Ref: Vasudevan 4th ed/p 464.Alpha particle consists of 2 protons and 2 neutrons bound together into a particle identical to Helium nucleus He2+.Beta particles are high energy, high speed electrons or positrons emitted by radioactive nuclei. Gamma rays are electromagnetic radiation of high frequency.X-rays are low energy photons.Penetration powen-Gamma ray > X ray. Beta particle > alpha particleIonising and damaging power: -Alpha particle> Beta particle > X ray> Gamma ray -### End" -3240,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A boy presented with multiple non suppurative osteomyelitis with sickle cell anemia , what will be the causative organism?, with the following options: A: Salmonella, B: S.aureus, C: H.influenza, D: Enterobacter species - -### Response: -sickle cell anemia can involve multiple bones hence it can cause multifocal osteomyelitis and causative organism is salmonella. REF : MAHESWARI 9TH ED -### End" -3241,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: March fracture is ?, with the following options: A: Neck of 2nd metatarsal, B: Neck of 3' metatarsal, C: Shaft of 4th metatarsal, D: Head of 5th metatarsal - -### Response: -Ans. is 'a' i.e., Neck of 2nd metatarsal Metatarsal stress fractures are common in distance runners and ballet dancers. The second metatarsal neck is the most likely site for stress fracture, but all metatarsals are susceptible. March fracture, also known as fatigue fracture or stress fracture of metatarsal bone, is the fracture of the distal third of one of the metatarsals occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and even those, like hospital doctors, whose duties entail much standing. March fractures most commonly occur in the second and third metatarsal bones of the foot. -### End" -3242,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Middle superior alveolar nerve is branch of, with the following options: A: Mandibular nerve, B: Maxillary nerve, C: Lingual nerve, D: Facial nerve - -### Response: -MAXILLARY NERVE DIVISION: IN MIDDLE CRANIAL FOSSA-Meningeal branch IN PTERYGOPALATINE FOSSA-Ganglionic branches Zygomatic: a.Zygomaticotemporal b.Zygomaticofacial Posterior superior alveolar IN INFRAORBITAL CANAL-Middle superior alveolar Anterior superior alveolar ON FACE-Infraorbital:palpebral,labial,nasal Ref BDC volume 3,sixth edition pg 368 -### End" -3243,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Macrophage activation syndrome is characterized by all except __________, with the following options: A: Hemophagocytosis, B: Hypofibrinogenemia, C: Hyperiglycidemia, D: Hypoferritenemia - -### Response: -Macrophage activation syndrome is characterised by all if the listed feature except Hypoferritenemia . Macrophage activation syndrome(MAS) is rare but potentially fatal complication of systemic JIA. It is characterized by the following: Macrophage hemophagocytosis in the bone marrow Hypofibrinogenemia (paradoxical fall in erythrocyte sedimentation rate ) (ESR) Hyperiglyceridemia Extreme hyperferritinemia Fever > 38.5oC Splenomegaly Cytopenia affecting atleast two or three cell lineages. Reference : nelson textbook of pediatrics 21st edition Pgno: 1262 -### End" -3244,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a child , Washes hands and puts on shoes at the age of ________, with the following options: A: 30 months, B: 36 months, C: 48 months, D: 60 months - -### Response: -Emerging patterns of social behaviour from 1-5years of age 15months Indicates some desires or needs by pointing Hugs parents 18months Feeds self Seeks help when in trouble May complain when wet or soiled Kisses parent with pucker 24months Handles spoon well Often tells about immediate experiences Helps to undress Listens to stories when shown pictures 30months Helps put things away Pretends in play 36months Plays simple games (in ""parallel"" with other children) Helps in dressing (unbuttons clothing and puts on shoes) Washes hands 48months Plays with several children, with the beginning of social interaction and role-playing Goes to the toilet alone 60months Dresses and undresses Asks questions about the meaning of words Engages in domestic role-playing Ref: Nelson paediatrics; Table 11-1 -### End" -3245,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Leather term is used for -, with the following options: A: Anthrax, B: Proteus, C: Diphtheria, D: Neisseria - -### Response: -Ans. is 'c' i.e., Diphtheria name is derived from the tough leathery pseudomembrane (diphtheros, meaning leather). -### End" -3246,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The net protein utilization of rice is -, with the following options: A: 20%, B: 40%, C: 63%, D: 81% - -### Response: -1gm of protein is assumed to be equivalent to 6.25g of N. Rice contain 7g of protein. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 584 -### End" -3247,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glycolipids are formed in -, with the following options: A: Mitochondria, B: Cytosol, C: Peroxisomes, D: Endoplasmic reticulum - -### Response: -Ans. is 'd' i.e., Endoplasmic reticulum o Like the glycoproteins, glycolipids (glycosphingolipids) are synthesized in the endoplasmic reticulum, then transported into the golgi apparatus and eventually otward to joini the outer surface of plasma membraneo Glycolipids are formed by attachment of a carbodydrate component (monosaccharide or oligosaccharide) to ceramide. They are commonly referred to as glycosphingo lipids because presence of sphingosine backbone (within ceramide).o Depending on the nature of carbohydrate component attached, four types of glycosphingolipids are recognized: Cerebrosides, Sulfatids, globosides and gangliosides1) Cerebrosides (Ceramide + monosaccharide):-# Cerebrosides are the simplest + glycolipids in which a monosaccharide is attached to ceramide.# The monosaccharide is commonly either glucose (glucocerebroside) or galactose (galactocerebroside).# Galactocerebroside is the most common cerebroside found in nerve tissue membrane, whereas glucocerebroside is the predominant glycolipid in extraneural tissues, where it serves as a precursor for synthesis of more complex glycolipids, e.g. gangliosides.2) Sulfatides:-# Sulfatides are are cerebrosides in which the monosaccharide (mostly galactose) contains a sulfate ester.3) Globosides (Ceramide + oligosaccharide):-# They contain two or more sugars (oligosaccharide chain) attached to ceramide.4) Gangliosides (Cerebroside + oligosaccharides + N-acetylneuromic acid NANA):-# Gangliosides are complex glycolipids, derived from glucocerebroside.# Ganglioside contain oligosaccharides and one or more molecules of sialic acid which is usually N-acetyl neuramic acid (NANA) attached to ceramide.# Several types of gangliosides such as GM1, GM2, GM3 etc have been isolated from brain and other tissues. -### End" -3248,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Creatinine is synthesized from:, with the following options: A: Glycine,arginine and methionine, B: Glycine and methionine, C: Ornithine and glycine, D: Thymine and ornithine - -### Response: -A Harper, 26lh ed, p. 268, Fig (31 - 6) & 25th ed, p. 354 -### End" -3249,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The infective form of toxoplasma gondii is -, with the following options: A: Oocyst, B: Bradycyst, C: Tachyzoite, D: All of the above - -### Response: -The oocyst is present in cat and other felines and not in humans. Oval or spherical in shape Contains a Sporoblast Formed by sexual reproduction (refer pgno:64 baveja 3 rd edition) -### End" -3250,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Left atrial filling pressure closely approximates with ?, with the following options: A: Pulmonary capillary wedge pressure, B: Central venous pressure, C: Intrapleural pressure, D: Intracranial pressure - -### Response: -The pulmonary wedge pressure or PWP, or cross-sectional pressure (also called the pulmonary aerial wedge pressure or PAWP, pulmonary capillary wedge pressure or PCWP, pulmonary venous wedge pressure or PVWP, or pulmonary aery occlusion pressure or PAOP), is the pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary aerial branch Because of the large compliance of the pulmonary circulation, it provides an indirect measure of the left atrial pressure Ref Harrison 20th edition pg 1456 -### End" -3251,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The inability to perceive the texture & shape an object occurs in lesion of., with the following options: A: Lateral spino-thalamic tract, B: Nucleus gracils, C: Spino reticular tract, D: Nucleus cuneatus - -### Response: -D. i.e. Nucleus cuneatus The middle pa of cuneate nucleus, the pars rotunds which receives impulses from digits, palm, dorsum of hand & forearm is specific for stereognosis.- Stereognosis is determination of texture & size of an object, is a function of cerebral coexThe sensory information of stereognosis to brain is carried by posterior column which includes tractus gracilis & tractus cuneatus Tractus gracilis bring sensation from lumber & sucral segments to nucleus gracilis (less specific for steriognosis)- Tractus cuneatus bring sensation from cervical & thoracic segments to nucleus cuneatus.Mnemonic - ""Gracilis for lower segments & Cuneatus for upper segments - G comes after C -### End" -3252,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Syndrome associated with thymic and parathyroid hypoplasia:, with the following options: A: Prader Willi syndrome, B: Angelman syndrome, C: Di George syndrome, D: MENU - -### Response: -Ans: c (Di George syndrome) Ref: Harrison, 16th ed,p. 1942; Nelson, 17th ed, p. 211, 694,735Di George syndrome is characterized by variable loss of T cell mediated immunity (due to hypoplasia of thymus), tetany (due to lack of parathyroids) and congenital defects of heart and great vessels.Di George syndromeIt is a syndrome of isolated T cell deficiency. Most commomn microdeletion syndromeMaldevelopment of thymic epithelial elements derived from 3 rd and 4th pharyngeal pouch there is deletion of short piece of long arm of chromosome 22 (22q 11) Autosomal dominant/ sporadicIt is also called Velocardiac facial syndrome.The acronym is CATCH-22C - Cardiac defectsA - Abnormal faciesT - Thymic hypoplasiaC - Cleft palateH - Hypocalcemia from parathyroid hypoplasia22 - Microdeletion chromosome 22 -### End" -3253,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following organism is identified by interferon, with the following options: A: Staphylococcus, B: Leptospira, C: Campylobacter, D: Tuberculosis - -### Response: -Interferon-gamma release assay: This test uses Mycobacterium tuberculosis antigen CFP10 which reacts with T-lymphocytes of the patient to release gamma interferon. This test is not very specific for pulmonary tuberculosis, hence is not recommended any longer. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th edition; Pg: 360 -### End" -3254,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are false about propofol except, with the following options: A: Propofol causes malignant hyperthermia, B: Propofol infusion at rate >4mg/hr causes propofol infusion syndrome, C: Propofol is the best bronchodilator, D: Propofol is cardiovascular stable drug - -### Response: -Propofol is bronchodilator, but ketamine is the best among all anaesthetic agents. Propofol has myocardial depressant action. i.v anaesthetic agents do not cause malignant hyperthermia. -### End" -3255,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are advantages of split thickness skin grafting except, with the following options: A: Good uptake, B: Reusable donor site, C: Less contraction, D: Large grafts can be harvested - -### Response: -.Advantages of SSG includes, 1. Technically easier. 2. Wide area of recipient can be covered. To cover large area like burns wound, graft size is increased by passing the graft through a Mesher which gives multiple openings to the graft, which can be stretched on the wider area like a net. It can cause expansion upto 6 times. 3. Graft take up is better. 4. Donor area heals on its own. ref:SRB;s manual of surgery,ed 3,pg no 281 -### End" -3256,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these can cause 3 -rd - nerve paralysis -a) Posterior communicating artery (PCA) aneurysmb) Tolosa - Hunt syndromec) Midbrain infarctd) Pons Infarcte) Lateral medullary lesion, with the following options: A: abc, B: bc, C: acd, D: bcd - -### Response: -Causes of occulornotor nerve paralysis - -Infarct, haemorrhage, demyelination, infection, tumor. -Aneurysm ofposterior communicating artery & basilar artery. -Aneurysm, infarct, compression, tumor, meningitis. -Internal carotid artery aneurysm, carotid-cavernous fistula, cavernous sinus thrombosis, tumors (pituitary adenoma, meningioma, metastasis), herpes zoster, Tolosa-hunt syndrome. -Infarction of nerve e.g. diabetes, giant cell arteritis. -### End" -3257,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following soft tissue sarcoma has propensity for lymphatic spread except, with the following options: A: Neurofibrosarcoma, B: Synol sarcoma, C: Rhabdomyosarcoma, D: Epitheloid sarcoma - -### Response: -Ans. is 'a' i.e., Neurofibrosarcoma Soft tissue sarcomas are tumors of mesenchymal origin. Unlike most carcinomas, soft tissue sarcomas rarely metastasize to the lymph nodes (<5%); therefore lymph node surgery usually is not necessary. -### End" -3258,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common pituitary adenomas are -, with the following options: A: Growth hormone secreting adenomas, B: ACTH secreting adenomas, C: TSH secreting adenomas, D: Prolactinomas - -### Response: -Ans. is 'd' i.e., Prolactinomas o Pituitary adenomas constitute approximate 10% of all primary intracranial neoplasms and about 1/3 to 1/2 of all suprasellar/juxtasellar masseso Pituitary adenomas are classified on the basis of hormone(s) produced by the neoplastic cells detected by immunohistochemical stains.o Most common pituitary adenomas are prolactinomas.o Pituitary adenomas can be differentiated from hyperplasia by reticulin stain (Absence of reticulin network is seen in adenoma)o Pituitary adenomas are sellar lesions but larger adenomas can extend through the diaphragm sella into the suprasellar region and compress the optic chiasm (causing visual field abnormalities) and other cranial nerves. Large adenomas can also erode the sellarturcica and extend into surrounding region (k/a invasive adenomas) -### End" -3259,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antisocial behaviour/ Dissocial personality is characterised by, with the following options: A: Excessive sensitivity to suspiciousness, B: Emotional coldness and lack of pressure, C: Unconcern for feelings of others, disregard for social norms, D: Self dramatization and exaggerated expression of emotions - -### Response: -1. Callous inconcern for the feelings of others. 2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules and regulations, 3. incapacity to maintain enduring relationships, though having no difficulty in establishing them 4. very low tolerance to frustration and a low threshold for discharge of aggression, including violence. 5. incapacity to experience guilt or to profit from experience, paicularly punishment. 6. marked proneness to blame others, or to offer plausible rationlisations, for the behaviour that has brought patient into conflict with society. Ref: ICD-10, CDDG, pg 159. -### End" -3260,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common genital lesion in HIV patient is ?, with the following options: A: Chlamydia, B: Herpes, C: Syphilis, D: Candida - -### Response: -Ans. is 'b' i.e., Herpes `Herpes simplex (in the developed world) and chancroid (in Africa) are the most common cause of genital ulceration in HIV infected patients.' - 'An Atlas of differential diagnosis in HIV disease' by Lipman, Gluck and Johnson 1st (1995) p. 30 -### End" -3261,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following bacteria is transmitted by Housefly?, with the following options: A: Leptospira, B: Listeria, C: V. cholerae, D: Yersinia - -### Response: -Ans. is 'c' i.e.,V. cholerae Cholera can be trasmitted by Housefly -### End" -3262,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Yellow fever is caused by -, with the following options: A: Arbovirus, B: Alpha virus, C: Sindbis, D: Chikungunaya virus - -### Response: -

YELLOW FEVER:- Zoonoses disease caused by arbovirus. Affects principally monkeys and other veebrates and is transmitted to humans by culicine mosquitoes. Reservoir- mokeys and forest mosquitoes., in urban areas reservoir is man besides Aedes aegypti. A temperature of 24 deg celcius or more required for its multiplication. Period of communicability- Blood of patients infective upto first 3-4 days {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.282}

-### End" -3263,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gene for Wilm's tumor is located on:, with the following options: A: Chromosome 1, B: Chromosome 10, C: Chromosome 11, D: Chromosome 12 - -### Response: -Gene for Wilm's tumor is located on Chromosome 11 2 genes associated with Wilms tumour WT1 gene (located on chr 11p13) WT2 gene (located on chr 11p15) -### End" -3264,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zollinger-ellison syndrome is not caused by tumors from, with the following options: A: Pancreas, B: Ovary, C: Colon, D: Duodenum - -### Response: -repeated question. Zollinger-Ellison syndrome (ZES) is caused by a non-beta islet cell, gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach to maximal activity, with consequent gastrointestinal mucosal ulceration. ZES may occur sporadically or as pa of an autosomal dominant familial syndrome, multiple endocrine neoplasia type 1 (MEN 1). The primary tumor is usually located in the duodenum, the pancreas, and abdominal lymph nodes, but ectopic locations have also been described (eg, hea, ovary, gall bladder, liver, kidney). -### End" -3265,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Raltegravir belongs to, with the following options: A: NIs, B: NNIs, C: INSTIs, D: CCR5 antagonist - -### Response: -More than 25 antiretrovirals (ARV) drugs in six mechanistic classes are Food and Drug Administration (FDA)-approved for treatment of HIV infection. These six classes include the nucleoside/nucleotide reverse transcriptase inhibitors (NIs), non-nucleoside reverse transcriptase inhibitors (NNIs), protease inhibitors (PIs), a fusion inhibitor (FI), a CCR5 antagonist, and integrase strand transfer inhibitors (INSTIs). In addition, two drugs, ritonavir (V or r) and cobicistat (COBI or c) are used solely as pharmacokinetic (PK) enhancers (or boosters) to improve the pharmacokinetic profiles of some ARV drugs (e.g., PIs and the INSTI elvitegravir ).Dolutegravir , Elvitegravir , Raltegravir are integrase strand transfer inhibitors (INSTIs). -### End" -3266,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 72-year-old patient with Parkinsonism presents with swollen feet. They are red, tender and very painful. You could clear up these symptoms within a few days if youtell the patient to stop taking:, with the following options: A: Amantadine, B: Benztropine, C: Bromocriptine, D: Levodopa - -### Response: -A characteristic side effect due to local release of CAs resulting in vasoconstriction is livedo reticularis and edema of ankles. Ref KD Tripati 8th ed. -### End" -3267,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corkscrew esophagus is seen in which of the following condition?, with the following options: A: Carcinoma esophagus, B: Scleroderma, C: Achalasia cardia, D: Diffuse esophageal spasm - -### Response: -Diffuse Esophageal Spasm Esophageal contractions are repetitive, simultaneous, and of high amplitude. Basic pathology is related to a motor abnormality of the esophageal body that is most notable in the lower two thirds of the esophagus. More common in women and is often found in patients with multiple complaints. Clinical feature Clinical presentation: Chest pain and dysphagia (may be related to eating or exeion and may mimic angina) Complain of squeezing pressure in the chest that may radiate to the jaw, arms, and upper back. The symptoms are often pronounced during times of heightened emotional stress. Diagnosis Barium swallow: Corkscrew or rosary-bead esophagus, segmental spasm or pseudodiveiculosis appearance Due to presence of teiary contractions Indicative of advanced disease Manometry is gold standard test for diagnosis. Treatment: Mainstay of treatment for DES is nonsurgical, and pharmacologic (Nitrates, calcium channel blockers) or endoscopic intervention (Bougie dilation) is preferred. Indications of surgery (long esophagomyotomy): Incapacitating chest pain or dysphagia who have failed medical and endoscopic therapy Presence of pulsion diveiculum of the thoracic esophagus -### End" -3268,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are significant risk factors for colonic carcinoma in an adenomatous polyp except, with the following options: A: Pedunculated polyp, B: Villous histology, C: Size > 2 cm, D: Atypia - -### Response: -Adenomatous polyps may be sessile or pedunculated. Cancers develop more frequently in sessile polyps. -Atypia, on histology, seen anywhere, is a risk factor for cancer. -### End" -3269,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triad of leukoerythroblastosis, tear drop erythrocytes and large platelets is seen in, with the following options: A: Essential thrombocytosis, B: Primary myelofibrosis, C: Myelodysplastic syndrome, D: Langerhan cell histiocytosis - -### Response: -Ans. (b) Primary myelofibrosis(Ref: Robbins 9th/pg 620/630)The most characteristic peripheral blood finding in PMF is myelophthisis, defined by the presence of leukoerythro- blastosis (presence of nucleated red blood cells, metamyelocytes, myelocytes, myeloblasts, and megakaryocytes) and dacryocytosis (Tear drop RBCs) -### End" -3270,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dystrophin is lacking in, with the following options: A: Polio, B: Duchenne's muscular dystrophy, C: Peroneal muscular atrophy, D: None of the above - -### Response: -Duchenne muscular dystrophy is caused due to mutation in the dystrophin gene. Loss of fuction of dystrophin gene located on the sho arm of X chromosome. Dystrophin is a very large protein found in the skeletal and cardiac miscle, and peripheral nerves. Robbins basic pathology 9th edition page no 802 -### End" -3271,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Development of spermatozoa (sperm) from spermatogonium takes how much time-, with the following options: A: 3 0-3 5 days, B: 40-45 days, C: 50-55 day, D: 70-75 days - -### Response: -Ans. is 'd' i.e., 70-75 days o Spermatogenesis refers to the process of formation of spermatozoa (sperm) from primitive germ cells (spermatogonia).o Spermatogenesis begins at puberty' and continues throughout adult life to decline in old age.o In humans, it takes an average of 74 days to form a mature sperm from primitive germ cells.o Spermatogenesis occurs in seminiferous tubules. -### End" -3272,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drug are used for management of Post Herpetic Neuralgia except, with the following options: A: Noriptyline, B: Capsaicin cream, C: Gabapentin, D: Cycloplegics - -### Response: --Cycloplegics have no role in neuropathic pain, provide relief in ocular pain due to spasm of muscles such as uveitis. -Simple analgesics such as paracetamol -Stronger analgesics such as codeine -Tricyclic antidepressants, e.g. noriptyline, amitriptyline -Carbamazepine for lancinating pain -Gabapentin (300-600 mg up to three times daily), sustained-release Oxycodone or both. -Capsaicin cream (active ingredient of chillie paper) is also used to relieve pain. -### End" -3273,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The advantage of bladder drainage over enteric drainage after pancreatic transplantation is better monitoring of, with the following options: A: HBA IC levels, B: Amylase levels, C: Glucose levels, D: Electrolyte levels - -### Response: -The specific complications of enteric drainage include intra-abdominal sepsis and adhesive small intestinal obstruction.Bladder drainage of the exocrine pancreas may result in the following complications:* bladder/duodenal anastomotic leaks;* cystitis (owing to effect of pancreatic enzymes);* urethritis/urethral stricture;* reflux pancreatitis;* urinary tract infection;* haematuria;* metabolic acidosis (due to loss of bicarbonate in the urine).Urinary drainage of the pancreas has the advantage that urinary amylase levels can be used to monitor for graft rejection. However, after bladder drainage, urinary complications are commonBailey and Love 26th edition pg: 1427 -### End" -3274,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The first investigation of choice in a patient with suspected subarachnoid haemorrhage should be -, with the following options: A: Non-contrast computed tomography, B: CSF examination, C: Magnetic resonance imaging (MRI), D: Contrast-enhanced computed tomography - -### Response: -Investigation of choice for acute SAH is non-contrast CT scan. -### End" -3275,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A newborn had a bilious vomiting after 6 hours of bih. X-ray of the abdomen shows double bubble sign. This is a feature of:, with the following options: A: Pyloric stenosis, B: Duodenal atresia, C: Ileal atresia, D: Esophageal atresia - -### Response: -Duodenal atresia is due to failure of recanalization of the duodenal lumen during weeks 3-7 of embryologic development. Newborn will have bilious vomiting in the first 24 hours of life. ""Double-bubble"" sign and absence of gas distal to the duodenum can be seen on plain films. Ref: Wyatt C., Moos P.J., Brown T.G. (2008). Chapter 14. Gastrointestinal Pathology. In C. Wyatt, P.J. Moos, T.G. Brown (Eds), Pathology: The Big Picture. -### End" -3276,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the only common pathogenic protozoan found in the duodenum and jejunum?, with the following options: A: Entamoeba coli, B: Balantidium coli, C: Giardia lamblia, D: Toxoplasma gondii - -### Response: -Giardia lamblia (also referred to as Giardia duodenalis or Giardia intestinalis) is the causative agent of giardiasis and is the only common pathogenic protozoan found in the duodenum and jejunum of humans. Large numbers of parasites attached to the bowel wall may cause irritation and low-grade inflammation of the duodenal or jejunal mucosa, with consequent acute or chronic diarrhea associated with crypt hyperophy, villous atrophy or flattening, and epithelial cell damage. Stools may be watery, semisolid, greasy, bulky, and foul smelling at various times during the course of the infection. Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 46. Medical Parasitology. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e. -### End" -3277,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Positive Shick's test indicates that the person is, with the following options: A: Immune to diphtheria, B: Hypersensitive to diphtheria, C: Susceptible to diphtheria, D: Carrier of diphtheria - -### Response: -Schick test: intradermal test to demonstrate circulating diphtheria antitoxin. This antitoxin may be present either due to previous infection or immunization. This test demonstrates the immunity or susceptibility of a person against diphtheria. Positive Schick test signifies that the person is susceptible to diphtheria due to the absence or lack of adequate amount of circulating antitoxin. Reference: Textbook of Microbiology; Baveja; 4th edition; Page no: 219, 220 -### End" -3278,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of meningitis in children between 6 months to 2 years of age is:, with the following options: A: Pneumococcus, B: Staphylococcus, C: H influenza, D: E.coli - -### Response: -Most common cause of meningitis from 3months to 2-3 years is due to Hemophilus Influenza, Streptococcus Pneumonia, Meningococci. Ref: Kliegman, Behrman, Jenson, Stanton (2008), Chapter 602, ""Central Nervous System Infections"", In the book, ""NELSON TEXTBOOK OF PEDIATRICS"", Volume 2, 18th Edition, New Delhi, Page 2514 -### End" -3279,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sudden painful loss of vision is seen in:, with the following options: A: Angle closure glaucoma, B: Endopthalmitis, C: Acute uveitis, D: All - -### Response: -Ans. All A, B, and C -### End" -3280,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common affected tissue in cysticercosis is:, with the following options: A: Brain, B: Eye, C: Muscles, D: Liver - -### Response: -Ans. is 'c'Rarely neurocysticercosis happens and most common site is Parenchymal and associate with Ingestion of infected eggs of Taenia solium with food and water. -### End" -3281,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A buffer that is most effective at a pH of about 4.5 is;, with the following options: A: Acetate buffer., B: Bicarbonate buffer, C: Phosphate buffer, D: Tris buffer - -### Response: -Ans. is 'a' i.e. Acetate BufferRef Guyton, 10/e, p349A buffer system is most effective when the pH of the system is near its pka valueLet's see the pka of the buffers given in the questionBufferPkaPhosphateBicarbonateAcetateTris 6.8 6.14.76 (Harper 25th/e p24) 8.3 (Harper 25th/ep23)* It's the acetate buffer which has its pka (4.76) value nearest to the pH of the system (4.5), hence it will be most effective at this pH. -### End" -3282,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are differential diagnosis for acute scrotum except, with the following options: A: Epididymitis, B: Hydatid torsion, C: Testicular torsion, D: Testicular cancer - -### Response: -In testicular malignancy, Usually, the patient presents with a painless testicular lump.A sensation of heaviness can occur if the testis is two or three times its normal size, but only a minority of patients experience pain.The hydatid of Morgagni (appendix testis) is a small embryological remnant at the upper pole of the testis. Can occasionally, undergo torsion, causing acute one-sided testicular pain. One-third of patients present with a palpable ""blue dot"" discoloration on the scrotum. (blue-dot sign)Ref: Bailey and Love 27e pg: 1507 -### End" -3283,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following factors has maximum effect on filtration of a drug by the glomerulus ?, with the following options: A: Lipid solubility, B: Plasma protein binding, C: Degree of ionization, D: Rate of tubular secretion - -### Response: -- Main Factors determining glomerular filtration - -   Renal blood flow -   Plasma protein binding - -- Lipid solubility does not affect glomerular filtration. -- Ionization determines tubular reabsorption.  -- Tubular secretion happens after glomerular filtration and so does not affect the process. -### End" -3284,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blackish discoloration present around firearm entry wound is due to, with the following options: A: unburnt gunpowder, B: Smoke, C: Flame, D: Friction burn and dirt - -### Response: -Ans) b (Smoke) Ref: KNS Reddy 29th ed p 195In case of a close range shot, tissue surrounding the wound are signed by flame, and blackened by smoke and tattooed by unburnt or partially burnt powder granulesContact shotClose shotDistant shotThe discharge from the muzzle consisting of the flame, powder metallic particles are blown into the track taken by the bulletThe discharge of muzzle is flame powder etc is within the range of the entrance woundThe discharge of the muzzle is outside the range of entrance woundConsequently there may be no burning no soot no tattooing around the entrance woundWound is signed by flame.Surrounded by soot(blackened) and shows tattooingNo burning, no tattooing, sootSkin surrounding the wound will have absence of abraded and grease collarSkin surrounding the wound shows abraded collar and grease collarAbraded collar may be presentSurrounding tissue may be cherry red due to presence of carboxyhaemoglobinCarboxy haemoglobin is present in the wound track in diminishing concentrationSurrounding tissue may be cherry red due to presence of carboxyhemoglobinWound may be small and irregular or large and irregularThe entrance wound is circular with inverted margins but the rebounding gases may level up or even evert the marginThe wound is circular with inverted margins and may be of same size or even smaller than The bullet due to initial stretching of skin -### End" -3285,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female pt. present with a hard. mobile lump in her rt. breast. Which investigation would be most helpful in making the diagnosis -, with the following options: A: FNAC, B: Needle biopsy, C: Excision biopsy, D: Mammography - -### Response: -An open biopsy is the most definitive investigation. -CSDT writes - -""The most reliable diagnostic test for breast cancer is open excisional biopsy. When the sample is properly taken by the surgeon and examined by the pathologist, such a test should give no false-negative and no false-positive results."" -"" Large-needle (core needle biopsy) is an accepted diagnostic technique n which a core of tissue is removed with a large cutting needle. As in the case of any needle biopsy, the main problem is sampling error due to improper positioning of the needle, giving rise to a false negative test result."" -### End" -3286,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about acute epididymitis is :, with the following options: A: Associated with urinary infection, B: Painless, C: Scrotum size is reduced, D: Does not mimic with torsion of testes - -### Response: -Ans is 'a' ie Associated with urinary infection Acute epididymitis and ac. epididymo chitis are inflammation of the epididymis and testis due to infective pathology.Infection reaches the epididymis through the vas from urethra. Sometimes it may be blood borne.MC infective organism in sexually active young males is Gonococcus and Chlamydia, and in children and older men are d/t urinary pathogen such as E. coli.Clinical symptomsThe pts. presents with a fever, very painful, swollen, red, tender scrotum.The epididymis and the testis are both swollen.The acute painful condition has to be differentiated from torsion of testis.Treatment antibiotics, rest & lots of fluid -### End" -3287,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Potassium reabsorption in Kidney occur -, with the following options: A: Paly in PCT and DCT, B: Paly in PCT and DCT, C: Coupled with sodium ions, D: None - -### Response: -D i.e. None -### End" -3288,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proposed guideline value for Radioactivity in drinking water is:, with the following options: A: Gross a activity 0.1 Bq/L and Gross b activity 1.0 Bq/L, B: Gross a activity 1.0 Bq/L adn Gross b activity 0.1 Bq/L, C: Gross a activity 1.0 Bq/L and Gross b activity 10.0 Bq/L, D: Gross a activity 10 Bq/L and Gross b activity 1.0 Bq/L - -### Response: -Key guidelines aspects of WHO recommended drinking water quality: Colour <15 true colour units (TCU) Turbidity <1 nephlometric turbidity units (NTU) pH: 6.5-8.5 Total dissolved solids (TDS) <500 mg/Litre Zero pathogenic microorganisms Zero infectious viruses Absence of pathogenic protozoa and infective stages of helminthes Fluoride <1.0 ppm (0.5-0.8 ppm: Optimum level) Nitrates <45 mg/Litre Nitrites <3 mg/Litre Gross alpha radiological activity <0.5 Bq/Litre (new guidelines -WHO) Gross Beta radiological activity <1.0 Bq/Litre (new guidelines-WHO) Ref: Park 25th edition Pgno: 762 -### End" -3289,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Section for expe witness under IEA is -, with the following options: A: 45, B: 32, C: 154, D: 65B - -### Response: -Ans. is 'a' i.e. 45 IEA sec 45 - Opinions of expes.-When the Cou has to form an opinion upon a point of foreign law or of science or a, or as to identity of handwriting , the opinions upon that point of persons specially skilled in such foreign law, science or a, are relevant facts. Such persons are called expes.IEA sec 65B - Admissibility of electronic recordsLEA sec 32 - Cases in which statement of relevant fact by person who is dead or cannot be found, etc ., is relevantIEA sec 154 - Question by pay to his own witness. -### End" -3290,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glutathione is a, with the following options: A: Dipeptide, B: Polypeptide, C: Tripeptide, D: Oligopeptide - -### Response: -Glutathione is -glutamyl cysteinyl glycine, i.e. glutathione is a tripeptide made up of 3 aminoacyl residues - Glutamate, Cysteine, Glycine Gluta - Glutamate Thi- Sulfur containing (Cysteine) One- Glycine (1 C amino acid) Glutathione is the major intracellular reducing substance/anti-oxidant SH group of glutathione is responsible for its antioxidant function. -### End" -3291,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is due to chronic smoking:, with the following options: A: Centri-acinar emphysema, B: Panacinar emphysema, C: Irregular emphysema, D: Mixed variety - -### Response: -Ans. (a) Centri-acinar emphysemaRef: Harrison 18th edition, Chapter 13* Centri-acinar lesions are more common and severe in the upper lobes, particularly in the apical segments.* In severe centriacinar emphysema the distal acinus also becomes involved, and so, as noted, the differentiation from panacinar emphysema becomes difficult.* This type of emphysema is most commonly seen as a consequence of cigarette smoking in people who do not have congenital deficiency of a^antitrypsin. -### End" -3292,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: most impoant cell damage in pathogenesis of ARDS is, with the following options: A: alveolar cell type 1, B: alveolar cell type 2, C: endothelial cell of capillary, D: due to macrophages - -### Response: -RESPIRATORY DISTRESS SYNDROME (ARDS) * Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting into the blood. * Acute respiratory distress syndrome was first described in 1967 by Ashbaugh and colleagues. * ARDS is also referred with variety of terms like * Stiff Lung * Shock lung * Wet lung * Post traumatic lung * Adult respiratory distress syndrome * Adult hyaline membrane disease * Capillary leak syndrome & * Congestive atelectasis. ARDS - PATHOGENESIS Insult (direct or indirect) =>Activation of inflammatory cells & mediators =>Damage to alveolar capillary membrane =>Increased permeability of alveolar capillary membrane =>Influx of protein rich edema fluid and inflammatory cells into air spaces =>Dysfunction of surfactant ref : robbins 10th ed -### End" -3293,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Soft chancre is a feature of-, with the following options: A: Syphilis, B: H. Ducreyi, C: Gonococcus, D: LGV - -### Response: -Ans. is 'b' i.e., H. DucreyiRemember* Soft sore (soft chancre) - Chancroid (ulcer caused by H. ducreyi).* Hard sore (Hard chancre) - Ulcer of primary syphilis (caused by T. pallidum) -### End" -3294,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Popcorn calcification in mammography is seen in -, with the following options: A: Fibroadenoma, B: Fat necrosis, C: Cystosarcoma phylloides, D: Ca Breast - -### Response: -""Large lobulated (popcorn) calcification have a characteristic mammographic appearance"" - Robbins -Fibroadenomas are the most common benign tumors of breast. -### End" -3295,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the gold standard test for Laryngopharyngeal Reflux?, with the following options: A: 24 hour double probe pH monitoring, B: Esophageal biopsy, C: Abnormal esophageal radiography (BariumSwallow), D: Esophageal motility studies - -### Response: -Currently, the Gold standard test for Laryngopharyngeal Reflux is 24 hour double probe pH monitoring. An arbitrary threshold of pH=4 is used to diagnose reflux whether at the esophageal probe (5 cm above the lower esophageal sphincter) for gastroesophageal reflux or at the pharyngeal probe (2 cm above the upper esophageal sphincter) for laryngopharyngeal reflux (LPR). -### End" -3296,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding permissible radiation, with the following options: A: For public - 0.5 mSv /year, B: For radiation workers - 0.5 mSv / year, C: For public 50 mSv /year, D: For radiation workers - 50 mSv / year - -### Response: -DOSE LIMIT: NCRP Exposure Type Dose Limits Occupational Exposure (Annual) Whole Body Effective Dose Lint (Stochastic Effects) Dose Equivalent Limit for organs (Non Stochastic Effects) 50 mSv Lens of Eye 150 mSv All others 500 mSv Public Exposure (annual) Effective dose equivalent knit, continous exposure Effective dose equivalent limit, infrequent exposure Dose Equivalent Limits for lens, skin and extremities 1 mSv 5 mSv 50 mSv Embryo Fells Exposures Total dose equivalent limit Dose Equivalent in a month 5 mSv 0.5 mSv Annual effective education and training exposure Dose Equivalent Limits for lens, skin and extremities 1 mSv 50 mSv Dose Limits set by ICRP (International Commission on Radiation Protection) Occupational Public Effective Dose (mSv/y) 20* 1 Equivalent Dose (mSv/y) To Lens of eye 150 15 Skin 500 50 Hands and Feet 500 - * Averaged over 5 years and not more than 30 mSv in any 1 year. AERB Guidelines for Radiation protection Dose Limitations Pa of the body Occupational Exposure Public Exposure Whole body (Effective dose) 20 mSv/ year averaged over 5 consecutive years; 30 mSv in any single year 1 mSv/y Lens of eyes (Equivalent dose) 150 mSv in a year 15 mSv/y Skin (Equivalent dose) 500 mSv in a year 50 mSv/y Extremities (Hands and feet) Equivalent dose 500 mSv in a year - For pregnant radiation workers, after declaration of pregnancy 1 mSv on the embryo fetus should not exceed. -### End" -3297,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a pa of Epithalamus?, with the following options: A: Pineal body, B: Posterior commissure, C: Trigonum habaenulae, D: Geniculate bodies - -### Response: -Geniculate bodies -### End" -3298,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Opinion of a people for a test was expressed as very satisfied, dissatisfied, very dissatisfied:, with the following options: A: Nominal, B: Ordinal, C: Interval, D: Ratio - -### Response: -Ordinal -### End" -3299,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bicarbonate is maximally absorbed from, with the following options: A: PCT, B: DCT, C: Collecting disc, D: Thick ascending loop of teenle - -### Response: -PCT -### End" -3300,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Asthenospermia means:, with the following options: A: Immotile sperms, B: Absent sperms, C: Dead sperms, D: Dysmorphic sperms - -### Response: -Ans: A (Immotile sperms) Ref: Harrison's 18th edn.Explanation:Azoospermia - Absence of sperm in the ejaculate.Aspermia - Zero volume ejaculate.Oligospermia - Low numbers of sperm.Asthenospermia - Poor sperm motility.Teratospermia - Abnormal morphology (shape) of sperm. -### End" -3301,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Multiple necrotic ulcers in prepuce of penis with tender, suppurative inguinal nodes is caused by-, with the following options: A: Chalmydia, B: Hemophilus ducreyi, C: Herpes simplex, D: Syphilis - -### Response: -B i.e. Hemophillus -### End" -3302,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diagnosis of traumatic rupture of diaphragm is done by?, with the following options: A: A.Laparoscopy, B: B.Chest X ray, C: C.Diagnostic peritoneal lavage, D: D.CT scan - -### Response: -The most accurate evaluation of diaphragmatic rupture is by video assisted thoracoscopy or laparoscopy, the latter offering the advantage of allowing the surgeon to proceed to a repair and additional evaluation of the abdominal organs . Chest X ray with nasogastric tube maybe helpful CT scan and diagnostic peritoneal lavage lack positive or negative predictive value. Reference: Bailey and Love's Sho Practice of Surgery, 26th edition, Pg no: 356- 357. -### End" -3303,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transmission of R factor is by -, with the following options: A: Conjugation, B: Transduction, C: Transformation, D: Lysogenic conversion - -### Response: -Conjugation - -Bacterial conjugation is the transfer of genetic material between bacteria through direct cell to cell contact or through a bridge- like the connection between two cells. -Conjugation is a process whereby a donor (male) bacterium makes physical contact with a recipient (female) bacterium. -Donor status is determined by the presence of plasmid. -This plasmid codes for specialized fimbria (sex pilus) and for self-transfer. -Sex pilus (conjugation tube) helps in the transfer of genetic material from male bacterium to female bacterium. -The plasmid is known as transfer factor (sex factor or fertility factor). -The plasmid may be R factor, which codes for transferrable multiple drug resistance. -The DNA of the plasmid replicates during transfer so that each bacterium receives a copy → Recipient becomes a donor and the donor retains its donor status. -### End" -3304,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Besides its propeies of decreasing intraocular pressure, timolol is preferred in the treatment of glaucoma because it-, with the following options: A: Produces no miosis, B: Possess membrane stabilizing activity, C: Increases outflow of aqueous humor, D: Is a selective beta-adrenoceptor blocker - -### Response: -Ans. is 'a' i.e., Produces no miosis -### End" -3305,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ideal contraceptive for lactating mothers is:, with the following options: A: Barrier method, B: Combined OCP, C: Lactational amenorrhoea, D: Progesterone only pill - -### Response: -lactational amenorrhoea An almost similar question was asked previously in 'All India' examination. Note that previously 'Most effective' contraceptive was asked. Now the question is different -Ideal' contraceptive is asked. Practically, there are no ideal contraceptives (neither for lactating women, nor for non-lactating women). An Ideal contraceptive is one which is - 100% effective, 100% safe, reversible with no side effects, and minimal effect on lactation. The Barrier methods and Combined OCPs can be easily ruled out; as barrier methods have high failure rates if used alone; while combined OCPs have a negative effect on breast milk production. Lactational amenorrhoea is the most ideal contraceptive for a lactating women, as it has viually no side effects, rather it has plethora of benefits for both mother and child. About effectiveness, it is almost equally effective to Progesterone only pills (POPs) when used perfectly. (see the below given table). Failure rates: Contraceptive method Typical use Perfect use LAM (6 months only) 2.0 0.5 IUD 0.8 0.6 POP 'mini pill' 8.0 0.5 Combined oral contraceptive 6-8 0.1 Barrier method 14 3.0 Lactational amenorrhoea (LAM) is a natural, safe and effective contraceptive method which can be used upto 6 months post paum if the following conditions are met. (Note that LAM is not pure simple exclusive breast feeding; following conditions need to be fulfilled) The mother should not experience vaginal bleeding after the 8 weeks postpaum. The baby is less than 6 months old. The baby is exclusively breastfed. Breast. feeding is done at least every 4 hrs. during the day and every 6 hrs during night. If the above conditions are fulfilled then LAM can give more than 98% protection from pregnancy. It has the added benefit of promoting exclusive breast feeding which is the ideal nutrition for infants. Lactational Amenorrhoea Advantages Disadvantages * Very effective if used perfectly * Can be used only for a sho * Has no side effects period (6 months post paum) * Promotes exclusive breast feeding, and therefore enhances maternal and infant health. * Does not require inseion of any device at the time of sexual intercourse * Can be initiated immediately postpaum * Is economical and requires no commodities or supplies * Reduces mother's lifetime risk of breast cancer. Physiology of LAM: Infant's suckling is the stimulus that initiates the state of lactational amenorrhea for breastfeeding women. The act of suckling elevates prolactin levels, and reduces GnRH from the hypothalamus. This reduces LH release thus inhibiting follicular maturation. This prevents ovulation. But, even with continued nursing, ovulation eventually returns after 6 months, so another method of contraception should be used 6 months postpaum, or sooner if the menses resume. Ovalation has been seen to resume even earlier in some patients, so some books advice 'Rule of 3' i.e. - another contraceptive method should be use along with LAM beginning from the 3rd postpaum month. - and if the women is paially breastfeeding or not breastfeeding, the contraceptive should begin by the 3rd postpaum week. Progesterone only pills are the most effective contraceptive during lactation amongst the options provided. They have drawbacks like: - Have to be taken regularly at the same time - Cause spotting or irregular bleeding, ectopic pregnancy, headache, nausea, acne, hirsuitism and weight gain -### End" -3306,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child is suffering from watery diarrhea. The isolated organism is showing darting motility. The most probable diagnosis is -, with the following options: A: Campylobacter, B: V. Cholerae, C: Enterotoxigenic E coli, D: Shigella - -### Response: -Ans. is 'b' i.e., V. Cholerae * Among the given options, Campylobacter and vibrio cholerae show darting motility.* V. Cholerae causes watery diarrhea, whereas Campylobacter usually causes dysentery.Types of MotilityMotilityOrganismsDarting* V. cholerae* Campylobacter* Gardnerella vaginalisStatelyClostridiaTumblingListeriaLashingBorreliaCorkscrew motilityT. pallidumGlidingMycoplasmaSwarmingProteus mirabilis & vulgaris, B. cereus, Cl tetani -### End" -3307,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common malignant tumor of parotid gland is?, with the following options: A: Mucoepidermoid carcinoma, B: Warthin's tumor, C: Squamous cell carcinoma, D: Pleomorphic adenoma - -### Response: -ANSWER: (A) Mucoepidermoid carcinomaREF: Sabiston Textbook of Surgery, 18th ed. Chapter 33""Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland and can be divided into low-grade and high-grade tumors""Also know:Most common benign & overall tumor of parotid gland is pleomorphic adenomaSecond most common tumor of parotid gland is warthin's tumorMost common malignant tumor of parotidgland is mucoepidermoid carcinomaMost common tumor of parotid gland in children is hemangiomaParotid tumor ivhich spreads by perineural invasion is Adenoid cystic carcinoma -### End" -3308,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is beta-blocker antagonist -, with the following options: A: Glucagon, B: Neostigmine, C: Ambenonium, D: All of the above - -### Response: -Ans. is 'a' i.e., ??? Glucagon (may be) o Glucagon is used in beta-blocker poisoning to combat bradycardia produced by b-blockers. Glucagon acts by increasing C-GMP in myocardium, in effect bypassing b-receptors - Action is independent of beta receptors.b-blocker poisoningo Overdose, including self poisoning, causes bradycardia, heart block, hypotension and low output heart failure that can proceed to cardiogenic shocko Death is more likely with agents having membrane stabilizing action.o Severe bronchoconstriction may occur.o Loss of conciousness may occur with lipid-soluble agents that penetrate the CNS.Treatment of b-blocker poisoning.o Atropine - is used to eliminate unopposed vagal activity that contribute to bradycardiao Glucagon and calcium - Are used for hypotension and symptomatic bradycardiao Isoprenaline can be used if there is no response. It has direct cardiac stimulant action via b1 receptorso Other sympathomimetics may be used according to desired agonist actions (b1, b2, a) required by the clinical conditions, e.g. dobutamine, dopamine, dopexaminey adrenaline, noradrenaline.o Amrinone can be used for inotropic effect.o Salbutamol or aminophylline may be used to counteract bronchoconstriction. -### End" -3309,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 59-year-old man is diagnosed with prostate cancer following a digital rectal examination. For the resection of prostate cancer, it is impoant to know that the prostatic ducts open into or on which of the following structures:, with the following options: A: Membranous pa of the urethra, B: Seminal colliculus, C: Spongy urethra, D: Prostatic sinus - -### Response: -Ducts from the prostate gland open into the Prostatic Sinus, which is a groove on either side of the urethral crest. The prostate gland receives the ejaculatory duct, which opens into the prostatic urethra on the seminal colliculus (a prominent elevation of the urethral crest) just lateral to the prostatic utricle, which is a small blind pouch. The bulbourethral gland lies on the lateral side of the membranous urethra within the deep perineal pouch, but its duct opens into the bulbous poion of the spongy (penile) urethra. -### End" -3310,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Safety pin appearance is seen in ?, with the following options: A: Vibrio vulnificus, B: Vibrio parahemolyticus, C: Pseudomonas aeuroginosa, D: H. influenzae - -### Response: -Ans. is `b' i.e., Vibrio parahemolyticus Bipolar staining (safety pin appearance) Some bacteria display a safety pin appearance due to the accumulation of dye at the poles of the cells. This characteristic is called bipolar staining. Bacteria showing bipolar staining are? Calymmatobacter granulomatis (Donovani granulomatis) Vibrio parahemolyticus Pseudomonas mallei Yersinia pestis Pseudomonas pseudomallei H. ducreyi -### End" -3311,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased Serum Calcium and Decreased Serum PO4 may be seen in all of the following, except:, with the following options: A: Primary hyperparathyroidism, B: Hypercalcemia of Malignancy, C: Vitamin D Intoxication, D: Familial benign Hypercalcemia - -### Response: -Answer is C (Vitamin D intoxication): Vitamin D Intoxication is not associated with decreased serum PO4 levels (Associated with normal or increased serum PO4) Primary Hyperparathyroidism, Familial Benign Hypercalcemia and hypercalcemia of malignancy may all be associated with increased serum calcium and decreased serum PO4. Vitamin D Intoxication is associated with increased serum calcium with normal or increased serum PO4 -### End" -3312,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The anterior triangle occupies the side of the neck in front of sternomastoid muscle. Each triangle presents boundaries in front:, with the following options: A: Anterior median line of the neck extending from symphysis menti to suprasternal notch., B: The midline of the neck, C: Midline of the neck up to the sternoclavicular joint, D: Posterior border of thyroid gland - -### Response: -Boundaries of anterior triangle are: -Anteriorly by the median plane. -Posteriorly by the sternocleidomastoid. -Superiorly by the base of the mandible and by a line joining the angle of -mandible to the mastoid process. -The apex of the triangle lies above the manubrium sterni -### End" -3313,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best method for comparison of death between two populations with age variation -, with the following options: A: Age adjusted rates, B: Crude rates, C: Proportional rates, D: None - -### Response: -Ans-A i.e., Age adjusted rates o Standardization (or adjustment) of rates is used to unable the valid comparison of groups that differ regarding an important health determinant (most commonly age).o Age adjustment or age standardization removes the confounding effect of different age structures of two different population and yields a single standardized rate, by which the mortality experience can be compared directly. -### End" -3314,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment for malignant melanoma is -, with the following options: A: Wide excision, B: Radiotherapy, C: Excision, D: Chemotherapy - -### Response: -Ans. is 'a' i.e., Wide excision Management of Malignant Melanomao Wide local excision of the primary tumor is the management of choice.The recommended margin of resection depends on the thickness of the tumor.Recommended Margins for Surgical Resection of Primary MelanomaTumor thicknessMargin Radius<1.0mm1.0cm1-4 mm2.0 cm>4 mm3.0 cm (Schwartz)Sabiston (18/ep773) and Harrison (17fep547) differ somewhat from Schwartz.According to Sabiston-Recommended Margins for Surgical Resection of Primary MelanomaTumor thicknessMargin RadiusIn situ0.5 cm<1.0 mm1.0 cm1-2 mm1.0-2.0 cm>2.0 mm> 2.0 cm (Sabiston)According to Harrison- Recommended Margins for Surgical Resection of Primary MelanomaTumor thicknessMargin RadiusIn situ0.5 cm< 1.0mm1.0cm> 1.0 mm2.0 cm (Harrison)o Sentinel lymph node biopsy is done for tumors more than 1 mm thick. If biopsy is positive complete lymph node dissection is done.Also knowTreatment of subungual melanoma - amputation of the distal digit to provide a 1 cm margin from the tumor. For fingers, amputation commonly involves only the distal phalanx; ray amputation is not required. (Sabiston 18/ep775) -### End" -3315,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Slowest conduction of velocity occurs in, with the following options: A: Atrial muscle, B: A. V. node, C: Purkinje fibre, D: Ventricular muscles - -### Response: -The total delay in the A-V nodal and A-V bundle system is about 0.13 second. This delay, in addition to the initial conduction delay of 0.03 second from the sinus node to the A-V node, makes a total delay of 0.16 second before the excitatory signal finally reaches the contracting muscle of the ventricles.Ref: Guyton and Hall textbook of medical physiology 13th edition. Page:125 -### End" -3316,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First treatment in asymptomatic gall bladder stone?, with the following options: A: Immediate surgery, B: Oral dissolution agents, C: Endoscopic sphincter ablation, D: Wait and watch - -### Response: -ANSWER: (D) Wait and watchREF: Schwartz pretest 7th ed p-204, CSDT 11th ed p-546, Bailey & Love 25th ed page 1121""Because fewpatients develop complications without previous biliary symptoms, prophylactic cholecystectomy in asymptomatic persons with gallstones is rarely indicated'Surgical treatment for asymptomatic gall stonesPrerequisites of medical therapy for gall stones* Diabetes* Radiolucent stones* Patients due to undergo bariatricsurgery for morbid obesity* Size<10mm* Functioning GB* Congenital hemolytic anemia* Non acute symptoms* Increased risk of complications1. Immunosuppressed2. Post-transplant* Increased risk of gall bladder cancer1. Large stone > 3cm2. Polyps of Gall bladder, especially if >10 mm3. Porcelain gallbladder(Calcified gall bladder wall) -### End" -3317,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Decreased serum ferritin levels are seen in, with the following options: A: Iron deficiency anemia, B: Thalassemia, C: Sideroblastic anaemia, D: Renal failure - -### Response: -Ans. a (Iron deficiency anemia). (Ref. Harrison's 17th /Table 98-4; 18th/Ch.103)# Hb contains 70% of iron and 3% myoglobin with remaining being ferritin.# Iron is readily absorbed in ferrous state, but most of the dietary iron is in ferric (Fe+3) state.FACTORS AFFECTING IRON ABSORPTION ARE:# Promoting factors:- Retarding factors:- High pH- Excess mucus- Bile salts- Phosphates- Chlorophyll- Phytates- Vitamin C- Antacids# Mobilferin binds more iron as binding sites increase.# As amount of transferrin in plasma increases, its % of iron saturation decreases.# More iron moves from intercellular iron carrier to transferrin and less binds to apoferritin.# As ferritin stores decreases, less iron is lost in mucosal shedding.# In iron deficiency anaemia ferritin levels decreases.# Normal TIBC is 300.# Low serum iron, decreased MCV with high TIBC is specific for iron deficiency anemia.FERRITIN# Free iron is highly toxic, and the pool of storage iron is tightly bound to either ferritin or hemosiderin.# Ferritin is a protein-iron complex found in all tissues but particularly in liver, spleen, bone marrow, and skeletal muscles.# Intracellular ferritin is located in both the cytosol and lysosomes, in which partially degraded protein shells of ferritin aggregate into hemosiderin granules.# The iron in hemosiderin is chemically reactive and turns blue-black when exposed to potassium ferrocyanide, which is the basis for the Prussian blue stain.# In iron-overloaded cells, most iron is stored in hemosiderin.# Very small amounts of ferritin normally circulate in the plasma.# Since plasma ferritin is derived largely from the storage pool of body iron, its levels correlate well with body iron stores.# In iron deficiency, serum ferritin is always < 12 mg/L, whereas in iron overload, high values approaching 5000 mg/L can be seen.# Iron is transported in plasma by an iron-binding glycoprotein called transferrin, which is synthesized in the liver. In normal individuals, transferrin is about 33% saturated with iron, yielding serum iron levels that average 120 mg/dL in men and 100 mg/dL in women.DIAGNOSIS OF MICROCYTIC ANEMIA TestsIron DeficiencyInflammationThalassemiaSideroblastic Anemia1SmearMicro/ hypoNormal; micro/ hypoMicro/hypo with targetingVariable2SI<30<50Normal to highNormal to high3TIBC>360<300NormalNormal4Percent saturation<1010-2030-8030-805Ferritin (mg/L)<1530-20050-30050-3006Hemoglobin patternNormalNormalAbnormalNormal -### End" -3318,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inferior mesenteric artery supplies all of the following except, with the following options: A: Rectum, B: Right colic flexure, C: Sigmoid colon, D: Descending colon - -### Response: -(B) Right colic flexure # Inferior mesenteric artery supplies: The left one third of the transverse colon; The descending colon; The sigmoid colon; The rectum; The upper part of the anal canal; The right colic flexure is supplied by the superior mesenteric artery. -### End" -3319,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The function of Genioglossus is?, with the following options: A: Retraction of tounge, B: Protruding tongue, C: Divergies to the same side, D: All of the above - -### Response: -Genioglossus is an extrinsic muscle of tongue ACTIONS OF GENIOGLOSSUS: It protrudes the tongue It pulls the posterior pa of tongue forwards and protrudes the tongue forwards Thus it is a life-saving muscle NOTES: Hyoglossus-depress the tongue Styloglossus-retracts the tongue Palatoglossus-elevates the tongue Ref BDC volume 3.6th edition pg 266 -### End" -3320,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements is true regarding enzyme inhibition?, with the following options: A: Sulfonamides inhibit folate reductase irreversibily, B: Ethanol inhibits aldehyde dehydrogenase when used in methanol poisoning, C: Acetylcholinesterase inhibition by malathion can be reversed by increasing the levels of Acetylcholine, D: Fluoroacetate competitively inhibits Aconitase - -### Response: -Sodium flouroacetate compete with acetic acid and form flouroacetic acid .This inhibit TCAcycle by poisoning aconitase enzyme activity. Ref: Perspective in mycological research by Perspective in mycological research, The encyclopedia of nutrition and good health By Robe A. Ronzio page 436; Medical toxicology By Richard C. Da page 65. -### End" -3321,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common oncogene involved in pancreatic adenoma, with the following options: A: P53, B: K-RAS, C: APC, D: DCC - -### Response: -85% of Carcinoma pancreas shows mutant K ras gene on codon 12. 60% show mutation of p53 gene in chromosome 17, over expression of EGFR. Reference : SRB's Manual of Surgery, 6th Edition, page no = 695. -### End" -3322,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about aminoglycosides is all except., with the following options: A: Are bacteriostatic, B: Distributed only extracellularly, C: Excreted unchanged in urine, D: Teratogenic - -### Response: -Ans. (A) Are bacteriostatic(Ref: KDT 8/e p793)The aminoglycosides are bactericidal antibiotics.They are more active at alkaline pH.They kill the bacteria by interfering with protein synthesis.They are distributed only extracellularly so the volume of distribution is nearly equal to the extracellular fluid volume.They are not metabolized, they are excreted unchanged in the urine.Aminoglycosides should be avoided during pregnancy because these can cause fetal damage (teratogenic) -### End" -3323,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Migration study is used to study, with the following options: A: Sociodemographic reasons for migration of a population, B: Prevalence of disease in a population, C: Environmental and genetic factors in a disease in population, D: Diseases with long incubation period - -### Response: -Large-scale migration of human populations from one country to another provides a unique oppounity to evaluate the role of the possible genetic and environmental factors in the occurrence of disease in a population.Migration studies can be carried out in 2 ways -a) Comparision of disease and death rates for migrants with that kin who have stayed at home. (Genetically similar groups living in different environmental conditions)b) Comparision of migrants with the local population of the host country. (genetically different groups living in the same environment)Park 23e pg: 67 -### End" -3324,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trident hand is seen in:, with the following options: A: Achondroplasia, B: Mucopolysacchoroidosis, C: Diphyseal achlasia, D: Cleidocranial dystosis - -### Response: -A i.e. Achondroplasia -### End" -3325,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is this mode of treatment called as?, with the following options: A: Russell's traction, B: 90-90 traction, C: Buck's traction, D: Gallows traction - -### Response: -Ans. D. Gallows tractionThe figure shows the child put on Gallows traction that is used to treat a patient less than 2 years' old who lands up with a fracture of shaft of femur. -### End" -3326,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false regarding Hydatidiform mole?, with the following options: A: In complete mole fetal parts are not seen, B: In partial mole all genetic material is paternally derived, C: It increases risk of invasive mole and choriocarcinoma, D: Karyotype of complete mole can be 46 XX - -### Response: -Partial mole is triploid. One egg is fertilized by 2 sperms. So all the genetic material is not completely paternal. -### End" -3327,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MMR is expressed as a rate per, with the following options: A: 100 live bihs, B: 1000 live bihs, C: 10000 live bihs, D: 100000 live bihs - -### Response: -Ref:Park's Text book of Preventive and Social Medicine 25th ed -### End" -3328,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Koenen's tumor are seen in?, with the following options: A: Neurofibromatosis, B: Tuberous sclerosis, C: Sturge weber syndrome, D: Tuberculosis - -### Response: -Ans. (b) Tuberous sclerosisRef : Dermatology by Otto Braun falco p 846, Harrison' internal medicine 18/e, chapter 53, p 410 -### End" -3329,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with Ewing's sarcoma. Histology shows small round cells. These cells are filled with which of the following -, with the following options: A: Glycogen, B: Iron, C: Fat, D: Mucin - -### Response: -Ewing sarcoma - -It is the second most bone sarcoma in children (after osteogenic sarcoma). -It is primary malignant small round cell tumor of bone. -It is derived from primitive neuroectoderm. -Age → 10-15 years, Sex → M > F -Usually arises in the diaphysis - -Femur & Tibia → 2/3rd -Flat bones of pelvis → 3/3rd - -Important microscopic features - -Scant cytoplasm in tumor cells which is clear because it is rich in glycogen. -Homer - Wright rosettes. - -Important Radiological features - -Onion-skin periosteal reaction. -Sun-rays appearance (more common in osteogenic sarcoma). -Codman's triangle (It is also more common in osteogenic sarcoma). -### End" -3330,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A syndesmosis type of joint:, with the following options: A: Sacro-iliac joint, B: Superior tibiofibular joint, C: Inferior tibiofibular joint, D: Sacro-coccygeal joint - -### Response: -Ans. c (Inferior tibiofibular joint), (ref Handbook of general anatomy by Chaurasia 3rd edition, p. 51).The incudomallear and incudostapedial joints are saddle and ball-and-socket synovial joints, respectively.CLASSIFICATION OF JOINTSA. SYNOVIAL 1.Ball and socketShoulder, Hip, Calcaneo-cuboid,Incudo-stapedial joint 2.CondylarKnee, TM joint 3.EllipsoidAtlanto-occipital, Metacarpophalangeal, Wrist, 4.HingeInterphalangeal, Elbow, Ankle 5.PivotAtianto-axial, Superior and inferior radioulnar 6.SaddleFirst metacarpophalangeal joint of Thumb,Sternoclavicular, Calcaneocuboid, Incudomalleolar.B. CARTILAGINOUS 1.Primary(synchondrosis/ hyaline cartilaginous)Joint between epiphysis &diaphysis of long bones.Spheno-occipital joint, First chondrosternalCostochondral, Sacrococcygeal joint 2.Secondary(symphysis/ fibrocartilaginous)Symphysis pubis, Manubriosternal , IntervertebralC. FIBROUS 1.Skull sutures- 2.SyndesmosisFoot plate stapes-oval window, Inf. tibiofibular joint 3.Gomphosis/peg and socketTooth -### End" -3331,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Exarticulation of teeth means:, with the following options: A: Intrusion, B: Extrusion, C: Sublimation, D: Avulsion - -### Response: -Avulsion  -Term used to describe the complete displacement of tooth from its alveolus. It is also called as exarticulation and most often involves the maxillary teeth. -### End" -3332,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the sodium-calcium exchanger (NCX), the ratio of Na+ : Ca++ exchange per event is:, with the following options: A: 6:01, B: 3:01, C: 1:01, D: 1:03 - -### Response: -NCX (sodium and calcium exchanger) is present in the myocardial fiber. It exchanges 3 Na+ with 1 Ca++. That is, 3 sodium ions are moved out of the cell for every 1 calcium ion brought in (L type Ca channels). -### End" -3333,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A sarcoidosis patient developed non caseating granulomas. Which type of hypersensitivity is responsible for developing granulomatous inflammation in this patient?, with the following options: A: Type I, B: Type II, C: Type III, D: Type IV - -### Response: -Delayed-type hypersensitivity or or type IV hypersensitivity is a T-cell mediated or inflammatory response in which the stimulation of antigen-specific effector T cells leads to macrophage activation and localized inflammation and edema within tissues. Three variants of type IV hypersensitivity reaction are recognized, contact, tuberculin type and granulomatous. Contact hypersensitivity and tuberculin-type hypersensitivity both occur within 72 hours of antigen challenge. Granulomatous hypersensitivity reactions develop over a period of 21-28 days - the granulomas are formed by the aggregation of macrophages and lymphocytes and may persist for weeks. This is the most impoant type of hypersensitivity response for producing clinical consequences. Examples of chronic diseases which manifest type IV granulomatous hypersensitivity are leprosy, tuberculosis, schistosomiasis, sarcoidosis, Crohn's disease. Ref: Immunology By David K. Male, 2006, Page 477, 486 ; Immunology by David K. Male, Jonathan Brostoff, Ivan Maurice Roitt, David B. Roth, Page 477-478 -### End" -3334,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female patient underwent mastectomy for carcinoma of breast. After a few days of surgery, she experienced a burning pain along the medial aspect of her arm. It is most likely due to?, with the following options: A: Phantom breast pain, B: Intercostobrachial neuralgia, C: Neuroma pain, D: Other nerve injury pain - -### Response: -Post-mastectomy pain syndrome (PMPS) is defined as a chronic pain condition, typically neuropathy in nature, that can follow surgery to the breast. PMPS can occur with any surgery to the breast, including mastectomy, lumpectomy, reconstruction, and augmentation. PMPS can be divided into three categories: phantom breast pain, intercostobrachial neuralgia, and neuroma pain. Phantom pain consists of painful sensations in the area of the removed breast. The intercostobrachial nerve is the lateral cutaneous nerve of the second thoracic root. It courses along the axillary vein and then provides sensation to the axilla and breast. The intercostobrachial nerve is frequently stretched or sacrificed during axillary lymph node dissections and is a common cause of PMPS. The scar from breast surgery can be a generator of pain. The pain has been attributed to underlying neuroma formation, axon impingement, and scar retraction. The symptoms associated with PMPS include shooting, stabbing, burning, and pins and needles in the breast, axilla, or medial arm. Ref: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal ... By Walter R. Frontera, Julie K. Silver, M. D., Thomas D. Rizzo, Jr. M.D., 2008, Page 589; Medical care of cancer patients by Sai-Ching Jim Yeung, Carmen R Escalante, Robe F. Gagel, Page 415 -### End" -3335,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Two weeks after bih, a neonate develops sepsis, skin vesicles, and conjunctivitis. Over the next several days, the baby's condition deteriorates with development of seizures, cranial nerve palsies, and lethargy. The baby dies approximately one week after onset of symptoms. Which of the following infectious agents would most likely cause this clinical presentation?, with the following options: A: Cytomegalovirus, B: Herpes simplex, C: Rubella, D: Syphilis - -### Response: -This is the history of neonatal herpes that manifests as a generalized infection in the neonate. Most common cause is HSV2. HSV2 is the most common cause of genital herpes, which manifests as painful vesicular lesions that ulcerate. The site of latent infection is sacral nerve root ganglia. -### End" -3336,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not true about the thoracic outlet syndrome, with the following options: A: Resection of first rib solves symptoms, B: Neurological features are most common, C: Positive adson's test, D: Radial nerve is commonly affected - -### Response: -Not the Radial nerve, but Ulnar nerve is most commonly affected in thoracic outlet syndrome. Thoracic Outlet Syndrome is the collective name which includes - Cervical rib syndrome Scalenus anterior syndrome Costoclavicular syndrome Hyperabduction syndrome Pectoralis minor syndrome First thoracic rib syndrome The syndrome is caused by compression of the brachial plexus or subclan vessels in the region of thoracic inlet. The symptoms may arise from neural, vascular or combined compression. Neurological symptoms (are more common) Compression of the brachial plexus usually affects its lower trunk (C8 & T1). Symptoms are - Pain, paraesthesia and numbness usually in the finger and hands in the ulnar nerve distribution. Symptoms of Aerial Compression are seen less frequently in about 1/4 of the cases. Symptoms are - Pain, numbness, paresthesia, coldness and weakness of the arm or hand. Raynauds phenomenon may also occur. Venous symptoms are less common and include edema, venous distention, pain and cyanosis. Diagnostic tests or manoeuvres : Adsons test Costoclavicular compressive test Hyperabduction test. Ref : S. Das text book of Surgery 3/e p170 -### End" -3337,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 69 year old edentulous alcoholic male who lives alone is admitted to the hospital for evaluation of a shoulder wound that is not healing well. On physical examination, numerous ecchymoses are noted on the posterior aspect of his legs and thighs. Careful examination of the man's skin reveals minute hemorrhages around hair follicles and splinter hemorrhages in the nail beds. Laboratory examination is remarkable for a hemoglobin of 10 (normal 14-18 g/dL); no other hematologic abnormalities are noted. Therapy should consist of ?, with the following options: A: Administration of factor VIII, B: Administration of iron, C: Administration of vitamin B12, D: Administration of vitamin C - -### Response: -The patient described suffers from scurvy, due to a deficiency of dietary vitamin C. Absence of vitamin C leads to impaired hydroxylation of proline residues in the nascent procollagen chains, leading to weakness of blood vessel walls. Clinically, the deficiency syndrome is characterized by perifollicular hemorrhages, fragmentation of hairs, purpura, ecchymoses, splinter hemorrhages, and hemorrhages into muscle. In patients with normal dentition, gum changes (swelling, bleeding, loosening of teeth) are also noted. Without supplementation with vitamin C, death may eventually occur. Administration of factor VIII would be indicated for factor VIII deficiency, which would also lead to a prolonged PTT (paial thromboplastin time), which was not noted. Administration of iron would be of benefit in iron-deficiency anemia, but there is no indication of a hypochromic, microcytic anemia in this patient. The anemia of scurvy is typically normochromic and normocytic, due to bleeding. Administration of vitamin B12 would be indicated for a megaloblastic anemia. Although a macrocytic anemia may be observed in scurvy (due to concomitant dietary folate deficiency or peurbations in the folate pool), this patient did not show macrocytosis. Ref: Bender D.A. (2011). Chapter 44. Micronutrients: Vitamins & Minerals. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds),Harper's Illustrated Biochemistry, 29e. -### End" -3338,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Clozapine except:, with the following options: A: More potently blocks D2 as compared to D1 receptors, B: Blood level below 350 ng/ml should be maintained to avoid agranulocytosis, C: Should not be used along with Carbamazepine, D: Should be discontinued if the WBC count is below 3,000/mm3 cells - -### Response: -Ans. (B) Blood level below 350 mg/ml should be maintained to avoid agranulocytosis(Ref: Drug Facts and Comparisons 2006/1205-1206; Goodman Gilman 12th/427,432)High plasma concentration of Clozapine increases the risk of seizures (not agranulocytosis). However, usual plasma concentration required in many persons is 300-600 ng/ml.Clozapine is an atypical antipsychotic drug that has high potency to block 5HT2 receptors as compared to D2 receptors. It has high potency to block D2 as compared to D1 receptors.It should not be used with Carbamazepine due to two reasons:Carbamazepine induces its metabolism and thus decreases the plasma concentration.Carbamazepine has bone marrow suppressant action and can add to agranulocytosis caused by Clozapine.Clozapine should be started at low doses (12.5 mg) and gradually dose should be increased. Baseline WBC counts should be measured and then weekly counts should be done atleast for first 6 months. When WBC count becomes less than 3000/mm3 or absolute neutrophil count becomes less than 1500/mm3, Clozapine should be discontinued. After discontinuation, weekly WBC counts should be less than 2000/mm3 or absolute neutrophil count below 1000/mm3 should not be started on Clozapine again. -### End" -3339,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best prognostic factor for head injury is:, with the following options: A: Glassgow coma scale, B: Age, C: Mode of injury, D: CT findings - -### Response: -Ans is 'a' ie. Glasgow coma scale Repeat from All India 07Harrison writes- "" In severe head injury, eye opening, the best motor response of the limbs, and verbal output have been found to be roughly predictive of outcome; these are summarized using the ' Glasgow coma scale ""Glasgow coma scale is used to determine the conscious level of the patientRanges from 3 to 15.A score of 7 or less is classed as comaA score of 9 or more excludes coma -### End" -3340,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lendrum stain is used for detecting, with the following options: A: Air embolism, B: Fat embolism, C: Amniotic fluid embolism, D: Pulmonary embolism - -### Response: -Lendrum's stain (Phloxine-Tarazine): This stain is used to detect amniotic fluid embolism deathsRef: the essentials of forensic medicine & toxicology-Dr.K.S.Narayana reddy 32nd edition pg no390-391 -### End" -3341,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurological basis for ""Phantom limb"" phenomenon:, with the following options: A: Bell-Magendie law, B: Weber-feschner Law, C: Psychodynamic theory, D: Law of projection - -### Response: -Ans. d (Law of Projection) (Ref. Ganong Physiology 22nd/pg. 126)Phantom limb is post-op complication of amputation of limb where patient feels amputated limb and sometimes it becomes painful. It is best explained by law of projection.Weber-Fechner LawMagnitude of sensation felt is proportionate to the log of intensity of the stimulusLaw of ProjectionPhantom limb is post-op complication of amputation of limb where patient feels amputated limb and sometimes it becomes painful. It is best explained by law of projection.Bell-Magendie LawThe basic unit of integrated reflex activity is the reflex arc. This arc consists of a sense organ, an afferent neuron, one or more synapses that are generally in a central integrating station, an efferent neuron, and an effector. In mammals, the connection between afferent and efferent somatic neurons is generally in the brain or spinal cord. The afferent neurons enter via the dorsal roots or cranial nerves and have their cell bodies in the dorsal root ganglia or in the homologous ganglia on the cranial nerves. The efferent fibers leave via the ventral roots or corresponding motor cranial nerves.The principle that in the spinal cord the dorsal roots are sensory and the ventral roots are motor is known as the Bell-Magendie law. -### End" -3342,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After administrative live vaccine, immunoglobulins are given after-, with the following options: A: 1 week, B: 2 weeks, C: 10 weeks, D: 12 weeks - -### Response: -.live vaccines should not be given for 12 weeks after an injection of normal human immunoglobulin.and if a live vaccine has already be given .NHIg injection sholud be deferred for 2 weeks. ref:park&;s textbook,ed 22,pg no 102 -### End" -3343,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum margin of excision is needed for:, with the following options: A: Malignant melanoma, B: BCC, C: SCC, D: Dermatofibrosarcoma protuberans - -### Response: -Margins of excision: Malignant melanoma: Margins to be taken depends on the tumor thickness and depth of invasion* < 1mm thickness - 1 cm margin* 1-4 mm thickness - 2cm margin* > 4mm thickness - 2-3 cm margin BCC: If tumor is non-aggressive involving trunk or extremities -Wide Local Excision If tumor is aggressive involving vital areas, cosmetic areas and recurrent - MOH'Smicrographic surgery SCC: Small or non-invasive SCC - Wide Local excision MOH'S MICROGRAPHIC Surgery- Large tumors- Aggressive tumors- Tumors involving vital areas/ cosmetic areas- Recurrent tumorsMOH'S MICROGRAPHIC SURGERY- Serial excision of tumor in small increments- Coupled with immediate microscopic analysis to ensure tumor removal- To limit resection of aesthetically valuable tissues Dermatofibrosarcoma protuberans: WLE with 2-4 cm circumferential margin + removal of underlying fascia Has unpredictable radial extensions of tumor|Permeate through large distances from primarynodule|Increased risk of recurrence after simple excision|(2-4 cm) circumferential margin is resected toprevent recurrence -### End" -3344,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Conventional site for taking biopsy In secondary amyloidosis is?, with the following options: A: Liver, B: Kidney, C: Rectum, D: Abdominal fat aspirate - -### Response: -The amyloidoses are a group of acquired and hereditary disorders characterised by extracellular deposition of insoluble proteins . These complex deposits consist of fibrils of the specific protein involved, linked to glycosaminoglycans, proteoglycans and serum amyloid P (SAP). Protein accumulation may be localised or systemic, and the clinical manifestations depend upon the organ(s) affected. The diagnosis of amyloidosis should be considered in all cases of unexplained nephrotic syndrome ,cardiomyopathy and peripheral neuropathy. Diagnosis The diagnosis is established by biopsy, which may be of an affected organ, rectum or subcutaneous fat. The pathognomonic histological feature is apple-green birefringence of amyloid deposits when stained with Congo red dye and viewed under polarised light. Immunohistochemical staining can identify the type of amyloid fibril present. Quantitative scintigraphy with radio-labelled SAP is a valuable tool in determining the overall load and distribution of amyloid deposits DAVIDSON&;S 22nd EDITION;PAGE NO 86 -### End" -3345,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a mechanism by which lightning causes injury?, with the following options: A: Compressed air pushed in front of the current, B: Direct effect of electric current, C: Super heated air, D: Expanded and repelled air - -### Response: -Lightening tends to cause injury by pushing the compressed air before the current but not in front of the current as mentioned in the option. This effect is called the 'sledge hammer blow' effect of Lightening as described by Spencer. Spencer formulated four mechanisms ""Lightning"" by which it does its effects on humans and the surroundings. They are: 1. Direct effect from the high voltage electric current discharge that passes to the eah. 2. Surface flash burning effect from the super heated air discharge. 3. The air is expanded and repelled - the mechanical effect brought about from the force of displaced air is exhibited around the flash. 4. Compression effect due to the movement of air pushed before the current - Sledge hammer blow effect. Ref: The Essentials of Forensic Medicine and Toxicology By Dr. K. S. Narayan Reddy, 27th Edition, Pages 295-296; Concise Textbook Of Forensic Medicine and Toxicology By Sharma, 2nd Edition, Page 73. -### End" -3346,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs can lead to SLE like reaction except?, with the following options: A: Hydralazine, B: Penicilline, C: Isoniazid, D: Sulphonamide - -### Response: -Ans. b. Penicilline -### End" -3347,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Population attributable risk is defined as:-, with the following options: A: Incidence of disease among exposed is so many times higher as compared to that among non-exposed, B: So much disease can be attributed to exposure, C: If risk factor is modified or eliminated, there will be so much annual reduction in incidence of disease in the given population, D: None of the above - -### Response: -Population Attributable Risk (PAR) It is the incidence of disease (or death) in total population minus incidence of disease (or death) among those who were not exposed to suspected causal factor. It is useful as it provides an estimation of amount by which incidence of disease could be reduced in that population if the suspected factor was eliminated or modified. PAR is useful for National health programmes and policies. -### End" -3348,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cherry red spot in retina is a feature of:, with the following options: A: Infantile Gaucher's disease, B: Niemann Pick disease, C: Fabry's disease, D: CRVO - -### Response: -Ans: B (Niemann Pick disease) Ref: Kanski 7th edition Clinical ophthalmology,, pg no 683-684Explanation:Causes of cherry red spot:Central retinal artery occlusionBlunt injury - Berlin's edeme or commotion retinaeQuinine toxicityMacular holeGangliosidosisMucolipidosisTay Sachs diseaseSandhoff diseaseNiemann Pick diseaseFaber diseaseMechanism of Cherry red spotThe fovea is the thinnest part of the retina & is devoid of ganglion cell layer.The following mechanisms causes cherry red spotWhen the retina becomes opaque due to edema (CRAO)Injury to the photoreceptors (Commotion retina)Due to intracellular accumulation of glvcolipids & phospholipids in the ganglion cellThe fovea remains transparent & transmits the underlying choroid.This appears as cherry red spot. -### End" -3349,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum oxygen concentration can be delivered by?, with the following options: A: , B: , C: , D: - -### Response: -Choice D: Reservoir face mask is a high flow, variable performance device. At flow rate of 12-15L/min the delivered Fi02 is in the range of 75-90%. Choice C is simple face mask while choice B is Nasal cannula and both can deliver limited oxygen up to 40% due to diffusion and mixing with air. Choice A: Venturi mask is a high flow, fixed performance device. It can deliver up to 60% oxygen. -### End" -3350,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ABVD regimen is used for, with the following options: A: CLL, B: ALL, C: NHL, D: Hodgkins lymphoma - -### Response: -ABVD regimen(doxorubicin,bleomycin,vinbladtine and dacarbazine) is used. Standard therapy for early stage patients without additional risk factors such asbulk disease or high ESR,is two cycles of ABVD combined with 20Gy radiotherapy to the involved area Standard therapy for early stage patients with additional risk factors is four cycles of ABVD combined with 30 Gy radiotherapy Reference-Davidson 23 rd edition -### End" -3351,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a topical vit. D analogue-, with the following options: A: Cholecalciferol, B: Doxercalciferol, C: Calcipotriol, D: Paricalcitol - -### Response: -Ans. is 'c' i.e., Calcipotriol VitDo It occurs mainly in two forms Vit D3 - Cholecalciferol - synthesized in skin under the influence of UV rays from 7-dehydrocholesterol.Vit D2 - Calciferol - present in irradiatiate food-yeast, fungi, bread,o Activation of Vit D takes place in following manner.o The final hydroxylation in the kidney by enzyme 1-a hydroxylase is the rate limiting step - enhanced by parathormone.o 1, 25 dihydroxy Vit D3 (calcitriol) is the active form of lit D3 -### End" -3352,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following anticancer drugs acts by hypomethylation?, with the following options: A: Gemcitabine, B: 5-FU, C: Decitabine, D: Homoharringotonine - -### Response: -Decitabine is used to treat myelodysplastic syndromes (diseases of the blood and bone marrow; MDS) and ceain types of anemia. This medicine is an antineoplastic (cancer medicine) . Mechanism of Action: Inhibits DNA methyltransferase, causing hypomethylation of DNA & cellular differentiation or apoptosis Pharmacokinetics Protein Bound: <1% Vd: 63-89 L/m2 Half-life: 30-35 min REFERENCE : www.mayoclinic.org , www.medscape.com -### End" -3353,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A premature baby of a diabetic mother was kept in incubator in neonatal ICU following respiratory distress. Which of the following indicates RDS in a newborn?, with the following options: A: Onset after 6 hours of age, B: Antenatal coicosteroid therapy in mother, C: Air bronchogram on chest X-ray, D: Term gestation - -### Response: -Radiological features of respiratory distress syndrome (RDS): Reticulogranular pattern Ground glass opacity Low lung volume Air bronchogram Whiteout lung (in severe disease) Must know: Hyaline membrane disease (HMD) or respiratory distress syndrome (RDS): It is common in preterm babies less than 34 weeks of gestation. It is the commonest cause of respiratory distress in a preterm neonate. Respiratory distress usually occurs within the first 6 hours of life. In addition to prematurity, asphyxia, acidosis, maternal diabetes, and cesarean section can increase the risk of developing RDS. Antenatal coicosteroid therapy in mother will decrease the incidence of RDS. Prenatal diagnosis: Determining L/S ratio in the amniotic fluid. Ref: Essential Pediatrics by O.P. Ghai, 7th edition, Page 143. -### End" -3354,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following measures sensitivity: September 2011, with the following options: A: True negatives, B: True positives, C: False positives, D: False negatives - -### Response: -Ans. B: True positives Sensitivity denotes true positives -### End" -3355,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In an ablated animal, myeloid series cells are injected. Which of the following is seen after incubation period?, with the following options: A: Fibroblast, B: T lymphocytes, C: RBC, D: Hematopoietic stem cell - -### Response: -The following flowchart is self explanatory for this question: -### End" -3356,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trotter's triad includes all of the following Except -, with the following options: A: Mandibular neuralgia, B: Deafness, C: Palatal palsy, D: Seizures - -### Response: -Trotter's triad - -Trotter's triad occurs in nasopharyngeal carcinoma -It includes:- - - -Conductive deafness (due to Eustachian tube blockage) -Temporo - parietal neuralgia (due to the involvement of ipsilateral Vth cranial nerve) -Palatal paralysis (due to involvement of Xth cranial nerve) -### End" -3357,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a Radioprotector, with the following options: A: Amifostine, B: IL-1, C: GM-CSF, D: BUDR - -### Response: -BUDR is a Non-hypoxic cell Radiosensitizer. -### End" -3358,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following trinucleotide repeat mutation occurs in coding regions of DNA?, with the following options: A: Myotonic dystrophy, B: Huntington's disease, C: Fragile x syndrome, D: Friedeich ataxia - -### Response: -In Huntington's disease CAG repeat mutation occurs in coding regions of DNA. -### End" -3359,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following enzymes is secreted both by exocrine pancreas and by intestinal mucosa?, with the following options: A: Carboxypeptidase, B: Trehalase, C: Elastase, D: Amylase - -### Response: -Secretions Secreted by 1. Pancreatic enzymes (trysin, chymotypsin, carboxypeptidase) 2. Insulin 3. Bicarbonates & water 4. Enterokinase 5. Sucrase, maltase, isomaltase, lactase 6. Amino peptidase & several dipeptidases 7. Cholecystokinins 8. Mucus (in duodenum) 9. Bile (initial poriton) 10. HCl 11. Ptyalin 12. Lingual lipase 13. Elastase 14. Trehalase 1. Pancreatic acini (exocrine pancreas) 2. Islets of langerhans (endocrine pancreas) 3. Epithelial cells of ducts & ductules leading from acini 4. Intestinal mucosa 5. Contained in enterocytes of mucosa (not secreted in intestinal juice) 6. Enterocytes of duodenum & jejunum 7. I cells of mucosa of duodenum & upper jejunum 8. Brunner's glands 9. Hepatocytes of liver 10. Parietal cells 11. Parotid gland 12. Lingual glands of mouth 13. Pancreas 14. Enterocytes of small intestine. -### End" -3360,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypocalcemia due to calcitonin is by, with the following options: A: Decreased excretion in kidney, B: Decreased bone resorption, C: Decreased intestinal reabsorption, D: Decreased renal reabsorption - -### Response: -Calcitonin lowers circulating calcium and phosphate levels. It exes its calcium-lowering effect by inhibiting bone resorption. This action is direct, and calcitonin inhibits the activity of osteoclasts in vitro. It also increases Ca2+ excretion in the urine. More hormone is secreted in young individuals, and it may play a role in skeletal development. In addition, it may protect the bones of the mother from excess calcium loss during pregnancy. Bone formation in the infant and lactation are major drains on Ca2+ stores, and plasma concentrations of 1,25-dihydroxycholecalciferol are elevated in pregnancy. They would cause bone loss in the mother if bone resorption were not simultaneously inhibited by an increase in the plasma calcitonin level. -### End" -3361,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about levamisole EXCEPT :, with the following options: A: Act as an immunostimulator, B: Act as an immunodepressor in high doses, C: Single dose is sufficient for the treatment of psoriasis, D: Acts as antihelminthic by causing depolarization - -### Response: -Levamisole is an immunomodulator acting as immunostimulant at low doses and immunodepressant at high doses. -It was used as anti-helminthic and causes depolarization by stimulating nicotinic receptors. -It is used for the treatment of colorectal carcinoma in combination with 5-FU. -It is slow to act in psoriasis and requires two-day therapy per week for prolonged periods. -### End" -3362,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an ophthalmic emergency?, with the following options: A: Macular hole, B: Retinal detachment, C: CRAO, D: Acute primary angle closure glaucoma - -### Response: -ANSWER: (A) Macular holeREF: YanofF Ophthalmology 2nd edition""A Macular hole is abreak in the central part of the retina (macula), causing blurred and distorted vision. While this can occur after trauma, it usually presents spontaneously. The treatment of macular hole involves surgery. While the repair of a macular hole is not an emergency thereis a general consensus that repair should occur within 6-12 months after onset to maximize visual recovery""""Eye injury, retinal detachment, and central retinal artery occlusion (CRAO) are among the most common ocular emergencies""Following are ocular emergencies:Acute infectious endophthalmitisAcute primary angle-closure glaucomaInfectious keratitisOrbital hemorrhageRetinal detachmentForeign bodyOrbital fracturesCorneal abrasions, lacerations, ulcersChemical burnsRuptured globeCRAORetrobulbar hematoma -### End" -3363,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incidence of cord prolapse is least in :, with the following options: A: Frank breech, B: Footling presentation, C: Transverse lie, D: Brow presentation - -### Response: -Ans. is a i.e. Frank breech Cord Prolapse Cord prolapse is the condition where the umbilical cord lies below the presenting pa after rupture of membranes. In cord presentation, the membranes are intact. In occult cord prolapse the cord is by the side of the presenting pa, but not felt by the examining fingers. Cord prolapse occurs more commonly in flexed / complete breech or in case of footling presentation because engagement in both cases occur late whereas in frank breech chances are less because engagement occurs early. Frank breech Most common in primigravida Engagement occurs early Less chances of cord prolapse Complete breech (Flexed breech) * Most common in multipara * Engagement occurs late * More chances of cord prolapse Also Know Factors associated with cord prolapse ? Mnemonic MTP contraindicated in Hea patients. M - Malpresentations - commonest being transverse lie followed by breech presentation T - Twins - specially incase of second twin P - Prematurity Contraindicated - Contracted pelvis In latrogenic viz - low rupture of membranes, manual rotation of head with versions. Hea - Hydraminos with membrane ruptrue. Patients - Placental factors viz minor degree of placenta pre with marginal inseion of cord, battle dore placenta or long cord. -### End" -3364,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In prayer Willi syndrome, which of the following is increased, with the following options: A: A. LH, B: B. FSH, C: C. TSH, D: D. Ghrelin - -### Response: -Ghrelin is a growth hormone secreatagogue and the only gut harmone with orexigenic propey It is primarily produced in the stomach. In children ,it's value is inversely related with body mass index and insulin values. robbins 8/e 441-2 9/e 444 -### End" -3365,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following agents is recommended for treatment of Gastrointestinal Stromal Tumors (GIST) -, with the following options: A: Sorafenib, B: Imatinib, C: Gefitinib, D: Erlotinib - -### Response: -Ans. is 'b' i.e., Imatinib Tyrosine kinase inhibitors imatinib and sunitinib are approved for the treatment of Gastrointestinal Stromal Tumors (GIST) -### End" -3366,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a feature of acute aerial Occlusion ?, with the following options: A: Cyanosis, B: Pallor, C: Paralysis, D: Paraesthesia - -### Response: -Ans is 'a' ie Cyanosis -### End" -3367,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arrange the following in increasing order for risk of malignancy1.Fibroadenoma2.Sclerosing adenosis3.Atypical ductal hyperplasia4.Lobular carcinoma is situ, with the following options: A: 2, 1, 3, 4, B: 1, 2, 3, 4, C: 1, 2, 4, 3, D: 2, 1, 4, 3 - -### Response: -Lesion -Relative risk - - - - -Fibroadenoma -1% - - -Sclerosing adenosis -1.5-2% - - -Atypical ductal hyperplasia -4-5% - - -Atypical lobular hyperplasia -8-10% -### End" -3368,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common injury to baby is:, with the following options: A: Fracture humerus, B: Fracture clavicle, C: Fracture, D: Fracture femur - -### Response: -B i.e. Clavicle -### End" -3369,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In all of these pathways ATP is produced, EXCEPT:, with the following options: A: Urea cycle, B: Electron transpo chain, C: TCA cycle, D: Anaerobic glycolysis - -### Response: -The urea cycle utilises 4 ATPs. 2 ATPs are needed to make carbamoyl phosphate, one is needed to make argininosuccinate and one is needed to restore AMP to ATP. Thus urea cycle does not produce ATP it only utilises ATP. The net yield of ATP from anaerobic glycolysis is 2. TCA cycle generate 3 NADH2, 2 FADH2 and 1 GTP. Hence, each TCA cycle yields 12 ATP molecules. As two acetyl CoA molecules are generated from each glucose this cycle occur twice yielding 24 ATP molecules. Complete oxidation of glucose glycolysis, pyruvate dehydrogenase, Krebs cycle, and the oxidative phosphorylation pathway yields 38 ATP. Since two ATPs were used during stage I reactions of glycolysis the net yield is 36 ATP. Ref: Textbook of Medical Biochemistry,3e By Dinesh Puri PAGE 175. Essentials of Biochemistry By Pankaja Naik Page 233. -### End" -3370,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Herpes virus is shed during which week of Herpes genitalis infection, with the following options: A: First week, B: Second week, C: Third week, D: Fourth week - -### Response: -Virus is shed usually only during 1st week of Herpes genitalis infection. -### End" -3371,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glucose transpo occur with the help of following ion in absorption in gut region, with the following options: A: Na+, B: K+, C: Ca+, D: CI- - -### Response: -Glucose is absorbed into the epithelial cells lining the mucous membrane of the small intestine from their brush border surface by an active transpo mechanism Sodium co-transpo mechanism. Binding of glucose & Na+ to carrier protein: The carrier protein in cell membrane has 2 binding sites, one for sodium & another for glucose.It is called sodium-dependent glucose transpoer-I. The conformational change in the carrier protein occurs only when the binding sites are occupied by the sodium & glucose present in the gut lumen forming the sodium- glucose - carrier complex. Ref: Medical Physiology, Indu Khurana -### End" -3372,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Periosteal reaction in a case of acute osteomyelitis can be seen earliest at: March 2012, with the following options: A: 5 days, B: 10 days, C: 15 days, D: 20 days - -### Response: -Ans: B i.e. 10 days The earliest sign to appear on the X-ray is a periosteal new bone deposition (periosteal reaction) at the metaphysis. It takes about 7-10 days to appear Osteomyelitis Earliest site of involvement: Metaphysis Diagnosis of acute OM: Blood culture (positive in 65% cases) Periosteal reaction seen in acute OM appears after: 10 days MC organism in acute OM: Staph. aureus Brodies abscess: - Equilibrium between host & organism; - Abscess cavity remains without fuher enlargement -### End" -3373,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following structures cross the Right Ureter Anteriorly, Except:, with the following options: A: Terminal ileum, B: Vas deferens, C: Genitofemoral nerve, D: Right Colic and ileo colic vessels - -### Response: -C i.e. Genitofemoral nerve Ureter is supplied by renal, gonadal (testicular or ovarian), Colic, aoa, iliac (common & internal), vesicle (superior & inferior) middle rectal & uterine aeries. -### End" -3374,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eosinophil production is increased by, with the following options: A: IL-1, B: IL-6, C: IL-5, D: TNF-A - -### Response: -TH1 cells produce the cytokine IFN-g, which activates macrophages in the classical pathway. TH2 cells secrete IL-4, IL-5, and IL-13, which recruit and activate eosinophils and are responsible for the alternative pathway of macrophage activation TH17 cells secrete IL-17 and other cytokines that induce the secretion of chemokines responsible for recruiting neutrophils and monocytes into the reaction. TNF induces acute inflammation by acting on neutrophils and endothelial cells. ref robbins 9th ed page 55 -### End" -3375,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is most reliable feature suggestive of malignant transformation of pheochromocytoma excusively?, with the following options: A: Presence of mitotic figures, B: Capsular invasion, C: Vascular invasion, D: None of the above - -### Response: -Ans. D. None of the above. (Ref. Robbin's 8th/pg. 1159).Robbins pathology 8th/ pg. 1159.......""Both capsular and vascular invasion may be encountered in benign lesions, and the presence of mitotic figures per se does not imply malignancy. Therefore, the definitive diagnosis of malignancy in pheochromocytomas is based exclusively on the presence of metastases. These may involve regional lymph nodes as well as more distant sites, including liver, lung, and bone.""PHEOCHROMOCYTOMAPheochromocytomas are neoplasms composed of chromaffin cells, which, like their non-neoplastic counterparts, synthesize and release catecholamines and, in some cases, other peptide hormones. These tumors are of special importance because, although uncommon, they (like aldosterone-secreting adenomas) give rise to a surgically correctable form of hypertension.Pheochromocytomas = ""rule of 10s"":# 10% = familial .# 10% = extra-adrenal, occurring most commonly at the organ of Zuckerkandl.# 10% = bilateral.# 10% = malignant: Frank malignancy is somewhat more common in tumors arising in extra-adrenal sites.Histopathology:# Microscopically, pheochromocytomas are composed of polygonal to spindle-shaped chromaffin cells and their sup- porting cells, compartmentalized into small nests, or ""Zellballen,"" by a rich vascular network.6# Electron microscopy reveals variable numbers of membrane-bound, electron-dense granules, representing catechola- mines and sometimes other peptides. The nuclei of the neoplastic cells are often quite pleomorphic.# Both capsular and vascular invasion may be encountered in benign lesions, and the presence of mitotic figures per se does not imply malignancy.# Therefore, the definitive diagnosis of malignancy in pheochromocytomas is based exclusively on the presence of metastases. These may involve regional lymph nodes as well as more distant sites, including liver, lung, and bone.Clinical features:# The dominant clinical manifestation of pheochromocytoma is episodic hypertension. 6# Classically, this is described as an abrupt, precipitous elevation in blood pressure, associated with tachycardia, palpitations, headache, sweating, tremor, and a sense of apprehension. Such episodes may also be associated with pain in the abdomen or chest, nausea, and vomiting.# In practice, isolated, paroxysmal episodes of hypertension occur in fewer than half of individuals with pheochro- mocytoma.# Sudden cardiac death may occur.Biochemical Tests:# Unclear which is the best test, although most patients will have clearly abnormal values.# 24h urine metanephrines, vanillylmandelic acid (VMA), and free catecholamines: Most feel this is the first best test, as the values are usually elevated. Urine metanephrines: >1.2mg/d. Can see falsely elevated levels if patient is on labetolol or buspirone (metabolite of buspirone mistakenly read as metanephrine).6# Plasma catecholamines: Must be drawn under strict guidelines including patient fasting, supine for 30 minutes, and needle inserted at least 20 minutes prior to blood draw. Norepinephrine >2000pg/ml or epinephrine >200pg/ml is 95% specific and 85% sensitive. Metanephrine and normetanephrine plasma measurement are probably the most sensitive because these metabolites released directly from adrenals (>90% and 24-40%, respectively).# Clonidine suppression test: indicated if urine and plasma studies non-diagnostic and history still suggestive. Biopsy: contraindicated. 6Radiologic tests:# CT scan: 87% sensitive because it may miss tumors < 1cm which means in MEN-2 can miss up to 25%.# MRI: 98-100% sensitive, bonus ability to differentiate an adrenal pheo from other adrenal masses by T2 weighted images showing hyperintensity of pheos.6# I131-MIBG scan: scan detect tumors missed by CT or MRI and is excellent for evaluation of metastasis. Patients should not be on phenoxybenzamine prior to scan.6# DOPA-PET scan: can detect tumors in unusual locations most sensitively and specifically. 6# Adrenal Vein sampling; only needed when work up is inconclusive .Rx:# Surgical removal is Rx of choice and are now being successfully removed laparoscopically.# Pre-operative Rx: Treat hypertension and volume contraction.# Hypertensive Rx:- Alpha blockade with phenoxybenzamine, a long acting alpha pre and post-synaptic adrenergic antagonist. 10mg BID and increase to 0.5mg/kg daily in divided doses as needed to control HTN for 2-3weeks prior to surgery. Hold the morning of surgery.Prazosin may be used but requires more frequent dosing. Phenoxybenzamine can be used as definitive therapy for inoperable and malignant tumours.- Beta blockade can be added to treat tachycardia after adequate alpha blockade has been started. Labetolol best with its alpha 1 and beta-adrenergic antagonist activity.- Metyrosine (alpha-methyl-para-tyrosine) inhibits catecholamine synthesis.- Calcium channel blockers may be used if beta-blocker not tolerated.# Highest risk periods are during anesthesia induction and when tumor is manipulated. Nitroprusside should be available. Post-operatively hypotension and shock may occur. Hypoglycemia may develop in 10-15% secondary to release of suppression of insulin by excess catecholamines. Catecholamine secretion should return to normal in about one week.Prognosis:# Can be cured with surgery, although recurrence rate 14% in one series, with half of those being malignant. Risk of recurrence highest in familial disorders. Pain from metastatic bone lesions can be relieved with radiation therapy +/- chemotherapy. Disorders of Adrenal MedullaPheochromoclytoma# Neoplasm of neural crest-derived chromaffin cells that secrete catecholamines (usually norepinephrine) - hypertension# Highest incidence in children and adults age 30-50 - Clinical: paroxysmal or constant hypertension is most classic symptom; also, sweating, headache, arrhythmias, palpitations# Lab values: elevated urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA)# The Rule of 10s for pheochromocytoma:- 10% extra-adrenal- 10% bilateral- 10% malignant- 10% affect children- 10% familialNeuroblastoma# Most common malignant extracranial solid tumor of childhood# Occurs most frequently in the adrenal medulla, but may arise in sympathetic chain# Amplification of the N-myc oncogene--more copies=more aggressive# Clinical: tumors grow rapidly, metastasize widely (especially to bone); prognosis in younger patients (less than 1 year old) better than for older children# Pathology: lobulated with areas of necrosis, hemorrhage, calcification# Microscopic appearance: rosette pattern of small cells -### End" -3376,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Rotator cuff is composed of four of the following muscles except:, with the following options: A: Teres minor, B: Supraspinatus, C: Infraspinatus, D: Teres major - -### Response: -D i.e. Teres major * For rotator cuff muscles are - supraspinatus, infraspinatus, subscapularis and teres minor (not major)Q.* The tendon of rotator cuff muscles blend with the joint capsule and form a musculo tendinous collar that surrounds the posterior, superior, and anterior aspect of gleno- humeral joint. -### End" -3377,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Supranuclear palsy of hypoglossal nerve results in all of the following, EXCEPT:, with the following options: A: Detion of tongue, B: Muscular twitching, C: Hemiatrophy of tongue, D: None of the above - -### Response: -Hypoglossal nerve palsy: Unilateral palsy results in mild detion of tongue towards the paretic side when it is protruded. Bilateral supranuclear palsy produces severe dysahria and dysphagia. Nuclear lesions of hypoglossal nerve results in bilateral flaccid paralysis of the tongue with atrophy and fasciculations. Speech and swallowing are impaired.Supra nuclear palsy of hypoglossal nerve does not result in atrophy, but intranuclear lesions can lead to hemiatrophy of tongue on the affected side. Detion of tongue to the affected side, muscular twitching are seen in both types. Ref: Snells Clinical anatomy, 6th Edition, Page 736, 737. -### End" -3378,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are mechanisms of IUCDs except:, with the following options: A: Chronic endometrial inflammation, B: Increase the motility of tubes, C: Inducing endometrial atrophy, D: Inhibition of ovulation in >80% of the users - -### Response: -Mechanism of Action: Several mechanisms are responsible for the contraceptive effect of an IUCD. The presence of a foreign body in the uterine cavity renders the migration of spermatozoa difficult. A foreign body within the uterus provokes uterine contractility through prostaglandin release and increases the tubal peristalsis so that the feilized egg is propelled down the fallopian tube and more rapidly than in normal and it reached the uterine cavity before the development of chorionic villi and thus is unable to implant. The device in situ causes leucocytic infiltration in the endometrium. The macrophage engulf the feilized egg if it enters the endometrial tissue which inimical to the implantation of the feilized ovum Progesterone-carrying device causes alteration in the cervical mucus which prevents penetration of sperm, in addition to its local action. It also causes endometrial atrophy. It prevents ovulation in about 40% Ref: Shaw&;s textbook of Gynaecology 17th edition Pgno: 261 -### End" -3379,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Beta-alanine is end product of metabolism of, with the following options: A: Uracil, B: Thymine, C: Guanine, D: Adenine - -### Response: -Uracil is a pyramidine and pyramidine metabolism produces beta alanine Ref-Sathyanarayana 4/e p380 -### End" -3380,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tiimour arising from totipotent cell is:, with the following options: A: Teratoma, B: Seminoma, C: Myoma, D: Lipoma - -### Response: -Ans: a (Teratoma) Ref: Robbins, 7th ed, p. 271TeratomaFormed of a variety of parenchymal cell types usually of all three germ layers.Arises from totipotent cells, so principally encountered in the gonads.They differentiate along various germ lines producing skin, muscle, fat, gut, epithelium,tooth etc.Other important termsDermoid cysts(Ovarian cystic teratoma)Differentiated along ectodermal lines forming a cystic tumour with hair sebaceous gland, skin, tooth etc.ChoristomaIt is the ectopic rest of normal tissueExample- Adrenal cell under kidney capsuleHamartomaA mass of disorganized but mature specialized tissue or cells indigenous to the organ .EgHamartoma of lung. -### End" -3381,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'Herbert's pits' are seen in, with the following options: A: Trachoma, B: Viral keratitis, C: Vernal conjunctivitis, D: Any of above - -### Response: -Ans. a (Trachoma) (Ref Khurana pg 91; Ophthalmology by Basak 4th/142; Parson 19th / Page 184)Herbert pits are the oval or circular pitted scars, left after healing of Herbert follicles in the limbal area, seen in the patients with trachoma.The signs of Trachoma are:A. Conjunctival:# Congestion of Upper Fornix and upper tarsal conjunctiva# Follicles on the upper Tarsal Conjunctiva; Bulbar Conjunctiva# Follicles contain multinucleated Giant Cells called as Leber's Cells# Velvety papillary Hyperplasia# Herbert's Pits (pathognomonic) - Follicles on the limbus# Arlt's Line is linear scar in sulcus subtarsalis due to Conjunctival Scarring# Concretions due to accum of dead epithe cells and mucus in glands of HenleB. Corneal signs:# Superficial keratitis# Herbert follicles (in limbal area)# Pannus - Is fine subepithelial neovascularisation seen at the upper limbus- Progressive Pannus - Infiltration ahead of vascularisation- Regressive Pannus - Vessels extend a short area beyond infiltration (Pannus Sicca)# Corneal ulcer# Herbert's Pits# Corneal opacity (end result).Additional Educational Points# International trachoma Initiative sponsors a programme called SAFE to control Trachoma0- Surgery,- Antibiotics,- Face wash &- Environmental change# Vernal keratoconjunctivitis is characterized by:- Called as Spring Catarrh0- Bilateral- Exogenous Allergen- Itching- Ropy Discharge0- Cobblestone Papillary hypertrophy,- Bulbar Conjunctiva has Horner Trantas Spots- Punctate epitheliapathy is earliest finding.- Maxwell Lyon sign is also seen.- Cornea has Pseudogerantoxon with Cupid Bow outline# Pterygium has Stocker's line which is due to deposition of IRON.0 -### End" -3382,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements are true regarding human T cell leukemia virus 1 except:, with the following options: A: It causes adult T cell lymphoma/leukaemia, B: It has tropism for CD 8 + T cell, C: It has long latent period of about 40 to 60 years, D: Leukaemia develop in only 3 to 5% of infected individual - -### Response: -HTLV1 causes adult T-cell leukemia/lymphoma (ATLL) Similar to the human immunodeficiency virus, which causes AIDS, HTLV-1 has tropism for CD4+ T cells, and hence this subset of T cells is the major target for neoplastic transformation. A high fraction of the leukemias express the transcription factor Fox P3, a marker of regulatory T cells (Tregs) that act to suppress immune responses. -### End" -3383,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Okazaki segments are required for :, with the following options: A: DNA synthesis, B: RNA synthesis, C: Protein synthesis, D: None of the above - -### Response: -A i.e. DNA synthesis -### End" -3384,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle tone increasing in patient trying to relax the muscles is seen in?, with the following options: A: Paratonia, B: Myotonia, C: Spasticity, D: Rigidity - -### Response: -Muscle tone increasing in patient trying to relax the muscles is seen in Paratonia. Paratonia (gegenhalten) is increased tone that varies irregularly in a manner seemingly related to the degree of relaxation, is present throughout the range of motion and affects flexors and extensors equally; it usually results from disease of the frontal lobes. Paratonia can be distinguished from spasticity by observing a lack of exaggerated deep tendon reflexes and a lack of a clasp-knife response. It can be distinguished from Parkinsonian (aka ""lead-pipe"") rigidity in that the amount of resistance in Parkinsonian rigidity does not vary with the velocity of the movement. -### End" -3385,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum amount of glucose absorption occurs at:, with the following options: A: PCT, B: DCT, C: Loop of henle, D: None - -### Response: -Glucose, amino acids, and bicarbonate are reabsorbed along with Na+ in the early portion of the proximal tubule. -### End" -3386,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gold standard investigation for chronic pancreatitis, with the following options: A: MRI, B: ERCP, C: Pancreatic function tests, D: Faecal fat estimation - -### Response: -ERCP(Endoscopic retrograde cholangiopancreatography) is the most accurate way of elucidating the anatomy of duct and, in conjunction with the whole organ morphology, can help to determine the type of operation required. Reference : Bailey & Love, 27th Edition, page no = 1231 -### End" -3387,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Facilitated diffusion is characterized by all except:, with the following options: A: Vmax, B: Competitive inhibition, C: Requires energy, D: Specificity - -### Response: -Facilitated diffusion is a carrier-mediated transpo. ATP is not consumed in this transpo. A conformational change in the carrier molecule causes the substance to be transpoed to the other side of the membrane. Some models hypothesised for the carrier proteins ~ flip-flop model, ferryboat model. Saturability, Specificity and inhibition are the characteristics of the Facilitated diffusion -### End" -3388,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the drug of choice of treatment of corneal ulcers caused by filamentous fungi ?, with the following options: A: Itraconazole, B: Natamycin, C: Nystatin, D: Ketoconazole - -### Response: -Natamycine(5%),Amphotericin B(0.1 to 0.3%), and either fluconazole(0.2%) or miconazole(10mg/ml) or voriconazole are effective against Aspergillus and Fusarium.Reference:Comprehensive ophthalmology,AK Khurana,6th edition,page no.106 -### End" -3389,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shoening of 2 mm of axial length of eye ball causes ?, with the following options: A: 3D myopia, B: 6D myopia, C: 3D hypermetropia, D: 6D hypermetropia - -### Response: -Ans. is. d., 6D hypermetropia Change in axial length can cause refractive error. It is the commonest form of ametropia (both myopia and hypermetropia). In hypermetropia, there is an axial shoening of eyeball. So, image is formed behind the retina. In myopia, there is an axial lengthening of eyeball. So, image is formed in front of the retina. 1 mm change in axial length leads to ametropia of 3D. For example 1 mm shoening in axial length causes hypermetropia of 3D. -### End" -3390,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Point shource epidemic is -, with the following options: A: Short term fluctuation, B: Periodic fluctuation, C: Long term fluctuation, D: Secular trend - -### Response: -Ans. is 'a' i.e., Short term fluctuation * Point source (single exposure) epidemic is short term fluctuation.* There are three kinds of time trends or fluctuations in disease occurenceA. Short term fluctuations - epidemics.B. Secular trends or long term fluctuations.C. Periodic fluctuation. -### End" -3391,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a Halogenated disinfectant?, with the following options: A: Iodophores, B: Hypochlorites, C: Bleaching powder, D: Savlon - -### Response: -Savlon is a Quaternary ammonium compound, combination of cetavlon and hibitane. Halogenated compounds : Bleaching powder Iodophores Hypochlorites -### End" -3392,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following features are seen in the viral pneumonia, EXCEPT:, with the following options: A: Bronchiolitis, B: Presence of interstitial inflammation, C: Predominance of alveolar exudates, D: Multinucleate gaint cells in the bronchiolar wall - -### Response: -Most predominant histological features of viral pneumonia are seen in the epithelium and adjacent interstitial tissue. Alveolar exudates are not seen in viral pneumonia. Bronchiolitis is present and is characterized histologically by neutrophilic exudates in the airway lumen and a predominantly mononuclear infiltrate in its wall. Ref: Textbook of Pediatric Emergency Medicine By Gary R. Fleishe, Page 914 ; Imaging of Pulmonary Infections By Nestor Luiz Mulle, Page 94 -### End" -3393,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sodomy is punishable under:NEET 14, with the following options: A: Sec. 354 IPC, B: Sec. 375 IPC, C: Sec. 377 IPC, D: Sec. 378 IPC - -### Response: -Ans. Sec. 377 IPC -### End" -3394,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Yoyo reflux -, with the following options: A: Duplication of ureter, B: Polycystic Kidney, C: Mellutary sponge Kidney, D: Pseudo kidney - -### Response: -Ans. is 'a' i.e., Duplication of ureter * Reflux of the urine from one limb of the collecting system to the other limb, rather than down towards the bladder is called yo-yo reflux (saddle reflux)* Cause: Duplication of ureters, partial duplication of ureters, duplicate renal pelvis* Another explanation of yo-yo reflux is the pressure gradient between two ureteric segments. The pressure of the lower moiety is generally higher than the upper moiety and therefore the urine generally refluxes from the lower moiety to the upper moiety* Duplication of the upper collecting system is one of the most common of renal anomalies* Complete duplication is associated with ectopic ureter, ureterocele or vesicoureteral reflux.* The incomplete duplication of the upper collecting system rarely causes urinary symptoms and usually does not carry clinically importance -### End" -3395,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All lesions are seen in leprosy except –, with the following options: A: Erythematous Macule, B: Hypopigmented patch, C: Vesicles, D: Flat & raised patches - -### Response: -Leprosy is not a vesiculo-bullous (blistering) disorder. -### End" -3396,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are injuries of lower end of radius except, with the following options: A: Smith's fracture, B: Colle's fracture, C: Night stick fracture, D: Baon's fracture - -### Response: -C i.e. Night stick fracture -### End" -3397,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about nesiritide are true EXCEPT:, with the following options: A: It is a BNP analogue, B: It can be used in decompensated CHF, C: It can be administered orally, D: It causes loss of Na+ in the urine - -### Response: -Nesiritide is a Natriuretic peptide useful in hea failure. It is administrated intravenously. It inhibits BNP degradation (REF. Essential of medical pharmacology KD TRIPATHI 8th Edition) -### End" -3398,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old man presents for a routine physical examination. The patient is tall (6 ft. 5 in) and on examination he was found to have an early diastolic murmur. His family pedigree is as given below. Which of the following is the mode of inheritance by which the disease is likely to be transmitted?, with the following options: A: Autosomal dominant, B: Autosomal recessive, C: X-linked recessive, D: X linked dominant disorder - -### Response: -Autosomal dominant Males and females are both affected (no sex predilection). Upto 50% of offsprings have chance of inheritance of disease, depending on disease penetrance. Affected male in 1st generation has passed disease gene to nearly half of his offsprings and so foh. -### End" -3399,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deficiency of hypocretin leads to, with the following options: A: Somnambulism, B: Bruxism, C: Narcolepsy, D: Restless leg symdrome - -### Response: -Hypocretin is a neurotransmitter that promotes wakefulness and it's deficiency leads to Narcolepsy. -### End" -3400,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All have high hepatic clearance EXCEPT, with the following options: A: Labetalol, B: Simvastatin, C: Morphine, D: Paracetamol - -### Response: -(D) Paracetamol HEPATIC CLEARANCE OF DRUGSLOWHepatic ClearanceINTERMEDIATEHepatic ClearanceHIGHHepatic Clearance* Carbamazepine* Caffeine* Lignocaine* Diazepam* Fluoxetine* Morphine* Ibuprofen* Midazolam* Pethidine* Phenytoin* Omeprazole* Propranolol* Warfarin* Paracetamol* Zidovudine> Low Hepatic Clearance does not mean that the drug is then cleared by the kidneys; it indicates that the capacity of the hepatic enzymes involved in the metabolism of the drug is low. -### End" -3401,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Monoamine neurotransmitter in brains is, with the following options: A: Serotonin, B: Glycine, C: GABA, D: Dopamine - -### Response: -There are three main classes of chemical substances that serve as neurotransmitters and neuromodulators: small molecule transmitters large-molecule transmitters gas transmitters. Small molecule transmitters include amino acids (eg, glutamate, g-aminobutyric acid , and glycine, acetylcholine, monoamines (eg, norepinephrine, epinephrine, dopamine, and serotonin. Large-molecule transmitters include neuropeptides such as substance P, enkephalin, and vasopressin. Neuropeptides are often co-localized with one of the small-molecule neurotransmitters Ref: Ganong's Review of Medical Physiology 26th edition -### End" -3402,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 57-year-old woman with a 20-year history of celiac disease now presents with weight loss, cramps, and abdominal discomfort. She is adherent to her gluten-free diet, and is not taking any new medications. On examination, her abdomen is soft and there is fullness in the right lower quadrant. A small bowel x-ray reveals an area of narrowing in the distal ileum, and there is thickening and nodularity of the mucosal folds. She undergoes surgical resection of the lesion, and the pathology report confirms a tumor that is more common in patients with celiac disease, Crohn's disease, or depressed immune function such as human immunodeficiency virus (HIV).For the above patient with a small bowel tumor, select the most likely diagnosis., with the following options: A: polypoid adenoma, B: lipoma, C: adenocarcinoma, D: primary gastrointestinal (GI) lymphoma - -### Response: -Primary small bowel lymphoma is more common in the settings of celiac disease, regional enteritis, congenital immune disorders, prior organ transplantation, autoimmune disorders, and AIDS. -### End" -3403,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is not metabolized by acetylation?, with the following options: A: Isoniazid, B: Hydralazine, C: Phenytoin, D: Procainamide - -### Response: -Metabolism by acetylation: Two types of individuals are found, slow and fast acetylators. -Acetylation is done by N acetyl transferase enzyme. Drugs metabolised by acetylation *Sulfonamide* Hydralazine* Isoniazid* Procainamide These drugs can cause SLE. -### End" -3404,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug directly acting on blood vessels is:, with the following options: A: Hydralazine, B: Verapamil, C: Propranolol, D: Methyaldopa - -### Response: -Ref:KDT 6/e p547 Some drugs used to treat hypeension, such as calcium channel blockers -- which prevent calcium from entering blood vesselwalls -- also dilate blood vessels. But the vasodilators that work directly on the vessel walls are hydralazine and minoxidil. -### End" -3405,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pfropf's Schizophrenia, with the following options: A: Schizophrenia in professors, B: Schizophrenia in children, C: Schizophrenia in patients, D: Schizophrenia in doctors - -### Response: -Pfropf's Schizophrenia is Schizophrenia seen in children. -### End" -3406,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dysphagia is caused by all except-, with the following options: A: Esophageal varices, B: Achalasia cardia, C: Stricture, D: Gastroesophageal reflux of long standing duration - -### Response: -Esophageal causes of dysphagia - -The lesions may lie in the lumen, in the wall or outside the wall of esophagus. - -a) Lumen : Obstruction to lumen can occur in atresia, foreign body, strictures, benign or malignant tumors. -b) Wall : It can be acute or chronic esophagitis, or motility disorders. The latter are : - -i)  Hypomotility disorders, e.g., achalasia scleroderma, amyotrophic lateral sclerosis. -ii) Hypermotility disorders, e.g., cricopharyngeal spasm, diffuse esophageal spasm. -c) Outsite the wall : The lesions cause obstruction by pressing on the esophagus from outside : - - -Hypopharyngeal diverticulum. -Hiatus hernia -Cervical osteophytes -Thyroid lesions, e.g., enlargement, tumors, Hashimoto's thyroiditis. -Mediastinal lesions, e.g., tumors of mediastinum, lymph node enlargement, aortic aneurysm, cardiac enlargement. -Vascular rings (dysphagia lusoria). - -Note : - -Gastroesophageal reflux can cause esophageal stricture and thus dysphagia. -### End" -3407,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trident hand is seen in –, with the following options: A: Achondroplasia, B: Mucopolysaccharidosis, C: Diphyseal achlasia, D: Cleidocranial dystosis - -### Response: -Trident hand is seen in achondroplasia. -### End" -3408,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about allosteric enzymes, EXCEPT:, with the following options: A: Allosteric enzymes can't have structure beyond the teiary structure, B: Allosteric enzymes have a regulatory site other than the active site, C: Allosteric enzymes do not show Michaelis-Menten kinetics, D: Allosteric modulators bind noncovalently to allosteric site - -### Response: -Be Aware that Question is asking about the wrong/false statement: Allosteric enzymes also contain a site other than active site which binds to allosteric regulator. Allosteric enzymes don't follow Michaelis-Menten kinetics. They do obey Hill's equation. Allosteric enzymes are usually multi-subunit enzymes. Binding of allosteric regulator to the allosteric site alters the substrate affinity of active site. This is known as cooperativity.This can be either positive or negative. A multi-subunit enzyme will obviously have quaternary structure - option a is wrong. -### End" -3409,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common glomerulonephritis associated with HIV is which of the following, with the following options: A: Focal segmental glomerulonephritis, B: Diffuse glomerulosclerosis, C: Membrane proliferative glomerulonephritis, D: Crescentric glomerulonephritis - -### Response: -A morphologic variant of FSGS is called collapsing glomerulopathy and is the most characteristics lesions of HIV related nephropathy Refer robbins 9/e p919 -### End" -3410,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about CA gall bladder except -, with the following options: A: Adenocarcinoma is the most common type, B: Prognosis is generally poor, C: Gall stones is a common associated factor, D: Vibrio Cholerae Infection has shown an association - -### Response: -Ans. is 'd' i.e., Vibrio Cholerae Infection has shown an association o Carcinoma of gall bladder are adenocarcinoma.o The most cammon sites of involvement are the fundus and the neck, about 20% involve the lateral wallso There are two growth patterns.i) Infiltrating-more commonii) Exophytico Important risk factors for gall bladder cancer are gallstones (most common risk factor)y obesity, female gender, old age, choledochal cyst, porcelain gallbladder, gall bladder polyps and chronic typhoid infection. -### End" -3411,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ECF best value is given by, with the following options: A: Mannitol, B: Inulin, C: D2O, D: Evan's blue - -### Response: -ECF volume is measured using inulin which is a polysaccharide.(Ref: Textbook of physiology N Geetha 2nd edition page no.61) -### End" -3412,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 1729. A 28 yr old female presented with malaise and generalised weakness since 6 month. Her appetite Is reduced and she has giddiness and palpitations on and off. There was no organomegaly. Laboratory Study showed normochromic to hypochromic anaemia and MCV-80. What Is the diagnosis, with the following options: A: Thalassemia minor, B: Iron deficiency anaemia, C: Chronic malaria, D: Folate deficiency - -### Response: -

Iron deficiency anemia is much more common in women between the age of 20 & 45 yrs than in men.The onset of this anemia is generally slow .The usual symptoms are weakness ,fatigue ,palpitations ,dyspnoea on exeion & pallor of skin, sclera & mucous membrane.

Also MCV will be less than 80fl in iron deficiency anemia .

Reference :Harsh mohan textbook of pathology sixth edition pg no 298.

-### End" -3413,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute aoic regurgitation is seen in all the following except, with the following options: A: Marfan's syndrome, B: Acute myocardial infraction, C: Bacterial endocarditis, D: Ankylosing spondylitis - -### Response: -Ref Harrison 19 th ed pg 1535 acute severe AR, as may occur in infective endo- carditis, aoic dissection, or trauma, the LV cannot dilate sufficiently to maintain stroke volume, and LV diastolic pressure rises rapidly with associated marked elevations of LA and PA wedge pressures. Pulmonary edema and/or cardiogenic shock may develop rapidly. -### End" -3414,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of renal stone?, with the following options: A: Calcium oxalate, B: Triple phosphate, C: Struvite stone, D: Urate stone - -### Response: -Ans. (a) Calcium oxalateRef.:Bailey and love 26th ed. /1292Types of Renal Stones (Urolithiasis):* Calcium stones (75-85%)# Made of calcium oxalate or Calcium oxalate plus calcium phosphate.* Struvite stone/Triple phosphate stone (15% of cases)# Also known as magnesium-ammonium-phosphate stone# Formed mainly after infection by urea splitting bacteria (Proteus and some staphylococci) - which causes alkaline urine - leads to precipitation of Mg -NH3 - PO4# Causes Staghorn calculi, which occupy large position of renal pelvis.* Uric acid stone# Common in patients with hyperuricemia (except in patients with gout) and in patients with rapid cell turnover (Example- in Leukemia patients).# Cause: Urine of pH less than 5.5 (uric acid is insoluble in acidic urine) a leading to saturation# It is radiolucent stone.* Cystine stone# Due to genetic defect in renal absorption of amino acid cysteine a leading to cystinuria. -### End" -3415,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Toxic shock syndrome is, with the following options: A: Most commonly due to TSST-1, B: Mensturation is a risk factor, C: Anti - staph antibodies are contraindicated, D: Most common cause is Staphylococcus aureus - -### Response: -Toxic shock syndrome is a potentially fatal multisystem disease presenting with fever, hypotension, myalgia, vomiting, diarrhoea, mucosal hyperemia and an erythematous rash which desquamates subsequently. This is associated with infection of mucosal or sequestered sites by toxic shock syndrome toxin(TSST)-producing S.aureus strains usually belonging to bacteriophage GROUP 1.TSST type 1(formerly also known as enterotoxin type F or pyrogenic exotoxin C) is most often responsible, though enterotoxins B or C may also cause the syndrome. Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; Tenth Edition; Page No: 204 -### End" -3416,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kim et al classification system deals with:, with the following options: A: Apical constriction, B: Apical foramen, C: Isthmus, D: No. of canals - -### Response: -According to Kim et al Classification; there are 5 types - -Type I incomplete isthmus between 2 canals. -Type II well defined, complete isthmus between 2 canals. -Type III very short but complete isthmus between 2 canals. -Type IV 3 or more canals with the complete or incomplete isthmus. -Type V 3 or more canals without any visible connection. -### End" -3417,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true about Mebendazole, with the following options: A: Safe in pregnancy, B: Broad spectrum antihelminthic, C: Relatively low systemic bioavailability, D: Active against both larva and adult worm - -### Response: -Ans. is 'a' i.e., Safe in pregnancy Mebendazole - It has broad spectrum antihelminthic activity. It is effective against both egg and adults in the following helminths.Round worm (Ascaris)Hookworm (Ancylostoma)Thread worm (Enterobius)Whip worm (Trichuris)Action on other parasites - Strongyloides - less effective against it.Tapeworm -75% cure rate has been achieved H. Nana - relatively insensitiveTrichinella spiralis - expels the worm out of intestine but not effective against larva.Absorption of mebendazole from intestine is minimal (75-90% of the dose is passed in faeces)Safety of mebendazole during pregnancy is not known, but is contraindicated on the basis of animal data.Also knowSite of action of Mebendazole is microtubular protein (b tubulin). -### End" -3418,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First evidence of primordial follicle can be seen in ovaries at :, with the following options: A: 5th month of intrauterine life, B: 7th month of intrauterine life, C: At bih, D: At pubey - -### Response: -At approximately 4 weeks, gonads form on the ventral surface of embryonic kidney at a site between 8th thoracic and 4th lumbar segments. Primordial follicle consists of a large cell, the primordial ovum(oogonia), which is surrounded by flattened cells,best termed as follicular epithelial cells. Reference: Shaw's Textbook of Gynaecology 15th edition, page 28 -### End" -3419,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Condyloma acuminata in pregnancy is best treated by:, with the following options: A: Podophyllin, B: Cryotherapy, C: Trichloroacetic acid, D: 5-FU cream - -### Response: -Condyloma acuminata - HPV types 6 and 11, mucocutaneous external genital was Trichloroacetic or bichloracetic acid, applied topically once a week, is an effective regimen for external was Cryotherapy is the best. Also laser ablation, or surgical excision can be tried for treatment in pregnancy Agents not recommended in pregnancy -Podophyllin resin -podofilox 0.5-percent solution or gel -imiquimod 5-percent cream -interferon therapy -sinecatechins. -### End" -3420,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The receptor response decline despite of the continued presence of a stimulus is know as:, with the following options: A: Accomodation, B: Adaptation, C: Refractoriness, D: Electrotonus - -### Response: -Adaptation: When a maintained stimulus of constant strength is applied to a receptor the frequency of the action potentials in its sensory nerve declines over time. This phenomenon is known as adaptation or desensitization. Ref: Ganong's Review of Medical Physiology, 21st Edition, Page 125 -### End" -3421,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The thinnest part of the lens capsule is?, with the following options: A: Anterior pole, B: Posterior pole, C: Posterior capsule, D: Apex - -### Response: -ANSWER: B -### End" -3422,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs intensify gastrointestinal motility Except, with the following options: A: Papaverine, B: Metoclopramide, C: Domperidone, D: Cisapride - -### Response: -Papaverine an opioid decreases motility Prokinetic drugs are 5-HT3 antagonists (granisetron, ondansetron, and tropisetron), 5-HT 4 -receptor agonists (Cisapride, Mosapride, Tegaserod), D 2 -receptor antagonists (Metoclopramide and domperidone), Cholinomimetic agonists (bethanechol, Neostigmine) Ref:Katzung 13th edition pg 531 -### End" -3423,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about sternocleidomastoid is, with the following options: A: Arises from sternum and clavicle, B: Inses on mastoid process, C: Motor supply by spinal accessory nerve, D: Tilt the head on opposite side - -### Response: -Actions of sternocleidomastoid - When one sternocleidomastoid muscle contracts, a) It turn the chin to the opposite side, b) It can also tilt the head towards the shoulder of same side Ref : B D Chaurasia's Human Anatomy , sixth edition, volume 3 , pg. no. 89 -### End" -3424,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carrier who acquires pathogen from another carrier is_____, with the following options: A: Convalescent carrier, B: Paradoxical carrier, C: Incubatory carrier, D: Healthy carrier - -### Response: -Ans. b (Paradoxical carrier) (Ref. Ananthanarayan 8th/76; Park PSM 20th/92)The term contact carrier is applied to a person who acquires the pathogen from a patient, while the term paradoxical carrier refers to a carrier who acquires the pathogen from another carrier.Carrier is a person who harbours the pathogenic microorganisms without suffering any ill-effect because of it.1 Type of carrierDefinitionE.G.1. Convalescent carrierWho has recovered from the disease and continues to harbour the pathogen in his bodyTyphoid, dysentry,CholeraWhooping cough, Diptheria2. Paradoxical carrierAcquires the pathogen from another carrier-3. Incubatory carrierShed the infectious agent during the incubation period of diseaseMeasles, Diptheria, HepatitisMumps, Polio, Pertusis, Influenza4. Temporary carrierCarrier state lasts for < 6 months-5. Chronic carriersMay last for several yrs and sometimes even for rest of one's lifeTyphoid, GonorrohoeaHepatitis B, Dysentry, Malaria6. Contact carrierPerson who acquires pathogen from patient-7. Healthy carrierHarbours the pathogen but never suffered from the disease caused by the pathogen-8. Pseudo carrierCarriers of avirulent organisms- -### End" -3425,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hepatomegaly is a feature of all of the following, Except :, with the following options: A: Von Girke's Disease, B: Hurler's Disease, C: Nieman Pick Disease, D: Hepatic porphyrias - -### Response: -Answer is D (Hepatic Pot phyrias): Frank Hepatomegaly is rare in hepatic porphyrias Although hepatomegaly may occasionally be seen in hepatic porphyrias, frank hepatomegaly is rare and not a prominent manifestation of hepatic porphyria . Hepatic porphyria is therefore the single best answer by exclusion Frank signs of hepatomegaly are rare in Hepatic Porphyrias but have been noted. Hepatic involvement in porphyria is variable Patients with acute hepatic porphyria generally have elevation of serum aminotransferases and bile acid levels. Patients with chronic hepatic porphyrias (porphyria cutanea tarda) may show liver enlargement with fatty infiltration but frank signs of hepatomegaly and iron overload are rare Hepatomegaly is a prominent manifestation of Hurler's syndrome, Nieman lick disease and Von Girke's Disease. -### End" -3426,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mental spines provide attachment to, with the following options: A: Genioglossus, B: Anterior & posterior bellies of digastric, C: Mylohyoid, D: Superior constrictor of pharynx - -### Response: -Mental spine also known as genial tubercle, is a small bony elevation found on the inner surface of mandible, in the midline. -There are 4 mental spines - superior and inferior pair. - - -Superior genial tubercle gives origin to genioglossus muscle of tongue. -Inferior genial tubercle gives origin to geniohyoid muscle. -### End" -3427,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old female was drunk and came to medicine OPD with complaints of chest pain with shoness of breath. Chest x ray film is given below. No history of trauma can be recalled by the patient. She never had a similar episode in the past. No history of smoking or pulmonary TB. Occupational history reveals that she is unemployed from past 6 months and was working in IT firm before that. Which of the following option is true in regards the management of the given pathology?, with the following options: A: X-ray appears normal. Just counsel the patient., B: Take the pt. for HRCT and then to OR., C: Pt needs a CT guided biopsy., D: Block is given below the first rib and then above the rib. - -### Response: -X ray depicts multiple posterior rib fracture. Intercostal nerve blocks are simple to perform and useful for pain management either as the primary intervention or as adjuncts. They are useful forpain in the chest wall and upper abdomen. Indications include: Incisional pain from thoracic surgery Analgesia for thoracostomy Herpes zoster or post-herpetic neuralgia Rib fractures Breast surgery Upper abdominal surgery Differentiating between visceral and somatic pain Intercostal block is given for management of multiple rib fractures. Block is given below the first rib and then above the rib (for the collateral branches). -### End" -3428,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Total gastrectomy is preferred for which type of gastric cancers, with the following options: A: Proximal Cancer, B: Distal Cancer, C: Ulcerating cancer in the body, D: Polypoidal cancer in the antrum - -### Response: -Answer- A. Proximal CancerFor proximal gastric carcinomaFor extensive tumors (eg. Linitis plastica)To obtain negative margins for distal gastric carcinoma -### End" -3429,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cytosolic cytochrome C plays an impoant function in:, with the following options: A: Apoptosis, B: Cell necrosis, C: Electron transpo chain, D: Cell division - -### Response: -. Apoptosis -### End" -3430,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inability to vocalise is?, with the following options: A: Aphonia, B: Mutism, C: Alogia, D: Dysarthria - -### Response: -Ans. (a) AphoniaRef: Kaplan 10th ed ch-8, Oxford Handbook of Psychiatry edited by David Semple, Roger Smyth -### End" -3431,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4-month-old infant with Tetralogy of Fallot presents with fever and loose stools. Which of the following is compatible with the diagnosis of Tetralogy spells?, with the following options: A: O2 saturation < 70% in room air, B: Inability to hear a murmur, C: Hepatomegaly, D: S3 gallop rhythm - -### Response: -Paroxysmal hypercyanotic attacks (hypoxic, ""blue,"" or ""tet"" spells) are a paicular problem during the first 2 years of life. The infant becomes hyperpneic and restless, cyanosis increases, gasping respiration ensue, and syncope may follow. The spells occur most frequently in the morning on initially awakening or after episodes of vigorous crying. Temporary disappearance or a decrease in intensity of the systolic murmur is usual as flow across the right ventricular outflow tract diminishes. -### End" -3432,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is Intrinsic Factor related to?, with the following options: A: Cobalamin absorption, B: Vitamin D, C: Folate absorbtion, D: Vitamin C - -### Response: -The gastric secretions arise from glands in the wall of the stomach that drain into its lumen, and also from the surface cells that secrete primarily mucus and bicarbonate to protect the stomach from digesting itself, as well as substances known as trefoil peptides that stabilize the mucus-bicarbonate layer. The glandular secretions of the stomach differ in different regions of the organ. The most characteristic secretions derive from the glands in the fundus or body of the stomach. These contain two distinctive cell types from which the gastric secretions arise: the parietal cells, which secrete hydrochloric acid and intrinsic factor; and the chiefcells, which produce pepsinogens and gastric lipase. The acid secreted by parietal cells serves to sterilize the meal and also to begin the hydrolysis of dietary macromolecules. Intrinsic factor is impoant for the later absorption of vitamin B12 or cobalamin. Pepsinogen is the precursor of pepsin, which initiates protein digestion. Lipase similarly begins the digestion of dietary fats.REF: GANONG&;S REVIEW OF MEDICAL PHYSIOLOGY, KIM BARRETT, HEDDWEN BROOKS, SCOTT BOITANO, SUSAN BARMANTWENTY THIRD EDITIONPAGE NO:432 -### End" -3433,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Half-life of Aldosterone is, with the following options: A: 5 mins, B: 8 to 10 mins, C: 15 to 20 mins, D: 60 to 90 mins - -### Response: -The plasma half-life of coisol is 60 to 90 minutes and is determined by the extent of binding and rate of inactivation -### End" -3434,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blastocyst formation occurs after how many days of fertilization -, with the following options: A: 2-3 days, B: 4- 5days, C: 7-9days, D: 8-11 days - -### Response: -Ans. is 'b' i.e., 4-5 days o After fertilization, zygote divides and ultimately forms blastocyst at which stage it gets implanted in the endometrium.o After the zygote formation, typical mitotic division of the nucleus occurs producing two blastomeres.o Two cell stage is reached approximately 30 hours after fertilization.o The blastomeres continue to divide by binary division through 4, 8,16 cell stage until a cluster of cells is formed and is called morula, resembling a mulberry.o Morula after spending about 3 days in the uterine tube enters the uterine cavity through the narrow uterine ostium (1 mm) on the 4th day in the 16 - 64 cell stage.o While the morula remains free in the uterine cavity on the 4th and 5th day, it is covered by a film of mucus. The fluid passes through the canaliculi of the zona pellucida which separates the cells of the morula and is now termed blastocyst.o Implantation occurs on the 6th day which corresponds to the 20th day of regular menstrual cycle. -### End" -3435,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amsler sign -, with the following options: A: Fuch heterochromatic iridocyclitis, B: Posner-schlossman syndrome, C: Uveal-effusion syndrome, D: None of the above - -### Response: -(Ref: Yanoff & Ducker 3rd/e p.865) During paracentesis in Fuch's heterochromic iridocyclitis, there is bleeding from neo-vasculorizarion. This is known as ""Amsler's sign"". -### End" -3436,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tympanic plexus present in -, with the following options: A: Tunica adventitia of internal jugular vein, B: Medial projection of middle ear cavity, C: Pa of tympanic membrane, D: All - -### Response: -B i.e. Medial projection of middle ear cavity Tympanic nerve arises from the glossopharyngeal nerve, just below the jugular foramen. It passes through the floor of middle ear and reaches onto the mucous membrane covering the promontory(2, where it splits into branches and joint branches of internal carotid plexus to form tympanic plexus. Promontary is round bulging in the medial or labyrinthine wall of middle ear cavityQ produced by the first turn of cholea. -### End" -3437,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: X-rays showing widening of sella but neurological and endocrinological investigations are normal, diagnosis is, with the following options: A: Pseudotumor cerebri, B: Empty sella sign, C: Chromophobe adenoma, D: Prolactinoma - -### Response: -Ans. is'a'i.e., Pseudotumor cerebriRef: Principles and Practice of Endocrinology and Metabolism p. 107""Elevated intracranial pressure is a potentially impoant contributory factor because it has been documented in patients with primary empty sella syndrome.Ten percent of the patients with benign intracranial hypeension have a co-existing empty sella."" -### End" -3438,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Feature of delerium -, with the following options: A: Altered sleep, B: Diorientation, C: Autonomicdisturbanes, D: All of the above - -### Response: -Ans. is 'd' i.e., All of the above Clinical features of deliriumo Delirium has an acute onset and rapid progress. The clinical features of delirium are : -Abnormalities of consciousness : - The most conspicuous feature is a clouding of consciousness which ranges from mild dulling to deep coma.Cognitive impairment: - Confusion or disorientation particularly to time and next to place and occasionally to person. Poor concentration, inattention, altered sensorium and disturbances of memory are seen. There is impairment of immediate and recent memory, remote memory is normal.Perceptual anomalies : - Delirium is the most common cause of illusion. Hallucination, particularly visual are common.Emotional disturbances : - Most commonly it is fear, followed by anxiety. Less commonly euphoria, apathy or depression may occur. Mood constantly fluctuates, i.e., labile mood.Language disturbances : - Mutism as well as rambling and incoherent speech.Psychomotor disturbances : - Hypo or hyperactivity, agitation.Disorder of sleep: - Sleep wake rhythm is usually altered. Sleep is fragmented and disturbed by nightmares. Diurnal variation with sedation in the day time and restlessness at night (Sun downing) is common.Autonomic disturbances : - Tachycardia, sweating, tremers.Neurological signs : - Tremor, seizure, choreiform movements.Electroencephalography (EEG) : - The most typical finding is diffuse (generalized) slowing. Low voltage fast activity is seen if the delirium is due to withdrawal of sedative drugs or alcohol.o All symptoms fluctuate in severity and rapidly with apparently normal periods (lucid intervals) in between. -### End" -3439,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the floowing is a side effect of SNRI, with the following options: A: premature ejaculation, B: delayed orgasm, C: cancer, D: hypotension - -### Response: -SNRI * IMPOANCE Dual antidepressant like TCA but better than TCA has it has no dryness of mouth, hypotension, sedation * MECHANISM Inhibits the reuptake of both serotonin and dopamine * DRUGS VENLEFEXINE DESVENLEFEXINE DULOXETINE * USE Duloxetine===PAIN ASSOSIATED WITH DIABTIC NEUROPATHY and STRESS URINARY INCONTINENCE Milnacipran===Fibromyalgia * SIDE EFFECTS DIASTOLIC HYPEENSION DELAYED ORGASM WITHDRAWL SYNDROME ON DISCONTINUATION, hence should not be abruptly stopped. To try slow tapering Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, 955 -### End" -3440,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement (s) is/are true about Hb–O2 dissociation curvea) Fetal Hb shifts curve to leftb) Hypothermia shifts curve to leftc) Hypercarbia shifts curve to leftd) Left shift cause more O2 release to tissue, with the following options: A: ab, B: a, C: ad, D: bc - -### Response: -Hb-O2 dissociation curve shift to left indicates more affinity of Hb to O2, and thus less delivery of O2 to tissues. -  -Shift to left seen in --        Increased pH --        Decreased 2,3 DPG, temperature, PCO2 --        HbF (Fetal) -  -Shift to right seen in --        Decreased pH --        Increased 2,3DPG, temperature, PCO2 --        HbS (Sickle cell) -### End" -3441,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The pain around the hip with flexion, adduction & internal rotation of lower limb in a young adult after a road traffic accident is suggestive of, with the following options: A: Intracapsular fracture of the femoral neck, B: Extracapsular fracture of the femoral neck, C: Posterior dislocation of hip, D: Anterior dislocation of hip - -### Response: -REF : MAHESWARI 9TH ED -### End" -3442,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A poion of the arch of the aoa is derived from which of the following?, with the following options: A: Aoic arch 1, B: Aoic arch 1, C: Aoic arch 3, D: Aoic arch 4 - -### Response: -D. Pa of the arch of the aoa is derived from aoic arch 4. -### End" -3443,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of Aboion :, with the following options: A: Ovofetal factor, B: Maternal hypoxia, C: Uterine fibroid, D: Cervical incompetence - -### Response: -Ovofetal factor -### End" -3444,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What&;s the name of the sign, with the following options: A: Egg shell calcification, B: Homans sign, C: Angle wing sign, D: Deep sulcus sign - -### Response: -Calcification Around the Periphery Lymph Nodes ; Most commonly seen in silicosis and coal-worker's pneumoconiosis. Also seen in sarcoid. Rarely in post-irradiated Hodgkin disease, blastomycosis, scleroderma, amyloid and histoplasmosis. Ref : David Sutton 9th ed -### End" -3445,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypoglycemia, hepatomegaly, growth retardation, muscle weakness and accumulation of limit dextrins is caused by which glycogen storage disease?, with the following options: A: Cori's disease, B: Von Gierke's disease, C: Anderson disease, D: Pompe's disease - -### Response: -a. Cori's disease(Ref: Nelson's 20/e p 715-725, Ghai 8/e p 655-657)Important Glycogen Storage Diseases:TypeNameEnzyme deficientCharacteristicsType IVon Gierke's diseaseGlucose-6-phosphataseLiver and renal tubule cells loaded with glycogen. Hypo-glycemia, lactic acidemia, ketosis, hyperlipidemia.Type IIPompe's diseaseLysosomal a-1 - 4 and 1 - 6-glucosidase(acid maltaseFatal, accumulation of glycogen in lysosomes, heart failure; muscle involvement seenType IIILimit dextrinosis, or Cori's diseaseDebranching enzymeAccumulation of a characteristic branched polysaccharide (resembling 'Limit dextrin')Type IVAmylopectinosis, Andersen's diseaseBranching enzymeAccumulation of a polysaccharide having few branch points. Death due to cardiac or liver failure in 1st year of life.Type VMcArdle's diseaseMuscle phosphorylaseDiminished exercise tolerance; Little or no lactate in blood after exercise; exercise-induced myoglobinuria secondary to rhabdomyolysis seenType VIHers diseaseLiver phosphorylaseQHigh glycogen content in liver, tendency towards hypoglycemia; Ketosis seen;Type VIITarui's diseasePhosphofructokinase in muscle and erythrocytesAs for type V + hemolytic anemia. -### End" -3446,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Digitalis has positive Inotropic effect-by the viue of its effect on:, with the following options: A: Na+K+ ATPase pump, B: Na Glucose channels, C: H+K+ ATPase pump, D: Calcium pump - -### Response: -Ref:KDT 6/e p496 Digitalis is used clinically because it exes a positive inotropic effect and because it slows transmission in the AV node in patients with supraventricular tachyarrhythmias. The positive inotropic effect is due to inhibition of the sodium/potassium pump at the outer cell membrane. -### End" -3447,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cholera toxin binds to which receptors in intestine-, with the following options: A: Sphingosine through A subunit, B: Sphingosine through B subumit, C: GM1 gangliosides through A subunit, D: GM1 gangliosides through B subunit - -### Response: -Ans. is 'd' i.e., GM1 gangliosides through B subunito V. cholerae produces cholera toxin, the model for enterotoxins, whose action on the mucosal epithelium is responsible for the characteristic diarrhoea of the cholera. Cholera toxin resembles heat labile toxin of E. coli.o Cholera toxin is a protein complex made up of six subunits --> a single copy of'A' subunit (Port A) and five copies of 'ET subunit (Part B). 'A' subunit has two fragments; Ai and A2. Cholera toxin |||A subunit (active part)B subunit|||| |Al fragmentA2 fragmentBinds to GM1 Ganglioside|| A DP ribosylation of G-proteinLinks the A, fragment to B subunit|Stimulation of adenyl cyclase and increased production of cAMPo cAMP inhibits the absorptive sodium transport system (decreases sodium & chloride reabsorption) and activates the secretory chloride transport system (increases chloride and bicarbonate secretion)o This leads to accumulation of sodium choride in the intestinal lumen.o Accumulated sodium chloride draws water into the lumen due to increased osmolality leading to watery diarrhoea.o Cholera toxin production is determined by a filamentous phage integrated with bacterial chromosome.o Endotoxin has no role in pathogenesis. -### End" -3448,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Keratomalacia is -, with the following options: A: Occurs due to Vit-A deficiency, B: Relatively benign condition, C: First feature of Vit- A deficiency, D: Also seen in retinitis pigmentosa - -### Response: -Keratomalacia is due to deficiency of vitamin A. -It is not relatively benign. Larger stromal defects in keratomalacia commonly result in blindness. -Earliest symptom is nightblindness and earliest sign is conjunctival xerosis. -Retinitis pigmentosa does not cause keratomalacia. -### End" -3449,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is fastest acting receptor?, with the following options: A: Beta1, B: M2, C: GABAa, D: Estrogen receptor - -### Response: -Ans. C. GABAaa. Ligand gated ion channels are the fastest acting receptors,b. Out of the options, the only ion channel receptor is GABAa. -### End" -3450,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old female is brought to the emergency room with crush injury of thigh following a motor vehicle accident. Best method to prevent gas gangrene is, with the following options: A: Thorough wound debridement, B: Hyperbaric oxygen therapy for wound, C: Anti-gas gangrene serum, D: Tetanus immunoglobulin - -### Response: -Answer: a) Thorough wound debridement (HARRISON 19TH ED, P-2077)GAS GANGRENEClostridial myonecrosis/Malignant edema/Anaerobic myositisUsually several species of Clostridia are involved along with E coli, proteus and staphylococciCl perfringens causes 60% of the cases; Most commonly by type ARemaining cases are caused by Cl septicum, Cl novyi and Cl histolyticumThe incubation period can be as short as 6 hours and is usually <4 daysMost important factor needed - low oxygen tensionPain and crepitusPatients frequently develop marked tachycardia, but in temperature may be only minimalNear absence of PMNs despite extensive tissue destruction is characteristicDiagnosisFrozen section biopsy of muscleReverse CAMP test - to identify Cl. perfringensGram staining:G+ bacilli without spores - Cl.perfringensCitron bodies and boat or leaf shaped bacilli - Cl.septicumLarge bacilli with oval or subterminal spores - Cl.novyiTreatmentSurgery debridement of the wound - mainstay of prophylaxis & treatmentClindamycin or metronidazole + penicillinHyperbaric O2Anti-gas gangrene serum - uncertain efficacy, not widely available, rarely used now -### End" -3451,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are clinical finding of Kwashiorkor except, with the following options: A: Seen soon after birth below 1 year, B: Appetite is poor, C: Presence of edema, D: Crazy pavement dermatosis seen - -### Response: -Kwashiorkor is in the age of 1 - 4 years. It is protein deficiency malnutrition seen in children who are weaned from mother's breast milk. -### End" -3452,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IDDM patient presents with septal perforation of nose with brownish black discharge, probable diagnosis is:, with the following options: A: Rhinosporidiosis, B: Aspergillus, C: Leprosy, D: Mucormycosis - -### Response: -Mucormycosis is fungal infection of nose and paranasal sinuses which may prove rapidly fatal if untreated. It is seen in uncontrolled diabetes or in those taking immunosuppressive drugs. It presents as black necrotic mass filling the nasal cavity and eroding the septum and hard palate. Treatment is by amphotericin B and surgical debridement. Most common fungal infection of nose is Aspergillosis. -### End" -3453,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 year old boy presents with progressive weakness in muscles, and difficulty in walking upstairs. He has difficulty in walking on his toes and has a waddling gait. Hyperophy of calf muscles in noted. His CPK levels are 10,000 IU. Which of the following is the most appropriate diagnosis -, with the following options: A: Duchenne muscular dystrophy, B: Polymyositis, C: Congenital myopathy, D: Myotonia congenita - -### Response: -Ans. is 'a' i.e., Duchenne muscular dystrophy Clinical features of DMD The age of onset is 2-5 years. Early development of the child is normal, the disease begins to manifest when the child stats walking. The child walks clumsily, has difficulty in climbing stairs and the gait is waddling. Hyperophy of calf muscle is a characteristic sign and is visible by the age of 4-5 years. This is called pseudohyperophy because it is not true hyperophy of muscles, instead the muscle is replaced by fat and connective tissues. Pelvic girdle involvement is very common and can be elicited by Gower's sign. There is characteristic involvement of the muscle Calf muscles Glutei Deltoid (All these muscles are hyperophied) Brachioradialis Tongue muscle Sternal head of pectoralis major ) spinatus Supra (These muscles are atrophied) Eventually all muscles are atrophied Intelligence is usually subnormal Patient die in the second decade of life because of respiratory failure or due to associated cardiomyopathy. Diagnosis of Duchenne's muscular dystrophy is made by ? Elevation of the enzymes of the muscle -4 creatinine phosphokinase. Histopathology demonstrates diffuse changes of degeneration and muscle fibres of varying size. -### End" -3454,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to CDC recommendations, HIV screening of pregnant women is -, with the following options: A: Opt in testing, B: Opt out testing, C: Compulsory, D: Symptomatic - -### Response: -Ans. is 'b' i.e., Opt out testing -### End" -3455,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for antrochoanal polyp in a 10yr. old child-, with the following options: A: Caldwell luc's, B: Intranasal polypectomy, C: Conservative treatment till 16 years, D: Exploratory rhinotomy - -### Response: -FESS is the surgical procedure of choice. -Intranasal polypectomy is the procedure of choice in those setups where endoscopic surgery is not practiced. -### End" -3456,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug not used for analgesia in a patient of head injury is:, with the following options: A: Morphine, B: NSAIDs, C: Rofecoxib, D: Acetaminophen - -### Response: -Ref: KDT 6/e p457 Morphine is contra-indicated in a patient with headband injury. Relative contraindications to morphine include: respiratory depression when appropriate equipment is not available Although it has previously been thought that morphine was contraindicated in acute pancreatitis, a review of the literature shows no evidence for this -### End" -3457,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shy Dragor Syndrome is, with the following options: A: Vasovagal syncope, B: Orthostatic hypotension, C: Intestinal polyp, D: Acute adrenergic shock - -### Response: -Shy Drager syndrome (SDS) is a rare condition that causes progressive damage to the autonomic nervous system. -A neurological syndrome associated with orthostatic hypotension. -The autonomic nervous system controls vital involuntary body function such as heart rate, breathing, and intestinal, urinary, and sexual functions. The autonomic nervous system also controls skin body temperature, and how the body responds to stress. Shy-Drager syndrome leads to dizziness or fainting when standing up, urinary incontinence, impotence, and muscle twitches. -### End" -3458,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased Ig A levels are seen in, with the following options: A: Alcoholic hepatitis, B: Alcoholic cirrhosis, C: Microvescicular fatty change, D: Macrovesicular fatty change - -### Response: -Serum IgA increased in - Alcoholic cirrhosis Serum IgM increased in -Primary biliary cirrhosis (Ref: Clin Exp Immunol.2009 Oct; 158(1): 115-124, Liver.1984 Jun;4(3): 214-8) -### End" -3459,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Repeat upper GI endoscopy in a patient with a gastric ulcer is performed after how many weeks of PPI therapy to assess the healing of the ulcer and confirm absence of malignancy:, with the following options: A: 2 weeks, B: 4 weeks, C: 6 weeks, D: 12 weeks - -### Response: -Repeat upper endoscopy is done in patients with a gastric ulcer after 6 to 10 weeks of acid suppressive therapy to confirm healing of the ulcer and absence of malignancy. 2% to 4% of repeat upper endoscopies have been repoed to disclose gastric cancer. Ref: Sleisenger and Fordtran's, E-9, P-305 -### End" -3460,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30-year-old gravida 5, para 4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to be continued. On examination, the string of the IUD is noted to be protruding from the cervical os. The most appropriate course of action is to, with the following options: A: Leave the IUD in place without any other treatment, B: Leave the IUD in place and continue prophylactic antibiotics throughout pregnancy, C: Remove the IUD immediately, D: Terminate the pregnancy because of the high risk of infection - -### Response: -Although there is an increased risk of spontaneous abortion, and a small risk of infection, an intrauterine pregnancy can occur and continue successfully to term with an IUD in place. However, if the patient wishes to keep the pregnancy and if the string is visible, the IUD should be removed in an attempt to reduce the risk of infection, abortion, or both. Although the incidence of ectopic pregnancies with an IUD was at one time thought to be increased, it is now recognized that in fact the overall incidence is unchanged. The apparent increase is the result of the dramatic decrease in intrauterine implantation without affecting ectopic implantation. Thus, while the overall probability of pregnancy is dramatically decreased, when a pregnancy does occur with an IUD in place, there is a higher probability that it will be an ectopic one. With this in mind, in the absence of signs and symptoms suggestive of an ectopic pregnancy, especially after ultrasound documentation of an intrauterine pregnancy, laparoscopy is not indicated. The incidence of heterotopic pregnancy, in which intrauterine and extrauterine implantation occur, is no higher than approximately 1 in 2500 pregnancies. -### End" -3461,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most important sensory organ in the ampulla is:, with the following options: A: Organ of corti, B: Macula, C: Otolith, D: Crista - -### Response: -Ans:D (Crista) Ref: Pal GK. Vestibular apparatus. In: Textbook of medical physiology. Abuja publishing house. 2007: 116: 886-88.Explanation:Receptor structureReceptor organDetected stimuliOtolith organs SacculeMacuiaGravitation & linear accelerationUtricleMaculaGravitation & linear accelerationSemicircular canals Horizontal canalAmpullaRotational accelerationAnterior canalAmpullaRotational accelerationPosterior canalAmpullaRotational accelerationNote:Macula - Sensory epithelium in saccule and utricle which contain hair cellsOtolith (or) otoconia - calcium carbonate crystals in otolith membraneEach ampulla contains Crista ampularis in which hair cells are located. These hair cells are embedded in a gelatinous mass cupula' (which does not contain otoliths)Organ of corti - loeaed in middle ear; involved in audition -### End" -3462,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common renal tumor in infant:-, with the following options: A: Renal cyst, B: Congenital mesoblastic nephroma, C: Neuroblastoma, D: Nephroblastoma - -### Response: -Most common renal tumor in children Congenital mesoblastic nephroma. PEDIATRIC TUMORS * MC malignant tumor of infancy * MC extra-cranial solid tumor in children * MC abdominal malignancy in children * NeuroblastomaQ * MC primary malignant renal tumor of childhood * Wilms' tumorQ * MC renal tumor of infancy * Congenital mesoblastic nephromaQ * MC soft tissue tumor in infants & children * RhabdomyosarcomaQ * MC solid tumor of childhood * Brain tumorQ * MC cancer of childhood * LeukemiaQ(30%) >Brain tumorsQ(22%) -### End" -3463,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In first step of haem synthesis, which amino acid is required ?, with the following options: A: Histidine, B: Folate, C: Glycine, D: Fe - -### Response: -Synthesis of heme: In first step of Haem synthesis, Glycine amino acid is required Glycine condenses with succinyl CoA to form 6-amino levulinate which serves as a precursor for heme synthesis.. Copper is necessary for the synthesis of haemoglobin (Cu is a constituent of ALA synthase, needed for heme synthesis.) Pyridoxal phosphate is required for the synthesis of d-amino levulinic acid (the precursor for heme) Conversion of Succinyl CoA to a-Amino-b-ketoadipate requires pyridoxal phosphate. This is the first step of synthesis of heme that takes place in the mitochondria. a-Amino-b-ketoadipate is rapidly decarboxylated to d-aminolevulinate. Succinyl-CoA+glycine- a-amino-b-ketoadipate+CoA-SH-d-aminolevulinate+CO2 -### End" -3464,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3 year old Child who has diurnal enuresis and soiling of clothes. Treatment required, with the following options: A: Urethroplasty, B: Behaviour modification, C: Put catheter for 7 days, D: Circumcision at 10 years - -### Response: -• In children with overactive bladder, urge incontinence, and dysfunctional voiding, -voiding at predetermined times aids in retraining the child to exercise voluntary bladder control. -• Behavioral modification has remained the mainstay of treatment for daytime wetting. -These measures focus on relearning and training the normal responses from the bladder and urethra. -• Bladder irritants such as caffeine should be eliminated from the diet. -• The child voids on waking, and subsequently at least every 2 h, during waking hours. As urgency improves, the interval between voids can be extended. -In children with infrequent voiding, in whom an elevated PVR volume is encountered, double voiding will both increase functional bladder capacity and decrease the risk of infection. -### End" -3465,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The population covered by each of the following is 1000, EXCEPT:, with the following options: A: ASHA worker, B: Anganwadi worker, C: Sub centre, D: Village health guide - -### Response: -The sub centre is the peripheral outpost of rural health care system. A sub centre is established for every 5000 population in general. In cases of hilly, tribal or backward areas, a sub centre is established for every 3000 population. Ref: Park 21st edition page: 839. -### End" -3466,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deregulation and depersonalization are seen in which type of disorder, with the following options: A: Dissociative disorder, B: Personality disorders, C: Mania, D: None - -### Response: -Multiple Personality (Dissociative Identity) Disorder In this dissociative disorder, the person is dominated by two or more personalities, of which only one is being manifest at a time. These personalities are usually different, at times even opposing. Each personality has a full range of higher mental functions and performs complex behaviour patterns. Usually, one personality is not aware of the existence of the other(s), i.e. there are amnesic barriers between the personalities. Both the onset and termination of control of the each personality is sudden. Classical examples in the published literature include 'Three Faces of Eve' and 'Sybil'. Trance and Possession Disorders Trance and possession disorders ( possession hysteria) are characterised by the control of person's personality by a 'spirit', during the episodes. Usually, the person is aware of the existence of the other (i.e. 'possessor'), unlike in multiple personalities. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 102 -### End" -3467,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 28 year patient from Bihar presents with on and off pain in right scrotum and then gradual onset swelling develops over the duration of 2 years. Trans illumination test is positive. Top of testis can be reached. The probable diagnosis is:, with the following options: A: Right hydrocele, B: Right inguinal hernia, C: Right epididymal cyst, D: Right encysted hydrocele of cord - -### Response: -Ans. (a) Right hydroceleRef: Bailey 26th Edition, page 1382HYDROCELE OF TESTISHydrocele are trans illuminant and it is possible to get above the swelling on examination of the scrotum. -### End" -3468,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Liver transplantation was first done by -, with the following options: A: Starzl, B: Huggins, C: Carrel, D: Christian Benard - -### Response: -The first human liver transplant was performed in 1963 by Dr. Thomas Starzl. -### End" -3469,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Danbury tremors seen in which chronic poisoning, with the following options: A: Arsenic, B: Lead, C: Mercury, D: Zinc - -### Response: -Mercurial tremors The hands are first affected. There will be tremors of the hands called Danbury tremors. It may progress to lips, tongue, arms, and legs. The tremors are moderately coarse and intentional to sta with and are interspersed by jerky movements. The advanced condition is called hatter's shake or glass blower's shake. ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 428 -### End" -3470,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Optimum oxygenation is maintained by adjusting following parameters -a — Tidal volume,b — PEEP,c — FiO2,d — respiratory rate, with the following options: A: a, b, B: b, c, C: c, d, D: d, a - -### Response: -PEEP and FiO2 determine optimum oxygenation. -### End" -3471,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most strongly implicated premalignant condition of the oral cavity is -, with the following options: A: Fordyce spots, B: Erythroplakia, C: Median rhomboid glositis, D: Erythema multiforme - -### Response: -Erythroplakia is analogous to the term leukoplakia which describes white patches. Together, these are the 2 traditionally accepted types of premalignant lesion in the mouth,When a lesion contains both red and white areas, the term ""speckled leukoplakia"" or ""eyhroleukoplakia"" is used. Although oral erythroplakia is much less common than leukoplakia, erythroplakia carries a significantly higher risk of containing dysplasia or carcinoma in situ, and of eventually transforming into invasive squamous cell carcinoma (a type of oral cancer). The most common areas in the mouth where erythroplakia is found are the floor of the mouth, buccal vestibule, the tongue, and the soft palate. It appears as a red macule or plaque with well-demarcated borders. The texture is characterized as soft and velvety. An adjacent area of leukoplakia may be found along with the erythroplakia Erythroplasia may also occur on the laryngeal mucosa,or the anal mucosa Ref Davidson 23rd pg 1209 -### End" -3472,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Scrub typhus is spread by: September 2007, with the following options: A: Ticks, B: Fleas, C: Trombiculid mite, D: Louse - -### Response: -Ans. C: Trombiculid mite Scrub typhus is a form of typhus caused by Orientia tsutsugamushi. Scrub typhus is transmitted by some species of trombiculid mites (""chiggers"", paicularly Leptotrombidium deliense), which are found in areas of heavy scrub vegetation. The bite of this mite leaves a characteristic black eschar that is useful to the doctor for making the diagnosis -### End" -3473,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is a pro-drug?, with the following options: A: Cyclophosphamide, B: Lisinopril, C: Metochlopramide, D: Ranitidine - -### Response: -Ans. is 'a' i.e., Cyclophosphamide -### End" -3474,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proper lip support for complete denture is provided primarily by:, with the following options: A: Convex surface of labial flange, B: Facial surface of teeth and simulated gingiva, C: Thickness of border in the vestibule, D: Festooned carvings on facial surface - -### Response: -Proclination of maxillary anterior teeth and the surrounding denture base simulating the gingiva provided for the bulk for lip support in complete denture. -### End" -3475,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a case of hypertrophic pyloric stenosis, the metabolic disturbance is, with the following options: A: Respiratory alkalosis, B: Metabolic acidosis, C: Metabolic alkalosis with paradoxical aciduria, D: Metabolic alkalosis with alkaline urine - -### Response: -Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria) - -Cause of paradoxical aciduria - -Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions. thus the urine becomes acidic and metabolic alkaline state is further aggravated. -### End" -3476,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transcripton is inhibited by:, with the following options: A: Actinomycin D, B: Amanitin, C: Chloramphenicol, D: Streptomycin - -### Response: -A i.e. Actinomycin -### End" -3477,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amyloid deposition is seen in: March 2013, with the following options: A: Papillary carcinoma thyroid, B: Follicular carcinoma thyroid, C: Medullary carcinoma thyroid, D: Anaplastic carcinoma thyroid - -### Response: -Ans. C i.e. Medullary carcinoma thyroid -### End" -3478,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 25 year old female presenting with lump in breast to OPD-First investigation is, with the following options: A: USG, B: Mammogram, C: MRI, D: PET - -### Response: -Ans. (a) USG(Ref Bailey and Love 27h edition Page 861)* USG is IOC in young females with Dense breast to evaluate a lump in Breast* It is not useful as a screening tool as it is operator dependent. -### End" -3479,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of death in ADPKD, with the following options: A: Renal failure, B: Ruptured berry aneurysm, C: Cardiovascular disease, D: Sepsis - -### Response: -Hypertensive or coronary artery disease is the most common cause of death in ADPKD. -### End" -3480,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enrichment media for cholera ?, with the following options: A: VR medium, B: TCBS medium, C: Cary-Blair medium, D: Alkaline peptone water - -### Response: -Ans. is 'd' i.e., Alkaline peptone water -### End" -3481,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which drug can be administered through all routes?, with the following options: A: Fentanyl, B: Paracetamol, C: Penicillin G, D: Azithromycin - -### Response: -Ref: Katzung 11th ed. p. 542Explanation:Most opioid analgesics are well absorbed when given by subcutaneous, intramuscular, and oral routes.Rectal suppositories of morphine and hydromorphone have been used when oral and parenteral routes are undesirable.The transderma I patch provides stable blood levels of drug and better pain control while avoiding the need for repeated parenteral injections.Fentanyl has been the most successful opioid in transdermal application and is indicated for the management of persistent unremitting pain.The intranasal route avoids repeated parenteral drug injections and the first-pass metabolism of orally administered drugs.Butorphanol is the only opioid currently available in the USA in a nasal formulation. Butorphanol has shown greater analgesia in women.Another alternative to parenteral administration is the buccal transmucosal route, which uses a fentanyl citrate lozenge or a ""lollipop'' mounted on a stick. -### End" -3482,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kupffer cells are found in, with the following options: A: Hea, B: Lungs, C: Liver, D: Spleen - -### Response: -Ref Robbins 8/e p834; 7/e p79;9/e p102 Kupffer cells, also known as stellate macrophages and Kupffer-Browicz cells, are specialized macrophages located in the liver, lining the walls of the sinusoids. They form pa of the mononuclear phagocyte system. -### End" -3483,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Age at which one becomes major: PGI 09; MAHE 12, with the following options: A: 18 years, B: 21 years, C: 25 years, D: 35 years - -### Response: -Ans. 18 years -### End" -3484,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug not used in liver cirrhosis, with the following options: A: NSAIDS, B: Rifampin, C: Phenothiazines, D: All of the above - -### Response: -(D) All of the above > Drugs that may cause ACUTE DOSE-DEPENDENT LIVER DAMAGE:(resembling acute viral hepatitis): acetaminophen; salicylates (doses over 2 grams daily)> Drugs that may cause ACUTE DOSE-INDEPENDENT LIVER DAMAGE (resembling acute viral hepatitis): acebutolol; indomethacin; phenylbutazone; allopurinol; isoniazid; phenytoin; atenolol; ketoconazole; piroxicam; carbamazepine; labetalol; probenecid; cimetidine; maprotiline; pyrazinamide; dantrolene; metoprolol; uinidine; diclofenac; mianserin; quinine; diltiazem; naproxen; ranitidine; enflurane; para-aminosalicylic acid; sulfonamides; ethambutol; penicillins; sulindac; ethionamide; henelzine; tricyclic antidepressants; halothane; phenindione; valproic acid; ibuprofen; phenobarbital; verapamil> Drugs that may cause Acute fatty infiltration of the liver: adrenocortical steroids; phenothiazines; sulfonamides; antithyroid drugs; phenytoin; tetracyclines; isoniazid; salicylates; valproic acid; methotrexate> Drugs that may cause CHOLESTATIC JAUNDICE: Actinomycin D; chlorpropamide; erythromycin; amoxicillin/clavulanate; cloxacillin flecainide; azathioprine cyclophosphamide; flurazepam; captopril; cyclosporine; flutamide; carbamazepine; Danazol; glyburide; carbimazole; diazepam; gold; cephalosporins; disopyramide; griseofulvin; chlordiazepoxide; enalapril; haloperidol; ketoconazole; norethandrolone; sulfonamides; mercaptopurine; oral contraceptives; tamoxifen; methyltestosterone; oxacillin; thiabendazole; nifedipine; penicillamine; tolbutamide; nitrofurantoin; phenothiazines; tricyclic antidepressants; nonsteroidal; phenytoin troleandomycin; anti-inflammatory drugs; propoxyphene; verapamil> Drugs that may cause Liver Granulomas (chronic inflammatory nodules) allopurinol; gold; phenytoin; aspirin; hydralazine; procainamide; carbamazepine; isoniazid; quinidine; chlorpromazine; isoniazid; quinidine; chlorpromazine; nitrofurantoin; sulfonamides; diltiazem; penicillin; tolbutamide disopyramide; phenylbutazone> Drugs that may cause Chronic liver disease Drugs that may cause active chronic hepatitis acetaminophen (chronic use, large doses); dantrolene; methyldopa; isoniazid; nitrofurantoin> Drugs that may cause liver cirrhosis or fibrosis (scarring) methotrexate; terbinafine HCI (Lamisil, Sporanox); nicotinic acid> Drugs that may cause chronic cholestasis (resembling primary biliary cirrhosis) chlorpromazine/valproic acid (combination); imipramine; thiabendazole; phenothiazines; tolbutamide; chlorpropamide/erythromycin (combination); phenytoin> Drugs that may cause LIVER TUMORS (benign and malignant) anabolic steroids; oral contraceptives; thorotrast; danazol; testosterone> Drugs that may cause DAMAGE TO LIVER BLOOD VESSELS adriamycin; dacarbazine; thioquanine; anabolic steroids; mercaptopurine; vincristine; azathioprine; methotrexate; vitamin A (excessive doses); carmustine; mitomycin; cyclophosphamide/cyclo-sporine (combination); oral contraceptives; -### End" -3485,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following route of approach is used in the treatment of thoracic extension of cervical goiter?, with the following options: A: Neck, B: Chest, C: Combined cervico-thoracic route, D: Thoracoscopic - -### Response: -In retrosternal goiter, resection of the goiter is carried out from the neck, a median sternotomy is sometimes needed. Cervical pa of the goiter is be mobilized first and retrosternal goiter is delivered by traction. Recurrent laryngeal nerve should be identified before delivering retrosternal goiter. Ref: Bailey and Love's Sho Practice of Surgery, 24th Edition, Page 788-9. -### End" -3486,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most potent estrogen is:, with the following options: A: Estrone (El), B: Estradiol (E2), C: Estriol (E3), D: All are equal in potency - -### Response: -Ans. is 'b' i.e., Estradiol (E2)* The three major naturally occurring estrogens in women are estrone (El), estradiol (E2), and estriol (E3). Estradiol is the predominant estrogen during reproductive years both in terms of absolute serum levels as well as in terms of estrogenic activity.* During menopause, estrone is the predominant circulating estrogen and during pregnancy estriol is the predominant circulating estrogen in terms of serum levels. Though estriol is the most plentiful of the three estrogens it is also the weakest, whereas estradiol is the strongest with a potency of approximately 80 times that of estriol.* Thus, estradiol is the most important estrogen in non-pregnant females who are between the menarche and menopause stages of life.* However, during pregnancy this role shifts to estriol, and in postmenopausal women estrone becomes the primary form of estrogen in the body -### End" -3487,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true regarding the mimicry of Strpyogenes ?, with the following options: A: Peptidoglycan and skin antigen, B: Cell wall protein and myocardium, C: Hyaluronic acid and synol fluid, D: Group A carbohydrate and vascular intima - -### Response: -Ans. is 'd' i.e., Group A carbohydrate and vascular intima Antigen cross-reactivity Various streptococcal components (specially strep. pyogenes) exhibit antigenic cross reaction with different tissues of the human body. -### End" -3488,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood in urine in a patient in labour is diagnostic of:, with the following options: A: impending scar rupture, B: Urethral injury, C: Obstructed labour, D: Cystitis - -### Response: -Blood in urine in a patient in labour is indicative of scar rupture.Previous history of classical cesarean section makes woman vulnerable to unpredictable rupture of uterus. (DC DUTTA TB of obstetrics 8th edtn pg 383) -### End" -3489,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the listed statements best characterizes the renal abnormality described as Kimmelstiel-Wilson disease?, with the following options: A: Amyloid nephrosis, B: Nodular glomerulosclerosis, C: Glycogen nephrosis, D: Hyaline aeriolosclerosis - -### Response: -Diabetes may produce abnormalities that affect any pa of the kidney, such as the glomerulus, the blood vessels (benign nephrosclerosis), the tubules (Armanni-Ebstein lesions, which refers to vacuolization of the cells of the proximal convoluted tubules), the interstitium, and the pelvis (infection leads to pyelonephritis and acute papillary necrosis). Diabetic lesions of the glomerulus include capillary basement thickening, diffuse glomerulosclerosis (increase in mesangium and mesangial cells), and nodular glomerulosclerosis. The latter refers to oval hyaline masses at the periphery of the glomerulus and is also called Kimmelstiel-Wilson disease. Nodular glomeruloscleroses may resemble amyloid, and, if they are present, amyloid staining should be done. Other characteristic lesions found in the glomerulus include ""capsular drops"" (round nodules found between Bowman's capsule and the parietal epithelium) and ""fibrin caps"" (subendothelial accumulations along capillary loops). -### End" -3490,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following patients needs to be staed on multidrug therapy for TB?, with the following options: A: A 43 year old with a history of tuberculosis treated with three drugs for 6 months, who has calcified granulomas on his chest X-ray., B: A 17 year old with a lymph node biopsy growing Mycobacterium tuberculosis, C: A 51 year old nurse who was inadveently exposed to a patient with active pulmonary tuberculosis in an emergency room for 30 minutes, D: A 34 year old man with cough and expectoration for 4 weeks, not responding to oral amoxycilin and symptomatic management. - -### Response: -A 17 year old with a lymph node biopsy growing Mycobacterium tuberculosis * Active tuberculosis at any site (the presence of culturable organisms or evidence of progressive disease) mandates multidrug therapy. * For patients with latent tuberculosis infection, treatment with a single drug will suffice to kill the small number of organisms. * The calcified granulomas in patient (a) are a sign of old disease; he does not need new treatment unless he becomes symptomatic. * The patients (c) and (d) have had low-risk exposures and would not be treated unless there was evidence of a change in skin tests. -### End" -3491,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ouabain acts by inhibiting:, with the following options: A: Adenyl cyclase, B: Ca++ channels, C: H+K+ ATPase, D: Na+K+ ATPase - -### Response: -Ref:KDT 6/e p496 -### End" -3492,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Savita is 32 weeks pregnant presents in causality and diagnosed as a case of APH. Vitals are unstable with BP 80/60 which of the following is next step in M/n:, with the following options: A: Careful observation, B: Blood transfusion, C: Medical induction of labor, D: Immediate cesarean section - -### Response: -Ans. is b, i.e. Blood transfusionRef. Dutta Obs. 6/e, p 259; Fernando Arias 3/e, p 342, fig. 13.2Unstable vitals (BP =80/60) belong most probably to moderate category bleeding.In Mild cases - Vitals remain stable.Severe cases - Patient is in shock with very low or unrecordable B.P.The gestational age of patient is 32 weeks: As discussed, beyond 36 weeks with moderate bleeding - terminate the pregnancy.Between 32-36 weeks moderate bleeding - Management depends on whether pulmonary maturity is achieved or not.If maturity is not achieved, patient is managed conservatively on:-Close monitoring-Blood transfusions-Betamethasone (to accelerate lung maturity)This is done for 24-48 hours.If patients condition improves: expectant management is continued.If patients condition does not improve: pregnancy is terminated.As the patient in the question is 32 weeks pregnant with moderate bleeding, first we will try to improve the general condition of the patient by giving blood transfusion. -### End" -3493,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are actions of factor II, except:, with the following options: A: Conversion of fibrinogen into fibrin, B: Platelet activation, C: Formation of plasmin, D: Activation of Factor XI - -### Response: -Plasmin is generated by enzymatic catabolism of the inactive circulating precursor plasminogen, either by a factor XII-dependent pathway (possibly explaining the association of factor XII deficiency and thrombosis) or by plasminogen activators. Factor II/Thrombin's impoant activities are the following: Conversion of fibrinogen into cross-linked fibrin - Thrombin directly conves soluble fibrinogen into fibrin monomers that polymerize into an insoluble fibril Amplifies the coagulation process, not only by activating factor XI, but also by activating two critical cofactors: factors V and VIII. Stabilizes the secondary hemostatic plug by activating factor XIII, which covalently cross-links fibrin. Platelet activation - Thrombin is a potent inducer of platelet activation and aggregation through its ability to activate PAR-1. -### End" -3494,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cherry red spot is seen in:, with the following options: A: Retinitis pigmentosa, B: Retinopathy of prematurity, C: Metachromatic leukodystrophy, D: CRV occlusion - -### Response: -C i.e. Metachromatic leukodystrophy -### End" -3495,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dialysis patients are prone to develop -, with the following options: A: Lead toxicity, B: Iron toxicity, C: Aluminium toxicity, D: Zinc toxicity - -### Response: -Answer- C. Aluminium toxicityAluminium intoxication is common in dialysis patients.It can cause anemia, osteomalacia and encephalopathy (dementia). -### End" -3496,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about sipple syndrome is?, with the following options: A: MCT, Pheochromocytoma, Mucocutaneous neuromas, B: MCT, Pheochromocytoma, Parathyroid adenomas, C: MCT, Pheochromocytoma, Pancreatic tumours, D: MCT, Pheochromocytoma, Diabetes - -### Response: -MEN 2 (also known as MEN 2a or Sipple's syndrome) Ref - davidsons 23e p689 -### End" -3497,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are included in Gradenigo's triad EXCEPT:, with the following options: A: Abducent nerve palsy, B: Retro-orbital pain, C: Aural discharge, D: Palatal palsy - -### Response: -Gradenigo's syndrome/ Gradenigo-Lannois syndrome/ Petrous apicitis It is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone. It was first described by Giuseppe Gradenigo in 1904 when he repoed a triad of symptoms consisting of periorbital unilateral pain related to trigeminal nerve involvement, diplopia due to sixth nerve palsy and persistent otorrhea, associated with bacterial otitis media with apex involvement of the petrous pa of the temporal bone (petrositis). -### End" -3498,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Occlusion of which aery would result in insufficient perfusion of the urinary bladder:, with the following options: A: Internal iliac, B: External iliac, C: Renal, D: Suprarenal - -### Response: -Internal iliac -### End" -3499,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are the side effect of using argon laser-, with the following options: A: Hypopigmentation, B: Crusting, C: Keloid formation, D: All the above - -### Response: -Argon Laser *Wavelength 488-514 nm *Penetration depth of 1mm, which can be increased by cooling. *Side effects: crusting and possible blistering of skin, irreversible hypopigmentation, transient hyperpigmentation, punctate atrophic or hyperophic scars, keloid formation. Ref: Lasers in otolaryngology by Karl bernd p.144 -### End" -3500,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following is an absolute contraindication for treatment of Thyrotoxicosis in pregnancy of 6 months duration:, with the following options: A: Antithyroid drug, B: I131 therapy, C: Telepaque, D: Surgery - -### Response: -Ans. is b, i.e. I131 therapyRef. Dutta Obs. 6/e, p 290; Williams Obs 23/e, p 1130Radioactive iodine is an absolute contraindication in the treatment of thyrotoxicosis in pregnancy. In fact, it should not be given to patients even wanting pregnancy within 6 months. -### End" -3501,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 70 year old man comes to clinical attention with progressive memory loss, urinary incontinence, and gait instability. MRI of the brain shows dilatation of the ventricular cavities, while the cerebral coex appears normal. No infarcts are seen. Repeated lumbar punctures reveal occasional increases in cerebrospinal fluid (CSF) pressure. A biopsy of the frontal coex demonstrates the absence of neurofibrillary tangles and senile plaques. Which of the following is the most appropriate treatment?, with the following options: A: Acetylcholinesterase inhibitors such as tacrine, B: Aspirin, C: L-DOPA, D: Ventricular shunt - -### Response: -This is an ""interdisciplinary"" question, which begins with a clinical scenario and ends by testing your knowledge of pathophysiology and pharmacology. The clinical presentation has the classic triad of memory loss, urinary incontinence, and gait abnormalities characteristic of normal pressure hydrocephalus (recently renamed intermittently raised pressure hydrocephalus). This condition results from intermittent increases in CSF pressure, leading to progressive damage to cerebral white matter and dilatation of the ventricles. No significant coical atrophy is present. The lack of Alzheimer-related changes in the biopsy and the measurements of CSF pressure suppo the diagnosis. Relief of CSF pressure can be obtained by placing a ventricular shunt, which usually improves clinical symptomatology. Tacrine and other inhibitors of acetylcholinesterase are used in the symptomatic therapy of Alzheimer disease. The pathology of this disease includes degeneration of cerebral cholinergic systems, such as the basal nucleus of Meyne, which project to the neocoex and are involved in memory and learning. Acetylcholinesterase degrades acetylcholine after release from presynaptic boutons. Acetylcholinesterase inhibitors therefore enhance the concentration of acetylcholine and amplify cholinergic neurotransmission. Aspirin is used to prevent aggregation and adhesion of platelets in patients with risk factors for cerebrovascular disease. Prophylactic aspirin treatment lowers the incidence of transient ischemic attacks and brain infarcts. L-DOPA is a precursor of dopamine, the neurotransmitter of the nigrostriatal neurons that degenerate in Parkinson disease. L-DOPA, especially in combination with a peripheral decarboxylase inhibitor, is therefore used in the treatment of this disorder. Ref: Ropper A.E., Ropper A.H. (2012). Chapter 209. Intracranial Hemorrhage and Related Conditions. In G.V. Lawry, J. Matloff, D.D. Dressler, D.J. Brotman, J.S. Ginsberg (Eds), Principles and Practice of Hospital Medicine. -### End" -3502,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zinc transpoer 8 antibody is seen in?, with the following options: A: Hashimoto's thyroiditis, B: Hypoparathyroidism, C: Type 1 diabetes mellitus, D: Type A insulin resistance - -### Response: -Autoimmune markers for newly diagnosed type 1 diabetes mellitus ICA antibody Glutamic Acid Decarboxylase (GAD65) Insulin islet cell antibody Tyrosine phosphatase Zinc transpoer 8 antibody -### End" -3503,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug, NOT metabolised by liver is :, with the following options: A: Penicillin G, B: Phenytoin, C: Erythromycin, D: Cimetidine - -### Response: -Ans. is 'a' Penicillin G Penicillin G is metalized mainly in kidneyApproximately 10% of the drug is eliminated by glomerular filtration and 90% by tubular secretionRest of the drugs given in the question erythromycin, cimetidine and phenytoin are metabolized in the liver. -### End" -3504,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Remitting and relapsing features are associated with, with the following options: A: Multiple Sclerosis, B: Guillain-Barre syndrome, C: Parkinson's disease, D: Subdural haematoma - -### Response: -(A) Multiple Sclerosis # Classification of Multiple Sclerosis> Progression of MS subtypes> Several subtypes, or patterns of progression, have been described. Subtypes use the past course of the disease in an attempt to predict the future course. They are important not only for prognosis but also for therapeutic decisions. In 1996 the United States National Multiple Sclerosis Society standardized four subtype definitions Relapsing remitting Secondary progressive Primary progressive Progressive relapsing> Relapsing-remitting subtype is characterized by unpredictable relapses followed by periods of months to years of relative quiet (remission) with no new signs of disease activity. Deficits suffered during attacks may either resolve or leave sequelae, the latter being more common as a function of time.> This describes the initial course of 85-90% of individuals with MS.> When deficits always resolve between attacks, this is sometimes referred to as benign MS.> The relapsing-remitting subtype usually begins with a clinically isolated syndrome (CIS). In CIS, a patient has an attack suggestive of demyelination, but does not fulfill the criteria for multiple sclerosis.> However only 30 to 70% of persons experiencing CIS later develop MS.> Guillain-Barre syndrome is an acute inflammatory demyelinating polyneuropathy (AIDP), an autoimmune disorder affecting the peripheral nervous system, usually triggered by an acute infectious process. It is included in the wider group of peripheral neuropathies. -### End" -3505,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an antidote of heparin?, with the following options: A: Sodium nitrite, B: Protamine sulphate, C: Thiosulphate, D: Coumarin - -### Response: -Intravenous infusion of protamine sulfate is used as antidote of heparin in case of life threatening hemorrhage. Protamines are basic low molecular weight positively charged proteins that have a high affinity for negatively charged heparin molecules. It binds tightly to heparin and thereby neutralizes its anticoagulant effect. Protamine only binds long heparin molecules. Therefore, it only paially reverses the anticoagulant activity of LMWHs and has no effect on fondaparinux. The very sho molecules of fondaparinux do not bind protamine. Heparin acts by binding to antithrombin III and induces a conformational change that accelerates the interaction of antithrombin III with other coagulation factors. Ref: Weitz J.I. (2011). Chapter 30. Blood Coagulation and Anticoagulant, Fibrinolytic, and Antiplatelet Drugs. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -3506,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sun flower cataractis seen in -, with the following options: A: Galactosemia, B: Injuries, C: Laurence Moon Biedel syndrome, D: Wilson's disease - -### Response: -Ref: Parson's 22nd/e p.264 & 21st/e p.259 -### End" -3507,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In cranial synostosis scaphyocephaly there is premature closure of which suture?, with the following options: A: Sagittal suture, B: Coronal suture, C: Larndid suture, D: All above - -### Response: -Sagittal craniosynostosis, or scaphocephaly, occurs when ceain bones in a child's skull fuse prematurely. At bih, a child's skull is made up of several separate bones with growth plates (also called 'sutures') between them. Because the skull is not a solid piece of bone yet, the brain can grow and expand in size Reference Harrison20th edition pg 2776 -### End" -3508,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are CNS stimulants except, with the following options: A: Amphetamines, B: Cocaine, C: Methylphenidate, D: Benzodiazepines - -### Response: -CNS stimulants are amphetamine, methylphenidate, atomoxetine, modafinil, cocaine, pemoline and caffeine. -### End" -3509,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the drug of choice to treat endometriosis :, with the following options: A: Testosterone propionate, B: Norethisterone, C: Medroxy progesterone, D: Danazol - -### Response: -Medroxy progesterone -### End" -3510,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of metabolic acidosis in anaesthesia is:, with the following options: A: Hypoventilation, B: Renal failure, C: Hypotension, D: Ketoacidosis - -### Response: -Hypotension (shock) causes tissue hypoxia leading to production of lactic acid and this lactic acidosis is th6 most common cause of metabolic acidosis seen during anaesthesia. -### End" -3511,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a sign of placental separation in stage III of labor:, with the following options: A: Gushing of blood, B: Discoid uterus, C: Filling of placenta in vagina, D: Increase in blood pressure - -### Response: -Ans. (a) Gushing of bloodRef. D.C Dutta 7h Ed. H31-312Clinical Course of Third Stage Of Labour* Third stage includes separation, descent and expulsion of the placenta with its membrane.Signs before and after placental separation* BEFORE SEPARATION: uterus becomes discoid in shape, firm in feel and non-ballottable.# Fundal height reaches slightly below the umbilicus* AFTER SEPARATION# Uterus becomes globular firm and ballotable# The fundal height is slightly raised# Sudden gush of vaginal bleeding upon separation.# Permanent lengthening of the cord. -### End" -3512,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sitaram a 40-year old man, met with an accident and comes to emergency depament with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is ?, with the following options: A: Pulmonary Laceration, B: Cardiac tamponade, C: Hemothorax, D: Splenic rupture - -### Response: -Ans is 'b' ie Cardiac Tamponade Road traffic accident can lead to all 4 condition but only cardiac tamponade can present the given signs & symptom. Cardiac Tamponade - It is accumulation of fluid in the pericardium in an amount sufficient to cause serious obstruction to the inflow of blood to the ventricles. Etiology: 3 most common causes are: - Neoplastic ds* - Idiopathic pericarditis* - Uremia* other causes include : Trauma, Cardiac operation, Tuberculosis The three principal feature of tamponade are elevation of intra cardiac pressures, limitation of ventricular filling and reduction of cardiac output. Clinical symptoms of tamponade Falling aerial pressure Pallor, rapid pulse Rising venous pressure Engorged neck veins Faint hea sounds Pulsus Paradoxus is an impoant clue to tamponade -### End" -3513,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skin involvement in toxic epidermal necrolysis?, with the following options: A: < 10 %, B: l0 - 20%, C: 20 - 30%, D: > 30% - -### Response: -Ans. is 'd' i.e., > 30% Erythema multiforme It is an acute , often self limited eruption characterized by a distinctive clinical eruption, the hallmark of which is target lesions (Iris lesions). EM can present with wide spectrum of severity which can be classified into 1. Erythema multiforme minor It is simply referred to as erythema multiforme (i.e. if not specified about other 2 types, erythema multiforme means EM minor). Localized eruption of skin with or without mucosal involvement. 2. Steven- Johnson syndrome (SJS) There are mucosal erosions with pruritic macules. In this epidermal detatchment is 10-30% of the body surface area. 3. Toxic epidermal necrolysis (TEN) When skin detachment is more then 30% of BSA. It is also called Lyell's syndrome. Therefore TEN & SJS are considered as single syndrome i.e. SJS-TEN syndrome (Erythema multiforme major). If area involved is more than 30% it is TEN & if area involved is 10-30%, it is SJS. -### End" -3514,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Late Complication of radiotherapy, with the following options: A: Nausea, B: Thrombocytopenia, C: Mucositis, D: Erythema - -### Response: -Mucositis (Inflammation of mucosa) is a late complication. -### End" -3515,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Plumbism is?, with the following options: A: Lead poisoning, B: Mercury poisoning, C: Thallium poisoning, D: Copper poisoning - -### Response: -Ans. is 'a' i.e., Lead poisoning o Plumbism is chronic lead poisoning. -### End" -3516,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Excessive intake (hypervitaminosis) of which of the following vitamin is associated with increased risk of congenital malformations -, with the following options: A: Vitamin-A, B: Biotin, C: Folic acid, D: Vitamin-K - -### Response: -Ans. is 'a' i.e., Vitamin A o It is absolutely contraindicated in pregnancy, as it is highly teratogenic; upto 25% exposed foetuses had bih defects-craniofacial, hea, and CNS abnormalities. -### End" -3517,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of Ig A is -, with the following options: A: Acts as a mucosal barrier for infection, B: Circulating antibody, C: Kills virus infected cells, D: Activates macrophages - -### Response: -Question repeated -### End" -3518,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Baby came for immunization for 1st time on 18 months. Which vaccine can be given:, with the following options: A: Only Pentavalent vaccine, B: Only DPT booster and OPV, C: Pentavalent, OPV, DPT, Measles and mumps, D: Only BCG plus OPV - -### Response: -Among given options only DPT Booster & OPV are given to child at 18 months of age in case of Delayed immunization. VACCINES & AGE LIMIT IN DELAYED IMMUNIZATION : Vaccine Age limit BCG, Hep B, Rotavirus, Pentavalent vaccine, fIPV, PCV till 1 yearof age. OPV, Measles, Vitamin A till 5yrs of age HiB till 6 years of age DPT till 7 years of age JE till 15 years of age TT till 16 years of age -### End" -3519,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Plasma volume is best evaluated by using, with the following options: A: Evan blue, B: Inulin, C: Mannitol, D: Radiolabelled water - -### Response: -Plasma volume is measured using dyes like Evans blur that binds specifically to plasma proteins.(Ref: Textbook of physiology N Geetha 2nd edition page no.62) -### End" -3520,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aoic dissection is associated with, with the following options: A: Systemic hypeension, B: Coarctation of Aoa, C: In 1"" trimester of pregnancy, D: Takayasu's aeritis - -### Response: -The factors that predispose to aoic dissection include systemic hypeension, a coexisting condition in 70% of patients, and cystic medial necrosis. Aoic dissection is the major cause of morbidity and moality in patients with Marfan syndrome ( Chap. 363 ) and similarly may affect patients with Ehlers-Danlos syndrome. The incidence also is increased in patients with inflammatory aoitis (i.e., Takayasu's aeritis, giant cell aeritis), congenital aoic valve anomalies (e.g., bicuspid valve), coarctation of the aoa, and a history of aoic trauma. In addition, the risk of dissection is increased in otherwise normal women during the third trimester of pregnancy. ref:Harrison&;s principles of internal medicine,ed 18,pg no 2063 -### End" -3521,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause dementia in an adult is, with the following options: A: Alzheimer's, B: Multi-infarct, C: Pick disease, D: Metabolic cause - -### Response: -Dementia is a chronic organic mental disorder characterised by impairment of intellectual function, impairment of memory, deterioration of personality with lack of personal care Alzheimer&;s is the commonest cause of dementia seen in about 70% of all cases of dementia in USA. It is more commonly seen in women (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no23) -### End" -3522,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enterotoxigenic E. Coli causes:, with the following options: A: Haemolytic uremic syndrome, B: Ischemic jejunitis, C: Toxic shock syndrome, D: Travellers diarrhea - -### Response: -Option 1 HUS By EHEC or Shigella dysenteriae type 1. Dissemination of toxin- Verocytotoxin or Shiga toxin to glomerular capillaries. Option 2 Ischemic jejunitis: Not caused by any pathogen. Due to local or systemic pathlogy Option 3 Toxic shock syndrome By Staphylococcus aureus or Streptococcus pyogenes. Due to toxins that act as superantigens. Option 4 ETEC Most common cause of traveler's diarrhea in the world. Most common cause of bacterial diarrheas in all ages. -### End" -3523,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30-year-old male presented with painful, deep recurrent oral aphthous ulcers. O/E ulcers had a yellowish necrotic base and appeared in crops, painful genital ulcers and skin lesions were also seen. A test was also done by the doctor wherein he injected normal saline intradermally. On ophthalmoscopic examination, B/L panuveitis was noted. Patient also complained of ahralgia in B/L knee joint. Lab findings revealed leukocytosis, raised ESR and raised CRP. Which of the following antibodies can be seen in the above condition: - ASCA Ab ANCA Ab Ab against ALPHA-ENOLASE Ab against selenium binding protein Anti-histone Ab, with the following options: A: 1, 2 and 5, B: 1, 3 and 5, C: 1, 3 and 4, D: 2, 3 and 4 - -### Response: -This is a case of Behcet's disease. 1st image shows and pyoderma gangrenosum. 2nd image shows erythema nodosum. Behcet's syndrome It is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. ASCA Ab, Ab against alpha enolase, Ab against selenium binding protein are seen. Pathergy test is positive. Skin lesions such as erythema nodosum, pyoderma gangrenosum, maculopapular rash etc. -### End" -3524,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Membranous urethral rupture causes collection of blood in -, with the following options: A: Ischiorectal fossa, B: Deep perineal pouch, C: Superficial inguinal region, D: Pelvic diaphragm - -### Response: -Ans. is 'b' i.e., Deep perineal pouch -### End" -3525,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraindication/s to hysteroscopy is/are -, with the following options: A: Cervical cancer, B: Vaginal bleeding, C: Pelvic inflammatory disease, D: All the above - -### Response: -Ans. is 'd' i.e., All the above Contraindications For Hysteroscopyo Pelvic inflammatory: diseaseo Herpes virus and other infectionso Vaginal bleedingo Intrauterine pregnancyo Cervical cancero Severe cervical stenosiso Unstable patient -### End" -3526,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs has both antihelminth and antiprotozoal activity ?, with the following options: A: Nitazoxanide, B: Emetine, C: Chloroquine, D: Diloxanidefuroate - -### Response: -Ans. is 'a' i.e., Nitazoxanide Nitazoxanide This is the salicylamidecogener of the antihelminthniclosamide, introduced for the treatment of giardiasis and cryptosporidiosis and is also active against other protozoa and helminthes including E. histolytica, T. vaginalis, Ascaris and H. nana. It is a prodrug which onn absorption is conveed into active for tizoxanide. Tizoxanide is an inhibitor of PFOR enzyme that is the essential pathway of electron transpo energy metabolism in anaerobic organisms. -### End" -3527,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which nerve is the secretory nerve to the nasal glands?, with the following options: A: Anterior ethimoidal, B: Posterior ethimoidal, C: Greater petrosal, D: Lesser palatine - -### Response: -The greater petrosal nerve, a branch of the facial nerve arises from the geniculate ganglion. It consists of preganglionic parasympathetic fibres which relay in the pterygopalatine ganglion and supply the secretomotor fibres to the lacrimal gland and the mucous glands of nasal cavity and palate.Anterior and posterior ethmoidal nerves and lesser palatine nerves supply the lateral wall of nose and nasal septum.Reference: Textbook of anatomy, Head Neck, and Brain, Vishram Singh, 2nd edition, page no.342,258 -### End" -3528,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Unfamiliarity of familiar things is seen in:, with the following options: A: Deja vu, B: Jamais vu, C: Deja entendu, D: Deja pence - -### Response: -Jamais vu refers to the feeling of unfamiliarity for familiar things. Deja vu refers to the feeling that an event which is being currently experienced has also happened in the past. -### End" -3529,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ligation of the following nerve will lead to paresthesia and pain on the dorsum of foot during venesections of great saphenous vein:, with the following options: A: Sural nerve, B: Geniculate, C: Saphenous nerve, D: Deep peroneal nerve - -### Response: -Saphenous vein ligation and stripping is still the more commonly performed procedure worldwide, and it may be the preferred therapy for patients with GSVs of very large diameter (>2 cm). Complications associated with GSV stripping include ecchymosis, lymphocele formation, DVT, infection, and saphenous nerve injury. The saphenous nerve is the terminal sensory branch of the femoral nerve and supplies cutaneous sensation to the medial aspect of the leg about and below the knee. Injury to the nerve cause pain or impaired sensation in the distribution of the nerve. Ref: Liem T.K., Moneta G.L. (2010). Chapter 24. Venous and Lymphatic Disease. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e. -### End" -3530,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following antibiotics acts by inhibiting cell wall synthesis, with the following options: A: Cefepime, B: Aminoglycosides, C: Erythromycin, D: Doxycycline - -### Response: -Cefipime[Ref. K.D.T. 6111/e P 669 & 5111/e p 6281 -### End" -3531,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following rheumatoid factor is not present in serum?, with the following options: A: Rheumatoid arthritis, B: Felty's syndrome, C: Still's disease, D: Present in all of the above - -### Response: -Still's disease is a variant of rheumatoid arthritis where rheumatoid factor is not seen. -### End" -3532,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An elederly male presented with headache, fever and hemiparasis of right side. On fuher examination and investigation a diagnosis of brain abscess was made. Which of the following antibacterial/ antibacterials is effective in this patient, with the following options: A: Gentamycin, B: Doxycycline, C: Streptomycin, D: A combination of Cephalosporin and Metronidazole - -### Response: -A 6-week combination of third-generation cephalosporin and metronidazole cures most cases of community-acquired brain abscess in immunocompetent patients. Coverage for streptococci can be attained by a high dose of penicillin G or a third-generation cephalosporin (eg, cefotaxime, ceftriaxone Ref Harrison20th edition pg 2234 -### End" -3533,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In multiple myeloma there is proliferation of -, with the following options: A: Plasma cells, B: Basophils, C: Eosinophils, D: Neutrophils - -### Response: -Ans. is 'a' i.e., Plasma cells Multiple myelomao Multiple myeloma is a plasma cell neoplasm characterized by involvement of the skeleton at multiple sites,o Plasma cells proliferate abnormally and the proliferated plasma cells infiltrate various organs, particularly bone marrow, but can also spread to lymph nodes and extranodal sites like skin,o The proliferation and survival of myeloma cells are dependent on several cytokines, IL-6 is particularly important,o The neoplastic plasma cells secrete abnormally large amounts of immunoglobulin.o The immunoglobulin secreted by neoplastic plasma cells are quiet different form the immunoglobulin normally present in the blood.o The normal immunoglobulin consists of two heavy and two lights chains molecules and the production of both chain is tightly balanced.o The immunoglobulin secreted in this condition may be : -Isolated light chain or heavy chain.May be an intact antibody molecule of any heavy chain subclass.May be an altered antibody or fragment. -### End" -3534,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of pneumo-peritoneum, as a result of colonscopic perforation in a young patient is -, with the following options: A: Temporary colostomy, B: Permanent colostomy, C: Closure + lavage, D: Symptomatic treatment - -### Response: -Perforation is the most common major complication after either diagnostic or therapeutic colonoscopy. Management Management of colonoscopic perforation depends upon the size of the perforation, the duration of time since the injury, and the overall condition of the patient A large perforation recognized during the procedure requires surgical exploration. Because the bowel has almost always been prepared prior to the colonoscopy, there is usually little contamination associated with these injuries and most can be repaired primarily. If there is significant contamination, if there has been a delay in diagnosis with resulting peritonitis, or if the patient is hemodynamically unstable, proximal diversion with or without resection is the safest approach. Occasionally, a patient will develop abdominal pain and localized signs of perforation after what was thought to be an uneventful colonoscopy. Many of these patients will have a ""microperforation"" which will resolve with bowel rest, broad-spectrum antibiotics, and close observation. Evidence of peritonitis or any deterioration in clinical condition mandates exploration. Similarly, free retroperitoneal or intraperitoneal air may be discovered incidentally after colonoscopy. In a completely asymptomatic patient, this finding is thought to result from barotrauma and dissection of air through tissue planes without a free perforation. Many of these patients can be successfully treated with bowel rest & broad-spectrum antibiotics. Surgical exploration is indicated for any clinical deterioration. Ref : Schwaz 9/e p1069 -### End" -3535,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female patient presented with depressed mood, loss of appetite and no interest in surroundings. There is associated insomnia. The onset of depression was preceded by a history of business loss and soon after it she developed the following symptoms for the past one year. True statement regarding management of this patient is?, with the following options: A: No treatment is necessary as it is due to business loss, B: SSRI is the most efficacious of the available drugs, C: Start SSRI treatment based on side effect profile, D: Combination therapy of 2 anti-depressant drugs - -### Response: -Ans. (C) Start SSRI treatment based on side effect profile(Ref: CMDT 2010/964)Depression associated with reactive disorders usually does not call for drug therapy and can be managed by psychotherapy and the passage of time. In severe cases -- particularly when vegetative signs are significant and symptoms have persisted for more than a few weeks -- antidepressant drug therapy is often effective. Drug therapy is also suggested by a family history of major depression in first-degree relatives or a past history of prior episodes.Drug selection is influenced by the history of previous responses if that information is available. If a relative has responded to a particular drug, this suggests that the patient may respond similarly. If no background information is available, a drug such as sertraline, 25 mg orally daily and increasing gradually up to 200 mg orally, or desipramine, starting with 50 mg orally and gradually increasing to 150 mg daily, can be selected and a full trial instituted. The medication trial should be monitored for worsening mood or suicidal ideation with patient assessments every 1-2 weeks until week 6. If successful, the medication should be continued for 6-12 months at the full therapeutic dose before tapering is considered. -### End" -3536,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tear-drop bladder is seen in -, with the following options: A: Tuberculosis, B: Hunner's ulcer, C: Perivescial hemorrhage with rupture, D: Perivesical hemorrhage without rupture - -### Response: -In case of extra peritoneal rupture of bladder a cystogram shows extravasation of contrast material into the pelvis around the base of bladder. The characteristic TEAR DROP' deformity represents bladder compression by a large pelvic haematoma. -### End" -3537,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alpha block on EEG is seen during which of the folllowing activities?, with the following options: A: Sleep, B: Seizures, C: Concentrating, D: None of the above - -### Response: -When attention is focused on something, the alpha rhythm is replaced by an irregular 13-30 Hz low-voltage activity, the beta rhythm. This phenomenon is called alpha block and can be produced by any form of sensory stimulation or mental concentration, such as solving arithmetic problems. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 15. -### End" -3538,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The finding of urine sodium concentration <20 mmol/L in hypovolemic hyponatremia implies, with the following options: A: Salt-wasting nephropathy, B: Diuretic therapy, C: Hypoaldosteronism, D: Trauma - -### Response: -Hypovolemic hyponatremia Urine sodium concentration >20 mmol/L Renal losses Diuretic excess Mineral coicoid deficiency Salt-losing deficiency Bicarbonaturia with Renal tubal acidosis and Metabolic alkalosis Ketonuria Osmotic diuresis Cerebral salt wasting syndrome Urine sodium concentration <20 mmol/L Extrarenal losses Vomiting Diarrhea Third spacing of fluids Burns Pancreatitis Trauma Ref: Harrison 19e pg: 299 -### End" -3539,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cephalic index is most useful in the identification of -, with the following options: A: Age, B: Sex, C: Religion, D: Race - -### Response: -Cephalic index is used for the determination of race. Race determination of skeleton -A) Cephalic Index -(C)  Cephalic index is defined as the index of the breadth of the skull. -Cephalic index = Max. the breadth of the skull —————————— Max. AP length of skull x 100 - Based on cephalic index races are classified into following three:- -1) Dolichocephalic (long-headed): Cephalic index is 70-75 and is a feature of Caucasians, -Pure Aryan (Indians), Aborigines, and Negroes. -2) Mesaticephalic (medium headed): Cephalic index is 75-80 and is a feature of Europeans, and Chinese. -3) Brachycephalic (short-headed): Cephalic index is more than 80 and is a feature of Mongolian. -B) Brachial Index - Brachial index is defined as- Brachial index = Length of radius ———————— Length of humerus x 100 - -Brachial index is 74.5 in Europeans and 78.5 in Negroes. - -C) Crural index  It is defined as- Crural index = Length of tibia ——————— Length of femur x 100  Crural index is 83.3 in Europeans and 86.2 in Negroes. -D) Humero-femoral index (HF index) - It is defined as- Humero-femoral index = Length of humerus ———————— Length of femur x 100  It is 69 in Europeans and 72.4 in Negroes. -E) Intermembral index - t is:- Intermembral index = Length of radius + humerus ———————————— Length of tibia + femur x 100 - -It is almost the same (70) in Europeans and Negroes. - -F) Orbit  It is square in Pure Aryans (Indians), Negroes, and Arborigines. It is triangular in Chinese and Europeans. It is ‘rounded’ in Mongols. -G) Nasal opening It is broad in Pure Aryans (Indians), Negroes, and Arborigines. It is narrow and elongated in Chinese and Europeans. -It is ‘rounded’ in Mongols. -H) Palate is rectangular in Pure Aryans (Indians), Negroes, and Arborigines. -It is triangular in Chinese and Europeans. It is rounded (or horseshoe-shaped) in Mongols. -### End" -3540,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tattooing in entry wound of a firearm injury is due to:, with the following options: A: Burns, B: Smoke, C: Gunpowder, D: Wads - -### Response: -Effects of different discharges from a gun: Fire / Flame -- burning at entrance wound along with burning or singeing of hairs. Smoke - Blackening effect or smudging Hot gases- Scorching effect Unburnt Gun powder - Tattooing effect, peppering or stippling effect Felt wad - Minor abrasion and bruise. Bullet / Pellet - Puncture wound with abrasion collar. -### End" -3541,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following events occurs in the rough endoplasmic reticulum?, with the following options: A: Core glycosylation of proteins, B: O-linked glycosylation, C: Sulfation, D: Protein sorting - -### Response: -The rough endoplasmic reticulum (RER) is the site of core glycosylation of proteins using the membrane-bound lipid carrier, dolichol, catalyzed by an oligosaccharide transferase. This is N-linked glycosylation, which occurs by an en bloc method in which dolichol is added to the protein. O-linked glycosylation occurs in the Golgi (answer b) by a mechanism involving oligosaccharide (glycosyl) transferases rather than en bloc. N linked oligosaccharides are the most common oligo saccharides found in glycoproteins and contain sugar residues linked to the NH2 amide nitrogen of asparagine. 0linked oligosaccharides have sugar residues linked to hydroxyl groups on the side chains of serine and threonine and are less common than the N-linked species. -### End" -3542,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Factors which is associated both with exsposure and disease is called -, with the following options: A: Confounding factor, B: Risk factor, C: Proximal risk factor, D: case - -### Response: -Confounding factor is defined as one which is associated both with exposure and disease and is distributed unequally in study and control groups. More specifically a confounding factor is one that although associated with exposure under investigation is itself independently of any such association, such as a risk factor for the disease. (refer pgno 72, park 23 rd edition) -### End" -3543,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The concept of simple act of ""Hand-washing between cases"" was introduced by, with the following options: A: Joseph Lister, B: Ignac Semmelweis, C: Holmes, D: Louis Pasteur - -### Response: -(B) Ignac Semmelweis # Hand washing was introduced by Ignaz Philipp Semmelweis.> Austrian obstetrician Ignac Semmelweis showed that puerperal sepsis could be reduced from over 10% to under 2% by the simple act of hand-washing between cases, particularly between post-mortem examinations and the delivery suite.> Louis Pasteur recognised that micro-organisms were responsible for spoiling wine, turning it into vinegar.> Joseph Lister introduced hand washing with carbolic acid, a disinfectant.> Lister then experimented with hand-washing, sterilizing instruments and spraying carbolic in the theatre while operating, in order to limit infection. Lister introduced both Antiseptic Technique & Aseptic Technique.> His lowered infection rate was very good and Listerian principles were adopted throughout many countries by a number of surgeons.> Lister is now known as 'Father of Antiseptic Surgery'> Robert Koch laid down the first definition of infective disease (Koch's postulates). -### End" -3544,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest presentation of infant with bilateral choanal atresia -, with the following options: A: Difficulty in breathing, B: Dysphagia, C: Smiling, D: Difficulty in walking - -### Response: -Bilateral choanal atresia presents as respiratory distress in newborn and requires support immediately after birth. -### End" -3545,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for generalized anxiety disorder -, with the following options: A: Alprazolam, B: Buspirone, C: Venlafaxine, D: Beta - blockers - -### Response: -Ans. is 'a' i.e., Alprazolam Treatment of generalized anxietyo Benzodiazepines are the drug of choice. Drugs in this group are diazepam, Lorazepam, Alprazolam, Oxazepam, chlordiazepoxide.o Other drugs used are buspirone; TCA (amptriptyline, imipramine, clomipramine, desipramine); SSRIs (Fluoxetine, Sertaline, Paroxetine, Citalopram); SNRIs (Venalafaxine), b-blockers.o Anticonvulsants with GABAergic properties may also be effective against anxiety, e.g., Gabapentin, Oxcarbazepine, Tiagabine, pregabaiin, and Valproate (divalporex). -### End" -3546,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diabetes mellitus is diagnosed if fasting blood glucose is?, with the following options: A: >100, B: >126, C: >110, D: >116 - -### Response: -ANSWER: (B) >126REF: Harrison's 18th ed ch: 344Criteria for the Diagnosis of Diabetes MellitusSymptoms of diabetes plus random blood glucose concentration >11.1 mmol/L (200 mg/dL)orFasting plasma glucose >7.0 mmol/L (126 mg/dL)orHBA1C > 6.5%:orTwo-hour plasma glucose >11,1 mmol/L (200 mg/dL) during an oral glucose tolerance test -### End" -3547,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the most probable cause of large head in this child?, with the following options: A: Osteogenesis imperfecta, B: Mucopolysaccharidosis, C: Hydrocephalus, D: Cerebral gigantism - -### Response: -c. HydrocephalusLarge head in an infant with venous prominences over scalp and presence of 'setting-sun sign', suggest hydrocephalus. -### End" -3548,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is indicator of Completed family size?, with the following options: A: Birth rate, B: Total fertility rate, C: Net reproduction rate, D: Gross reproduction rate - -### Response: -Ans. b (Total fertility rate) (Ref. Park's textbook of PSM 22nd/386)FERTILITY RELATED STATISTICSTotal Fertility Rate (TFR)Total fertility rate represents the average number of children a women would have if she were to pass through her reproductive years bearing children at the same rates as the women now in each age group give the approximate magnitude of ""COMPLETED FAMILY SIZE"".General Fertility Rate (GFR)=Number of live births in an area during the year------------------------------------------Midyear female population age 15-44 (or) 49 in the same area in same yrx 1000General Marital Fertility Rate (GMFR)Number of live births per % 1000 married women in the reproductive age group (15-44 or 49) in a given year.Age-specific Fertility RateThey are also sensitive indicators of family planning achievement.Gross Reproduction Rate (GRR)Average number of girls that would be born to a woman if she experiences the current fertility pattern throughout her reproductive span (15-44 or 49 years).Net Reproduction Rate (NRR)Net reproduction rate (NRR) is defined as the number of daughters a newborn girl will bear during her lifetime assuming fixed age-specific fertility and mortality rates. -### End" -3549,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A mother is diagnosed to have sickle cell disease, her husband is normal. What is the chances of having children with sickle cell disease and sickle cell trait respectively?, with the following options: A: 0 and 100%, B: 25 and 25%, C: 50 and 50%, D: 10 and 50% - -### Response: -Sickle cell anemia is an autosomal recessive disease. If mother has sickle cell disease (SS) and father is normal (AA), all of the offspring will be sickle cell trait (SA). Thus percentage of sickle cell disease (SS) will be zero and that of sickle cell trait (SA) will be 100%. Ref: Robbins Pathologic Basis of Disease, 7th Edition, Page 628 ; Children and Their Families: The Continuum of Care By Vicky R. Bowden, Page 1207 -### End" -3550,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: a 51 yr old male complaints of blood stained stools and abdominal pain diagnosis ?, with the following options: A: sigmoid colon, B: chrons disease, C: intussusception, D: diveiculosis - -### Response: -Intussusception is a condition in which one segment of intestine ""telescopes"" inside of another, causing an intestinal obstruction (blockage). Although intussusception can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines. Symptoms: Vomiting; Hematochezia; Abdominal pain... ref : bailey and love 27th ed -### End" -3551,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Squeeze technique is used for -, with the following options: A: Impotence, B: Premature ejaculation, C: Infertility, D: Priaprism - -### Response: -Squeeze (Semen's) technique → For premature ejaculation. -Sensate focus technique → For impotence. -### End" -3552,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are vectors except -, with the following options: A: Ticks, B: Spider, C: Mosquito, D: Fly - -### Response: -Ticks are the vectors of Q fever, relapsing fever, KFD, Tularemia Mosquito are the vectors of malaria, filaria, Japanese encephalitis, dengue, chikungunya Flies are the vectors of typhoid, diarrhoea,dysentery, cholera, gastroenteritis, anthrax, yaws. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 833,834 -### End" -3553,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phildalphia chromosome is mostly seen in:, with the following options: A: CML, B: Leukemoid reaction, C: Eosinophilia, D: Malaria - -### Response: -CML -### End" -3554,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are components of vaginal sphincter, EXCEPT:, with the following options: A: External urethral sphincter, B: Internal urethral sphincter, C: Bulbospongiosus, D: Pubovaginalis - -### Response: -Four muscles compress the vagina and act as sphincters:PubovaginalisExternal urethral sphincterUrethrovaginal sphincterBulbospongiosusRef: Clinically Oriented Anatomy By Keith L. Moore, Ahur F. Dalley, II, Anne M. R. Agur, 2013, Page 389. -### End" -3555,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Parathormone has all of the following effects, except -, with the following options: A: Increased bone resorption, B: Increased Ca+2 reabsorption in kidney, C: Increased phosphate reabsorption in kidney, D: Increased calcitriol synthesis - -### Response: -Ans. is ""c"" i.e., Increased phosphate reabsorption in kidney o Paratharmone is 84 aminoacid polypeptide hormone secreted from parathyroid glands.o Its secretion is regulated by plasma Ca++ concentration -- fall in Ca++ concentration increases the secretion of paratharmone.o ActionsPTH increases resorption of calcium from bone --> most prominant action.PTH increases calcium reabsorption from distal tubules of kidney.PTH decreases phosphate reabsorption from proximal tubules of kidney.PTH has no direct effect on calcium absorption from intestine but increases it indirectly by enhancing the formation of calcitriol by activating la-hydroxylose.PTH decreases calcium level in milk, saliva, and ocular lens -- may be responsible for development of cataract in hypothyroidism. -### End" -3556,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of atonic bladder is:, with the following options: A: Injury to sacral plexus, B: Injury to upper thoracic cord, C: Pregnancy, D: UTI - -### Response: -A i.e. Injury to sacral plexus -### End" -3557,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Jerne's hypothesis is for, with the following options: A: Isotypic network, B: Idiotypic network, C: Alotypic network, D: Immune complex - -### Response: -Ans. b (Idiotypic network) (Ref. Anantanarayan, Microbiology, 6th ed., 91)Sequential anti-idiotypic antibody formation is the basis of Jeme's network hypothesis of immune regulation.IMMUNOGLOBULIN SPECIFICITIES# The immunoglobulin specificity of the greatest biological importances is idiotypic specificity pertaining to the nature of the antigen binding sites (paratopes); the specific antigenic determinants on the paratope are called idiotopes.# The sum total of idiotopes on an Ig molecule constitutes its idiotype.# By immunisation with Fab fragments, anti-idiotypic antibodies can be produced. These resemble the epitopes of the original antigen.# Used as a vaccine, these show protection against the original antigen (pathogen or tumor) in experimental animals.# Sequential anti-idiotypic antibody formation is the basis of Jerne's network hypothesis of immune regulation.# The antigenic specificities which distinguish between the different classes and subclasses of immunoglobulins present in all normal individuals of a given species are termed isotypic Specificities.# Antigenic specificities which distinguish immunoglobulins of the same class, between different groups of individuals in the same species, are called allotypic specificities.# Immunoglobulin allotypes have been studied in detail in the rabit and guinea pig by using type-specific immune sera.# Antiallotype antibodies are also found in sera containing 'rheumatoid arthritis factor'.# Two allotypic systems are known in humans - the Gm system (for gamma marker) and the InV system (abbreviation of patent's name). The Gm is associated with the Fc portion of the IgG heavy chain. More than 25 Gm types have been identified so far the InV system is associated with the Kappa light chain and so has been renamed Km. Three Km allotypes have been identified.# Genetic markers associated with IgA are called 'Am'.# To date, in the human system no allotypic markers have been found for lambda light chains or m, d or e heavy chains. -### End" -3558,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following maintain the stability of ankle joint except:, with the following options: A: Cruciate ligament, B: Shape of the bones, C: Tendons of muscle which cross the joint, D: Collateral ligament - -### Response: -Cruciate ligament Cruciate ligaments are found in the knee and not ankle. Cruciate ligaments are pairs of ligaments arranged like a letter X. They are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They maintain anteroposterior stability of the knee joint. -### End" -3559,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anaesthesia breathing circuit recommended for spontaneous breathing is, with the following options: A: Mapleson A, B: Mapleson B, C: Mapleson C, D: Mapleson D - -### Response: -TypeA or Magills circuit is used in Spontaneous ventilation. Type D is used in controlled ventilation. TypeB and Type C are obselete nowadays -### End" -3560,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dose of levonorgestrel used for emergency contraception:-, with the following options: A: 0.75 mg within 72 hours, B: 1.5 mg within 72 hours, C: 1.5 ug within 72 hours, D: 3 ug within 72 hours - -### Response: -Levonorgestrel is Doc for emergency contraception 0.75 mg tablets ( 2 tablets) 12 hrs apa. 1.5 mg tablet ( 1 tablet ) within 72 hrs. This is the only method of emergency contraception approved for use by Drug Controller of India Note:- IUCD - used up to 5th day after intercourse. -### End" -3561,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following subtype of lung carcinoma produces superior vena cava syndrome: September 2009, with the following options: A: Small cell carcinoma, B: Adenocarcinoma, C: Anaplastic carcinoma, D: Squamous cell carcinoma - -### Response: -Ans. A: Small cell carcinoma -### End" -3562,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Von Willebrand's disease is all except :, with the following options: A: Increased bleeding time, B: Factor VIII c levels are decreased in circulation, C: Defect in VWF is detected by ristocetin, D: None - -### Response: -Answer is D None (All statements are true) Von Willebrand disease is associated with decreased levels of VWF and factor VIII in circulation. Bleeding time and APTT are prolonged. Platelet aggregation in response to ristocetin is abnormal which indicates a deficit in VWF or Ristocetin cofactor. Von Willebrand Von Willebrand disease is caused by a defect of deficiency of VWF factor and presents as bleeding and coagulation disorder. VWF factor is required fir normal platelet adhesion and aggregation. VWF factor is the plasma carrier for factor VIII which is required for intrinsic pathway of the coagulation cascade. VWF disease by demonstrating decreased aggregation. -### End" -3563,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increasing severity of mental retardation in male members over generations is a result of, with the following options: A: Mitochondrial DNA mutation, B: Frameshift mutation, C: Y linked disorders, D: Trinucleotide repeat mutation - -### Response: -Ref Robbins 8/e p169-171; 9/e p169 Triplet Repeat Mutations: Fragile X Syndrome Fragile X syndrome is the prototype of diseases in which the causative mutation occurs in a long repeating sequence of three nucleotides. Other examples of diseases associated with trinucleotide repeat mutations are Huntington disease and myotonic dystrophy. About 40 diseases are now known to be caused by this type of mutation, and all dis- orders discovered so far are associated with neurodegen- erative changes. In each of these conditions, amplification of specific sets of three nucleotides within the gene disrupts its func- tion. Ceain unique features of trinucleotide repeat muta- tions, described later, are responsible for the atypical pattern of inheritance of the associated diseases. Fragile X syndrome results from a mutation in the FMR1 gene, which maps to Xq27.3. The syndrome gets its name from the karyotypic appearance of the X chromosome inthe original method of diagnosis: Culturing patient cells in a folate-deficient medium typically revealed a discontinuity of staining or constriction in the long arm of the X chromosome. This method has now been supplanted by DNA-based analysis of triplet repeat size as discussed later. With a frequency of 1 in 1550 for affected males and 1 in 8000 for affected females, fragile X syndrome is the second most common genetic cause of mental retardation, after Down syndrome. Clini- cally affected males have moderate to severe mental retar- dation. The characteristic physical phenotype includes a long face with a large mandible, large eveed ears, and large testicles (macroorchidism). Although characteristic of fragile X syndrome, these abnormalities are not always present or may be quite subtle. The only distinctive physi- cal abnormality that can be detected in at least 90% of postpubeal males with fragile X syndrome is macroorchidism. As with all X-linked diseases, fragile X syndrome pre- dominantly affects males. Analysis of several pedigrees, however, reveals some patterns of transmission not typi- cally associated with other X-linked recessive disorders (Fig. 6-17). These include the following: * Carrier males: Approximately 20% of males who, by ped- igree analysis and by molecular tests, are known to carry a fragile X mutation are clinically and cytogeneti- cally normal. Because carrier males transmit the trait through all their daughters (phenotypically normal) to affected grandchildren, they are called normal transmit- ting males. -### End" -3564,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: You are a doctor. You visit a village and want to make a quick estimate of the infant population of the area. Which of the following measures can you use?, with the following options: A: No. of TT injections in last one year, B: No. of folifer tablets consumed in one year, C: Female population in reproductive age group, D: Literacy rate - -### Response: -.healthy ifants would have been born to mothers who had a regular antenatal visits as well as followups.so by obtaining an estimate of total number of folifer tablets consumed at that area during a given period indirectly helps in the calculation of number of infants born to that area. -### End" -3565,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ketanserine is, with the following options: A: 5HT 1b antagonist, B: 5HT2 antagonist, C: 5HT 1a agonist, D: 5HT 1d antagonist - -### Response: -5-HT2A antagonistsEdit Antagonists of the 5-HT2A receptor are sometimes used as atypical antipsychotics(contrast with typical antipsychotics, which are purely dopamine antagonists). They include: Cyproheptadine blocks 5-HT2A, H1 and is a mild anticholinergic. Methysergide is a 5-HT2A antagonist and nonselective 5-HT1 receptor blocker. It causes retroperitoneal fibrosis and mediastinal fibrosis. Quetiapine blocks 5-HT2A, 5-HT1A, dopamine receptors D1 and D2, histamine receptor H1, and A1 adrenoreceptors. 5-HT2A/2C antagonistsEdit Ketanserin Antihypeensive. Blocks 5-HT2A, 5-HT2C and Alpha 1 (A1) adrenoreceptors. Risperidone antipsychotic Trazodone antidepressant Clozapine antipsychotic. Blocks 5-HT2A, 5-HT2C and D4 receptors. Nefazodone acts primarily as a potent 5-HT2A antagonist. Refer kDT 6/e p167 -### End" -3566,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pandemics are caused by, with the following options: A: Hepatitis B, B: Influenza A, C: Influenza - B, D: Cholera - -### Response: -An epidemic usually affecting a large population of the population, occurring over a wide geographic area such as a section of a nation, the entire nation, a continent or the world eg. influenza pandemics of 1918 and 1957, cholera EI Tor in 1962 and acute haemorrhagic conjunctivitis in 1971 and 1981 Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 101 -### End" -3567,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is not used for the overactive bladder, with the following options: A: Duloxetine, B: Darifenacin, C: Oxybutynin, D: Flavoxate - -### Response: -Refer Goodman and Gilman 12e 231,232 Anticholinergic drugs are indicated for overactive bladder and darifenacin, solefenacin,oxybutynin,tolterodine and fesoteradine are commonly used for this condition . -### End" -3568,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common tumour of mediastinum?, with the following options: A: Thymoma, B: Lymphoma, C: Neurogenic tumor, D: Neuro blastic tumor - -### Response: -MC mediastinal masses are neurogenic tumors (20% of mediastinal tumors), usually found in the posterior mediastinum, followed by thymoma located in the anterior mediastinum. Lung cancer typically spreads to the lymph nodes in the mediastinum. -### End" -3569,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diethyltoluamide is an effective, with the following options: A: Larvicidal, B: Agent againts pupae of anophales, C: Repellent, D: Space spray - -### Response: -Diethyl toluimide /deetis an all purpose repellant. -They are used for application on skin, and their chief advantage is short duration of protection.Repellant are contact poisons. -They are used as peraonal protective measure against mosquito bite. -Other neasure are using mosquito nets and screening. -Parks textbook of preventive and social medicine.K Park -### End" -3570,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with salicylic acid poisoning has the following aerial blood gas analysis repo : pH = 7.12 : pCO2 = 18mmHg; HCO3 = 12mmol/L. The resulting acid base abnormality can be best labeled as:, with the following options: A: Metabolic acidosis with compensatory respiratory alkalosis, B: Metabolic acidosis with compensatory respiratory alkalosis, C: Respiratory acidosis with metabolic alkalosis, D: Metabolic acidosis - -### Response: -Answer is A (Metabolic acidosis with compensatory respiratory alkalosis): With pH < 7.35 (7.12) acidosis is confirmed. Abbnormal CO2 with change in opposite to expected. (acidosis should have increased CO2) indicates that the change in compensatory (compensatory respiratory alkalosis), Decreased bicarbonates with change in keeping with change in pH suggests that the problem is metabolic. Thus the whole picture respresents metabolic acidosis with compensatory respiratory alkalosis. Explanation : Acid base disorders needlessly, confuse many people, but if a few simple rules are applied then interpretation and diagnosis are easy. pH < 7.35 is acidosis ; pH > 7.45 is alkalosis If change in HCO3 is termed as metabolic If change in HCO3- is in keeping with the pH (i.e. if there is acidosis and HCO3- decreased) the problem is a Metabolic one. If change in HCO3 is opposite with the pH (if there is acidosis and HCO3 is increased or normal) the problem is compensatory metabolic. If change is CO2 is termed as respiratory If change in CO2 is in keeping with the pH (if in acidosis CO2 is raised) the problem is termed respiratory If change in CO2 is opposite with the pH (if there is acidosis and CO2 is decreased or normal) problem is termed as compensatory respiratory. STEP III : Final deduction Because metabolic component is primary and respiratory component is compensatory the acid base disorder is Metabolic acidosis with compensatory Respiratory alkalosis. -### End" -3571,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preferential expression of gene depending on parent of origin is called as, with the following options: A: Genomic imprinting, B: Mosaicism, C: Chimerism, D: Cloning - -### Response: -Ans. (a) Genomic imprintingRef: Robbin's pathology 9th ed. /172-173Preferential expression of an allele depending on parental origin is genomic imprinting.* Praderwili syndrome: Deletion of paternal chromosome 15* Angelman syndrome:Deletion of maternal chromosome 15* Beckwith weidmann syndrome: have two paternal but no maternal copies of chromosome 11* Albright's hereditary osteodystrophy: mutation in Gs alpha subunit leading to short stature, brachydactyl and PTH resistance only when mutation is inherited from the mother. -### End" -3572,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Formication is seen with ?, with the following options: A: Acute amphetamine intoxication, B: Chronic use of amhetamine, C: Alcohol withdrawal, D: Cannabis poisoning - -### Response: -Ans. B. Chronic use of amhetamineMagnan's syndrome (also called formication) is seen in chronic cocaine and chronic amphetamine abuse. -### End" -3573,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The sympathetic and parasympathetic systems exert functionally opposite influences on the following parameters except:, with the following options: A: Heart rate, B: Atrial refractory period, C: Pupil diameter, D: Intestinal motility - -### Response: -Ans. B. Atrial refractory periodMost organ receive dual innervation by both SNS and PNS. The level of activity of an organ at a given moment is the sum of sympathetic and parasympathetic tone. However, refractory period of atrial fibers is decreased by sympathetic as well as parasympathetic influences.OrganSNSPNSHeartIncreases HR, ContractionDecreases HRLungBronchodilationBronchoconstrictionGITDecreased motility, Contraction of sphinctersIncreased muscle motilityRelaxation of sphinctersBlood vesselContraction in cutaneous and splanchnic BV, Relaxation in skeletal muscle BVNo direct effect on BV*.Dilation in coronary BV via releases of EDRF(NO)EyeMydriasisMiosis and accommodation for near visionBladderUrinary Retention (contraction of sphincter)Voiding (Contraction of detrusor; relaxation of trigone)GenitaliaEjaculationErection -### End" -3574,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following aery give rise to uterine aery?, with the following options: A: Aoa, B: Common iliac, C: Internal iliac aery, D: External iliac - -### Response: -Uterus receives blood supply from uterine and ovarian aery. Uterine aery is a branch of anterior trunk of internal iliac aery. Ovarian aery is a direct branch of aoa. Other branches of anterior trunk of internal iliac aery are: Umbilical aery Obturator aery Uterine aery Inferior vesical and vaginal aery Middle rectal aery Internal pudendal aery Inferior gluteal aery Branches of posterior trunk of internal iliac aery are: Iliolumbar aery Lateral sacral aery Superior gluteal aery Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 12. Pelvis and Perineum. Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 2. Maternal Anatomy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. -### End" -3575,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28 years old female at term presents with gush of fluid and regular contractions. Prenatal investigations reveals Rh negative, antibody negative, husband- Rh positive homozygous. After 10 hours her labor progresses and delivered 3600g baby via normal vaginal delivery. Placenta did not separate spontaneously and manual removal was done. The next step of investigation is, with the following options: A: RhoGAM, B: Indirect Coomb's test, C: Direct Coomb's test, D: Detection of fetal cells in maternal circulation - -### Response: -Answer: c) Direct Coomb's testRh NEGATIVE PREGNANCYINVESTIGATION OF Rh NEGATIVE MOTHERSI-Husband's blood grouping & Rh typing.II-Obstetric History: If the woman is primi, it is unlikely for the baby to be affectedIII-Antibody detection: In all cases of Rh negativity, albumin antibody is detected by indirect Coomb's test at 12th week to detect unbound antibodies in maternal serum.If the test is found negative, it is to be repeated at 28th and 36th week in primi & at monthly intervals from 24th week onwards in multi.If the test is found positive:Genotype of the husband should be determined If he is found to be homozygous, the fetus is likely to be affected & in heterozygous, the fetus may be affected in 50% cases.Quantitative estimation of the albumin antibody at weekly intervals. A titre of 1:16 or antibody level >10 lU/ml is critical.Fetal Rh status & blood grouping is done by amniocentesis.Amniocentesis is done & bilirubin in the amniotic fluid is estimated by spectrophotometer at 250-700nm wave length.In presence of bilirubin, there is a ""deviation bulge"" at 450nm wave length.This deviation is plotted in a Liley's chart.ANTI-D ADMINISTRATIONCalculation of the dose: Approximate volume of fetal blood entering into the maternal circulation is estimated by Kleihauer-Betke test/ rosette. (Calculating the RBC's under 50 low power fields).80 fetal RBCs correspond to 4 ml of fetal bloodDosage: 10mg for every 1 ml of fetal whole bloodTime of administration & Dosage:It should be given when the baby born is Rh positive and the direct Coombs test is negative.Should be given preferably within 72 hours or earlier following delivery or abortion.First trimester- abortion, ectopic pregnancy, chorion villous biopsy: 50 mg l.m.Beyond twelve weeks & Following delivery: 300mg l.m.In case of Rh iso immunization:Cord should be kept long (2-4cms) to enable exchange transfusion if requiredCord blood sample should be taken from the placental end for:ABO and Rh groupingDirect Coomb's testMeasurement of serum bilirubinHemoglobin estimationBlood smear for presence of immature RBC's. -### End" -3576,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antineutrophil cytoplasmic antibodies(ANCA) are seen in, with the following options: A: Wagner's granulomatosis, B: Diabetes mellitus, C: Rheumatoid ahritis, D: Charg straus syndrome - -### Response: -Refer robbins 9/e p511 Granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, is a rare multisystem autoimmune disease of unknown etiology. Its hallmark features include necrotizing granulomatous inflammation and pauci-immune vasculitis in small- and medium-sized blood vessels. Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), is a long-term systemic disorder that involves both granulomatosis and polyangiitis. It is a form of vasculitis (inflammation of blood vessels) that affects small- and medium-size vessels in many organs but most commonly affects the upper respiratory tract and the kidneys. Therefore, the signs and symptoms of GPA are highly varied and reflect which organs are supplied by the affected blood vessels. Typical signs and symptoms include nosebleeds, stuffy nose and crustiness of nasal secretions, and inflammation of the uveal layer of the eye. Damage to the hea, lungs and kidneys can be fatal. -### End" -3577,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for NSAID induced peptic ulcer disease is, with the following options: A: Pirenzapine, B: Omeprazole, C: Cimetidine, D: Misoprostol - -### Response: -Misoprostol is the most specific drug for NSAIDS induced peptic ulcer but it is not the drug of choice for any ulcer. DOC for all types of peptic ulcer including NSAIDs induced peptic ulcer are proton pump inhibitors. -### End" -3578,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is true about Focal nodular hyperplasia Except, with the following options: A: Unusual benign tumor of liver, B: Commonly symptomatic and occurs as multiple liver nodules, C: More common in females than in males, D: Contain hepatocytes and Kupffer cells - -### Response: -It&;s a benign condition of unknown aetiology, seen in females showing focal overgrowth of functioning liver tissues with fibrous stromal suppo and also it presents as a solitary nodule. Reference : SRB edition :5 page no: 607& 608 -### End" -3579,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CDC recommended treatment for uncomplicated gonorrhea -, with the following options: A: Ceftriaxone, B: Tetracycline, C: Azithromycin, D: Cootrimoxazole - -### Response: -Ans. is 'a' i.e., Ceftriaxone For uncomplicated gonococcal infection ceftriaxone is DOC (along with azithromycin or doxycyclin to cover chlamydial infection). For penicillin allergic patients quinolones are DOC. Person who can not tolerate both cephalosporin and quinolones, spectinomycin is DOC. -### End" -3580,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 32-year-old female, asymptomatic, not requiring blood transfusion, presents with Hb 13.0 gm/dl. Her HbF levels levels are 95%, Hb A2 1.5%. Which of the following is the most likely diagnosis?, with the following options: A: Hereditary persistence of fetal hemoglobin, B: Beta homozygous thalassemia, C: Thalassemia intermedia, D: Beta heterozygous thalassemia - -### Response: -- In given pt, even though HbF levels are elevated, these pts have normal Hb levels & asymptomatic without any requirement of any transfusions. Hence, thalassemia is ruled out - These features points towards the diagnosis of Hereditary persistence of fetal hemoglobin (HPFH) - It is benign condition in which fetal hemoglobin ( HbF) production is increased & continued into adulthood Patient remains asymptomatic even without blood transfusion No anemia; no splenomegaly -### End" -3581,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following operations are used for genital prolapse except :, with the following options: A: Fothergill's, B: Fenton's, C: Ward Mayo, D: Le Foe - -### Response: -Fenton's -### End" -3582,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common malignant tesicular neophasm is -, with the following options: A: Teratoma, B: Seminoma, C: Choricocarcinoma, D: Lymphoma - -### Response: -Ans. is 'b' i.e., Seminoma -### End" -3583,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young adult concludes that he is never going to be in a relationship after his experience of twice being rejected for a date. This is:, with the following options: A: Personalization, B: All or none thinking, C: Over generalization, D: Selective abstraction - -### Response: -The example in the question is of overgeneralization. In this cognitive error, the individual makes conclusions based on very little data or experience. Alternative possibilities are not considered. -### End" -3584,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which anticonvulsant is safe during pregnancy ?, with the following options: A: Valproic acid, B: Carbamazepine, C: Ethosuximide, D: Phenytoin - -### Response: -Carbamazepine -### End" -3585,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aldosterone mainly acts upon, with the following options: A: PCT, B: Loop of Henle, C: Glomerulus, D: Distal renal tubule - -### Response: -Aldosterone is the main mineralocoicoid hormone secreted by the adrenal coex, the principal biological activity of which is the regulation of electrolyte and water balance by promoting the retention of sodium (and, therefore, of water) and the excretion of potassium; the retention of water induces an increase in plasma volume and an increase in blood pressure. Its secretion is stimulated by angiotensin II.Aldosterone is mineralocoicoid hormone produced by the zona glomerulosa of the adrenal coex; its major action is to facilitate potassium exchange for sodium in the distal renal tubule, causing sodium reabsorption and potassium and hydrogen loss.Ref: Ganong&;s review of medical physiology;24th edition; page no-364 -### End" -3586,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sitting without suppo is appear at which month, with the following options: A: 5 month, B: 6 month, C: 7 month, D: 8 month - -### Response: -Ans. is 'b' i.e., 6 month -### End" -3587,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Brow presentation, head of the fetus:, with the following options: A: Complete hyperextension, B: Partial extension, C: Complete flexion, D: Partial flexion - -### Response: -Ans. (b) Partial extensionRef. William's Obstetrics 23rd ed. Ch 17* In cephalic presentation, the fetal head may assume a position between these extremes:# Vertex presentation: Head is flexed sharply so that the chin is in contact with the thorax. The occipital fontanel is the presenting part, and this presentation is referred to as a vertex or occiput presentation.# Sinciput/Military presentation: Partially flexed head in some cases, with the anterior (large) fontanel, or bregma, as presenting.# Brow presentation: head is partially extended (see Fig).# These two presentations (sinciput and brow) are usually transient. As labor progresses, sinciput and brow presentations almost always convert into vertex or face presentations by neck flexion or extension, respectively.# Face presentation: Much less commonly, the fetal neck may be sharply extended so that the occiput and back come in contact, and the face is foremost in the birth canal, giving it the face presentation. -### End" -3588,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Febuxostat:, with the following options: A: Anti-gout and Xanthine Oxidase inhibitor, B: Purine inhibitor, C: Dose adjustment required in renal impairment, D: Has uricosuric action - -### Response: -Ans. (a) Anti-gout and Xanthine Oxidase inhibitorRef. Katzung's Pharmacology 10th ed. Ch 36* Febuxostat is a non-purine inhibitor of xanthine oxidase and thereby reduces the formation of xanthine and uric acid and is useful in management of gout.* It is 80% absorbed following oral administration and extensively metabolized in the liver.* All of the drug and its metabolites appear in the urine although less than 5% appears as unchanged drug. Because it is highly metabolized to inactive metabolites, no dosage adjustment is necessary for patients with renal impairment. -### End" -3589,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which antidepressant is relatively contraindicated in young men secondary to its side effect of priapism?, with the following options: A: Seraline, B: Trazodone, C: Imipramine, D: Amitriptyline - -### Response: -5-HT2 AntagonistsTwo antidepressants are thought to act primarily as antagonists at the 5-HT2 receptors: trazodone and nefazodoneThe most common adverse effects associated with the 5-HT2 antagonists are sedation and gastrointestinal disturbances. Sedative effects, paicularly with trazodone, can be quite pronounced. Thus, the treatment of insomnia is currently the primary application of trazodone. Sexual effects are uncommon with nefazodone or trazodone treatment as a result of the relatively selective serotonergic effects of these drugs on the 5-HT2 receptor rather than on SE. However, trazodone has rarely been associated with inducing priapism.Priapism (an abnormally prolonged erection) is estimated to happen in 1 in every 10,000 patients treated with trazodone.Ref: Harper&;s Biochemistry; 12th edition; Page no: 526 -### End" -3590,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AH plus and AH 26 are:, with the following options: A: Root canal cement, B: Medicated root canal paste, C: Fillers, D: Root canal filling material - -### Response: -AH plus and AH 26 are resin based sealers. -### End" -3591,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are side effects of Lithium except, with the following options: A: Hypothyroidism, B: Diabetes Insipidus, C: Hypercalcemia, D: Leucopenia - -### Response: -Lithium causes increase in Leucocyte count, not Leucopenia. Often it is used to treat Leucopenia. -### End" -3592,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has preserved light touch and absent pain and temperature over the left upper limb. This pattern of sensory loss is called-, with the following options: A: Stock and glove type, B: Segmental type, C: Dissociated type, D: Mononeuritis type - -### Response: -Dissociated sensory loss describes the loss of pain and temperature sensation resulting from involvement of the crossing of spinothalamic second-order neurons, with sparing of dorsal column function. Worsening spasticity is attributable to increasing involvement of the descending coicospinal tracts Ref Harrison20th edition pg 2236 -### End" -3593,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Critical temperature of oxygen is?, with the following options: A: 20, B: 118, C: 36.5, D: 400C - -### Response: -Ans. is 'b' i.e., -118 -### End" -3594,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coicosteroid which is given by inhalation route is:, with the following options: A: Prednisolone, B: Beclomethasone, C: Dexamethasone, D: Hydrocoisone - -### Response: -Beclomethasone -### End" -3595,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sensory nerve supply of middle ear cavity is provided by:, with the following options: A: Facial, B: Glossopharyngeal, C: Vagus, D: Trigeminal - -### Response: -(b) Glossopharyngeal(Ref. Scott Brown, 8th ed., Vol 2 page 535)The sensory supply of the middle ear is by the tympanic plexus which is formed by the Jacobson's nerve which is the tympanic branch of Glossopharyngeal (IX) along with sympathetic plexus from around the internal carotid. -### End" -3596,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 7 Year old boy with boggy swelling of the scalp with multiple discharging sinuses with cervical lymphadenopathy with easily pluckable hair. What would be done for diagnosis -, with the following options: A: Pus for culture, B: KOH mount, C: Biopsy, D: Patch test - -### Response: -

DERMATOPHYTOSIS Infection caused by dermatophytes. Classified based on site of involvement.Tinea capitis- scalp involvement. TINEA CAPITIS:-Infection can be either endothrix/ectothrix.Ectothrix involves both the inside and outside of hair shaft.Endothrix involves only the inside of hair shaft.Causative organism:-Trichophyton and microsporumEctothrix-M.canis,M.audouinii, M.distoum,M.ferrugineum,M.gypseum and T.verrucosum.Endothrix-T.tonsurans,T.violaceum, T.soudanenseFavus caused by T.schoenleinii Two types- inflammatory and non inflammatory. Non inflammatory-1. Dry scaling2. Black dot-Hair breaks at the surface of the scalp and appears as swollen black dots.3. Grey patch-Hair breaks close to the surface or a few mm above and there is skin scalp scaling. Inflammatory-1. Kerion- most inflammatory form of tinea capitis. Characterised by wet, purulent,boggy swelling with inflamed painful pustules,nodules and plaques. Hairs donot fall out but can be pulled out without pain.2. Favus- patches of redness and scaling with disc/ cup shaped yellow crusts (scutula) pierced by one/ two hairs which donot break. A fetid odour may be present. After many years,atrophic patches develop,causing permanent alopecia. Wood's lamp examination and KOH mound confirms the diagnosis. {Reference: IADVL textbook of dermatology, page 255 -### End" -3597,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is determined by measuring sciatic notch index in a skeleton?, with the following options: A: Determination of age, B: Identification of sex, C: Determination of race, D: Cause of death - -### Response: -Sciatic notch index is a trait used for differentiating sex by measuring sciatic notch. Formula is, Sciatic notch index = (width of sciatic notch/depth of sciatic notch) * 100 It is normally 4-5 in males and 5-6 in females Ref: Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 56. -### End" -3598,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fungal meningitis in an immunocompromised individual is most commonly caused by, with the following options: A: Aspergillus, B: Penicillium, C: Candida albicans, D: Cryptococcus neoformans - -### Response: -(D) Cryptococcus neoformans # Fungal Infections in the immunocompramised i.e. in AIDS patients:> Candidiasis (esophageal, tracheal, or pulmonary)> Crypttococcosis (CNS infection)> Coccidioidomycosis (disseminated)> Histoplasmosis (disseminated) -### End" -3599,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The technique of Psychological autopsy is useful in studying the causation of, with the following options: A: Schizophrenia, B: Personality disorders, C: Drug dependence, D: Suicide - -### Response: -Etiology: Some of the common causes of suicide are: Psychiatric Disorders are a major cause of suicide. Some common causes are: Depression: Major depression Depression secondary to serious physical illness. Reactive depression, secondary to life stressors, e.g. family and/or marital disputes, failure in goal achievement, occupational and financial difficulties, and death of significant others. Alcoholism and drug dependence Schizophrenia Genetic factors (a concordance rate of 18% in monozygotic twins) and biochemical factors (low levels of 5-HIAA) are impoant in some case of suicide. -### End" -3600,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Millennium Development Goals (MDGs) are based upon:-, with the following options: A: WHO health records, B: UNICEF health criteria, C: United National Millennium Declaration, D: SEARO Millennium Declaration - -### Response: -Millennium Development Goals are based upon United Nations Millennium Declaration The millennium development goals (MDGs) were the eight international development goals for the year 2015 that had been established following the millennium summit of the United Nations in 2000, following the adoption of the United Nations millennium declaration. All 189 United Nations member states, at that time & at least 22 international organizations, committed to help achieve MDGs by 2015. -### End" -3601,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Henoch–Schonlein purpura renal involvement is not seen generally if no involvement till ?, with the following options: A: 1 month after onset, B: 2 month after onset, C: 3 month after onset, D: 4 month after onset - -### Response: -Renal involvement occurs in 20% to 50% of HSP, usually within 4 weeks of presentation, and less commonly precedes the other symptoms. -The onset of abnormalities may follow the onset of other symptoms by weeks (80% within 4 weeks) or even months (97% within 3 months). - -Coming back to question - -According to me the best answer is 4 months because renal involvement may be seen up to 3 months after the onset of other symptoms (examiner is asking about the renal involvement after onset of disease, not after the onset of other symptoms). -""Renal manifestations usually start at the onset or within 3 months of the onset of other symptoms"" — Pediatric nephrology -Other symptoms, e.g. rash, will also take some time to appear after the onset of disease. Thus, renal involvement may occur up to more than 3 months after onset of the disease. -### End" -3602,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a patient suspected to be suffering from vesicoureteric reflex, which one of the following radiological investigations may confirm the diagnosis ?, with the following options: A: Intravenous urography, B: Micturating cystourethrography, C: Pelvic ultrasound, D: Antegrade pyelography - -### Response: -VUR is confirmed by a micturating cystogram and a DMSA scan is used to assess the degree of renal scarring. VUR occurs in 1-2% of the asymptomatic paediatric population but in 30-40% of children with a UTI and is apparent in 90% of children with renal scarring on an IVU. VUR is graded as follows: Grade I: reflux into the ureter. Grade II: reflux into the ureter and renal pelvis. Grade III: reflux is associated with mild/moderate dilatation on an IVU. Grade IV: additional blunting of fornices. Grade V: absent papillary impressions. Grades I-III generally resolve spontaneously. Surgery (ureteric re-implantation, periureteric injections of Teflon or collagen) should be considered if episodes of acute PN recur despite antibiotic therapy or if severe reflux is accompanied by a surgically correctable malformation. (source : Bailey 27th ed , chapter 76 , pg no 1404 -### End" -3603,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common ovarian malignancy in post menopausal period is, with the following options: A: Serous cystadenoma, B: Fibroma/thecoma, C: Teratoma, D: Mucinous tumor - -### Response: -Ans a Ref: Sheila balakrishnan page 256Epithelial tumor: Majority are seen in post menopausal woman, peak incidence between 50-60.30-40:peak incidence of borderline tumorsLess common under 40 yrsMost common epithelial tumor is serous cystadenoma followed by mucinous.Sex cord stromal tumors: can occur at all ages Germ cell tumors: common among children, young adults -### End" -3604,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How would a drug that competes with ACh for receptors at the motor end plate affect skeletal muscle? It would:, with the following options: A: Produce uncontrolled muscle spasms, B: Cause the muscles to contract and be unable to relax, C: Cause muscles to relax and be unable to contract, D: Make the muscles more excitable - -### Response: -Ref: KD Tripathi pharmacology 7th edition (page.no: 58) Anticholinergic drugs compete with acetylcholine for receptors at NM junction . Anticholinergic opposes the action of Ach causing relaxation of the muscle. -### End" -3605,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hardly-weinberg law is related to -, with the following options: A: Population genetics, B: Health economics, C: Social medicine, D: None of the above - -### Response: -Hardly-weinberg law is related to population genetics Hardly-weinberg law states that the relative frequencies of each allele tends to remain constant from generation to generation in the absence of of forces that change the gene frequencies. ref; (page no;827) 23rd edition of PARK&;s textbook of Preventive and Social medicine -### End" -3606,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Baroreceptor reflex, true is, with the following options: A: From aoic and carotid body, B: Causes aerial vasoconstriction when BP falls, C: Causes decrease in HR when BP increases, D: Causes increase in HR when BP increases - -### Response: -Basically, this reflex is initiated by stretch receptors, called either baroreceptors or pressoreceptors, located at specific points in the walls of several large systemic aeries. A rise in aerial pressure stretches the baroreceptors and causes them to transmit signals into the CNS. Ref: Guyton and Hall textbook of medical physiology 13th edition. Page: 219 When BP increases ,it stimulates baroreceptors in carotid Sinus and aoic arch that increases the nerve traffic in CN IX and X. This leads to excitation of the NTS in the medulla---- inhibits vasomotor centre interneurons. ---- decreases sympathetic output and causes vasodilatation, bradycardia,decrease in cardiac output and fall in BP. Excitation of NTS also directly inhibits hea by stimulating vagus nerve . -### End" -3607,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a feature of Korsakoff Psychosis is, with the following options: A: Normal sensorium, B: Loss of recent memory, C: Loss of long term memory, D: Confabulation - -### Response: -A i.e. Normal Sensorium -### End" -3608,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the age of tendon transfer in post polio residual paralysis -, with the following options: A: <6 months, B: 1 year, C: 2 years, D: >5 years - -### Response: -Ans. is 'd' i.e., > 5 years * The available musclepower is redistributed either to equalize an unbalanced paralysis, or to use the motorpower for a more useful function.* It is not done before 5 years of age, asthe child has to be manageable enough tobe taught proper exercises.* More commonlyperformed tendon transfers are as follows:i) Transfer of extensor hallucis longus (EHL)from the distal phalanx of great toe tothe neck of the first metatarsal (modifiedjones operation). This is done to correctfirst metatarsal drop in case of tibialisanterior muscle weakness.ii) Transfer of peronius tertious and brevismuscles (evertors of the foot) to thedorsum of the foot. The transfer isrequired in a foot with dorsiflexor weakness.Evertors can be spared for moreuseful function of dorsiflexion of the foot.iii) Hamstring (knee flexors) transfer to thequadriceps muscle to support a weak knee extensor. -### End" -3609,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following condition is associated with Gottron's sign?, with the following options: A: Dermatomyositis, B: SLE, C: Scleroderma, D: MCTD - -### Response: -Gottron's sign is a characteristic feature of dermatomyosistis. It is a violaceous, erythematous, symmetrical rash that occur on the extensor surface of the metacarpophalangeal and interphalangeal joints. Similar lesions can also occur over the elbow and knees. Other features of dermatomyositis are -heliotrope rash which is a reddish purple rash that occur on the eyelids which is associated with swelling of the eyelid. -Periungal erythema -abnormal nail bed capillary loops and -cracking of the skin of the tips of fingers are also seen in dermatomyositis. -### End" -3610,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Human development index include all EXCEPT, with the following options: A: Life expectancy at birth, B: GDP per capita, C: Adult literacy rate, D: Life expectancy at one year age - -### Response: -(Life expectancy at one year) (16-Park 20th)HUMAN DEVELOPMENT INDEX-INDICATORSPHYSICAL QUALITY OF LIFE1. Longevity (Life expectancy at birth)2. Knowledge (Adult literary rate and mean years of school)3. Income (GDP per capita in purchasing power parity in US dollers)1. Infant mortality rate2. Life expectancy at age one3. Literacy* HDI - value ranges between O to 1* Norway and Australia are at maximum human development category* India comes in the medium human development categoryHUMAN POVERTY INDEX - three basic dimensions1. A long and healthy life - Probability at birth of not surviving to age 402. Knowledge - Adult literacy rate3. A decent standard of living(i) Percentage of population not using an improved water source(ii) Percentage of children under weight for age* The latest WHO protocol for classification and measurement of disability is - ICF (International classification of functioning)* Components of IDEAS (Indian Disability Evaluation and Assessment Scale (IDEAS))(i) Self care - body hygiene(ii) Interpersonal activities (social relationship)(iii) Communication and understanding(iv) Work - Includes three areas- Employment / Housework / Education (school / college)Disabilities are Act (1995)* Blindness* Leprosy cured* Mental retardation* Low vision* Hearing impairment* Mental illness** * Locomotor disability -### End" -3611,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paltauf's hemorrhage may be seen in:, with the following options: A: Drowning., B: Hanging, C: Snake bite, D: Rape - -### Response: -Ans. a (Drowning)In drowning, fluid actually penetrates alveolar wall to enter tissues & the blood vessels.The alveolar wall may rupture due to increased pressure during the forced expiration & produce hemorrhage which when presents subpleurally is called Paltauf 's haemorrhage.Paltauf's haemorrhages are shining, pale bluish red, & may be minute or 3 to 5 cm in diameter. -### End" -3612,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False regarding acanthosis nigricans is, with the following options: A: Prognostic indicator, B: Velvety plaques on diy hyperpigmentation, C: Confirmatory sign of malignancy, D: Gastric adenocarcinma is commonest malignant association - -### Response: -C. i.e. Confirmatory sign of malignancy -### End" -3613,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antipsychotic drug with prolonged action, with the following options: A: Trifluperazine, B: Thioridazine, C: Penfluridol, D: Fluphenazine - -### Response: -D i.e. Fluphenazine -### End" -3614,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Small intestinal peristalsis is controlled by :, with the following options: A: Myentric plexus, B: Meissners plexus, C: Vagus nerve, D: Para sympathetic system - -### Response: -Myenteric (Auerbach&;s) plexus is situated b/w and innervates outer longitudinal & middle circular muscular layers and is primarily concerned with motor controlQ. Submucosal (meissner&;s) plexus situated between middle circular layer and mucosa is primarly concerned with control of intestinal secretionQ as it innervates glandular epithelium, intestinal endocrine cells & submucosal blood vessels. Ref: Guyton 12th Ed. -### End" -3615,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A nullipara is on investigations for her infeility. She had a history of pulmonary tuberculosis which was treated effectively. If genital tuberculosis is the reason for her infeility, which organ can be affected the most?, with the following options: A: Tubes, B: Uterus, C: Cervix, D: Vagina - -### Response: -Genitourinary TB includes renal, ureteral, bladder, uterine-fallopian, prostatic, and epididymal disease. It is slightly more common in women than men and tends to involve older populations. The commonest site of affection is the Fallopian tubes. Both the tubes are affected simultaneously. The initial site of infection is in the submucosal layer (interstitial salpingitis) of the ampullary pa of the tube. The fimbriae are eveed and the abdominal ostium usually remains patent. The elongated and distended distal tube with the patent abdominal ostium gives the appearance of 'tobacco pouch'. Ref: Textbook of Gynaecology edited by D C Dutta, 4th edition, Page 129-130. -### End" -3616,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about ASHA -, with the following options: A: Male, B: Resident of village, C: 35-55 years age, D: Literate upto class five - -### Response: -Ans. is 'b' i.e., Resident of Village o ASHA must primarily be a woman resident of the village - married/ widowed/ divorced, preferably in the age group of 25 to 45 years.o She should be a literate woman with formal education up to class ten. This may be relaxed only if no suitable person with this qualification is available. -### End" -3617,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Level of prevention that includes Specific protection:, with the following options: A: Primordial, B: Primary, C: Secondary, D: Tertiary - -### Response: -Ans. b (Primary). (Ref: Park, PSM, 22nd/ 39, 351, 356, 361).LEVELS OF PREVENTIONPrimordial prevention# It is first prevention in its purest form i.e. prevention of emergence of development of risk factors in countries or population groups in which they have not yet appeared.# Efforts taken to discourage children from adopting harmful habits.# Main intervention is through the individual or the mass education.Primary prevention# Action taken prior to the onset of the disease, which removes possibility that a disease will ever occur.# Intervention is done in a pre-pathogenesis phase of a disease.# It is accomplished by health promotion, promotion of quality of life and specific protection.# It is applied to prevention of chronic disease (CAD, hypertension and cancer) based on elimination/modification of the risk factors by two strategies, namely;-Population/mass- High riskSecondary prevention# Action, which halts the progress of disease at its incipient stage and prevents complications.# Intervention includes early diagnosis and treatment.# It is largely the domain of clinical medicine, but is an imperfect tool in control of transmission.Tertiary prevention# When a disease has advanced beyond its early stage, it is still possible to accomplish prevention by tertiary intervention in late pathogenesis phase.# All measures available to decrease or limit impairment and disabilities, minimize sufferings and to promote adjustment to irremediable diseases. -### End" -3618,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child is having nocturnal asthmatic attack 2 times in a week, day time attack is 3 times or more, can be categorized as?, with the following options: A: Severe persistent asthma, B: Moderate persistent asthma, C: Mild intermittent, D: Mild persistent - -### Response: -Moderate persistent asthma REF: Nelson's pediatrics 17th ed page 767 CLASSIFICATION OF CHILDHOOD ASTHMA: Asthma Days with Nights Lung Long-Term-Control Medication Quick? Severity Symptoms with Function Relief Medication Symptoms Step 1: Mild <3 per week <3 per FEV1 or PEF No daily medication Sho-acting g-agonist Intermittent month =80% of predicted; PEF variability <20% needed as needed and before exercise; Use =3 times per wk may indicate need to initiate long? term-control therapy Step 2: Mild =3 per week 3-4 per FEV1 or PEF Anti-inflammatory: Sho-acting g-agonist Persistent month =80% of predicted; PEF variability 20-30% either low-dose inhaled glucocoicoid, cromolyn, nedocromil, or leukotriene modifier. as needed and before exercise; daily use or increasing use may indicate need for additional long-term? control therapy Sustained-release theophylline is an alternative Step 3: Moderate Persistent Daily symptoms daily use of sho-acting A-agonists >1 time per week FEV1 or PEF >60 and =80% of predicted; PEF variability >30% Anti-inflammatory: inhaled lucocoicoids (medium-dose) or inhaled glucocoicoids (low-dose) and either long-acting S-agonist Sho-acting S-agonist as needed and before exercise; daily use or increasing use may indicate need for additional long-term? control therapy (LABA), leukotriene modifier, sustained? release theophylline, or LABA tablets. Step 4: Continual Frequent FEV1 or Anti-inflammatory: Oral glucocoicoid if Severe Persistent symptoms, limited PEF =60% of inhaled glucocoicoids (high- needed. Sho-acting 8-agonist physical predicted; dose) and long-acting as needed and before activity, frequent PEF variability bronchodilator: either LABA, leukotriene exercise; daily use or increasing use may exacerbations >30% modifier, sustained- release theophylline, and/or LABA tablets. indicate need for additional long-term? control therapy -### End" -3619,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In cases of recurrent aboions, most common uterine malformation seen is?, with the following options: A: Mullerian fusion defects, B: Uterine syncytium, C: Unicornuate uterus, D: Uterine agenesis - -### Response: -Mullerian fusion defects REF: William's 22' ed chapter 9 Abnormal Mullerian duct formation or fusion defects may develop spontaneously or may follow in utero exposure to diethylstilbestrol is the commonest cause of uterine factors leading to recurrent spontaneous aboions. -### End" -3620,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Positive predictive value of a screening test is measured by-, with the following options: A: True positive x 100 (True positive + False positive), B: True negative x 100 (false positive + false negative), C: True positive x 100\/ (True positive + False negative), D: True negative x 100 (True positive + False negative - -### Response: -. -### End" -3621,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corneal dystrophy associated with acid mucopolysaccharidosis is:, with the following options: A: Lattice, B: Granular, C: Macular, D: Peripheral - -### Response: -Ans. Macular -### End" -3622,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Polytrauma in paediatric age group most common feature is -, with the following options: A: Hypothermia, B: Hypovolemic shock, C: Hypotension, D: Hypoxemia - -### Response: -Ans. is 'b' i.e., Hypovolemic shock o Due to the greater physiological capacity and ability' of children to compensate for fluid loss, hypotension is a very late and ominous sign of hypovolaemic shock.o Once they have become hypotensive, deterioration can be rapid and fatal.o As the surface area to body volume ratio of children is high, thermal energy' loss is higher and hypothermia is a higher risk. -### End" -3623,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Digoxin is contraindicated in(REPEAT), with the following options: A: Supraventricular tachycardia, B: Atrial fibrillation, C: Congestive hea failure, D: Hyperophic obstructive cardiomyopathy - -### Response: -non selective beta blockers(propanolol)are the Agents of choice for hyperophic obstructive cardiomyopathy in hyperophic obstructive cardiomyopathy, the left ventricular outflow tract is narrowed during systole due to hyperophic septum.. obstraction is worsened by Factors increasing myocardial contractility-digitalis,sympathetic stimulation factors decreasing left ventricular filling-valsalva maneuver,peripheral vasodilators Refer kDT 6/e p143 -### End" -3624,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication of mumps in children is -, with the following options: A: Orchitis, B: Aseptic meningitis, C: Pancreatitis, D: Myocarditis - -### Response: -Mumps has been repoed to cause about 10_15%of aseptic meningitis. Which is more severe REF:ANANTHANARYANAN TTEXTBOOKOF MICROBIOLOGY 9EDITION PGNO.508 -### End" -3625,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The incidence of mental illness is the maximum if the causal factors affect a particular period –, with the following options: A: Perinatal period, B: First five years of life, C: School age, D: Adolescence - -### Response: -The root of mental health are in early childhood (first 5 years of life) - Park -Other crucial period for mental illness : - - - -Pregnancy (Prenatal period) -School age -Adolescence -Old age -### End" -3626,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alkalinisation of urine may be done in cases of poisoning with:, with the following options: A: Barbiturates, B: Amphetamines, C: Alcohol, D: Morphine - -### Response: -Achieving a urinary pH of 7.5 to 9 promotes excretion of drugs that are weak acids such as long acting barbiturates (phenobarbital). Ref: The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Pages 456, 519; Parikh's Textbook of Medical Jurisprudence and Toxicology, 6th Edition, Page 8.17; Modi's Medical Jurisprudence and Toxicology, 23rd Edition, Page 17; KDT, 6th Edition, Page 392 -### End" -3627,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Guinea worm prophylaxis, all are true, except ?, with the following options: A: Acute search of new cases, B: Identification of carriers, C: Mass treatment with Mebendazole, D: Health education to people to use a sieve for straining drinking water - -### Response: -Ans. is 'c' i.e., Mass t/t with mebendazole o No drug is suitable for effective mass treatment of Dracunculiasis. o The drugs effective for t/t of cases of Dracunculiasis Niridazole Mebendazoel Metronidazole -### End" -3628,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CB 1 antagonist used in smoking cessation is ?, with the following options: A: Naloxona, B: Rimonabant, C: Vareniloline, D: Bupripion - -### Response: -Ans. is 'b' i.e., Rimonabant Rimonabant A selective cannabinoid receptor-1 (CB-1) antagonist which is being tried as antismoking and antiobesity drug. -### End" -3629,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Craniotabes is seen in following except?, with the following options: A: Rickets, B: Syphilis, C: Osteogenesis imperfecta, D: Thalassemia - -### Response: -Ans. is 'd' i.e., Thalassemia Craniotabes is seen in o Rickets o Hydrocephalus o Osteogenesis imperfecta o Syphilis -### End" -3630,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the cardiac cycle duration (sec) in a man at hea rate of 75/min?, with the following options: A: 0.4, B: 0.8, C: 1, D: 1.6 - -### Response: -Duration of cardiac cycle (at hea rate of 75/min) is 0.8sec out of which duration of systole is 0.27sec and diastole is 0.53sec. Length of Systole and Diastole: Cardiac muscle has the unique propey of contracting and repolarizing faster when the hea rate is high, and the duration of systole decreases from 0.27 s at a hea rate of 65-0.16 s at a rate of 200 beats/min. The reduced time interval is mainly due to a decrease in the duration of systolic ejection. However, the duration of systole is much more fixed than that of diastole, and when the hea rate is increased, diastole is shoened to a much greater degree. For example, at a hea rate of 65, the duration of diastole is 0.62 s, whereas at a hea rate of 200, it is only 0.14 s Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 30. The Hea as a Pump. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e. -### End" -3631,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A three week old infant presented in the paediatric outpatient department having non bilious vomiting; which is projectile in nature. O/E child is found to be slightly dehydrated. A vigorous peristaltic wave was seen to move from left hypochondrium to umbilicus after feeding. The most likely diagnosis in the infant is:, with the following options: A: Pyloric stenosis, B: Abdominal Tuberculosis, C: Gastro-esophageal reflux disease, D: Cyclical vomiting - -### Response: -Ans. A. Pyloric stenosisThis is a classical presentation of Idiopathic HPS. It is the most common surgical disorder of gastrointestinal tract in infants.This disorder is 4-6 times more common in boys than girls. In 75-80% of affected infants, a firm olive shaped mass is palpable in the medgastrium. USG abdomen is the diagnostic investigation and shows muscle thickness of >4mm & pylorus length>16mm. -### End" -3632,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fracture neck femur cause of non-union, with the following options: A: smoking, B: Poor nutrition of the patient, C: Injury to blood supply with shearing stress, D: Old age and osteoporosis - -### Response: -Estimates of wall shear stress at various locations in the circulation have been level of shear stress due to alterations in blood flow rate and vessel wall diameter.in part, in vivo responses of injured or activated endothelium to shear stress. -### End" -3633,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of intra peritoneal abscess is, with the following options: A: Right superior intra peritoneal space, B: Left superior intra peritoneal space, C: Right inferior intra peritoneal space, D: Left inferior intra peritoneal space - -### Response: -Most common site of abscess in lying and dependent positive - Right inferior intra peritoneal space. -### End" -3634,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bisphosphonates are prescribed to a patient with the following advice, with the following options: A: Take empty stomach with plenty of water, B: Take after meals, C: Discontinue if gastritis develops, D: Discontinue if severe bone pain occurs - -### Response: -Ans. (A) Take empty stomach with plenty of water(Ref: KDT 8th/370)Bisphosphonates are to be taken empty stomach in the morning with full glass of water and patient is instructed not to lie down or take food for at least 30 min. These measures are required to prevent contact of the drug with esophageal mucosa which result in esophagitis. -### End" -3635,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are presentation of retinoblastoma except:, with the following options: A: Leucocoria, B: Squint, C: Cataract, D: Glaucoma - -### Response: -C i.e. Cataract -### End" -3636,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Great cardiac vein drains into -, with the following options: A: Anterior cardiac vein, B: Coronary sinus, C: Thebesian vein, D: Venae cordis minimi - -### Response: -Ans. is 'b' i.e., Coronary sinus Veinous drainage of heart1. Coronary sinus: Opens into right atrium and has following tributries : (i) Great cardiac vein, (ii) Middle cardiac vein, (iii) Posterior vein of left ventricule, (iv) Small cardiac vein, (v) Oblique vein of left atrium and (vi) Sometimes right marginal vein.2. Anterior cardiac vein : Opens into right atrium.3. Venae cardis minimi (thebasian veins) : Open into right atrium.4. Right marginal vein : More often opens into right atrium but sometimes into coronary sinus. -### End" -3637,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Keshan disease is caused due to deficiency of:, with the following options: A: Selenium, B: Chromium, C: Iodine, D: Iron - -### Response: -Keshan disease is an endemic cardiomyopathy found in children and young women residing in regions of China where dietary intake of selenium is low ( Ref: Harrison's principle of internal medicine 17th edition, chapter 71. -### End" -3638,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Raised calcium and phosphorus are seen in -, with the following options: A: CRF, B: Vitamin D intoxication, C: Hyperparathyroidism, D: pseudohypoparathyroidism - -### Response: -

Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of PTH. The elevation of circulating hormone usually leads to hypercalcemia and hypophosphatemia.Hypercalcemia in vitamin D intoxication is due to an excessive biologic action of the vitamin, perhaps the consequence of increased levels of 25(OH)D rather than merely increased levels of the active metabolite 1,25(OH) 2 D (the latter may not be elevated in vitamin D intoxication). 25(OH)D has definite, if low, biologic activity in the intestine and bone. The production of 25(OH)D is less tightly regulated than is the production of 1,25(OH) 2 D. Hence concentrations of 25(OH)D are elevated severalfold in patients with excess vitamin D intake. The diagnosis is substantiated by documenting elevated levels of 25(OH)D >100 mg/mL. Hypercalcemia is usually controlled by restriction of dietary calcium intake and appropriate attention to hydration. These measures, plus discontinuation of vitamin D, usually lead to resolution of hypercalcemia. However, vitamin D stores in fat may be substantial, and vitamin D intoxication may persist for weeks after vitamin D ingestion is terminated. Such patients are responsive to glucocoicoids, which in doses of 100 mg/d of hydrocoisone or its equivalent usually return serum calcium levels to normal over several days; severe intoxication may require intensive therapy(harrison 18 pg 3108)

-### End" -3639,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bilateral pleural effusion may occur in all of the following conditions except:, with the following options: A: Pneumococcal pneumonia, B: Constrictive pericarditis, C: Congestive cardiac failure, D: Nephrotic syndrome - -### Response: -Exudative Pleural EffusionTransudative Pleural effusionExudative pleural effusion occurs when local factors that influence the formation and absorption of pleural fluid are altered.Transudative pleural effusion occurs when systemic factors that influence the formation and absorption of pleural fluid are altered.LIGHT's CRITERIATotal serum protein > 3 gm/dlPleural fluid protein/serum protein > 0.5Pleural fluid LDH/serum LDH > 0.6Pleural fluid LDH >2/3rd upper limit of serumTotal serum protein <3 gm/dlPleural fluid protein/serum protein < 0.5Pleural fluid LDH/serum LDH < 0.6Pleural fluid LDH <2/3rd upper limit of serumCausesNeoplasms - metastatic diseases, mesothelioma Infections - bacterial, viral, fungal, parasitic tuberculosis Pulmonary embolism Collagen vascular disorders - SLE, rheumatoid ahritis, Wegener's granulomatosis Gastrointestinal diseases UraemiaMeig's syndrome Chylothorax, hemothorax Ovarian hyperstimulation syndrome Drug-induced - bromocriptine, amiodarone, nitrofurantoin, dantrolene Congestive hea failureCirrhosisTrapped lung Nephrotic syndromeHypoalbuminemiaHepatic hydrothoraxPeritoneal dialysisConstrictive pericarditis SVC obstructionMyxedemaUrinothoraxRight-sided pleural effusionLeft sided pleural effusionCCF, CRF Liver cirrhosis with poal hypeensionAmoebic liver abscess Subphrenic abscessThoracic duct involvement below D5 level Pancreatitis Pericardial inflammation Oesophagal ruptureLeft-sided subdiaphragmatic abscessThoracic duct involvement above D5 levelBilateral pleural effusionPleural effusion in AIDSCCF Meig's syndrome Pulmonary infarction HypoalbuminemiaMalignancy Kaposi sarcoma Parapneumonic effusion Tuberculosis Cryptococcosis Lymphoma (Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 2181) -### End" -3640,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The best indicator for determining the general level of air pollution in an urban area is, with the following options: A: Sulphur dioxide, B: Carbon dioxide, C: Hydrogen, D: Nitrogen - -### Response: -(A) Sulphur dioxide > Best indicators of air pollution are sulphur dioxide, smoke, suspended particles.# Monitoring of air pollution> Best indicators of air pollution are sulphur dioxide, smoke and suspended particles> These are monitored on a daily basis over several sites. The results are then collected by a central agency.> Sulphur dioxide: This gas is a major contaminant in many urban and industrial areas. Its concentration is estimated in all air pollution surveys, -### End" -3641,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following tests can be used for diagnosing celiac disease except:, with the following options: A: Anti - gliadin antibodies, B: Anti - ulcer antibodies, C: Anti- Endomysial antibodies, D: Anti-tissue transglutaminase antibodies - -### Response: -Antibody testing, immunoglobulin A anti-tissue transglutaminase antibody (IgA TTG), is the best first test, The most sensitive and specific antibodies for the confirmation of celiac disease are Anti tissue transglutaminase IgA, Anti endomysial IgA, Anti reticulin IgA , correlate with the degree of mucosal damage. Anti-gliadin antibodies were one of the first serological markers for coeliac disease. -### End" -3642,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During a disaster, rapidly classifying the injured on the basis of likelihood of their survival with prompt medical intervention, is a part of, with the following options: A: Search, rescue and first aid, B: Tagging, C: Triage, D: Disaster mitigation - -### Response: -Triage: -Consists of rapidly classifying the injured ‘on the basis of severity of their injuries and likelihood of their survival’ with prompt medical intervention. -### End" -3643,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statements regarding octreotide are all of the following except: September 2009, with the following options: A: Synthetic octapeptide, B: Used in variceal bleeding, C: Contraindicated in acromegaly, D: Useful in secretory diarrhea - -### Response: -Ans. C: Contraindicated in Acromegaly Octreotide is an synthetic octapeptide that mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone. Salt form of this peptide, octreotide acetate, is used as an injectable depot formulation for the treatment of acromegaly, the treatment of secretory diarrhea and flushing episodes associated with carcinoid syndrome, and treatment of diarrhea in patients with vasoactive intestinal peptide-secreting tumors (VlPomas). Octreotide has also been used off-label for the treatment of severe, refractory diarrhea from other causes. It is used in toxicology for the treatment of prolonged recurrent hypoglycemia after sulfonylurea and possibly meglitinides overdose. Octreotide has also been used with varying degrees of success in infants with nesidioblastosis to help decrease insulin hypersecretion. In patients with suspected esophageal varices, octreotide can be given to help decrease bleeding. Octreotide may be useful in the treatment of thymic neoplasms. It has been used in the treatment of malignant bowel obstruction. Octreotide may be used in conjunction with midodrine to paially reverse peripheral vasodilation in the hepato-renal syndrome. By increasing systemic vascular resistance, these drugs reduce shunting and improve renal perfusion, prolonging survival until definitive treatment with liver transplant. -### End" -3644,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of heavy chain disease is?, with the following options: A: Alpha chain disease, B: Gamma chain disease, C: Mu chain disease, D: Delta chain disease - -### Response: -Ans. is 'a' i.e., Alpha chain disease * Heavy chain diseases are plasma cell disorders that are typically malignant. They are a form of paraproteinemias in which incomplete monoclonal immunoglobulins (true paraproteins) are produced. They consist of only heavy chain components (either alpha , gamma , mu , or delta ) without light chains.* The clinical picture is more like lymphoma than multiple myeloma* There are four forms:i) Alpha chain disease (Seligmann's disease)- most common typeii) Gamma chain disease (Franklin's disease)iii) Mu chain diseaseiv) Delta chain disease -### End" -3645,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rate of recurrence of breech presentation in the second pregnancy is, with the following options: A: 5%, B: 10%, C: 15%, D: 20% - -### Response: -Following one breech delivery, recurrence rate for second pregnancy to have breech is 10% and that for a subsequent third pregnancy is 27%. -### End" -3646,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In controlled ventilation – a) Patient is activeb) Patient is passivec) Ventilator is actived) IPPVe) Ventilater is passive, with the following options: A: abc, B: bcd, C: ac, D: bd - -### Response: -Controlled mechanical ventilation is total support ventilator, i.e. total support is provided by ventilator :- ventilator is active and does all the work; patient is passive. CMV is also known as intermittent positive pressure ventilation (IPPV). -### End" -3647,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lymphatic drainage of clitoris :, with the following options: A: Lymph node of Cloquet, B: Deep inguinal, C: Superficial inguinal, D: Obturator - -### Response: -B i.e. Deep inguinal lymph nodeGlans of penis / & clitoris drain through deep inguinal lymph node of cloquetQ -### End" -3648,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lytic lesion in skull are seen in following except:, with the following options: A: Multiple myeloma, B: Metastasis ca bronchus, C: Thalassemia, D: Ca prostate - -### Response: -D i.e. Ca Prostate -### End" -3649,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common chromosomal syndrome is:, with the following options: A: Fragile X-syndrome, B: Trisomy 17, C: Trisomy 21, D: Trisomy 13 - -### Response: -c. Trisomy 21(Ref: Nelson's 20/e p 618-619)Down syndrome (Trisomy 21) is the most common of the chromosomal disorder.Trisomy 16 is the most common trisomy overall, however most do not survive and die in utero Hence, among the live births, or among children, most common chromosomal abnormality is Trisomy 21 -### End" -3650,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for cheese reaction ?, with the following options: A: Prazocin, B: Pentazocin, C: Phentolamine, D: Phenoxybenzamine - -### Response: -Ans. is 'c' i.e., Phentolamine Cheese reaction Ceain varieties of cheese, beer, wines, picked meat and fish, yeast extract contain large quantities of tyramine, dopa. In MAO inhibited patients these indirectly acting sympathomimetic amines escape degradation in the intestinal wall and liver - reaching into systemic circulation they displace large amount of NA from adrenergic nerve endings Hypeensive crisis, cerebrovascular accidents. This can be treated by i.v. injection of a rapidly acting phentolamine. Prazosin and chlorpromazine are alternative. -### End" -3651,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following statements is NOT true:, with the following options: A: An Additional Sessions Judge can award any 'punishment authorized by law', B: An Assistant Sessions Judge can award imprisonment for a term exceeding 10 years, C: Death sentence passed by an Additional Sessions Judge has to be confirmed by the High /Cou, D: An Assistant Sessions Judge cannot pass a death sentence - -### Response: -An Assistant Sessions Judge can award imprisonment for a term exceeding 10 years (Sessions cou is located at district headquaers. It can pass any sentence authorized by law but a sentence of death must be confirmed by the high cou (Sec. 366 CrPC). Assistant Sessions cou can pass any sentence except a sentence of death or imprisonment for a term> 10 yrs (Sec. 28 CrPC).) -### End" -3652,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ocular manifestation of HIV are all except:, with the following options: A: Predispose to viral, bacterial and fungal function, B: Kaposi sarcoma, C: CMV retinitis, D: None - -### Response: -Ans. None -### End" -3653,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following enzyme is deficient in Niemann pick disease?, with the following options: A: Sphingomyelinase, B: Hexosaminidase-A, C: Aryl sulfatase, D: Galactosidase-A - -### Response: -Niemann-Pick disease (NPD) is a lipid storage disorder that results from the deficiency of a lysosomal enzyme, acid sphingomyelinase. The enzymatic defect results in pathologic accumulation of sphingomyelin (which is a ceramide phospholipid) and other lipids in the monocyte-macrophage system. Systemic involvement includes progressive lung disease, hepatosplenomegaly, sho stature, and pancytopenia. Ref: Clinical Studies in Medical Biochemistry Edited By Robe H. Glew, Miriam D. Rosenthal, 2006, Page 192; Lehninger Principles of Biochemistry, 4th Edition, Page 356 -### End" -3654,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common serotype of HPV associated with invasive cervical carcinoma is, with the following options: A: HPV 16, B: HPV 18, C: HPV 32, D: HPV 36 - -### Response: -. -### End" -3655,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are indications for bariatric surgery except -, with the following options: A: BMI>40kg/m2, B: BMI> 35 kg/m2 with atleast one comorbidity, C: BMI>30 with long standing diabetes, D: Failure of other methods of wight loss - -### Response: -Ans. is 'c' i.e., BMI>30 with long standing diabetes Indications for bariatric surgerya) BMI > 40 kg/m2b) BMI >35 kg/m2 with atleast one comorbidityc) Patient at high risk of obesity associated morbidity and mortalityd) Failure of other methods of wight loss -### End" -3656,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person is consuming alcohol since 10 years is brought to hospital emergency with complains of fearfulness, misrecognition, self talking and seeing snakes and reptiles all around him. Physical dependence is present since last 2 years. He has an intense craving for alcohol and from last 1 year, he is having behavioural changes and experiencing different family and social issue. Sometimes he is said to have few tremors during night. The person is suffering from:March 2013 (b, d, f), with the following options: A: Alcoholic psychosis, B: Delirium tremens, C: Wernicke's Korsakoff syndrome, D: Schizophrenia - -### Response: -Ans. B i.e. Delirium tremens -### End" -3657,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old man is seeing a male psychologist for dynamic psychotherapy. He feels very angry with the psychologist as he finds that the psychologist is exeing his authority like his abusive father. The phenomenon is known as?, with the following options: A: Acting out, B: Boundary violation, C: Transference, D: Resistance - -### Response: -This phenomenon is known as transference because the patient unconsciously relates the therapist to someone from his past (i.e. his abusive father). Conversely , the feeling doctor feels towards the patient based on current feelings and feelings from the past is known as counter transference. -### End" -3658,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the central nervous system (CNS), oligodendrocytes share a similar function with, with the following options: A: Gemistocytes, B: Astrocytes, C: Schwann cells, D: Microglial cells - -### Response: -Oligodendrocytes in the central nervous system (CNS) share a similar function with Schwann cells in the peripheral nervous system-synthesis of myelin. Oligodendrocytes are small, round, lymphocyte-size cells that produce and maintain CNS myelin, which is primarily located in the white matter. Ceain diseases, such as progressive multifocal leukoencephalopathy, caused by a papovavirus, specifically attack oligodendrocytes and produce demyelination. Oligodendrogliomas are malignant tumors that are derived from oligodendrocytes. However, unlike Schwann cells, oligodendrocytes contribute segments of myelin sheaths to more than one axon. Gemistocytes are reactive astrocytes that have an eosinophilic cytoplasm. They are commonly seen along the periphery of cerebral infarctions. Some astrocytomas have a gemistocytic appearance. Astrocytes provide the structural framework for the neurons and are analogous to the fibroblasts in connective tissue. However, scarring in the brain is not associated with collagen synthesis but with filling in the defect with the cellular processes of astrocytes. A cerebral abscess is the only example of CNS repair with collagen, which is derived from the blood vessels. Microglial cells are derived from monocytes. They are the phagocytic cell of the CNS. Ependymal cells line the ventricles of the brain and the spinal canal. They do not produce CSF nor are they responsible for reabsorption of CSF, a function relegated to arachnoid cells. Ref - Harrison's principles of internal medicine 20e pg 349 , britannica.com -### End" -3659,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Histone acetylation causes?, with the following options: A: >Increased Heterochromatin formation, B: >Increased Euchromatin formation, C: >Methylation of cystine, D: >DNA replication - -### Response: -Increased Euchromatin formation Histone acetylation promotes Euchromatin formation (transcriptionally active DNA). Deacetylation and methylation promotes Heterochromatin formation (transcriptionally inactive DNA). There are five classes of histones, designated HI, H2A, H2B, H3, and H4. These small proteins are positively charged at physiologic pH as a result of their high content of lysine and arginine. Because of their positive charge, they form ionic bonds with negatively charged DNA. Histones help in condensation of DNA into chromosomes. Two molecules each of H2A, H2B, H3, and H4 form the structural core of the individual nucleosome ""beads."" Around which a segment of the DNA double helix is wound nearly twice. (Histone HI, is not found in the nucleosome core, but instead binds to the linker DNA chain between the nucleosome beads.). Nucleosomes are fuher arranged into increasingly more complex structures that organize and condense the long DNA molecules into chromosomes. These histone proteins can undergo reversible modifications at their N-terminal end (like acetylation, methylation or phosphorylation). These modifications help in regulation of gene expression. Acetylation of the lysine residues at the N terminus of histone proteins removes positive charge on the lysine and thereby decreases the interaction of the histone with the negatively charged DNA. As a result, the condensed chromatin is transformed into a more relaxed structure allowing transcription factors to access specific regions on the DNA. Deacetylation restores the positive charge, causing stronger interactions between histones and DNA. Thus histone acetylation enhances transcription while histone deacetylation represses transcription. Relaxed, transcriptionally active DNA is referred to as euchromatin. More condensed, inactive DNA is referred to as heterochromatin. Histone acetylation is catalyzed by histone acetyltransferases (HATS) and histone deacetylation is catalyzed by histone deacetylases (denoted by HDs or HDACs). Another difference noted between transcriptionally active and inactive chromatin is the extent of methylation of cytosine bases in CG-rich regions (CG islands) of many genes. It has been observed that transcriptionally active genes are less methylated (hypomethylated) than their inactive counterpas. Thus formation of euchromatin is promoted by acetylationand formation of heterochromatin is promoted by deacetylation and methylation. The action of methylation is indirect and has no effect upon charge. -### End" -3660,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inheritance of colour blindness is -, with the following options: A: Y linked, B: X linked recessive, C: Autosomal dominant, D: Autosomal recessive - -### Response: -Ans. is 'b' i.e., X linked recessive * Colour blindness has X linked recessive inheritance.* Hence it has criss cross inheritance.* It passes from a carrier mother to her son.* Females are carriers in this disease. -### End" -3661,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wahin-Finkeldey giant cells are seen in ?, with the following options: A: Measles, B: Rubella, C: Influenza, D: Rickettsial pox - -### Response: -Ans. is 'a' i.e., Measles Wahin-Finkeldey cells are multinucleated giant cells. These cells are pathognomic of measles and are found in lymphoid organs, lung and sputum. -### End" -3662,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following Is not feature of ahritis in acute rheumatic fever?, with the following options: A: Elevated ASO titer, B: Joint deformities are common sequel, C: Dramatic response to aspirin, D: Involvement of large joints - -### Response: -Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:146-147 Rheumatic Fever Acute, recurrent, inflammatory disease, mainly of children (aged 5-15 years), typically occurring 1-5 weeks after group A streptococcal infection. Pathophysiology 1. Cross reactivity of host antistreptococcal antibodies to cardiac antigens 2. Microbe initiated autoimmune reactivity. Jones Criteria for Diagnosis of Rheumatic Fever Major Criteria Carditis Pancarditis, seen in 50-60% of patients, develops within the first 2 weeks of rheumatic fever. Pericarditis is evidenced by presence of a pericardial rub, myocarditis by tachycardia, soft S1, presence of S3 and CCF and endocarditis by the presence of Carey-Coombs' murmur (mitral diastolic murmur). Ahritis (60-75%) Flitting and fleeting type of polyahritis involving large joints with no residual deformity is seen in 60-75% of patients and occurs early in rheumatic fever. Jaccod's ahritis: Ulnar detion of 4th and 5th finger with flexion at metacarpophalangeal joints is the only residual deformity seen in rheumatic polyahritis. Subcutaneous Nodules Non-tender nodules are seen over bony prominences like elbows, shin, occiput, spine in 3-5% of patients and occur 3-6 weeks after onset of rheumatic fever. Patients who have subcutaneous nodules almost always have carditis. Erythema Marginatum (< 5% and evanescent) Macular lesions with an erythematous rim and central clearing in a bathing suit distribution are seen in < 5% of patients and occur early in rheumatic fever. Chorea (Sydenham's Chorea) (2-30%) A neurological disorder with rapid, involuntary and purposeless non-repetitive movements with a self limiting course of 2-6 weeks is more common in females and is a late manifestation of rheumatic fever. Minor Criteria Clinical 1. Fever 2. Ahralgia 3. Previous history of rheumatic fever or rheumatic hea disease. Laboratory 1. Acute phase reactants (leucocytosis, raised ESR, C-reactive protein) 2. Prolonged PR interval in ECG (> 0.2 sec). WHO Criteria Jones major and pa of the minor criteria except prior history of rheumatic fever/rheumatic hea disease and C-reactive protein. Essential Criteria Evidence for recent streptococcal infection as evidenced by: 1. Increase in ASO titre a. > 333 Todd units (in children) b. > 250 Todd units (in adults). 2. Positive throat culture for streptococcal infection. 3. Recent history of scarlet fever. Two major (or) one major and two minor criteria, in the presence of essential criteria, is required to diagnose Acute Rheumatic Fever. A Positive Rheumatic Fever history is usually elicited in only 50% of patient with Rheumatic Hea Disease. -### End" -3663,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An oblique of olecranon. If displaced proximally. The treatment is, with the following options: A: Excision & resuturing, B: Tension band wiring, C: Elbow is imbolised by cast, D: Open reduction & external fixation - -### Response: -B i.e. Tension band wiring -### End" -3664,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about polioviruses is -, with the following options: A: Most cases are symptomatic, B: Spastic paralysis, C: Injectables and severe exercise increases chance of paralysis, D: Inactivated polio vaccine are given to child less than 3 years of age - -### Response: -91-96% cases of polio virus infections results in inapparent or subclinical infection .There are no presenting complaints .Recognition only by virus isolation or rising antibody titre. In case of paralytic polio the predominant sign is asymmetrical flaccid paralysis. The primary course of immunisation consists of 4 inoculations. First 3 doses are given at interval of 1to 2 months and 4th dose 6 to 12 months after 3rd dose. IPV first dose is given when 6 weeks old.Additional doses are recommended prior to school entry and then every 5 years until 18 years Reference : Park's Textbook of preventive and social medicine, 24th edition.Pg no. 221 -### End" -3665,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: true about graft versus host disease is, with the following options: A: Associated with solid organ transplantation, B: Graft must contains immunocompetent T cells, C: It is seen in immunosuppressant persons, D: Also called as runt disease - -### Response: -Ref Robbins 9/e p232-233 Graft versus host reaction occurs in any situation in which immunological competent cells or there precursor are transplanted into immunological crippled recipient cells and the transfer cells recognize alloantigens in the host -### End" -3666,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The mechanism that protects normal pancreas from autodigestion is :, with the following options: A: Secretion of biocarbonate., B: Protease inhibitors present in plasma., C: Proteolytic enzymes secreted in inactive form., D: The resistance of pancreatic cells. - -### Response: -Ans. is 'c' i.e. proteolytic enzymes secreted in inactive form The pancreatic enzymes have the capability of digesting the pancreas itself (mainly proteases)(Auto digestion of pancreas is considered to be the main pathogenic mechanism for pancreatitis)Normally, auto digestion of pancreas is prevented by several means :The enzymes are synthesized as inactive pro enzymes (with the exception of amylase and lipase)They are sequestered in membrane bound zymogen granules in acinar cellsActivation of pro enzymes requires conversion of inactive trypsinogen to active trypsin by duodenal enteropeptidaseTrypsin inhibitors are present within acinar and ductal secretionsIntra pancreatic release of trypsin activates an enzyme or enzymes that degrades other enzymes to inert products.Lysosomal enzymes are capable of degrading zymogen granules when normal acinar secretion is impaired or blocked.Acinar cells are remarkably resistant to the action of trypsin, chymotrypsin and phospholipase A2Regarding option V pancreatic enzymes require alkaline medium for their activity so bicarbonate secretion will help in their activity. -### End" -3667,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cotard's syndrome has, with the following options: A: Persecutory delusions, B: delusion of marital infedility, C: Nihilistic delusions, D: referential delusions - -### Response: -In the 19th century, the French psychiatrist Jules Cotard described several patients with a syndrome called delire de negation. sometimes referred to as nihilistic delusional disorder or Cotard syndrome. Patients with the syndrome complain of having lost not only possessions, status, and strength but also their hea, blood, and intestines. this is more commonly seen in depression. persecutory and referential delusions are common in psychosis like schizophrenia delusion of marital infedility is common in othello syndrome Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th edition, Page 336,307 -### End" -3668,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following technique is employed in radiotherapy to counteract the effect of tumour motion due to breathing?, with the following options: A: Gating, B: Shunting, C: Modulation, D: Arc technique - -### Response: -The technique employed in radiotherapy to counteract the effect of tumour motion due to breathing is known as gating. In gated radiotherapy, beam is turned on only during a ceain phase of respiratory cycle, generally at the end of expiration. Respiration is monitored using external markers placed on the patients chest, which are assumed to move similarly to the tumor. This is done in patients who can breathe regularly and reproducibly. Advantage of this technique is that, it decreases the internal target volume and reduce the volume of normal tissue that is irradiated. Disadvantage of this approach is prolonged treatment time and lack of direct imaging of tumor position during treatment. Ref: Lung Cancer By Kemp H. Kernstine, Page 209; Biomedical Physics in Radiotherapy for Cancer By Barry Allen, 2012 -### End" -3669,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for pleomorphic adenoma:-, with the following options: A: Superficial parotidectomy, B: Radical parotidectomy, C: Enucleation, D: Radiotherapy - -### Response: -PLEOMORPHIC ADENOMA It isMC benign salivary gland tumor and MC tumor of major salivary glandsQ. MC site is parotid tail (superficial lobe)Q CLINICAL FEATURES Presents as painless swelling without any appreciable change in size, with typical site at below, in front and behind the ear lobuleQ. DIAGNOSIS FNAC is diagnosticQ TREATMENT Superficial parotidectomy (Patey's operation)Q Excision of whole gland in cases of pleomorphic adenoma of submandibular gland Name of incision for parotidectomy: Lazy 'S', modified Blairs or Sistrunk incisionQ -### End" -3670,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Indications for needle aspiration in liver abscess are :, with the following options: A: Recurrent, B: Left lobe, C: Refractory to treatment after 48-72 hrs., D: > 10 cms size - -### Response: -Ans. is 'b' i.e. left lobe The abscesses referred to in this question are amebic abscesses and not pyogenic abscesses as drainage is indicated in every pyogenic abscess. The mainstay of treatment for amebic abscesses is metronidazole which is curative in over 90% of pts. Clinical improvement is seen within 3 days. Aspiration is only recommended for following conditions - for diagnostic unceainity - for failure to respond to therapy in 3 to 5 days (5 to 7 days according to Maingot's) - abscesses with high risk to rupture (abscess > 5 cms, left lobe abscess) - pyogenic superinfection -### End" -3671,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old male presented with signs and symptoms of restrictive hea disease. A right ventricular endomyocardial biopsy revealed deposition of extracellular eosinophilic hyaline material. On transmission electron microscopy, this material is most likely to reveal the presence of, with the following options: A: Non branching filaments of 7.5 to 10 nm, B: Cross banded fibres with 67 m periodicity, C: Weber Palade bodies, D: Concentric whorls of lamellar structures - -### Response: -Amyloidosis is the major cause of restrictive cardiomyopathyCardiac amyloid is classically suspected from thickened ventricular walls with an ECG that shows low voltage.By electron microscopy, all types of amyloid consist of continuous, nonbranching fibrils with a diameter of approximately 7.5 to 10 nm. X-ray crystallography and infrared spectroscopy demonstrate a characteristic cross-b-pleated sheet conformationHarrison 19e pg: 1567 -### End" -3672,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which statement best describes the common femoral aery?, with the following options: A: The Femoral Aery initially lies lateral to the vein, and moves to lie posteriorly as it descends., B: Gives the Profunda Femoris branch within the Femoral Sheath., C: Lies between the Saphenous vein and Femoral Vein below level of the Thigh., D: Lies over Pectineus as it passes under the Inguinal Ligament. - -### Response: -The Femoral Aery initially lies lateral to the vein, and moves to lie posteriorly as it descends. Saphenous Nerve is the terminal branch of the Femoral nerve and initially lies lateral to the aery, passing anteriorly as it descends ,so Femoral Aery lies between Femoral Vein and Saphenous Nerve. The Common Femoral Aery is the continuation of the External Iliac Aery and commences beneath the Inguinal Ligament at the mid-inguinal point. The branches of the Femoral Aery include the Superficial Epigastric, Superficial Circumflex iliac, superficial external pudendal, deep external pudendal aeries, muscular branches, the profunda femoris aery and the descending genicular aery . The Profunda Femoris Aery arises posterolaterally from the Femoral Aery about 3.5 cm distal to the Inguinal Ligament. It overlies the tendon of psoas. It is separated from Pectineus by the Femoral Vein. -### End" -3673,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: N K cells activity is enahnced by -, with the following options: A: IL-1, B: TNF, C: IL-2, D: TGP-b - -### Response: -IL-2 promote growth and differentiation of T & B cells , cytotoxicity of T & NK cells Reff: Ananthanarayan & Panikers textbook of microbiology 9th edition pg: 154 table 15.3 -### End" -3674,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The CSF findings in TB meningitis include:, with the following options: A: High sugar + low protein, B: Low sugar + high protein and lymphocytosis, C: High sugar + high chloride, D: Low sugar + high protein and lymphopenia - -### Response: -b. Low sugar + high protein and lymphocytosis(Ref: Nelson's 20/e p 2936-2948, Ghai 8/e p 563-565)Lymphocytosis is seen in Tuberculous meningitis, though in early stages, CSF neutrophilia may be seen -### End" -3675,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for Acute Adrenal Crisis is:, with the following options: A: Norepinephrine, B: Hydrocoisone, C: Dexamethasone, D: Fludrocoisone - -### Response: -Answer is B (Hydrocoisone): The treatment of choice for acute adrenal insufficiency is Glucocoicoid Replacement Therapy. Hydrocoisone is the preferred steroid fir Glucocoicoid replacement therapy in acute adrenal crisis since it has both glucocoicoid and mineralocoicoid actions. In cases where the diagnosis of acute adrenal insufficiency is suspected (not confirmed) Dexamethasone is preferred as the initial steroid of choice because Dexamethasone does not compete with the coisol assay. 'Glucocoicoid replacement should be initiated by bolus injection of 100 mg Hydrocoisone, followed by the administration of 100-200mg hydrocoisone over 24 hours either by continuous infusion or provided by several IV or IM Injections. Mineralocoicoid replacement can be initiated once the daily hydrocoisone dose has been reduced to less than 50 mg because at higher doses hydrocoisone provides sufficient stimulation of glucocoicoid receptors' -### End" -3676,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On accident there is damage of cervical spine, first line of management is:, with the following options: A: X-ray, B: Turn head to side, C: Maintain airway, D: Stabilise the cervical spine - -### Response: -C i.e. Maintain airway Initial Evaluation And Emergency Care In Spinal Trauma All the trauma patients are at risk of spinal injury. Many of the spinal injury patients are multiple trauma victims and there fore require emergency treatment(' The treatment priorities are preserving life (15, ), limb, and function. The spine must be protected as these priorities are addressed sequentially. (i.e. undue movements of spine are avoided)Q. The ABCs of trauma are followed in order of priority, with airway ventilation andcirculationQ being secured before fuher evaluation proceeds. Throughout the evaluation of other body systems, the cervical spine should be presumed injured and thus immobilized to avoid fuher neurological injury. Proper extrication of the patient and immobilization of cervical spine at the accident scene are critical to avoid fuher neurological injuryQ. The head and neck to be aligned with the long axis of trunk and immobilized in supine positionQ. Cervical extension should be avoided because it narrows the spinal canal more than flexionQ. Neutral flexion- extension head and neck alignment is optional(' during prehospital transpo of patients with cervical spine injury. Helmet & shoulder gear should be left in position until personnel trained in safe removal technque are available. After all life threatening injuries have been identified and stabilized, the secondary evaluation, including an extremity examination and neurological examination, can be safety carried out. When a spinal cord injury is suspected methyl prednisolone (steroid)Q should be staed. Most benefit occurs in the first 8 hoursQ, and additional effect occurs with in first 24 hours. The dose of methyl prednisolone is 30mg/kg loading doseQ + 5.4 mg/ kg/ hour x23 hourQ. When a medical center is reached, if a definitive cervical spine injury is identified & deemed unstable, skeletal traction for immobilization, reduction or both(' may be applied (eg. Gardner -wells traction, Halo traction etc) Summary of National Acute Spinal Cord Injury Study Protocols - Methyl prednisolone bolus 30 mg/ kg then infusion 5.4 mg/kg/h - Infusion for 24 hours if bolus given within 3 hours of injury - Infusion for 48 hrs if bolus given within 3 to 8 hrs of injury - No benefit if methyprednisolone staed more than 8 hours after injury - No benefit with naloxone - No benefit with tirilzad. -### End" -3677,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Collateral circulation is established in:, with the following options: A: Lungs, B: Kidneys, C: Spleen, D: Hea - -### Response: -Collateral channels are blood vessels which allow blood to flow directly from one aery to another. Aeries in the lungs, kidneys, and spleen are end-aeries. Such aeries have no anastomoses with their neighboring aeries; collateral circulation is not seen in these organs. In the normal human hea there are no functional intercoronary channels or existing collaterals. Sudden blockade of an aery may lead to ischemia and necrosis of the corresponding poion of myocardium. However, if narrowing of a coronary aery occurs slowly, there may be development of collateral vessels. Collateral channels have also found to be developed in skeletal muscle circulation -### End" -3678,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is NOT associated with thiazide diuretics?, with the following options: A: Hypercalciuria, B: Hyponatremia, C: Hypokalemia, D: Hyperuricemia - -### Response: -(Ref: KDT 6/e p567) Thiazides cause hypercalcemia by decreasing its excretion (hypocalciurea) whereas loop diuretics cause hypocalcemia by increasing its excretion. (remember LOOP LOOSES CALCIUM). -### End" -3679,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is granted orphan drug status for the treatment of Dravet's syndrome?, with the following options: A: Stiripentol, B: Icatibant, C: Pitolisant, D: Tafamidis - -### Response: -Stiripentol increases GABA transmission. It is granted orphan drug status for the treatment of Dravet's syndrome (Severe myoclonic epilepsy in infants).Icatibant is a bradykinin B2 receptor antagonist. It is used for acute attacks of hereditary angioedema in adults with C1-esterase inhibitor deficiency.Pitolisant (a/k/a Tiprolisant) is an inverse agonist of an H3 receptor. It is under trial for schizophrenia and Parkinson's disease.Tafamidis stabilizes the correctly folded tetrameric form of TTR. It is used in familial amyloid polyneuropathy. -### End" -3680,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At physiological pH, carboxy terminal of peptide is, with the following options: A: Positive charged, B: Negative charged, C: Neutral, D: Infinitely charged - -### Response: -In ion-exchange chromatography, proteins interact with the stationary phase by charge-charge interactions. Proteins with a net positive charge at a given pH will tightly adhere to beads with negatively charged functional groups such as carboxylates or sulfates (cation exchangers). -  -Harper, Ed 30, Pg 27 -### End" -3681,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For the following dyslipidemias, select the most characteristic finding.Type III hyperlipoproteinemia., with the following options: A: palmar plane xanthomas, B: triglycerides > 1000, C: subcutaneous extensor tendon xanthomas, D: low serum cholesterol - -### Response: -In the rare familial form, raised yellow plaques appear on palms and fingers, and reddish-yellow xanthomas occur on the elbows. This disorder is felt to be secondary to accumulation of abnormal chylomicron and very low-density lipoprotein (VLDL) remnants. It is probably due to inherited homozygous defects in Apo E-II structure. -### End" -3682,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of abdominal aortic aneurysm is:, with the following options: A: Trauma, B: Vsculitis, C: Syphilis, D: Atherosclerosis - -### Response: -• “90% all abdominal aortic aneurysms are related to atherosclerotic disease and most of these aneurysms are below the level of renal arteries.” -• Aneurysm: permanent and irreversible localized dilatation of blood vessel with at least 50% increase in diameter -• Ectasia: dilatation <50% of normal diameter -• AAA (abdominal aortic aneurysm) is diagnosed if diameter >3 cm in males or >2.6 cm in females -• MC location: Aorta >Iliac >Popliteal >Femoral (AIPF) -• MC site of extra-cranial arterial aneurysm is infrarenal aorta -• MC site of peripheral aneurysm: Popliteal aneurysm -• Degenerative aneurysms (caused by atherosclerosis) are MC AAA (90%) -• Width of aneurysm is most important predicting factor of rupture. -• Juan Parodi introduced endovascular aortic aneurysm repair (EVAR). -Classification -• True (all three layers of vessel are involved), false (do not have all three layers of vessel) -• Infected (mycotic) aneurysm are false aneurysm -• Dissecting aneurysm (dissection with aneurysmal dilatation of false lumen) -• Fusiform (symmetrical enlargement involving whole circumference of artery) -• Saccular (affect only part of the arterial circumference) have higher risk of rupture -### End" -3683,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Medical ""Etiquette"" is:, with the following options: A: Conventional way of couesy towards professional members, B: Couesy towards client/patient, C: Couesy towards female, D: Couesy towards other members of society. - -### Response: -Conventional way of couesy towards professional members -### End" -3684,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triage is -, with the following options: A: Treating the most serious cases, B: Categorisation of the patients and treating them according to the available resource, C: Cautery burns, D: Treating mentally ill patients - -### Response: -- triage consists of rapidly classifying the injured on the basis of severity of their injuries and the likelihood of their survival with prompt medical intervention. - it is based on internationally accepted four colour code system. Reference: Park's textbook of preventive and social medicine, 23rd edition, pg no: 796 <\p> -### End" -3685,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Methicillin-resistant staphylococci do not respond to β–lactam antibiotics because :, with the following options: A: They produce a β–lactamase which destroys methicillin and related drugs, B: They elaborate an amidase which destroys methicillin and related drugs, C: They have acquired penicillin binding protein which has low affinity for β-lactam antibiotics, D: They are less permeable to β-lactam antibiotics - -### Response: -Resistance to most penicillins is due to elaboration of beta-lactamase. -Methicillin is most resistant penicillin to β-lactamase. -Staphylococcus aureus develops resistance to methicillin by the acquisition of altered penicillin-binding proteins. -### End" -3686,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Linear coefficient of thermal expansion of composites is, with the following options: A: 1 ppm/ oC, B: 40 ppm/ oC, C: 260 ppm/ oC, D: 1000 ppm/ oC - -### Response: -Linear coefficient of thermal expansion: - -TOOTH : 9-11 PPM/ oC  -AMALGAM : 25  -GOLD : 15   -COMPOSITES : 40  -GIC : 25  -DENTAL WAXES : HIGHEST 260-600 PPM/ oC  - -Reference- Sturdevant 6th ed P:237 -### End" -3687,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True morbidity in a population can be calculated by?, with the following options: A: Sentinel surveillance, B: Passive surveillance, C: Active surveillance, D: Monitoring - -### Response: -Ans. is 'c' i.e., Active surveillance o True morbidity is calculated by --> Active surveillance o Missing cases are detected by --> Sentinal surveillance -### End" -3688,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Immune reconstitution inflammatory syndrome typically occurs following anti retroviral therapy after a duration of:, with the following options: A: 1-2 weeks, B: 2-6 weeks, C: 6-12 months, D: 1-2 years - -### Response: -Typically immune reconstitution inflammatory syndrome occurs within 2-12weeksof initiation of A, though it may present later between 6 weeks to 6 months. Ref: -### End" -3689,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Features of serotonin syndrome associated with SSRI and MAOIs are, with the following options: A: Tremors, B: Agitation, C: Cardiovascular collapse, D: Hypothermia - -### Response: -Co-prescription of serotonergic drugs with other serotonergic agents and especially MAOIs can lead to serotonin syndrome.it is characterised by classic triad of mental status changes,neuromuscular abnormalities and autonomic hyperactivity.these include anxiety, agitation, confusion, clonus, hyperreflexia, myoclonus, rigidity, increased hea rate, tremor, flushing, hypehermia and excessive sweating. Death can occur in severe serotonin syndrome. (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no185) -### End" -3690,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Test shown is:, with the following options: A: Card Test, B: Froment's Sign, C: Pointing index, D: Pen Test - -### Response: -Ans. (c) Pointing indexThe image shows presence of point index with lesion of median nerve. The remaining three choices A, C, D are seen in ulnar nerve Damage. -### End" -3691,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Runt disease is due to, with the following options: A: Hypogammaglobulinemia, B: GVHD, C: Autoimmunity, D: Immunosuppression - -### Response: -Runt disease is graft versus host disease produced experimentally in Laboratory animals. -### End" -3692,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Administration of pure O2 to hypoxic patients is dangerous because, with the following options: A: Apnea occurs due to hypostimulation of peripheral chemoreceptors, B: Pulmonary edema, C: DPG, D: Convulsions - -### Response: -The respiratory centres maybe depressed in hypercapnic patients. Breathing may only be occurring due to the activation of peripheral chemoreceptors sensitive to the hypoxia. When pure Oxygen is given to the patients, the stimulus to the peripheral receptors is gone and may result in apnoea. -### End" -3693,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antagonist of benzodiazepine is?, with the following options: A: Naltrexone, B: Flumazenil, C: Naloxone, D: N-Acetyl cysteine - -### Response: -ANSWER: (B) FlumazenilREF: Harrisons 17th edTable 35-4, Goodman and Gillman's 11th edition page 270 Repeat Pharmacology 2013 Session 2, December 2009Indirect Repeat December 2009, December 2010, Forensic Medicine PD June 2012 See APPENDIX-42 below ""ANTIDOTES & TOXICOLOGY"" APPENDIX - 42AntidotesAntidotePoison/drug/toxinN-AcetylcysteineAcetaminophenCarbon tetrachlorideOther hepatotoxinsAmyl nitrite, sodium nitrite and sodium thiosulfate (Cyanide antidote kit)NitrilesBromatesChloratesCyanide (e.g., HCN, KCX and NaCN)Mustard agentsNitroprussideSmoke inhalation (combustion of synthetic materials)Antivenin, Crotalidae Polyvalent (Equine Origin)Pit viper envenomation (e.g. rattlesnakes, cottonmouths, timber rattlers and copperheads)Antivenin, Crotalidae Polyvalent Immune Fab - Ovine (CroFab)Pit viper envenomation (e.g.. rattlesnakes, cottonmouths, timber rattlers and copperheads)Atropine sulfateAlpba2 agonists (e.g., clonidine)Alzheimer drugs (e.g., donepezil, galantamine, rivastigmine, tacrine)Antimyesthenk agents (e.g., pyridostigmine)Bradyarrhythmia-producing agents (e.g., beta blockers, calcium channel blockers and digitalis glycosides)Cholinergic agonists (e.g., bethanechol) .Muscarine-containing mushrooms Nerve agents (sarin, soman, tabun and VX)Organophosphate and carbamate insecticidesDigoxin immune FabCardiac glycoside-containing plants (foxglove and oleander)Digitoxin, DigoxinEthanolEthylene glycolMethanolFlumazenilBenzodiazepinesZaleplonZolpidemFolic acid and Folinic acid (Leucovorin)Formaldehyde/Formie AcidMethanolMethotrexate, trimetrexatePyrimethamineTrimethoprimFomepizoleEthylene glycolMethanolGlucagonBeta blockersCalcium channel blockersHypoglycemiaHypoglycemic agentsHydroxocobalaminNitrilesBromatesChloratesCyanide (e.g., HCN, KCN and NaCN)Mustard agents NitroprussideSmoke inhalation (combustion of synthetic materials)Hyperbaric oxygen (HBO)Carbon monoxideCarbon tetrachlorideCyanideHydrogen sulfideMethemoglobinemiaMethylene blueMethemoglobin-inducing agents including;Aniline dyesDapsoneLocal anesthetics (e.g., benzocaine)MetoclopramideNaphthaleneNitrates and nitritesNitrobenzenePhenazopyridineNalmefene and NaloxoneACE inhibitorsAlpha2 agonists (e.g., clonidine)Imidazoline decongestants (e.g., oxymetazoline and tetrahydrozoline) LoperamideOpioids (e.g., codeine, fentanyl, heroin, meperidine, morphine)Physostigmine salicylateAntihistaminesAtropine and other anticholinergic agentsDhatura poisoningIntrathecal baclofenPhytonadione (Vitamin Kl)Long-acting anticoagulant rodenticides (e.g., brodifacoum and bromadiolone) WarfarinPralidoxime chloride (2-PAM)Antimyesthenic agents (e.g., pyridostigmine)Nerve agents (sarin, soman, tabun and VX)Organophosphate insecticidesTacrineProtamine sulfateEnoxaparinHeparinPyridoxine hydrochloride (Vitamin B6)Acrylamide Ethylene glycol Hydrazine Isoniazid (INH)Sodium bicarbonateChlorine gasHyperkalemiaSerum Alkalinization:Agents producing a quinidine-like effect as noted by widened QRS complex on EKG (e.g., amantadine, carbamazepine, chloroquine,cocaine, diphenhydramine, flecainide,tricyclic antidepressants, quinidine)Urine Alkalinization:Weakly acidic agents (chlorpropamide, methotrexate, phenobarbital and salicylates)Deferoxamine and DeferasiroxAcute iron poisoningDimercaprol (BAL in oil)Hydrofluoric acid (HF)Hyperkalemia (not digoxin-induced)HypermagnesemiaCalcium disodium EDTA (Versenate)Acute arsenic poisoning,Acute mercury poisoning,Lead poisoning (in addition to EDTA)Dicobalt EDTACyanide poisoningSucdmer/ Dimercaptosuccinic acid (DMSA)Lead poisoning,Arsenic poisoning,Mercury poisoningDimercapto-propane sulfonate (DMPS)Severe acute arsenic poisoning,Severe acute mercury poisoningD-Penicillamine (Cuprimine)Mainly in: copper toxicityOccasionally adjunctive therapy in: Gold toxicity, Arsenic poisoning, Lead poisoning, Rheumatoid arthritisBotulinum antitoxin * Bivalent (types AB)<< Trivalent (types ABE)Food-borne botulismWound botulismBotulism as a biological weaponNote: Not currently recommended for infant botulismL-CarnitineValproic acidCyproheptadine HCLMedications causing serotonin symdromeDantrolene sodiumMedications causing neuroleptic malignant symdrome (NMS)Medications causing malignant hyperthermiaInsulin and dextroseBeta blockersCalcium channel blockers (diltiazem, nifedipine, verapamil)Octreotide acetateSulfonylurea hypoglycemic agents (e.g., glipizide, glyburide)Sodium thiosulfateBromatesChloratesMustard agentsNitroprussideThiamineEthanolEthylene glycolPrussian blue, ferric hexacyan ofer rateRadioactive cesium (Cs-137), radioactive thallium (Tl-201), and nonradioactive thallium -### End" -3694,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Single best prognostic indicator of successful treatment with single-dose Methotrexate is, with the following options: A: Gestational sac size, B: Serum b-hCG level, C: Absence of fetal cardiac activity, D: Pain abdomen - -### Response: -The best candidate for medical therapy is the woman who is asymptomatic, motivated, and compliant. With medical therapy, some classic predictors of success include a low initial serum b-hCG level, small ectopic pregnancy size, and absent fetal cardiac activity. Of these, initial serum b-hCG level is the single best prognostic indicator of successful treatment with single-dose MTX. Specifically, repoed failure rates are 1.5 percent if the initial serum b-hCG concentration is <1000 mIU/mLReference: William's Obstetrics; 25th edition; Chapter 19; Ectopic pregnancy -### End" -3695,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following condition does not cause multiple painful ulcers on tongue?, with the following options: A: TB, B: Sarcoidosis, C: Herpes, D: Behcet disease - -### Response: -Ans. (b) SarcoidosisRef : Harrison 19th ed. / 237, 417* Painful ulcers in mouth# Apthous ulcers# Behcet disease# Denture stomatitis# Thermal burns# Tuberculosis# Herpes# Carcinoma tongue# Arsenic poisoning -### End" -3696,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to embryologist, embryo is termed till: (PGI June 2008), with the following options: A: 8 weeks of fertilization, B: 10 weeks after LM P(Last menstrual period), C: 10 weeks after ferti lization, D: 12 weeks after LMP - -### Response: -Ans: A (8 weeks of fertilization) The embryo is defined as products of conception after fertilization to 8 weeks?. Thereafter (8 wk onward) it is called a fetus.The Prenatal period: Dutta Obstetrics 6th/41Ovular period or germinal period lasts for first 2 wks following ovulation, in spite of the fact that the ovum is fertilized, it is still designated as Ovum.Embryonic period in humans begins at fertilization (2nd week of gestation) and continues until the end of the 10th-week gestation* (8th week of development).The fetal period begins at the end of the 10th week of gestation (8th week of development) & ends in delivery. -### End" -3697,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paramyxoviruses are most commonly associated with which of the following diseases?, with the following options: A: Fifth disease, B: Rubella, C: Croup, D: Tonsillitis - -### Response: -Both mumps and measles are well-recognized paramyxovirus infections. This group also includes parainfluenza virus, which causes laryngotracheobronchitis (croup) in children, and respiratory syncytial virus, which can cause bronchiolitis in infants. Paramyxoviruses have glycoprotein spikes that extend their lipid membrane and are responsible for hemagglutination activities. -### End" -3698,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 24-year-old woman has throbbing left-sided headaches which get worsen with movement and got aggravated by loud noises. She also has nausea along with it. Patient needs a dark quiet room during episodes. Which of the following best explains the pathogenesis of the patient's headache syndrome?, with the following options: A: Diffuse muscular contraction of the neck and scalp, B: Disinhibition of the central pacemaker neurons in the posterior hypothalamic region, C: Dysfunction of monoaminergic sensory control systems in brainstem and hypothalamus, D: Focal cerebral vasodilation in the region of the brain that is the focus of the pain - -### Response: -The patient describes a typical history for migraine headaches, the second most common cause of headache and most common cause of headache-related disability Simplified Diagnostic Criteria for Migraine Repeated attacks of headache lasting 4-72 h in patients with a normal physical examination, no other reasonable cause for the headache, and: At Least 2 of the Following Features: Plus at Least 1 of the Following Features: Unilateral pain Throbbing pain Aggravation by movement Moderate or severe intensity Nausea/vomiting Photophobia and phonophobia Common triggers include: Lack of sleep or excessive sleep Stress Hormonal fluctuations Alcohol Barometric pressures changes. Pathogenesis: 1) SENSORY SENSITIVITYthat is characteristic of migraine is due to dysfunction of monoaminergic sensory control system in brainstem and hypothalamus 2) TRIGEMINO VASCULAR SYSTEM-Release of vasoactive peptides- eg CGRP. Activation of cells in the trigeminal nucleus results in the release of vasoactive neuropeptides, paicularly calcitonin gene-related peptide (CGRP), at vascular terminations of the trigeminal nerve and within the trigeminal nucleus Clinical application-CGRP receptor antagonists have now been shown to be effective in the acute treatment of migraine.Methysergide was found to antagonize ceain peripheral actions of 5-HT and having anti-inflammation propeies .it is used as the first drug capable of preventing migraine attacks. The triptans are potent agonists of 5-HT1B and 5-HT1D receptors.Triptans arrest nerve signaling in the nociceptive pathways of the trigeminovascular system, at least in the trigeminal nucleus caudalis and trigeminal sensory thalamus, in addition to promoting cranial vasoconstriction, act by vascular target. 3)VASCULAR THEORY- Vasoconstriction of intracranial blood vessels & later on reflex vasodilation of extracranial blood vessels that causes pulsatile headache 4) DOPAMIN HYPERSENSITIVITY-There is dopamine receptor hypersensitivity in migraine patients . -### End" -3699,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are types of Primary headache except:, with the following options: A: Migraine, B: Cluster, C: Tension, D: Temporal aeritis - -### Response: -Types of headache: Primary headache Secondary headache Headache & its associated features occur in absence of exogenous cause. Types: Tension-type Migraine Idiopathic stabbing Exeional Cluster Headache caused by exogenous disorders. Types: Systemic infections Head injury Vascular disorders Subarachnoid hemorrhage Brain tumor EXTRA EDGE: Most common cause of headache = Tension headache MC cause of 2o headache = Infection MC cause of frontal headache= Tension headache MC cause of temporal headache = Giant Cell Vasculitis (MC vasculitis in geriatric age group) -### End" -3700,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false about Duchenne muscular dystrophy?, with the following options: A: Duchenne muscular dystrophy is less severe than Becker's dystrophy, B: X-linked recessive, C: Dilated cardiomyopathy is seen, D: Intellectual impairement is common - -### Response: -Duchenne muscular dystrophy is more severe than Becker&;s dystrophy. Becker&;s dystrophy is similar to Duchenne muscular dystrophy with a genetic defect at the same locus (Xp21) but clinically less severe. Impoant differences between Duchenne and Becker&;s muscular dystrophy: Duchenne&;s dystrophy Becker&;s dystrophy Onset Age: 2-3 years Age: 5-15 years Weakness Progressive Variable Intellectual impairement Common Uncommon Prognosis Wheel chair dependent bby adolescence Ambulatory till early adult life Death By the age of 18-20 years By the age of 40-50 years Ref: Nelson textbook of pediatrics 21st edition Pgno: 3281 -### End" -3701,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following structures is not at immediate risk of erosion by cholesteatoma ?, with the following options: A: Long process of incus, B: Fallopian canal containing facial nerve, C: Horizontal/ lateral semicircular canal, D: Base plate of stapes - -### Response: -Ans. is 'd' i.e., Base plate of stapes Cholesteatoma has the propey to destroy the bone by viue of the enzymes released by it. Structures immediately at the risk of erosion are : - Long process of incus. Fallopian canal containing facial nerve. Horizontal / lateral semicircular canal -### End" -3702,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gguardian of the genome""?, with the following options: A: p53, B: Mdm2, C: pl4, D: ATM - -### Response: -. p53 -### End" -3703,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bacteria are simple genetic units with all of the following properties, EXCEPT:, with the following options: A: They are diploid, B: Their genetic material is organized into a single chromosome, C: Their DNA has intervening sequences (introns) in almost all genes, D: They use same genetic code as all the eukaryotes - -### Response: -Prokaryotes can't have introns, because they have transcription coupled to translation.  -They don't have time/space for that, since intron splicing will stop the coupling. Eukaryotes evolved the nucleus, where splicing can be done. -The parts of the gene sequence that are expressed in the protein are called exons, because they are expressed, while the parts of the gene sequence that are not expressed in the protein are called introns, because they come in between the exons. -### End" -3704,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of metastasis from bronchogenic carcinoma:, with the following options: A: Brain, B: Bone, C: Liver, D: Spine - -### Response: -Ans: b (Liver) Ref: Robbins, 7th ed, p. 760Among the options given liver is the most common site of metastasis from bronchogenic carcinoma. But according to Robbins more than half of the cases of lung carcinoma spread to adrenal, and adrenals are the most common site of metastasis from lung carcinoma. So if both liver and adrenals are given in the option, choose adrenals.Order of metastasisAdrenals: > 50%Liver: 30-50%Brain: 20%Bone: 20%Important points of the various types of bronchogenic carcinomaAdenocarcinomaMost common histological type worldwideMost common histological type in life time non- smokersMost common histological type in young patientsMost common Ca lung which metastizes to opposite lungPeripheral in distributionMost common variety associated with thrombophlebitisSquamous cell CaMost common histological type in IndiaCavities are seenCentral in distributionPancoast tumor is squamous cell variety. It is located in the apex (not in the centre)Most common variety associated with hypercalcaemiaIt has best prognosisSmall cell CaMost common variety associated with paraneoplastic syndromesMost common variety associated with hypokalemiaMost responsive to chemotherapy and radiation. But due to late detection it has the worst prognosisNoteMost common variety associated with gynaecomastia - large cell carcinoma -### End" -3705,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common extra pulmonary involvement of TB ?, with the following options: A: Bone, B: Lymph nodes, C: Pleura, D: Ileocecal - -### Response: -Most common extra pulmonary involvement: lymph nodes > pleura> ileocecal - GI TB most common site- ileocecal -### End" -3706,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: LHRH analogue used in breast cancer -, with the following options: A: Cetrorelix, B: Anastrazole, C: Leuprolide, D: Tamoxifen - -### Response: -Ans. is 'c' i.e., Leuprolide o Among the given options only leuprolide is GnRH (LHRH/FSHRH) analogue. o Cetrorelix is GnRH antagonist, tamoxifen is SERM and anastrozole is aromatase inhibitor. -### End" -3707,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with recurrent bacterial infections is diagnosed to have a genetic deficiency in myeloper-oxidase. The cause of increased susceptibility to infections is -, with the following options: A: Defective neutrophil degranulation, B: Defective production of prostaglandins, C: An inability to produce hydroxyhalide radicals, D: Decreased oxygen consumption after phagocytosis - -### Response: -Harshmohan textbook of pathology 7th edition. the mechanism of microbicidal killing is by oxidative damage by the production of reactive oxygen metabolites. NADPH Oxidase present in the cell membrane of phagosome reduced oxygen to super oxide ion. Superoxide is subsequently conveed to hydrogen peroxide. MPO acts on hydrogen peroxide in the presence of halide to form hypohalous acid. This is called hydrogen peroxide- MPO- halide system . And is more potent anti bacterial system.. -### End" -3708,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The impoant light microscopical feature in Alpo syndrome are all, EXCEPT:, with the following options: A: Interstitial fibrosis, B: Tubular hyperophy, C: Segmental proliferative, D: Glomerular changes - -### Response: -The light microscopic findings are not characteristic in alpo syndrome. It will be normal in early years of life. In older patients the changes seen are 1. Interstitial fibrosis, 2. Tubular atrophy, 3. Foam cells, 4. Segmental proliferative The presence of interstitial foam cells has been considered as suggestive of Alpo syndrome. Ref: Dan Med Bull 2009;56:105-52 -### End" -3709,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Location Hasner's of valve?, with the following options: A: Opening of nasolacrimal duct, B: Sphenoidal sinus opening, C: Frontal sinus opening, D: Ethmoidal sinus opening - -### Response: -Opening of nasolacrimal ductNasolacrimal duct opens into inferior meatus and is closed by a mucosal flap called Hasner's valve -### End" -3710,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rockall score is used in prognosis of, with the following options: A: Upper GI bleed, B: Lower GI bleed, C: Hepatic encepholapathy, D: IBD - -### Response: -Rockall risk scoring system attempts to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding. Ref Davidson edition23rd pg ,793 -### End" -3711,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young lady presented with bilateral nodular lesions on shins. She was also found to have bilateral hilar lymphadenopathy on chest X-ray. Mantoux test reveals indurations of 5 mms. A skin biopsy would reveal -, with the following options: A: Non caseating Granuloma, B: Vasculitis, C: Caseating Granuloma, D: Malignant cells - -### Response: -Skin lesions in this patient is Erythema nodosum. -Erythema nodosum, bilateral hilar lymphadenopathy negative Mantoux test is strongly suggestive of sarcoidosis. - -Skin biopsy (or biopsy from hilar nodes, conjunctiva, lip, or spleen, intraabdominal nodes) would reveal non-caseating granulomas. - -Signs and symptoms of sarcoidosis -Any organ system of the body can be involved. However, lungs with lymph nodes, skin and eye are the three most common sites involved in sarcoidosis. -I.   Lungs with lymph nodes (95%) - -Respiratory complaints including a cough and dyspnea are the most common presenting symptoms. -Usually, the infiltrate in sarcoidosis are predominantly an upper lobe process. -There is bilateral hilar lymphadenopathy. - -II. Skin (24%-43%) - -Erythema nodosum -Maculopapular lesions -Hyper-or hypopigmentation -Keloid formation and subcutaneous nodules -Lupus pernio → Involvement of the bridge of the nose, the area beneath the eyes and cheek. It is diagnostic for a chronic form of sarcoidosis. -Lofgren's syndrome → Erythema nodosum with hilar adenopathy and uveitis. - -III. Eye (12-29%) - -Uveitis → Cause Photophobia, blurred vision, increased tearing -Retinitis → Cause Photophobia, blurred vision, increased tearing -Pars plastic → Cause Photophobia, blurred vision, increased tearing - -IV Non-specific constitutional symptoms are fatigue (most common), fever, night sweat and weight loss. Other organs/systems involved are - -Liver                              -Spleen                           -Endocrine → Granuloma can secret 1-25 (OH)2 Vit D which causes hypercalcemia. -Uveoparotid fever → Uveitis + parotitis + VII nerve palsy, it is associated with Heerfordt - waldenstrom syndrome. -Parotid glands            -Heart -Brain (Neurosarcoidosis) -### End" -3712,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anisocoria in dim light is maximally seen in -, with the following options: A: 3rd nerve palsy, B: Pharmacological mydriasis, C: Horner syndrome, D: Parasympathetic paralysis - -### Response: -Anisocoria is a condition characterised by the unequal size of the eyes' pupils. Anisocoria which is worsened ( greater asymmetry between the pupils) in the dark suggests the small pupil (which should dilate in dark conditions) is the abnormal pupil. Suggests horner's syndrome or mechanical anisocoria. Anisocoria which is greater in bright light suggests the larger pupil (which should constrict in bright conditions) is the abnormal pupil. Suggests adie tonic pupil oculomotor nerve palsy, damaged iris and pharmocologic dilatation. -### End" -3713,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient with cirrhosis is positive HBs Ag+ and has increased levels of alpha feto protein. What is the most probable diagnosis ?, with the following options: A: Submassive hepatic necrosis, B: Hepatocellular carcinoma, C: Massive hepatic necrosis, D: None of the above - -### Response: -Ans. is `b' i.e., Hepatocellular carcinoma Cirrhosis, hepatitis B positive and alpha fetoprotein strongly suggests hepatocellular carcinoma. -### End" -3714,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about thiopentone except, with the following options: A: Na2CO3 is a preservative, B: contraindicated in porphyria, C: Agent of choice in shock, D: Has cerebroprotective action - -### Response: -In situations where the baroreceptor response will be blunted or absent (eg, hypovolemia, congestive hea failure, b-adrenergic blockade), cardiac output and aerial blood pressure may fall dramatically due to uncompensated peripheral pooling of blood and direct myocardial depression. So, sodium thiopental is contraindicated in shock. Ref: Morgan & Mikhail's clinical anesthesiology 6e -### End" -3715,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Case fatality rate of typhoid is -, with the following options: A: 10%, B: 20%, C: 30%, D: 40% - -### Response: -

Typhoid fever:- Typical continuous fever for 3-4 weeks,relative bradycardia with involvement of lymphoid tissue. Without effective treatment, typhoid kills over 10% of those infected. Causative agent- Salmonella typhi. S.paraA and S.paraB are infrequent. Reservoir- man Case - a case is infectious as long as bacilli appear in stools /urine. Carriers:- 1. Convalescent carriers-excrete bacilli for 6-8 weeks,after which their number dimnishes rapidly. 2. Chronic carriers- persons who excrete bacilli for more than a year after a clinical attack. In most chronic carriers,the organism persists in gall bladder and in biliary tract. Source of infection- faeces and urine of cases/carriers. Age group involved mostly is 5-19 yrs old. Males affected more than females. Incubation period- 10-14 days. Mode of transmission: faecal oral route/ urine oral routes. Treatment of carriers:- Intensive course of ampicillin/ amoxycillin (4-6g/day) together with probenecid for 6 weeks. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.235}

-### End" -3716,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding fovea, which of the following statements is true –a) Has the lowest threshold for lightb) Contains only conesc) Contains only rodsd) Maximum visual acuitye) Is located at apex of optic nerve, with the following options: A: acd, B: bcd, C: abc, D: abd - -### Response: -Fovea centralis contains only cones; therefore, has maximum visual acuity and lowest threshold for light. -Option d is absurd as there is no apex in the optic nerve. It is orbital apex where the optic nerve enters the eye socket. -### End" -3717,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of gall stone impactation is -, with the following options: A: Duedenojejunal junction, B: Proximal to iliocaecal junction, C: Distal to iliocaecal junction, D: Colon - -### Response: -Ans is 'b' i.e., Proximal to Ileocaecal junction -### End" -3718,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old farmer has itchy erythematous papular lesions on face, neck, 'V' area of chest, dorsum of hands and forearms for 3 years. The lesions are more severe in summers and improve by 75% in winters. The most appropriate test to diagnose the condition would be:, with the following options: A: Patch test, B: Skin biopsy, C: Intradermal prick test, D: Estimation of IgE levels in blood - -### Response: -Patient in the question is showing features of chronic allergic contact dermatitis, as indicated by the clinical manifestations in exposed areas of the body and its exacerbation during summer season. Patch testing is done to document sensitivity to a specific antigen. In this procedure, a battery of suspected allergens is applied to the patient's back under occlusive dressings and allowed to remain in contact with the skin for 48 hrs. After removal of the dressings the area is examined for evidence of delayed hypersensitivity reactions (e.g., erythema, edema, or papulo vesicles). Ref: CURRENT Medical Diagnosis and Treatment, 2012, Chapter 6; Harrison's Principles of Internal Medicine, 18h Edition, Chapter 51. -### End" -3719,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bowler hat sign is seen in, with the following options: A: Sigmoid volvulus, B: Midgut volvulus, C: Intussusception, D: Sessile colonic polyp - -### Response: -BOWLER HAT SIGN: Cup shaped filled defect seen on air contrast barium enema that represents POLYP if it points towards lumen. The ""bowler-hat sign"" represents the appearance of a sessile colonic polyp observed at an oblique angle on a double contrast barium enema. The bowler-hat sign is formed by a ring of barium adjacent to the base of the polyp surrounding a domed layer of barium coating the surface of the polyp. -### End" -3720,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Focal length of high power objective lens of microscope?, with the following options: A: 40mm, B: 16mm, C: 20mm, D: 4mm - -### Response: -Ans. is 'd' i.e., 4 mmProperties of Microscopic Objective LensPropertyScanningLow PowerHigh PowerOil ImmersionMagnification4x10x40-45x 90-100xNumerical Aperature0-100.250.55-0.651.25-1.4Approximate focal length40 mm16mm4 mm 1.8-2.0 mmWorking distance17-20 mm4-8 mm0.5-0.7 mm0.1 mmApproximate resolving power with light of 450 nm(blue light)2.3 mm0.9 mm0.35 mm0.18 mm -### End" -3721,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady in her first trimester with hyperemesis gravidarum wakes up with diplopia and mental confusion and nystagmus. What is the probable diagnosis?, with the following options: A: Pregnancy induced hypeension, B: Wernicke's syndrome, C: Occipital infarction, D: Pituitary apoplexy - -### Response: -Wernicke's encephalopathy (WE) is a potentially reversible yet serious neurological manifestation caused by vitamin B1(thiamine) deficiency. It is commonly associated with heavy alcohol consumption. Other clinical associations are with hyperemesis gravidarum (HG), starvation, and prolonged intravenous feeding. Most patients present with the triad of ocular signs, ataxia, and confusion, nystagmus It can be associated with life-threatening complication like central pontine myelinolysis (CPM). -### End" -3722,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statement are true regarding Intraductal papillary mucinous neoplasms (IPMNs) of pancreas, except:, with the following options: A: Mainly involve the head of pancreas, B: Precursor lesion of pancreatic carcinoma, C: Usually involves large ducts of pancreas, D: There is presence of ovarian stroma on histology - -### Response: -Intraductal papillary mucinous neoplasms (IPMNs) Mucin-producing neoplasms that involve the larger ducts of the pancreas. More frequently seen in men Involve the head of the pancreas more often than the tail. Two features are useful in distinguishing IPMNs from mucinous cystic neoplasms: Absence of the dense ""ovarian"" stroma. Involvement of a pancreatic duct. Just as with mucinous cystic neoplasms, IPMNs can progress to an invasive cancer. -### End" -3723,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MBBS 1st year girl came to OPD complaining of intermittent episodes of feeling of impending doom accompanied by intense perspiration Usually the episodes occur prior to her exams what is the most likely diagnosis, with the following options: A: Panic attack, B: Generalised anxiety disorder, C: Phobia, D: Schizophrenia - -### Response: -Panic attacks typically include some of these signs or symptoms: Sense of impending doom or danger. Fear of loss of control or death. Rapid, pounding hea rate. Sweating. Trembling or shaking. Shoness of breath or tightness in your throat. Chills. Hot flashes. ref : robe hales 6th ed -### End" -3724,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are surface anaesthetics except -, with the following options: A: Lignocaine, B: Bupivacaine, C: Procaine, D: Cinchocaine - -### Response: -Ans. is 'b' i.e., Bupivacaine o Topical anaesthesia (surface anaesthesia) is produced by topical application of local anaesthetics to mucous membrane or abraded skin. o Surface anaesthetics are Dibucaine (Cinchocaine) Lignocaine Benoxinate Oxethazaine Prilocaine Tetracaine (Amethocaine) Cocaine Benzocaine Butamben o Procaine has very less potent surface anaesthetic action (1/10) --> not used as surface anaesthetic. o But amongst the given options best answer is bupivacaine, it does not have surface anaesthetic action. -### End" -3725,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diagnostic of antemoum drowning ?, with the following options: A: Palatauf's hemorrhage, B: Weeds and grass in clenched hands, C: Emphysema aquosum, D: Water in esophagus - -### Response: -Ans. is 'b' i.e., Weeds and grass in clenched hands -### End" -3726,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of th efollowing is not a component of NAXOS syndrome ?, with the following options: A: wooly hair, B: lipomatous skin, C: hyperkeratosis of palms, D: arrythmogenic right ventricular hyperophy - -### Response: -NAXOS SYNDROME: PLAKOGLOBIN GENE MUTATION desmosome protien defect fibrofatty tissue replaces myocardium which is stained by mason trichrome stain . REF : ROBBINS 10TH ED -### End" -3727,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Small fiber neuropathy is seen in?, with the following options: A: HIV, B: Vitamin B12 deficiency, C: AIP, D: Cisplatin toxicity - -### Response: -Small unmyelinated peripheral nerve fibers, Categorized as C fibers, In skin and organs. Innervate the skin (somatic fibers) , Help to control autonomic function. Causes of Small Fiber Neuropathy: 1. Diabetes mellitus 2. Leprosy 3. Amyloidosis 4. Tangier's disease 5. Sjogren syndrome 6. HIV 7. Sarcoidosis -### End" -3728,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zero order kinetics occur in following drug with high dose:, with the following options: A: Phenytoin, B: Digoxin, C: Amiloride, D: Lithium - -### Response: -Ans. A. PhenytoinZero order kinetics is due to saturation of metabolizing enzymes i.e. enzymes reach their Vmax Eg (Zero WATT power)ZeroW-Warfarin,A-Alcohol,T-Theophylline,T-Tolbutamide,Power-Phenytoin,Other - Salicylates, omeprazole -### End" -3729,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient in psychodynamic therapy has been coming late to the last few sessions and complaining in the session that he has nothing to talk about. His therapist points out that they were making very rapid progress into uncovering some of the difficult thoughts and feelings the patient had about his parents up until several weeks ago. This recent change in the patient's behavior is an example of what therapeutic principle?, with the following options: A: Counter transference, B: Abreaction, C: Ego strength, D: Resistance - -### Response: -Freud noticed that patients in spite of their suffering and their ove desire to change tended to cling to their symptoms and resisted the analyst's effos to produce insight. He called these powerful internal forces that oppose change resistance. Resistance takes place at any point in the treatment and paicularly when unacceptable impulses or thoughts threaten to come into consciousness or a maladaptive defense mechanism is challenged. Resistance can manifest itself in many different ways, including withholding impoant thoughts from the analyst, falling silent during sessions, forgetting appointments, forgetting to pay the analyst, falling asleep during session, and considering dropping out of treatment. The possible manifestations of resistance are countless and depend on the patient's defense mechanisms and personality. In other words, the patient's intrapsychic defenses manifest as resistance in the context of his or her interpersonal relationship with the analyst. Freud thought that resistance should be uncovered by the analyst but not challenged or interpreted. Modern analysts believe that resistance should be analyzed through the patient's free associations suppoed by the analyst's observations. -### End" -3730,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Flexor tendon tenosynovitis"" is a hallmark feature of, with the following options: A: Rheumatoid ahritis, B: Ankylosing spondylitis, C: Psoriatic ahritis, D: Osteoahritis - -### Response: -Flexor tendon tenosynovitis is a frequent hallmark of RA and leads to decreased range of motion, reduced grip strength, and ""trigger"" fingers. Progressive destruction of the joints and soft tissues may lead to chronic, irreversible deformities. Ulnar detion results from subluxation of the MCP joints, with subluxation of the proximal phalanx to the volar side of the hand. Hyperextension of the PIP joint with flexion of the DIP joint (""swanneck deformity""), flexion of the PIP joint with hyperextension of the DIP joint (""boutonniere deformity""), and subluxation of the first MCP joint with hyperextension of the first interphalangeal (IP) joint (""Z-line deformity"") also may result from damage to the tendons, joint capsule, and other soft tissues in these small joints. Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 380; Rheumatoid Ahritis -### End" -3731,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following statements are related to tubercular salpingitis except :, with the following options: A: The abdominal ostium may be patent with eversion of fimbriae, B: The early lesion may be confused with adenocarcinoma on histology, C: Genital tuberculosis is always secondary and the tubes are invariably the primary sites S, D: Salpingitis isthmica nodosa is the exclusive pathology to tuberculosis - -### Response: -Salpingitis isthmica nodosa It is related to tubercular infetion although it may be residue of any form of chronic interstitial salpingitis there is infiltration of tubal mucosa directly into the muscularis resembling adenomyosis It is one form of endometriosis of tube D.C.DUTTA'S TEXTBOOK OF GYNAECOLOGY,Pg no:172,6th edition -### End" -3732,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the following is a NaSSa, with the following options: A: miazapine, B: clozapine, C: nefazadone, D: sealine - -### Response: -NaSSA * IMPOANCE Nor adrenergic and specific serotonergic antidepressant * MECHANISM * Alpha 2 adrenergic receptor antagonism=== increase serotonin and NA * 5HT2,3 antagonist============increase sleep and appetite * DRUGS miazapine * USE Elderly with depression * SIDE EFFECTS hyperlipidemia ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955 -### End" -3733,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dengue hemorrhagic fever is caused by ?, with the following options: A: Infection with more virulent dengue virus, B: Infection with same dengue virus repeatedly, C: Infection with dengue virus in immunocompromized host, D: Infection with more than one dengue virus - -### Response: -Ans. is `d' i.e., Infection with more than one dengue virus DENGUE FEVER Dengue fever is caused by arboviruses (at least 4 serotypes have been recognized) It is transmitted by Aedes (Aedes aegypti is the main vector). The reservoir of infection is both man and mosquito. The transmission cycle is Man-mosquito-man Dengue fever occurs both epidemically and endemically. Epidemics stas in rainy season and are usually explosive. Aedes mosquito becomes infective by feeding on a patient from the day before onset to the 5th day of illness. -### End" -3734,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following syndromes is best associated with congenital heart disease?, with the following options: A: Lesch-Nyhan syndrome, B: Rasmussen syndrome, C: Holt-Oram syndrome, D: Leopard syndrome - -### Response: -c. Holt-Oram syndrome(Ref: Nelson's 20/e p 746, Ghai 8/e p 413)Discussing about the options one by one,Name of the syndromeClinical featuresa. Lesch-Nyhan syndromeHyperuricemia, intellectual disability, dystonia, choreoathetosis, spasticity, dysarthric speech and compulsive self-biting, usually beginning with eruption of teethb. Rasumussen syndromeIt is an immune mediated disease associated with intractable unilateral seizures, progressive hemiparesis and intellectual dysfunctionc. Holt-Oram syndromeASD & bony abnormalities, with a strong familial tendency (autosomal dominant inheritance)d. LEOPARD syndromeLentigines (multiple), Electrocardiographic conduction abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnormalities of genitalia, Retardation of growth, Deafness -### End" -3735,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old female presented to ER unconscious. Her mother tells you about her having recurrent syncopal episodes. Her BP is 80/60 mm Hg and you order an ECG. Treatment is, with the following options: A: Adenosine, B: DC shock, C: Cathether Ablation, D: Radiofrequency ablation - -### Response: -HR = 300/1.5=200 B.P.M Narrow QRS (80/100 m sec) PSVT or AVN ST depression, hidden P waves. Since question says BP decreased so Cardioversion /DC shock Given (If question stated patient conscious: Adenosine should be given) Option C: Used to prevent arrythmia (recurrence of tachy arrythmia). It's not an emergency treatment Option D: Used in WPW syndrome Multifocal Atrial Tachycardia: Narrow QRS (MAT): RR variable P wave variable, Morphology changes are seen M.A.T: Variable p wave altitude Electrical Alterans: Variable QRS complex T.D.P: variable BROAD QRS complex -### End" -3736,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of Marfan's syndrome, EXCEPT:, with the following options: A: Lens dislocation, B: Aortic regurgitation, C: Mousy odor urine, D: Pneumothorax - -### Response: -Ans. is 'c' Mousy odour urine Mousy odour urine is a feature of homocystinuriaMarfan's syndrome:It is characterized by a triad of:Long thin extremities* frequently associated with other skeletal changes such as loose joints* and arachnodactyly *Reduced vision as a result of dislocation of lens*Aortic aneurysm* -### End" -3737,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cirrhosis of liver with poal hypeension occurs in all except:, with the following options: A: Cystic fibrosis, B: Alpha 1 anti-trypsin deficiency, C: Wilson's disease, D: Schistosomiasis - -### Response: -Schistosomiasis can lead to Poal HTN but not cirrhosis. Wilson's disease is an inherited disorder of copper homeostasis with failure to excrete excess amounts of copper, leading to its accumulation in the liver and resultant cirrhosis. Alpha 1 antitrypsin deficiency results from an inherited disorder that causes abnormal folding of the alpha-1- AT protein, resulting in failure of secretion of that protein from the liver and these patients are at greatest risk for developing chronic liver disease. Cystic fibrosis is an uncommon inherited disorder & Secondary biliary-type cirrhosis occurs in it. -### End" -3738,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a dimorphic fungi, with the following options: A: Histoplasma Capsulatum, B: Sporothrix schenckii, C: Pencillium marnefeii, D: Pneumocystis Jiroveci - -### Response: -Dimorphic fungi - -H - Hitoplasma -S - Sporothrix -B - Blastomyces -C - Coccidiodes -P - Paracocciodes -P - penicillium -### End" -3739,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Polyol pathway is responsible for formation of, with the following options: A: Fructose from glucose, B: Galactose From Fructose, C: Galactose From Glucose, D: Glucose From Fructose - -### Response: -Polyol pathway is responsible for the formation of fructose from glucose Fig: The sorbitol (polyol) pathway -### End" -3740,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient sustained blunt trauma to eye after that the developed sudden loss of vision with deep anterior chamber, Most likely cause is -, with the following options: A: Lens dislocation, B: Berlin's oedema, C: Retinal haemorrhage, D: Recession of angle of AC - -### Response: -Amongst the given options only two can cause deep anterior chamber :- - - -Angle recession -Dislocation of the lens - - -In angle recession, glaucoma develops many years after the trauma and there is no sudden loss of vision. -Dislocation of lens can cause sudden loss of vision immediately. -### End" -3741,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following multiple lesions are not seen?, with the following options: A: Enchondroma, B: Osteoid osteoma, C: Fibrous dysplasia, D: GCT - -### Response: -Osteoid osteoma: Zone of sclerosis surrounding a radiolucent pa is seen POLYOSTOTIC BONE LESIONS Fibrous dysplasia Enchondroma Osteochondroma Ewing's sarcoma Giant cell tumor (Goltz syndrome) Metastasis Multiple myeloma Bone infarction Osteomyelitis -### End" -3742,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following in the natural course of disease has no reversal of the shunt?, with the following options: A: ASD, B: VSD, C: TOF, D: PDA - -### Response: -Ans. c. TOF (Ref. Myong K. Park 5/e p238)Natural History of TOF: (Myong K. Park 5/e p238)Infants with acvanotic gradually become cyanotic as a result of worsening condition of the infundinular stenosis and polycythemiaPolycythemia develop secondary to cyanosisHypoxic spells may develop in infantsGrowth retardation may be present if cyanosis is severeBrain abscess and cerebrovascular accidents rarely occurSABE is occasionally a complicationSome patients, particularly those with severe TOF develop ARCoagulopathy is a late complication of longstanding cyanosisEisenmenger syndromeEisenmenger syndrome was so named by Dr. Paul Wood after Dr. Victor Eisenmenger, who first described the condition in 1897.Congenital heart defects causing Eisenmenger syndromeAtrial septal defectsVentricular septal defectsPatent ductus arteriosusMore complex types of acyanotic heart disease.Calcium chloride is not given in the treatment of cyanotic spells in a patient of TOF.Management of Anoxic Spells in Tetralogy of FallotKnee chest positionHumidified oxygenMorphineQ 0.1 to 0.2 mg/kg SCObtain venous pH; sodium bicarbonateQ 1-3 ml/kg (diluated) IVPropranolol 0.1 mg/kg/IV (during spell)Q; 0.5-1 mg/kg/6 hourly orally (alternatives: metoprolol, esmoiol)Vasopressors: Methoxamine (Vasoxy1) IM or IV drip (Phenylephrine is a vasopressor)QCorrect anemiaConsider surgeryTetralogy of FallotCommonest congenital cyanotic congenital heart diseaseQ in children above the age of 2 years constituting almost 75 percent of all blue patients.Hemodynamics:Physiologically the pulmonary stenosis causes concentric right ventricular hypertrophy without cardiac enlargementQ and an increase in right ventricular pressure.Severity of cyanosis is directly proportional to the severity of pulmonic stenosis, but the intensity of the systolic murmur is inversely proportional to the severity of pulmonic stenosisQ.Since the right ventricle is e.ffectively decompressed by the ventricular septal defect, congestive failure never occurs in TOFQ.The late and soft P2 is generally inaudible in TOF. The S2 is therefore single and the audible sound is A2.On auscultation, the diastolic interval is completely clear in TOF as there is no third or fourth sound or diastolic murmur.Clinical Features:MC symptoms are dyspnoea on exertion and exercise intoleranceQ.Squatting is not specific for TOF, TOF is the commonest congenital lesion in which squatting is notedQ.Characteristic features:Normal sized heart with upturned apexQ (suggestive of RVH)Absence of main pulmonary artery segment gives it the shape described as 'Cor-en Sabot'Q Pulmonary fields are oligaemicQAortic-mitral valve continuity is maintainedQ.Complications:Anemia, infective endocarditis, venous thrombosisParadoxical embolism, hemiplegia, brain abscessQTreatment:Medical management for anemia and management of complications.Palliative operations in TOF1. Blalock-Taussig shunt: Subclavian artery-pulmonary artery anastomosisQ.2. Potts shunt: Descending aorta is anastomosed to pulmonary arteryQ.3. Waterston's shunt: Ascending aorta-right pulmonary artery anastomosisQ.Definitive operations: Closing the VSD and resecting the infundibular obstructionQ.Fallot'sTrilogyTetralogyPentalogy* Pulmonary stenosisQ* Atrial septal defectQ* Right ventricular hypertrophQ* Pulmonary stenosisQ* Ventricular septal defectQ* Right ventricular hypertrophyQ* Ovemding or dextroposed aortaQ.* Tetralogy of Fallot + ASDQ or patent foramen ovaleQ -### End" -3743,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""adder head"" appearance on excretory urography is seen in, with the following options: A: Hydronephrosis, B: Infantile polycystic kidney, C: Ureterocele, D: Horseshoe kidney - -### Response: -(Ureterocele) (1310-LB) (1290-B & L 25th)Ureterocele is a cystic enlargement of the intramural portion of the ureter thought to result from congenital atresia of the ureteric orifice.* The ""adder-head' on excretory urography is typical* Usually the cyst wall is composed of urothelium only and the diagnosis is confirmed by the cystoscopic appearance of a translucent cyst enlarging and collapsing as urine flows in from the upper ureter. -### End" -3744,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corkscrew esophagus is seen in which of the following conditions?, with the following options: A: Carcinoma esophagus, B: Scleroderma, C: Achalasia cardia, D: Diffuse esophageal spasm - -### Response: -Ans. (d) Diffuse esophagus spasmRef Sabiston 20th edition, Pages 1015-1018 Salient Points in DES:* Most common in women (Achalasia - Equal)* High amplitude repetitive contraction (Achalasia - Low Amplitude)* Chest pain and dysphagia* Cork screw appearance* Gold standard - Manometry* Main stay of management is Nonsurgical and medical with nitrates and CCB* Long esophagomyotomy is for failed cases and cases with epiphrenic diverticulumSalient Points in Nut cracker esophagus:* Super squeeze esophagus* MC and Most painful hypermotility disorder.* Medical management is the only option. -### End" -3745,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a reservoir for measles, with the following options: A: Man, B: Soil, C: Fomites, D: Monkey - -### Response: -- Measles occurs only in humans. There is no animal reservoir of infection.The challenges of measles elimination include:1) weak immunization systems2) high infectious rate of measles3) Conflict regions4) refusal of immunization by some populations5) Changing epidemiology of measles (increased transmission among adolescents and adults) 6) Need to provide catch-up measles vaccination7) gaps in human and financial resources park 23e pg: 146 -### End" -3746,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of salivary gland stones is -, with the following options: A: Submandibualr gland, B: Parotid Gland, C: Sublingual Gland, D: Equally common in all salivary glands - -### Response: -Ans. is 'a' i.e., Submandibualr gland ""Eighty percent of all salivary stones occur in the submandibular glands because their secretions are highly viscous. ""- Bailey and Love 25/eo Eighty percent of submandibular stones are radio-opaque and can be identified on plain radiographs. In contrast parotid stones are usually radiolucent and rarely visible on plain radiography. -### End" -3747,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Right axis detion is seen In all except-, with the following options: A: Ostium primum ASD, B: Dextrocardia, C: Pulmonary hypeension, D: Ostium secundum ASD - -### Response: -Right axis detion also may occur as a normal variant (paicularly in children and young adults), as a spurious finding due to reversal of the left and right arm electrodes, or in conditions such as right ventricular overload (acute or chronic), infarction of the lateral wall of the left ventricle, dextrocardia, left pneumothorax, and left posterior fascicular block. The ECG in severe pulmonary hypeension shows P pulmonale, right axis detion, and RV hyperophy. In ostium secundum ASD, electrocardiogram (ECG) usually shows right-axis detion and an rSr' pattern in the right precordial leads representing enlargement of the RV outflow tract. ( Harrison&;s principle of internal medicine,18th edition,pg no.1834 ) -### End" -3748,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for stone in Submandibular duct compressing distal to Lingual nerve is, with the following options: A: Submandibular excision, B: Antibiotics, C: Intraoral removal, D: Observe - -### Response: -Distal Stones are removed by intraoral method. -Proximal stones are removed by submandibular excision. -### End" -3749,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Electron transpo from cytochrome 'b' to cytochrome `c' is inhibited by ?, with the following options: A: Oligomycin, B: Antimycin, C: Piericidin, D: Carbon monoxide - -### Response: -Ans. is 'b' i.e., Antimycin Cytochrome b to cytochrome CI (complex III) is inhibited by dimercaprol, antimycin A, BAL and naphthyloquinone. -### End" -3750,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paracetamol poisoning produces?, with the following options: A: Metabolic alkalosis, B: Metabolic acidosis, C: Coloured swreat, D: Arthralgia - -### Response: -ANSWER: (B) Metabolic acidosisREF: Harrison 17Th ed chapter 48Paracetamol poisoning can cause metabolic acidosis -### End" -3751,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is not an RNA virus?, with the following options: A: Hepatits A, B: Hepatitis B, C: Hepatitis C, D: Hepatitis D - -### Response: -Ans: b (hepatitis B) Ref:Ananthanarayan, 7 p. 547Among the hepatitis virus only DNA virus is hepatitis B virus (Hepadna virus). Just go through theFeatureHAVHBVHCVHDVHEVAgentSSRNA icosahedral,capsid unenvelopedDSRNAComplex structure envelopedSSRNA envelopedSS defective virus envelopedSSRNA unenvelopedClassificationPicoma virus(enterovirus typelll)Hepadna virusFlaviUnknowncalcivirusTransmissionfaecooralparentralparentralparentralfaecooralIP15-45 days(2-6 weeks)30-180 days(2-6 mon)30-90 days 1-3 mon30-50 days 1-2 mon50-60 days 1/2 - 2 monthOnsetacuteinsiduousinsiduousinsiduousacuteIllnessmildOcc. severemoderateOcc. severeMild except in pregnancy (fulminant in 40 %)Carrier statenilcommonpresentNil(only with HBV)niloncogenicityNilyesyesnilNilSpecific Rx.Ig & vaccineIg& vaccinenilHBV vaccineNil -### End" -3752,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In ectopic pregnancy all are useful for diagnosis except, with the following options: A: Culdocentesis, B: USG, C: Beta HCG, D: Flat abdomen - -### Response: -Ans) d (Flat abdomen) Ref Williams 22nd ed pg 259All except flat abdomen are useful for diagnosing ectopic pregnancy.Ectopic pregnancyCommonest site - AmpullaCommonest cause - PID (Salpingitis)Other causes - IUCD (Progestasert)- Tubal surgery- Adhesion following pelvic surgery- ARTPrevious ectopic -10% chance of recurrent ectopicModes of termination of tubal pregnancy--- Tubal abortion (most common)- Tubal rupture- Tubal mole- Continuation of pregnancyUterus in ectopic - Decidua without Chorionic villusArias- Stella reaction - Typical adenomatous change of endometrial glandsTubal mptureMost common in isthmic regionIsthmic mpture - 6-8wksAmpullary mpture - 8-12 wksInterstitial mpture - 16wksTriad- AmenorrhoeaAbdominal pain - Most constant feature of triadVaginal bleedingOther symptoms - Nausea, vomiting, fainting attacksInvestigation of choice - TVSAbsence of intrauterine pregnancy with a positive pregnancy testFluid in pouch of douglasAdnexial mass clearly separated from ovaryRarely cardiac pulsationOthers - beta HCG, laparoscopy, D & CS. progesterone>25mg/ml- Intra uterine <5mg/ml- AbnormalStudiford criteria - Primary abdominal pregnancySpiegelberg criteria - Ovarian pregnancyPaalman and Me Elin criteria- Cervical pregnancyDmgs used - Methotrexate KC1 Hyperosmolar glucose Ru-486. Indication for Methotrexate in ectopic pregnancy(1) Patient haemodynamically stable(2) Tubal diameter <4cm without cardiac activities(3) Beta-HCG levelSurgery - Linear salpingostomy- Linear salpingotomy- Salpingectomy- Milking of tube -### End" -3753,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The preferred public health approach to control non-communicable disease is -, with the following options: A: Shift the population based approach, B: Focus on high risk individuals for reduction of risk, C: Early diagnosis and treatment of identified cases, D: Individual disease based veical programmes - -### Response: -It is integrated approach .It differs from country to country and year to year . Because it may involve socioeconomic risk factors, metabolic, nutritional and lifestyle. So it may be shifted through population based data. Ref-Park&;s textbook of Preventive and Social Medicine 24th edition. -### End" -3754,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Human serum albumin, the most abundant blood protein, has multiple roles, including acting as a buffer to help maintain blood pH. Albumin can act as a buffer because of which one of the following?, with the following options: A: The protein contains a large number of amino acids., B: The protein contains many amino acid residues with different pKa values., C: The amino and carboxyl ends of albumin can donate and accept protons in the range of physiologic pH., D: Albumin contains peptide bonds that readily hydrolyze, consuming hydrogen and hydroxyl ions. - -### Response: -The side chains of the amino acid residues in proteins contain functional groups with different pKa values. Therefore, they can donate and accept protons at various pH values and act as buffers over a broad pH spectrum. There is only one N-terminal amino group (pKa 9) and one C-terminal carboxyl group (pKa 3) per polypeptide chain. At physiologic pH, these groups would not be accepting or donating protons because the amino terminal group would always be protonated, and the carboxyl terminal carboxylic acid would always be deprotonated. Peptide bonds are not readily hydrolyzed, and such hydrolysis would not provide buffering action. Hydrogen bonds have no buffering capacity because the hydrogen in these bonds is not donated or accepted once the bond is formed. -### End" -3755,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disruption or disorganization of biological rhythm is observed in, with the following options: A: Schizophrenia, B: Anxiety, C: Depression, D: Mania - -### Response: -Disturbance of biological functions is common with depression, with insomnia (or sometimes increased sleep), loss of appetite and weight (or sometimes hyperphagia and weight gain), and loss of sexual drive. When the disturbance is severe, it is called as melancholia ( somatic syndrome) The somatic syndrome in depression is characterised by: a. A significant decrease in appetite or weight b. Early morning awakening, at least 2 (or more) hours before the usual time of awakening c. Diurnal variation, with depression being worst in the morning d. Pervasive loss of interest and loss of reactivity to pleasurable stimuli e. Psychomotor agitation or retardation. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.72 -### End" -3756,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Beta 1 antagoinst used in congestive cardiac failure?, with the following options: A: Atenolol, B: Metoprolol, C: Salbutamol, D: Terbutaline - -### Response: -Ans. is 'b' i.e., Metoprolol o Beta blockers approved for use in CHF are Carvedilol (most commonly used), metoprolol and bisoprolol. o Other agents can also be used (see above explanation). -### End" -3757,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Killian Dehiscence is in, with the following options: A: Superior constrictor, B: Inferior constrictor, C: Middle constrictor, D: None - -### Response: -In the posterior wall of pharynx, the lower pa of the thyropharyngeus is a single sheet of muscle, not overlapped internally by the superior and middle constrictors. This weak pa lies below the level of the vocal folds or upper border of the cricoid lamina and is limited inferiorly by the thick cricopharyngeal sphincter. This area is known as Killian's dehiscence.Pharyngeal diveicula are formed by outpouching of the dehiscence. Ref BDC volume3,sixth edition pg 234 -### End" -3758,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following statements is false regarding vincristine -, with the following options: A: It is an alkaloid, B: Its use is associated with neurotoxicity, C: It does not cause alopecia, D: It is a useful drug for induction of remission in acute lymphoblastic leukaemia - -### Response: -Ans. is 'c' i.e., It does not cause alopecia o Vincristine belongs to the plant alkaloid group of anticancer. o Useful for inducing remission in childhood ALL (not useful in maintenance therapy) o It can also be used for pediatric solid tumors (Wilm's tumor, neuroblastoma, rhabdomyosarcoma) and lymphomas. o Prominent adverse effects? o Peripheral neuropathy Alopecia SIADH -### End" -3759,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hemodialysis may be used for each of the following poisonings Except, with the following options: A: Kerosene oil, B: Barbiturates, C: Alcohol, D: Lithium - -### Response: -A few toxins can be removed effectively by dialysis. These include phenobarbital, salicylates, theophylline, methanol, quinine, and lithium **The drug should be readily available in blood for it to be filtered. Ie, Volume of distribution should be low Examples of drugs with large volumes of distribution (> 5 L/kg) include antidepressants, antipsychotics, antimalarials, opioids, propranolol, and verapamil. Drugs with a relatively small V (< 1 L/kg) include salicylate, ethanol, phenobarbital, lithium, valproic acid, and phenytoin Ref - Krishan Vij textbook of forensic medicine pg:451 Katzung 13e pg:1001 -### End" -3760,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Percentage of water in amniotic fluid :, with the following options: A: 42%, B: 64%, C: 76%, D: 99% - -### Response: -Composition of amniotic fluid : Water -98-99% Solid -1-2% -Inorganic, Organic, Suspended paicles. Ref:Datta Obs 9e pg 34. -### End" -3761,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true about Annual Infection rate of tuberculosis ?, with the following options: A: 1% increase in AIR is equivalent to 70 new cases of TB, B: It is one of the best indicator for evaluating tuberculosis problem and its trend, C: It expresses attacking force of Tuberculosis in community, D: It is 1.7 % in India - -### Response: -Ans. is 'a' i.e., 1% increase in AIR is equivalent to 70 new cases of TB Annual Infection Rate (also known as Tuberculin conversion index) o AIR is the % of population under study who will be newly infected by M. tuberculosis amongst the noninfected of the preceeding survey during the course of one year. o It reflects the annual risk of being infected (or reinfected) in a given community. o In other words, it expresses the attacking force of TB in a community. o It is considered one of the best indicator to evaluvate the TB problem and its trend. o In developing countries, every I% of of annual risk of infection is said to correspond to 50 new cases of smear positive pulmonary TB, per year for 1,00,000 general population. o The higher the rate the greater the problem. o Good treatment programme lowers the risk of TB infection in the community. -### End" -3762,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 62 year old diabetic female patient presented with history of progressive right-sided weakness of one-month duration. The patient was also having speech dificulty. Fudus examination showed papilledema. Two months ago, she also had a fall in her bathroom and struck her head against a wall. The most likely clinical diagnosis is:, with the following options: A: Alzheimer's disease, B: Left parietal glioma, C: Left MCA territory stroke, D: Left chronic subdural haematoma - -### Response: -Answer is D (Left chronic subdural hematoma): The presence of progressive hemiparesis and aphasias together with signs of raised ICT (papilloedema) in an elderly patient, developing weeks after sustaining a mild head injury is characteristic of chronic subdural hematoma. -### End" -3763,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are cardinal signs of inflammation except:, with the following options: A: Pain, B: Swelling, C: Redness, D: Absence of functional loss - -### Response: -Celsus first listed the four cardinal signs of inflammation: rubor (redness), tumor (swelling), calor (heat), and dolor (pain). These signs are hallmarks of acute inflammation. A fifth clinical sign, loss of function (functio laesa), was added by Rudolf Virchow. -### End" -3764,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle relaxant of choice in a patient with serum bilirubin of 6 mg/dl and serum creatinine of 4.5 mg/dl is:, with the following options: A: Vecuronium, B: Atracurium, C: Pancuronium, D: Mivacurium - -### Response: -Ans. (B) Atracurium(Ref: KDT 8th/e p380)Atracurium is eliminated by Hoffman's elimination. It means it neither require liver for metabolism, nor kidney for excretion. Its molecules spontaneously rearrange to make it inactive. Thus it is safest muscle relaxant in a patient with liver and kidney disease. -### End" -3765,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6-month infant presented with multiple papules and exudative lesions on the face, scalp, trunk and few vesicles on the palms and soles for 2 weeks. His mother had H/O itchy lesions. Most likely diagnosis:, with the following options: A: Scabies, B: Infantile eczema, C: Infantile seborrheic dermatitis, D: Impetigo contagiosa - -### Response: -Ans. A. ScabiesScabies is due to infestation with human scabies mite, which is an obligate parasite and has no separate existence outside the human body. The disorder is notorious for the intensity of itch that it causes, even in the presence of relatively minor physical signs. Physical signs are essentially those of eczema and the effects of scratching vesicle are seen, but excoriations and prurigo-like papules are more common. -### End" -3766,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following can velli used to treat alcohol dependence except:, with the following options: A: Naltrexone, B: Acamprosate, C: Flumazenil, D: Disulfiram - -### Response: -Ref: Katzung 11/e p395 Flumazenil is a benzodiazepine antagonist used for treat of benzodiazepine overdose and not for alcohol dependence. -### End" -3767,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following radioisotope is not used as permanent implant:, with the following options: A: Iodine-125., B: Palladium-103, C: Gold-198., D: Caesium-137 - -### Response: -D i.e. Cesium - 137 -### End" -3768,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CAD predisposing factors-a) Homocysteinemiab) ↓ Lipoprotein Bc) ↑ Fibrinogend) ↑ HDLe) ↑ plasminogen activator inhibitors 1, with the following options: A: acd, B: bde, C: cde, D: ace - -### Response: -Homocysteine and Prothrombotic (↑ fibrinogen and ↑ plasminogen activator inhibitors) factors are emerging risk factors for atherosclerosis and coronary heart disease. -### End" -3769,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is oral contrast agent?, with the following options: A: Sonavist, B: Levovist, C: Sono Rx, D: Echogen - -### Response: -Sono Rx is a oral ultrasound contrast agent Other ultrasound contrast agents Given in the other options are used intravenously -### End" -3770,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One TB infected person can infect how many people in lyr -, with the following options: A: 20, B: 30, C: 10, D: 5 - -### Response: -Ans. is 'c'i.e., 10 o Tuberculosis is transmitted mainly by droplet infection and dropled nuclei generated by sputum-positive patients with pulmonary tuberculosis.o Coughing generates the largest number of droplets of all sizes. The frequency and vigour of cough and the ventilation of the environment influence transmission of infection,o Patient with infectious pulmonary tuberculosis disease can infect 10-15 persons in a year.Epidemiological indices of tuberculosiso Indices or parameters are needed to measure the tuberculosis problem in a community as well as for planning and evaluation of control measures.o The following epidemiological-indices are used in tuberculosis problem measurement and programme strategy' :-Prevalence of infectionIt is the percentage of individuals who show a positive reaction to the standard tuberculin test.Incidence of infection (Annual infection rate) It is the percentage of population under study who will be newly infected by M.tuberculosis among the non- in fected of the preceding survey during the course of one year.It reflects the annual risk of being infected (or reinfected) in a given community, i.e. it expresses the attacking force of tuberculosis in a community.It is also known as tuberculin conversion index.This parameter is considered one of the best indicators for evaluating the tuberculosis problem and its trend.Prevalence of disease or case rateIt is the percentage of individuals w hose sputum is positive for tubercle bacilli on microscopic examination.It is the best available practical index to estimate the number of infectious cases or case load in a community.Incidence of new casesIt is the percentage of new TB cases (confirmed by bacteriological examination) per 1CKK) population occurring during one yearPrevalence of suspected casesThis is based on X-ray examination of chest.Prevalence of drug resistant casesIt is the prevalence of patient excreting tubercle bacilli resistant to anti-tubercular drugs.Mortality rateThe number of deaths from tuberculosis every year per 1,000 population. -### End" -3771,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Keratomalacia is due to -, with the following options: A: Vit-A deficiency, B: Keratoconus, C: Vitamin E deficiency, D: Also seen in retinitis pigmentosa - -### Response: -Ans. is 'a' i.e., Vit-A deficiency o Keratomalacia It is a common condition in developing countries and is due to deficiency of vitamin A.o The condition is usually bilateral.o In keratomalacia, the cornea becomes dull and insensitive, hazy and yellow infiltrates form until finally the whole tissue undergoes necrosis and seems to melt away within a few hourso A characteristic feature is the absence of inflammatory reaction.o Keratomalacia is often precipitated by an acute systemic illness such as measles, penumonia or severe diarrhoea. -### End" -3772,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most common congenital anomaly?, with the following options: A: Cleft lip, B: Cleft palate, C: Cleft lip and cleft palate both, D: None - -### Response: -Ans. C Cleft lip and cleft palate bothRef: Clinical Anatomy, Vishram Singh, pg. 306* The cleft lip and palate are the most common congenital anomalies of the head and neck, occurring in 1 per 750 live births. -### End" -3773,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In idiopathic polymyositis, following are seen except:, with the following options: A: Ocular muscles are not involved, B: Pharyngeal muscles involved, C: Cutaneous manifestations, D: Proximal limb muscles invariably involved - -### Response: -Answer is C (Cutaneous manifestation): Cutaneous manifestations (Rash) are a feature of Dermatomyositis and are characteristically absent in Polymyositis. Polymyositis Dermatomyositis Age of onset > 18 yr Adulthood and childhood Familial associations No No Extramuscular manifestations Yes Yes Associated conditions Connective tissue diseases Systemic autoimmune diseases Yes Frequent Scleroderma and mixed connective tissue disease (overlap syndromes) Infrequent Malignancy Viruses Drugs Parasites and bacteria No Yes Yes Yes Yes, in upto 15% of cases Unproven Yes, rarely No Pathogenic mechanism T cell Immune complex Skin Rash/ Dermatitis No Yes Pharyngeal muscle involvement Yes Yes Proximal muscle involvement Yes Yes Ocular muscle involvement No No Facial muscle involvement No No -### End" -3774,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most commonly involved muscle in cases of abdominal wall hematoma?, with the following options: A: Rectus abdominis, B: External oblique, C: Internal abdominis, D: Transverses abdominis - -### Response: -Ans AMost commonly involved muscles - incases of traumatic hematomas - in descending order of frequency are:# Rectus abdominus (Most common).# Iliopsoas.# Thighs# Gluteal. -### End" -3775,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Post-menopausal, hormone that shows an increase is?, with the following options: A: Progesterone, B: Estrogen, C: FSH, D: Androgens - -### Response: -FSH REF: Novak's gynecology 12th ed p. 450-452 Estrogens , progesterone and total androgen production is decreased after menopause , however FSH increases due to negative feedback of estrogen over FSH production by pituitary. -### End" -3776,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stages of herpetic lesions includes all except, with the following options: A: Vesicle, B: Crusting, C: Chancre, D: ulceration - -### Response: -Herpes genitalis lesions show 3 stages of development  - -Vesicle -Ulceration -Crusting. -### End" -3777,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle not supplied by Lateral plantar nerve, with the following options: A: Abductor digiti minimi, B: Adductor Halluis, C: 1st Lumbrical, D: Flexor digitorum accesorious - -### Response: -1st lumbrical is supplied by Medial plantar Nerve. Rest 3 lumbricals are supplied by Lateral plantar nerve. -### End" -3778,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with recurrent bouts of severe cough followed by an audible whoop. Which of the following is considered the best type of specimen to isolate the organism and confirm the diagnosis., with the following options: A: Nasopharyngeal swab, B: Cough plate, C: Throat Swabs, D: Anterior Nasal Swab - -### Response: -Presence of recurrent bouts of severe cough followed by an audible whoop suggests a diagnosis of pertusis (Whooping cough). -Nasopharyngeal Swab is the single best specimen to isolate the organism from the options provided. -### End" -3779,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Several weeks after surgical dissection of her left axilla for the removal of lymph nodes for staging and treatment of her breast cancer, a 32-year-old woman was told by her general physician that she had ""winging"" of her left scapula when she pushed against resistance during her physical examination. She told the physician that she had also experienced difficulty lately in raising her right arm above her head when she was combing her hair. In a subsequent consult visit with her surgeon, she was told that a nerve was accidentally injured during the diagnostic surgical procedure and that this produced her scapular abnormality and inability to raise her arm normally. What was the origin of this nerve?, with the following options: A: The upper trunk of her brachial plexus, B: The posterior division of the middle trunk, C: Roots of the brachial plexus, D: The posterior cord of the brachial plexus - -### Response: -The long thoracic nerve was injured during the axillary dissection, resulting in paralysis of the serratus anterior. The serratus anterior is important in rotation of the scapula in raising the arm above the level of the shoulder. Its loss results in protrusion of the inferior angle (""winging"" of the scapula), which is more obvious when one pushes against resistance. The long thoracic nerve arises from brachial plexus roots C5, C6, and C7. The upper trunk (C5,C6) supplies rotator and abductor muscles of the shoulder and elbow flexors. The posterior division of the middle trunk contains C7 fibers for distribution to extensor muscles; likewise, the posterior cord supplies extensors of the arm, forearm, and hand. The lateral cord (C5, C6, and C7) gives origin to the lateral pectoral nerve, the musculocutaneous nerve, and the lateral root of the median nerve. There is no sensory loss in the limb in this patient; injury to any of the other nerve elements listed here would be associated with specific dermatome losses. -### End" -3780,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common side effect of IUD insertion is -, with the following options: A: Bleeding, B: Pain, C: Pelvic, D: Ectopic pregnancy - -### Response: -Most common side effect → Bleeding -Most common side effect requiring removal of the device → Pain -### End" -3781,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs which cause both physical and psychological dependence are, with the following options: A: Morphine, B: Alcohol, C: Nicotine, D: All the above - -### Response: -All the above-mentioned drugs produce both physical and psychological dependence in varying degrees Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 326 -### End" -3782,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which analgesic is not used in Acute myocardial infarction -, with the following options: A: Morphine, B: Pentazocine, C: Pethidine, D: Buprenorphine - -### Response: -Ans. is 'b' i.e., Pentazocine Its use is associated with tachycardia & rise in BP is due to sympathetic stimulation. This increases cardiac work and hence is better avoided in coronary ischemia and myocardial infarction. Note - Petnidine also causes tachycardia (anticholinergic action) --> contraindicated in MI. -### End" -3783,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ocular manifestation in giant cell arteritis?, with the following options: A: Arteritic AION, B: Nonarteritic AION, C: Papilledema, D: Horners Syndrome - -### Response: -Ans. a. Arteritic AIONAION occurs due to interference of blood supply to anterior part of optic nerve (posterior ciliary artery)AION can be clinically differentiated into:Arteritic AIONNonarteritic AION*. Due to giant cell arteritis*. Due to occlusion of short posterior ciliary artery*. Sudden, severe visual loss (6/60)*. Sudden, moderate visual loss (>60/60 non-progressive)*. Most common in females, 7-8th decade*. Most common males, 5th-6th decade*. Premonitory symptoms like pain, Amaurosis Fugax present*. Premonitory symptoms like pain, Amaurosis Fugax absent*. Usually Bilateral-fellow eye affected within days to weeks*. Usually Unilateral (>70%)*. Pale optic disc*. Hyperemic optic with small cup*. Poor prognosis*. Good prognosis -### End" -3784,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sleep-wake cycle if external cue is removed will be which of the following?, with the following options: A: Unchanged, B: Greater than 24 hrs, C: Less than 24 hrs, D: Greater than 12 hours - -### Response: -Circadian clocks keep running even when the environmental cues (changes in light and dark) are removed, but the period of this free-running rhythm is generally a little less or a little more than 24 hours. More frequent is more than 24 hours. Ref: Chest Medicine: Essentials of Pulmonary and Critical Care Medicine edited by Ronald B. George, Richard W. Light, Michael A. Matthay, Richard A. Matthay, 2010, Page 461. 2. Psychiatric Mental Health Nursing By B. T. Basavanthappa, 2007, Page 141 -### End" -3785,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paneth cells characterized by, with the following options: A: More number of lysosomal enzyme, B: High concentration of zinc, C: More concentration of EFR, D: Foamy cells - -### Response: -Paneth cells are zinc-containing cells widely distributed in Lieberkuhn's crypts of small intestine in many species, but their function has remained obscure. Our previous study showed that a single intravenous injection of diphenylthiocarbazone (dithizone), a zinc chelator, forms zinc-dithizonate complexes in the cytoplasm of Paneth cells to ensure rapid and selective killing of the cells. REFERENCELE nih.gov -### End" -3786,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 62-year-old man presents with several weeks of excruciating stabbing pain in his right cheek. This pain occurs several times a day, lasts for a few seconds, and is so intense that he often winces or cries out. Episodes of pain can sometimes be caused by touching the face, or by air blowing on his face. What is the most likely diagnosis?, with the following options: A: Carotid artery aneurysm, B: Migraine, C: Trigeminal neuralgia, D: Glossopharyngeal neuralgia - -### Response: -Facial or head pain that is repetitive, severe, stabbing, and lasts just a few seconds is characteristic of the cranial neuralgias: trigeminal, glossopharyngeal, and occipital neuralgia. Of the cranial neuralgias, trigeminal neuralgia (tic douloureux) is the most common and typically occurs in middle-aged patients. Earlier onset can indicate underlying multiple sclerosis. The pain usually occurs unilaterally in the second or third division of the trigeminal nerve and is classically precipitated by light touch of the face. The first-line treatment is carbamazepine, but about one-third of patients do not respond to medical treatment and require invasive management such as microvascular decompression of the trigeminal nerve. Glossopharyngeal neuralgia is much less common, is felt in the throat, and is precipitated by swallowing or yawning. In occipital neuralgia the episodes of pain originate from the base of the skull. Headaches associated with migraine tend to be throbbing and last for hours at a time. Headaches associated with brain tumors are steadily progressive and are often made worse by Valsalva maneuver and by recumbency (i.e., typically worse at night). Carotid artery aneurysms may cause stroke or facial swelling but rarely cause headache. -### End" -3787,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: This pressure time graph is seen which mode of ventilation:-, with the following options: A: VCV, B: PCV, C: PSV, D: CPAP - -### Response: -In this graph constant Pressure is achieved which is seen in Pressure Control Ventilation. The major benefit of PCV is ability to control peak alveolar pressure which is a pressure most closely related to alveolar distention and injury, Thus PCV is protecting alveoli from overdistension. Pressure control modes of ventilation In a pressure controlled mode of ventilation, the inspiratory pressure is the control variable, and is maintained during the inspiratory phase. As a result of this, the pressure waveform is ""square"". This increases the mean airway pressure (i.e. the area under the pressure/time graph is greater). Volume - controlled ventilation, where the inflation volume is preselected, and the ventilator automatically adjusts the inflation pressure to deliver the desired volume. the rate of lung inflation can be constant or decelerating. Modes of ventilation Control mode ventilation (CMV) Pressure control ventilation (PCV) Pure control modes (all breath is supplied by Ventilator, breath is not taken by the patient) Synchronized intermittent minute ventilation (SIMV) breath can be supplied by the Ventilator and can be taken by the patient Pressure suppo ventilation (PSV) Continuous positive airway pressure (CPAP) Pure spontaneous mode (in which all the breath has to be taken by the patient) -### End" -3788,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common biotype of S. aureus causing human infection ?, with the following options: A: A, B: B, C: C, D: D - -### Response: -Ans. is 'a' i.e., A Staphylococcus aureus has been classified into six biotypes : A, B, C, D, E and F. Most human pathogenic strains belong to biotype A. -### End" -3789,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ALL L3 morphology is a malignancy arising from which cell lineage –, with the following options: A: Mature B cell, B: Precursor B cell, C: Immature T cell, D: Mixed B cell & T cell - -### Response: -Cellular classification of ALL -French-American-British (FAB) system divides ALL into three morphological subtypes. -i) LI lymphoblasts - -Most common type (80-85%) -Cells have scanty cytoplasm and inconspicuous nucleoli. -Have better prognosis - -ii) L2 lymphoblasts - -Cells are large and more pleomorphic in size with more abundant cytoplasm and prominent nucleoli. - -iii) L3 - lymphoblast - -Least common -Morphology is identical to urkitt's lymphoma cells i.e., mature B cells with surface immunoglobulin positive. -### End" -3790,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proximal muscle weakness atrophy in a child with PEM due to which electrolyte disturbance:, with the following options: A: Hypokalemia, B: Hypomagnesemia, C: Hypophosphatemia, D: Hypocalcemia - -### Response: -C i.e. HypophosphatemiaRef: Nelson, Textbook of Pediatrics, 20th edition, page 833Explanation:Hypokalemia:* Heart and skeletal muscle (muscle weakness and cramps) are especially vulnerable to hypokalemia* Paralysis is a possible complication, generally only at levels <2.5 mEq/L (starts with the legs, followed by the arms)* Slows gastrointestinal motility (constipation levels <2.5 mEq/L)* Impairs bladder function, potentially leading to urinary retention* Causes polyuria and polydipsiaHypocalcemia:* Muscular pain and cramps are early manifestations; they progress to numbness, stiffness, and tingling of the hands and feet positive Chvostek or Trousseau sign or laryngeal and carpopedal spasms.* Convulsions with or without loss of consciousness teeth erupt late and irregularly. Enamel formation is irregular, and the teeth may be unusually soft.Hypophosphatemia:* Hypophosphatemia is a serum phosphate concentration < 2.5 mg/dL (0.81 mmol/L)* Hemolysis and dysfunction of white blood cells.* Proximal muscle weakness and atrophy* Rhabdomyolysis* Cardiac dysfunction* Neurologic symptoms, such as tremor, paresthesia, ataxia, seizures, delirium and comaHypomagnesaemia:* Magnesium levels <0.7 mg/dL* Causes secondary hypocalcemia by impairing the release of PTH by the parathyroid gland and through blunting the tissue response to PTH* Dominant manifestations of Hypomagnesaemia are due to hypocalcemia: tetany, positive Chvostek and Trousseau signs and seizures -### End" -3791,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following has strong affinity for hemoglobin and acts in blood to act as ""mop-up"" molecule to bind hemoglobin?, with the following options: A: Ferritin, B: Transferrin, C: Haptoglobin, D: Albumin - -### Response: -Ans. c (Haptoglobin). (Ref. Robbin, Pathology, 7th ed., 624; Harrison, Internal medicine 15th ed., s608)Free Hb in plasma is promptly bounded by an alphal globulin, the haptoglobin that acts as 'mop-up' producing a complex that is rapidly cleared by mononuclear phagocyte system, thus preventing excretion in urine; hence in intravascular hemolysis serum haptoglobin is decreased.GENERAL FEATURES OF HEMOLYTIC DISORDERSGeneral examinationJaundice, pallorOther physical findingsSpleen may be enlarged; bossing of skull in severe congenital casesHemoglobinFrom normal to severely reducedMCV, MCHUsually increasedReticulocytesIncreasedBilirubinIncreased (mostly unconjugated)LDHIncreased (up to 10X normal with intravascular hemolysis)HaptoglobinReduced to absent -### End" -3792,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve of 6'h arch is ?, with the following options: A: Superior laryngeal nerve, B: Internal laryngeal nerve, C: External laryngeal nerve, D: Recurrent laryngeal nerve - -### Response: -Ans. is 'd' i.e., Recurrent laryngeal nerve Nerve of 4th and 6th arches is vagus nerve, which is distributed.Through superior laryngeal nerve for 4th arch derivatives.Through recurrent laryngeal nerve for 6th arch derivatives -### End" -3793,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are branches of lumbar plexus EXCEPT:, with the following options: A: Iliohypogastric nerve, B: Ilioinguinal nerve, C: Obturator nerve, D: Subcostal nerve - -### Response: -Subcostal nerve is the anterior division of the 12th thoracic nerve, is larger than the other intercostal nerves. -### End" -3794,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most common cause of non-traumatic acute chest pain?, with the following options: A: Tuberculosis, B: GIT causes, C: Ischemic hea disease, D: Costochondritis - -### Response: -MCC of non-traumatic acute chest pain- GIT Causes > Ischemic Hea Disease -### End" -3795,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Chronic alcoholic blames the family environment as a cause of his alcoholism. This is phenomenon of, with the following options: A: Projection, B: Denial, C: Rationalization, D: Sublimation - -### Response: -Ans:C-RationalizationRationalization or rationalisation (also known as making excuses) is a defense mechanism in which controversial behaviors or feelings are justified and explained in a seemingly rational or logical manner to avoid the true explanation, and are made consciously tolerable--or even admirable and superior--by plausible means. It is also an informal fallacy of reasoning. -### End" -3796,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About narcolepsy all are true except?, with the following options: A: Associated with cataplexy, B: Equal in male and female, C: NREM, D: Hypnogogic hallucinations - -### Response: -Ans. (c) NREMRef. Kaplan and sadock's 10/e, chapter 24.2 -### End" -3797,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3 yr old child has eczematous dermatitis on extensor surfaces. His mother has a history of bronchial asthma. Diagnosis could be, with the following options: A: Atopic dermatitis, B: Contact dermatitis, C: Seborrhic dermatitis, D: Infantile eczematous dermatitis - -### Response: -A i.e. Atopic Dermatitis -### End" -3798,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Scorpion venom resembles venom of -, with the following options: A: Cobra, B: Viper, C: Krait, D: All of the above - -### Response: -scorpion venom is clear toxalbumin and can be classified as hemlolytic or neurotoxic small quantity is injected REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 324 -### End" -3799,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child , Draws man with 2-4 pas besides head at the age of _________, with the following options: A: 30 months, B: 36 months, C: 48 months, D: 60 months - -### Response: -Emerging patterns of Adaptive milestones from 1-5years of age 15months Makes a tower of 3 cubes Makes a line with a crayon Inses raisin in a bottle 18months Makes a tower of 4 cubes Imitates scribbling Imitates veical stroke Dumps raisin from a bottle 24months Makes a tower of 7 cubes (6 at 21 mo) Scribbles in a circular pattern Imitates horizontal stroke Folds paper once imitatively 30months Makes a tower of 9 cubes Makes veical and horizontal strokes, but generally will not join them to make cross Imitates circular stroke, forming a closed figure 36months Makes a tower of 10 cubes Imitates construction of ""bridge"" of 3 cubes Copies circle Imitates cross 48months Copies bridge from model Imitates construction of ""gate"" of 5 cubes Copies cross and square Draws man with 2-4 pas besides the head Identifies longer of 2 lines 60months Draws a triangle from copy Names heavier of 2 weights Ref: Nelson paediatrics; Table 11-1 -### End" -3800,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common post-operative complication of spinal anaesthesia ?, with the following options: A: Post-spinal headache, B: Hypotension, C: Meningitis, D: Urinary retention - -### Response: -Ans. is 'a' i.e., Post-spinal headache -### End" -3801,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which carcinoma metastases to heart?a) Ca breastb) Ca stomach c) Ca lungd) Ca urinary bladder e) Osteosarcoma, with the following options: A: a, B: bc, C: ac, D: b - -### Response: -""Although cardiac metastases occur in 1-20% of all tumor types, the relative incidence is especially high in malignant melanoma and, to a somewhat lesser extent, in leukemia and lymphoma. In absolute terms, the most common primary originating sites of cardiac metastases are carcinoma of the breast and lung, reflecting the high incidence of these cancers. Cardiac metastases almost always occur in the setting of widespread primary disease, and most often either primary or metastatic disease exists elsewhere in the thoracic cavity"" -— Harrison 17th/1497 -""The most frequent tumors involving the heart as metastases are carcinomas of the lung & breast,melanomas, leukemias & lymphomaf -— Robbins 7tb/614 -Table (CSDT 11th/ 434): -### End" -3802,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Growth phase of hair is, with the following options: A: Anagen, B: Metagen, C: Telogen, D: None - -### Response: -A i.e. Anagen -### End" -3803,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Esotrotropia is most commonly associated with, with the following options: A: Hyperopia, B: Myopia, C: presbyopia, D: Astigmatism - -### Response: -Near vision impaired they try to compensate by increasing their accomodation Infants are hyperopic by 2.5 D they are esotropic at bih ref : ak khurana 7th ed -### End" -3804,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Merkel cell is derived from, with the following options: A: Ectoderm, B: Neural crest, C: Mesoderm, D: Endoderm - -### Response: -Skin structures derived from two of three primary germ layers. # Ectoderm: epidermis, adnexal structures, Merkel cells, melanocytes (neural crest), and nerves (neuroectoderm) # Mesoderm: fibroblasts, LCs, vessels, and inflammatory cells. Ref:- Review of Dermatology by Alikhan; pg num:-11 -### End" -3805,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The diagnosis of allergic rhinitis in children is established as they reach the age of, with the following options: A: 2years, B: 3years, C: 4years, D: 6years - -### Response: -Allergic rhinitis (AR) is an inflammatory disorder of the nasal mucosa marked by nasal congestion, rhinorrhea, and itching, often accompanied by sneezing and conjunctival inflammation. The symptoms may appear in infancy; with the diagnosis generally established by the time the child reaches age 6years. The prevalence peaks late in childhood.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 143; Allergic Rhinitis -### End" -3806,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following subtype of lung carcinoma produces superior vena cava syndrome:September 2009, with the following options: A: Small cell carcinoma, B: Adenocarcinoma, C: Anaplastic carcinoma, D: Squamous cell carcinoma - -### Response: -Ans. A: Small cell carcinoma -### End" -3807,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements regarding idiopathic edema are true, EXCEPT:, with the following options: A: It is due to estrogen mediated sodium retention, B: It is not related to menstrual cycle, C: It is associated with an increased water retention in upright position, D: In some cases ACEI is useful - -### Response: -Idiopathic edema is an ill-defined syndrome characterized by intermittent pitting edema secondary to Na and water retention. There is only very little evidence to prove that sodium retension is occuring under the influence of estrogen. Patients present with swelling of legs, hand, rarely face along with abdominal bloating. It occurs almost exclusively in women and is much worse with prolonged standing. Cyclic idiopathic edema is associated with conditions such as lipedemia, chronic venous insufficiency and lympheodema. Ref: Diseases of The Kidney and Urinary Tract By Robe W. Schrier, 8th Edition, Pages 2151-2158 ; Lymphedema Management: The Comprehensive Guide for Practitioners By Joachim Zuther, 2nd Edition, Page 104 -### End" -3808,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 18-year-old girl, sexually active for the past 3 years. Her family history is negative for cancer and cardiac disease. Examination is unremarkable. Which of the following screening tests should this patient would most benefit from ?, with the following options: A: Colonoscopy, B: Mammography, C: Pap smear, D: Pelvic scan - -### Response: -- There is increased risk for cancer cervix due to the early age at the first sexual intercourse. - PAP smear should be done as screening test. - Time to do PAP smear Any women >21 yrs of age. Any women 3 yrs after 1st sexual exposure in India From 21 to 29 yrs, sexually active women should have cytology every 3 yrs From 30 to 65 yrs: CO- TEST(PAP+ HPV) : If negative then 5 yearly. If only cytology done, then once in 3 yrs if cytology is negative In high risk females (who have recently been treated for cervical dysplasia or who are HIV positive ), should undergo Pap smear examination annually ; provided the previous few consecutive Pap smears are normal. After 65 yrs : no more PAP, if 3 cytology are negative or 2 CO-TEST are negative. -### End" -3809,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ABC transpoer ?, with the following options: A: P. glycoprotein, B: Membrane sparing, C: Channel, D: Adenylyl cyclase - -### Response: -Ans. is'a' i.e., P. glycoproteinATP-binding cassette transpoers (ABCtranspoers) are integral transmembrane proteins that utilize ATP as an energy source to translocate a variety of substrates across membranes.P-glycoprotein is an ATP-binding cassette (ABC) transpoer and is an impoant factor to limit membrane permeability in several tissues and/or elimination pathways into urine (rend tubles) and bile (liver). -### End" -3810,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AML with gum infiltration and hepatosplenomegaly is most probably:, with the following options: A: ALL, B: M3, C: M2, D: M4 - -### Response: -. M4 -### End" -3811,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Buprenorphine partial agonist at which opioid receptor?, with the following options: A: Mu, B: Kappa, C: Delta, D: Lambda - -### Response: -Ans. is 'a' i.e., Mu o Buprenorphine is partial agonist on mu receptor and antagonist at Kappa receptor.Nature of interaction of opioid ligands with the three major types of opioid receptors, along with equivalent analgesic dosesLigandm (mu)k (kappa)d (delta)Analgesic dose (mg)1. MorphineAgo. (St)Ago. (W)Ago. (W)102. NalorphineAnta. (St)Ago. (M)--3. PentazocineP. Ago., Anta. (W)Ago. ( M)-30-604. ButorphanolP. Ago. (W)Ago. (St)-1-35. BuprenorphineP. Ago.Anta. (M)-0-3-046. NaloxoneAnta. (St)Anta. (M)Anta. (W)-7. NaltrexoneAnta. (St)Anta. (M)Anta. (W)_8. Met/Leu enkephalinAgo. (M)-Ago. (St)_9. (3-EndorphinAgo. (St)-Ago. (St)_10. Dynorphin A, BAgo. (W)Ago. (St)Ago. (W)- -### End" -3812,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Descending order of cancer prevalence in males -, with the following options: A: Lung > oral > pharynx > esophagus, B: Oral>pharynx>lungs>esophagus, C: Pharynx>lung>oral>esophagus, D: Esophagus>oral>stomach>lung - -### Response: -Park's textbook of preventive and social medicine 23rd edition 5 year prevalence of cancer in males in India 1. Lip and oral cavity = 12.6% 2.pharynx=7% 3.lungs =3.7% 4. Esophagus = 2.1% . -### End" -3813,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is type B breathing circuit, with the following options: A: D, B: C, C: B, D: A - -### Response: -Type b breathing circuit –both inlet and expiratory outlet valve are closer to patient. -### End" -3814,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve supply of opponens pollicis ?, with the following options: A: Superficial branch of ulnar nerve, B: Deep branch of ulnar nerve, C: Median nerve, D: Posterior interosseous nerve - -### Response: -Hand muscles supplied by median nerve are :- i) Thenar muscles (except adductor pollicis) :- Flexor pollicis brevis, opponens pollicis and abductor pollicis brevis. Adductor pollicis is supplied by ulnar nerve. ii) First two lumbricals. Hand muscles supplied by ulnar nerve are :? 1) Superficial terminal branch : It supplies palmaris brevis and skin of palmar surface of medial 1% fingers. 2) Deep terminal branch : It supplies adductor pollicis, all interossei, medial two (3rd & 4th)lumbricals and all hypothenar muscles except palmaris brevis (i.e. abductor digiti minimi, flexor digiti minimi, opponens digiti minimi). -### End" -3815,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A pregnant female 28 years complains of hematemesis after an episode of vomiting, on upper GI endoscopy this is the appearance, what is the most common site of this condition?, with the following options: A: Just below the Gastroesophageal junction, B: Cardia, C: Lower 1/3 of the esophagus, D: Lesser curvature of stomach - -### Response: -Ans. A Just below the Gastroesophageal junction Ref- Mallory-Weiss Left and Right: A linear mucosal laceration caused by the force of vomiting, generally at or just below the esophagogastric junction, resulting in bleeding. Seen here is an elliptical-shaped mucosal tear which has stopped bleeding, from the forward view (on the left) and from the retroflexed position (on the right). Image Source- -### End" -3816,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aerial O2 content is reduced in one of the following, with the following options: A: Stagnant hypoxia, B: Anemic hypoxia, C: Histotoxic hypoxia, D: Ischemic hypoxia - -### Response: -the anemic type, in which the amount of functional hemoglobin is too small, and hence the capacity of the blood to carry oxygen is too low Ref: guyton and hall textbook of medical physiology 12 edition page number: 353,354,355 -### End" -3817,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which morphological type of cataract is most visually handicapping, with the following options: A: Coical, B: Nuclear, C: Posterior subcapsular, D: Zonular - -### Response: -Posterior subcapsular cataract is near the nodal point of the eye and hence decreases the vision mostly -### End" -3818,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chyluria is associated with passage of urine which is:, with the following options: A: White, B: Dark yellow, C: Straw coloured, D: Brown - -### Response: -Answer is A (White) Chyluria is associated with assage of white coloured milk like urine. Underlyingndition condition Hematuria, Hemoglobinuria, Myoglobinuria Jaundice Chyluria Massive uric acid crystalluria Porphyrinuria Alkaptonuria Drugs Rifampicin Phenytoin Chloroquine Triamterene Methylene blue Metronidazole, imipenem/cilastatin, methyldopa Foods Beetroot Rhubarb, senna Carotene Possible urine coloration Pink, red , brown or black Dark yellow to brown White and milky Pink Red (possibly darkening upon standing or fluorescence in UV light) Brown to black Orange to red Red Brown Green Blue Darkening upon standing Red Yellowish-brown or red Brown -### End" -3819,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A new born who has frothing of mouth. Cyanosis is present on day one. The most probable diagnosis is:, with the following options: A: Lung hypoplasia, B: Lung cyst, C: Diaphragmatic hernia, D: Esophageal atresia - -### Response: -Ans. d. Esophageal atresia (Ref: Ghai 7/e p151: Nelson 19/e p1262)A new born who has frothing of mouth. Cyanosis is present on day one. The most probable diagnosis is esophageal atresia.'The diagnosis of esophageal atresia is entertained in an infant with excessive salivation along with coughing or choking during the first oral feeding.'Esophageal atresia:The diagnosis of esophageal atresia is e.ntertained in an infant with excessive salivation along with coughing or choking during the first oral feeding.Lung hypoplasia:The history may include poor fetal movement or amniotic fluid leakage and oligohydramnios.The neonate may be asymptomatic or may present with severe respiratory distress or apnea that requires extensive ventilatory support.In older children, dyspnea and cyanosis maybe present upon exertion, or a history of repeated respiratory infections maybe noted.Lung cyst:Found most often in young adults and are rare in infancy.The usual symptoms are the result of compression by the cyst, e.g., dyspnoea, dysphagia, cough and chest pain.Diaphragmatic hernia:Classic triad: Respiratory distress + Dextrocardia + Scaphoid abdomenQThe MC presentation is respiratory distress due to severe hypoxemia.The infant appears dyspneic, tachypneic, and cyanotic, with severe retractions.The anteroposterior diameter of the chest maybe large and the abdomen may be scaphoidQ. -### End" -3820,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secondary ossification centre appears before bih at, with the following options: A: Upper end of femur, B: Lower end of femur, C: Lower end of tibia, D: Lower end of fibula - -### Response: -Long Bone Diaphysis (shaft) - derived from primary ossification center. * present at 6 - 8 weeks of IUL. Epiphysis (ends) - derived from secondary ossification center. * appear after bih Except - Lower end of femur & sometimes upper end of tibia. | Their secondary ossification center appears before bih. -### End" -3821,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cerebello pontine angle tumour is most commonly:, with the following options: A: Acoustic neuroma, B: Cholesteotoma, C: Meningioma, D: All of the above - -### Response: -Ans: a (Acoustic neuroma)Ref: Dhingra E.N.T. 3rd /e p. 143 & 2nd/e p. 116 -### End" -3822,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following branches of the Vthnerve supply the Duramater except, with the following options: A: Anterior ethmoidal, B: Posterior ethmoidal, C: Auriculotemporal, D: Mandibular - -### Response: -C i.e. Auricotemporal nerveAnterior cranial fossa is supplied by anterior & posterior ethmoidal nerves, maxillary nerve (nervous meningus medius) and mandibular nerve (nervus spinosus)Q. Middle cranial fosa is supplied by maxillary (nervus meningus medius) & mandibular (nervus spinosus) nerves and filaments from trigeminal ganglion. Posterior cranial fossa is supplied by nervus tentorii (tentorial nerve), upper cervical (C1, C2, C3) spinal nerves and meningeal branches of vagus (10), hypoglossal -### End" -3823,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Single dose treatment for gonorrhea ?, with the following options: A: Azithromycin, B: Tetracyline, C: Ceftriaxone, D: Erythromycin - -### Response: -Ans. is 'c' i.e., Ceftriaxone For uncomplicated gonococcal infection, single dose of IM ceftriaxone is the drug of choice. It is given along with azithromycin (single dose) or doxycyline (BD for 7 days) to cover chlamydial infection -### End" -3824,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following forms radiopaque stones:, with the following options: A: Xanthine., B: Oxalate., C: Uric acid., D: None. - -### Response: -Radiopaque stones: cysteine, oxalate & struvite -Radiolucent stones: xanthine, uric acid. -Allopurinol may lead to xanthine stones. -### End" -3825,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All agents can be given for induction of anesthesia in children except:, with the following options: A: Halothane, B: Sevoflurane, C: Morphine, D: N20 - -### Response: -C i.e. Morphine - Intravenous route is most preferred method for induction in childrenQ because it provides overall better control of anesthesia & less chances of aspiration. The only problem is that it is difficult to put IV line. Sevoflurane is inhalational agent of choice for inductioin of anesthesia in pediatric (and adult) patients, because of rapid onset of action & nonpengency Q. It can be used safely in hepatitis & intestinal obstructionQ. Desflurane & isoflurane are more pungent and are associated with more coughing, breath holding & laryngeal spasm during inhalational inudction, so not used as first choice. -Methoryflurane is highly nephrotoxic so not preferred Infants and elderly are more susceptible to respiratory depressant action of morphine (KDT). In infants this is d/t poorly developed respiratory centre. -### End" -3826,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In hand injury first structure to be repaired should be, with the following options: A: Muscle, B: Bone, C: Skin, D: Nerve - -### Response: -For musculoskeletal injuries, early total care allows definitive fixation of all unstable long bone, spinal and pelvic fractures within 36 hours of injury. This facilitates nursing care, allows early mobilisation of the patient and reduces pulmonary complications and length of stay on intensive care. If a sequence of fracture fixations is required, at the conclusion of each procedure the surgeon and anaesthetist should determine whether the patient's physiological status has been maintained sufficiently to allow the next procedure, or whether the patient should return to critical care for a fuher period of resuscitation. Ref: Bailey and love 27th edition Pgno : 326 Sequence of repair in Hand injuries Bone shoening and stabilization/Fixation Extensor tendon repair Flexor tendon repair Aerial anastomosis Nerve repair Venous anastomosis Skin/Wound closure Pneumonic: BE FAN of VeinS Ref: Master techniques in ohopaedic surgery series by Morgan and cooney (2008) Pgno : 487 -### End" -3827,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a peroxisomal free radical scavenger, with the following options: A: Superoxide dismutase, B: Glutathione peroxidase, C: Catalase, D: All the above - -### Response: -ref Robbins 9/e p48 -### End" -3828,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bohlers angle is decreased in facture of -, with the following options: A: Calcaneum, B: Lisfranc, C: Scaphoid, D: Lunate - -### Response: -Ans. is 'a' i.e., Calcaneum Radiological angles on Lateral view of Calcaneum* Bohler's Tuber Joint Angle and Crucial Angle of Gissane are measured for Intra Articular Fractures of Calcaneum.1) Bohler's angle (tuber joint angle)# It measues the angular relationship between talus and calcaneum line : -a) Drawn from the posterosuperior margin of the calcaneal tuberosity through the tip of the posterior facet of the subtalar joint,b) Drawn from the tip of the posterior facet through the superior margin of the anterior process of the calcaneum.# Normally this angle ranges between 20 & 40deg# Flattening of this angle is a classic x-ray sign of depressed fracture of calcaneum.2) Crucial angle of Gissane# This angle is formed betweenDownward portion of the posterior facet and the upward portion (This angle wedge the lateral process of Talus)# Normal angle of Gissane is approximately 100deg# An Increase in the angle of Gissane indicates intraarticular fracture of calcaneum (by axial compressive force). -### End" -3829,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The major contribution of the amniotic fluid after 20 weeks of gestation :, with the following options: A: Ultrafiltrate and maternal plasma, B: Fetal urine, C: Fetal lung fluid, D: Fetal skin - -### Response: -Fetal urine -### End" -3830,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 month old child presents with two weeks history off fever, vomiting and alteration of sensorium Cranial CT scan reveals basal exudates and hydrocephalus, the most likely etiological agent is –, with the following options: A: Mycobacterium tuberculosis, B: Cryptococcus neoformans, C: Listera monocytogenes, D: Streptococcus pneumoniae - -### Response: -Insiduous /gradual onset of fever over a duration of two weeks, with features of raised intracranial tension in the form of vomiting and altered sensorium with characteristic basal exudates and hydrocephalus on cranial CT scan are almost characteristic of tuberculous meningitis. -TUBERCULOUS MENINGITIS - -Tuberculous meningitis usually arises from the formation of metastatic caseous lesions in the cerebral cortex or meningitis that develops during the lymphohaematogenous spread of primary infection. This initial lesion increases in size and discharges tubercle bacilli in the subarachnoid space. -This results in gelatinous basal exudate which interferes in the normal flow of CSF, in and out of the ventricular system at the level of basal cisterns leading to a communicating hydrocephalus. - -Clinical manifestations of tuberculous meriins - -The clinical course of TB meningitis has three stages - - - -Prodromal stage or stage of invasion - - -Insidious onset                                                     o Headache and vomiting -Low grade fever, loss of appetite                    o Photophobia -Disturbed sleep                                                    o Constipation - -2. Stage of meningitis -Signs of meningeal irritation develops - Neck rigidity, Kernig's sign -3. Stage of coma -o Loss of consiousness                           o Bradycardia - -Pupils are dilated & fixed                 ❑ Chyne-strokes or Biot type of respiration -Episodic decerebration - -CT findings in TBM : - -Basal cisterns are obliterated by isodense / hyperdense exudate -Post contrast there is a avid enhancement of the basal meninges extending into the ambient, sylvian, pontine and chiasmatic cisterns. - -Meningeal enhancement may continue over the cerebral and cerebellar hemispheres. -3. Hydrocephalus is present in 45-87% of patients at time of diagnosis. -### End" -3831,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oily substance secreting gland is: September 2009, with the following options: A: Sweat gland, B: Meibomian gland, C: Salivary gland, D: Lacrimal gland - -### Response: -Ans. B: Meibomian glandThe meibomian glands (or tarsal glands) are a special kind of sebaceous glands at the rim of the eyelids inside the tarsal plate, responsible for the supply of meibum, an oily substance that prevents evaporation of the eye's tear film, prevents tear spillage onto the cheek, makes the closed lids aiight and acts as a blockade for tear fluid, trapping tears between the oiled edge and eyeball -### End" -3832,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following questionnaire is sued for screening, with the following options: A: Alcoholism, B: Tobacco use, C: IV drug abuse, D: All of the above - -### Response: -.it is called as CAGE questionerre C====Cut down=========== has the patient tried to cut down theuse of alcohol A====Annoyed============has the patient been annoye of using alcohol G====Guilt==============has the patient ever felt guilty about the use of alcohol E====Eye opener==========has the patient used alcohol as an eye opener each point has to be given 1 score score more than 2 indicates more towards suspision towards alcohol use disoder it is a screening instrument used for alcohol E -### End" -3833,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding the hip joint, which of the following statements is true ?, with the following options: A: Retinaculum attaches femur to hip, B: Inferior gluteal nerve supplies the abductors of the hip, C: Capsule is attached to the intertrochanteric line, D: iliopsoas cuses abduction of hip - -### Response: -Superior gluteal nerve supplies the abductors of the hip-gluteus medius and gluteus minimus. Iliopsoas causes flexion of hip. Capsule is attached to acetabular labrum on hip bone and intertrochanteric line on femur. -### End" -3834,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kanagawa phenomenon on wagatsuma agar is shown by, with the following options: A: V.Cholerae, B: V.Parahemolyticus, C: V.Vulinificus, D: V.alginotyticus - -### Response: -Kanagawa phenomenon is enhanced β hemolysis shown by V.parahemolyticus. -### End" -3835,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: As regard the PCOS and hyperinsulinaemia:a) Hyperinsulinaemia is observed in about 40% to 5O% of women with PCOSb) Hyperinsulinaemia stimulates hepatic synthesis of SHBGc) Metformin causes hypoglycaemia in normo-glycaemic womend) Metformin has many other health benefits, with the following options: A: b, B: c, C: ac, D: ad - -### Response: -Insulin resistance and compensatory hyperinsulinaemia is observed in about 40% of women with normal weight and 80% obese women with PCOS. Hyperinsulinaemia results in decreased hepatic synthesis of SHBG and increased ovarian androgen biosynthesis. Metformin reduces weight, BMI fasting insulin levels, blood pressure and LDL cholesterol. -Metformin does not cause hypoglycemia neither in normoglycaemic patients nor with diabetic individuals. -### End" -3836,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common mechanism of resistance to drugs in Staphylococcus is, with the following options: A: Conjugation, B: Transformation, C: Episomes, D: Transduction - -### Response: -Transduction is phage-mediated genetic recombination in bacteria. In simplest terms, a transducing paicle might be regarded as a bacterial nucleic acid in a phage coatStaphylococci are variably susceptible to many antimicrobial drugs. Resistance is caused by several mechanisms, one of these is: b-Lactamase production is common, is under plasmid control, and makes the organisms resistant to many penicillins (penicillin G, ampicillin, ticarcillin, piperacillin and similar drugs). The plasmids are transmitted by transduction and perhaps also by conjugation.Reference: Jawetz, Melnick, & Adelberg's Medical Microbiology; 27th edition; Chapter 13; The Staphylococci -### End" -3837,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which group of nerve fibres are least susceptible to LA?, with the following options: A: A alpha, B: A beta, C: B, D: C - -### Response: -ANS. DErlanger-Gasser classification of nervesFiber typesFunctionAverage fiber diameters (mm)Average conduction velocity (m/s)AaPrimary muscle spindle afferents, motor to skeletal muscle15100 (70-120)ApCutaneous touch and pressure afferents850 (30-70)AyMotor to muscle spindle520(15-30)A5Cutaneous temperature and pain afferents<315(12-30)BSympathetic preganglionic37(3-15)CCutaneous pain afferents sympathetic postganglionic11 (02-2)LA susceptiblity: A delta>gamma>A beta>A alpha>B>CHypoxia: B > A> CPressure: A > B > C -### End" -3838,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fibrosis is due to-, with the following options: A: TGF-b, B: TNF-a, C: IL - 7, D: IL -10 - -### Response: -Robbins and Cotran pathologic basis of disease South Asia edition. Robbins 9/e p46 *activated macrophages secrete 1 growth factors ,TGF Beta:tissue repair and fibrosis. 2 IL 10 ,TGF Beta: anti inflammatory effect. -### End" -3839,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ECT is currently indicated as a line of treatment in the following conditions except:, with the following options: A: Catatonic schizophrenia, B: Severe depression with psychosis, C: Manic depressive psychosis, D: Obsessive compulsive disorder - -### Response: -ECT is rarely used in the treatment of OCD Electoro-Convulsive therapy Sessions scheduled 2-3 times weekly on nonconsecutive days. Twice-weekly treatments are associated with less memory impairment than thrice-weekly treatments. For a seizure to be effective in the course of ECT, it should last at least 25 seconds. Indications of ECT Depression with suicide risk, stupor, psychotic depression, intolerance to drugs Catatonic schizophrenia Mania Others- Intractable seizures, Delirium,Parkinson disease -### End" -3840,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: B/L Occlusion of distal branches of PCA leads to:, with the following options: A: Parinaud's syndrome, B: Weber's syndrome, C: Anton's syndrome, D: Benedikt syndrome - -### Response: -Anton's syndrome: Visual anosognosia associated with confabulation in the setting of obvious visual loss and coical blindness Due to B/L Occlusion of distal branches of PCA. Parinaud's syndrome: Triad of upgaze paralysis, convergence retraction nystagmus, pupillary light-near dissociation. Weber's syndrome: Presence of an ipsilateraloculomotor nerve palsy Contralateral hemiparesis or hemiplegia due to occlusion of P1 PCA. Benedikt syndrome: Lesion in Red nucleus and 3rd n. nucleus I/L 3rd N. palsy, C/L chorea and resting tremors. -### End" -3841,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During blood transfusion, clotting of transfused blood is associated with, with the following options: A: ABO incompatibility, B: Minor blood group incompatibility, C: Rh incompatibility, D: Transfusion through Ringer's lactate - -### Response: -Most transfusion reactions are hemolytic and are due to clerical errors that result in administration of blood with major (ABO) and minor antigen incompatibility. Interestingly, Rh incompatibility is not associated with intravascular hemolysis. Administration of blood through hypotonic solutions such as 5% dextrose and water results in swelling of the erythrocytes and hemolysis. Calcium-containing solutions such as Ringer's lactate cause clotting within the intravenous line rather than hemolysis and may lead to pulmonary embolism. Delayed transfusion reactions, caused by a presumed anamnestic immune response that occurs 3-21 days after blood is infused, result in a hemolytic anemia. -### End" -3842,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most frequently damaged cranial nerve with a motor component, with the following options: A: Occulomotor, B: Trigeminal, C: Facial, D: Glossopharyngeal - -### Response: -Traumatic Cranial Neuropathies: the most common cranial nerves which recieve traumatic injuries include olfac, tory, facial and audiovestibular nerves the lower cranial nerves are less often involved -### End" -3843,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following ligament is not attached to talus ?, with the following options: A: Talonavicular ligament, B: Spring ligament, C: Deltoid ligament, D: Cervical ligament - -### Response: -Ans. is 'b' i.e., Spring ligament -### End" -3844,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metropathia hemorrhagica is best treated by :, with the following options: A: Curettage of uterus, B: Progestogen, C: Oestrogen, D: Clomiphene - -### Response: -Progestogen -### End" -3845,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are advantages of transdermal drug delivery systems except, with the following options: A: They produce high peak plasma concentration of the drug, B: They produce smooth and nonfluctuating plasma concentration of the drug, C: They minimize interindividual variation in the achieved plasma drug concentration, D: They avoid hepatic first pass metabolism of the drug - -### Response: -Ref-KDT 6/e p9 Transdermal route ts emploved for highly liid soluble drugs that can tra verse intact skin. The wize of the pores in tansdermal patch is adjusted to produce aunitorm and smouth absorption of the drug. This will thus, pro duce a delaved d smaller peak. in the plasma concentration. As the drug. is soins directly in the blood stream, tirst pass metabolism is avoided. -### End" -3846,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is NOT seen in occulomotor palsy, with the following options: A: Lateral and upward gaze, B: Ptosis, C: Loss of light reflex, D: Dilatation of pupil - -### Response: -The paralysis of third nerve results in : Ptosis or drooping upper eye lid - paralysis of levator palpebrae superior. Lateral squint (lateral & downward gaze) Dilation of pupil - paralysis of parasympathetic fibers to sphincter pupillae muscle. Loss of accommodation Foreward projection of eye / proptosis Diplopia -### End" -3847,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thin filament consists of all except:, with the following options: A: Actin, B: Troponin, C: Myosin, D: Tropomyosin - -### Response: -Myosin is thick filament. All others  in the options are thin filaments. -### End" -3848,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice in detecting small para-aoic lymph node is -, with the following options: A: Ultra sound scan, B: CT scan, C: Lymphangiography, D: Aeriography - -### Response: -Ans. is 'b' i.e., CT scan -### End" -3849,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is responsible for protection from ultraviolet rays: September 2011, with the following options: A: Stratum corneum, B: Langerhans cells, C: Apocrine sweat glands, D: Melanocyte - -### Response: -Ans. D: Melanocyte Structure involved in protection against ultraviolet radiation is melanin produced by melanocytes and transferred to keratinocytes -### End" -3850,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 33-year-old man presented with a slowly progressive swelling in the middle third of his right tibia. X-ray examination revealed multiple sharply demarcated radiolucent lesions separated by areas of dense and sclerotic bone. Microscopic examination of a biopsy specimen revealed island of epithelial cells in a fibrous stroma. Which of the following is the most probable diagnosis?, with the following options: A: Adamantinoma, B: Osteofibrous dysplasia, C: Osteosarcoma, D: Fibrous coical defect - -### Response: -Ans. Adamantinoma -### End" -3851,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 8 years. old child presents with lethargy multiple epiphyseal breaks, wormian bones with growth retardation and mental retardation Diagnosis is –, with the following options: A: Rickets, B: Hypothyroidism, C: Scurvy, D: Hypoparathyroidism - -### Response: -Multiple epiphyseal breaks, wormian bones with lethargy, growth retardation and mental retardation suggest the diagnosis of hypothyroidism. - -X-ray findings of hypothyroidism - -Delayed appearance of epiphysis -Multiple foci of ossification → Epiphyseal dysgenesis -Epiphyseal breaking of 12th thoracic and 1st or 2nd lumbar vertebrae. - -Skull →  - -Large fontanelle -Wide sutures -Wormian bones -Enlarged & rounded sella turcica - - -Delayed dentition -### End" -3852,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rim - sign on nephrogram is seen in, with the following options: A: Hydronephrosis, B: Absent kidney, C: Wilm's tumor, D: Renal cell carcinoma - -### Response: -Causes of Rim - nephrogram are : - -Renal vein thrombosis. -Hydronephrosis. -Acute complete renal artery occlusion. -### End" -3853,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest site of Pleomorphic adenoma is ?, with the following options: A: Parotid salivary gland, B: Submandibular salivary gland, C: Sublingual gland, D: Submaxillary gland - -### Response: -Ans. is 'a' i.e., Parotid salivary glandPleomorphic adenoma o This is the Commonest neoplasm of Salivary glands.o The most Common salivary gland involved is Parotid - represent about 60% tumors in the parotid. o Submandibular and minor salivary glands may also be involved rarely.o Pleomorphic adenoma ---> Parotid > Submandibular > minor salivary glands.o They are derived from a mixture of ductal (epithelial ) and myoepithelial cells and therefore they show both epithelial and mesenchymal differentiation - Also called mixed tumor. -### End" -3854,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Abnormal baseline variability in fetus is defined as:, with the following options: A: Beat to beat variation < 5 mins, B: Beat to beat variation < 5 for 40 mins, C: Beat to beat variation < 5 for 60 mins, D: Beat to beat variation < 5 for 90 mins - -### Response: -Normal baseline variability is more than 5 and less than 25 .It is measured by estimating the difference in beats per minute between the highest peak and lowest trough of fluctuation in a one minute segment of the trace.5 bpm or less is considered reduced variability. Refer page no 529,520,521 of Text book of obstetrics,sheila balakrishnan,2 nd edition. Absence of accelerations, reduced base line variability of < 5 bpm for > 90 minutes denote a hypoxic fetus. Decreased baseline variability may be due to fetal sleep, infection, hypoxia, anomalies or due to maternal medications. Reduced baseline variability, with late or variable deceleration increases the risk of CP. Interpretation of the CTG should always be made in the context of clinical picture. Reference: Dutta's Textbook of Obstetrics 7th edition page no 611 -### End" -3855,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypokalemia ECG changes -, with the following options: A: Tall T wave, B: Short QRS interval, C: Depressed ST segment, D: Absent P wave - -### Response: -Ans. is 'c' i.e., Depressed ST segment E.C.G. manifestations of electrolyte disordersHyperkalemiao A tall peaked and symmetrical T-waves is the first change seen on ECG in patients with hyperkalemia,o RR interval lengthens and QRS duration increases.o Flattening or disappearance of P wave.o ST elevation.o Widening of the ORS complexes due to a severe conduction delay and may become 'sine wave.The progresion and the severity ofthe E.C.G change do not correlate well with the serum potassium concentration.Hypokalemiao Similar to hyperkalemia, hypokalemia produce changes on the E.C.G which are not necessary related to serum potassium level.Depression of the ST segmentDecrease in amplitude ofT waves (inversion of the T waves)Increase in amplitude ofU wavesU and T wave merge in some cases to fortn a T-U wave which may be misdiagnosed as prolonged QTinterval.P wave can become larger and wider and PR interval prolong slightly.QRS duration may increase when hypokalemia becomes more severe.Hypocalcemiao Prolongation of the Q T intervalDue to prolongation of the phase 2 of the ventricular action potential and lengthening of the ST segment while the T wave (which correlate with time for repolarisation remains unaltered).Hypercalcemiao Shortening of the QT interval(Primarily due to a decrease in phase 2 of the ventricular action potential and resultant decrease in ST segment duration).Hypothermiao Causes slow impulse conduction through all cardial tissues resulting inProlongation of all the ECG intervalsRRPRQRSQTo There is also elevation of the J point "" (Only if the ST segment is unaltered producing characteristics T or osborne wave). -### End" -3856,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following are Causes of hypotonia in a 2 year old child except, with the following options: A: Trisomy 21, B: Spinal muscular atrophy, C: Congenital muscular dystrophy, D: Cerebral Palsy - -### Response: -All the above causes presents exclusively with hypotonia (either central or peripheral), except cerebral palsy (CP). Cerebral palsy commonly presents with hypeonia, though hypotonic CP is a known entity; its occurrence is uncommon than hypeonic CP. -### End" -3857,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bone marrow biopsy is absolutely indicated in which of the heamatological conditions?, with the following options: A: Acute leukemia, B: Megaloblastic anemia, C: Hairy cell leukemia, D: Thalassemia - -### Response: -All of the above options are indications for bone marrow examination. Since bone marrow cannot be aspirated in hairy cell leukemia, bone marrow biopsy becomes an absolute indication for establishing the diagnosis. Ref: Harrison's Principles of Internal Medicine, 16th Edition, Page 652; Davidson's Principles and Practice of Medicine, 20th Edition, Page 1047. -### End" -3858,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Probencide interacts with, with the following options: A: Streptomycin, B: Ampicillin, C: Vancomycin, D: Erythromycin - -### Response: -Interaction of probeecid Competitively blocks active transpo of organic acids at all sites especially renal tubules. it inhibits excretion of penicillin or ampicellin and increases its blood level It also inhibits urinary excretion of cephalosporins, sulfonamides, methotrexates and indomethacin. It enables tubular secretion of nitrofurantoin Salicylates, pyrazinamide and ethambutol inhibit uricosuric action of probeecid It inhibits biliary excretion of rifampicin Refer kDT 6/e p209 -### End" -3859,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A pregnant woman is found to have excessive accumulation of amniotic fluid. Such polyhdramnios is likely to be associated with all of the following conditions, except;, with the following options: A: Twinning, B: Microanencephaly, C: Oesophageal atresia, D: Bilateral renal agenesis - -### Response: -Ans. is 'd' i.e. Bilateral renal agenesisRef Repeat, Dutta Obs. 6th/e, p 214 (5th/e, p225)Etiology of polyhydramniosFetal anomalies - (About 20% of cases)Anencephaly - About 50% of casesOpen spina bifidaOesophageal or Duodenal atresiaFetal clefts and neck massesHydrops fetalis due to Rh iso immunizationPlacentalChoriocarcinoma of the placentaMultiple pregnancyHydramnios is more common in uniovular twins, usually affecting the second sac.MaternalDiabetes (50% cases have polyhydramnios)Renal or Cardiac abnormalitiesAlso rememberNormal volume of liquor at 10 weeks- 30 ml20 weeks- 250 ml 30 - 40 weeks - 500 - 1500 mlPolyhydramnios: when amniotic fluid is > 2000 ml.OligohydramniosWhen amniotic fluid < 100 mlSonographic diagnosis is made when amniotic fluid index is 5 cm or lessCauses of oligohydramniosAmnion nodosum - failure of secretion by the cells of amnion covering the placentaRenal agenesis or obstruction of the urinary tract 1UGR associated with placental insufficiencyAffecting one sac of uniovular twin, with an excess of fluid in the otherPostmaturity (dysmaturity) -### End" -3860,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prevention or treatment of osteoporosis in post- menopausal women may be acheived by all EXCEPT, with the following options: A: Estrogen and progesterne hormone replacement therapy, B: Calcium and vitamin D supplementation, C: Bisphosphonates, D: Multivitamins - -### Response: -Multivitamins do not play any role in treatment of osteoporosis. Vitamin D is the essential vitamin. (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 330) -### End" -3861,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following gram positive organism is most common cause of UTI among sexually active women-, with the following options: A: Staphylococcus epidermidis, B: Staphylococcus aureus, C: Staphylococcus saprophyticus, D: Enterococcus - -### Response: -Ans. is 'c' i.e., Staphylococcus saprophyticus Staph saprophyticus . Staph saprophyticus may be present on normal human skin and the periurethral area and can cause urinary tract infection, paicularly in sexually active young women. . Staph saprophyticus strains causing UTI are usually sensitive to most antibiotics, except nalidixic acid. . Staph saprophyticus is novobiocin resistant. -### End" -3862,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following sequences places the lipoproteins in the order of most dense to least dense?, with the following options: A: HDL/VLDL/chylomicrons/LDL, B: HDL/LDL/VLDL/chylomicrons, C: LDL/chylomicrons/HDL/VLDL, D: VLDL/chylomicrons/LDL/HDL - -### Response: -Because chylomicrons contain the most triacylglycerol, they are the least dense of the blood lipoproteins. Because VLDL contains more protein than chylomicrons, it is denser than chylomicrons, but less dense than LDL. Because LDL is produced by the degradation of the triacylglycerols of VLDL, LDL is denser than VLDL. HDL is the most dense of the blood lipoproteins. It has the most protein and the least triacylglycerol (see Tables below).The Four Major Statin Benefit GroupsPatient StatusStatin TreatmentPatient exhibits clinical atherosclerotic cardiovasculardisease (ASCVD)aIf age<=75 years, a high-intensity statina; if >75 years, or not a candidate for a high-intensity statin, a moderate-intensity statincPatient with LDL-cholesterol >=190 mg/dL; no ASCVDHigh-intensity statin (moderate-intensity statin if not a candidate for high-intensity statin)Patients with type 1 or 2 diabetes aged 40-75 years with LDL- cholesterol between 70 and 189 mg/dL, no ASCVDModerate-intensity statin; if the calculated 10-y ASCVD risk is >=7.5%, a high-intensity statinNo clinical ASCVD or diabetes with LDL-cholesterol between 70 and 189 mg/dL, and an estimated 10-y ASCVD risk of >=7.5%Moderate-to high-intensity statin Characteristics of the Major LipoproteinsLipoproteinDensity Range (g/mL)Particle Diameter (mm) RangeElectrophoretic MobilityLipid(%)a TGCholPLFunctionChylomicrons0.93075-1,200Origin80-952-73-9Deliver dietary lipidsChylomicron remnants0.930-1.00630-80Slow pre-b Return dietary lipids to the liverVLDL0.930-1.00630-80Pre-b55-805-1510-20Deliver endogenous lipidsIDL1.006-1.01925-35Slow pre-b20-5020-4015-25Return endogenous lipids to the liver; precursor of LDLLDL1.019-1.06318-25b5-1540-5020-25Deliver cholesterol to cellsHDL2 1.063-1.1259-12a5-1015-2520-30Reverse cholesterol transportHDL3 1.125-1.2105-9a Reverse cholesterol transportLp(a)1.050-1.12025Pre-b aThe remaining percent composition is composed of apolipoproteins. Chol, the sum of free and esterified cholesterol; HDL, high-density lipoprotein; IDL, intermediate-density lipoprotein; LDL, low-density lipoprotein; Lp(a), Lipoprotein ""little"" a; PL, phospholipid; TG, triacylglycerols; VLDL, very low-density lipoprotein. -### End" -3863,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phage encoded exotoxin fo vibrio cholerae resembles which toxin of E. coli ?, with the following options: A: Heat labile toxin, B: Heat stable toxin, C: Shiga like toxin, D: Verocytotoxin - -### Response: -Ans. is 'a' i.e., Heat labile toxin Heat labile toxin of E. coli and cholera toxin resemble each other in their structure, antigenic propeies and mode of action. Both act by activating adenyl cyclase in the enterocyte to form cyclic adenosine 5' monophosphate (c AMP). Heat stable toxin of E. coli acts by activation of cyclic guanosine monophosphate (c GMP) in the intestine. -### End" -3864,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are good prognostic factors for acute lymphoblastic leukemia except -, with the following options: A: Age of onset between 2-8 years, B: Initial WBC count less than 50000, C: Hyper ploidy, D: t(9:22), t(8:14), t(4:11) - -### Response: -t (9:22), t (8:14), t (4:11) Repeat from Nov 09 Q no.116 -### End" -3865,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bone forming tumors are -a) Osteosarcomab) Osteoid osteomac) Giant cell tumourd) Osteoblastomae) Chondrosarcoma, with the following options: A: abd, B: bcd, C: abc, D: ab - -### Response: -Bone forming tumors - -Benign : - Osteoma, Osteoid osteoma, Osteoblastoma. -Malignant : - Osteosarcoma -### End" -3866,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest cause of acute folliculitis (hair follicle infection) is, with the following options: A: Staphylococcus aureus, B: Beta hemolytic streptococcus, C: Propionibacterium acnes, D: Streptococcus viridans - -### Response: -Acute folliculitis are of two types: superficial and deep. The most common causative organism is Staphylococcus aureus. Superficial folliculitis is also caused by Pseudomonas aeruginosa.Reference : page 41 IADVL's Concise Textbook of Dermatology -### End" -3867,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 70 kg man with height of 1.75 m will have BMI in the range of -, with the following options: A: Underweight, B: Overweight, C: Obese, D: Normal - -### Response: -Ans. is 'd' i.e., NormalBMI =Weight (Kg)----------------(Height in meters)2=70------(1.75)J= 22.86 (Normal BMI) BMI =Weight in kg----------------(Height in meters)2=50------(1.50)2= 22.22 Classification of adults according to BMIClassificationBMIRisk of comorbiditiesUnderweight< 18.50Low (but risk of other clinical problems increased)Normal range18.50-24.99AverageOverweight:> 25.00 Pre-obese25.00-29.99IncreasedObese class I30.00-34.99ModerateObese class II35.00-39.99SevereObese class III> 40.00Very severe* Thus, the patient in question is classified into normal range. -### End" -3868,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The mode of toxicity of the following poison is:-, with the following options: A: Hypokalemia, B: Hyperkalemia, C: Hypocalcemia, D: Hypercalcemia - -### Response: -Mode of toxicity of barium 1. Hypokalaemia and neuromuscular blockade: The rapid onset of the marked hypokalaemia so characteristic of barium intoxication is due to sequestering of potassium by muscle cells. Barium clogs the exit channel for potassium ions in skeletal muscle cells. 2. Barium stimulates striated, smooth, and cardiac muscle resulting in violent peristalsis, aerial hypeension and arrhythmias. -### End" -3869,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about relation of epiploic foramen, with the following options: A: IVC inferiorly, B: Poal vein posteriorly, C: Hepatic aery superiorly, D: Bile duct anteriorly - -### Response: -Epiploic Foramen - it is also known as Foramen of Winslow, aditus or opening to the lesser sac. This is a veical slit-like opening through which the lesser sac communicates with the greater sac. The foramen is situated at the level of the 12th thoracic veebra. Boundaries - Anteriorly: Right free margin of the lesser omentum containing the poal vein, the hepatic aery, and the bile duct. Posteriorly : The inferior vena cava, the right suprarenal gland and T12 veebra. Superiorly : Caudate process of the liver. Inferiorly : First pa of the duodenum and the horizontal pa of the hepatic aery. Ref : B D Chaurasia's Human Anatomy , seventh edition, volume 2 , pg .no. 263 -### End" -3870,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient after alcoholic drink fell asleep in chair overnight with hanging arm and develops Saturday Night Palsy. Which of the following best describes the clinical manifestations?, with the following options: A: Neuropraxia, B: Axonotmesis, C: Neurotmesis, D: Necroptosis - -### Response: -Ans. (a) NeuropraxiaRef: Maheshwari 5th ed. 169* In most cases of compressive radial neuropathy, the type of injury is a ""neuropraxia"" that does not involve damage to the axon.* Neuropraxia is classified as a transient conduction block of motor or sensory function without neuronal degeneration. Therefore, despite decreased motor function, patients with neuropraxia are able to regain normal neurologic function within several weeks to months.* Posture-induced radial neuropathy, known as Saturday night palsy, occurs because of compression of the radial nerve. The clinical symptoms of radial neuropathy are similar to stroke or a herniated cervical disk, which makes it difficult to diagnose. NeurotmesisAxonotmesisNeurapraxiaPathological Anatomical continuityMay be lostPreservedPreservedEssential damageComplete disorganisation,Schwann sheaths preservedNerve fibres interruptedSelective demyellnation of larger fibres, no degeneration of axonsClinical Motor paralysisCompleteCompleteCompleteMuscle atrophyProgressiveProgressiveVery littleSensory paralysisCompleteCompleteUsually much sparingAutonomic paralysisCompleteCompleteUsually much sparingElectrical phenomena Reaction of degenerationPresentPresentAbsentNerve conduction distal to the lesionAbsentAbsentAbsentMotor-unit action potentialsAbsentAbsentAbsentFibrillationPresentPresentOccasionally detectableRecovery Surgical repairEssentialNot necessaryNot necessary -### End" -3871,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an activator of LCAT?, with the following options: A: Apo-E, B: Apo-Al, C: Apo-B 48, D: Apo-B 100 - -### Response: -(Refer: DM Vasudevan, Textbook of Biochemistry, 7th edition, pg no: 249) -### End" -3872,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Water content in infant, with the following options: A: 60-70 %, B: 75-80 %, C: 80-90 %, D: > 90% - -### Response: -Ans. is 'b' i.e., 75-80% Schwaz writes - ""the highest percentage of Total Body Water is found in newborns, with approximately 80% of their total body weight comrpised of water. This decreases to about 65% by 1 year of age and therafter remains fairly constant through childhood"". -### End" -3873,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When an inddividual is resting in a room with the air temperature 21degC and the humidity of 80%, the greatest amount of heat lost from body is by, with the following options: A: Elevation of body metabolism, B: Vaporisation of sweat, C: Respiration, D: Radiation - -### Response: -During intense exercise, the body loses 85% of its heat through sweating. Radiation (similar to heat leaving a woodstove). This normal process of heat moving away from the body usually occurs in air temperatures lower than 68degF (20degC). The body loses 65% of its heat through radiation. Ref: guyton and hall textbook of medical physiology 12 edition page number:867,868,869 -### End" -3874,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The receptors for umami taste are specifically stimulated by:, with the following options: A: Glutamate, B: Sucrose, C: Quinine, D: Lysyltaurine - -### Response: -Umami taste is due to activation of a truncated metabotropic receptor, mGluR4, in the taste buds. Glutamate in food may also activate ionotropic glutamate receptors to depolarize umami receptors. Sucrose stimulates sweet receptors; quinine activates receptors for bitter taste. Lysyl taurine is a compound that activates receptors for salty taste. Salt and sour tastes are triggered by activation of ionotropic receptors (ligand-gated ion channel) Sour, bitter, and umami tastes are triggered by activation of metabotropic receptors (GPCRs). -### End" -3875,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anti-tubercular drug not given in liver disease is ?, with the following options: A: Isoniazid, B: Ethambutol, C: Pyrazinamide, D: Rifampicin - -### Response: -Ans. is 'c' i.e., Pyrizinamide o Among the given options, only ethambutol is safe in liver disease. Other three drugs cause hepatotoxicity and should be avoided. o However, if the question is repeated as such, best answer is pyrazinamide because of following statement of Harrison-""In case of presence of hepatic risk factors or if during treatment hepatitis develops in a patient, one might rechallange the patient with rifampicin and isoniazid but pyrizinamide is never given"". -### End" -3876,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are associated increased REM latency, except -, with the following options: A: First night effect, B: SSRIs, C: Narcolepsy, D: Restless leg syndrome - -### Response: -Ans. is 'c' i.e. narcolepsy Increased REM latencyReduced REM latencyo Post traumatic stress disordero Narcolepsyo Restless leg syndromeo Depression, Bipolar disordero First night effecto Cushing syndromeo SSRIso Addison's diseaseo TCAso Untreated sleep apneao Ethanolo Withdrawal of REM suppressing drugso Lithiumo OCD o Schizophrenia -### End" -3877,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About NPCB, all are true except:, with the following options: A: Increase cataract surgery rate to 450 operations per lakh population, B: Intra-ocular lens implantation in more than 80 percent cataract surgery cases, C: 100% coverage of vitamin A prophylaxis doses from 9 months to 3 years of age, D: Development of 50 pediatric ophthalmic units - -### Response: -Ans is 'c' i.e. 100% coverage of vitamin A prophylaxis doses from 9 months to 3 years of age The National Programme for Control of Blindness (NPCB) was launched by the Government of India, Ministry of Health and Family Welfare, in the year 1976 as a 100% centrally sponsored scheme/Programme with the goal of reducing the prevalence of blindness from 1.49% to 0.3% by the year 2000 - this was later revised to the year 2020 in conjunction with VISION 2020Targets for Tenth five year plan:To increase the cataract surgery rate to 450 operations per lakh population;Intra-ocular lens implantation in more than 80% cataract surgery cases by 2007; Development of 50 pediatric ophthalmology units;Facilities for early diagnosis and treatment of glaucoma and diabetic retinopathy;Setting up 20,000 Vision Centres in rural areas;Development of 25 fully operational eye bank network; andDeveloping human resources and institutional capacity for eye care by providing training to eye surgeons and other personnel at various levels, supply of ophthalmic equipments and grant-in-aid to NGOs.Also see:School Eye Screening Programme under NPCB Under the National Programme for Control of Blindness, all children aged 10-14 years will be screened for refractive errors by trained teachers.Children who cannot read the 6/9 line with any eye are then sent to the ophthalmic assistant of the CHC for refraction test.Children needing spectacles are then provided free spectacles by opticians who have been contracted by the NPCB. -### End" -3878,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Absorbable suture material is, with the following options: A: Polyglactine, B: Polypropylene, C: Polyethylene, D: Polybutester - -### Response: -(A) Polyglactin) (38- Bailey & Love 26th)Absorbable suture material Absorption rateNon absorpable suture material* Catgut (plain)}Natural 7-10 days* Silk}Natural* Catgut (chromic)within 90 days* Linen* Polyglactin (Vicryl) 60-90 days* Polyglyconate (Maxon) 180 day* Polyglycolic acid 60-90 days* Polydiaxanone (PDS) 180 days* Polyglycaprone (Monocryl) 90-120 days* Surgical steel* Nylon (Ethilon/Nurolon)* Polyester (Mersilene/Ethibond)* Poly butester* Polypropylene (Proline) -### End" -3879,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 17 year old female presents with a pruritic rash localized to the wrist. Papules and vesicles are noted in a bandlike pattern, with slight oozing from some lesions. The most likely cause of the rash is NOT RELATED -DERMATOLOGY, with the following options: A: Herpes simplex, B: Shingles, C: Contact dermatitis, D: Seborrheic dermatitis - -### Response: -Contact dermatitis causes pruritic plaques or vesicles localized to an area of contact. In this case, a bracelet or wristband would be the inciting agent. The dermatitis may have vesicles with weeping lesions. The process is related to direct irritation of the skin from a chemical or physical irritant. It may also be immune-mediated. -### End" -3880,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic features of Rokitansky -- Kuster Hauser syndrome are all of the following except :, with the following options: A: Absent uterus, B: Absent vagina, C: Anovulation, D: 46 -- XX - -### Response: -Anovulation Mayer Rokitansky Kuser Syndrome (MRKH) is the complete failure in the development of the mullerian ducts resulting in absence of the fallopian tubes, uterus and most of vaginadeg (as of vagina is formed by Mullerian duct). Mayer Rokitansky-Kuster Hauser syndrome Karyotype = 46 XXdeg Phenotype = Female Associated abnormalities are : Renal ectopy and agenesis (Horse shoe shaped kidney)deg Skeletal abnormalitiesdeg (most common - scoliosis) Cardiac anomalies.deg Clinical features : Patient present between 15-18 years of age with primary amenorrhoea.deg (eugonadotropic amenorrhea). Secondary sexual characteristics are normaldeg as ovaries are normal (because of their separate embryonic origin, so ovulation is also normal.) P/V = Vagina is felt like a blind pouch and uterus is absent.deg Findings are confirmed by USG.deg Ideal method for demonstrating Uterine malformations is MRI.deg Management : Repair of vaginal agenesis done either by frank dilatation or vaginoplasty. Vaginoplast should onl be performed when the girls is just married or about to be marripri Frank Dilatation : This non-surgical procedure consists of a woman applying gradual pressure with progressively increasing dilators over the mullerian pit for 15 minutes twice a day. An indentation is created by the end of 3 to 6 month. Some have satisfactory intercourse, but in many, vaginal size is inadequate and they need a surgical procedure eventually. Surgical management : Vaginoplasty either by Mc Indoe operation Differential Diagnosis : Testicular feminization syndrome. Mayer Rokitansky-Kuster Hauser syndrome can be differentiated from testicular feminizing syndrome on the basis of : -### End" -3881,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HIV sentinel surveillance is used to calculate:, with the following options: A: Detection of high risk group, B: Prevalence, C: Monitoring disease trend, D: Detection of incidence - -### Response: -HIV sentinel surveillance used to calculate Trend finding HIV sentinel surveillance (HSS) in India HIV sentinel surveillance (HSS) in India, since its inception in 1998, has evolved into a credible and robust system for HIV epidemic monitoring and acclaimed as one of the best in the world. Sentinel surveillance provides essential information to understand the trends and dynamics of HIV epidemic among different risk groups in the country It aids in refinement of strategies and prioritization of focus for prevention, care and treatment intervention under the National AIDS Control Programme (NACP) HIV estimates of prevalence, incidence and moality developed based on findings from HIV Sentinel Surveillance enable the programme in assessing the impacts the impacts at a macro level. Ref: Park 22nd ed/ 400. -### End" -3882,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is NOT a feature of fetal alcohol syndrome?, with the following options: A: Microcephaly, B: Low intelligence, C: Large propoionate body, D: Septal defects of hea - -### Response: -The diagnosis of Fetal alcohol syndrome (FAS) typically is based on the observance of a triad of abnormalities in the newborn, including: A cluster of craniofacial abnormalities CNS dysfunction Pre- and/or postnatal stunting of growth Craniofacial abnormalities commonly observed in the diagnosis of FAS consist of a pattern of microcephaly, a long and smooth philtrum, shoened palpebral fissures, a flat midface, and epicanthal folds. CNS dysfunction following in utero exposure to alcohol manifests in the form of hyperactivity, attention deficits, mental retardation, and learning disabilities. ASDs and VSDs are most common. Ref: Schuckit M.A. (2011). Chapter 23. Ethanol and Methanol. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -3883,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following conditions are associated with coombs positive hemolytic anemia, except:, with the following options: A: Thrombotic Thrombocytopenic purpura (TTP), B: Scleroderma, C: SLE, D: PAN - -### Response: -Thrombotic Thrombocytopenic purpura (TTP), shows coomb's negative microangiopathic hemolytic anemia. Ref: Amit Ghosh, MD (2010), Chapter 11, ""Hematology: Benign Hematology"", In the book, ""Mayo Clinic Internal Medicine Board Review"", 9th Edition, New york, Page 378; Harrison's Principles of Internal Medicine, 16th Edition, Page 612 -### End" -3884,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bacteria showing antigenic variation -, with the following options: A: Yersinia, B: Bordetella, C: Brucella, D: Borrelia - -### Response: -Bacteria showing antigenic variation are :- - -Neisseria (Meningococci, Gonococci) -Streptococcus spp -Mycoplasma -Borrelia burgdorferi -### End" -3885,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triglycerides are maximum in:, with the following options: A: Chylomicrons, B: VLDL, C: LDL, D: HDL - -### Response: -A i.e. Chylomicron -### End" -3886,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blockage along the course of the minor salivary duct which causes pooling of saliva behind the obstruction and localized swelling, is known as:, with the following options: A: Ranula, B: Retention mucocele, C: Mucous extravasation mucocele, D: Sialolithiasis - -### Response: -In the retention mucocele, there is a blockage along the course of the minor salivary duct which causes pooling of saliva behind the obstruction and localized swelling. This pooling of saliva causes a  pressure build-up and dilates the duct of the minor salivary gland. This dilated ductal epithelium forms a lining around the saliva and mimics a cyst-like lesion. -Ranula is the clinical term for a mucocele occurring on the floor of the mouth after trauma to components of the sublingual glands. Two varieties of ranula exist: cystic (mucus retention cyst) and pseudocystic (mucus retention phenomenon or mucocele). In the cystic type, there is partial obstruction of the distal end of a sublingual gland duct that results in a small epithelial lined cyst usually less than 1 cm in diameter. However, the pseudocystic type, which is more common, forms as a result of extravasation of mucus into the fibrous connective tissue after a tear in a sublingual gland duct and, as in the case of a mucocele, arises as a result of the escape of mucus into the adjacent connective tissue. The clinical term 'plunging ranula' is used when extravasated mucus dissects through the mylohyoid muscle and along the fascial planes of the neck, producing a swelling evident in the floor of the mouth.  -Key concept: -Ranula is specifically for this mucocele occurring on the floor of the mouth after trauma to components of the sublingual glands. -John S. McDonald, in McDonald and Avery's Dentistry for the Child and Adolescent (Tenth Edition), 2016 -### End" -3887,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: pBest result for large capillary (port wine) hemangioma is -, with the following options: A: Tattooing, B: Cryosurgery, C: Laser, D: Excision with split thickness grafting - -### Response: -Ans. is 'c' i.e., Laser ablation Pulsed dye laser (PDL) therapy is considered the standard of care for the treatment of capillary malformations. It is based on the concept of selective photothermolysis.. The beam is selectively absorbed by red- pigmented material such as hemoglobin in the blood vessels of the lesion. This produces selective heat destruction of capillary vessel walls with minimal damage to the overlying epidermis, which leads to lightening of the port wine stain without scarring.""The best treatment to date for early and intermediate port wine stains is with the pulsed dye laser. The method of treatment is termed selective photothermolysis. The beam is selectively absorbed by red- pigmented material such as hemoglobin in the blood vessels of the lesion. This produces selective heat destruction of these structures, and the treated area becomes whiter. ""-- CSDT 13/eCapillary malformations (port wine stains or nevus flammeus)o Capillary malformations (port wrine stains or nevus flammeus) are 3owr-flow vascular malformations of dermal capillaries and postcapillary venules.o They are present at birth as bianchable pink to red patches.o They may be located anywhere on the body, most commonly on the face, typically with a unilateral or segmental distribution that respects the midline.o On the face, they tend to follow the distribution of the trigeminal nerve branches (segments VI , V2 , and V3 )o Capillary malformations do not regress, but grow in proportion to the child's growth and become thicker and darker in color during adulthood.Port wine stainStraw berry angiomasSalmon patcho Isa vascular malformation.o Baby is normal at birtho Also k/a Macular stain or stork biteo It is present at birtho Appears at the age of 2 - 3 weekso Present at birtho Grows along with the childo Grows at a rapid rate upto 4-6 monthss of age and then ceases to grow and spontaneous involution begins.o Seen over the forehead in the midline and over the occiputo Do not regress. o Disappear by the age of 1 year o Involution is slow but is complete by 5-7 years of age. o Emptying sign is demonstrable in strawberry angioma. Tip to remembero patch can be removed.o Strawberry decays.o Wine does not decay, (so port wine stain remains for whole life)o Treatment includes pulse day laser or surgical excision. -### End" -3888,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Waddling gait (Sailor's gait) is seen in, with the following options: A: Bilateral CTEV (Congenital Talipes Equino Varus), B: Bilateral CDH (Congenital Dislocation of Hip), C: Congenital genu recurvation, D: Bilateral calcaneo-valgus deformity - -### Response: -(B) Bilateral CDH (Congenital Dislocation of Hip) # Myopathic gait (or Waddling gait) is a form of gait abnormality.> The ""waddling"" is due to the weakness of the proximal muscles of the pelvic girdle.> The patient uses circumduction to compensate for gluteal weakness.> Conditions associated with a myopathic gait include pregnancy, congenital hip dysplasia, muscular dystrophies and spinal muscular atrophy, metaphyseal chondrodysplasia, diaphyseal dysplasia, limb girdle dystrophy. -### End" -3889,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Source of ammonia in urine ?, with the following options: A: Glutaminase, B: Urease, C: Glutamate dehydrogenase, D: Arginase - -### Response: -Ans. is 'a' i.e., Glutaminase In many tissues like liver, kidney and brain, ammonia combines with glutamate to yield glutamine, by the action of glutamine synthase. The brain is a rich source of glutamine synthase and it predominantly detoxifies ammonia by this route. ATP ADP+Pi Glutamate + NH, 4 Glutamine Glutamine synthetaseGlutamine is a nontoxic major transpo form of ammonia. The glutamine is transpoed by blood to liver where deamination (removal of amino group) of glutamine takes place. Glutaminase cleaves glutamine to yield glutamate and free ammonia (ammonium ion). The ammonia is conveed by liver to urea. 0 H2Glutamine ________________________ Glutamate + NH, GlutaminaseFormation and secretion ammonia by renal tubular cells maintain acid base balance. Ammonia is formed from glutamine by glutaminase. Excretion of ammonia increases in metabolic acidosis and decreases in metabolic alkalosis. -### End" -3890,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which statement regarding measles is false?, with the following options: A: Koplik's spots cannot be seen in conjunctival or vaginal mucosa, B: Vitamin A administration is pa of management of clinical measles, C: CD 150 and PVRL4 are receptors for measles virus, D: Pneumonia is the common cause of death in children with measles - -### Response: -Measles: Koplik's spots on inner cheeks, vagina, conjunctiva- pathognomonic of measles CD 150 and PVRL4 are receptors for measles virus Vitamin A administration is pa of management of clinical measles Pneumonia is the common cause of death in children with measles -### End" -3891,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about M. tuberculosis is -, with the following options: A: Strict aerobes, B: Gram negative, C: Thin cell wall, D: all - -### Response: -Ans. is 'a' i.e., Strict aerobes Morphology . M. tuberculosis is an obligate aerobe. . M. tuberculosis is a straight or slightly curved rod. . Electron micrograph of thin section show that thick cell wall is composed of three layers enclosing a trilaminar plasma membrane. . M. tuberculosis is Gram positive. -### End" -3892,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major surfactant is ?, with the following options: A: Dipalmitoyl lecithine, B: Dipalmitoyl cephaline, C: Dipalmitoyl serine, D: Dipalmitoyl inositol - -### Response: -Ans. is 'b' i.e., Decrease the surface tension of the fluid lining the alveoliDipalmitoyl-phosphatidylcholine (dipalmitoyl-lecithin) is the main surface tension lowering phospholipid in surfactant. -### End" -3893,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following HBV gene codes for HBeAg?, with the following options: A: PreC+C, B: S, C: X, D: C - -### Response: -Ans. a (Pre C+C) (Ref. Robbin's pathology 7th/ 18-D; Ananthanarayan Microbiology, 7th/ 552)HBV is a partially double-stranded deoxyribonucleic acid (DNA) virus packaged with a core protein (HBcAg) and DNA polymerase, and enclosed by envelope proteins (HBsAg). Following receptor-mediated entry into hepatocytes, the virus enters the nucleus, where its DNA is frequently integrated into the host genome.The HBV has four genes: S, P, C, and X. The S gene codes for the ""major"" envelope protein (HBsAg). The largest is P gene. It codes for DNA polymerase. The C gene codes for HBeAg and HBcAg. The C gene has a precore and a core region. If translation is initiated at the precore region, the protein product is HBeAg. If translation begins with the core region, HBcAg is the protein product. HBeAg is a marker of HBV replication and infectivity. The precore region is not necessary for viral replication. Precore mutants can replicate. They are readily detectable by HBV DNA in serum, but hepatitis B e antigen (HbeAg) is absent. The X gene codes for HBxAg. The product of the X gene is hepatitis B x antigen (HBxAg). It may be involved in carcinogenesis. Basal core promoter mutants cause a reduction in HBeAg production.Protein synthesis proceeds from 4 open reading frames:# Envelope proteins - Major, Middle, and Large - (HBsAg) from the -S gene, pre-Sl, and pre-S2 gene sequences;# The e antigen (HBeAg) and core protein (HBcAg) from the -C gene and pre-C gene sequence;# DNA polymerase protein from the -P gene; and# Transactivator X-protein from the -X gene. -### End" -3894,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diabetic patients are advised to avoid foods with high glycemic index. Which of the following has highest glycemic index?, with the following options: A: Pasta, B: White rice, C: Yoghu, D: Whole wheat bread - -### Response: -The glycemic index of a starchy food is a measure of its digestibility, based on the extent to which it raises the blood concentration of glucose compared with an equivalent amount of glucose or a reference food such as white bread or boiled rice. Eating foods with low glycemic index will result in lower glucose levels after meals. Low glycemic index foods have values of 55 or less and include many fruits (apples, oranges) and vegetables, grainy breads, pasta, legumes, milk, and yoghu. High glycemic index foods have values of 70 and over and include baked potato, white bread, and most white rice. Glycemic index is lowered by the presence of fats and protein when the food is consumed in a mixed meal. Cooking methods can also affect the glycemic index--thus mashed potatoes have a higher glycemic index than baked potato. Ref: German M.S. (2011). Chapter 17. Pancreatic Hormones and Diabetes Mellitus. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e. -### End" -3895,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following malignancy is associated with underlying progression and spreads characteristically in a stepwise fashion and hence staging the disease is an impoant prognostic factor? -, with the following options: A: Hodgkin's lymphoma, B: Multiple myeloma, C: Mature T cell NHL, D: Mature B cell NHL - -### Response: -Hodgkin&;s disease primary arises within the lymph nodes and involves the extranodal sites secondarily Based on the extent of involvement of the disease ,Staging is studied in order to select proper treatment and assess the prognosis. Reference textbook of Pathology 6th edition author: Harsha Mohan page number 369-373 -### End" -3896,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Left gastric artery is a branch of -, with the following options: A: Hepatic artery, B: Splenic artery, C: Superior nesenteric artery, D: Coeliac trunk - -### Response: -Ans. is 'd' i.e., Coeliac trunk o Arterial supply of stomach is as follows -Along lesser curvature : Left gastric artery (branch of coeiiac trunk) and right gastric artery (branch of proper hepatic artery').Along greater curvature : Right gastroepiploic artery (branch of gastroduodenal artery) and left gastroepiploic artery (branch of splenic artery').Fundus : 5-7 short gastric arteries (branches of splenic artery).o Most consistently largest artery' to stomach is left gastric artery. -### End" -3897,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most potent topical corticosteroids is –, with the following options: A: Hydrocortisone butyrate cream 0.1%, B: Betamethasone valerate cream 0.1%, C: Clobetasol propionate cream 0.5%, D: Clobetasone butyrate cream 0.5% - -### Response: -Clobitasol propionate 0.5% is a superpotent (class 1-most potent class) topical steroid. -### End" -3898,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug not used for treatment of acute Hyperkalemia is:, with the following options: A: Insulin + glucose, B: Potassium exchange resins, C: Calcium carbonate, D: Sodium bicarbonate - -### Response: -Drugs used for hyperkalemia- insulin-drives potassium into the cell calcium carbonate or calcium chloride sodium bicarbonate loop diuretics or thiazide diuretics ESSENTIALS of medical PHARMACOLOGY SIXTH EDITION-KD TRIPATHI Page:570,571 -### End" -3899,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following techniques are used to control bleeding from bone during mastoid surgery except -, with the following options: A: Cutting drill over the bleeding area, B: Diamond drill over the bleeding area, C: Bipolar cautery over the bleeding area, D: Bone wax - -### Response: -Cutting drill over the bleeding area will increase the bleeding instead of stopping it. -Diamond drill over the bleeding area will produce heat and stop the bleeding -Bipolar cautery can be used to control bleeding during mastoid surgery (Not monopolar cautery) -Bone wax is also commonly used to control bleeding during mastoid surgery (It seals the bleeding site). -### End" -3900,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a survey, many children are examined and were found to have urogenital abnormalities. Which congenital anomaly is associated with an increased risk of bladder carcinoma ?, with the following options: A: Medullary sponge kidney, B: Double ureter, C: Unilateral renal agensis, D: Bladder exstrophy - -### Response: -Congenital anomalies associated with an increased risk of bladder cancer are: patent urachus exstrophy bladder Both increase the risk for adenocarcinoma. -### End" -3901,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Semen analysis of a young man who presented with primary infertility revealed low volume, fructose negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility?, with the following options: A: Colour duplex ultrasonography of the scrotum, B: Transrectal ultrasonography, C: Retrograde urethrography, D: Spermatic venography - -### Response: -First lets briefly review the anatomy of male internal genitalia -Sperms are produced in testes and then stored and mature within the epididymis. Vas deferens carries the sperms from epididymis to the urethra where they open by separate openings into the prostatic urethra. Just before opening each vas deferens is joined by ducts of seminal vesicles. Vas deferens and seminal vesicle ducts join to form the ejaculatory duct. -The secretions of seminal vesicles form a large part of seminal fluid and contain fructose and a coagulating enzyme called the vesiculase. - -Now coming to the question. - -Semen analysis forms an important part of infertility assessment. -Low ejaculatory volume is caused by -retrograde ejaculation into the bladder or -obstruction of the vas deferens or the ejaculatory duct -Azoospermia may be seen in -testicular failure or -obstruction of vas deferens -Absence of fructose suggests -seminal vesicles agenesis or obstruction. -A semen that is low in volume with azoospermia and absence of fructose suggests → either obstruction of the ejaculatory ducts or congenital absence of the vas deferens and seminal vesicles. -The anatomy of the vas deferens & seminal vesicles can be investigated by vasography (where contrast medium is injected into the vas deferens) or TRUS (Trans rectal ultrasonography), however TRUS is superior to vasography and is the investigation of choice. -Also know -Semen specimen should be obtained following at least 3 days of abstinence and examined within 1 to 2 hrs. At least 2 specimens are examined several weeks apart. -### End" -3902,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Water lily appearance in chest X-ray suggestive of the following condition:, with the following options: A: Bronchiectasis, B: Bronchopleural fistula, C: Hydatid cyst, D: Sequestration cyst of lung - -### Response: -Chest X-ray finding of hydatid cyst of the lung: Dense homogenous opacity Collapsed laminated membrane produces an irregular projections in a fluid level due to rupture of the cyst- 'Water-lily appearance' Crescentic cap of air, when it communicates into bronchial tree Ref: Srb's Manual of Surgery By Bhat, 2012, Page 1205. -### End" -3903,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: I cells secrete, with the following options: A: Secretin, B: Gastrin, C: CCK, D: Motilin - -### Response: --Cholecystokinin (CCK) is secreted by cells in the mucosa of the upper small intestine. It has a plethora of actions in the gastrointestinal system, but the most impoant appear to be the stimulation of pancreatic enzyme secretion, the contraction of the gallbladder (the action for which it was named), and relaxation of the sphincter of Oddi, which allows both bile and pancreatic juice to flow into the intestinal lumen. -Gastrin is produced by cells called G cells in the antral poion of the gastric mucosa -Secretin is secreted by S cells that are located deep in the glands of the mucosa of the upper poion of the small intestine -Motilin is secreted by enterochromaffin cells Reference ; GANONG'S REVIEW OF MEDICAL PHYSIOLOGY 23RD EDITION Pg 745,746,747 -### End" -3904,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of hydatiform mole is -, with the following options: A: Chemotherapy only, B: Hysterectomy & chemotherapy, C: Only hysterectomy, D: Suction & evacuation - -### Response: -Ans. is 'd' i.e., Suction and Evacuation Managem_entof Hydatid.iform mole:o Suction evacuation (SE) is the prefered method of treatment. It is safe, rapid and effective in almost all cases. Suction evacuation can safely be done even when the uterus is of 28 weeks of gestation. -### End" -3905,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apoptosis is differentiated from necrosis by the following feature-, with the following options: A: Absence of inflammation, B: Cell swelling, C: Disruption of plasma membrane, D: Passive process - -### Response: -Ans. is 'a' i.e. Absence of inflammation o Two very important differentiating features from necrosis are:-1) Absence of inflammation2) Intact cell membraneApoptosisNecrosiso Death of a single cello Death of many contiguous cells (usually)o Cell size decreases (Shrinkage)o Increased cell size (swelling)o Plasma membrane intacto Disruption of plasma membraneo Lysosomal and other organelles remain intacto Lysosomal breakdown with release of hydrolaseso Cellular contents do not leak outo Cellular contents leak outo Adjacent inflammation absento Adjacent inflammation present.o In early stage require protein synthesiso T Protein synthesiso Active process Energy dependento Passive process Not energy dependento May be pathological or physiologicalo Always pathological -### End" -3906,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A premature infant is born with a patent ductus aeriosus. In closure can be stimulated by administration of:, with the following options: A: Prostaglandin analogue, B: Estrogen, C: Anti-estrogen compounds, D: Prostaglandin inhibitors - -### Response: -Patent ductus aeriosus represents persistent patency of the vessel. The ductus aeriosus usually closes within 2 or 3 days after bih and becomes the ligamentum aeriosum. Constriction of the ductus postnatally involves a complex interaction of increased paial pressure of oxygen, decreased circulating prostaglandin E2 (PGE2), decreased PGE2 ductal receptors, and decreased pressure within the ductus. Subsequent vessel-wall hypoxia of the ductus promotes fuher closure through inhibition of prostaglandin and nitric oxide within the ductal wall. For premature infants, treatment with indomethacin, a prostaglandin inhibitor, is usually the first-line therapy. Ibuprofen has achieved closure rates equivalent to those of indomethacin with less renal toxicity. When PDA fails to close with indomethacin or for term infants with a persistent PDA, surgical or interventional closure is recommended. Ref: Brown D.W., Fulton D.R. (2011). Chapter 83. Congenital Hea Disease in Children and Adolescents. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e. -### End" -3907,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: LARC (Long acting reversible contraceptives) include?, with the following options: A: Implants, B: Injections, C: IUCD, D: All of the above - -### Response: -Ans. D. All of the aboveLong-acting reversible contraception (LARC) are methods of birth control that provide effective contraception for an extended period of time without requiring user action. They include injections, intrauterine devices (lUDs) and subdermal implants. They are the most effective reversible methods of contraception because they do not depend on patient compliance. In addition to being long-lasting, convenient, they are very cost effective. -### End" -3908,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is the physical appearance of________ causing pelvic infection., with the following options: A: Trichomonas vaginalis, B: Candida albicans, C: Mycoplasma, D: Gardenella - -### Response: -Above organism is Trichomonas vaginalis It is an anaerobic flagellated protozoan Trichomoniasis Caused by Trichomonas vaginalis - flagellate protozoan motile organism Symptoms: severe itching and severe pruritis Colpitis Macularis (Strawberry Vagina) Greenish yellow, frothy discharge Rx: Metronidazole Rx both female and male paner -### End" -3909,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The spindle shaped age pyramid denotes, with the following options: A: Developed country, B: Developing country, C: Underdeveloped country, D: Middle east country - -### Response: -Age pyramids The age structure of a population is best represented as shown in the fig: Such a representation is called an ""Age Pyramid"". A vivid contrast may be seen in the age distribution of men and women in India and in Switzerland. The age pyramid of India is typical of developing countries, with a broad base and a tapering top. In the developed countries, as in Switzerland,* the pyramid generally shows a bulge in the middle, and has a narrower base Ref: Park 25th edition Pgno : 516 -### End" -3910,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common pulmonary manifestation in AIDS:, with the following options: A: TB, B: Pneumonia, C: Bronchiectasis, D: Mycobacterial avium intercellular - -### Response: -Pulmonary disease is one of the most frequent complications of HIV infection. The M/C manifestation of pulmonary disease is Pneumonia. Most common AIDS- defining illnesses are :- Recurrent bacterial pneumonia, Tuberculosis, and Pneumonia due to the unicellular fungus P.jiroveci. -### End" -3911,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Typical feature of olfactory sensation is?, with the following options: A: High quantitative detection, B: Stimulus required is very small, C: Non volatile substance can stimulate, D: Different areas sense different smells - -### Response: -The olfactory sensory neurons are located in a specialized por- tion of the nasal mucosa, the yellowish pigmented olfactory epi- thelium. In dogs and other animals in which the sense of smell is highly developed (macrosmatic animals), the area covered by this membrane is large; in microsmatic animals, such as humans, it is small. In humans, it covers an area of 5 cm2 in the roof of the nasal cavity near the septum (Figure 14-1). The human olfactory epi- thelium contains 10 to 20 million bipolar olfactory sensory neurons interspersed with glia-like suppoing (sustentacular) cells and basal stem cells. The olfactory epithelium is said to be the place in the body where the nervous system is closest to the external world. Each neuron has a sho, thick dendrite that projects into the nasal cavity where it terminates in a knob containing 10 to 20 cilia (Figure 14-2). The cilia are unmyelinated processes about 2 mm long and 0.1 mm in diameter and contain specific receptors for odorants (odorant receptors). The axons of the olfactory sensory neurons pass through the cribriform plate of the ethmoid bone and enter the olfactory bulbs (Figure 14-1). New olfactory sensory neurons are generated by basal stem cells as needed to replace those damaged by exposure to the environment. The olfactory renewal process is carefully regulated, and there is evidence that in this situation a bone morphogenic protein (BMP) exes an inhibitory effect. BMPs are a large family of growth factors originally described as promoters of bone growth but now known to act on most tissues in the body during development, including many types of nerve cells.Ref: Ganon pg.no219 -### End" -3912,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the volume of reservoir bag used in neonatal resuscitation, with the following options: A: 240 ml, B: 500 ml, C: 750 ml, D: 1000 ml - -### Response: -The volume of reservoir bag used in neonatal resuscitation is 250 mlThe volume of reservoir bag used in resuscitation of infants is 500 ml** almost all of the manufacturers are using bag sizes between 240 mL and 320 mL for infants and 500 mL for children -### End" -3913,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Annual Under-five deaths globally repoed are:, with the following options: A: 6 million, B: 8 million, C: 10 million, D: 12 million - -### Response: -Under-five Deaths: Burden: 6.3 million Under-five deaths in world (2014) Leading causes of deaths: (45% associated with PEM) Pneumonia Low bih weight and prematurity Bih asphyxia Diarrhoea Malaria Ref: WHO population data, WHO website, 24th edition Pgno: 609 -### End" -3914,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lab values: pH 7.56, paCO2- 20, HCO3- 20 .Interpret?, with the following options: A: Respiratory alkalosis, uncompensated, B: Respiratory alkalosis, compensated, C: Respiratory alkalosis, paially compensated, D: Metabolic alkalosis, paially compensated - -### Response: -pH - 7.56 (Alkaline) PaCO2 - 20 (low) HCO3 - 20 (low) * So this is Respiratory alkalosis * PaCO2 | by 20 mm Hg * So HCO3 to be | by 4x2=8 * HCO3 to be b/w (14 -18) * HCO3 in question 20 & pH-alkaline So respiratory alkalosis but paially compensated -### End" -3915,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is true of ulcerative colitis:, with the following options: A: String sign of Kantor positive, B: Skip lesions are seen, C: Rectum is always involved, D: Fistulas are common - -### Response: -Ans. (c) Rectum is always involved* In ulcerative colitis rectum is always involved.* In ulcerative colitis least involved area: Anus -### End" -3916,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following features are seen in dengue hemorrhagic fever except: September 2010, with the following options: A: Positive tourniquet test, B: Platelet counts less than 1 lac, C: Falling hematocrit value, D: Acute onset of high fever - -### Response: -Ans. C: Falling hematocrit value The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a rash with thrombocytopenia and relative leukopenia- low paltelet and WBC count. Dengue infection can affect many organs and thus may present unusually as liver dysfunction, renal impairment, meningoencephalitis or gastroenteritis. Fever, headaches, eye pain, severe dizziness and loss of appetite. Hemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhoea) Thrombocytopenia (3or estimated as less than 3 platelets per high power field) Evidence of plasma leakage (Hematocrit more than 20% higher than expected, or drop in hematocrit of 20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinemia) Encephalitic occurrences -### End" -3917,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are features of exstrophy of the bladder except :, with the following options: A: Epispadias, B: Cloaca] membrane is present, C: Posterior bladder wall protrudes through the defects, D: Umbilical and inguinal hernia - -### Response: -Ans is 'b' i.e., Cloacal membrane present Exstrophy of bladder (Ectopia vescicae) * There is defect in the infraumbilical pa of the anterior abdominal wall, associated with incomplete development of the anterior wall of the bladder. * The posterior wall of the bladder protrudes through the defect and urine spus onto the abdominal wall from the uretral orifices. * The public rami are widely separated. The femurs are rotated externally and the child 'waddles like a duck'. * The rectus muscles which are inseed on the pubic rami are also widely separated. * An umbilical hernia though usually small is present along with extrophic bladder. In males, there is complete epispadias with a wide and shallow scrotum. Undescended testis and inguinal herniasare common. Females also have epispadias, with separation of the two sides of the clitoris and wide separation of the labia. The anus is dislocated anteriorly in both sexes and there may be rectal prolapse. The consequence of untreated bladder exstrophy are total urinary incontinence and an increased incidence of bladder cancer, usually adenocarcinoma. Embryology - The basic defect in extrophy bladder is abnormal overdevelopment of the cloacal membrane and its rupture. The timing of the rupture of this defective cloacal membrane determines the variant of the exstrophyepispadias complex that results. -### End" -3918,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which cereal is not to be given in celiac sprue?, with the following options: A: Wheat, B: Maize, C: Corn, D: Rice - -### Response: -Ans. (a) WheatRef.: Harrison 19th ed. /1940* Coeliac disease is caused by a reaction to gliadin found in wheat, oats, rye and Barley. Upon exposure to gliadin, there is production of anti-tissue transglutaminase antibody which cross-reacts with small-bowel tissue, causing an inflammatory reaction.* This leads to villous atrophy and leads to osmotic diarrhea. -### End" -3919,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following radioisotopes are used as systemic radionuclides, EXCEPT:, with the following options: A: Iridium192, B: Strontium89, C: Samarium153, D: Phosphorus32 - -### Response: -Systemic radionuclides are non sealed radio nuclides which are administered orally, intravenously or intracvitarily. Sodium iodide (I131), sodium phosphate (P32), samarium 153, strontium 89 chloride and rhenium are used as systemic radionuclides. Ref: Principles of Radiation Oncology By Carlos and Luther, 4th Edition, Pages 636-7 -### End" -3920,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common infection in patients with prosthetic valves is-, with the following options: A: Pneumococcus, B: Pseudomonas, C: Staphylococcus, D: Enterococci - -### Response: -Most common infection in patients with prosthetic valves is infective endocarditis by staphylococcus Ref Davidson 23rd edition pg 450 -### End" -3921,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are histicytosis except -, with the following options: A: Letter seiwe syndrome, B: Chloroma, C: Handschuller-christian triad, D: Eosinophilic granuloma - -### Response: -Ans. is 'b' i.e., Chloroma -### End" -3922,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: a patient had mocturnal eneuresis with depressive symptoms and was staed on antidepressent, what is the drug, with the following options: A: amitriptilline, B: imipramine, C: clomipramine, D: seraline - -### Response: -TCA * MECHANISM This is an antidepressant with three rings. It acts by blocking the transpoers of neurotransmitters resulting in increased neurotransmitters in synapse DRUGS AMITRYPTILLINE IMIPRAMINE CLOMIPRAMINE DESIPRAMINE NORIPTILLINE DOXEPINE * USE AMITRYPTILLINE========PAIN WITH DEPRESSION IMIPRAMINE==========CHILDHOOD ENEURESIS CLOMIPRAMINE========OCD * SIDE EFFECTS ANTI HISTAMINERGIC==== sedation, weight gain ANTI MUSCURANIC=======dryness of mouth ANTI ADRENERGIC========hypotension, giddiness SWITCH TO MANIA when used in BIPOLAR DEPRESSION Ref. kaplon and sadock, synopisis of psychiatry, 11 th edition, 955 -### End" -3923,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the following tri cyclic antidepressent used in the mangement of nocturnal eneuresis, with the following options: A: imipramine, B: fluoxetine, C: bupropion, D: seraline - -### Response: -TCA * MECHANISM This is an antidepressant with three rings. It acts by blocking the transpoers of neurotransmitters resulting in increased neurotransmitters in synapse DRUGS AMITRYPTILLINE IMIPRAMINE CLOMIPRAMINE DESIPRAMINE NORIPTILLINE DOXEPINE * USE AMITRYPTILLINE========PAIN WITH DEPRESSION IMIPRAMINE==========CHILDHOOD ENEURESIS CLOMIPRAMINE========OCD * SIDE EFFECTS ANTI HISTAMINERGIC==== sedation, weight gain ANTI MUSCURANIC=======dryness of mouth ANTI ADRENERGIC========hypotension, giddiness SWITCH TO MANIA when used in BIPOLAR DEPRESSION Ref. kaplon and sadock, synopsis o psychiatry, 11 th edition, pg no. 955 -### End" -3924,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice used to treat MRSA is?, with the following options: A: Metronidazole, B: Vancomycin, C: Imipenem, D: Clindamycin - -### Response: -ANSWER: (B) VancomycinREF: Antibiotic policies: fighting resistance - page 256, Clinical Medicine a Practical Manual for Stud. & pract. by Agarwal - page 372The current drug of choice for serious infections with MRSA remains vancomycin at most institutions'""Vancomycin in a dose of 1 5 mg/kg to a maximum of lgm, given twice a day, is the drug of choice for MRSA. Teicoplanin in a dose of 400 mg/day in a single dose is equally effective"" -### End" -3925,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is renin inhibitor -, with the following options: A: Losartan, B: Benazepril, C: Remikiren, D: Imidapril - -### Response: -Ans. is 'c' i.e., Remikiren -### End" -3926,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudoclaudication is due to the compression of ?, with the following options: A: Femoral aery, B: Femoral nerve, C: Cauda Equina, D: Popliteal aery - -### Response: -Ans. is 'c' i.e., Cauda Equina Pseudoclaudication is intermittent claudication due to compression of the Cauda Equina. Cauda Equina Claudication: is produced as a result of compression of the cauda equina due to conditions such as lumbar canal stenosis (congenital or spondylosis) or protrusion of disc. -### End" -3927,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false regarding frontal sinusitis ?, with the following options: A: Pain shows periodicity, B: Most common sinus involved in infants and children, C: Pain is referred to as office headache, D: Tenderness is present just above the medial canthus of eye - -### Response: -Ans. is 'b' i.e., Most common sinus involved in infants and children Most common sinus involved in infant and children is Ethmoid sinus. Clinical features of acute sinusitis Most common presenting patient's compliant is persistent nasal discharge which can be of any quality (thin, thick, clear, or purulent). Nasal discharge from a sinus infection can be blood - tinged from excessive nose blowing and irritation. The clinical symptoms of acute sinusitis have been classified into major and minor. -### End" -3928,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Waking up at night, screaming with fear, at 2.5 years age, is generally a manifestation of-, with the following options: A: Organic illness, B: Normal development pattern, C: Castration anxiety, D: Separation anxiety - -### Response: -Ans. is 'd' i.e., Separation anxiety o Separation anxiety disorder is characterized by unrealistic and persistent worries of possible harm befalling the affected child or his or her primary caregivers, reluctance to go to school or sleep without being hear the parents persistent avoidance of being alone, nightmares involving themes of separation numerous somatic symptoms and complaints of subjective distress. -### End" -3929,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The oxygen carrying capacity of an 18-year-old boy with hemoglobin of 14 g/dl is, with the following options: A: 14, B: 16, C: 18, D: 22 - -### Response: -Ans. (c) 18(Ref: Ganong, 25th ed/p.640)Oxygen Carrying Capacity of HemoglobinEach gram of hemoglobin transport 1.34 mL of oxygenSo, here in the question, its 14x1.34=18 -### End" -3930,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Structure(s) passing between middle and inferior constrictor muscles of pharynx is/are:, with the following options: A: Superior laryngeal artery and vein, B: Styloglossus, C: Internal laryngeal branch of superior laryngeal nerve, D: Only (a) and (c) - -### Response: -Superior laryngeal vessels and internal laryngeal branch of superior laryngeal nerve which supplies pyriform fossa and sensory fibres to larynx above the level of vocal cord enters through thyrohyoid membrane between middle and inferior constrictors. -### End" -3931,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Basal ganglia calcification is seen in all except:, with the following options: A: Hypoparathyroidism, B: Wilson's disease, C: Perinatal hypoxia, D: Fahr's syndrome - -### Response: -B i.e. Wilson's disease -### End" -3932,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best bone of the following to assess the age of a person between 20-50 years is, with the following options: A: Skull, B: Ribs, C: Sternum, D: Pubic symphysis - -### Response: -Age changes at pubic symphysis The changes in the pubic symphysis are the best criteria to assess the age from third to fifth decade. The changes occurs on three components: dorsal surface, ventral surface, and margin. At the age of about 20 years, there is formation of horizontal ridges of bone on the aicular surface which first stas on the upper poion of the ventral surface and extends to the dorsal surface. This is called billowing. At about 25-35 years, the surface becomes granular and the ventral nd dorsal margins are well defined. A rim formation stas from the dorsal surface extends to the ventral surface. At about 35 -45 years, the upper and lower end will be raised and also the ventral margin by bony extension which is called lipping and the beaded rim development will be complete on all around the margins of the aicular surface. By 45-55 years, the beaded rim stas breaking. By 55-65 years the breakdown of the rim is more and by the end of seventh decade the breakdown of the rim will be complete. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr. PC IGNATIUS PAGE NO90 -### End" -3933,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type of dengue serotypes are ?, with the following options: A: 2, B: 4, C: 5, D: 10 - -### Response: --Dengue is caused by dengue virus. - there are four virus serotypes which we designated as DENV1, DENV2, DENV3 and DENV4. Reference: Park's textbook of preventive and social medicine, 23rd edition, pg no:247 <\p> -### End" -3934,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Microscopic examination of articular surface of a synovial joint demonstrates?, with the following options: A: Hyaline cartilage, B: Adipocytes, C: Endothelial cells, D: Periosteum - -### Response: -ANSWER: (A) Hyaline cartilageREF: Basic histology, Carlos & Jose, 11th edition, Chapter 7, Cartilage, Textbook of human histology 4th e p. 92-94See APPENDIX-2 below for ""Types of cartilage"" APPENDIX - 2Types of Cartilages Hyaline CartilageElastic CartilageFibrocatilageCompositionType II collagenChondroitin sulfateType II collagenElastin fibersType I collagenPerichondriumPresentPresentAbsent Articular cartilageArytenoid cartilageThyroid cartilageCricoid cartilageEpiphyseal growth plateNasal septumCostal cartilage of ribsAuricleAuditory tubeEpiglottisCuneiform cartilage of larynxEpiglottisExternal auditory canalArticular discsIntervertebral discsMenisciPubic symphysisGlenoid labrumAcetabular labrum -### End" -3935,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lupus Pernio is seen in:, with the following options: A: Tuberculosis, B: SLE, C: PAN, D: Sarcoidosis - -### Response: -Answer is D (Sarcoidosis): Pernio is a typical cutaneous manifestation of Sarcoidosis. Lupus Pernio is the most typical and easily recognizable skin lesions of Sarcoidosis. It is characterized by the presence of violaceous, purple blue shiny swollen lesions over the bridge of nose, beneath the eyes and over the cheeks. This specific complex of involvement of the bridge of nose, the area beneath the eyes and the cheeks is considered diagnostic for a chronic form of Sarcoidosis. -### End" -3936,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Subjective test of hearing is?, with the following options: A: Pure tone audiometry, B: Oto acoustic emission, C: BERA, D: Impedence audiometry - -### Response: -ANSWER; (A) Pure tone audiometryREF: Achars Textbook of Pediatrics (4th Edn) by Swama Rekha Bhat p: 612, Nelson's pediatrics 18th ed ch: 636Subjective testsObjectives testsBirth -5months : behavoria! tests without rein - forcement6months -30months: visual reinforcement audiometry30 months - 5 years: play audiometry> 5yrs: speech tests> 5yrs: pure tone audiometry> 5yrs: pure tone audiometryOtoacoustic emissions: low specificity and takesaround 12 minstympanometryBERA: high specificity , takes around 21 mins Impedence audiometry Acoustic reflectometryChild s cooperating is needed for subjective tests. -### End" -3937,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bradycardia is common after injection of:, with the following options: A: Midazolam, B: Succinylcholine, C: Dopamine, D: Isoprenaline - -### Response: -Ans. (B) Succinylcholine(Ref: KDT 8th/e p378)Succinylcholine is a depolarizing neuromuscular blocker. In contrast to ganglionic blocking properties of competitive neuromuscular blockers (like d-TC), it stimulates the ganglia.Initially bradycardia is seen due to stimulation of parasympathetic ganglion which is followed by tachycardia and hypertension due to stimulation of sympathetic ganglia.Dopamine and isoprenaline possess b1 agonistic activity and thus can cause tachycardia.Midazolam is a benzodiazepine. It does not affect CVS at therapeutic dose but produces bradycardia at toxic levels. -### End" -3938,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a 10-month-old infant presents with intussusception, likely cause is:, with the following options: A: Peyer's patch hypertrophy, B: Meckel's diverticulum, C: Mucosal polyp, D: Duplication cyst - -### Response: -Ans. (a) Peyer's patch hypertrophyRef: Bailey 26th edition, Page 1184* Most common etiology for intussusception in infants is hypertrophied Peyer's patches which is usually due to rhinovirus infection -### End" -3939,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a fracture shaft humerus, which of the following complication requires immediate surgery?, with the following options: A: Compound fracture, B: Nerve injury, C: Brachial aery occlusion, D: Comminuted fracture - -### Response: -C i.e. Brachial aery occulsion The absolute indications for immediate operative management of fracture shaft humerus are - associated vascular injuryQ (eg. branchial aery rupture, occlusion etc) and associated higher grade (not all) open woundsQ -### End" -3940,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common tumor of small bowel in children:, with the following options: A: Lymphoma, B: Carcinoma, C: Leiomyosarcoma, D: Adenocarcinoma - -### Response: -SMALL - BOWEL NEOPLASM MC tumor of small bowel : Stromal tumor> Adenoma MC tumor of small bowel in children: Lymphoma MC malignant tumor of small bowel: Adenocarcinoma >Carcinoid MC site of small bowel malignancy, carcinoids, lymphoma: Ileum -### End" -3941,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 65yr old male with his of Diabetes and HTN presents Ito OPD with complaints of diplopia and squint on examination secondary detion is seen to be more than primary detion Which of the following is the most probable diagnosis, with the following options: A: Paralytic squint, B: Incomitant squint, C: Restrictive squint, D: Pseudo squint - -### Response: -ref : ak khurana 7th ed -### End" -3942,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Five-day self subsiding pain is diagnostic of ?, with the following options: A: Anal fissure, B: Fi stul -in -ano, C: Thrombosed external hemorrhoids, D: Thrombosed internal hemorrhoids - -### Response: -Ans. is 'c' i.e., Thrombosed external hemorrhoids -### End" -3943,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Queckensted test is done for ?, with the following options: A: Glomus tumor, B: CSF rhinorrhea, C: Otosclerosis, D: Acoustic neuroma - -### Response: -Ans. is 'b' i.e., CSF rhinorrhea Detection of CSF Leak 1. Biochemical tests Concentrations of Glucose are higher in CSF than in nasal discharge. Glucose value > 30-40 mg% and protein value < 100 mg % (max 200 mg %) suppo a diagnosis of CSF leak. Presence of I3,transferrin is the most definitive test for detection of CSF and I32transferrin assay is the test of choice when a confirmatory test is needed, because of high sensitivity as well as specificity. I3-trace protein (prostaglandin D synthase) is also used, however it is nonspecific as it is also present in human testes, hea and seroma. 2. Basic clinical tests Tissue test (Handker chief test) : - Unlike nasal mucous, CSF does not cause a tissue to stiffen. Filter paper test : - Sample of nasal discharge on a filter paper exhibits a light CSF border and a dark central area of blood, i.e., double ring sign or halo sign. Queckensted test : - Compression of the jugular vein leas to increased CSF leak due to increase in ICP. Rhinoscopy : - Visualization of CSF leak from paranasal sinus. 3. CSF tracers Intrathecal fluorescein dye adminstration, radionuclide cisternography, CT cisternography. -### End" -3944,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following diagnostic criterion is most characteristic of Kawasakis disease, with the following options: A: Periungual desquamation, B: Generalised lymphadenopathy, C: Splenomegaly, D: Exudative conjunctivitis - -### Response: -Ans) a (Periungual desquamation) Ref Nelson 18th ed p 1039Bilateral bulbar conjunctival injection without exudates and cervical lymphadenopathy are present in the classical criterion for diagnosis. So both B and C can be excluded. Splenomegaly is not mentioned in the GI manifestations of Kawazakis disease.Usually cervical lymphadenopathy is seen in about 30% of patients where as rest of the diagnostic criterias are seen in more than 80% of patients For classic Kawasaki disease, the diagnostic criteria require the presence of fever for at least 5 days and at least four of five of the other characteristic clinical features of illness.CLASSIC CLINICAL CRITERIAFever persisting at least 5 daysPresence of at least 4 principal features:Changes in extremitiesAcute: Erythema of palms, soles; edema of hands, feetSubacute: Periungual peeling of fingers, toes in weeks 2 and 3Polymorphous exanthemaBilateral bulbar conjunctival injection without exudatesChanges in lips and oral cavity: Erythema, lips cracking, strawberry tongue, diffuse injection of oral and phyryngeal mucosaeCarvical lymphadenopathy (>1.5 cm diameter) usually unilateral Gastrointestinal tract manifestation of Kawazaki disease* Diarrhea, vomiting, abdominal pain* Hepatic dysfunction* Hydrops of gallbladder -### End" -3945,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gas gangrene is caused by all except aEUR', with the following options: A: Cl. histolyticum, B: Cl. novyi, C: Cl. septicum, D: Cl. sporogenes - -### Response: -Cl. sporogenes Gas gangrene is characterized by rapid and extensive necrosis of muscle accompanied by gas formation and systemic toxicity. Gas gangrene is caused by following species of clostridium tetani :? - Clostridium perfringen (80%) - Clostridium septicum - Clostridium novyi - Clostridium histolyticum Incubation period of gas gangrene depends upon the causative organisms - Clostridium perfringens - 10-48 hrs - Clostridium septicum - 2-3 days Clostridium novyi - 5-6 days Laboratory diagnosis of Gas gangrene :? The diagnosis of gas gangrene must be made primarily on clinical grounds and the function of the laboratory is only to provide confirmation of clinical diagnosis as well as identification and enumeration of infecting organisms. Specimens:? - Tissue in the necrotic area - Tissue from the muscles at the edge of the affected area - Exudate from the active site of infection - Gram positive rods with few inflammatory cells Other diseases caused by clostridium species -### End" -3946,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Abductor of vocal cord is, with the following options: A: Cricothyroid, B: Post cricoarytenoid, C: Thyro arytenoid, D: Lat cricoarytenoid - -### Response: -The posterior cricoarytenoids are the only intrinsic muscles of the larynx which abduct the vocal cords to allow entry of air through rima glottidis to the respiratory tract below. When posterior cricoarytenoids contract muscular processes of both carotenoids rotate medially. As a result, vocal processes rotate laterally. i.e. abducting vocal cords and providing wide diamond shaped opening of the glottis. If they are paralyzed the adductor muscles of the larynx take the upper hand and the person might die due to the lack of air. Hence, the posterior cricoarytenoids are called safety muscles of the larynx.Cricothyroid tenses the vocal cords.Lateral cricoarytenoid adducts the vocal cords.Thyroarytenoid relaxes the vocal cords.Reference: Textbook of anatomy, Head neck, and brain, Vishram Singh, 2nd edition, page no.224 -### End" -3947,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest clinical feature of Senile cataract, with the following options: A: Glare, B: Frequent change of glasses, C: Coloured halos, D: Uniocular polyopia - -### Response: -Earliest clinical feature of Senile cataract is Glare -Most common symptom at presentation is Frequent change of glasses -### End" -3948,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypersecretory glaucoma is seen in:, with the following options: A: Epidemic dropsy, B: Marfan's syndrome, C: Hypeension, D: Diabetes - -### Response: -A. i.e. Epidemic dropsy Epidemic dropsy is caused by sanguinarineQ an active alkaloid in seeds of Argemone mexicanaQ, which is used to adulterate mustard oil seeds. -### End" -3949,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DIC is common in which AML -, with the following options: A: Nonocytic (M5), B: Promyelo cytic (M3), C: Erythrocytic (M6), D: Megakaryocytic (M7) - -### Response: -Ans. is 'b' i.e., Promyelocytic Tumor cells in acute promyelocytic leukemia (M3) release procoagulant and fibrinolytic factors that cause disseminated intravascular coagulation (DIC). -### End" -3950,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Natural family planning method ?, with the following options: A: Abstinence, B: Coitus interruptus, C: BBT, D: Safe peroid - -### Response: -Ans. is 'c' i.e., BBT Miscellaneous methods of contraceptions These are (i) Abstinence, (ii) Coitus interruptus, (iii) Safe period (rhyth method), and (iv) Natural family planning methods. Abstinence There is complete abstinence from sexual intercourse. It is not used and can hardly be considered as a method of contraception to be advocated to the masses. Coitus interruptus It is the oldest method of voluntary feility control. The male withdraws before ejaculation, and thereby tries to prevent deposition of semen into vagina. Failure rate is very high 25%. Natural family planning methods These are :? Basal body temperature (BBT) method : It is based on the principle that there is rise BBT at or just before ovulation. Cervical mucus method (Billings method or ovulation method) : It is based on the observation that at the time of ovulation cervical mucus becomes watery clear resembling raw egg white, smooth, slippery and profuse. Symptothermic method : This method combines temperature, cervical mucus and safe period (calender method) methods. -### End" -3951,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year old male complains of a vague dragging sensation in his abdomen for the last 6 months. There was no history of fever, renal colic or dysuria. Physical examination reveals a blood pressure at 150/96 mm Hg. Renal ultraound : Bilaterally enlarged kidneys with multiple cysts. Urinary analysis: Mild Proteinuria WBCs 4/HPF (Normal: < 5/HPF) RBCs 10/HPF (Normal :< 5/HPF) The renal pathology was a result of -, with the following options: A: Nephrolithiasis, B: Enlarged prosate, C: Polycystic kidney disease, D: Deposition of immune complexes in the glomeruli - -### Response: -Polycystic kidney disease - Asymptomatic till fouh decade. Clinical manifestations -progressive bilateral formation of renal cysts, hypeension, abdominal mass, flank pain(frequent symptom in 60%of pts) . Pain may result from cyst hemorrhage , infection or nephrolithiasis. Gross hematuria resulting from cyst rupture occurs in 40%of patients in their course of disease and many will have recurrent episodes. Proteinuria is a minor feature. Ref:Harrison 20 th edition pg no 2152 -### End" -3952,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for extra mammary Paget&;s disease is, with the following options: A: Vulva, B: Vagina, C: Penis, D: Anus - -### Response: -.It is superficial manifestation of an intraductal carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola.most commonly extra mammary manifestations of paget&;s disease is seen in the vulva. * Paget's disease of penis (Erythroplasia of Querat is persistent rawness of glans penis). ref:SRB&;s manual of surgery,ed 3,pg no 1009,473 -### End" -3953,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following structures develops from 2nd brachial arch, EXCEPT:, with the following options: A: Buccinator, B: 7th cranial nerve, C: Anterior belly of digastric, D: Stapes - -### Response: -The second branchial arch forms bony and muscular structures from the ear (proximally) to the hyoid bone (distally), including the muscles of facial expression that are innervated by the facial nerve (cranial nerve (CN) VII). The posterior belly of digastric muscle develops from the mesoderm of second branchial arch hence it is supplied by the facial nerve. The anterior belly develops from the mesoderm of first branchial arch and hence supplied by mandibular nerve. -### End" -3954,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Lardaceous spleen"" is due to deposition of amyloid in:, with the following options: A: Sinusoids of red pulp, B: White pulp, C: Penicillary aery, D: Splenic trabeculae - -### Response: -Sinusoids of red pulp -### End" -3955,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: You are in the causlity when a student, is brought in with a shoulder injury sustained while playing football. In comparing the symmetry of his two shoulders, you notice a marked elevation of the distal end of his clavicle with respect to the acromion on the injured side. X-ray examination reveals a grade III shoulder separation. In order for this to have occurred, which ligament must be torn?, with the following options: A: Coracoacromial, B: Coracoclavicular, C: Costoclavicular, D: Superior glenohumeral - -### Response: -A shoulder separation is an injury to the acromioclavicular joint. A first degree separation involves stretching the ligaments, but maintenance of the joint. A second degree separation involves tearing of the joint capsule and coracoclavicular ligament, but still continuity. A third degree separation involves total disruption of the joint and the coracoclavicular ligament.Since the patient has a third degree shoulder separation, you know he must have torn his coracoclavicular ligament. The coracoacromial ligament contributes to the stability of the acromioclavicular joint, but damaging this ligament is not the hallmark of a third degree shoulder separation. The costoclavicular ligament connects the first rib to the clavicle. The superior glenohumeral ligament contributes to the stability of the shoulder joint, but not to the stability of the acromioclavicular joint. The transverse humeral ligament holds the tendon of the long head of the biceps in place in the inteubercular groove. -### End" -3956,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is NOT a type of mesenteric cyst:, with the following options: A: Mesothelial, B: Enterogenous, C: Chylolymphatics, D: Epidermoid - -### Response: -Ans. (d) EpidermoidRef: Schwartz 9th ed/1277, Sahiston 19th ed. /1104-05Types of mesenteric cystFeatures* Chylolymphatic cystMC age for mesenteric cyst-2nd decade of life* Simple (mesothelial cyst)MC in womenC/F: painless abdomen swelling>recurrent attack of abdomen pain without* Enterogenousvomiting>acute abdomen(torsion,rupture, hrage,infection)* Urogenital remnant* DermoidDiagnosis of mesenteric cystCT scan is IOCUSG-helpful Chylolymphatic mesenteric cystMe type* Arise from misplaced lymphatic tissue* MC at mesentry of ileum* Thin walled,with clear fluid(pic above)* Unilocular,solitary* Blood supply independentTreatment of choice-Chylolymphatic- EnucleationEnterogenous- Resection and anastomosis -### End" -3957,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are Experimental / Interventional studies except:, with the following options: A: Randomised control trials ., B: Field trials., C: Community trials., D: Ecological studies. - -### Response: -Ecological study (Correlational study): - -Type of analytical (observational) epidemiological study which provide the ‘least satisfactory type of evidence on causality’ -Units of study: Population -Advantage: Data can be used from populations with different characteristics -Potential problem: Socio-economic confounding -Ecological fallacy: Is an error of interpretation of statistical data in an ecological study, whereby characteristics are ascribed to a group of individuals which they may not possess as individuals -### End" -3958,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The radioisotope used for ablation of thyroid gland is, with the following options: A: Iodine 123, B: Iodine 125, C: Iodine 131, D: Technetium 99 pertechnate - -### Response: -Ans. (c) Iodine 131Sutton 7th/1504 -### End" -3959,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Ca cervix, with the following options: A: 90% associated with HPV, B: Immunocompromised patients, C: OCP, D: All - -### Response: -Ans. is a, b and c i.e. 90% associated with HPV; OCP; and Immunocompromised Patients Risk factors for development of Ca cervix : Coitus before the age of 18 years.deg Multiple sex paners.deg Delivery of V baby before 20 years of age.deg Poor personal hygiene.deg Poor socioeconomic status. Smokingdeg, Alcohol, Drug abuse. Women with STDdeg, HIV infectiondeg, HSV-20, HPV infectiondeg or condyloma Immunocompromised individualsdeg Women with H/O Preinvasive lesionsdeg OCPdeg and progesterone use over long periods.deg ""HPV is central to the development of cervical neoplasia. HPV - DNA is found in 95% of all squamous cell carcinoma & 90% of all adenocarcinomas."" -### End" -3960,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a sign of successful stellate ganglion block –, with the following options: A: Nasal stuffness, B: Guttman sign, C: Homer's syndrome, D: Bradycardia - -### Response: -Signs of successful stellate ganglion block :- Horner's syndrome, flushing of face, conjuctival congestion, nasal stuffiness (Guttman's sign), injection of tympanic membrane (Mueller's syndrome), increased skin temprature, lacrimation. -### End" -3961,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common presenting manifestations of Meniere's disease are all except:, with the following options: A: Tinnitus, B: Vertigo, C: Sensorineural deafness, D: Loss of consciousness - -### Response: -(d) Loss of consciousness(Ref. Scott Brown, 8th ed., Vol 2, 819)The patient is fully conscious and oriented during an attack of Meniere.Meniere being a disturbance of peripheral vestibular system is therefore not characterised by any focal (such as diplopia, dysarthria, paresthesia, etc.) or generalised neurological symptoms like loss of consciousness, seizures, etc.The neurological symptoms accompany a central vestibular disturbance.However, vertigo of Meniere may be associated with vagal symptoms i.e. diaphoresis, pallor, nausea, vomiting, abdominal cramps, diarrhoea and bradycardia. -### End" -3962,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meconium is excreted by a new born till...day :, with the following options: A: 2, B: 3, C: 6, D: 4 - -### Response: -3 -### End" -3963,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The causative organism of hemolytic uremic syndrome is, with the following options: A: ETEC, B: Shigella, C: Salmonella, D: Pseudomonas - -### Response: -The hemolytic uremic syndrome may occur as a complication in severe cases due to shigella. EHEC can give rise to diarrhea to fatal hemmorhagic colitis and hemmorhagic uraemic syndrome paicularly in young children and the elderly. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; pg: 293 -### End" -3964,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient of glaucoma with bronchial asthma presents to the emergency with status asthamaticus, causative agent might have. been, with the following options: A: Pilocarpine eye drop, B: Timolol eye drop, C: Betaxolol eye drop, D: Levobunolol eye drop - -### Response: -B i.e. Timolol eye drop B2 receptors are responsible for bronchodialation, therefore blocking B2 would aggravate asthma and Timolol is nonselective beta blocker (i.e. blocks B1 & B2 both) Topical nonselective 0 blockers (e.g. timolol) are contraindicated in asthma Q, COPD, CHF, sinus bradycardia & AV blocks where as selective pi blockers (e.g. betaxolol) are C/I in sinus bradycardia & atrioventricular blocks only. -### End" -3965,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements regarding ticlopidine is TRUE?, with the following options: A: It blocks GpIIb/IIIa receptors on platelet membrane, B: It prevents ADP mediated platelet adenylyl cyclase inhibition, C: It inhibits thromboxane A2 synthesis in platelets, D: It does not prolong bleeding time - -### Response: -Abciximab, eptifibatide and tirofiban inhibits GpIIb/IIIa receptors. Ticlopidine and clopidogrel inhibits ADP receptors. Aspirin inhibits TXA2 synthesis in platelets. Bleeding time is prolonged by antiplatelet drugs whereas PT is prolonged by oral anticoagulants and aPTT by heparin. -### End" -3966,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common manifestation of mumps in adult males -, with the following options: A: Aseptic meningitis, B: Encephalitis, C: Orchitis, D: Sinusitis - -### Response: -Ans. is 'c' i. e., Orchitis o Orchiyid is the most common manifestation of mumps among postpubertal males -### End" -3967,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mastoid process is which type of epiphysis, with the following options: A: Pressure, B: Aberrant, C: Atavistic, D: Traction - -### Response: -Mastoid process is a Traction epiphysis.Traction epiphysis is produced due to the pull of the muscles and therefore provide attachment to the muscle. for e.g., sternocleidomastoid muscle puts a traction upon the mastoid process.Note: The mastoid process does not begin to develop until the end of the second year. Before the mastoid process develops, the facial nerve is a subcutaneous structure and is in danger of being damaged by an incision behind the ear, if it extends too far down. Types of epiphysis: Pressure epiphysis Traction epiphysis Atavistic epiphysis Aberrant epiphysis -Aicular ends(takes pa in transmission of weight) Example- Head of femur - Nonaicular(does not take pa in transmission of weight) *Provides attachment to one or more tendons which exe traction on the epiphysis. Example- Tubercles of humerus, mastoid process. - Phylogenetically an independent bone, which in humans is fused to another bone Example- coracoid process of scapula Is not always present Example- Epiphysis of head of first metacarpal -### End" -3968,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paraduodenal recess is associated with which vessel, with the following options: A: Superior mesenteric vessel, B: Inferior mesenteric vein, C: Gastroduodenal vessles, D: Celiac vessels - -### Response: -Para duodenal recess is an occasional recess in the peritoneum to the left of the terminal poion of the duodenum located posterior to a fold containing the inferior mesenteric vein. ref - Researchgate.net -### End" -3969,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Number of inpatient beds in PHC ?, with the following options: A: 6, B: 10, C: 20, D: 25 - -### Response: -PHC → 6 beds -CHC → 30 beds -### End" -3970,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The prevalence of diabetes mellitus in a population was found to be 10 per cent. What is the probability that three people selected at random from the population have the disease?, with the following options: A: 0.003, B: 0.001, C: 0.03, D: 0.01 - -### Response: -Three people randomly selected from a population and having diabetes are events occurring together but not associated with each other i.e. they are independent of each other. Hence, the multiplication law of probability is applicable here. Since the probability of one person having the disease is 10 per cent or 1/10, the probability of three people having the disease is 1/10 x 1/10 x 1/10 = 1/1000 or 0.001. Ref: Methods in Biostatistics: For Medical Students and Research Workers, By BK Mahajan, Sixth Edition, Pages 105-108. -### End" -3971,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Relation of caudate lobe of liver is :, with the following options: A: Posterior to poal vein, B: Anterior to right inferior phrenic aery, C: Posterior to ligamentum teres, D: Posterio to ligamentum venosum - -### Response: -B. i.e. Anterior to . Inferior Phrenic aery -### End" -3972,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ca urinary bladder commonly presents as :, with the following options: A: Haematuria, B: Frequency, C: Dysuria, D: Abdominal lump - -### Response: -Ans is 'a' ie hematuria [Ref. Bailey & love, 25/e p1336 (24/e, p1363; 23/e, p1229)\""Painless hematuria is by far the most common symptom and should be regarded as indicative of a bladder carcinoma until proven otherwise. ""Also RememberMC primary tumor which gives secondary to penis is- bladder carcinoma*Commonest tumor of Urinary bladder -Transitional cell Ca*Commonest tumor of U.B. in a child - Rhabdomyosarcoma*MC symptom of renal cell Ca -Painless hematuriaMC symptom of wilm's tumor - mass in abd.MC symptom of bony metastasis -pain*MC symptom of renal stone -pain*Earliest symptom of vesical calculus- frequency*Cardinal symptom of renal trauma -hematuria*MC symptom of acute arterial occlusion -Pain* -### End" -3973,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Liquefactive"" Necrosis as a primary even is most often seen in:, with the following options: A: Kidneys, B: CNS, C: Spleen, D: Liver - -### Response: -CNS -### End" -3974,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4 years old child presented with generalized edema and ascites. There was no hypertension or hematuria. Renal function tests were normal. Urinalysis revealed massive proteinuria. Most probable underlying cause is:, with the following options: A: Membranous glomerulonephritis, B: Minimal change disease, C: Post streptococcal glomerulonephritis, D: IgA nephropathy - -### Response: -Ans b. Minimal change diseaseGeneralized edema in a child with massive proteinuria, with no hypertension or hematuria & normal renal function suggests a diagnosis of Nephrotic syndrome due to minimal change disease; -### End" -3975,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the adult hea, floor of fossa ovalis represents:, with the following options: A: Septum intermedium, B: Septum primum, C: Septum spurium, D: Septum secundum - -### Response: -Ans. B: Septum primumFossa ovalis and anulus ovalis lie on the atrial septum, which separates the right atrium from the left atrium.The fossa ovalis is a shallow depression, which is the site of the foramen ovale in the fetus.The anulus ovalis forms the upper margin of the fossa.The floor of the fossa represents the persistent septum primum of the hea of the embryo, and the anulus is formed from the lower edge of the septum secundum -### End" -3976,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A perimenopausal lady with well differentiated adenocarcinoma of uterus has more than half myometrial invasion, vaginal metastasis and inguinal lymph node metastasis. She is staged as:, with the following options: A: Stage IIIB, B: Stage IIIC, C: Stage IV A, D: Stage IV B - -### Response: -The lady in above question has cancer spread to inguinal lymph nodes i.e. stage IVB. -### End" -3977,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cataract is NOT seen with, with the following options: A: Steroids, B: Vitamin B12 deficiency, C: Diabetes mellitus, D: Homocystinuria - -### Response: -(B) Vitamin B12 deficiency # CAUSES OF CATARACT> Age: Age is the most common cause> Trauma: Blunt trauma, Electrical injuries> Radiation: Ultraviolet light: glassblowers, Lasers> Genetics Chromosome abnormalities associated with cataracts -- 1 q21.1 deletion syndrome, cri-du-chat syndrome, Down synd ome, Patau's syndrome, trisomy 18 (Edward's syndrome), and Turner's syndrome, and Neurofibromatosis type 2. Examples of single-gene disorder -- Alport's syndrome, Conradi's syndrome, myotonic dystrophy, and oculocerebrorenal syndrome or Lowe syndrome.> Skin diseases: Atopic dermatitis & Eczema: Ichthyosis (cuneiform cataracts); Basal-cell nevus & Pemphigus> Smoking and alcohol> Medications: Corticosteroids, Antipsychotics, Miotics> Post-operative: Vitrectomy, Cataract Surgery> Metabolic and nutritional diseases: Aminoaciduria or Lowe's syndrome, Diabetes mellitus, Fabry's disease, Galactosemia /galactosemic cataract, Homocystinuria, Hyperparathyroidism, Hypoparathyroidism, Hypervitaminosis D, Hypothyroidism, Hypocalcaemia, Mucopolysaccharidoses, Wilson's disease> Congenital: Congenital syphilis, Cytomegalic inclusion disease, Rubella, Cockayne syndrome\> Genetic syndromes: Down syndrome, Patau syndrome, Edwards syndrome> Infections: Cysticercosis, Leprosy, Onchocerciasis, Toxoplasmosis, Varicella> Secondary to other eye diseases: Retinopathy of prematurity, Aniridia, Uveitis, Retinal detachment, Retinitis pigmentosa -### End" -3978,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alcoholic paranoia is associated with:, with the following options: A: Fixed delusions, B: Hallucinations, C: Drowsiness, D: Impulsivity - -### Response: -Alcoholic paranoia usually presents with delusion of infidelity (also known as morbid jealousy). Patient with delusion of infidelity has a false belief that his paner/spouse is having an affair. -### End" -3979,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Breath sounds are decreased in all the following except, with the following options: A: Lobar pneumonia, B: Pneumothorax, C: Pleural effusion, D: Atelectasis - -### Response: -In pleural effusion, pneumothorax and in atelectasis the breath sounds become absent or reduced. While in lobar pneumonia breath sounds increases. Reference : Davidson, 23rd Edition, page no : 547. -### End" -3980,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anterior interosseous nerve is a branch of-, with the following options: A: Radial nerve, B: Median nerve, C: Ulnar nerve, D: Axillary nerve - -### Response: -Ans. is 'b' i.e., Median nerve o Anterior interosseous nerve is a branch of median nerve,o Anterior interosseous artery is a branch of ulnar artery. -### End" -3981,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to WHO leprosy is a public health problem if prevalence is more than, with the following options: A: 0.10%, B: 0.01%, C: 0.50%, D: 1% - -### Response: -At the end 2000, leprosy was a public health problem in 10 countries (prevalence rate > 1/10,000), mainly in Africa, Asia and Latin America. Thus to call it a public health problem prevalence per 10,000 should be more than 1 and per 100 should be > 0.01. -### End" -3982,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hepatic enzyme undergoes phosphorylation from the dephosphorylated state. Which of the following is true?, with the following options: A: Affected by the level of Catecholamines, B: Occurs in starvation rather than well-fed state, C: Always activated by c-AMP dependent protein kinase, D: Always activates the enzyme - -### Response: -Ans- B cAMP is not an activator always. It can be other kinases like serine-threonine kinases, However, in starvation, there is always phosphorylation of enzymes by glucagon or catecholamines -### End" -3983,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The systematic study of human disease and social conditions/factors is known as:, with the following options: A: Social physiology, B: Social pathology, C: Socialised medicine, D: Social medicine - -### Response: -SOCIAL PATHOLOGY: Study of social problems which undermine the social, psychological or economical health of the populations. Used to describe relationship between disease and social conditions. Social pathology is uncovered by 'Social Surveys'. Social medicine: Investigate social, environmental & genetic factors affecting disease patterns & disability. Promote methods to prevent diseases &health measures which are protective. Socialized medicine: Medical service & education provided by State, but regulated by professional groups . EXTRA EDGE: - SOCIAL CONSTRAINS: Povey, Migration, Industrialization. - SOCIAL EVILS: Smoking, alcoholism ; Castism, gender bias , Child labour, prostitution. - SOCIAL DETION: Drug abuse, Delinquency, Suicide. -### End" -3984,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest malignant bone tumor is, with the following options: A: Multiple myeloma, B: Osteosarcoma, C: Ewings sarcoma, D: Giant cell tumor - -### Response: -Refer Robbins page no 8th 609-611 Multiple also called as Kahlers disease -### End" -3985,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28 Years old white female presents with a 15-day history of malodorous vaginal discharge and pruritus. She reports that the smell is worse after intercourse and is accompanied by a white discharge. No significant medical or gynecological history. She is in a stable monogamous relationship and has never been pregnant. Which of the following diagnostic features is consistent with Bacterial vaginosis?, with the following options: A: Vaginal fluid pH > 6, scanty secretions with increased para basal cells, B: Vaginal fluid pH > 4.5, presence of clue cells on the smear and fishy odor on KOH mount, C: Vaginal fluid pH > 4, presence of hyphae on KOH mount, D: Vaginal fluid pH > 5, motile trichomonads on microscopy - -### Response: -Answer: b) Vaginal fluid pH > 4.5, presence of clue cells on the smear and fishy odor on KOH mountVAGINAL INFECTIONSDiagnosticCriteria Differential Diagnosis of Vaginal infectionsNormalBacterialvaginosisCandidiasisTrichomoniasisBacterial (strep, staph, E.coli)Vaginal pH3.8-4.2>4.5<4.5>4.5>4.5DischargeClear,FlocculentThin, gray or white, adherent HomogenousWhite, curdy, Cottage- Cheese likeYellow to green Frothy adherentPurulentAmine odor (KOH,""whiff"" test)AbsentPresent(Fishy)AbsentAbsentAbsentMicroscopicLactobacilliClue cells, coccoid Bacteria, No WBCMycelia,buddingYeast,pseudohyphaeTrichomonads WBC> 10/hpfMany WBCsMain patient ComplaintsNoneDischarge, bad odour- possibly worse after intercourseltching\burningdischargeFrothy discharge, bad odour, vulval pruritis, dysuria & multiple small punctuate strawberry spots on the vaginal vault and portio vaginalis of the cervix (strawberry vagina)Thin, watery discharge,pruritus -### End" -3986,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best prognosis amongst the following histological variants of breast carcinoma is seen with -, with the following options: A: Intraductal, B: Colloid (mucinous), C: Lobular, D: Medullary - -### Response: -. -### End" -3987,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hydroxylation of proline in collagen requires which of the following:, with the following options: A: Vitamin C, B: Fe2++, C: a-ketoglutarate, D: All of the above - -### Response: -Ans. D. All of the aboveProline and Lysine are hydroxylated to form hydroxyl proline and hydroxyl lysine in the presence of enzyme hydroxylase and requires Fe2++' ascorbic acid (Vitamin C), oxygen and a- ketoglutarate. -### End" -3988,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug of choice for status epilepticus is ?, with the following options: A: Propofol, B: Lorazepam, C: Thiopentone, D: Haloperidol - -### Response: -Ans. is 'b' i.e., Lorazepam -### End" -3989,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are principles of tendon transfers except, with the following options: A: There should be no contracture at the joint, B: The line of pull must be straight, C: One tendon must do one function only, D: A muscle power less than 3 can also be used - -### Response: -Answer- B. The line of pull must be straightAdequate strengthThe tendon chosen as a donor for transfer must be strong enough to perform its new function in its altered position.Selecting an appropriate motor is impoant because a muscle will lose one grade of strength following transfer. Do not transfer muscle that has been reinnervated or muscle that was paralyzed and has returned to function. -### End" -3990,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common malignant tumor of kidney in children is:, with the following options: A: Renal cell carcinoma, B: Mesoblastic nephroma, C: Wilm's tumour, D: None of the above - -### Response: -Wilms' tumor is the most common primary malignant tumor of the kidney in children. Ref: Schwaz's principle of surgery 9th edition, chapter 39. -### End" -3991,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About type-II pneumocytes, which is not true:, with the following options: A: Do not secrete surfactant, B: Mesodermal, C: Form blood air barrier, D: Appear at 5th month of intrauterine life - -### Response: -Do not secrete surfactant -### End" -3992,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements is true about hapten -, with the following options: A: It induces brisk immune response, B: It needs carrier to induce immune response, C: It is a T-independent Antigen, D: It has no association with MHC - -### Response: -Haptens are small molecules that elicit an immune response only when attached to a large carrier such as a protein Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:87 -### End" -3993,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug require therapeutic dose monitoring?, with the following options: A: Phenytoin, B: Warfarin, C: Metformin, D: Propanolol - -### Response: -(Ref: Katzung, 14th ed. pg. 432; KDT, 6th ed. pg. 34-35)Therapeutic dose monitoring (TDM) is used to monitor the effect of drug through plasma concentration.Criteria to do TDMWhen response of drug can't be measured.Note:#Response of warfarin measured by INR.#Response of metformin measured by blood glucose level.#Response of propanolol measured by BP measurement.If any drug having narrow therapeutic index (unsafe drugs).If a drug is showing wide variation in pharmacokinetics.Drugs in which TDM done (Remembered as: DAAALI)DigitalisAminoglycosides (Gentamicin)Anti-epilepticsAnti-CancerLithiumImmuno suppressant (Cyclosporine, Tacrolimus, Sirolimus)Therapeutic drug range for some anti-seizure drugDrugReference rangeCarbamazepine4-12Clobazam0.03-0.30Ethosuximide40-100Phenytoin10-20Phenobarbital15-40Valproate40-100Lamotrigine3-15Levetiracetam12-46Oxcarbazepine5-35Topiramate5-20 -### End" -3994,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transducin is required for, with the following options: A: Smell, B: Hearing, C: Taste, D: Vision - -### Response: -Ans. (d) Vision(Ref: Ganong, 25th ed/p. 178)The G protein coupled receptor in rods is called ""Transducin''Role of transducin is to activate the enzyme phosphodiesterase that degrades cGMP -### End" -3995,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the most common cause of death in amyloidosis?, with the following options: A: Renal failure, B: Cardiac failure, C: Sepsis, D: None - -### Response: -Amyloidosis: -The kidneys are the most frequently affected organ (80%). Renal amyloidosis is usually manifested by proteinuria, which is often in the nephrotic range and associated with significant hypoalbuminemia and edema or anasarca; rarely, tubular rather than glomerular deposition of amyloid can produce azotemia without significant proteinuria.  -Cardiac symptoms are the second most common presentation (40%), but cardiac dysfunction is associated with death in 75% of patients -### End" -3996,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is true about gallstones, with the following options: A: Pigment gallstones are most common, B: Bacterial nidus of infection may be seen, C: Even if asymptomatic gallbladder should be removed, D: They are mostly solitary - -### Response: -Recently bacterial infection has been shown to play the role in pathogenesis of gallstone, this adds to the growing pool of studies finding an infectious nidus in these gallstones Brown stones are related to bile statsis and infection Gram negative bacteria (E.coli and Klebsiella) secretes beta-glucuronidase, which deconjugate soluble conjugated bilirubin Free unconjugated bilirubin precipitates and combines with calcium and bile to form brown pigment stones. Stones from whenever static foreign bodies are present in the bole duct (stents or parasites such as clonorchis sinensis and Ascaris lumbricoides Ref: Sabiston 20th edition Pgno : 1492 -### End" -3997,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 52-year-old man complains of episodes of severe unilateral, stabbing facial pain that is intermittent for several hours, and then disappears for several days. The pain is described as ""electric shock-like"" and only lasts a few seconds. Physical examination of the face and mouth is entirely normal. Which of the following treatments is most effective for this condition?, with the following options: A: morphine, B: indomethacin, C: cimetidine, D: carbamazepine - -### Response: -This patient has trigeminal neuralgia. Carbamazepine (an anticonvulsant drug) is given in doses varying from 600 to 1200 mg/day. Phenytoin has also been used. The two drugs can also be used in combination. Operative procedures include alcohol injection of the nerve or ganglion, partial section of the nerve in the middle or posterior fossa, decompression of the root, and medullary tractotomy. Radiofrequency surgery can destroy pain fibers but spare motor fibers. -### End" -3998,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for status epilepticus is:-, with the following options: A: Valproate, B: Phenytoin, C: Lorazepam, D: Carbamazepine - -### Response: -Seizure First-Line drugs Alternatives 1. GTCS Valproate (DOC) Lamotrigine Phenytoin Carbamazepine Oxcarbazepine Topiramate Felbamate Barbiturates 2. Focal Carbamazepine (DOC) Lamotrigine Phenytoin Levetiracetam Most other drugs except ethosuximide and benzodiazepines 3. Absence Valproate (DOC) Ethosuximide Lamotrigine Clonazepam 4. Myoclonic Atonic Valproate (DOC) Lamotrigine Topiramate Clonazepam Clobazam Felbamate Rufinamide 5. Infantile spasms ACTH (DOC) Vigabatrin Coicosteroids 6. Febrile Diazepam 7. Status epilepticus Lorazepam Diazepam 8. Lennox-Gastaut Syndrome Valproate (DOC) Rufinamide Clobazam Felbamate Lamotrigine Topiramate 9. Eclamptic seizures Magnesium sulphate -### End" -3999,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Milian's ear sign is positive in:, with the following options: A: Cellulitis, B: Erysipelas, C: Impetigo contagiosa, D: Borderline Tuberculoid Leprosy - -### Response: -Erysipelas is infection of dermal lymphatics by Group A Beta-hemolytic streptococi,characterized by erythema,tenderness and lesions have raised margins. -Milians's ear sign : positive, that is involvement of ear is seen in erysipelas. -### End" -4000,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female multipurpose worker should be able to detect all of the following except –, with the following options: A: Anemia, B: Renal disease, C: Hydramnios, D: Malpresentation - -### Response: -FHW estimates hemoglobin to detect anemia -Refers cases of abnormal pregnancy (Hydroamnion, Malpresentation) and cases with medical and gynecological problems to PHC. -### End" -4001,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following factors are produced by hepatocytes except, with the following options: A: Fibrinogen, B: Prothrombin, C: Von willebrand factor, D: Factor VIII - -### Response: -Von Willebrand factor large-> 20,000 kD multimeric molecule composed of +- 200 kD monomers, synthesized by vascular endothelium, megakaryocytes, and platelets; vWFs hemostatic efficiency is related to multimer size.Ref: Ganong&;s review of medical physiology 23rd edition Page no: 532 -### End" -4002,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following enzyme is used in the treatment of acute myocardial infarction, with the following options: A: Urokinase, B: Papain, C: Asparginase, D: Serratiopeptidase - -### Response: -Urokinase is a plasminogen activator. Helps in fibrinolysis. Alteplase, reteplase, and tenecteplase made from genetic recombination are more commonly used now. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 107-112 -### End" -4003,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First step in epidemic done by an epidemiologist?, with the following options: A: Identity the cases, B: Confirm the diagnosis, C: Identify the prone people, D: Identify the causative factors - -### Response: -Ans. is 'b' i.e., Confirmation of diagnosis Steps for Investigation of Epidemic : Verification of diagnosis : Is the first step in investigation of an epidemic' Confirmation of existence of an epidemic: Compare with disease frequencies during same period in previous years Epidemic threshold: An arbitrary limit of '2 standard errors from the endemic occurrence' Defining the population at risk: Obtaining the map of the area Calculation of 'appropriate denominator of population at risk' Rapid search for all cases and their characteristics: Medical survey Epidemiological case sheet Searching for more cases: Search for new cases is carried out everyday, till the area is declared free of epidemic; this period is usually taken as 'twice the incubation period of the disease since the occurrence of last case' Data analysis: Formulation of hypothesis Testing of hypothesis Evaluation of ecological factors Fuher investigation of population at risk Writing the repo -### End" -4004,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following increases secretion of GH?, with the following options: A: Senescence, B: Insulin-like growth factor-1 (IGF-1), C: Somatostatin, D: Hypoglycemia - -### Response: -Hypoglycemia is a potent stimulus for GH. GH decreases with aging and in response to the hypothalamic inhibitory hormone somatostatin. GH secretion would decrease in response to both exogenous GH administration and IGF-1 as a result of negative feedback inhibition -### End" -4005,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Air travel in pregnancy is not recommended after What gestational age, with the following options: A: 12 Weeks, B: 22 Weeks, C: 30 Weeks, D: 36 Weeks - -### Response: -According to ACOG guidelines, pregnant women can safely fly upto 36 weeks gestation. -### End" -4006,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meconium aspiration is done for 3 times but no breathing occurs. Next step in resuscitation would be-, with the following options: A: Chest compression, B: O2 inhalation, C: Bag & mask intubation, D: Trikling of sole - -### Response: -Ans. is 'd' i.e., Trikling of sole To solve this question, one should know the resuscitation protocol of newborn. Resuscitation protocol o As soon as the baby is delivered, five signs are assessed ? Clearance of meconium Active breathing or crying Good muscle tone (flexed posture and active movement of baby). Pink color (look at tougue and lips) Term gestation (delivery between 37-42 weeks of pregnancy). o If all signs are positive no active resuscitation is required. o If any of the 5 signs is absent, baby requires resuscitation. o The baby should be placed under the heat source (radiant warmer) and subjected to a set of intervention known as initial steps. Initial steps of resuscitation 1. Positioning The neonate should be placed on her back or side with the neck slightly extended. This can be achieved by putting a rolled blanket or towel under the shoulders, elevating them 3/4 or 1 inch off the mattress. 2. Suctioning The mouth and nose should be suctioned The mouth is suctioned first to ensure that there is nothing for the infant to aspirate when the nose is suctioned. One should not inse the catheter very deep in mouth or nose for suction -4 Stimulation of posterior pharynx during the first few minutes after bih can produce a vagal responce, causing severe bradycardia or apnea. 3. Dry, stimulate and reposition After suctioning, the baby should be dried by using pre-warmed linen to prevent heat loss. A brief tactile stimulation in the form of flicking the soles or rubbing the back may be provided in case of non-establishment of good respiratory effos. 4. Free flow of oxygen If the baby continues to be depressed, provide free flow of oxygen using a facemask. After providing initial steps, the baby should be evaluated for three signs ? Respiration Hea rate (HR) Color If baby has good breathing, HR >100 and pink color, he should be given suppoive care. If the baby is not breathing well or HR o After the infant has received 30 seconds of ventilation with 100% oxygen by bag and mask, evaluation of hea rate should be done - HR >100 ----> Discontinue ventilation if spontaneous respiration is present HR 60 to 100 --> Continue ventilation Below 60 ---> Continue ventilation + chest compressions After 30 seconds of chest compressions, the hea rate is checked. HR HR> 60 Discontinue chest compression but continue bag & mask ventilation until the hea rate is above 100. -### End" -4007,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mazabraud syndrome is characterized by?, with the following options: A: Fibrous dysplalsia intramuscular myxoma, B: FD with skeletal changes and cutaneous pigmentation, C: FD with craniofacial, rib and skin deformities, D: FD with early puberty and hyperparathyroidism - -### Response: -Mazabraud's syndrome is a rare disorder characterized by the association of single or multiple intramuscular myxomas with fibrous dysplasia -### End" -4008,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Age related dementia has been associated with increased levels of, with the following options: A: Homocysteine, B: Cysteine, C: Tourine, D: Methionine - -### Response: -Identification of modifiable risk factors provides a crucial approach to the prevention of dementia.. The findings are consistent with moderately raised plasma total homocysteine (>11 mmol/L), which is common in the elderly, being one of the causes of age-related cognitive decline and dementia Ref Harrison20th edition pg 2445 -### End" -4009,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about telomerase:, with the following options: A: Has RNA polymerase activity, B: Causes carcinogenesis, C: Present in somatic cells, D: Absent in germ cells - -### Response: -After each mitosis (cell doubling), there is progressive shortening of telomeres which are the terminal tips of chromosomes. -Telomerase is the RNA enzyme that helps in repair of such damage to DNA and maintains normal telomere length in successive cell divisions. However, it has been seen that after repetitive mitosis for a maximum of 60 to 70 times, telomeres are lost in normal cells and the cells cease to undergo mitosis. -Telomerase is active in normal stem cells, but not in normal somatic cells. -Cancer cells in most malignancies have markedly upregulated telomerase enzyme, and hence telomere length is maintained. Thus, cancer cells avoid ageing, mitosis does not slow down or cease, thereby immortalising the cancer cells. - -Mohan H. Textbook of pathology. Jaypee Brothers Medical Publishers; 2015. Edition 7. Page 208 -### End" -4010,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following conditions is a person held responsible for a crime, with the following options: A: Alcoholic paranoia, B: Delirium tremens, C: Voluntary drunkenness, D: Dhatura intoxication - -### Response: -C i.e. Voluantry drunkenness -### End" -4011,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A pregnant lady in her first trimester presents with vaginal bleeding. On examination the os is closed and uterine size corresponds to the period of amenorrhoea. The condition could be: September 2005, with the following options: A: Septic aboion, B: Complete aboion, C: Inevitable aboion, D: Threatend aboion - -### Response: -Ans. D: Threatend Aboion Estimates repo that up to 50% of all feilized eggs abo spontaneously, usually before the woman knows she is pregnant. Among known pregnancies, the rate is approximately 10%. These usually occur between 7 and 12 weeks of gestation. Increased risk is associated with women over age 35, women with systemic disease (such as diabetes or thyroid dysfunction), and those with a history of 3 or more prior spontaneous aboions Threatened aboion-The process of aboion has staed but has not progressed to a state from which recovery is impossible. It presents with painless, slight bleeding per vaginum. Digital examination reveals a closed external os. Uterine size corresponds to the period of amenorrhoea. Inevitable aboion-The process of aboion has staed and have progressed to a state from where recovery is impossible. It presents with painful, increased bleeding per vaginum. Digital examination reveals a dilated internal os. Complete aboion- It presents with painless, slight bleeding per vaginum. Digital examination reveals a closed external os.Uterine size is smaller than the period of amenorrhoea. Septic aboion presents with clinical evidence of infection of uterus and its contents. -### End" -4012,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sudden induced hypermetropia is seen in -, with the following options: A: Trauma, B: Sudden blood sugar level change in diabetics, C: SLE, D: Rheumatoid arthritis - -### Response: -Ans. is 'b' i.e. Sudden blood sugar level change in diabetics o The occurrence of transitory refractive changes in diabetic patients has been recognized.o Refractive changes in diabetes are due to alterations in the power of the lens because of osmotic interactions between the lens and aqueous.o Myopia with hyperglycaemia was then explained as being due to osmotic hydration of the lens due to salt retention. Rosen accounted for hyperopia with hyperglycaemia by assuming that hydration must involve the nucleus as well. -### End" -4013,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cremasteric muscle nerve supply:, with the following options: A: Ilioinguinal nerve, B: Iliohypogastric nerve, C: Genital branch of genitofemoral nerve, D: Femoral nerve - -### Response: -Ans. C Genital branch of genitofemoral nerveRef: Gray's Anatomy Review E-book, P 221* The cremaster muscle is a muscle that covers the testis and the spermatic cord.* The cremaster muscle is supplied by the cremasteric artery which is a branch of inferior epigastric artery.* The cremaster muscle is innervated from the genital branch of the genitofemoral nerve. It receives distinctly different innervation and vascular supply in comparison to the internal oblique. -### End" -4014,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eradication of Helicobacter pylori has been proved to beneficial in which of the following disorders of the stomach, with the following options: A: Low grade malt lymphoma, B: Erosive gastritis, C: Carcinoma stomach, D: Gastroesophageal disease - -### Response: -HELICOBACTER PYLORI hydrolyses urea so as to release ammonia which through negative feedback mechanism increases the gastrin release from G-cells. * Infection occurs in the stomach, i.e. body, fundus, antrum, which in turn disrupts the mucosal barrier and causes a chronic inflammatory response which leads to gastritis, gastric ulcer. * It also secretes cytotoxins (cagA and vacA) which may also be involved in inflammatory reaction or malignancy. * Even though normal duodenum cannot harbour the Helicobacter, duodenum with gastric metaplasia can very well get infected by Helicobacter which explains why Helicobacter is involved in duodenal ulcer. Ref: SRB&;s manual of surgery,3 rd ed, pg no 751 -### End" -4015,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Angiotensinogen is secreted by ?, with the following options: A: Kidney, B: Lung, C: Liver, D: Brain - -### Response: -Ans. is 'c' i.e., Liver Angiotensinogen (a, - globulin) is produced in liver and is conveed to angiotensin I (A-I) with the help of renin which is secreted by juxtaglonierular cells of afferent aerioles of kidney and lacis cells (located in the junction between the afferent and efferent aerioles). Angiotensin I is conveed to Angiotensin II (A-II) by angiotensin conveing enzyme (ACE). Which is located primarily on the luminal surface of vascular endothelial cells, especially in lungs. -### End" -4016,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the management of symptomatic Benign Prostatic Hyperplasia with finasteride the period of trial required for determining a satisfactory response is, with the following options: A: 1 month, B: 2 months, C: 4 months, D: 6 months - -### Response: -Finasteride is 5-alpha reductase inhibitor which inhibits conversion of testosterone to dihydrotestosterone. It is effective in palpably enlarged prostate(>50g). 5mg is used daily for at least 6 months for satisfactory response. It has fewer side effects. It is contraindicated in obstructive uropathy or carcinoma prostate.Reference : page 1047 SRB&;s manual of surgery 5th edition and page 1350 Bailey and Love&;s sho practice of surgery 25th edition -### End" -4017,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 1-month-old infant presents to your office with an umbilical hernia. It is reducible but prolapses again almost immediately. It is TRUE that this defect, with the following options: A: Is present in all children at birth, B: Will not close spontaneously, C: Should be repaired if still present at 3 months of age, D: Should be repaired at this time if it is >1 cm in diameter - -### Response: -The umbilical hernia is the only hernia universally present at birth due to the need for umbilical cord patency up to that instant. After birth, the vast majority of umbilical hernias close by age 3-5 years. The risk of incarceration is low and repair is usually reserved for children older than 3-5 years of age or those with a fascial defect >1-2 cm in diameter. -### End" -4018,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epidemics of conjunctivitis are known to occur with:, with the following options: A: Bacterial infections, B: Viral infections, C: None of the above, D: Both of the above - -### Response: -Ans. Both of the above -### End" -4019,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 15 mm/cm hyperpigmented lesion on shoulder enlarging and hair over it ?, with the following options: A: Melanocytic nevus, B: Becker nevus, C: Sebaceous nevus, D: Comedo nevus - -### Response: -Ans. is 'b' i.e., Becker nevus Becker Nevus Usually stas in adolescence as an irregular smooth hyperpigmented macule. Usually involves shoulder, anterior chest and scapular region, although any pa of the may be involved. Slowly grows in size of a palm wile acquiring thick dark hair. Often lesion resembling acne vulgaris in different stages may appear on surface. No treatment is required. -### End" -4020,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ujjwala scheme is for prevention of, with the following options: A: Child abuse, B: Child labour, C: Child trafficking, D: Child marriage - -### Response: -UJJAWALA SCHEME: - -Description: A Comprehensive Scheme for Prevention of Trafficking and Rescue, Rehabilitation and Re-integration of Victims of Trafficking for Commercial sexual exploitation -Ministry: Ministry of Women and Child Development -Launch: 4th December 2007 - -Target Group/ Beneficiaries (V-V): Women and children, who are -– Vulnerable to trafficking for commercial sexual exploitation -– Victims of trafficking for commercial sexual exploitation -Main Components -– Prevention -– Rescue -– Rehabilitation -– Re-Integration -– Repatriation (Cross-border) -### End" -4021,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DOC for belladona poisoning, with the following options: A: Neostigmine, B: Physostigmine, C: Pyridostigmine, D: Edrophonium - -### Response: -Physostigmine is an anticholinesterase & chemically it is a tertiary amine which can cross BBB. -It is DOC for Belladona, Datura & Atropine poisoning. -### End" -4022,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shingles is caused by, with the following options: A: HBV, B: Ureaplasma, C: Mycoplasma, D: Varicella - -### Response: -Shingles, also known as zoster or herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area.Typically the rash occurs in a single, wide stripe either on the left or right side of the body or face. Two to four days before the rash occurs there may be tingling or local pain in the area.Otherwise there are typically few symptoms though some may have fever or headache, or feel tired. The rash usually heals within two to four weeks; however, some people develop ongoing nerve pain which can last for months or years, a condition called postherpetic neuralgia (PHN). In those with poor immune function the rash may occur widely] If the rash involves the eye, vision loss may occur. Shingles is due to a reactivation of varicella zoster virus (VZV) in a person's body.The disease chickenpox is caused by the initial infection with VZV.Once chickenpox has resolved, the virus may remain inactive in nerve cells.When it reactivates, it travels from the nerve body to the endings in the skin, producing blisters.Risk factors for reactivation include old age, poor immune function, and having had chickenpox before 18 months of age.How the virus remains in the body or subsequently re-activates is not well understood. Exposure to the virus in the blisters can cause chickenpox in someone who has not had it, but will not trigger shingles.Diagnosis is typically based on a person's signs and symptoms. Varicella zoster virus is not the same as herpes simplex virus; however, they belong to the same family of viruses. The shingles vaccine reduces the risk of shingles by 50% to 90%, depending on the vaccine used. It also decreases rates of postherpetic neuralgia, and if shingles occurs, its severity.If shingles develops, antiviral medications such as aciclovir can reduce the severity and duration of disease if staed within 72 hours of the appearance of the rash.Evidence does not show a significant effect of antivirals or steroids on rates of postherpetic neuralgia.Paracetamol, NSAIDs, or opioids may be used to help with the acute pain. Ref Harrison20th edition pg 1339 -### End" -4023,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about regional blood flow in pregnancy except:, with the following options: A: Uterine blood flow at term is 750 ml/min, B: Blood flow through skin decreases, C: Renal blood flow increases by 50%, D: Pulmonary blood flow increase - -### Response: -Ans. is b, i.e. Blood flow through skin decreasesRef Dutta Obs 9/e, p 49REGIONAL DISTRIBUTION OF BLOOD FLOW DURING PREGNANCY: Uterine blood flow is increased from 50 ml/ min in non-pregnant state to about 750 ml near term. The increase is due to the combined effect of uteroplacental and fetoplacental vasodilatation. Pulmonary blood flow (normal 6000 ml/min) is increased by 2500 ml/min (i.e. 40% increase). Renal blood flow (normal 800 ml) increases by 400 ml/min (i.e. 50% increase) at 16th week and remains at this level till term. The blood flow through the skin and mucous membranes reaches a maximum of 500 mL/min by 36th week. Heat sensation, sweating or stuffy nose complained by the pregnant women can be explained by the increased blood flow. -### End" -4024,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skin depigmentation b/L chronic uveitis and tinitus are features of -, with the following options: A: Vogt Koyanagi harada syndrome, B: Waadenberg Syndrome, C: Al po Syndrome, D: Werner's Syndrome - -### Response: -A i.e. Vogt-Koyanagi Harda Syndrome -### End" -4025,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gout can be precipitated by:, with the following options: A: Calcium channel blockers, B: Omeprazole, C: Thiazide diuretics, D: Digitalis - -### Response: -Answer is C (Thiazide Diuretics): Hyperuricemic Syndromes: Pathophysiology and Therapy (Karger Medical and Scientific Publishers, 2005)/ 9 -### End" -4026,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice to confirm Hemochromatosis as the cause of cardiomyopathy is :, with the following options: A: ECG, B: Echo, C: MRI, D: CT - -### Response: -Answer is C (MRI) Cardiac MRI is the investigation of choice in cardiomyopathy from Hemochromatosis. Cardiac MRI helps distinguish amongst various causes of restrictive cardiomyopathy. Cardiac MR1 in hemochromatosis allows non-invasive detection and quantification of myocardial iron load and distribution. Cardiac MRI is the imaging modality of choice as Echocardiography may be unable to distinguish hemochromatosis from dilated cardiomyopathy -### End" -4027,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is given at intervals as a pusatile therapy?, with the following options: A: GnRH, B: GH, C: PSH, D: Estrogen - -### Response: -Ans. a (GnRH) (Ref. KDT 6th/pg. 239; Shaw's Textbook of Gynaecology 13th/pg. 309)Since only pulsatile exposure to GnRH induces FSH/LH secretion, while continuous exposure desensitizes pituitary gonadotropes resulting in loss of Gn release, therapy with GnRH or its analogues is not useful in the Rx of hypogonadism.Pulsatile GnRH is used in1. Hypothalamic amenorrhea2. Hypothalamic hypogonadal infertility3. Cryptorchism in males4. PCOD and endometriosisContinuous or monthly depot GnRH is used in1. Precocious puberty2. Contraception3. DUB4. Endometriosis5. Shrink the fibroid preoperatively6. Shrink endometrium prior to transcervical resection in DUB. -### End" -4028,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Referred pain in external haemorrhoids is due to -, with the following options: A: Common pudendal nerve, B: Inferior rectal nerve, C: Splanchnic nerve, D: Sympathetic nerve - -### Response: -Pain sensation below the pectinate line is carried by inferior rectal nerve, a branch of pudendal nerve. -### End" -4029,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Influenza virus belongs to family -, with the following options: A: Picomaviridae, B: Calciviridae, C: Orthomyxoviridae, D: Paramyxoviridae - -### Response: -Ans. is 'c* i.e., Orthomyxoviridae RNA VirusesPicornaviridae:Poliovirus, Coxsackievirus, Eehovirus, Enterovirus, Rhinovirus, Hepatitis A virusCalicivtridae: Norwalk virus. Hepatitis E virusTogaviridae: Rubella virus, Eastern equine encephalitis virus, Western equine encephalitis virusFlaviviridae: Yellow fever virus, Dengue virus, St. Louis encephalitis virus. West nile virus. Hepatitis C virus. Hepatitis G virusCoronaviridae: Coronavi rusesRhabdoviridae: Rabies virus. Vesicular stomatitis virusFiloviridae :: Marburg virus, Ebola virusParamyxoviridae: Parainfluenza virus, Respiratory syncytial virus, Newcastle disease virus , Mumps virus. Rubeola (measles) vimsOrthomyxoviridae: Influenza vims -### End" -4030,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6-year-old child has had repeated episodes of otitis media. She undergoes an uneventful surgical placement of pressure-equalization (PE) tubes. In the recovery room, she develops a fever of 40degC (104degF), rigidity of her muscles, dark colored urine, and metabolic and respiratory acidosis. Which of the following therapies is most likely to be beneficial for this child's condition?, with the following options: A: Acidification of the urine, B: Administration of intravenous antibiotics after obtaining blood cultures, C: Intravenous administration of dantrolene, D: Administration of tetanus immuno globulin and a booster dose of DTaP - -### Response: -In addition to the findings listed in the question, patients experiencing malignant hyperthermia (MH) also have clinical findings of tachycardia, arrhythmia, tachypnea, and cyanosis, as well as laboratory findings of myoglobinuria, elevated serum creatine kinase levels, and evidence of acute renal failure. This myopathy is usually inherited as an autosomal dominant trait; the gene is on chromosome 19 and codes for the ryanodine receptor, a calcium release channel. A family history of similarly affected relatives would suggest the need to evaluate all family members for this condition; prevention (or treatment) is with dantrolene sodium. The test of choice to identify a patient at risk for this condition is the caffeine contracture test, in which a muscle biopsy tissue specimen is attached to a strain gauge and then exposed to caffeine. Patients at risk for MH have a diagnostic muscle spasm. Ryanodine receptor (RYR1) gene sequencing is also available.Acidification of the urine might be helpful for an aspirin overdose, but the child has no history of having aspirin ingestion. The findings in the question do not support tetanus (immunoglobulins not helpful) nor seizure activity (diazepam not indicated). The rapid nature of this child's change in status makes septicemia unlikely; antibiotics and blood cultures likely are not warranted. -### End" -4031,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The alveoli are filled with exudate the air is displaced conveing the lung into a solid organ. This description suggests-, with the following options: A: Chronic bronchitis, B: Bronchial asthma, C: Bronchiectasis, D: Lobar pneumonia - -### Response: -Ans. is 'd' i.e., Lobar pneumonia -### End" -4032,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 29yr old women comes to clinic because of heat intolerance, excess sweating, thinning of hair. She had family H/O of autoimmune disease, she is 8 wks pregnant and has had no other issues during pregnancy. Medical H/O includes hypehyroidism. Lab studies are positive for thyroid stimulating immunoglobulin. Wof drug is most appropriate for treatment, with the following options: A: Methimazole, B: Propylthiouracil, C: Radioactive iodine, D: Oxytocin - -### Response: -This is a case of Grave's disease, which results in thyrotoxicosis. Inhibit hormone synthesis (Antithyroid drugs) Includes Propylthiouracil, Methimazole, Carbimazole. Mech of action:- Antithyroid drugs bind to the thyroid peroxidase and prevent oxidation of iodide/ iodotyrosyl residues, thereby; (i) Inhibit iodination of tyrosine residues in thyroglobulin (ii) Inhibit coupling of iodotyrosine residues to form T3 and T4. Ref:- kd tripathi; pg num:- 252,253 -### End" -4033,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prudent diet is:, with the following options: A: Diet for dietary goal achievement, B: Diet, which contains variety of foods to safe guard from deficiencies, C: on which a person or group lives, D: Diet, which fulfills recommended daily allowances - -### Response: -(Diet for dietary goal achievement) Prudent diet is diet developed by National nutrition and food policy for achievement of ""dietary goal"". The Prudent diet recommended by WHO is: * Dietary fat < 20-30 % of total daily intake * Saturated fat <10% of total energy intake. * Avoid excessive consumption of refined carbohydrates. * Energy rich sources (fat and alcohol) restricted. * Salt intake should not be more than 5gm per day. * Proteins should be 15 to 20% of daily intake. * Junk foods should be reduced. -### End" -4034,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Artery not involved in Vascular anastemosis around Acromian, with the following options: A: Thyrocervical Trunk, B: Thoracoacromial trunk, C: Anterior circumflex humeral artery, D: Posterior circumflex humeral artery - -### Response: -Acromial Branch of Thyrocervical Trunk (Branch of 1st part of Subclavian artery). -Acromial Branch of Thoracoacromial trunk (Branch of 2nd part of Axillary artery). -Acromial branch of  posterior circumflex humeral artery form anastomosis around Acromian. -### End" -4035,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: EBV enters B-cells through?, with the following options: A: CD-1, B: CD-2, C: CD-21, D: CD-19 - -### Response: -Ans. is 'c' i.e., CD-21 The virus enter the pharyngeal epithelial cells and B cells through (CR 2 / or CD21) receptors. -### End" -4036,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Decomposition of a body produces green colour due to hydrogen sulphide accumulating. Where does this colour change first occur?, with the following options: A: Face, B: Iliac fossa, C: Around umbiticus, D: Palms and soles - -### Response: -Right Iliac fossa is the first region to show this discolourization. Because Caecum lies superficially in Right ILiac fossa. -### End" -4037,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Colour of nitrous oxide cylinder is?, with the following options: A: Blue, B: Blue body with white shoulder, C: White, D: Black - -### Response: -N2O (blue) Cyclopropane (orange) Oxygen (black & white) Entonox (blue & white) -### End" -4038,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trochanteric fracture of the femur is best treated by -, with the following options: A: Dynamic hip screw, B: Inlay plates, C: Plaster in abduction, D: Plaster in abduction and internal rotation - -### Response: -Dynamic hip screw (DHS) plate is the implant of choice for fixation. -These days proximal femoral nail (PFN) is also commonly used. -### End" -4039,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme activity is expressed as: (PGI Dec 2006), with the following options: A: Millimoles/lit, B: Mg/lit, C: Mg/dl, D: Micromoles/min - -### Response: -Ans: D (Micromoles/min) Enzme activity is expressed as micromoles of substrate converted to product per minute^ under optical condition of measurement. One standard unit {or international unit) of enzyme activity (U) is that activity which catalyses transformation of 1 micromole of substrate per minute.Modern method of enzyme activity is in katals (Kat)1 Kat=Conversion of 1 mole of substrate per second. -### End" -4040,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about apoptosis is all except?, with the following options: A: Considerable apoptosis may occur in a tissue before it becomes apparent in histology, B: Apoptotic cells appear as round mass of the intensely eosinophilic cytoplasm with dense nuclear chromatin fragments, C: Apoptosis of cells induce inflammatory reaction, D: Condensation of chromatin - -### Response: -Ans. (c)Apoptosis of cells induce inflammatory reactionRef: Robbin's pathology 9th ed. 152-53Remember Important Features of Apoptosis* Formation of cytoplasmic blebs and apoptotic bodies* Cell shrinkage: The cells are smaller in size and the cytoplasm is dense* Chromatin condensation: This is the most characteristic feature of apoptosis* Absence of inflammation* Gel Electrophoresis of DNA shows 'Step ladder Pattern. -### End" -4041,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following iodinated compound is present in a maximum concentration in the thyroid?, with the following options: A: Monoiodotyrosine (MIT), B: Diiodotyrosine (DIT), C: T3, D: Reverse T3 - -### Response: -THYROID HORMONE SYNTHESIS AND SECRETIONThyroid hormones are synthesized in the colloid, near the apical cell membrane of the follicular cells. Catalyzed by the enzyme thyroidal peroxidase, iodide in the thyroid cell is oxidized to iodine.The iodine enters the colloid and is rapidly bound at the 3 position to tyrosine molecules attached to thyroglobulin, forming monoiodotyrosine (MIT).MIT is next iodinated at the 5 position, forming diiodotyrosine (DIT).Two DIT molecules then condense in an oxidative process (""coupling reaction"") to form one thyroxine (T4) molecule.Some T3 is probably formed within the thyroid gland by condensation of MIT with DIT. A small amount of reverse T3 (rT3) is also formed.In the normal thyroid, the average distribution of iodinated compounds is 23% MIT, 33% DIT, 35% T4, 7% T3, and 2% reverse T3. -### End" -4042,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Role of calcitonin is:, with the following options: A: Lower Ca level, B: Increase Ca level, C: Decrease PO4, D: None of the above - -### Response: -Lower Ca level -### End" -4043,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Polyhydroaminosis is volume of amniotic fluid more than: September 2005, with the following options: A: 1000 ml, B: 2000 ml, C: 3000 ml, D: 4000 ml - -### Response: -Ans. B: 2000 ml Because the normal values for amniotic fluid volume increase during pregnancy, the actual volume that constitutes polyhydramnios is dependent on the gestational age of the fetus. Polyhydramnios usually refers to amniotic fluid volumes greater than 2000 ml. The range of fluid values diagnostic of oligohydramnios is not as wide as that for polyhydramnios. Less than 200 ml, or when amniotic fluid index is less than 5 cm, is usually considered to be indicative of oligohydramnios. -### End" -4044,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: With DMPA, the next injection may be taken latest by:, with the following options: A: 12 weeks, B: 13 weeks, C: 15 weeks, D: 17 weeks - -### Response: -DMPA is effective for 13 weeks. It has grace period of 4 weeks, which means that this woman can get her next injection before completed 17 weeks. If she comes later than 17 weeks, then she will be given injection but will have to use backup for next 7 days, as injections would take time to become effective. -### End" -4045,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anesthetic drug of choice in asthmatic: ( Repeat ), with the following options: A: Ketamine, B: Propofol, C: Etomidate, D: Propofol - -### Response: -Ans: B (Ketamine) Ref: Miller '? Anesthesia, 7th ed. & Ajay YadavExplanation:KetamineCauses Dissociative anesthesiaPhencyclidine derivativeNMDA receptor agonistAnesthetic PropertiesOnset of Action: 30 - 60 secondsEarly regain of consciousness after 15 - 20 min due to RedistributionElimination half life: 2-3 hoursStrong analgesic propertyMetabolised in Liver and products exreted in urineNot a muscle relaxantPrimary site of action - Thalamo-neo-cortical projectionsCardiovascular SystemIncreases arterial BP,Increases heart rate &Increases cardiac outputIV agent of choice in SHOCKRespiratory SystemPotent BronchodilatorGood induction agent for asthmaticsUpper airway reflexes remain largely intactIncreases salivatory & Tracheo bronchial secretionsUsing glycopyrollate or atropine becomes necessaryCentral Nervous SystemIncreases Intracranial pressure and can precipitate seizuresEmergence reactions:These are seen at emergenceVivid dreamingIllusionsExtracorporeal experiences like floatingExcitementConfusionEuphoriaFearHallucinations:Auditory and Visual hallucinations (Most common side effect of Ketamine)Treated with BenzodiazepineOther SystemsEyeIncrease intraocular tensionPupils dilate moderatelyNystagmusGITIncreases intragastric pressureSalivary secretions increasedMuscluarIncreases muscle toneIncreased non-puposeful movementsDoseCan be given IV. IM, oral. Rectal and intrathecal routeIV -- 2mg/kgIM- 5-10mg/kg AdvantagesInduction Agent of Choke inAsthmaticsShock (HYPOTENSION)Children ( Now Sevoflurance is DOC)Constrictive pericarditisCardiac tamponadeCan be used as SOLE agentCan be used safely at remote places and in inexperienced hands since does not depress heart or respirationPreferred agent when patient is in FULL STOMACH (Preserves laryngo- pharyngeal reflexes)Contraindicated inHead injuryICSOLEye injuryOpthal pathologyIschemic heart diseaseVascular aneurysmPsychiatric diseasesDrug addictsHypertensives -### End" -4046,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Biological value is maximum in:, with the following options: A: Egg, B: Milk, C: Soyabean, D: Pulses - -### Response: -Egg -### End" -4047,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young male patient presented to OPD with urethral discharge. On urine examination pus cells were found but not organisms. Which method would be the best for culture, with the following options: A: McCoy cell line, B: Thayer Main medium, C: PPLO broth, D: Cooked meat medium - -### Response: -Ans. a. McCoy cell line Urine examination in a patient of urethral discharge demonstrating only pus cells but no gram-negative diplococcic suggest ""non-gonococcal urethritis"". The most common cause of non-gonococcal urethritis is Chlamydia trachomatis. Chlamydia trachomatis is cultured on McCoy cells, HeLa cells or Hep-2 cells. Culture Media Organism McCoy cell line ChlamydiaQ Thayer Main medium NeisserieQ PPLO broth MycoplasamQ Cooked meat medium Cooked meat mediumQ Organisms causing Non-gonococcal Urethritis Chlamydia trachomatis (MC) Q Gardnerella vaginalisQ Urea plasma urealyticumQ Candida albicans Mycoplasma genitaliumQ Trichomonas vaginalis Herpes virusQ Mechanical or chemical iinitation CMVQ -### End" -4048,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A girl with acute promyelocytic leukemia was admitted for management. While on treatment she developed tachypnea, fever and pulmonary infiltrates. What should be done for the treatment of this problem?, with the following options: A: Dexamethasone, B: Cytarabine, C: Doxorubicin, D: Methotrexate - -### Response: -Ans. (A) Dexamethasone(Ref: Harrison 19/e p1686-87)The features given are known as APL differentiation syndrome which can occur while treatment with tretinoin. The treatment is with steroids. -### End" -4049,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maple syrup urine disease can be caused by a problem with the metabolism of which particular compound., with the following options: A: Glycogen, B: Collagen, C: Dopamine, D: Valine - -### Response: -Some amino acids (isoleucine, tryptophan, phenylalanine, and tyrosine) are both glucogenic and ketogenic because their degradation pathway forms multiple products.a. Amino acids that are converted to pyruvate (see Figure I).(1). The amino acids that are synthesized from the intermediates of glycolysis (serine, glycine, cysteine, and alanine) are degraded to form pyruvate.(a). Serine is converted to 2-phosphoglycerate, an intermediate of glycolysis, or directly to pyruvate and NH4+ by serine dehydratase, an enzyme that requires PLP.(b). Glycine, in a reversal of the reaction utilized for its synthesis, reacts with methylene-FH4 to form serine.1. Glycine also reacts with FH4 and NAD+ to produce CO2 and NH4+ (glycine cleavage enzyme).2. Glycine can be converted to glyoxylate, which can be oxidized to CO2 and H2 O or converted to oxalate.(c). Cysteine forms pyruvate. Its sulfur, which was derived from methionine, is converted to H2 SO4 , which is excreted by the kidneys.(d). Alanine can be transaminated to pyruvate.b. Amino acids that are converted to intermediates of the TCA cycle (see Figure II).(1). The carbons from the four groups of amino acids form the TCA cycle intermediates: a-ketoglutarate, succinyl-CoA, fumarate, and oxaloacetate.(a). Amino acids that form a-ketoglutarate (see Figure III).1. Glutamate can be deaminated by glutamate dehydrogenase or transaminated to form a- ketoglutarate.2. Glutamine is converted by glutaminase to glutamate with the release of its amide nitrogen as NH4+ 3. Proline is oxidized so that its ring opens, forming glutamate semialdehyde, which is oxidized to glutamate.4. Arginine is cleaved by arginase in the liver to form urea and ornithine. Ornithine is transaminated to glutamate semialdehyde, which is oxidized to glutamate.5. Histidine is converted to formiminoglutamate (FIGLU). The formimino group is transferred to FH4, and the remaining five carbons form glutamate.(b). Amino acids that form succinyl-CoA (see Figure IV)1. Four amino acids are converted to propionyl-CoA, which is carboxylated in a biotin requiring reaction to form methylmalonyl-CoA, which is rearranged to form succinyl-CoA in a reaction that requires vitamin B12 (seen previously in the metabolism of odd-chain number fatty acids).a). Threonine is converted by a dehydratase to NH4+ and a-ketobutyrate, which is oxidatively decarboxylated to propionyl-CoA.In a different set of reactions, threonine is converted to glycine and acetyl-CoA.b). Methionine provides methyl groups for the synthesis of various compounds; its sulfur is incorporated into cysteine; and the remaining carbons form succinyl-CoA.i. Methionine and ATP form S-adenosylmethionine (SAM), which donates a methyl group and forms homocysteine.ii. Homocysteine is reconverted to methionine by accepting a methyl group from the FH4 pool via vitamin B12 .iii. Homocysteine can also react with serine to form cystathionine. The cleavage of cystathionine produces cysteine, NH4+ , and a-ketobutyrate, which is converted to propionyl-CoA.c). Valine and isoleucine, two of the three branched-chain amino acids, form succinyl-CoA (see Figure IV).i. The degradation of all the three branched-chain amino acids begins with a transamination followed by an oxidative decarboxylation catalyzed by the branched-chain a-keto acid dehydrogenase complex (Figure V). This enzyme, like pyruvate dehydrogenase and a-ketoglutarate dehydrogenase, requires thiamine pyrophosphate, lipoic acid, CoA, flavin adenine dinucleotide (FAD), and NAD+.ii. Valine is eventually converted to succinyl-CoA via propionyl-CoA and methylmalonyl-CoA.iii. Isoleucine also forms succinyl-CoA after two of its carbons are released as acetyl-CoA.(c). Amino acids that form fumarate1. Three amino acids (phenylalanine, tyrosine, and aspartate) are converted to fumarate (see Figure II).a). Phenylalanine is converted to tyrosine by phenylalanine hydroxylase in a reaction requiring tetrahydrobiopterin and O2 (Figure VI).b). Tyrosine, obtained from the diet or by hydroxylation of phenylalanine, is converted to homogentisic acid. The aromatic ring is opened and cleaved, forming fumarate and acetoacetate.c). Aspartate is converted to fumarate via reactions of the urea cycle and the purine nucleotide cycle.d). Aspartate reacts with IMP to form AMP and fumarate in the purine nucleotide cycle.(d). Amino acids that form oxaloacetate (see Figure II)1. Aspartate is transaminated to form oxaloacetate.2. Asparagine loses its amide nitrogen as NH4+ , forming aspartate in a reaction catalyzed by asparaginase.c. Amino acids that are converted to acetyl-CoA or acetoacetate (see Figure VI).(1). Four amino acids (lysine, threonine, isoleucine, and tryptophan) can form acetyl-CoA, and phenylalanine and tyrosine form acetoacetate. Leucine is degraded to form both acetyl-CoA and acetoacetate.In maple syrup urine disease, the a-keto acid dehydrogenase involved in metabolism of the branched-chain amino acids (valine, isoleucine, and leucine) is defective. McArdle disease is caused by a defective muscle glycogen phosphorylase, such that the muscle cannot generate glucose from glycogen, leading to exercise intolerance. Glycogen accumulates in the muscle because of this enzyme deficiency (McArdle disease is one of the glycogen storage disease). A defect in the synthesis or processing of collagen will lead to a variety of diseases, of which Ehlers-Danlos syndrome is one (osteogenesis imperfecta is another). Parkinson disease is caused by low levels of dopamine in the nervous system. In the initial stages of Parkinson disease, giving DOPA can reduce the severity of the symptoms because DOPA can be decarboxylated to form dopamine. DOPA can easily enter the brain, whereas dopamine cannot. Tay-Sachs disease results from an inability to degrade GM2, a ganglioside (it is also a sphingolipid). The enzyme missing is b-hexosaminidase.I. Amino acids derived from the intermediates of glycolysis. These amino acids can be synthesized from glucose and can be reconverted to glucose in the liver.II. The degradation of amino acids. A. Amino acids that produce pyruvate or the intermediates of the TCA cycle. These amino acids are considered glucogenic because their carbons can produce glucose in the liver. B. Amino acids that produce acetyl-CoA or ketone bodies. These amino acids are considered ketogenic. CoA, coenzyme A; HMG-CoA, hydroxymethylglutaryl-CoA; TCA, tricarboxylic acid.III. Amino acids related through glutamate. These amino acids contain carbons that can be converted to glutamate, which can be converted to glucose in the liver. All of these amino acids except histidine can be synthesized from glucose.IV. Amino acids that can be converted to succinyl-CoA. The amino acids methionine, threonine, isoleucine, and valine, which form succinyl-CoA via methyl malonyl-CoA, are all essential. Because succinyl-CoA can form glucose, these amino acids are glucogenic. The carbons of serine are converted to cysteine and do not form succinyl-CoA by this pathway. A defect in cystathionine synthase causes homocystinuria. A defect in cystathionase causes cystathioninuria. B12-CH3, methyl cobalamin; N5-CH3-FH4, N 5- methyl tetrahydrofolate; PLP, pyridoxal phosphate; SAM, S-adenosylmethionine; TCA, tricarboxylic acid.V. The degradation of the branched-chain amino acids. Valine forms propionyl-CoA. Isoleucine forms propionyl-CoA and acetyl-CoA. Leucine forms acetoacetate and acetyl-CoA. CoA, coenzyme A; FAD, flavin adenine dinucleotide; HMG-CoA, hydroxymethylglutaryl-CoA.VI. A. Ketogenic amino acids. Some of these amino acids (tryptophan, phenylalanine, and tyrosine) also contain carbons that can form glucose. Leucine and lysine are strictly ketogenic; they do not form glucose. B. A deficiency in various steps leads to the diseases indicated. CoA, coenzyme A; NAD, nicotinamide adenine dinucleotide; NADP, nicotinamide adenine dinucleotide phosphate; PKU, phenylketonuria; PLP, pyridoxal phosphate; TCA, tricarboxylic acid cycle. -### End" -4050,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement about Barret esophagus is:-, with the following options: A: Goblet cells seen on histology, B: Patient may lead to malignancy after few years, C: Columnar to squamous metaplasia, D: Chronic GERD is the predisposing factor - -### Response: -Option C: Squamous changes to Columnar -### End" -4051,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Microsatellite sequence is:, with the following options: A: Small satellite, B: Extra chromosomal DNA, C: Short sequence (2-5) repeat DNA, D: Looped-DNA - -### Response: -Ans. C. Short sequence (2-5) repeat DNA(Ref: Robbins 9/e page 179)Repeat length Polymorphism or Short Tandem Repeats or Variable Number Tandem RepeatsDepending on the repeat size it is divided into Microsatellite-- Repeat size of 2-6bp.Minisatellite - Repeat size of 15-70bp. -### End" -4052,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a standing man, in midaxillary line, lower border of pleura reaches:, with the following options: A: 6th rib, B: 8th rib, C: 10th rib, D: 12th rib - -### Response: -Surface marking of pleura""All the even ribs, in order: 2, 4, 6, 8, 10, 12 show its route"":Rib2: Sharp angle inferiorlyRib4: The left pleura does a lateral shift to accommodate heaRib6: Both diverge laterallyRib8: Midclavicular lineRib10: Midaxillary lineRib12: The back -### End" -4053,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following not true about alveolar lining?, with the following options: A: Type II cells make up 95% of the lining, B: Type II cells contain lamellar inclusion bodies, C: Type II cells secrete surfactant, D: None of the above - -### Response: -The alveoli contain two types of epithelial cells. Type I cells are flat cells with large cytoplasmic extensions and are the primary lining cells of the alveoli, covering approximately 95% of the alveolar epithelial surface area. Type II cells (granular pneumocytes) are thicker and contain numerous lamellar inclusion bodies. A primary function of these cells is to secrete surfactant; however, they are also impoant in alveolar repair as well as other cellular physiology. Although these cells make up approximately 5% of the surface area, they represent approximately 60% of the epithelial cells in the alveoli. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 35. -### End" -4054,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deformity with decreased carrying angle is -, with the following options: A: Cubitus varus, B: Mannus varus, C: Cubitus valgus, D: Mannus valgus - -### Response: -Ans. is 'a' i.e., Cubitus varus Carrying angle:* Angle between long axis of arm and forearm is called carrying angle.* It is measured with the elbow in full extention.* Angle is more in females because of lower level of trochlea in female. Normal value is 5-15deg.* Cubitus Varus develops with is reduced carrying angle and cubitus valgus is increased carrying angle.* Varus - distal part towards midline and valgus is distal part away from midline. -### End" -4055,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dissociative anaesthesia is produced by, with the following options: A: Ketamine, B: Etomidate, C: Propofol, D: Thiopentone - -### Response: -Dissociative anaesthesia is characterized by profound analgesia, immobility, amnesia with light sleep and feeling of dissociation from once own body and the surroundings - Cataleptic stateKetamine (phencyclidine) induces dissociative anaesthesia.(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.294) -### End" -4056,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The treatment of peptic ulcer involves:, with the following options: A: Antacids, B: Ranitidine, C: Sucralfate, D: All - -### Response: -Ans: dRef: Harrison, 16thed, p. 1753 -### End" -4057,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intra-tumoral calcification in the brain is seen in all except?, with the following options: A: Craniopharyngioma, B: Meningioma, C: Oligodendroglioma, D: Hemangioblastoma - -### Response: -Intratumoral calcification develops in the slow-growing tumors like Craniopharyngioma Meningioma Oligodendroglioma -Hemangioblastoma is a highly vascular tumor. -### End" -4058,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All can he incinerated except-, with the following options: A: Cytotoxic waste, B: Sharps, C: Anatomical waste, D: Infectious waste - -### Response: -Ans. is 'b' i.e., Sharps o Incineration of waste sharp (category No-4) is not recommended. o The recommended method for treatment and disposal is disinfection by chemical treatment / autoclaving /microwaving and multilation / shredding. -### End" -4059,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HPV responsible for Condyloma Acuminatum are?, with the following options: A: Types 5 and 8, B: Types 6 and 11, C: Types 16 and 18, D: Type 13 and 32 - -### Response: -ANSWER: (B) Types 6 and 11REF: Fitz Patricks Dermatology 6th ed Page 2124, 2125, 2127, Robbins Pathology, 6th Ed, Page 1013 & Harrisons, 15th Ed, Page 1119See details of Condyloma Acuminatum in Dermatology 2002See APPENDIX - 31 below for ""HUMAN PAPILLOMAVIRUS"" APPENDIX - 31Human Papilloma Virus:DiseaseHPV TypeCommon warts2, 7Plantar warts1, 2, 4, 63Flat warts3,10Anogenital warts6,11, 42, 44 and others(types 6 and 11 account for about 90% of all cases)Genital cancersHighest risk: 16,18, 31, 45 HPV types (16 and 18 cause 70% of cervical cancer)Other high-risk: 33, 35, 39, 51, 52, 56, 58, 59 Probably high-risk: 26, 53, 66, 68, 73, 82Epidermodysplasia verruciformisHPV types 5 and 8Heck's disease- Focal epithelial hyperplasia (oral)13, 32Oral papillomas6, 7,11,16, 32HPV-positive Oropharyngeal cancer16Laryngeal papillomatosis6,11 -### End" -4060,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following blood gas results is most likely in a patient with hyperventilation caused by anxiety?, with the following options: A: increased PCO2, B: decreased PO2, C: decreased pH, D: decreased PCO2 - -### Response: -The behavioral respiratory control system of the brain drives the hyperventilation, which leads to decreased PCO2 and increased pH. If alkalemia is present with the hypocarbia, symptoms can be quite significant. They include dizziness, visual impairment, syncope, and seizures secondary to cerebral vasoconstriction; paresthesia's, carpopedal spasm, and tetany (secondary to decreased free serum calcium); muscle weakness (secondary to hypophosphatemia); and cardiac arrhythmias (secondary to alkalemia). -### End" -4061,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The sensation of posterior aspect of tongue is by, with the following options: A: Glossopharyngeal nerve, B: Vagus nerve, C: Hypoglossal nerve, D: Mandibular nerve - -### Response: -The glossopharyngeal nerve is the nerve for both general sensation and taste for the posterior one third of the tongue including the circumvallate papillae.The posterior most pa of the tongue is supplied by the vagus nerve through the internal laryngeal branch.The sensory supply of anterior two thirds is lingual nerve where as the taste sensation from the anterior two thirds is carried out by chorda tympani except vallate papillae(pre-trematic branch of first arch). REF.BDC VOL 3,Fifth edition. -### End" -4062,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An infant can regard his parent's face, follow to midline, lift his head from the examining table, smile spontaneously, and respond to a bell. He does not yet regard his own hand, follow past midline, nor lift his head to a 45deg angle off the examining table. Which of the following is the most likely age of the infant?, with the following options: A: 1 month, B: 3 months, C: 6 months, D: 9 months - -### Response: -At one month, infants typically regard face, follow items to the midline, begin to vocalize, respond to a bell, and lift their head from the examining table. An 8-week-old child normally should be able to smile and coo when smiled at or talked to. Not until about 3 months of age would an infant be expected to follow a moving toy from side to side and also in the vertical plane. -### End" -4063,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about coarctation of aorta except -, with the following options: A: Delay at the femoral artery as a manifestation, B: A high incidence of bicuspid aortic valves is seen in patients with coarctation of the aorta, C: Association with turners syndrome is seen, D: Boot shaped heart is a feature - -### Response: -Ans. is 'd' i.e., Boot shaped heart is a featureCoarctation of aortao Coarctation of aorta (CoA) is a constriction of aorta due to sharp indentation involving anterior, lateral and posterior wall of aorta.o The medial wall is spared in the narrowing.o 98% of coarctation occur just below the origin of left subclavian occur at the origin of ductus arteriosus (Juxtaductal coarctation). It may occur just proximal to subclav ian A. also,o COA may be a feature of turner syndrome, and is associated with a bicuspid aortic valve,o When COA is associated with mitral valve abnormality and subaortic stenosis, it is referred to as shone complex.o Coarctation of Aorta is a quite common structural abnormality.o Males are affected twice often as females although females with Turner syndrome frequently have a coarctation,o Two classic forms of coarctation of Aorta have been described.1)An infantile form with tubular hypoplasia of the Aortic arch proximal to a PDA that is often asymptomatic in childhod. (This is known as coarctation syndrome).2) An ""adult"" form in which there is discrete ridge like infolding of the Aorta just opposite to closed ductus arteriosus.Although coarctation of Aorta may occur as a solitary defect it is accompanied by -o Bicuspid aortic valve in 50% cases and may be associated withCongenital Aortic stenosis, ASD, VSD, mitral regurgitation and Berry aneurysm of the circle of willis.Clinical manifestations of COAo Symptoms of coarctation of aorta occurs due to decrease in blood supply distal to aortic obstruction,o If obstruction is distal to left subclavian artery, manifestations are due to arterial insufficiency to lower limbs.Intermittent claudicationPainWeakness of LegDysnea on runningWeak pulses and lower BP in the lowrer extremities - Delayed or weak impalpable femorals compared to strong brachial arteries.o Collateral circulation develops between precoarctation arterial branches and the post coarctation arteries through enlarged intercostal and internal mammary arteries,o This produces radiologically visible erosions (notching) of undersurface (inferior) ofribs.o Hypertension - Headache, dizziness.o If the obstruction is proximal to left subclavian artery - Blood supply to left arm (supplied by left subclavian) is interrupted whereas blood supply to right arm is normal - Pressure difference in two arms.Murmur in coarctation of aortao The blood passing through the narrowed aorta - Midsystolic murmur in anterior part of chest, back and spinous process.o When lumen becomes severlv narrowed the blood flow through it, turns into a high velocity jet - Continous murmur.o COA is associated writh bicuspid aortic valve in 50-80% of patients. The bicuspid valve produce aortic regurgitation - Diastolic murmur. -### End" -4064,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vegetations on under surface of cusps are found in, with the following options: A: Infective endicarditis, B: Libman sacks endocarditis, C: SABE, D: Rheumatic fever - -### Response: -Refer robbins 9/e 562 Vegetations of libman sacks endocarditis occur on surface of cusps.both surfaces are involved but most commonly affects under surface -### End" -4065,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug induced lupus antibodies are-, with the following options: A: Anti-Rho, B: Ds-DNA, C: Anti-Sm, D: Anti-histone antibody - -### Response: -harshmohan textbook of pathology 7th edition. *anti histone antibody which is antibody against histone associated with DNA in chromatin is seen paicularly in cases of drug infused lupus than in SLE -### End" -4066,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19 year old boy fell from the motor bike on his shoulder. The doctor diagnosed him a case of Erbs paralysis. The following signs and symptoms will be observed except -, with the following options: A: Loss of abduction at shoulder joint, B: Loss of lateral rotation, C: Loss of pronation at radioulnar joint, D: Loss of flexion at elbow joint. - -### Response: -Movements affected in Erb’s palsy --        Shoulder - -   Abduction -   Lateral rotation - --        Forearm - -   Flexion -   Supination - --        Biceps & Supinator jerks lost --        Sensation over lower part of deltoid lost -### End" -4067,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Causes of localized hypopigmented macule or patch are all except ?, with the following options: A: Vitiligo, B: Piebaldism, C: Pityriasis alba, D: Freckle - -### Response: -Ans. is 'd' i.e., Freckle -### End" -4068,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Action Potential is, with the following options: A: Decremental phenomenon, B: Does not obey all or none phenomenon, C: K+ goes from ECF to ICF, D: Threshold stimulus is required - -### Response: -All-or-Nothing Principle: Once an action potential has been elicited at any point on the membrane of a normal fiber, the depolarization process travels over the entire membrane if conditions are right, but it does not travel at all if conditions are not right. This principle is called the all-or-nothing principle, and it applies to all normal excitable tissues.The threshold for Initiation of the Action Potential: An action potential will not occur until the initial rise in membrane potential is great enough to create the positive feedback. This occurs when the number of sodium ions entering the fiber becomes greater than the number of potassium ions leaving the fiber. A sudden rise in membrane potential of 15 to 30 millivolts is usually required.Ref: Guyton; 13th edition; Chapter 5; Membrane Potentials and Action Potentials -### End" -4069,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about transfer of electrons in electron transpo chain is ?, with the following options: A: All the complexes are arranged in an increasing order of redox potential, B: The direction of transpo of electrons in Complex I ->C - Complex III Q - Complex IV, C: All the complexes are arranged in an increasing order of energy, D: 10 hydrogen ions get translocated when FADH2 electrons get into electron transpo chain - -### Response: -Ans. is 'a' i.e., All the complexes are arranged in an increasing order of redox potential*The complexes of electron transpo chain are arranged in an increasing order of redox potential or decreasing order of energy level.The direction of transpo of electrons from NADH is Complex I -) Q Complex III -) Complex C -> Complex IV Oxygen.The direction of transpo of electrons from FADH2 is Complexx II Q Complex III - Complex C -) Complex IV - Oxygen. -### End" -4070,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyperphenylalaninemia is due to defect in the enzyme:, with the following options: A: Phenylalanine hydroxylase:, B: Tyrosinase, C: Homogentisic acid oxidase, D: Ornithine transcarbamylase - -### Response: -a. Phenylalanine hydroxylase(Ref: Nelson's 20/e p 636-636)Deficiency of the enzyme phenylalanine hydroxylase or of its cofactor tetrahydrobiopterin (BH4) causes accumulation of phenylalanine in body fluids and in the brain. -### End" -4071,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50 year old man with advanced tuberculosis has developed signs of severe acute adrenal insufficiency. The patient should be treated immediately with a combination of:, with the following options: A: Aldosterone and fludrocoisone, B: Triamcinolone and dexamethasone, C: Coisol and fludrocoisone, D: Dexamethasone and metyrapone - -### Response: -Patient should be given both mineralocoicoids as well as glucocoicoid. - Aldosterone and Fludrocoisone both are mineralocoicoids. -Highest mineralocoicoid activity is seen with Aldosterone - Triamcinolone and Dexamethasone both are glucocoicoids. - Coisol is glucocoicoid and Fludrocoisone is a mineralocoicoid. - Dexamethasone is a glucocoicoid whereas Metyrapone is anti-glucocoiocid. -### End" -4072,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recent oral direct thrombin inhibitor which can be used for prevention of stroke is, with the following options: A: Dabigatrin, B: Ximelagatran, C: Lepirudin, D: Saxagliptin - -### Response: -Refer Katzung 11/e p 594 Ximelagatran was the first viral direct thrombin inhibitor approved, however it was later withdrawn because of hepatotoxicity. Recently a new direct thrombin inhibitor Dabigatrin had been approved for the prophylaxis of stroke and systemic embolism in nonvalvular atrial fibrillation -### End" -4073,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vit B 12 is absorbed in, with the following options: A: Stomach, B: Deudenum, C: Ileum, D: Colon - -### Response: -The  cobalamin-lF complex travels through the gut. The complex binds to specific receptors on the surface of the mucosal cells of the ileum. The binding of the complex and entry of B12 into the mucosal cells is mediated by Ca2+ ions. In the  mucosal  cells,  B12  is  converted  to methyf cobalamin. lt is then transported in the circulation in  a  bound form to  proteins namely  transcobalamins. -### End" -4074,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurofibromatosis 1 criteria include all except:, with the following options: A: Brain tumor, B: Acoustic neuromas, C: Dysplasia of the sphenoidal and tibial bone, D: Cafe-au-lait spots - -### Response: -In Neurofibromatosis 1 (NF1), two or more of the following clinical manifestations are present: Six or more Cafe-au-lait macules Axillary and inguinal freckling Two or more iris Lisch nodules Two or more neurofibromas or 1 plexiform neurofibroma A distinctive osseous lesion such as sphenoidal and tibial dysplasia Optic gliomas A 1st degree relative with NF1 Ref: Nelson textbook of pediatrics 21st edition pgno: 3141 -### End" -4075,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Whiff test is done for:, with the following options: A: Vaginal candidiasis, B: Trichomoniasis, C: Bacterial vaginosis, D: Syphilis - -### Response: -Whiff test is done to diagnose Bacterial vaginosis, where ""Fishy amine odor"" is seen after adding KOH to the discharge sample. -### End" -4076,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following feature distinguishes Crohn's disease from Ulcerative colitis ?, with the following options: A: Transmural involvement, B: Presence of polyps, C: Mucosal edema, D: Lymphocyte infiltrate - -### Response: -- Crohn's disease is associated with transmural inflammation whereas only superficial layers are involved in ulcerative colitis. Feature Crohn Disease Ulcerative Colitis Macroscopic Bowel region involved Any site of GIT Colon only Distribution Skip lesions Diffuse Stricture Yes Rare Wall appearance Thick Thin Microscopic Inflammation Transmural Limited to mucosa, submucosa Pseudopolyps may/ may not be present Markedly present Ulcers Deep, knife-like Superficial, broad-based Lymphoid reaction Marked Moderate Fibrosis Marked Mild to none Serositis Marked Mild to none Granulomas Yes ( 35%) No Fistulae/sinuses Yes No Clinical Perianal fistula Yes (in colonic disease) No Fat/vitamin malabsorption Yes No Malignant potential With colonic involvment yes Yes Recurrence after surgery Common No Toxic megacolon No Yes All feature may not be present in a single case. TRUE LOVE CLASSIFICATION OF UC. -### End" -4077,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A washer man presents with thickness erosion & discoloration of web spaces of toes diagnosis is –, with the following options: A: Psoriasis, B: Tinea Unguium, C: Both, D: Candidiasis - -### Response: -This washer man has fungal infection (thickening & erosion) of web space. Which may be either T pedis or candidal intertrigo. But, the examinar has not mentioned about specific lesions which :- - - -Red (erythematous) scaly lesion with central clearing and peripheral spreading → In T. pedis. -Red (erythematous) plaque with satellite pustules (peripheral pustules), and fine scales at periphery or some times white coloured plaque In candidal intertirigo. - - -T. pedis is not given in the option, so we are left only with candida. -T. unguium is the dermatophitic infection of nail (not web space) -### End" -4078,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not involved in generation of proton gradient?, with the following options: A: NADPH dehydrogenase, B: Coenzyme Q cytoreductase, C: Succinate CoQ reductase, D: Cytochrome reductase - -### Response: -Proton gradient : The inner mitochondrial membrane, as such, is impermeable to protons (H+) and hydroxyl ions (OH-). The transpo of electrons through ETC is coupled with the. translocation of protons (H+) across the inner mitochondrial membrane (coupling membrane) from the matrix to the intermembrane space. The pumping of protons results in an electrochemical . or proton gradient. This is due to the. accumulation of more H+ ions (low pH) on the outer side of the inner mitochondrial membrane than the inner side. The proton . gradient developed due to the electron flow in the respiratory chain is sufficient to result in the synthesis of ATP from ADP and Pi. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 229 -### End" -4079,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ABO incompatibility not seen with:, with the following options: A: Fresh frozen plasma, B: Platelet rich plasma, C: Single donor platelets, D: Cryoprecipitate - -### Response: -ABO incompatibility is seen with Whole Blood Plasma Platelets -ABO incompatible plasma carries a high risk of transfusion reactions, therefore, plasma transfusions should always be ABO compatible. -The platelets bear the intrinsic ABO antigens. So, platelet-rich plasma and single donor platelets also should be preferably ABO compatible. -So, the answer of exclusion is cryoprecipitate. It is not carrying ABO antigens but should preferably be ABO compatible to avoid even the minimal risk of hemolytic reaction. -### End" -4080,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fertilization most commonly occurs at:, with the following options: A: Ampulla, B: Interstitium, C: Isthmus, D: Uterine cavity - -### Response: -Ans. A. Ampulla* Fertilization is the process of fusion of the spermatozoon with the mature ovum.* Almost always, fertilization occurs in the ampullary part of the uterine tube. -### End" -4081,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypogonadism in cirrhosis is due to ?, with the following options: A: Direct effect of alcohol on testes, B: Increased estrogen due to decreased catabolism, C: Increased peripheral conversion of androgens into estrogen, D: All - -### Response: -Ans. is 'a' i.e., Direct effect of alcohol on testes ; 'b' i.e., Increased estrogen due to decreased catabolism; 'c' i.e., Increased peripheral conversion of androgens into estrogeno The testicular atrophy is due to disorder of hormonal metabolism or direct toxic effect on testis.o In cirrhosis of liver a combined testicular and pituitary abnormality leads to decreased testosterone production. The decreased testosterone (i.e. androgen insufficiency) production most likely result from inhibition of L H secretion by estrogens in patients with chronic liver disease.o The increased estrogen production result from impaired hepatic extraction of adrenal androstenedione and subsequent increased extraglandular conversion to estrone and estradiol.o The hyperestrogenemia cause hypogonadism and gynecomastia. -### End" -4082,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true for Kyasanur Forest Disease except: March 2012, with the following options: A: Caused by Arbovirus, B: Transmitted by bite of infective ticks, C: Incubation period of 1 week, D: Man to man transmission is seen - -### Response: -Ans: D i.e. Man to man transmission is seen Kyasanur forest disease/KFD It is a febrile disease associated with haemorrhages caused by an arbovirus flavivirus and transmitted to man by bite of infective ticks Incubation period is estimated to be between 3 and 8 days There is no evidence of man to man transmission. -### End" -4083,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Japanese encephalitis is caused by -, with the following options: A: Culex, B: Flavi virus, C: Pigs, D: None - -### Response: -Japanese encephalitis is a mosquito borne disease caused by group B arbovirus ie Flavivirus and transmitted by culcine mosquitoes.Pig is the major veebral host of JE virus Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no.302 -### End" -4084,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oxidation without oxygen leads to formation of which product -, with the following options: A: Pyruvate, B: Fructose, C: Lactate, D: None - -### Response: -Ans. is 'c' i.e., Lactateo Final product of glycolysis in the absence of O2 (anerobic glycolysis) is lactate.Anaerobic glycolysiso It occurs in the absence of oxygen. The pyruvate is fermented (reduced) to lactate in single stage.o The reoxidation of NADH (formed in the glyceraldehyde-3-phosphate dehydrogenase step) by respiratory chain is prevented as same NADH is utilized at lactate dehydrogenase step. So, there is no net production of NADH. Thus, there is net gain of 2 ATP only.o Unlike pyruvate which is converted to acetyl CoA to enter into krebs cycle, lactate cannot be further utilized by further metabolic pathways. Thus, lactate can be regareded as dead end in glycolysiso Anaerobic glycolysis occurs in exercising skeletal muscle, RBCs, lens, some region of retina, renal medulla, testis and leucocytes. -### End" -4085,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Copper T is ideally inseed at-, with the following options: A: Just before menstruation, B: On the 26th day, C: Just after menstruation, D: On the 14th day - -### Response: -Ans. is 'c' i.e., Just after menstruation Timing of inseion Although the loop can be inseed at almost anytime during a woman's reproductive years (except during pregnancy), the most propitious time for loop inseion is during mensturation or within 10 days of the beginning of a menstural period. o During this period, inseion is technically easy because the diameter of the cervical canal is greater at this time than during the secretory phase. o The uterus is relaxed and myometrial contractions which might tend to cause expulsion are at a minimum. o In addition, the risk that a woman is pregnant is remote at this time. -### End" -4086,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is likely to be found in a patient with the lesion in shaded area?, with the following options: A: Fluent speech output, B: Normal repetition, C: Acalculia, D: Dysahric speech pattern - -### Response: -Wernicke's aphasia is caused by a lesion in the posterior superior temporal gyrus of the dominant hemisphere. It is characterized by impaired language comprehension, inability to repeat, and fluent speech output with paraphasic errors. The only associated neurologic sign may be a right superior quadrantanopia second~ to the proximity of the inferior optic radiation to Wernicke's area in the left temporal lobe. Ref - Harrison's internal medicine 20e pg 158-159, 159t, 161 -### End" -4087,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Retraction of tympanic membrane touching promontory. What is sade's grade?, with the following options: A: 1, B: 2, C: 3, D: 4 - -### Response: -Ans. is 'c' i.e., 3 Atelectic grades of pars tensa Sade classification:: Grade 1 = slight retraction of TM over the annulus Grade 2 = the TM touches the long process of the incus Grade 3 = the TM touches the promontory Grade 4 = the TM is adherent to the promontory -### End" -4088,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which method of Medical Termination of Pregnancy is not used in the first trimester of pregnancy?, with the following options: A: Intrauterine instillation of hypertonic saline, B: Suction and evacuation, C: Mifepristone, D: Misoprostol - -### Response: -Ans. is 'a' i.e., Intrauterine instillation of hypertonic saline o Following table depicts the methods of medical termination of pregnancy used in first and second trimester abortion. Intrauterine instillation of hypertonic saline is preferred in the second trimester and not the first.METHODS OF TERMINATION OF PREGNANCYFirst Trimester (Up to 12 Weeks)Second Trimester (13-20 Weeks)Medicalo Mifepristoneo Mifepristone and misoprostol (PGE,)o Methotrexate and misoprostolo Tamoxifen and misoprostolSurgicalo Menstrual regulation (see p.646)o Vacuum aspiration (MVA/EVA) see p.646)o Suction evacuation and/or curettageo Dilatation and evacuation :# Rapid method# Slow methodo Prostaglandins PGE2 (misoprostol), 15 methyl PGF2 a (Carboprost), PGE, (Dinoprostone) and their analogs (used-intravaginally, intramuscularly or intraamniotically)o Dilation and evacuation (13-14 weeks)o Intrauterline Instillation of hyperosmotic solutions# Extra-amniotic-ethacridine lactate, Prostaglandins (PGE,, PGE2 a)# Extra-amniotic saline infusion (isotonic) with a transcervical catheter balloon# Intra-amniotic hypertonic urea (30%), saline (20%)o Oxytocin infusion - high dose used along with either of the above two methodso Hysterotomy (abdominal) - less commonly done -### End" -4089,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following surface glycoproteins is most often expressed in human hematopoietic stem cell (HSC)?, with the following options: A: CD23, B: CD30, C: CD33, D: CD34 - -### Response: -Surface antigen/Marker Normal cellular distribution CD34 Pluripotent hematopoietic stem cells & progenitor cells of many lineages. CD23 Activated mature B cells CD30 Activated B cells, T cells, and monocytes; Reed-Sternberg cells and variants CD33 Myeloid progenitors and monocytes -### End" -4090,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Duane Retraction Syndrome is most commonly characterised by, with the following options: A: Deficiency in action of 6th nerve characterized by difficult abduction, B: Weakness of superior oblique, C: Presence of corneal pigmentation, D: Presence of acute increase in intraocular pressure - -### Response: -Answer- A. Deficiency in action of 6th nerve characterized by difficult abductionDuane retraction syndrome represents the most frequent and most prominent congenital (CCDD). cranial dysinnervation d.isorderDuane retraction syndrome is a congenital strabismus that is usually caused by failure of normal development of the abducens nerve (the sixth cranial nerve). There is absence ofthe abducens nerve and fascicle with anomalous innervation of the lateral rectus muscle by the oculomotor nerve. -### End" -4091,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has oral ulcer and skin bullae, which are slow to heal. The lesion is, with the following options: A: Intradermal, B: Suprabasal, C: Epidermal, D: Sub corneal - -### Response: -Ans. b. Suprabasal Bulla on body and oral mucosa in a 50 years old male is suggestive of Pemphigus vulgaris. Pemphigus vulpris: Characterized by cutaneous (thin walled, delicate and flaccid bulkier and mucosal blisters. Mucosal lesions are present in all patients, oral mucosa most frequently involved, painful erosions extend peripherally with shedding of mucosaQ. Bulla is intra-epidermar, the split being suprabasalQ. Presence of acantholytic cells (rounded keratinocytesQpresent in the blister cavity and at the edge of the blister) with row of tombstone appearance Types of Bullae Intra-Epidermal PemphigusQ Herpes simplex/zosterQ Molluscum contagiosumQ Variola/varicellaQ EczemaQ Darriers diseaseQ Miliria rubraQ PompholyxQ Sub-Epidermal PemphigoidQ Dermatitis herpetiformisQ Herpes gestationalisQ BurnsQ Erythema multiformeQ Epidermolysis b.ullosa Lichen planus bullosaQ -### End" -4092,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Confounding factor can be eliminated by-, with the following options: A: Correlation, B: Standardization, C: Randomization, D: Matching - -### Response: -. a ""confounding factor""is defines as one which is associated both with exposure and disease and is distributed unequally in study and control groups.a cofounding factor by itself is a risk factor for the disease independently of any association.which can be eliminated mainly by matching. ref:park&;s textbook,ed22,pg no 63 -### End" -4093,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are involved in auditory pathway except, with the following options: A: Trapezoid body, B: Lateral geniculate body, C: Inferior colliculus, D: Superior olivary complex - -### Response: -It is the medial geniculate body that is involved. (Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 6th edition; page no.14 figure 2.2) -### End" -4094,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement regarding extracellular fluid to intracellular fluid is:, with the following options: A: ECF is rich in K+, B: ECF volume is twice that of the ICF, C: ECF is rich in organic anion, D: There is high sodium and low potassium in ECF - -### Response: -Option A is incorrect. ICF is rich in K+; ECF has a low concentration of K+. Option B is incorrect. ICF volume (28 L) is twice the volume of ECF (14 L). Option C is incorrect. ICF is rich in organic anions, the proteins. Other anions in ICF are inorganic phosphate. Option D is correct. There is high sodium and low potassium in ECF. -### End" -4095,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is not a marker of active replicative phase of chronic hepatitis B?, with the following options: A: HBV DNA, B: HBV DNA polymerase, C: Anti-HBC, D: AST and ALT - -### Response: -Ans. (c) Anti-HBC Anti-HBC has no relation with viral replication HBV DNA, HBV DNA polymerase represent active viral replication Level of HBV DNA correlates well with the degree of liver injury as suggested by raised AST, ALT It is not compulsory in chronic active hepatitis that HBeAg is positive. Infact HBeAg negative chronic hepatitis B is more dangerous. -### End" -4096,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraindications for breast feeding are all except, with the following options: A: Hepatitis - B infection of mother, B: Tetracycline treatment of mother, C: Acute bacterial mastitis, D: All - -### Response: -Ans. is a, b and c i.e. Hepatitis B infection of the mother; acute bacterial mastitis; and Tetracycline Breast feeding is not contraindicated in case of maternal hepatitis B infection as explained in previous question. Option '13' Lithium is contraindicated during pregnancy (see Answer 6) Option 'c' i.e. Acute bacterial mastitis. ""In case of acute bacterial mastitis breast feeding should be continued as it is helpful in avoiding abscess formation. If the infected breast is too tender to allow suckling, gentle pumping until nursing can be resumed is recommended."" Option `d' Tetracycline : according to KDT ""Tetracycline is secreted in breast milk and can cause teeth discoloration and impaired growth in infants and children therefore is contraindicated during lactation."" But all other books and extensive internet search (see Drug.com/Rxlist.com) says that tetracycline is not contraindicated during lactation but should be used cautiously in nursing mothers. -### End" -4097,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A pay was attended by a group of 100 people. Out of 100, 60 cases were repoed to be infected with food poisoning. 12 deaths were recorded. what is the case fatality rate in above scenario?, with the following options: A: 6%, B: 15%, C: 20%, D: 30% - -### Response: -Case fatality rate is: (12 deaths/ 60 cases)*100 = 20% Case fatality rate (Ratio)- (Total number of deaths due to a paicular disease/Total number of cases due to the same disease)*100Case fatality rate Represents the killing power of a disease. It is typically used in acute infectious diseases (e.g. , food poisoning, cholera, measles). Case fatality is closely related to virulence -### End" -4098,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28 year old female patient with patches of burns and swelling of arm. Histopathological findings reveal swelling of endopasmic reticulum, blebs from cell membrane, loss of microvilli, presence of myeloid bodies and no changes in nucleus. Which type of injury is seen in this patient?, with the following options: A: Irreversible cell injury, B: Autolysis, C: Pyroptosis, D: Reversible cell injury - -### Response: -Reversible cell injury:- -→ Hypoxia is the most common cause of cell injury. -→ Oxygen is an important requirement of mitochondria, for the formation of ATP, therefore hypoxia will result in earliest involvement of mitochondria, resulting in decreased formation of ATP. -→ Important organelles affected are - -Cell membranes (require ATP for functioning of Na+ - K+ pump) -Endoplasmic reticulum (require ATP for protein synthesis) -Nucleus. - -→ Swelling of organelles like endoplasmic reticulum, results in decreased protein synthesis. -→ Bleb results due to outpouching from the cell membrane to accommodate more water. -→ Loss of microvilli. -→ Formation of cellular organelle like endoplasmic reticulum. These are composed of phospholipids. -→Myelin figures are intracellular whorls of laminated lipid material. -​​When these myelin figures are present in membrane-bound structure, containing lysosome enzymes, these are known as myeloid bodies. -### End" -4099,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atypical pneumonia is caused by -, with the following options: A: Staph aureus, B: Stre pneumonia, C: P carinii, D: H influenzae - -### Response: -Ans. is 'c' i.e., P carinii o Important causes of atypical pneumonia are Mycoplasma pneumoniae (most common cause), viruses (influenza, RSV, adenovirus, rhinovirus, corona virus), legionella, chlamydia, coxiella bumetti, and P. carinii. -### End" -4100,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The contraceptive method with a failure rate of <5 is, with the following options: A: Oral contraceptive pills, B: Copper-T, C: Vaginal sponge, D: Condom - -### Response: -The oral contraceptives are highly effective contraceptive method -The failure rate is very low ( 0.3℅), as ovulation is inhibited -### End" -4101,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following prevents aspiration?, with the following options: A: LMA, B: Oropharyngeal airway, C: Nasopharyngeal airway, D: Proseal LMA - -### Response: -Ans. is 'd' i.e., Proseal LMA [Ref: Understanding Paediatric Anaesthesia Td/e p. 141A type of definite airwayDefinite airway is an airway that is adequately secured in trachea and it adequately protect the airway from aspiration.ProSeal (PLMA), a modification of Classic LMA, has a gastric drainage tube placed lateral to main airway tube which allows the regurgitated gastric contents to bypass the glottis and prevents the pulmonary aspiration. -### End" -4102,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50 years old male patient with weight 65 kg, pH 7.05, PCO, 15 mmHg, HCO3 5 mEq/L and base excess/ deficit -40 mEq/L. How much sodium bicarbonate has to be given in first 4 hour, with the following options: A: 150 mEq, B: 300 mEq, C: 450 mEq, D: 600 mEq - -### Response: -Answer- A. 150 mEq -### End" -4103,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are risk factors for depression except, with the following options: A: Middle aged female, B: Hypothyroidism, C: Age above 70yrs either sex, D: 18yrs old teenager - -### Response: -Depression is common among middle-aged women, elderly and who are divorced or separated with disturbed personal family history. Here the better option is 18yr old teenager Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 604-607 -### End" -4104,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The value of proteins in Soyabean is about ?, with the following options: A: 43%, B: 50%, C: 58%, D: 58% - -### Response: -Ans. is 'a' i.e., 43% -### End" -4105,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following chemical reaction is involved in the conversion of noradrenaline to adrenaline?, with the following options: A: Hydroxylation, B: Carboxylation, C: Methylation, D: Dehydrogenation - -### Response: -Catecholamines are derivatives of phenylalanine/tyrosine. ""Nor"" in noradrenaline (norepinephrine) indicates the absence of methyl group. The methyl group of adrenaline (epinephrine) is derived from S-Adenosyl methionine (AdoMet) -### End" -4106,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The vasodilatation produced by carbon dioxide is maximum in one of the following:, with the following options: A: Kidney, B: Brain., C: Liver., D: Hea. - -### Response: -B i.e. BrainThe metabolic changes that produce vasodilatation, in most tissue, is decrease in O2 & pHT CO2 is associated with cutaneous & cerebral vosodilatationQ, but vasoconstriction elsewhere & usually a slow rise in BP. -### End" -4107,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about creatinine clearance test is true:, with the following options: A: Creatinine clearance test is the most accurate / gold standard test for assessing GFR, B: Creatinine clearance may overestimate the actual GFR as renal function declines, C: Creatinine clearance may underestimate the actual GFR as renal function declines, D: Creatinine clearance is more accurate than Inulin clearance in estimating GFR - -### Response: -Answer is B (Creatinine clearance may overestimate the actual GFR as renal function declines) Creatinine clearance may overestimate the GFR as renal function declines, since secretion of creatinine from tubular cells is increased as renal function declines (when GFR decreases). Creatinine is an endogenous metabolite that is freely. filtered by the glomerulus but is also actively secreted by the proximal tubular cells into the renal tubules in very small amounts. In the steady state such 'Secretion' of creatinine into the tubules is minimal, however as GFR falls creatinine secretion is increased. Creatinine clearance thus over estimates the actual GFR especially in conditions with mild to moderate reductions in GFR. Inulin is still considered the 'Gold standard' test for assessing GFR. Inulin clearance is more accurate than creatinine clearance as Inulin is not secreted by tubular cells. -### End" -4108,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Males are more commonly affected than females in which of the following genetic disorders?, with the following options: A: Autosomal recessive disorder, B: Autosomal dominant disorder, C: X-linked recessive disorder, D: X-linked dominant disorder - -### Response: -Analysis ofX-linked recessive disorders Males have an X and Y chromosome. No corresponding locus for a mutant allele of the X chromosome on the Y chromosome. Mutant recessive gene on the X chromosome expresses itself in a male child because it is not suppressed by a normal allele. Whereas in the female, the presence of a normal allele on other X-chromosome prevents the expression of the disease. Females only act as carriers. -### End" -4109,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The characteristic finding in USG of ectopic pregnancy is, with the following options: A: Resistance in color doppler, B: Absence of gestational sac in uterus, C: Free fluid in peritoneal cavity, D: Complex adnexal mass - -### Response: -An ectopic pregnancy occurs when a feilized egg implants and grows outside the main cavity of the uterus -### End" -4110,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 63 year old man presents with a triad of angina, syncope and congestive hea failure. Which of the following valvular hea lesion can be suspected-, with the following options: A: antral stenosis, B: Tricuspid regurgitation, C: Aoic stenosis, D: Aoic regurgitation - -### Response: -Even severe AS may exist for many years without producing any symptoms because of the ability of the hyperophied LV to generate the elevated intraventricular pressures required to maintain a normal stroke volume. Most patients with pure or predominant AS have gradually increasing obstruction over years, but do not become symptomatic until the sixth to eighth decades. Exeional dyspnea, angina pectoris, and syncope are the three cardinal symptoms. Dyspnea results primarily from elevation of the pulmonary capillary pressure caused by elevations of LV diastolic pressures secondary to reduced left ventricular compliance and impaired relaxation. Angina pectoris usually develops somewhat later and reflects an imbalance between the augmented myocardial oxygen requirements and reduced oxygen availability. Exeional syncope may result from a decline in aerial pressure caused by vasodilation in the exercising muscles and inadequate vasoconstriction in nonexercising muscles in the face of a fixed CO, or from a sudden fall in CO produced by an arrhythmia. ( Harrison&;s principle of internal medicine,18th edition,pg no.1939 ) -### End" -4111,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a toddler few drops of blood was noticed per rectally. What can be the most probable diagnosis among the conditions given below?, with the following options: A: Adenomatous polyposis coli, B: Juvenile Rectal polyp, C: Rectal ulcer, D: Piles - -### Response: -This child is most likely suffering from juvenile polyp. Adenomatous polyposis coli, rectal ulcer and piles are diseases of the adults. Juvenile polyp is a benign, pedunculated and solitary lesion occuring mainly in the rectosigmoid colon. t is usually seen in children between 3 to 5 years of age, and is rare before 1 year. It ususally autoamputates by 15 years. Passage of small amount of bright red blood on a normal or constipated stool is the most common manifestation. -### End" -4112,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Troponin-T is preferable to CPK-MB in the diagnosis of acute myocardial infarction (MI) in all of the following situations except:, with the following options: A: Bedside diagnosis of MI, B: Postoperatively (after CABG), C: Reinfarction after 4 days, D: Small infarcts - -### Response: -Answer is C (Reinfarction after four days) Because cardiac troponins are elevated for prolonged periods (> I week) an episode of recurrent ischaemia after four days would be more readily diagnosed with a marker that remains elevated in blood more briefly such as cKMB .4,41, returns to normal levels by 72 hours. Limitation of troponin measurements : Because these markers remain elevated for prolonged periods (> 1 week) episodes of recurrent ischemic discomfo and suspected recurrent MI are more readily diagnosed with a serum cardiac marker that remains elevated in the blood more briefly such as CKMB or myoglobin. -### End" -4113,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug can be accumulated in foetus in very significant amount if given to pregnant mother?, with the following options: A: Thiopentone, B: Propofol, C: Midazolam, D: Lignocaine - -### Response: -Local anaesthetic and opioids are bases. Once they reach the fetus they become nonionized (due to highly acidic pH) and can not come back to maternal circulation leading to toxic accumulations in fetus. -### End" -4114,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following statements are true about DPT vaccine except -, with the following options: A: Aluminium salt has an adjuvant effect, B: Whole cell killed bacteria of Bordetella peusis has an adjuvant effect, C: Presence of acellular peusis component, D: Presence of H.Influenza B component increase its immunolgenecity - -### Response: -H.influenza B is not a component of DPT vaccine. Acellular peussis component is present. Peussis component in DPT vaacine enhances the potency of the diphtheria toxoid. Adsorption on a mineral carrier like aluminium phosphate or hydroxide increases the immunological effectiveness of the vaccine. Ref:PARK&;S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23rd edition , Page :162 -### End" -4115,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Crohn's disease can be seen in -, with the following options: A: Jejunum only, B: Colon only, C: Terminal ileum and right side, D: Mouth to anus - -### Response: -• Chronic, transmural inflammatory disease of the GIT for which the cause is unknown. -• Can involve any part of the alimentary tract from the mouth to the anus but most commonly affects the small intestine and colon -• Involvement of both large and small intestine: 55% -• Involvement of only small intestine: 30% -• Involvement of only large intestine: 15% -• Crohn’s disease primarily attacks young adults in the 2nd and 3rd decades of life. -• More common in smokers and urban dwellers -• Two genders are affected equally with strong familial association -• Upper GI Crohn’s disease is most frequently found in the gastric antrum and duodenum. -• In patients with colonic disease, rectal sparing is characteristic. -Etiology: Unknown -• Infectious agents proposed as potential causes: Mycobacterium paratuberculosis and measles virus. -• The identification in 2001 of the CARD-15/NOD2 mutation (on chromosome 16q, also known as IBD-1 locus) provided the first definitive genetic link to the condition and is relatively specific for Crohn’s disease. -### End" -4116,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All drains into middle meatus except:, with the following options: A: lacrimal duct, B: Maxillary sinus, C: Frontal sinus, D: Ethmoidal sinus - -### Response: -Anterior group of paranasal sinus which includes maxillary, frontal and anterior ethmoidal. They all open in the middle meatus and their ostia lie anterior to basal lamella of middle turbinate Ref: Dhingra 7e pg 209. -### End" -4117,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least rigid maxillary major connector is:, with the following options: A: Complete palate, B: Single palatal strap, C: Double palatal bar, D: U-shaped - -### Response: -U -Shaped Palatal Connector: -From both the patient's standpoint and a mechanical standpoint, the U-shaped palatal connector is  the least desirable of maxillary major connectors. It should never be used arbitrarily. When a large  inoperable palatal torus exists and occasionally when several anterior teeth are to be replaced, the U-  shaped palatal connector may have to be used. In most instances, however, other designs will serve  more effectively. The following are the principal objections to the use of the U-shaped connector: - -Its lack of rigidity (compared with other designs) can allow lateral flexure under occlusal forces,  which may induce torque or direct lateral force to abutment teeth. -The design fails to provide good support characteristics and may permit impingement of  underlying tissue when subjected to occlusal loading. -Bulk to enhance rigidity results in increased thickness in areas that are a hindrance to the tongue. -### End" -4118,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is TRUE about poal vein?, with the following options: A: Formed by the superior mesenteric vein, B: Formed by the splenic vein, C: Situated deep to the hepatic aery and cystic duct, D: All of the above - -### Response: -Poal vein collects blood from the foregut, midgut, and hindgut. The poal vein is located deep to the hepatic aery and cystic duct and is formed by the union of the superior mesenteric vein and splenic vein, deep to the neck of the pancreas. Blood from poal vein transpoed to the hepatic sinusoids of the liver for filtration and detoxification. The hepatic sinusoids empty into the common central vein, which empties into the hepatic veins and ultimately drains into the inferior vena cava. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 10. Midgut and Hindgut. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy. -### End" -4119,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Feature of Apoptosis, with the following options: A: Cell is enlarged, B: Karyorrhexis, C: Plasma membrane intact, D: Enzymatic digestion - -### Response: -Features of Necrosis and ApoptosisFeatureNecrosisApoptosisCell sizeEnlarged (swelling)Reduced (shrinkage)NucleusPyknosis - karyorrhexis - karyolysisFragmentation into nucleosome-sizefragmentsPlasmamembraneDisruptedIntact; altered structure,especially orientation of lipidsCellularcontentsEnzymatic digestion;may leak out of the cellIntact; may be released inapoptotic bodiesAdjacentinflammationFrequentNoPhysiologic orpathologicroleInvariably pathologic(culmination ofirreversible cellinjury)Often physiologic, means ofeliminating unwanted cells;may be pathologic after someforms of cell injury, especiallyDNA damageRef: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 2; Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death -### End" -4120,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How does staph aureus become resistant to methicillin:, with the following options: A: Heat shock protein, B: Protein A, C: Transpeptidase, D: Protein C - -### Response: -Ans. (c) TranspeptidaseRef: Microbiology by Ananthanarayan and Paniker 8th ed. /197, 201-202Resistance develops due to alteration in transpeptidase (penicillin binding protein) on which all beta lactam antibiotics act- so MRSA is resistant to all b-lactam antibiotics. -### End" -4121,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypercalcemia is not seen in:, with the following options: A: Lithium therapy, B: Chronic renal failure, C: Multiple myeloma, D: Vitamin A deficiency - -### Response: -Answer is D (Vitamin A deficiency). Hypercalcemia is seen with Vit. A intoxication (not deficiency) due to associated high bone turnover. Causes of hypercalcemia: Parathyroid related Vitamin D related * * * Primary hyperparathyroidism Q Lithium therapy Q Familial hypercalciuric hypercalcemia * * * Vitamin D intoxication Increased 1, 25 (OH), D eg. SarcoidosisQ; other granulomatous ds. Idiopathic hypercalcemia of infancy Malignancy related Associated high bone turnover * Solid tumor with metastasis (Breast) * HypehyroidismQ * Solid tumor with paraneoplastic syndromes * hnmobilizationu (Carcinoma Breast/Lung /Kidney etc.) * ThiazidesQ * Hematological malignancies: * Vitamin A intoxicationQ Multiple myelomaQ / Lymphoma / * Paget 's disease Leukemia Associated With Renal FailureQ * Pheochoromocytoma (rare) * Severe secondary hyper-parathyroidism * MEN syndromes * Aluminum intoxication * Milk Alkali syndrome -### End" -4122,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following conditions, the root can be left in the alveolar process?, with the following options: A: Small root fragment, if size is 4-5 mm in length, B: The root must be deeply embedded in bone, C: The tooth involved must not be infected, and there must be no radiolucency around the apex., D: All of the above - -### Response: -Conditions for a root to be left in the alveolar process: - -The root fragment must be small, usually no more than 4 to 5mm in length. -The root must be deeply embedded in bone. -The tooth involved must not be infected, and there must be no radiolucency around the apex. -When the risk is too great, if removal of the root will cause excessive destruction of surrounding tissue or damages important structures like inferior alveolar nerve or the root is pushed into tissue spaces or maxillary sinus. -### End" -4123,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of snakebite all, except AFMC 11, with the following options: A: Firm bandage to occlude lymphatic, B: Incision over wound, C: Reassure the patient, D: Immobilization of bitten pa - -### Response: -Ans. Incision over wound -### End" -4124,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Food poisoning 2 hours after intake of food:, with the following options: A: Salmonella typhi, B: Bacillus cereus, C: Staphylococcus aureus, D: Clostridium - -### Response: -Ans. (c) Staphylococcus aureusRef: Microbiology by Ananthanarayan and Paniker 8th ed. /198, Harrison's 18th ed. /Ch 128* Among the given options staph aureus has the shortest incubation period (1-6 hrs).* Staphylococcus causes food poisoning by enterotoxin A, due to intake of milk or milk products.# It is a preformed, heat stable enterotoxin, which stimulate the vagus nerve causing vomiting as main and first symptom.# I.P. < 6 hours* Outbreaks following picnics where potato salad, mayonnaise, and cream pastries have been served offer classic examples of staphylococcal food poisoning.* Bacillus cereus is an important cause of food poisoning, isolated from soil, vegetables, milk cereals, meat etc.* It produces 2 types of food poisoning:Diarrhea type- main symptomEmetic type- main symptom* Associated with wide range of food intake including meat, puddings etc.* I.P. 8-16 hrs* Occurs due to heat labile enterotoxin* Associated with intake of Chinese fried rice* I.P. 1-5 hrs* Due to pre-formed, heat stable toxin# Clostridium perfringens causes gastroenteritis after intake of infected meat or meat products. I.P. - 8-16 hours.# Clostridium botulism causes food poisoning due to consumption of canned food. I.P. 1 to 3 days. -### End" -4125,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Echoviruses are cytopathogenic human viruses that mainly infect the:, with the following options: A: Respiratory system, B: Central nervous system, C: Blood and lymphatic systems, D: Intestinal tract - -### Response: -Echoviruses are cytopathogenic human viruses that mainly infect the intestinal tract. Echoviruses were discovered accidentally during studies on poliomyelitis. They were named enteric cytopathogenic human orphan (ECHO) viruses because, at the time, they had not been linked to human disease and thus were considered ""orphans."" Echoviruses now are known to infect the intestinal tract of humans; they also can cause aseptic meningitis, febrile illnesses, and the common cold. Echoviruses range in size from 24 to 30 nm in diameter and contain a core of RNA. -### End" -4126,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False regarding Bochdalek hernia is -, with the following options: A: Spleen and kidney can herniate, B: Occurs posterolaterally, C: Always occurs on right side, D: Hernia may or may not have sac - -### Response: -Ans. is 'c' i.e., Always occur on the right side Bochdalek hernia occurs mostly on left side (80%) I have no idea about option 'd' -### End" -4127,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about myositis ossificans progressiva (child with heterotopic ossification) is?, with the following options: A: Pneumonia is common, B: Life longevity is normal, C: Most common site involved is the spine, D: Onset is before 6 years - -### Response: -Myositis ossificans progressiva is a autosomal dominant disease is characterized by heterotopic ossification most commonly involving spine and congenital deformities of hand and feet. The disease usually stas before 6 years of age. In myositis ossificans progressiva, the life expectancy is decreased and the commonest cause of death is lung diseases. Ref: Harrison 17/e, Page 2416. -### End" -4128,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following cranial nerve is a pure motor nerve?, with the following options: A: 3, B: 5, C: 8, D: 9 - -### Response: -Pure sensory 1-olfactory 2-optic 8-vestibulocochlear Pure motor 3-oculomotor 4-trochlear 6-abducent 11-accessory 12-hypoglossal Mixed 5-trigeminal 7-facial 9-glossopharyngeal 10-vagus -### End" -4129,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following toxic states is not associated with anemia?, with the following options: A: Clostridial sepsis, B: Snake venom, C: Lead poisoning, D: Listerosis - -### Response: -Ans. is 'd' i.e., Listerosis * The toxic or chemical injury states associated with anemia include: Clostridial sepsis, Snake venom, Lead poisoningClassification of Anemia According to Underlying MechanismMechanismSpecific ExamplesBlood Loss Acute blood lossChronic blood lossTraumaGastrointestinal tract lesions, gynecologic distrubances*Increased Red Cell Destruction (Hemolysis)Inherited genetic defects Red cell membrane disordersHereditary spherocytosis, hereditary elliptocytosisEnzyme deficiencies Hexose monophosphate shunt enzyme deficienciesG6PD deficiency, glutathione synthetase deficiencyGlycolytic enzyme deficienciesPyruvate kinase deficiency, hexokinase deficiencyHemoglobin abnormalities Deficient globin synthesisThalassemia syndromesStructurally abnormal globins (hemoglobinopathies)Sickle cell disease, unstable hemoglobinsAcquired genetic defects Deficiency of phosphatidylinositol-linked glycoproteinsParoxysmal nocturnal hemoglobinuriaAntibody-mediated destructionHemolytic disease of the newborn (Rh disease), transfusion reactions, drug-induced, autoimmune disorders Mechanical trauma Microangiopathic hemolytic anemiasHemolytic uremic syndrome, disseminated intravascular coagulation, thrombotic thrombocytopenia purpuraCardiac traumatic hemolysisDefective cardiac valvesRepetitive physical traumaBongo drumming, marathon running, karate choppingInfections of red cellsMalaria, babesiosisToxic or chemical injuryClostridial sepsis, snake venom, lead poisoningMembrane lipid abnormalitiesAbetalipoproteinemia, severe hepatocellular liver diseaseSequestrationHypersplenismDecreased Red Cell ProductionInhertod genetic defects Defects leading to stem cell depletionFanconi anemia, telomerase defectsDefects affecting erythroblast maturationThalassemia syndromesNutritional deficiencies Deficiencies affecting DNA synthesisBp and folate deficienciesDeficiencies affecting hemoglobin synthesisIron deficiency anemiaErythropoietin deficiencyRenal failure, anemia of chronic diseaseImmune-mediated injury of progenitorsAplastic, anemia, pure red cell aplasiaInflammation-mediated iron sequestrationAnemia of chronic diseasePrimary hematopoietic neoplasmsAcute leukemia, myelodysplasia, myeloproliferative disordersSpace-occupying marrow lesionsMetastatic neoplasms, granulomatous diseaseInfections of red cell progenitorsParvovirus B19 infectionUnknown mechanismsEndocrine disorders, hepatocellular liver disase -### End" -4130,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young boy presented with a lesion over his right buttock, which had peripheral scaling with central scarring. The investigation of choice would be?, with the following options: A: Tzanck smear, B: KOH preparation, C: Biopsy, D: Sabourad's agar - -### Response: -Central clearing: T. Corporis - KOH smear Central scarring: Lupus vulgaris - Biopsy Central crusting: Leishmaniasis - LT body demonstration -### End" -4131,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How many pairs of flagella does Giardia lamblia possess -, with the following options: A: One, B: Two, C: Three, D: Four - -### Response: -Ans. is 'd' i.e., Four Giardia (review)o Giardia is a flagellate protozoao It is the only common protozoa that inhabits the duodenum and jejunum (upper small intestine) of human.o Infective form - cysto Mode of transmission - Ingestion of cysto Giardia exists in two forms -### End" -4132,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deposition of calcium in dying tissue is called, with the following options: A: Metastatic calcification, B: Dystrophic calcification, C: Heterotropic calcification, D: Normal calcification - -### Response: -Dystrophic calcification is encountered in areas of necrosis of any type. It is viually inevitable in the atheromas of advanced atherosclerosis, associated with intimal injury in the aoa and large aeries and characterized by the accumulation of lipids Metastatic calcification can occur in normal tissues whenever there is hypercalcemia( Robbins Basic Pathology, 9th edition, page 26 ) -### End" -4133,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common nerve damaged in CSOM is(REPEAT QUESTION), with the following options: A: III, B: VII, C: II, D: VI - -### Response: -Facial paralysis occurs as a complication of both acute and chronic otitis media. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 88) -### End" -4134,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Use of valproate during pregnancy may result in, with the following options: A: Mental retardation, B: Respiratory depression, C: Hydantoin syndrome, D: Neural tube defect - -### Response: -Valproate crosses the placenta and has been repoed to have caused teratogenic effects, including neural tube defects (anencephaly, meningomyelocele, and spina bifida) in the fetus when the mother received valproate during the first trimester of pregnancy. -### End" -4135,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most active single chemotherapeutic agent in the treatment of Leiomyosarcoma -, with the following options: A: Adriamycin, B: Doxorubicin, C: Methotrexate, D: b or a - -### Response: -Ans. is 'b' or 'a' i.e., Doxorubicin or Adriamycin o Doxarubicin (adriamycin) has been shown to be an effective agent against leiomyosarcomas arising in the uterus. o The best responses in cases of soft tissue tumors have been observed with doxarubicin (adriamycin) and ifsofamide (not in option) -### End" -4136,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are peptide-based except, with the following options: A: ACTH, B: GnRH, C: Thyroxin, D: TRH - -### Response: -Thyroxin is a lipid-soluble hormoneRef: DM Vasudevan, 7th edition, page no: 672 -### End" -4137,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chromosome involved in pathogenesis of MEN 4?, with the following options: A: 10, B: 11, C: 12, D: 13 - -### Response: -Chromosome aberrations in MEN MEN 1 11q13 MEN 2 10 ( RET proto-oncogene) MEN 3 10 ( RET Proto-oncogene) MEN 4 12p13 -### End" -4138,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minimum vision loss with which cataract –, with the following options: A: Blue dot cataract, B: Zonular cataract, C: Anterior polar cataract, D: Posterior polar cataract - -### Response: -In blue dot cataract, opacities are usually stationary and do not affect vision. -### End" -4139,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 23 year old female presents to the clinic with history of recurrent aboions. While investigating this patient for recurrent aboions all of the following tests are to be done EXCEPT:, with the following options: A: Parental cytogenetics, B: Thyroid profile, C: Antiphospholipid antibodies, D: TORCH infection screening - -### Response: -Recurrent miscarriage is defined as a sequence of three or more consecutive spontaneous aboion before 20 weeks. Investigations: 1) Blood glucose (fasting and post prandial), VDRL, thyroid function test, ABO and Rh grouping (husband and wife), toxoplasma antibodies IgG&IgM 2) Autoimmune screening - lupus anticoagulant and anticardiolipin antibodies 3) Serum LH on D2/D3 of the cycle 4) Ultrasonography - to detect congenital malformations of uterus, polycystic ovaries and uterine fibroid 5) Hysterosalpingography in the secretory phase 6) Laryngoscopy 7) Karyotyping (husband and wife) 8) Endocervical swab to detect chlamydia, mycoplasma, and bacterial vaginosis -### End" -4140,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to a recent Supreme Court Judgment, doctor can be charged for Medical Negligence under section 304-A, only if:, with the following options: A: If he is from corporate hospital, B: If negligence is from inadvertent error, C: Gross negligence, D: Res Ipsa Loquitur - -### Response: -Ans is 'c' i.e. Gross negligence Ref: Reddy Forensic 28/e p34Section 304A: deals with causing death by negligence. The section states- ""Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both ""Section 304 A deals with criminal negligence. Criminal negligence occurs when the doctor shows gross lack of competence, or gross inattention or inaction, gross recklessness, or wanton indifference to the patient's safety, or gross negligence in the selection and application of remedies. It involves an extreme departure from the ordinary standard of care.""A doctor will not be criminally liable if a patient dies due to an error of judgment or carelessness or want of due caution, though he can be liable to pay compensation."" - Reddy ForensicMore on Medical negligence is described in Q no. 40 of May 2011 -### End" -4141,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28-year-old woman is evaluated for infeility and amenorrhea. She is obese and has significant facial hair in a male distribution. Laboratory studies reveal an increase in serum LH, as well as in total serum testosterone and in the testosterone metabolite dehydroepiandrosterone sulfate. A pelvic ultrasound examination would probably reveal which of the following findings?, with the following options: A: A mass resembling a bunch of grapes projecting into the vagina, B: Blood-filled cysts in the ovary, C: Fluid accumulation in the fallopian tubes, D: Multiple small follicular cysts on the ovary - -### Response: -The findings are those of the Polycystic Ovary (Stein-Leventhal) Syndrome, an impoant cause of infeility in young women that is characterized by amenorrhea, infeility, obesity and hirsutism Increased levels of LH and of androgens are often found, and it has been thought that LH may stimulate follicular theca-lutein cells, with consequent hyperproduction of androgens. Hyperinsulinemia may lead to increased ovarian androgen production, which then may lead to increased LH. The syndrome is characterized by multiple small follicular cysts, a markedly thickened ovarian capsule, and coical stromal fibrosis. A mass resembling a bunch of grapes projecting into the vagina is characteristic of sarcoma botryoides. Blood filled cysts on the ovary are termed ""chocolate cysts"" and are associated with endometriosis, another cause of infeility. Fluid accumulation in the fallopian tubes is termed hydrosalpinx. -### End" -4142,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is detected in peripheral blood smear -, with the following options: A: Malaria, B: Toxoplasma, C: Babesia, D: Brucella - -### Response: -Forms in peripheral blood P.vivax - trophozoites ,schizonts,gametocytes P.falciparum- ring worms and gametocytes P.malariae- trophozoites ,schizonts, gametocytes P.ovale- trophozoites, schizonts,gametocytes (refer pgno: 59 baveja 3 rd edition) -### End" -4143,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Ig gene rearrangement & Ig diversity:, with the following options: A: Somatic mutations theory, B: DNA rearrangement, C: Appropriate class switching, D: All - -### Response: -A, B, C i.e. Somatic mutations theory, DNA rearrangement, Appropriate class switching -### End" -4144,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The mode of inheritance of Incontinentia pigmenti is -, with the following options: A: Autosomal dominant, B: Autosomal recessive, C: X-linked dominant, D: X-linked recessive - -### Response: -Ans- C X-linked dominant -### End" -4145,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary center of ossification appears in -, with the following options: A: Epiphysis, B: Metaphysis, C: Diaphysis, D: None - -### Response: -Primary center of ossification → in diaphysis -Secondary centers of ossification → in epiphysis -### End" -4146,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mitochondria havea) Plasmid DNAb) Circular DNAc) Single stranded DNAd) Double stranded DNA, with the following options: A: bd, B: d, C: ab, D: ac - -### Response: -Mitochondrial DNA is small circular double stranded DNA molecule. -### End" -4147,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Genetic association of Diabetes?, with the following options: A: MHC, B: VHL, C: CTLA4, D: PDGF-R - -### Response: -Answer- C. CTLA4Type I DiabetesCTLA4 (cytotoxic T lymphocyte-associated 4)- 2q3I -35 -### End" -4148,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pancreas divisum is:, with the following options: A: Duplication of the pancreas, B: Failure of fusion of dorsal & ventral pancreatic buds, C: Formation of more than two pancreatic buds, D: Formation of only one pancreatic bud - -### Response: -Ans. B. Failure of fusion of dorsal & ventral pancreatic budsPancreas divisum occurs when the dorsal and ventral pancreatic buds fail to fuse with each other. As a result, the two parts of pancreas derived from two buds remain separate from each other. -### End" -4149,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Communication between middle ear and Eustachian tube is obliterated in which surgery?, with the following options: A: Tympanoplasty, B: Schwaz operation, C: Modified radical mastoidectomy, D: Radical mastoidectomy - -### Response: -In radical mastoidectomy, the opening of Eustachian tube is closed by curetting its mucosa and plugging the opening with tensor tympani muscle or cailage. -### End" -4150,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The development of the respiratory system begins during the fourth week of development as an evagination of the, with the following options: A: First branchial pouch, B: First branchial cleft, C: Vental wall of the foregut, D: Dorsal wall of the midgut - -### Response: -The respiratory diverticulum is an evagination of the endodermal floor of the foregut. All of the epithelial surfaces of the respiratory system are derived from this evagination. -The first branchial pouch is the endodermal imagination that forms the eustachian tube and the middle ear linings. -The first branchial cleft is an ectodermal imagination that forms the external ear canal. -The sixth branchial arch contributes to the cartilage of the larynx. -### End" -4151,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In glycolysis, the following forms as the byproduct:, with the following options: A: Pyruvate, B: H2O, C: H+, D: All of the above - -### Response: -Glycolysis is the metabolic pathway that breaks down (catabolism) hexose (six-carbon) monosaccharides such as glucose, fructose, and galactose into two molecules of pyruvate, two molecules of ATP, two molecules of NADH, two water (H2O) molecules, and two hydrogen ions (H+). Ref: Janson L.W., Tischler M.E. (2012). Chapter 6. Carbohydrate Metabolism. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry. -### End" -4152,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following enzymes decreases gastric motility:, with the following options: A: Secretin, B: CCK-PZ., C: Both., D: None. - -### Response: -Secretin augments the action of CCK-PZ but secrete watery alkaline pancreatic juice. -Thus, both SECRETIN and CCK-PZ decreases gastric motility. -### End" -4153,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proper management of a child with an absolute neutrophil count (ANC) of 100/mm3 would be, with the following options: A: The start of broad-spectrum intravenous antibiotics, B: Careful physical examination and chest radiograph; close observation pending result of blood cultures, C: Granulocyte transfusion, D: Nutritional support with oral iron and intramuscular injection or vitamin B12 - -### Response: -A child with an absolute neutrophil count (ANC) of 100/mm3 is severely neutropenic and is at risk of death from overwhelming septicemia. Because most signs of infection (e.g., pneumonitis, pyuria) depend on the presence of neutrophils, serious infection may be present in such a patient without producing characteristic physical, radiologic, or laboratory findings. Thus, broad spectrum antibiotics (to treat a variety of possible infections) must be initiated promptly after cultures are obtained. Deferring treatment until culture results are available may result in overwhelming septicemia and death. Granulocyte transfusions usually are not beneficial in these patients because of the short survival time of the cells in the bloodstream (plasma half-life is approximately 7 hours). Iron and vitamin B12 are treatments for nutritional anemias and are of no therapeutic' value in neutropenia. -### End" -4154,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The syndromic management of urethral discharge includes, with the following options: A: Neisseria gonorrhoeae and herpes genitalis, B: Chlamydia trachomatis and herpes genitalis, C: Neisseria gonorrhoeae and Chlamydia trachomatis, D: Syphilis and chancroid - -### Response: -Ans. c. Neisseria gonorrhoeae and Chlamydia trachomatisSyndromic ManagementUrethral discharge: Neisseria gonorrhoeae and Chlamydia trachomatisGenital ulcer disease: Syphilis and Chancroid -### End" -4155,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Persons with intermittent explosive disorder generally display all of the following except?, with the following options: A: Aggressive outbursts and violence, B: Destruction of propey, C: Remorse, regret and embarrassment about their actions, D: Bulimia - -### Response: -Intermittent explosive disorder is characterized by repeated outbursts of aggressive, violent behavior during which person may attack and harm others and vandalize and destroy propey. Following these outbursts they are often contrite, expressing remorse, regret and embarrassment about their actions. -### End" -4156,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A dead body is found to have marks like branching of a tree on front of chest. The most likely cause of death could be due to:, with the following options: A: Fire-arm, B: Lightening injury, C: Injuries due to bomb blast, D: Road traffic accident - -### Response: -B i.e. Lightening injury -### End" -4157,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding stapedial reflex, which of the following is true -, with the following options: A: It helps to enhance the sound conduction in middle ear, B: It is a protective reflex against loud sound, C: It helps in masking the sound waves, D: It is unilateral reflex - -### Response: -Stapedius muscle helps to dampen very loud sound and thus prevents noise trauma to the inner ear. It is supplied by VII nerve (facial nerve). Lesions of facial nerve lead to loss of stapedial reflex and hyperacusis or phonophobia i.e. intolerance to loud sounds. -For more details see chapter – physiology of hearing and assessment of hearing loss of the guide -NOTE: -Stapedial reflex = Acoustic reflex -### End" -4158,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true except., with the following options: A: E. coli is an aerobe and facultative anaerobes, B: Proteus forms uric acid stones, C: E. coli is motile by peritrichate flagella, D: Proteus causes deamination of phenylalanine to phenylpyruvic acid - -### Response: -Ans. is 'b' i.e., Proteus forms uric acid stones(Ref: Surgical Pathology by Ackermann, p. 1124; Ananthanarayan, 9th/e, p. 274, 282 and 8th/e, p. 270)Uric acid stone formation takes place in acidic urine, in the presence of hyperuricemia which may result from inborn errors of metabolism such as gout or the Lesch-Nyhan Syndrome.Proteus produces ammonia and contributes to alkalinity. It does not thus lead to formation of uric acid stones. The alkalinity leads to necrosis of renal tubular epithelium and precipitation of phosphate stones.The distinctive character of proteus genus is deamination of phenyl alanine to phenyl pyruvic acid (PPA +ve).E. coli are motile by peritrichous flagella.E. coli is an aerobe and facultative anaerobe. -### End" -4159,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The treatment options for patients with RRMS (relapsing-remitting multiple sclerosis) are all except, with the following options: A: IFN - 1 b, B: IFN - 1 a, C: Glatiramer acetate, D: TNF - a - -### Response: -Ans. is 'd' i.e., TNF - a -### End" -4160,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Painful are syndrome is seen in all except -, with the following options: A: Complete tear of supraspinatus, B: # greater tuberosity, C: Subacromial bursitis, D: Supraspinatus tendinitis - -### Response: -Painful are syndrome is seen in incomplete tear of supraspinatus tendon (not in complete tear). -### End" -4161,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are characteristics of Rett syndrome Except, with the following options: A: Microcephaly, B: Autistic behavior, C: Autosomal recessive inheritance, D: Peculiar wringing motion of the hands - -### Response: -The genetics of Rett syndrome has not yet been determined. Although it is thought to be a genetic syndrome, no inheritance pattern and no enzymatic deficiency or other metabolic explanation has been established for Rett syndrome. The other characteristics (autistic behavior, microcephaly, the peculiar wringing motion of the hand, dementia) are common in patients with this disorder -### End" -4162,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Graft versus host disease is due to ?, with the following options: A: Immunocompetent T cells in graft tissue, B: Immunocompetent T cells in host, C: Immunocompetent B cells in graft tissue, D: Immunocompetent B cells in host - -### Response: -Ans. is 'a' i.e., Immunocompetent T cells in graft tissue Graft versus host disease Graft versus host disease occurs in any situation in which immunologically competent cells or their precursors are transplanted into immunologically crippled patients and the transferred cells recognize alloantigens in the host. Graft versus host disease occurs most commonly in the setting of allogenic bone marrow transplantation but may also follow transplantation of solid organs rich in lymphoid cells (e.g. the liver) or transfusion of unirradiated blood. Recipients of bone marrow transplants are immunodeficient because of either their primary disease or prior treatment of the disease with drugs or irradiation. When such recipients receive normal bone marrow cells from allogenic donors, the immunocompetent, T cells present in the donor marrow recognizes the recipient's HLA antigen as foreign antigen and react against them. Both CD4+ and CD8+T cells recognize and attack host tissues. In clinical practice GVH can be so severe that bone marrow transplants are done only between ILIA matched donor and recipient. Acute GVH disease occurs within days to weeks after allogenic bone marrow transplantation. Although any organ may be affected, the major clinical manifestation results from involvement of the immune system and epithelia of the skin, liver and intestines. Involvement of the skin in GVH disease is manifested by a generalized rash leading to desquamation in severe cases. Destruction of small bile ducts gives rise to jaundice and mucosal ulceration of the gut results in bloody diarrhoea. Immunodeficiency is a frequent accompaniment of GVH disease. The immunodeficiency may be a result of prior treatment, myeloablative preparation for the graft, a delay in repopulation of the recipient's immune system and attack on host's immune cells by grafted lymphocytes. Affected individuals are profoundly immunosuppressed and are easy prey to infections. Although many different types of organisms may infect patients, infection with cytomegalovirus is paicularly impoant. -### End" -4163,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The indications of cast metal inlay are all except, with the following options: A: The cavity’s width exceeds ⅓ the intercuspal distance, B: Strong, self-resistant cusps present, C: Occlusal surfaces are not to be changed, D: The tooth is not to be used as an abutment - -### Response: -Inlays - -An inlay can be defined as a restoration which has been constructed out of mouth from gold, porcelain or other materials and then cemented into the prepared cavity of a tooth. - -Indications - -The cavity's width does not exceed one-third the intercuspal distance. -Strong, self-resistant cusps are there. -Minimum or no occlusal facets  present and if present, are confined to the occlusal surfaces only. -The tooth is not to be used as an abutment for a fixed or removable prosthesis. -Occlusal or occluding surfaces are not to be changed by the restorative procedure. - -MDS Prep Bytes (Cast Restoration – Inlay) -### End" -4164,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute orchitis all are seen except -, with the following options: A: Increased local temprature, B: Decreased blood flow, C: Etythematous scrotum, D: Raised TLC - -### Response: -Ans. is 'b' i.e., Decreased blood flow o USG shows increased blood flow in acute stage.o Ischemic orchitis may set in, in late stages resulting in reduced blood flow on USG. -### End" -4165,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a characteristic retinal finding on examining a patient with malignant hypeension?, with the following options: A: Exudates, B: Cotton wool spots, C: Retinal haemorrhage, D: Narrowing of aerioles - -### Response: -Cotton wool spots are characteristically seen in malignant hypeension. Other features of malignant hypeension are papilloedema, retinal oedema over posterior pole and clusters of superficial flame shaped hemorrhages. Ref: Ophthalmology By Khurana, 3e page 255 -### End" -4166,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest condition associated with menorrhagia is :, with the following options: A: Adenomyosis, B: Fibroid, C: Granulosa cell tumour, D: Polycystic ovary - -### Response: -Fibroid -### End" -4167,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Substrate level phosphorylation occur in step catalysed by which of the following enzyme in TCA cycle?, with the following options: A: Isocitrate dehydrogenase, B: Malate dehydrogenase, C: Aconitase, D: Succinate thiokinase - -### Response: -Succinate thiokinase is the enzyme that generates ATP directly by substrate-level phosphorylation. In Krebs cycle succinate thiokinase catalyze the conversion of Succinyl CoA into succinate. In this step GDP is phosphorylated to GTP. GTP can then be conveed to ATP by reacting with an ADP molecule. Substrate-level phosphorylation is a type of metabolism that results in the formation and creation of adenosine triphosphate (ATP) or guanosine triphosphate (GTP) by the direct transfer and donation of a phosphoryl (P03) group to adenosine diphosphate (ADP) or guanosine diphosphate (GDP) from a phosphorylated reactive intermediate. In glycolysis substrate level phosphorylation occur in two steps: Conversion of 1,3 BPG to 3 Phosphoglycerate catalyzed by Phosphoglycerate kinase Conversion of Phosphoenolpyruvate to pyruvate catalyzed by Pyruvate kinase Ref: Textbook of Biochemistry By D M Vasudevan, 3rd Edition, Page 195 -### End" -4168,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secondary osteosarcoma is associated with, with the following options: A: Paget's disease, B: Osteogenesis imperfect, C: Melhoreostosis, D: Anklyosing spondylitis - -### Response: -Causes of secondary osteosarcomaPaget&;s DiseaseFibrous dysplasiaRadiationEnchondromatosisHereditary multiple exostosesChronic osteomyelitisBone infarction (Refer: Manish Kumar Varshney's Essential Ohopedics Principles & Practice, 1st edition, pg no. 191, 192) -### End" -4169,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following condition is true of Barret oesophagus, with the following options: A: A biopsy will show a histological finding of columnar to squamous metaplasia, B: It is known precursor of carcinoma of the stomach, C: The most common location6id proximal third of +e oesophagus, D: It is a known precursor of adenocarcinoma of the esophagus - -### Response: -Barrett Esophagus Barrett esophagus is a complication of chronic GERD that is characterized by intestinal metaplasia within the esophageal squamous mucosa. The incidence of Barrett esophagus is rising, and it is estimated to occur in as many as 10% of individuals with symptomatic GERD. Barrett esophagus is most common in white males and typically presents between 40 and 60 years of age. The greatest concern in Barrett esophagus is that it confers an increased risk of esoph- ageal adenocarcinoma. Genomic sequencing of biopsies involved by Barrett esophagus has revealed the presence of mutations that are shared with esophageal adenocarci- noma, in keeping with the idea that Barrett esophagus is a precursor lesion to cancer. Potentially oncogenic mutations are more numerous when biopsies demonstrate dysplasia, which is detected in 0.2% to 2% of persons with Barrett esophagus each year. The presence of dysplasia, a prein- vasive change, is associated with prolonged symptoms, longer segment length, increased patient age, and Caucasian race. Although the vast majority of esophageal adenocar- cinomas are associated with Barrett esophagus, it is impor- tant to remember that most individuals with Barrett esophagus do not develop esophageal tumors. -### End" -4170,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most effective medical treatment of nasal polypi is:, with the following options: A: Topical decongestant nasal drops, B: Anti-histaminic, C: Topical steroids, D: Non-steroid anti-inflammatory drugs (NSAIDs) - -### Response: -Topical corticosteroids cause regression of nasal polypi. Anti-histaminic do not help in regressing polypi. NSAIDs can actually lead to formation of nasal polypi. -### End" -4171,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pressure of normal uterine contractions is between 190-300. Units in terms of which units., with the following options: A: Montevideo units, B: Mm of Hg, C: Cm of water, D: Joules/kg - -### Response: -1 montevideo unit = Intensity of constraction x number of contractions in 10 mins. -Montevideo unit is to define uterine activity. -As per this: -Clinical labour usually commences when uterine activity reaches values between 80-120 Montevideo units (This translates into approximate 3 contractions of 40 mm of Hg every 10 minutes). -During labour – Normal uterine contractions are between 190 – 300 Montevideo units (At the time of delivery it is 300 Montevideo units) -Extra Edge - -Uerine contractions are clinically palpable only after their intensity exceeds > 10 mm of Hg -Uterine contractions are not associated with pain unless their intensity is > 15 mm of Hg. -### End" -4172,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Toughest layer of Cornea is, with the following options: A: Descement membrane, B: Endothelium, C: Connective tissue stroma, D: Pre descement membrane - -### Response: -Toughest layer of Cornea is Pre descement membrane. -### End" -4173,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a selective serotonin & nor epinephrine reuptake inhibitor ?, with the following options: A: Fluoxetine, B: Venlafaxine, C: Sealine, D: Arnoxipine - -### Response: -Ans. is 'b' i.e., Venlafaxine o Impoant SNRIs are :- Venalafaxine, Milnacipram, desvenalafaxine, Duloxetine. -### End" -4174,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Name the accelerator used in Zinc oxide eugenol paste:, with the following options: A: Olive oil, B: Linseed oil, C: Zinc acetate, D: All of these - -### Response: -In Zinc Oxide Eugenol impression pastes, other anhydrous formulations contain acetic acid or zinc acetate to accelerate the reaction. In any case, water provides additional acceleration. -Ref: Phillips 12edition page no 179 -### End" -4175,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following electrocardiographic changes is found in hypercalcaemia -, with the following options: A: PropongedQ-T interval, B: Sho Q-T interval, C: Increased QRS interval, D: Sho P-R interval - -### Response: -ECG Changes in Hypercalcaemia The main ECG abnormality seen with hypercalcaemia is shoening of QT interval In severe hypercalcaemia, Osborn waves (J waves) may be seen Ventricular irritability and VF arrest has been repoed with extreme hypercalcaemia Bizarre-looking QRS complexes Very sho QT interval J waves = notching of the terminal QRS, best seen in lead V1 Ref Harrison 20th edition pg 1435 -### End" -4176,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: RET gene mutation is associated with which malignancy -, with the following options: A: Pheochromocytoma, B: Medullary carcinoma thyroid, C: Lymphoma, D: Renal cell carcinoma - -### Response: -Ans. is 'b' i.e., Medullary carcinoma thyroid o RET p ratoon cumene is a growth factor receptor (receptor tyrosine kinase)o The RET protein Is a receptor for the glial cell lined derived neurotrophic factor and structurally related proteins that promote cell survival during neural development. -### End" -4177,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Charles Phillips procedure?, with the following options: A: Small bowel atresia, B: Meconium ileus, C: Recurrent small bowel obstruction, D: Sigmoid volvulus - -### Response: -Ans. C. Recurrent small bowel obstruction. (Ref LB 25th pg. 1198)Rx of acute intestinal obstruction# GI drainage# Fluid and electrolyte replacement# Relief of obstruction# Surgical Rx is necessary for most cases of intestinal obstruction but should be delayed until resuscitation is complete, provided there is no sign of strangulation or evidence of closed-loop obstruction.Indications for early surgical intervention# Obstructed or strangulated external hernia# Internal intestinal strangulation# Acute obstructionRX OF RECURRENT INTESTINAL OBSTRUCTION DUE TO ADHESIONSSeveral procedures may be considered in the presence of recurrent obstruction, including:# Repeat adhesiolysis (enterolysis) alone;# Noble's plication operation;# Charles Phillipss transmesenteric plication;# intestinal intubation.Their relative efficacy remains unclear.In Noble's intestinal plication all involved intestine is freed. Adjacent coils (average length 15-20 cm) are sutured with serosal sutures to form gentle curves. If only a proportion of the small bowel is plicated, the mesentery must be united to prevent internal hernias. This procedure is time-consuming, and associated with a high morbidity and recurrent symptoms.In the Charles-Phillips operation. following adhesiolysis, the bowel is placed in an orderly fashion and three long synthetic sutures are passed through the mesentery of the plicated bowel, each doubled hack upon itself and tied loosely. The stitch should pass a few centimetres from the bowel wall and not be adjacent to it. The resultant bowel should look like a packet of sausages. Results from this procedure are relatively good.Intraluminal tube insertion (Baker), via a Witzel jejunostomv or gastrostomy, may facilitate the formation of gentle curves. Most tubes have an inflatable balloon near the tip to facilitate placement within the caecum. This procedure is associated with a long postoperative ileus, and reports of outcome are conflicting.RX OF VOLVULUS:# May involve the small intestine, Caecum, or sigmoid colon; neonatal nidgut volvulus secondary to midgut malrotation is life-threatening.# The commonest spontaneous type in adult is sigmoid volvulus.# Sigmoid volvulus can be relieved by decompression per anum# Surgery is required to prevent or relieve ischemia.Rx of MECONIUM ILEUS# Uncomplicated meconium ileus may respond to Rx with hyperosmolar gastrografin enema; this draws fluid into the gut lumen and also has detergent properties, which help to liquefy the meconium.# Meconium ileus complicated by intestinal perforation, volvulus, or atresia, or unresponsive to enemas, demands surgery.# Various surgical procedures are used including intestinal resection and temporary stoma formation, resection and primary anastomosis, and, in uncomplicated cases, enterostomy and irrigation of the bowel.# The Bishop-Koop operation with its irrigating stoma is now only rarely used.Rx of INTESTINAL ATRESIA# In most cases of jejunal or ileal atresia, the distal end of the dilated proximal small bowel is resected and primary end- to-end anastomosis is possible.# Ocassionally, a temporary stoma is required before definitive repair. -### End" -4178,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minimum filteration through glomerulatus ?, with the following options: A: Glucose, B: Inulin, C: Creatinine, D: Myoglobin - -### Response: -Ans. is 'd' i.e., MyoglobinWater is freely filterable through glomerular barrier. A filterability of 1.0 means that the substance is filtered as freely as water; a filterability of 0.75 means that the substance is filtered only 75 percent as rapidly as water. Substances that are freely filterable (filterability 1.0) are water, sodium, glucose, Bicarbonate, inulin, and creatinine. Myoglobin is paially filterable (filterability of 0.75) and albumin is almost not filterable (filterability of 0.005) under normal conditions. -### End" -4179,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice in drug induced parkinsonism is:, with the following options: A: Levodopa, B: Benzhexol, C: Amantidine, D: Carbidopa - -### Response: -Ans. (B) Benzhexol(Ref: KDT 8/e p460)Central anticholinergics like trihexy phenydyl (Benzhexol) are the only drugs effective in drug induced Parkinsonism. -### End" -4180,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serum C3 is persistently low in the following except -, with the following options: A: Post-streptococcal glomerulonephritis, B: Membranoproliferative glomerulonephritis, C: Lupus nephritis, D: GlomerulonePhritis related to bacterial endocarditis - -### Response: -Blood findings: Complement levels in post-streptococcal GN: Transient reduction during the disease Return to normal in 6-8 weeks. Urinary findings: Oliguria Mild proteinuria Hematuria(smoky or cola colored urine) Red cell casts or dysmorphic red cells (red cells with cellular protrusions or fragmentation) Ref: RAM DAS NAYAK EXAM PREPARATORY MANUAL FOR UNDERGRADUATES 2nd ed. pg no: 601 -### End" -4181,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following pathology on x-ray can be seen in?, with the following options: A: Psoriasis, B: Osteoahritis, C: Gouty Ahritis, D: Ankylosing spondylitis - -### Response: -Licked candy stick appearance refers to tapering of the tips of the metacarpal bones, metatarsal bones, phalanges or clavicles and is usually associated with: *Psoriatic ahropathy *Rheumatoid ahritis *Leprosy *Neuropathic joint -### End" -4182,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Capacitation of sperm proceeds in -, with the following options: A: Epididymis, B: Female genital tract, C: Fallopian tubes, D: Testis - -### Response: -Ans. is 'b' i.e., Female genital tract Sperm capacitationo Physiochemical change in the sperm by which it becomes hypermotile and is able to bind and fertilize a secondary oocyte.o Takes place in the female genital tracto Takes about 2-6 hours.o Changes involve : cAMP dependent phosphorylation with increase in intracellular pH (influx of Ca2+ and efflux of H+). -### End" -4183,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Erythema chronicum migrans is seen in ?, with the following options: A: Lyme's disease, B: Glucagonoma, C: Gastrinoma, D: Phaeochromocytoma - -### Response: -'a' i.e. Lyme's disease -### End" -4184,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 1 yr child weighing 6 kg is suffering from Acute Gastroenteritis along with signs of sunken eyes & skin pinch going back to normal very rapidly. What will be your management?, with the following options: A: RL infusion 120 ml in the first hour followed by 360 ml in the next 5 hours, B: RL INFUSION 180 ml in the first hour followed by 420 ml in the next 5 hours, C: RL INFUSION 180 ML IN the first hour followed by 480 ml in the next 5 hours, D: RL INFUSION 240 ml in the first hour followed by 360 ml in the next 5 hours - -### Response: -* Severe dehydration constitutes a medical emergency requiring immediate resuscitation with intravenous fluids. * Intravenous access should be obtained, and patients should be administered a bolus of 20-30 mL/kg lactated Ringer&;s (LR) or normal saline (NS). * If pulse, perfusion, and/or mental status do not improve, a second bolus should be administered. * After this, the patient should be given an infusion of 70 mL/kg LR or NS over 5 hours (children < 12 months) or 2.5 hours (older children). * If no peripheral veins are available, an intraosseous line should be placed. Serum electrolytes, bicarbonate, urea/creatinine, and glucose levels should be sent. Reference: GHAI Essential pediatrics, 8th edition -### End" -4185,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cords of Billroth in spleen are found in, with the following options: A: Mantle zone, B: Trabecular zone, C: Red pulp, D: White pulp - -### Response: -75% of spleen is red pulp, predominantly having RBCs. 25% of spleen is white pulp, predominantly having WBCs Red pulp contains sinusoids which are filled with RBCs & blood and splenic cords of billroth White pulp contains lymphoid follicles &periaerial lymphatic sheath. -### End" -4186,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Goal for blindness under NPCB is to reduce prevalence of blindness in 2020 to ?, with the following options: A: 0.10%, B: 0.30%, C: 0.50%, D: 1.00% - -### Response: -

NPCB:National programme for control of blindness Launched in the year 1976 as a 100% centrally sponsored programme and incorporate the earlier trachoma control programme staed in the year 1968. The programme was launched with the goal to reduce the prevalence of blindness from 1.4 to 0.3 %. Objectives:- 1. Reduce the backlog of avoidable blindness through identification and treatment of curable blind at primary, secondary and teiary levels. 2. Develop and strengthen the strategy of NPCB for ""Eye health for all"" and prevention of visual impairment through provision of comprehensive universal eye care services. 3. Strengthen and upgrade the Regional institutes of ophthalmology to become centre of excellence in various sub specialities of ophthalmology. 4. Strengthening the existing infrastructural facilities and developing additional human resource for providing high quality comprehensive eye care in all districts of the country. 5. To enhance community awareness on eye care and lay stress on preventive measures. 6. Increase and expand research for prevention of blindness and visual impairment. 7. To secure paicipation of voluntary organisations or private practitioners in eye care delivery. School eye screening programme:- Children are first screened by trained teachers . Children suspected to have refractive error are seen by ophthalmic assistants and corrective spectacles are prescribed or given free for persons below povey line. {Reference-park&;s textbook of preventive and social medicine, 23rd edition, pg no.439}

-### End" -4187,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about nasolabial cysts except, with the following options: A: They are Bilateral, B: Present in adults, C: Strong female predilection, D: Derived from odontogenic epithelium - -### Response: -Nasolabial Cysts/Nasoalveolar Cyst/Klestadt&;s Cyst:- * It is a rare non odontogenic cyst which originates from epithelial entrapment in the line of fusion between maxillary and median nasal elevation. * Female >Male * Bilateral in approximately 10 % of all cases. * Usually present in 4th and 5th decades of life. * It lies on the bone and causes an excavation. It is closely attached t o floor of the nose. * It presents as a smooth and soft bulge in the lateral wall and floor of vestibule anterior to inferior turbinate. * Large cyst obliterates the alar facial fold (nasolabial sulcus). Treatment:- It is by surgical excision using sublabial approach. Ref:- Scott Brown 7th/ed; pg num:- 1320 -### End" -4188,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At the end of 8th month, testes descend into, with the following options: A: Superficial inguinal ring, B: Inguinal canal, C: Scrotum, D: Deep inguinal ring - -### Response: -C i.e. Scrotum -### End" -4189,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lung volume reduction operations have been developed as a method of managing patients with, with the following options: A: Asbestosis, B: Emphysema, C: Bronchiectasis, D: Amyloidosis - -### Response: -In a patient with diffuse severe emphysema, resection or pa of the damaged lung may allow the patient's residual lung to function more efficiently. This technique may serve either as an alternative to lung transplantation or as a bridge until an appropriate donor organ is available. ref - Harrisons internal medicine 20e pg 1997 -### End" -4190,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following indicates death of fetus in uterus :, with the following options: A: Spalding sign, B: Failure of uterus to enlarge, C: Blood stained discharge, D: Absence of fetal movements - -### Response: -Spalding sign -### End" -4191,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preservation of cusps and marginal ridges is:, with the following options: A: Primary resistance form., B: Primary retention form., C: Convenience form., D: Secondary retention form. - -### Response: -Features of primary resistance form are: - -Box shape. -Flat floor. -Preservation of cusps and marginal ridges. -Rounded internal and external line angles. -### End" -4192,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The behaviour therapeutic falls in management of enuresis, The pharmacological drug of choice for this case in, with the following options: A: Phenytoin, B: Diazepalm, C: Imipramine, D: Alprax - -### Response: -Enuresis Defined as normal, complete evacuation of the bladder at a wrong place and time at least twice a month after 5 year of age. More than 85% children attain complete diurnal and nocturnal control by 5 years of age. Enuresis is primary when the child has never been dry and secondary when bed wetting stas after a minimum period of six months of dryness at night. It is said to be monosymptomatic if not accompanied by any lower urinary tract infection and nocturnal if it occurs during sleep. It has to be differentiated from continuous or intermittent incontinence or dribbling.The bed is usually soaking wet in enuresis, compared to incontinence in which there is loss of urine without normal emptying of bladder. ETIOLOGY:- 1. Maturation delay is most likely cause. 2. Anxiety producing episodes during the 2 nd to 5 th years, the time for development of nocturnal bladder control, are associated with increased risk of enuresis. 3. Lack of circadian rhythm of ADH or impaired response of kidneys to ADH. 4. Secondary enuresis can be precipitated by acute stressful condition or traumatic experience. Bladder irritability due to urinary tract infection or severe constipation with the full rectum impinging on the bladder can cause enuresis. 5. Conditions causing polyuria, spina bifida, ectopic ureter and giggle and stress incontinence are other causes. Treatment:- General advice given to all enurectic children but active treatment need not begin before 6 years of age. Caffeinated drinks like tea , coffee, sodas should be avoided in evening. Adequate fluid intake during day as 40% in morning, 40% in afternoon and 20% in evening is recommended. First line of treatment is usually non pharmacological, comprising motivational therapy and use of alarm devices. Motivational therapy:- Successful in curing enuresis upto 25%. The child is reassured and provided emotional suppo.Every attempt is made to remove any feeling of guilt. The child is encouraged to assume active responsibility, including keeping a dry night diary, voiding urine before going to bed, and changing wet clothes and bedding. Dry nights should be credited with praise.punishments and angry parenteral response should be avoided. Child is encouraged both to void frequently enough to avoid urgency and daytime incontinence and to have daily bowel movement. Alarm therapy: Involves the use of device to elicit a conditioned response of awakening to the sensation of full bladder. Best used afteemr seven years if age. Successful in two third cases without much recurrence. The alarm device consists of a small sensor attached to child&;s underwear or a mat under the bed sheet and an alarm attached to the childs collar or at bedside. When the child stas wetting, sensors are activated thus causing the alarm to ring. Pharmacotherapy:- Used if enuresis persists despite alarm therapy, regular voiding habits, exclusion or treatment of constipation, exclusion of post voidal residual urine. Imipramine works by aleing the arousal sleep mechanism. It gives satisfactory initial response at dise of 1-2.5 mg/ kg/ day. Relapse rate after discontinuation of therapy seen. Cardiac arrythmia is a serious adverse effect. Anticholinergic drugs reduce uninhibited bladder contractions and are useful in children who have significant daytime urge incontinence besides nocturnal enuresis. Usual dose is 5 mg for oxybutynin, 2 mg for tolterodine. Desmopressin works by reducing volume of urine. Reference: GHAI Essential pediatrics, 8th edition -### End" -4193,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following are manifestations of Felty's syndrome except:, with the following options: A: RA, B: Splenomegaly, C: Thrombocytopenia, D: Neutropenia - -### Response: -Ans. C. ThrombocytopeniaFelty's syndrome is defined by the clinical triad of neutropenia, splenomegaly, and nodular RA and is seen in less than 1% of patients. -### End" -4194,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following effects are produced by mu opioid receptor except ?, with the following options: A: Tachycardia, B: Miosis, C: Sedation, D: Euphoria - -### Response: -Effects of Mu opioid receptor activation results in S- Sedation A- Analgesia C- Constipation R- Respiratory depression U- eUphoria M- Miosis -### End" -4195,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coloured halos are seen in all, EXCEPT, with the following options: A: Mucopurulent conjunctivitis, B: Acute anterior uveitis, C: Tetracycline, D: Glaucoma - -### Response: -C i.e. Tetracycline Glucomas Q -Primary angle closure glucoma (due to corneal edema & stretching Q) - Open angle glucomaQ Acute mucopurulent conjunctivitis Q (due to mucus) Corneal scar Krukenberg spindle (Pigmentary glucoma)Q Cataract Q (lens opacity) Vitreous opacities - e.g. haemorrhage, asteroid bodies, synchysis scintillans etc. Any haze of ocular media Q Contact lens overwear (due to corneal abrasion) Too intense exposure to light as in snow blindness Asymmetrical placement of intraocular lens in relation to pupillary apeure Drugs - acetophenazine, acetyldigitoxin, amiodarone, amodiaquine, amyl nitrite, butaperazine, carphenazine, chloroquine, chlorine dioxide, chlorpromazine, coisone, deslanoside, dexamethasone, diethazine, digitalis, digitoxin, digoxin, ethopropazine, ethylene diamine, fluorometholone, fluphenazine, gitalin, hydrocoisone, hydroxychloroquine, lanatoside C, medrysone, mesoridazine, methidilazine, methotrimeprazine, methylprednisolone, nitroglycerin, nitronaphalene, oral contraceptives, ouabain, paramethadione, perazine, pericyazine, promazine, promethazine, propiamazine, quinacrine, thiethylperazine, thiopropazine, thioproperazine, thioridazine, trifluoperazine, triflupromazine, trimeprazine, trimethadione and sterile water. * Tetracycline is not included in this long drug list & haze in ocular media can occur in acute anterior uveitis due to aqueous flare & K.P's. -### End" -4196,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Collagen in basement membrane, with the following options: A: Type I, B: Type II, C: Type III, D: Type IV - -### Response: -Repeated question. -### End" -4197,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of Hypernephroma except, with the following options: A: Persistent pyrexia, B: Hematuria, C: Polycythemia, D: Lower pole involvement - -### Response: -RCC commonly occurs in upper pole of kidney . The classic triad of loin pain, loin mass and haematuria is seen in <10% of patients with a renal tumour. Nowadays, the majority of diagnoses result from incidental findings. This shift is a consequence of the widespread use of USS and CT imaging, performed for other reasons. That said, paraneoplastic syndromes - symptoms caused by hormones or cytokines excreted by the tumour cells or by an immune response against the tumour - are not uncommon in RCC and symptoms include hypercalcaemia, fever and erythrocytosis . ( ref : - Bailey 27th ed , chapter 76 , pg no : 1417 ) -### End" -4198,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epiphora & lagopthalmous following VII nerveinjury is due to?, with the following options: A: Failure of lacrimal pump, B: Increased lacrimal secretion, C: Nasolacrimal duct obstruction, D: None of the above - -### Response: -Ans. is 'a' i.e., Failure of lacrimal pump Symptomatic epiphora following facial paralysis is most often associated with one or more of the following ? Impairment of eyelid closure. A compromised lacrimal pump. Lower lid laxity -### End" -4199,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The overdrive mechanism observed during hyperventilation is due to, with the following options: A: image_question, B: image_question, C: image_question, D: image_question - -### Response: -The ventral respiratory group contributes to the extra respiratory drive (overdrive mechanism) During quiet breathing: Expiration is a passive process and the neurons from the ventral respiratory group remain almost totally inactive during quiet respiration. Unlike the dorsal respiratory group (DRG; dorsal group of neurons), VRG (the ventral group of neurons) doesnot appear to paicipate in the basic rhythmic oscillations that control respiration. Extra-respiratory drive(overdrive mechanism) : When the reapiratory drive for increased pulmonary ventilation becomes greater than normal, for example, during exercise, respiratory signals spill over to VRG from DRG. So, VRG contributes to the extra respiratory drive (overdrive mechanism). The neurons of VRG contribute to both inspiration and expiration; especially, they are impoant in providing powerful expiratory signals to the abdominal muscles during very heavy expiration. Dorsal Respiratory group Ventral Respiratory group Location Nucleus Tractus Solitarius in medulla Nucleus Retro Ambigualis in medulla Function Inspiratory ramp signals- stimulates inspiration Inactive during quiet breathing; Active during forced expiration. Ref: Ganong&;s Review of Medical Physiology 26th edition Pgno: 645-657 -### End" -4200,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Monckeberg&;s calcific sclerosis affects the medium-sized muscular aeries by involving, with the following options: A: Intima, B: Media, C: Adventitia, D: All of the above - -### Response: -Monckeberg medial sclerosis is characterized by calcification of the walls of muscular aeries, typically involving the internal elastic membrane. Persons older than age 50 are most commonly affected. The calcifications do not encroach on the vessel lumen and are usually not clinically significant.Ref: Robbins; 9th edition; Chapter 11; Blood Vessels; Page no: 490 -### End" -4201,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement about campylobacter is FALSE?, with the following options: A: Humans are the only reservoirs, B: Source of infection is poultry, C: Campylobacteriosis is due to C-jejuni, D: C-Jejuni sequelae is GBS - -### Response: -Animals are the primary reservoir of Campylobacter and the bacteria are transmitted to humans by ingestion of contaminated food or by direct contact with pets. The most common source of human infection is undercooked poultry, but outbreaks have been caused by contaminated rural water supplies and unpasteurized milk. Campylobacter jejuni infection is associated with Guillain Barre syndrome an acute demyelinating polyneuropathy that is preceded by the infection. It is thought to be due to an antibody elicited by lipooligosaccharides in the C jejuni cell envelope that cross-react with similar molecules in the host peripheral nerve myelin. Ref: Ray C.G., Ryan K.J. (2010). Chapter 32. Vibrio, Campylobacter, andHelicobacter. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. -### End" -4202,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement about folic acid?, with the following options: A: It is present in all the green leafy vegetables, B: It is proven to decrease the occurrence of neural tube defects when taken prenatally, C: Wheat flour in India is foified with folate as in USA, D: Active form of folic acid is tetrahydrofolate - -### Response: -Folic acid : 1.Folic acid acts as a carrier of one-carbon units. 2.The active form of folic acid (pteroyl glutamate) is tetrahydrofolate. 3.Sources: Leafy Green Vegetables, Legumes, Seeds, Liver, 4. The folates in foods may have up to seven additional glutamate residues linked by -peptide bonds. In addition, all of the one-carbon substituted folates may also be present in foods. 5. The extent to which the different forms of folate can be absorbed varies, and folate intakes are calculated as dietary folate equivalents--the sum of g food folates + 1.7 x g of folic acid (used in food enrichment). 6.Prevents NTD in the fetus, and Lowers homocysteine. 7.Metabolism: The one-carbon fragment of methylene-tetrahydrofolate is reduced to a methyl group with the release of dihydrofolate, which is then reduced back to tetrahydrofolate by dihydrofolate reductase. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 151 -### End" -4203,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The thoracic duct receives tributaries from all of the following except -, with the following options: A: Bilateral ascending lumbar trunk, B: Bilateral descending thoracic trunk, C: Left upper intercostal duct, D: Right bronchomediastinal lymphatic trunk - -### Response: -The left bronchomediastinal lymphatic trunk is a tributary of the thoracic duct. Right bronchomediastinal lymphatic trunk does not drain to the thoracic duct. -### End" -4204,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thyroid carcinoma secreting ACTH, with the following options: A: Follicular ca, B: Medullary ca, C: Papillary ca, D: Anaplastic ca - -### Response: -Ans. (b) Medullary caMedullary Cancer Thyroid:* 5% of thyroid cancers* Arises from Parafollicular C cells which are derived from Ultimobranchial Bodies.* Mc Site is supero lateral* C cells secrete CALCITONIN* Secretes ACTH, Serotonin, Calcitonin, CEA, Histaminidases, PG E2 and PGF2 Alpha.* FNAC showing amyloid is diagnostic -### End" -4205,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which pathogens adhere to respiratory epithelium -, with the following options: A: RSV, B: Influenza, C: Parainfluenza, D: HBV - -### Response: -RSV was obtained from children with lower respiratory tract infection.Because ut caused cell fusion and the firmation of multinucleated syncitia in cell cultures it was named RSV . REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:510 -### End" -4206,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A neonate having congenital diaphragmatic hernia developed respiratory distress. Breath sounds were decreased on the left side. After bag and mask ventilation. ET tube was put and the maximal cardiac impulse shifted to the right side. What should be the next step in management ?, with the following options: A: Confirm the position of endotracheal tube by x-ray chest, B: Remove tube & Reattempt intubation, C: Naso gastric tube inseion, D: Chest x-ray - -### Response: -The tube is inseed into the nose or mouth and slid into the stomach. The formula is then put into the tube and flows through it into the stomach. A nasogastric tube with a guide wire is a soft silicone tube that may be left in place for up to a month. Reference: GHAI Essential pediatrics, 8th edition -### End" -4207,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Associated with panic disorder are all except -, with the following options: A: Seratonin, B: GABA, C: Cholecystokinin (CCK), D: Glutamate - -### Response: -Ans is 'd' i.e. GlutamateEtiology of panic disorder Neuroanatomical correlates * It is believed that panic disorder arises from abnormal functioning of the fear network resulting in themaladaptive activation of the fear response which manifests as a panic attack.These fearful experiences may lead to a learned fear memory as demonstrated by avoidant behavior following the onset of PD as well as the feelings of anxiety regarding future episodes.AmygdalaThe amygdala is a key structure of the limbic system with a role in the perception of fear, the fear response and learned fear memory and reduced activity of this region appears to contribute to panic disorder.Periaqueductal GreyThe periaqueductal gray (PAG) is a midbrain structure that has long been shown to be involved in approach and avoidance defense mechanisms.Its role in the pathobiology of panic disorder has been described and may be the locus where panic attacks arise.Upon stimulation, either electrically or through chemical modulators, animal models have exhibited characteristics of a panic response.Anterior cingulated cortexPanic disorder has been associated with a reduction in gray matter volume of the right anterior cingulated cortex.The anterior cingulated cortex has a number of cognitive functions, playing roles in error detection, and emotional modulation.In particular, the rostral dorsal ACC is functionally activated during anticipation of negative interoceptive threat and body sensation such as hyperventilation, a common symptom of a panic attack.CerebellumWhile it is well established that the cerebellum is responsible for balance, the integration of sensory inputs for coordinating fine movements and locomotion, evidence is accumulating that the cerebellum also has a role in cognitive functions such as impulsivity, and may contribute to mental disease.Inhibition of cerebellar nuclei was observed in a model of panic involving deep brain stimulation of the dorsolateral PAG that elicited panic-like symptoms. It was shown that activation of deep cerebellar nuclei was significantly reduced after inducing a panic model of escape with the largest effect being in the vermis and fastigial nucleus.Neurotransmitters and PPIt is believed that dysregulation of various neurotransmitter system in brain regions involving the emotional and physiological correlates of panic and acute anxiety are the basis of panic disorder.Neurotransmitters implicated includeNoradrenaline (especially in the locus coeruleus)Endogenous opioidsSerotoninGABACCKOrexinSerotonergic systemSerotonin has been implicated in panic disorder following research showing that drugs modulating the serotonin system were also able to reduce panic attacks.Serotonin in the brain stem and PAG reduce panic symptoms, but within the amygdale, it works to increase anticipatory anxiety, a critical component of panic disorder.There is an observed reduced functioning of serotonergic receptors within the raphe nuclei in panic patients. Evidence indicates that patient with panic disorder are particularly sensitive to serotonin depletionGABA * Reduced GABAergic inhibitory activity in the PAG and brain regions projecting to the amygdale are believed to play a role in panic disorder...Certain substances can induce panic attack. They are called panicogens. Panicogens can be broadly classified into two groupsPanicogensAct by activating the HPA axis Other specific neurotransmitter systemsCholecystokinin (CCK)YohimbineCuffienceM chlorophenylpiperazineN-methyl- b carboline 3-carboxamide * Carbon-di-oxide * Sodium bicarbonate* Sodium lactateCCK * Cholecystokinin-tetrapeptide (CCK-4) has been established in models of generating panic and genetic studies in CCK system genes, which identified new susceptibility alleles, indicate a role of the this molecule in panic disorder.OrexinRecent findings suggest that the activation of the orexin (or hypocretin) system may be involved in the panic disorder including an increase of orexin in CSF of panic subjects.Orexin is a neurotransmitter deriving mainly from the lateral hypothalamic area and has roles in arousal, and respiration, two characteristic facets of the pathophysiology of panic disorder. -### End" -4208,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum fat is found in ?, with the following options: A: Buffalo milk, B: Goat milk, C: Human milk, D: Cow milk - -### Response: -Ans. is 'a' i.e., Buffalo milk -### End" -4209,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is not a feature of liver histology in Non-cirrhotic portal fibrosis (NCPF)?, with the following options: A: Fibrosis in and around the portal tracts, B: Thrombosis of the medium and small portal vein branches, C: Non specific inflammatory cell infiltrates in the portal tracts, D: Bridging fibrosis - -### Response: -Fibrosis in noncirrhotic portal fibrosis is confined to portal and periportal region. -Fibrosis bridging one portal tract to another (bridging fibrosis) is not seen. -Pathology : - -Non-cirrhotic portal fibrosis is primarily a vascular disorder of the liver characterized by fibrous intimal thickening of the portal vein or its branches in patients with non-cirrhotic portal hypertension. - -Vascular changes - -Hallmark of the disease is thrombosis/sclerosis of the portal vein branches. -The portal vein is dilated with sclerosis of the walls and in autopsy thrombin, in medium or small portal vein branches with accompanying areas of ischaemic necrosis have been reported. -Aberrant Intrahepatic vessels may be present in the periportal area, which correspond to dilated terminal portal vein branches or venues. These are often termed as ""megasinusuoids"" or periportal angiomatosis. - -Fibrosis - -Vascular changes are accompanied by the portal and periportal fibrosis of varying extent. -### End" -4210,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following test is used to estimate the amount of feto-maternal hemorrhage?, with the following options: A: Coombs' test, B: Kleihauer Betke test, C: Lily's spectrophotometer, D: Schrill's test - -### Response: -Ans. B. Kleihauer Betke testKleihauer-Betke test is used to estimate amount of fetal maternal hemorrhage. A maternal blood sample is treated with an acid-dilution procedure allowing identification of fetal blood cells. Comb's test prenatal detection of antibodies (Rh) in Rh negative mother as a screening test. Liley spectrophotometer is used in plotting amniotic fluid bilirubin in case of Rh sensitized mother after Amniocentesis. Shrill test:- Cervical biopsy test in suspected Ca cervix. Gram iodine is used as a Steiner. Healthy' tissue stains brown while carcinomatous are a remains unstained. -### End" -4211,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A woman attends antenatal clinic with complaint mild pain in lower abdomen on left side, her periods are regular and UPT was positive at home. A TVS was done and uterine cavity is empty, and no adnexal mass is seen. Her serum beta HCG is 700 IU/L. what is the next step?, with the following options: A: Give single dose of methotrexate, B: Perform laparoscopy, C: Perform serum beta HCG after 48 hr, D: Perform serum Beta HCG after 7 days - -### Response: -Ans. C. Perform serum beta HCG after 48 hrThis is a case of pregnancy of unknown location. The beta HCG value is less than the discriminatory zone of 1500mIU/ml on TVS. ""With these PULs, serial b-hCG level assays are done to identify patterns that indicate either a growing or failing IUP. Levels that rise or fall outside these expected parameters increase the concern for ectopic pregnancy. Thus, appropriately selected women with a possible ectopic pregnancy, but whose initial b-hCG level is below the discriminatory threshold, are seen 2 days later for further evaluation. Trends in levels aid diagnosis."" -### End" -4212,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metabolic encephalopathy presents with, with the following options: A: Broca's aphais, B: Anomic aphasia, C: Transcortical sensory aphasice, D: transcortical motor aphasia. - -### Response: -Ans. is 'b' anomic aphasia ""Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy and Alzheimer's disease"" - HarrisonAnomic aphasia is dysfunction where a person is unable to name objects.His articulation, comprehension and repetition are intact, but naming, word finding and spellings are impaired. -### End" -4213,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apoprotein-A-1 is associated with:, with the following options: A: LDL, B: VLDL, C: HDL, D: Chylomicrons - -### Response: -Apolipoprotein A-IIt is the major protein component of high density lipoprotein (HDL) in plasma.Chylomicrons secreted from the intestinal enterocyte also contain ApoAl but it is quickly transferred to HDL in the bloodstream.The protein promotes fat efflux, including cholesterol, from tissues to the liver for excretion.It is a cofactor for lecithin cholesterolacyltransferase (LCAT) which is responsible for the formation of most plasma cholesteryl esters.Defects in the gene encoding it are associated with HDL deficiencies, includingTangier disease, and with systemic non-neuropathic amyloidosis. -### End" -4214,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 36-year-old primigravid woman at 36 weeks' gestation comes to the physician for a prenatal visit. She is experiencing good fetal movement and has had no loss of fluid, bleeding from the vagina, or contractions. She has no complaints. Her past medical history is significant for mitral stenosis, which she developed after an episode of rheumatic fever as a child. She also has asthma for which she uses an albuterol inhaler daily. She has herpes outbreaks approximately once a year. At her last visit she was found to be positive for Group B Streptococcus colonization. For which of the following disease processes would this patient benefit by having a forceps-assisted vaginal delivery at the time of delivery?, with the following options: A: Asthma, B: Group B Streptococcus (GBS) colonization, C: Herpes, D: Mitral stenosis - -### Response: -Ans:D.)Mitral Stenosis. Mitral valve stenosis is one of the more common valvular lesions seen in pregnancy. The most common cause of mitral stenosis is rheumatic endocarditis. During normal pregnancy there is an increase in the cardiac output and an increase in preload and circulating volume. Patients with mitral stenosis have a fixed, decreased valve area, which places them at risk for the development of pulmonary hypeension and pulmonary edemA. Control of arrhythmias is absolutely essential in these patients because they are at increased risk, given the left atrial enlargement that often goes along with their mitral stenosis. Labor and delivery can be a paicularly dangerous time for these patients. Therefore, patients with significant mitral stenosis should be monitored invasively using a Swan-Ganz catheter. It is recommended that the second stage of labor be shoened using forceps or vacuum to prevent excess maternal Valsalva effos and maternal tachycardia. Asthma ( Choice A)is not an indication for forceps-assisted vaginal delivery. In terms of mode of delivery, asthmatic patients may be managed like any other patient in the second stage of labor. Group B Streptococcus colonization (Choice B) is an indication for intravenous penicillin or clindamycin (if the patient has an allergy to penicillin). These antibiotics are given to prevent GBS sepsis in the neonate. GBS colonization is not an indication for forceps-assisted vaginal delivery. Herpes (Choice C) can be transmitted to the fetus at the time of delivery. Therefore, when lesions are present in the bih canal, most obstetricians recommend cesarean delivery. -### End" -4215,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A man presents with a 6-month history of recurrent oral ulceration. He has yellowish ulcerations on his lip which are erythematous, with a central halo and nodular lesions on his shin. Diagnosis is:, with the following options: A: Behcet's disease, B: Pemphigus vulgaris, C: Fixed drug eruption, D: Herpes labialis - -### Response: -. Ans. a. Behcet's disease (Ref: Harrison I9/ep2194, IS/e p2801)Diagnosis of a patient who presents with a 6-month history of recurrent oral ulceration, yellowish ulcerations on the lip, erythematous, with a central halo and nodular lesions on shin is Behcetdisease.Behcet's Syndrome* Behcet's syndrome is chronic multisystem relapsing vascular inflammatory disease (vasculitis) of unknow n origin* Behcet's disease is primarily a small vessel vasculitis but it can also involve large vessels both arteries and veins.* Associated with HLA-B5* Disease affect young patients: Both males and females are equally affectedBehcet's SyndromeDiagnostic CriteriaEssential criteria + Two non-essentia! criteria are required for diagnosisEssential criteriaNon-essentia! criteriaRECURRENT ORAL ULCERATIONS:* Oral ulceration is the hallmark of the disease* Sin qua non for diagnosis* Types of ulcers: Minor aphthous, major aphthous and herpetiform ulcers* Features of Oral ulcers:- PainfulShallow with a central yellowish necrotic base- Appear singly or in crops- Subside without leaving scars (persist for 1-2 weeks)RECURRENT GENITAL ULCERS:* Less common but more specific* Do not affect glans or urethra* Produce scars (scrotal scars)EYE LESIONS:* Anterior uveitis (recurrent hypopyon)* Posterior uveitis, Retinal vasculitisSKIN LESIONS:* Erythema nodosum, Pseudofollicullitis* Pseudopustular lesions, Acneiform nodules POSITIVE PATH ERG Y TEST:* Pathergy refers to hyperactivity of skin to any intracutaneous injection or needle stick* Pathergy is characteristic feature of Behcet's, although the mechanism is unknown* Pathergy is said to be positive if a papule or pustule >2 mm develops 24-48 hours after needle prick to a depth of 5 mm. Other Clinical Features* Arthritis- Non-deforming arthritis commonly affects knees and ankles* Vascular Lesions (Thrombophlebitis):- Superficial or deep peripheral vein thrombosis (25%)- Arterial thrombosis may be seen* Neurological Involvement (5-10%)- Dural vein thrombosis* Pulmonary symptoms:- Pulmonary artery vasculitis may occur and present with dyspnea, cough, chest pain, hemoptysis* Gastrointestinal involvement:- Mucosal ulceration of gut similar to Crohn's disease -### End" -4216,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Obligatory intracellular organism is ?, with the following options: A: Mycoplasma, B: Chlamydae, C: Cryptococcus, D: H.pylori - -### Response: -Ans. is 'b' i.e., Chlamydia -### End" -4217,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Notochord develops into?, with the following options: A: Annulus fibrosus, B: Dorsal root ganglia, C: Nucleus pulposus, D: Veebral body - -### Response: -As the embryo enlarges,the notochord elongates considerably and lies in the midline,in the position to be later occupied by the veebral column. However ,the notochord doesn't give rise to the veebral column.most of it disappears,but pas of it persists in the region of each interveebral disc as the nucleus pulposes HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:60 -### End" -4218,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glanzmann thrombasthenia is due to, with the following options: A: Decreased GpIb, B: Decreased GpIIb/IIa, C: Anti-GpIIb/IIIa antibodies, D: Inhibition or deficiency of ADAMTS 13 - -### Response: -Glanzmann thrombasthenia is an autosomal recessive disorder. There is a failure of primary platelet aggregation with ADP or collagen due to inherited deficiency of two platelets membrane glycoproteins. It is caused due to deficiency of glycoprotein IIb- IIa. -### End" -4219,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Toxic dose of lithium, with the following options: A: o.6 mEq/L, B: 1.2 mEq/L, C: 2.0 mEq/L, D: Ghai 8/e p 196-197)In individuals who have completed primary & booster vaccination with DTP, TT boosters every 10 yrs provide sufficient protection. -### End" -4224,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in congestive cardiac failure except:, with the following options: A: Kerly B lines, B: Prominent lower lobe vessel, C: Pleural Effusions, D: Cardiomegaly - -### Response: -B i.e. Prominent lower lobe vessels In CCF/ Left hea failure there is cephalization of pulmonary vascularity (i.e. dilatation of upper lobe & constriction of lower zone vessels)Q, Kerley A lines (interlobular septal thickening)Q, Kerley (septal) B lines, perihilar haze and pseudoeffusionQ. Radiological features of left ventricle failure / congestive cardiac failure (produced due to pulmonary venous hypeension). Stage I Equalization (at pulmonary capillary wedge pressure 13-15 mm Hg) f/b cephalization of pulmonary vascularity (at 16-18 mmHg PCWP). It is characterized by: - Constriction & blurring of lower zone vesselsQ - Effacement of hilar angle Dilatation & prominence of upper lobe vesselsQ. Exceptions to this pattern of redistribution are basal emphysema & pulmonary parenchymal diseases of upper lobe. Stage 2 Interstial pulmonary edema (at PCWP-19124 mm Hg) occurs d/ t presence of fluid within peribroncho-vascular interstial tissue. It is seen as: - Peribronchial thickening /cuffing & indistinct vessel margins - Kerley A lines is 3-4 cm long lines of interlobular septal thickening radiating from hila to mid & upper long zones.. - Kerley (septal) B lines i.e. sho horizontal reticulations within lateral subpleural lung bases. - Perihilar hazeQ d/t hilar interstitial edema - Pseudoeffitsion d/t thickened pleural fissures and back ground haze (ground glass appearance)Q. Stage 3 Alveolar edema (at PCWP >25 mm Hg) occurs when the interstitial fluid accumulates at rates faster than it can be removed by the lymphatics. It is seen as - Bat's wing appearance d/t bilateral perihilar & basilar air space opacification - B/L small pleural effusion usually occurs when systemic venous pressure is also elevated as in right hea failure. -### End" -4225,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The hydrolytic step leading to the release of a polypeptide chain from a ribosome is catalyzed by which of the following?, with the following options: A: Dissociation of ribosomes, B: Peptidyl transferase, C: Release factors, D: Stop codons - -### Response: -Peptidyl transferase is responsible for the release of peptidyl chain from a ribosome The release is not done by releasing factor, During termination of translation we have releasing factors: In prokaryotes - RF 1 2 3 Eukaryotes - eRF Releasing factor (misnomer) - it can only recognize the stop codon Hence, The hydrolytic step leading to the release of a polypeptide chain from a ribosome is catalyzed by Peptidyl transferase (not by releasing factors). -### End" -4226,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs used in ADHD are, with the following options: A: Atomoxetine, B: Methylphenidate, C: Dextro-amphetamine, D: All the above - -### Response: -ADHD: Attention Deficit Hyperactivity disorder. Difficulty in paying attention, difficulty in controlling behaviour and hyperactivity. Etiology- both genetic and environmental factors. Abnormality in dopamine transpoer and thyroid receptor beta genes in some patients. Inattention behaviour:- 1. Early distraction by extraneous stimuli 2. Careless mistakes in school 3. Difficulty sustaining attention in tasks or play 4. Forgetful in daily activities. 5. Does not seem to listen to what is being said 6. Daydreams, easily confused, move slowly. 7. Fails to finish schoolwork 8. Difficulty in processing information as quickly and accurately as others. Hyperactive behavior:- 1. Runs about or climbs excessively inappropriately 2. Fidgets with hands and feet 3. Trouble sitting still during dinner, school 4. Difficulty doing quiet tasks or activities Impulsive behavior:- 1. Difficulty awaiting turns in games 2. Blus out answers to question 3. Interrupts conversations Three subtypes are known: 1. Predominantly hyperactive impulsive 2. Predominantly inattendive 3. Combined hyperactive impulsive and inattentive. Diagnosis is primarily clinical, using thorough clinical interview of parents and use of behaviour rating scales. Physical examination includes direct observation of child and ruling out chronic systemic illnesses that affect child&;s attention span. Management: Educating the parents Treatment involves combination of behavior therapy and medications. Drugs :- Stimulants ( methylphenidate, anphetamine and their derivatives) are effective in ameliorating inattention, hyperactivity and impulsivity. Atomoxetine, a selective norepinephrine reuptake inhibitor and extended release preparations of selective alpha adrenergic agonists( guanfacine, clonidine) has proved to be effective. Reference: GHAI Essential pediatrics, 8th edition -### End" -4227,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about exotoxins -, with the following options: A: Lipopolysaccharide, B: Not antigenic, C: Can be toxoided, D: Heat stable - -### Response: -EXOTOXINS: Proteins heat labile actively secreted by cells diffuse into surrounding medium readily separable from cultures by physical means such as filtration action often enzymatic specific pharmacological effects for each exotoxinspecific tissue affinities active in very minutes dose highly antigenic action specifically neutralized by antibody Ref Ananthanarayan & paniker's Textbook of Microbiology 9th edition pg no 75 -### End" -4228,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For pancreatic injury true is -, with the following options: A: Most are iatrogenic, B: Blunt trauma most common, C: Urine amylase is diagnostic, D: HRCT is investigation of choice - -### Response: -Ans. is 'd' i.e., HRCT is investigation of choice o Pancreas being a retroperitoneal structure, peritoneal lavage is not helpful in making the diagnosis of pancreatic injury.o CT scan is the best diagnostic procedure, apart from an exploratory' laprotomy.More about Pancreatic injuryo About two-thirds are due to penetrating injuries and rest one-third due to blunt trauma,o Pancreatic injuries are usually associated with injury to other visceral organ. Isolated pancreatic injuries are rare.o In blunt injuries which are usually the result of midline upper abdominal trauma (eg. car seat belt, cycle handle), junction of the neck and body of the pancreas are most commonly injured as they are pressed against the vertebral column.o Major abdominal vascular injuries are present in more than 75% of cases of penetrating trauma.""The presence of pancreatic duct injury appears to be a key factor in postoperative morbidity "" SabistonAlso knowo Serum amylase levels are elevated in most patients with significant pancreatic trauma, but they are also increased in up to 90% of severe abdominal trauma patients who do not have pancreatic injury. Thus measurement of amylase at the time of hospital admission is not helpful in identifying those with pancreatic injury. On the other hand a progressive rise in serum amylase activity is a more specific indicator of pancreatic injury.Treatmento The treatment of pancreatic injury depends on its grade and extent.Minor injuries not involving a major duct may be treated nonoperatively.Moderate injuries usually require operative exploration, debridement, and the placement of external drains.More severe injuries including those with major duct injury or transection of the gland, may require distal resection or external drainage. -### End" -4229,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Concentration of sodium in mOsm/l in low osmolar ORS is?, with the following options: A: 45, B: 75, C: 90, D: 60 - -### Response: -Concentration of sodium in low osmolar ORS is 75 mOsm/l Osmolarity reduced to avoid possible adverse effects of hypeonicity on net fluid absorption by reducing the concentration of glucose and sodium chloride in the solution . Ref: PARK&;S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23rd edition pg 224 -### End" -4230,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True or false regarding muscles of tongue -A. Palatoglossus arises from palatine aponeurosis and descends in the -palatoglossal arch -B. Hyoglossus protrudes the tongue forwards -C. Genioglossus arises from upper genial tubercle of mandible and it’s -upper fibers retract the tongue -D. Styloglossus is inserted onto dorsum of tongue -E. Hyoglossus is inserted into side of tongue between styloglossus and -inferior longitudinal muscle of tongue, with the following options: A: A - True, B - True, C - False, D - True, E - True, B: A - False, B - False, C - True, D - False, E - True, C: A - False, B - True, C - False, D - True, E - False, D: A - True, B - False, C - True, D - False, E - True - -### Response: -Genioglossus is the protruder of tongue. Styloglossus is inserted into sides of tongue. -### End" -4231,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tracheostomy reduces dead space by -, with the following options: A: By-passing upper airway, B: Increasing V/Q ratio, C: Raising airflow resistance, D: By all of the above mechanisms - -### Response: -Ans. is 'a' i.e., By-passing upper airway o Important effects of tracheostomy on respiratory physiologya) Tracheostomy decreases dead space as upper air ways and nasal cavity are bypassed.b) Tracheostomy decreases ventilation/perfusion (V/Q) ratio. Increased dead space increases ventilation/perfusion ratio as the dead space (containing air) is ventilated but not perfused for gaseous exchange. Tracheostomy decreases the dead space, therefore it will decrease the V/Q ratio.c) Tracheostomy reduces the airflow resistance -### End" -4232,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reis buckler dystrophy affects which layer of the cornea?, with the following options: A: Epithelium, B: Stroma, C: Bowman's layer, D: Endothelium - -### Response: -CLASSIFICATION OF CORNEAL DYSTROPHIES Dystrophies are classified according to the anatomic site most severely (primarily) involved, as follows: Anterior dystrophies Stromal dystrophies Posterior dystrophies primarily affects epithelium and Bowman's layer Primarily affects stroma Primarily affects the corneal endothelium and Descemet's membrane 1. Epithelial basement membrane dystrophy 2. Reis-Buckler's dystrophy 3. Meesman's dystrophy 4. Recurrent corneal erosion syndrome 5. Stocker-Holt dystrophy 1. Granular (Groenouw's type I) dystrophy 2. Lattice dystrophy 3. Macular (Groenouw's type II) dystrophy 4. Crystalline (Schnyder's) dystrophy 1. Cornea guttata 2. Fuchs' epithelial-endothelial dystrophy (late hereditary endothelial dystrophy). 3. Posterior polymorphous dystrophy (of Schlichting). 4. Congenital hereditary endothelial dystrophy(CHED). Reis-Buckler dystrophy Also known as ring-shaped dystrophy (due to the typical lesion) primarily involving the Bowman's layer is a progressive corneal dystrophy occurring in childhood. It has got an autosomal dominant inheritance. Most patients get frequent attacks of recurrent corneal erosions that usually result in diffuse anterior scarring. Treatment: In early cases, it is same as that of recurrent corneal erosions, i.e. by patching. However, most of the patients ultimately need lamellar or penetrating keratoplasty. Reis-Bucklers corneal dystrophy, is a rare, corneal dystrophy of unknown cause, in which the Bowman's layer of the cornea undergoes disintegration. The disorder is inherited in an autosomal dominant fashion, and is associated with mutations in the gene TGFB1. Ref: Khurana; 4th ed; Pg 117 -### End" -4233,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Goose neck deformity is seen in, with the following options: A: CHPS, B: Ischemic colitis, C: Ileocecal TB, D: Crohn's disease - -### Response: -Ileocecal TB: Goose neck deformity occurs due to contracted, cicatrized, and pulled-up cecum as well as straightening of the terminal ileum. -### End" -4234,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudo bubo is seen in ?, with the following options: A: Donovanosis, B: LGV, C: Chancroid, D: Leprosy - -### Response: -Ans. is 'a' i.e., Donovanosis -### End" -4235,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ancylostoma enters the human body by -, with the following options: A: Ingestion, B: Inhalation, C: Penetration of skin, D: Inoculation - -### Response: -Ancylostoma enters the human body by penetration of skin. ANCYCLOSTOMA DUODONALE (Hookworm): Host - Man. Infective form - 3rd stage filariform (L3) larva. Mode of transmission- penetration of skin by 3rd stage filariform (L3) larva (by walking bare foot in dampen soil). Habitat- small intestine. -### End" -4236,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Absorption of fats is associated with all except, with the following options: A: Pancreatic lipase, B: Colipase, C: Gastric lipase, D: Bilirubin - -### Response: -Micellar formation is essential for the absorption of fat-soluble vitamins such as vitamin A, D and K. iii. The micelles are aligned at the microvillous surface of the jejunal mucosa. Fatty acids, 2-MAG and other digested products passively diffuse into the mucosal cell The hydrophobic poions of bile salts intercalate into the large aggregated lipid, with the hydrophilic domains remaining at the surface. This leads to breakdown of large aggregates into smaller and smaller droplets. Thus the surface area for action of lipase is increased. Long chain fatty acids are absorbed into the intestinal cell wall, where they are re-esterified, made into chylomicrons and enter into lymphatics. Sho chain fatty acids are directly absorbed into blood capillaries. Bile acids are reabsorbed into poal veinRef: DM Vasudevan, page no: 129 -### End" -4237,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which Mucopolysaccharide does not contain Uronic acid, with the following options: A: Heparin, B: Dermatan sulphate, C: Keratan sulphate, D: Hyaluronic acid - -### Response: -Keratan sulphate has N-acetyl glucosamine and galactose. It does not contain uronic acid. -It general all Mucopolysaccharides, contain a disaccharide repeat unit having aminosugar and Uronic acid. -### End" -4238,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non-caseating granulomas are seen in the following EXCEPT, with the following options: A: Tuberculosis, B: Byssinosis, C: Hodgkin's disease, D: Metastatic lung carcinoma - -### Response: -Ans. d (Metastatic lung carcinoma). (Ref. Robbin, Pathology, 6th ed., 83)# In tuberculosis, granuloma is characterized by central area of necrosis (caseation), when classical.# However non-caseating granulomas can also be seen in TB.# Non-caseating granuloma:- Leprosy,- Syphilis,- Sarcoidosis,- Berylliosis,- Lymphogranuloma inguinale,- Certain mycotic infections- Reactions of irritant lipids. -### End" -4239,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pandemic are caused by-, with the following options: A: Hepatitis B, B: Influenza-A, C: Influenza-B, D: Influenza-C - -### Response: -Ans. is 'b i.e., Influenza-A Pandemic --> Influenza, cholera Eltor, Acute hemorrhagic, Conjuctivitis. Epidemic --> Measles, Chickenpox, Cholera Endemic --> Hepatitis A, typhoid fever Sporadic ---> Polio, Tetanus, Herpes zoster, meningococcal meningitis. -### End" -4240,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following anaesthetic modality is to be avoided in sickle cell disease?, with the following options: A: General anaesthesia, B: Brachial plexus block, C: IV. Regional Anaesthesia, D: Spinal - -### Response: -The complications of IVRA is mainly attributable to the use of the tourniquet. On inflation of the touniquet there is physiological deoxygenation. In patients with sickle cell disease this might lead to sickling crisis. In these patients IVRA causes stasis, local acidosis and hypoxia. Hence IVRA is best avoided in sickle cell disease patients. Adequate oxygenation of the patient would be prudent. Ref: Complications of regional anesthesia By Brendan T. Finucane, Page 216; Essentials of Regional Anesthesia By Alan David Kaye, Richard D. Urman, Nalini Vadivelu; McGlamry's comprehensive textbook of foot and ankle surgery, 3rd ed, Vol 2 By Alan S. Banks, E. Dalton MacGlamry, Page 180; Surgery and anesthesia in sickle cell disease (By M Koshy, SJ Weiner, ST Miller, LA Sleeper, E Vichinsky, AK Brown,Y Khakoo, and TR Kinney). -### End" -4241,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 50-year-old man presents to the speech therapist complaining of dryness of the mouth. The therapist performs a swallowing study and, on examination, finds that the man has a lack of salivary secretion from the submandibular gland. This indicates a lesion of which of the following nervous structures?, with the following options: A: Lingual nerve at its origin, B: Lesser petrosal nerve, C: Superior cervical ganglion, D: Chorda tympani in the middle ear cavity - -### Response: -Chorda tympani nerve contains preganglionic parasympathetic fibres responsible for secretion of the submandibular gland. Lingual nerve at its origin is not yet joined by the chorda tympani. Superior cervical ganglion provides sympathetic fibres, which supply blood vessels in the submandibular gland. Lesser petrosal nerve contains preganglionic parasympathetic fibres that synapse in the otic ganglion. Auriculotemporal nerve contains postganglionic parasympathetic fibres, which are responsible for secretion of the parotid gland. -### End" -4242,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ejection of milk is caused by, with the following options: A: Oxytocin, B: ADH, C: Progesterone, D: Thyroxine - -### Response: -Oxytocin plays roles in sexual reproduction, in paicular during and after childbih. It is released in large amounts after distension of the cervix and uterus during labor, facilitating bih, maternal bonding, and, after stimulation of the nipples, breastfeeding. Both childbih and milk ejection result from positive feedback mechanisms.ADH (antidiuretic hormone) a hormone secreted by neurosecretory cells of the HYPOTHALAMUS and released by the posterior lobe of the PITUITARY GLAND. ADH stimulates the reabsorption of water through the distal convoluted tubule of the KIDNEY nephron in mammals and thus limits the water content and the overall volume of urine.Progesterone also known as P4 is a C-21steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species. Progesterone belongs to a class of hormones called progestogens and is the major naturally occurring human progestogen.thyroxine a thyroid hormone that contains iodine and is a derivative of the amino acid tyrosine, occurring naturally as l-thyroxine; its chemical name is tetraiodothyronine. It is formed and stored in the thyroid follicles as thyroglobulin and released from the gland by the action of a proteolytic enzyme. It is deiodinated in peripheral tissues to form triiodothyronine (T3), which has a greater biological activity.Ref: Ganong&;s review of medical physiology;24th edition; page no-151 -### End" -4243,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sputum examination for AFB is a type of-, with the following options: A: Primary prevention, B: Secondary prevention, C: Teiary prevention, D: Primordial prevention - -### Response: -Ans. is 'b' i.e., Secondary prevention Sputum for AFB is used for diagnosis of TB, so that treatment can be staed -### End" -4244,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mutton fat keratic precipitate and Busacca nodules are seen in –, with the following options: A: Granulomatous uveitis, B: Non–granulomatous uveitis, C: Posterior uveitis, D: Choroiditis - -### Response: -Mutton fat keratic precipitate and Busacca's nodule are seen in granulomatous uveitis. -### End" -4245,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in asthma except -, with the following options: A: Cyanosis, B: Wheezing, C: Clubbing, D: Dysnea - -### Response: -Ans. is `c' i.e., Clubbing ""Clubbing offingers is unusual in uncomplicated cases"". -### End" -4246,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common organism involved in nosocomial infection -, with the following options: A: Staph aureus, B: E. coli, C: Legionella, D: Strep pneumonia - -### Response: -UTI is the most common type of nosocomial infection. . Most common cause of UTI ---> E coli . Most common cause of UTI in ICU ----> Candida . Overall staph aureus is a leading cause of nosocomial infection. . Staph aureus is the most common cause of surgical wound infection - . Most common cause of primary bacteremia --> Coagulase negative staphylococcus. REF : ananthanarayana 10th ed -### End" -4247,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Continuation of inner layer of choroid is -, with the following options: A: Nonpigmented layer of retina, B: Sclera, C: Pigmented layer of retina, D: None - -### Response: -Ans. is 'c' i.e., Pigmented layer of retina o Choroid is the posterior most part of the vascular coat of the eyeball (anterior part of vascular coat is iris and middle part is ciliary body).o Choroid extends from the optic disc to ora serrata.o Its inner surface is smooth, brown and lies in contact with pigmented epithelium of the retina. The outer surfce is rough and lies in contact with sclera,o It is thicker posteriorly (0.22 nun) than anteriorly (0.1 mm).Coats of the eyeballo The eyeball comprises of three coats.Fibrous Coat (outer coat) : Cornea (anterior 1/6) and sclera (posterior 5/6).Vascular Coat (Uveal tissue) : Iris (anterior), ciliary body (middle) and choroid (posterior)Nervous Coat (Inner coat) : Retina. -### End" -4248,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IUGR is caused by all EXCEPT: March 2004, with the following options: A: Rh incompatibility, B: Smoking, C: Anemia, D: CRF - -### Response: -Ans. A i.e. Rh incompatibility -### End" -4249,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudo jaundice is seen during the treatment with which antituberculous agent?, with the following options: A: Rifabutin, B: Clarithromycin, C: Pyrazinamide, D: Ethambutol - -### Response: -Less common adverse reactions of rifabutin are flu like syndrome, anterior uveitis, Clostridium difficile-associated diarrhea, a diffuse polymyalgia syndrome, and yellow skin discoloration ""pseudo-jaundice"". Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 1377 -### End" -4250,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior cerebral aery supplies A/E, with the following options: A: Pons, B: Midbrain, C: Thalmus, D: Striate coex - -### Response: -Posterior cerebral aery supplies occipital, temporal, thalamus, lentiform nucleus, pineal, medial geniculate body, choroid plexus of inferior horn of lateral ventricle, 3rd ventricle, midbrain Ref: Gray's 40e/p-252 -### End" -4251,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most likely cause of bronchiolitis in a 6 months old infant is:, with the following options: A: Measles virus, B: Mumps virus, C: Respiratory syncytial virus, D: Parainfluenza virus - -### Response: -Option 3 RESPIRATORY SYNCYTIAL VIRUS Infants: RSV is the most common cause of lower respiratory tract infection below 1 year of age, causing bronchiolitis, pneumonia, and tracheobronchitis. Bronchiolitis is usually self-limiting, but may cause a serious disease in premature infants, in immunocompromised hosts, and in individuals with underlying lung diseases. Option 1, 2 Measles virus and Mumps virus do not cause bronchiolitis. Option 4 Human parainfluenza viruses are one of the major causes of lower respiratory tract disease: Common cold syndrome such as rhinitis and pharyngitis is the MC presentation Croup (laryngotracheobronchitis): Seen with type 1 and 2 and involves older children Pneumonia or bronchiolitis: Seen with type 3, but less common than RSV. -### End" -4252,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mantle cell lymphomas are positive for all of the following except -, with the following options: A: CD23, B: CD20, C: CD5, D: Cyclin D1 - -### Response: -Mantle cells lymphomas are usually CD23 negative. They are positive for CD5, CD20 and CD43. -### End" -4253,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amount of Protein present in 100ml of breast milk is, with the following options: A: 2.2 g, B: 1.1 g, C: 0.55g, D: 3.3g - -### Response: -Amount of Protein present in 100ml of breast milk is: 1.1 g/dl -### End" -4254,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anesthesia of choice for induction of anesthesia in children is?, with the following options: A: Desflurane, B: Halothane, C: Sevoflurane, D: Isoflurane - -### Response: -Sevoflurane REF: Morgan's anesthesia 3"" ed p. 404, 570, 860, 884 ""Sevoflurane is anesthetic of choice for induction in pediatrics because of rapid onset and non-pungency"" Induction in pediatrics patient Inhalation -- Sevoflurane in N20 Intravenous (preferred) - rapid acting barbiturate like thiopental or Propofol followed by non-depolarizing muscle relaxant. Intramuscular- Ketamine Muscle relaxant (MR)- Rocuronium -### End" -4255,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10-year-old child presents with fever since 24 hours. History reveals 3 episodes of chest infection and passage of bulky, foul smelling stools. The most probable diagnosis is?, with the following options: A: Cystic fibrosis, B: Maple syrup urine disease, C: Bilirubin conjugation defect, D: Crigler-Najjar syndrome - -### Response: -Recurrent chest infections & bulky, foul smelling stools point to a diagnosis of cystic fibrosis -### End" -4256,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Linitis plastica is found in A/E -, with the following options: A: Syphillis, B: Carcinoma, C: Sarcoid, D: Leiomyosarcoma - -### Response: -Ans. is 'd' i.e., Leiomyosarcoma -### End" -4257,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corpulence index means:, with the following options: A: Measurement of obesity, B: Measurement of copper level in serum., C: Measurement of iron losses in faeces, D: Pressure difference between the chambers of hea - -### Response: -Measurement of obesity -### End" -4258,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nicotinic receptors are seen in all except: September 2007, with the following options: A: Neuromuscular junction, B: Autonomic ganglia of autonomic nervous system, C: Bronchial smooth muscle, D: Brain - -### Response: -Ans. C: Bronchial Smooth Muscle The nicotinic cholinergic receptors are found in the neuromuscular junctions of somatic muscles; stimulation of these receptors causes muscular contraction. They are also found in the autonomic ganglia of autonomic nervous system and central nervous system Muscarinic receptors are found in: M 1-brain M 2-hea M 3-smooth muscle M 4-smooth muscle, pancreatic acinar and islet tissue -### End" -4259,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fluorescent dye for ophthalmological diagnosis is injected in –, with the following options: A: Antecubital vein, B: Popliteal vein, C: Femoral vein, D: Subclavian vein - -### Response: -The technique of fluorescein angiography comprises rapidly injecting 5 ml of 10% solution of sterile sodium fluorescein dye in the antecubital vein and taking serial photographs of the fundus. -### End" -4260,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of Simple cyst of liver:, with the following options: A: Percutaneous drainage, B: Cysto enterostomy, C: Deroofing, D: Aspiration - -### Response: -Ans. (c) De roofingRef: Sabiston Page 1469/ 20th edition* Simple cysts of the liver contain serous fluid, do not communicate with the biliary tree, and do not have septations.* 50% are single, Cuboidal/columnar epithelium as single layer is the lining.* They are regarded as Congenital Malformationa.* Spherical, Ovoid shape and can be large as 20cm* They can compress liver, regional atrophy and contralateral Hypertrophy.* IOC is USG* MC complication is Intracystic Bleeding.* Asymptomatic cysts no treatment needed.* Symptomatic cysts need Aspiration and injection of sclerosant.* Laparoscopic fenestration (Deroofing) is preferred treatment. -### End" -4261,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paracetamol causes:, with the following options: A: Renal failure, B: Pancreatic toxicity, C: Neurotoxicity, D: Hepatotoxicity - -### Response: -Ref: Goodman & Gillman 13th ed. P 696* Paracetamol/Acetaminophen is a non-selective COX inhibitor* Use: Analgesic and antipyretic agent. Preferred in patients where aspirin is contraindicated* Usual dose: 325-650mg every 4-6 hours. Maximum FDA recommended dose is 4gm/day* Peak plasma concentration: 30-60 minutes* Half-life: 2 hours* Metabolism of acetaminophen in liver by:# Hepatic conjugation with glucuronic acid (~60%),# Sulfuric acid (~35%),# Cysteine (~3%);# CYP mediated N-hydroxylation to form NAPQI (N-acetyl-p-benzoquinone imine)* Note: NAPQI is one of the highly reactive intermediate metabolite of acetaminophen metabolism. This usually reacts with sulfhydryl groups is GSH - rendered harmless.* In hepatotoxicity condition GSH level depleted.SIDE EFFECTS* The most serious acute adverse effect of over dosage of acetaminophen is a potentially fatal hepatic necrosis.* Due to hepatotoxicity there is saturation of glucuronide and sulfate conjugation and increasing amounts undergo CYP-mediated N-hydroxylation to form excess of NAPQI (it accumulates due to depletion of GSH).* The highly reactive NAPQI causes enzymatic dysfunction, produces oxidative stress and apoptosis.* In adults hepatotoxicity may occur after ingestion of single dose of 10-15g. Doses of 20-25g is potentially fatal.TREATMENT OF ACETAMINOPHEN TOXICITY:* Activated charcoal within 4 hours of ingestion decreases absorption by 50-90%* N-acetylcysteine: antidote of choice for acetaminophen toxicity. It acts by detoxifying NAPQI by:# Repleting GSH stores# Conjugate directly with NAPQI by serving as a GSH substituteIn Paracetamol Toxicity:* Liver enzyme abnormalities typically peak 72-96 hours after ingestion* Biopsy: Centrilobular necrosis with sparing of the periportal area* Other side effects: Renal tubular necrosis and Hypoglycemic coma -### End" -4262,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true about somnambulism among the following is, with the following options: A: Low level motor skill/function is present, B: Sleep walking, C: Disorder of sleep arousal, D: Patient consciousness is not preserved - -### Response: -* Somnambulism is an arousal parasomnia consisting of a series of complex behaviours that result in large movements in bed or walking during sleep. * Also called sleep walking, in this condition individual arises from bed and ambulates without fully awakening. * Individuals can engage in a variety of complex behaviours while unconscious. * Sleepwalks characteristically begin toward the end of the first or second slow wave sleep episodes (NREM stage III and IV). * Sleepwalking episodes may range from sitting up and attempting to walk to conducting an involved sequence of semi-purposeful actions Ref:- Kaplan & Sadock's Synopsis of Psychiatry 10th edition; Pg num:- 762 -### End" -4263,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kayser Fleischer ring is found in which layer of cornea ?, with the following options: A: Bowman's membrane, B: Substantia propria, C: Descemet's membrane, D: Endothelium - -### Response: -Ans. Descemet's membrane -### End" -4264,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a pregnant female, there is decreased requirement of the spinal anaesthetic agent because of all of the following except –, with the following options: A: Exaggerated lumbar lordosis, B: Decreased volume of subarachnoid space, C: Engorgement of epidural veins, D: Increased sensitivity of the nerves to anaesthetic agent - -### Response: -A smaller dose of local anaesthetic is nedded to produce the same level of neuraxial block in pregnant women compared with nonpregnant women. -The causes may be :- - - -Compression of the inferior vena cava by the pregnant uterus causes ""distension or engorgment"" of the epidural venous plexus. This decreases the volume of the epidural space and also the volume of the CSF per spinal segment. Therefore a given dose of epidural or intrathecal local anaesthetic will produce a greater degree of demiatomal involvement. -Pregnant women exhibit increase susceptibility to local anaesthetics. - - -Apex of lumbar lordosis cauded to thoracic kyphosis is reduced in supine position. This may enhance the cephalad spread of CSF. -### End" -4265,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in ARDS, Except:, with the following options: A: Pulmonary edema, B: Hypoxia, C: Hypercapnia, D: Stiff lung - -### Response: -Ans. is 'c' Hypercapnia (Ref. Harrison, 17/e, p 1680-1681 & 16/e, p 1592 (15/e, p. 1524)).Hypocapnia is seen in ARDS.ARDS is an acute* diffuse* alveolar injury * that is caused by variety of aetiological factors. Patients with ARDS are often seriously ill with some other diseases and the features of ARDS are superimposed on it.It is characterized by acute diffuse alveolar damage leading to necrosis and loss of type I pneumocytes*. Endothelial damage also occurs leading to exudation of protein rich fluid into alveoli and resulting in pulmonary edema and formation of hyaline membrane*. Hyaline membrane is composed of fibrin* together with coagulated cell debris*. Hyaline membrane leads to decreased compliance and stiff lung.These changes result in diffusion defects. Due to low diffusion capacity of 02 hypoxemia occurs. Hypoxemia causes increase in respiratory rate due to which C02 wash out occurs so the level of CO2 is low in ARDS.Criteria for diagnosis of ARDS are:Antecedent history of precipitating conditions.Refractory hypoxemia* - Pa02 < 60 mmHg.Radiological evidence of newly evolving bilateral pulmonary infiltrates suggestive of pulmonary edema*.A pulmonary artery occlusion pressure (PAOP) less than 15-18 mmHg in the presence of normal colloid oncotic pressure.Total thoracic compliance less than 30 ml/cm H2O. -### End" -4266,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Two way method of communication is known as:, with the following options: A: Didactic method, B: Hippocratic method, C: Socratic method, D: None of the above - -### Response: -Two way communications is also known as Socratic method where both the communicator and the audience can take pa. Ref: Park 21st edition page: 794. -### End" -4267,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major change occurring in blood vessels in hypertension -a) Atherosclerosisb) Hyaline arteriosclerosisc) Multiple small aneurysmsd) Fibrinoid necrosis, with the following options: A: c, B: d, C: ab, D: bd - -### Response: -Vascular  pathology  in Hypertension -Hypertension is associated with two forms of small blood vessels disease - -1. Hyaline arteriolosclerosis - -There is homogenous, pink, hyaline thickening of arteriolar wall. -The lumen becomes narrow. -It is characteristic of benign hypertension. -It may also occur in diabetes and aging. - -2. Hyperplastic arteriosclerosis - -It is characteristic of malignant hypertension. -There is concentrentic, laminated thickening of arteriolar wall → onion skinning. -There is mutinous intimal thickening and fibrous intimal thickening. -There may be accompanied fibrinoid deposits with necrosis of the vessels wall → fibrinoid necrosis. -### End" -4268,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following statements truly represents Bell's paralysis?, with the following options: A: Facial nerve paralysis and contralateral Hemiparesis, B: Combined paralysis of the facial, trigeminal and abducens nerves, C: Idiopathic ipsilateral paralysis of the facial nerve, D: Facial nerve paralysis with uveitis and parotid enlargement - -### Response: -(c) Bell's palsy is idiopathic LMN palsy of facial nerve causing ipsilateral paralysis of face.(Ref. Scott Brown, 6th ed., 1400)Ipsilateral Facial nerve paralysis and contralateral Hemiparesis along with ipsilateral VI nerve palsy constitutes Millard Gubler syndrome. It is a form of ""crossed hemiplegia,"" as the paralysis of muscles controlled by the facial nerve occurs on the same side as the lesion, while the hemiplegia of muscles below the neck occurs on the opposite side from the lesionIn Bell's palsy facial palsy may be associated with other cranial nerve neuropathies which are Vth, VIIIth, IXth and Xth.Facial nerve paralysis with uveitis and parotid enlargement constitutes Heerfordt's syndrome. -### End" -4269,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Black water fever is a special manifestation of malaria caused by;, with the following options: A: P. falciparum, B: P. malariae, C: P. ovale, D: P. vivax - -### Response: -Ans. A. P. falciparumBlackwater fever (BWF) is a severe clinical syndrome, characterized by intravascular hemolysis, hemoglobinuria (with passage of black urine), and acute renal failure caused by a variety of factors in patients with P. falciparum infestation. -### End" -4270,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amount of liquor is maximum at :, with the following options: A: 32-34 weeks, B: 34-36 weeks, C: 36-38 weeks, D: 38-40 weeks - -### Response: -Amniotic fluid volume is related to gestational age. It measures about 50mlat 12 weeks, 400ml at 20 weeks and reaches its peak of 1 litreat 36-38 weeks. Thereafter the amount dimnishes , till term when it measures about 600-800ml.As the pregnancy continues post term about 200ml at 43 weeks. Reference: Dutta Textbook of Obstetrics 7th edition page 38 -### End" -4271,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common cause of seizures in a patient of AIDS is, with the following options: A: Toxoplasmosis, B: Cryptococcal meningitis, C: Progressive multifocal leucoencephalopathy, D: CNS lymphoma - -### Response: -Ans. is 'a' i.e., Toxoplasmosis Neurological manifestations of H.I.V. AIDS dementia complex (HIV encephalopathy) is a result of direct effects of HIV on CNS (not an oppounistic disease). It is subcoical dementia. Most common cause of seizures --> Toxoplasma Most common cause of meningitis --> Cryptococcus M.C. cause of focal neurological deficit --> Toxoplasma Toxoplasmosis is the most common CNS infection in AIDS. CNS lymphoma and prograssive multifocal leukoencephalopathy may occur. -### End" -4272,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to Einthoven's law:, with the following options: A: 1+2=3, B: 1+3=2, C: 2+3=1, D: 1+2+3=0 - -### Response: -The sum of the voltages in lead 1&3 equals the voltage in lead 2, mathematically this principle is called as Einthoven law. -Einthoven’s Law: -Einthoven’s law states that if the ECGs are recorded simultaneously with the three limb leads, the sum of the potentials recorded in leads I and III will equal the potential in lead II. -### End" -4273,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: SRK formula is used to calculate -, with the following options: A: Power of intraocular lens, B: Corneal curvature, C: Corneal endothelial cell count, D: Extent of retinal detachment - -### Response: -Intraocular lesn power calculation:- Which requires Keratometry (K), Axial length of eyeball or Biometry (L) and a constant (A). It is calculated SRK formula :- (Ref: Yanoff; Jay S. Duker 2009 Ophthalmology 3rd/e p.416-419) -### End" -4274,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ICF is, with the following options: A: 14 L, B: 20 % of body weight, C: 28 L, D: 33% of body weight - -### Response: -In a 70 kg normal manThe intracellular compament contains on average about 28 litres of fluid.The extracellular compament contains on average about 14 litres of fluid, of which the interstitial space has approximately 10.5 litres of fluid and intravascular is approximately 3.5 litres.(Ref. Textbook of physiology AK Jain 5th edition page no.24 table 1.3.1) -### End" -4275,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements are true about obsession except:, with the following options: A: It is a repetitive thought or image, B: Patient believes that the images or thoughts are imposed by others, C: Content of obsession can be about sex or god, D: Patient gets disturbed when unable to remove the thoughts or images - -### Response: -Obsessions are repetitive thoughts, images or impulses. Often the content of thoughts is about sex or god and patient tries to stop these anxiety provoking thoughts unsuccessfully. Please remember, that a patient with obsession identifies the repetitive thought as his ""own thoughts"" and not something that is imposed by others. if the patient indeed believes that the thought has been imposed by others, it would then be diagnosed as ""thought inseion"" and not an obsession. -### End" -4276,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The loading dose of Aminophylline is-, with the following options: A: 50-75 mg/kg, B: 0.5-1.0 mg/kg, C: 2.0-3.5 mg/kg, D: 5-6 mg/kg - -### Response: -Ans. is 'd' i.e. 5-6 mg/kg o Aminophylline is a preparation of theophylline, where theophylline is complexed with EDTA. o The i.v. injection must be slow (loading dose of 5 mg/kg over 20 min followed by an infusion of 9 mg/kg/h, adjusted according to subsequent plasma theophylline concentrations). -### End" -4277,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hernia with hydrocele is ---hernia:, with the following options: A: Gibbon's, B: Fruber's, C: Dobson's, D: Leobel's - -### Response: -Gibbon's hernia Hernia with hydrocele Berger's hernia Hernia into pouch of Douglas Beclard's hernia Femoral hernia through opening of saphenous vein Amyand's hernia Inguinal hernia containing appendix Ogilve's hernia Hernia through the defect in conjoint tendon just lateral to where it inses with the rectus sheath Stammer's hernia Internal hernia occurring through window in the transverse mesocolon after retrocolic gastrojejunostomy Peterson hernia Hernia under Roux limb after Roux - en - Y gastric bypass Valpeau hernia Hernia in front of femoral vessels Holthouse hernia Inguinal hernia with extension of the loop of intestine along inguinal ligament -### End" -4278,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reliable method of identification of person is -, with the following options: A: Gustafson's method, B: Galton method, C: Scar, D: Anthropometry - -### Response: -Ans. is 'b' i.e., Galton method o Galton method or Finger prints or dactylography is the best system of identification till date,o The fingerprints are capable of endless variation so that there is one chance in sixty four billions of two persons having identical prints.Dactylography / Dermatoglyphics / Galton system / Finger printso Finger prints are present from birth both on epidermis and dermis, remain constant through out life and can't be altered without destroying true skin.o Finger print pattern is absolutely individual i.e. no two hands are entirely alike, not even identical twins. That's why, it is best (most sensitive and most specific) and most reliable method of identification (Quetelet'srule of biological variation). DNA fingerprinting may be same in monozygotic twins,o The pattern is neither inherited nor identical in any two persons. So the paternity cannot be proved through finger print patterns. However, paternity can be proved by DNA finger printing.o Loops (67% most common) > whorls (25%) > arches (7%) > composite (2% least common) are four main types of pattern.o It is accepted that chances of 2 finger prints matching 16 ridge characteristic are infinitely small (Parikh's). In practice 8-16 (Reddy) /16 - 20 (Seth, Simpson) points offine comparision are accepted as proof of identity.o Locard's poroscopy method is study of microscopic pores, formed by mouths of ducts of subepidermal sweat gland present on ridges of fingers. These pores are permanent, remain un changed during life and are very useful when only fragments offingerprints are available. Each milimeter contains 9-18 pores,o Criminals may attempt to multilate finger prints by applying CO, snow, corrosive agents, burns or eroding against hard surface. But these manners do not destroy finger prints permanently unless true skin is completely destroyed. -### End" -4279,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tamsulosin is a competitive antagonist for which of the following receptors?, with the following options: A: Alpha 1A, B: alpha 2, C: beta 1, D: beta 2 - -### Response: -Tamsulosin is an alpha 1 blocker with a higher activity for alpha 1A and alpha 1D receptors. Ref: Padmaja 4th edition page no 104 -### End" -4280,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following antihypeensive agents is contraindicated in patients with chronic renal disease?, with the following options: A: Hydrochlorothiazide-triamterene, B: Furosemide, C: Prazosin, D: Nifedipine - -### Response: -Potassium-sparing diuretics such as the triamterene component of a mixed thiazide - potassium-sparing diuretic combination can cause hyperkalemia. All of the other agents, including hydrochlorothiazide (alone), furosemide, prazosin, nifedipine, and alpha-methyldopa are safe to use in chronic renal failure. The dosage of all of these agents, however, should be reduced when renal failure supervenes. In addition to the potassium-sparing diuretics, the ACE inhibitors and angiotensin receptor blockers can also significantly raise the serum potassium level. Thus they must never be used in patients with chronic renal failure who are receiving any kind of potassium-sparing diuretic or other potassium supplement for any reason. Second, they are at least relatively contraindicated when patients develop the degree of renal insufficiency necessary to produce chronic renal failure. Ref: Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy, 3rd Ed, Page 442-446 -### End" -4281,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young girl complains of dryness of the nose and the palate. This would indicate a lesion of which of the following ganglia?,, with the following options: A: Nodose ganglion, B: Otic ganglion, C: Submandibular ganglion, D: Pterygopalatine ganglion - -### Response: -Postganglionic parasympathetic fibers originating in the pterygopalatine ganglion innervate glands in the palate and nasal mucosa. The postganglionic parasympathetic fibers from the otic ganglion supply the parotid gland, those from the submandibular ganglion supply the submandibular and sublingual glands, and those from the ciliary ganglion supply the ciliary muscle and sphincter pupillae. The nodose (inferior) ganglion of the vagus nerve is a sensory ganglion. -### End" -4282,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Macrophage, granuloma, erythrophagocytosis are found ina) Ulcerative colitisb) Necrotising enterocolitisc) Regional ileitisd) Typhoid, with the following options: A: ab, B: bc, C: cd, D: ac - -### Response: -There is confusion between option c & d because macrophage and granuloma are seen in crohn's disease (Regional ileitis), while erythrophagocytosis is seen in typhoid fever. -- Regional Ileitis or crohn's disease has the histological features of transmural inflammatory cell infiltrate consisting of chronic inflammatory cells (lymphocytes, plasma cells & macrophges) which is the classical microscopic feature. Noncaseating, sarcoid like granulomas are present in all the layers of the affected bowel wall in 60% of cases & may even be seen in the regional lymph nodes. There is also patchy ulceration of the mucosa which may take the form of deep fissures, widening of submucosa due to edema & foci of lymphoid aggregates. -- In typhoid fever, there is hyperemia, edema and cellular proliferation consisting of phagocytic histiocytes, lymphocytes & plasma cells. There is phagocytosis of RBC → erythrophagocytosis. -### End" -4283,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is true about Histoplasmosis -, with the following options: A: In early stage it is indistinguishable from TB, B: Culture is not diagnostic, C: Mycelial forms are infectious form, D: Person to person spread occurs by droplet infection - -### Response: -Chronic cavitary histoplasmosis is seen in smokers who have structural lung disease (e.g. bullous emphysema) is characterized upper-lobe infiltrates, cavitation, and pleural thickening- mimics cavitary tuberculosis. -Isolation of fungi by culture and demonstration of dimorphism is diagnostic. -Reservoir of infection: Soil -Microconidia (spores) are the infective form and mode of infection is inhalation. -Person to person or animal to man transmission in not known so far for Histoplasmosis. -### End" -4284,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Charas is :, with the following options: A: Leaves of Cannabis Indica, B: Flowers of Cannabis Indica, C: Stem of Cannabis Indica, D: Resin exudate of Cannabis Indica - -### Response: -D i.e. Resin exudates of cannabis Indica -### End" -4285,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are indicators of ovulation except: March 2008, with the following options: A: Increase in cervical mucus, B: Abdominal cramps, C: LH surge, D: Fall in body temperature - -### Response: -Ans. D: Fall in body temperature Frequent physical signs indicating ovulation are: Increased body temperature LH surge Increased cervical mucus -cervical mucus is most abundant and becomes clear and slippery and stretches like egg white Change of position and firmness of cervix Abdominal cramps (Mittelschmerz) Increased libido Tender breasts -### End" -4286,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a measure of dispersion?, with the following options: A: Mean deviation, B: Standard deviation, C: Mode, D: Range - -### Response: -Ans: c (Mode) Ref: Park, 19th ed, p. 701Measures of dispersion include:a) Mean deviationb) Standard deviationc) RangeThe range is the simplest measure of dispersion. It is the difference between the highest and lowest figures in the sample.Mean deviation-is the average of the deviations from the arithmetic mean, and is given by the fonnulaStandard deviation- is the most frequently used measure of deviation. It is defined as the root mean square deviation.Measures of central tendency include# Mean# Mode -- not affected by the extreme items.# Median -### End" -4287,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incubation period of mumps?, with the following options: A: 7-14 days, B: 14-24 days, C: 20-3 days, D: 30-40 days - -### Response: -Ans- B 14-24 days Incubation Period. Time it takes to start having symptoms after contact with infection. Contagious Period. Time during which a sick child's disease can spread to others. Sometimes, children can return to school before this period is over. Infections that cannot be spread to others. Many common bacterial infections are not spread to others. Examples are ear, sinus, bladder, or kidney infections. Pneumonia also cannot be passed to others. Sexually transmitted diseases are usually not spread to children. But, they can be spread if there is sexual contact or shared bathing. Infection Exposure Table DISEASE INCUBATION PERIOD (DAYS) CONTAGIOUS PERIOD (DAYS) Skin Infections/Rashes: Chickenpox 10-21 2 days before rash until all sores have crusts (6 - 7days) Fifth disease (Erythema infectiosum) 4-14 7 days before rash until rash begins Hand, foot, and mouth disease 3-6 Onset of mouth ulcers until fever gone Impetigo (strep or staph) 2-5 Onset of sores until 24 hours on antibiotic Lice 7 Onset of itch until 1 treatment Measles 8-12 4 days before rash until 4 days after rash appears Roseola 9-10 Onset of fever until rash gone (2 days) Rubella (German measles) 14-21 7 days before rash until 5 days after rash appears Scabies 30-45 Onset of rash until 1 treatment Scarlet fever 3-6 Onset of fever or rash until 24 hours on antibiotic Shingles (contagious for chicken pox) 14-16 Onset of rash until all sores have crusts (7 days) (Note: No need to isolate if sores can be kept covered.) Warts 30-180 Minimally contagious Respiratory Infections: Bronchiolitis 4-6 Onset of cough until 7 days Colds 2-5 Onset of runny nose until fever gone Cold sores (herpes) 2-12 Footnote 1 Coughs (viral) or croup (viral) 2-5 Onset of cough until fever gone Diphtheria 2-5 Onset of sore throat until 4 days on antibiotic Influenza 1-2 Onset of symptoms until fever gone Sore throat, strep 2-5 Onset of sore throat until 24 hours on antibiotic Sore throat, viral 2-5 Onset of sore throat until fever gone Tuberculosis 6-24 months Until 2 weeks on drugs (Note: Most childhood TB is not contagious.) Whooping cough 7-10 Onset of runny nose until 5 days on antibiotic Intestinal Infections: Diarrhea, bacterial 1-5 Footnote 2 for Diarrhea Precautions Diarrhea, giardia 7-28 Footnote 2 for Diarrhea Precautions Diarrhea, traveler's 1-6 Footnote 2 for Diarrhea Precautions Diarrhea, viral (Rotavirus) 1-3 Footnote 2 for Diarrhea Precautions Hepatitis A 14-50 2 weeks before jaundice begins until jaundice resolved (7 days) Pinworms 21-28 Minimally contagious, staying home is unnecessary Vomiting, viral 2-5 Until vomiting stops Other Infections: Infectious mononucleosis 30-50 Onset of fever until fever gone (7 days) Meningitis, bacterial 2-10 7 days before symptoms until 24 hours on IV antibiotics in hospital Meningitis, viral 3-6 Onset of symptoms and for 1-2 weeks Mumps 12-25 5 days before swelling until swelling gone (7 days) Pinkeye without pus (viral) 1-5 Mild infection, staying home is unnecessary Pinkeye with pus (bacterial) 2-7 Onset of pus until 1 day on antibiotic eyedrops Notes Cold sores: Less than 6 years old, contagious until cold sores are dry (4-5 days). No isolation if sores are on part of body that can be covered. More than 6 years old, no isolation necessary if beyond touching, picking stage. Diarrhea Precautions: Contagious until stools are formed. Stay home until fever is gone, diarrhea is mild, blood and mucus are gone, and toilet-trained child has control over loose stools. Shigella and E-coli 0157 require extra precautions. Consult your child care provider regarding attendance restrictions. Author: Barton D. Schmitt, M.D., FAAP -### End" -4288,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aery usually torn in temporal bone fracture is: Odisha 11, with the following options: A: Middle meningeal aery, B: Posterior auricular aery, C: Transverse facial aery, D: Deep temporal aery - -### Response: -Ans. Middle meningeal aery -### End" -4289,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HRT therapy can increase the risk of -, with the following options: A: Osteoporosis, B: Breast carcinoma, C: Alzeihmer's disease, D: Colorectal cancer - -### Response: -Ans. is 'b' i.e., Breast carcinoma o HRT increases the risk of the following:# Endometrial cancer# Breast carcinomao Reduced risk of the following with HRT:# Alzeihmer's disease# Colorectal cancer# Osteoporosis# Age related hearing loss# HRT prevents lens opacities -### End" -4290,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Health index characteristics are all except ?, with the following options: A: Validity, B: Reliability, C: Affordability, D: Feasibility - -### Response: -Ans. is 'c' i.e., Affordability There has been some confusion over terminology: health indicator as compared to health index (plural: indices or indexes). It has been suggested that in relation to health trends, the term indicator is to be preferred to index, whereas health index is generally considered to be an amalgamation of health indicators (56). Characteristics of indicators Indicators have been given scientific respectability: for example ideal indicators. a) Should be valid, i.e., they should actually measure what they are supposed to measure; b) Should be reliable and objective, i.e., the answers should be the same if measured by different people in similar circumstances. c) Should be sensitive, i.e., they should be sensitive to changes in the situation concerned. d) Should be specific, i.e., they should reflect changes only in the situation concerned, e) Should be feasible, i.e., they should have the ability to obtain data needed, and; f) Should be relevant, i.e., they should contribute to the understanding of the phenomenon of interest. -### End" -4291,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Guillain Barre Syndrome (GBS), Except:, with the following options: A: Ascending paralysis, B: Flaccid paralysis, C: Sensory level, D: Albumino-Cytological Dissociation - -### Response: -Answer is C (Sensory level): Guillion Barre syndrome is not associated with a distinct sensory level. Sensory involvement in GBS is mild. Although sensory symptoms (tingling / paraesthesias) may be prominent, cutaneous sensory deficits (eg loss of pain and temperature sensations) are usually mild (Harrison's) or even absent (Current Neurology). Motor Sensory Autonomic Rapidly evolving motor paralysis * Sensory disturbance may or may not be present * Autonomic Ascending (usually) in GBS and a distinct sensory level is not seen. involvement is Areflexic * Mild sensory involvement common (Reflexes Diminished or absent) - Cutaneous sensory deficits (e.g. loss of pain * May occur even in Symmetric (Weaknes is usually symmetric) and temperature sensation) are usually mild patients whose GBS is otherwise mild (Harrison's) or absent (Current Neurology) Flaccid Sphincter tone is normal - Sensory symptoms such as paraesthesias, tingling etc may be prominent (hut objective * Manifestations include * Loss of vasomotor Facial Nerve and other cranial nerves may be involved. sensory loss on clinical examination is mild/absent. control (Fluctuation in B.P / Postrual Bulbar muscles may be involved with difficulty in swallowing, speech etc. * Bladder dysfunction is uncommon. It is usually transient and seen only in severe cases (If Hypotension) * Cardiac Life threatening respiratory paralysis requiring ventilation may be seen. Bladder disturbance is prominent and comes early diagnostic possibilities other that GBS should be considered). dysrhythmias Prognosis Recovery is usually remarkable in GBS, although all patients may not recover fully. Approximately 85% of patients with GBS achieve a fill functional recovery within several months to a year-Harrison 15'''/2509 Treatment Treatment includes intravenous immunoglobulins (IV IG) or plasmapharesis both of which are equally effective (treatment should be initiated as early as possible as immunotherapy is believed to be no longer effective if initiated 2 weeks after first motor symptoms). -### End" -4292,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: L-J cha is used for monitoring-, with the following options: A: Accuracy, B: Precision, C: Sensitivity, D: Specificity - -### Response: -

L J cha is used for monitoring of accuracy. Accuracy : degree of closeness of a measured or calculated quantity to it&;s actual ( true) value. Reference: A. Dictionary of Public Health by J Kishore,p5,410. <\p> -### End" -4293,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young boy presents with swollen knee, on getting hit over lateral aspect of knee and there was a twist while playing. Joint line tenderness was present. Anterior Drawer test done was negative. X-ray shows no fracture. Which structure is most likely to be damaged in the person:-, with the following options: A: ACL, B: Medial Meniscus, C: PCL, D: Lateral Meniscus - -### Response: -Joint line tenderness goes towards medial meniscus. Anterior drawer test negative rule out ACL tear which can also be damaged in this type of forced and can be confused with. Symptoms include joint line pain, catching, popping and locking, weakness and giving way (instability) sometimes. Deep squatting and duck walking are usually painful. 1. McMurray's test is positive 2. Apley's grinding test is positive 3. Difficult to perform full squatting and toe walk in squatting position (Payr's sign) 4. Steinmann tenderness test. 5. Thessaly test 6. Ege's test (weight bearing McMurray test) -### End" -4294,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a characteristic feature of Kala-azar ?, with the following options: A: Splenomegaly, B: Leukocytosis, C: Anemia, D: Hypoalbuminemia - -### Response: -VL is caused by the protozoon Leishmania donovani complex (comprising L. donovani, L. infantum and L. chagasi). India, Sudan, Bangladesh and Brazil account for 90% of cases of VL. Other affected regions include the Mediterranean, East Africa, China, Arabia, Israel and other South American countries . In addition to sandfly transmission, VL has also been repoed to follow blood transfusion, and disease can present unexpectedly in immunosuppressed patients - for example, after renal transplantation and in HIV infection. The majority of people infected remain asymptomatic. In visceral disease, the spleen, liver, bone marrow and lymph nodes are primarily involved. Clinical features In the Indian subcontinent, adults and children are equally affected; elsewhere, VL is mainly a disease of small children and infants, except in adults with HIV co-infection. The incubation period ranges from weeks to months (occasionally, several years). The first sign of infection is high fever, usually accompanied by rigor and chills. Fever intensity decreases over time and patients may become afebrile for intervening periods ranging from weeks to months. This is followed by a relapse of fever, often of lesser intensity. Splenomegaly develops quickly in the first few weeks and becomes massive as the disease progresses. Moderate hepatomegaly occurs later. Lymphadenopathy is common in Africa, the Mediterranean and South America but is rare in the Indian subcontinent. Blackish discoloration of the skin, from which the disease derived its name, kala-azar (the Hindi word for 'black fever'), is a feature of advanced illness but is now rarely seen. Pancytopenia is common. Moderate to severe anaemia develops rapidly and can cause cardiac failure. Thrombocytopenia, often compounded by hepatic dysfunction, may result in bleeding from the retina, gastrointestinal tract and nose. In advanced illness, hypoalbuminaemia may manifest as pedal oedema, ascites and anasarca (gross generalised oedema and swelling). As disease progresses, there is profound immunosuppression and secondary infections are very common. These include tuberculosis, pneumonia, gastroenteritis, severe amoebic or bacillary dysentery, boils, cellulitis, chickenpox, shingles and scabies. Without adequate treatment, most patients with clinical VL die. Ref Harrison20th edition pg 1077 -### End" -4295,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Water content in lens is-, with the following options: A: 64%, B: 35%, C: 1%, D: 28% - -### Response: -Water content of lens is 64%. Ref: Parson Ophthalmology 22nd/e p.261&21st/e p.256. -### End" -4296,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common of aery involved in MI, with the following options: A: LAD, B: RCA, C: LCX, D: Diagonal branch of LAD - -### Response: -Acute occlusion of the proximal left anterior descending (LAD) aery is the cause of 40% to 50% of all MIs and typically results in infarction of the anterior wall of the left ventricle, the anterior two thirds of the ventricular septum, and most of the hea apex; more distal occlusion of the same vessel may affect only the apex. Similarly, acute occlusion of the proximal left circumflex (LCX) aery (seen in 15% to 20% of MIs) will cause necrosis of the lateral left ventricle, and proximal right coronary aery (RCA) occlusion (30% to 40% of MIs) affects much of the right ventricle. (Robbins basic pathology,9th edition,pg no.378) -### End" -4297,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 76-year-old woman presents to the office for evaluation of symptoms of weight loss, anxiety, and palpitations. The symptoms started 1 month ago, and are involuntary. She has no prior history of anxiety or palpitations and her only medical history is hypertension for which she is taking losartan.On examination, the blood pressure is 120/70 mm Hg, heart rate is 100/min and regular. On auscultation the heart sounds are normal and the lung clear. There is a thyroid goiter, warm skin, and a fine tremor in her hands. Which of the following is the most likely cardiac finding?, with the following options: A: prolonged circulation time, B: decreased cardiac output, C: paroxysmal atrial fibrillation, D: pericardial effusion - -### Response: -Atrial fibrillation is particularly common in older individuals with hyperthyroidism. Thyroid disease may affect the heart muscle directly or there may be excessive sympathetic stimulation. Common symptoms of thyrotoxic heart disease include palpitations, exertional dyspnea, and worsening angina. Pericardial effusion, and aortic insufficiency are not usual finding in thyrotoxicosis, and the cardiac output is increased in hyperthyroidism, not decreased. -### End" -4298,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are features of splenic rupture on plain X-ra3, abdomen except:, with the following options: A: Obliteration of psoas shadow, B: Obliteration of splenic outline, C: Obliteration of colonic air hubble, D: Elevation of left hemidiaphragm - -### Response: -Ans. Obliteration of colonic air hubble -### End" -4299,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statement are true about Frey's syndrome except:-, with the following options: A: Gustatory sweating, B: Aberrant misdirection of sympathetic fibers of auriculotermporal nerve, C: Botulinum toxin is one of the treatments suggested, D: Less chances with enucleation than parotidectomy - -### Response: -Frey's syndrome is aberrant misdirection of Parasympathetic fibres of auriculotemporal nerve- not sympathetic fibres. Frey's syndrome A.K.A gustatory sweating (or) Auriculotemporal syndrome When a parotidectomy is performed if damage is occurred to secretomotor parasympathetic fibres of parotid gland that arises from auriculotemporal nerve. Due to this there is an aberrant cross innervation between secretomotor fibres of parotid gland and sympathetic fibres of sweat glands occurs. Which upon gustatory stimulation makes the patient sweat in the cheek region rather having increased salivation Diagnosis: - Minors Starch Iodine test Management: Anti-perspirant application Inj. Botulinum toxin - Most effective t/t Tympanic neurotomy -### End" -4300,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are ECG changes in hypokalemia, except:U wave, with the following options: A: U wave, B: ST segment sagging, C: T-wave flattening or inversion, D: QT interval prolongation - -### Response: -Answer is D (QT Interval prolongation) Hvpokalemia may also present with a apparently prolonged QT interval on ECG. However this apparently prolonged QT interval is in reality the QU interval that mimics a prolonged QT interval due to fusion of T-U waves. Prolonged QT interval is the single best answer of exclusion. QT interval and 11% pokalemia Hypokalemia causes an 'apparent' prolongation of the QT interval but the real QT interval remains 'normal' The apparent prolongation of QT interval is due to fusion of the T and U waves (T-U fusion) -### End" -4301,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child's Child-Turcotte-Pugh is used in :, with the following options: A: Pancreatitis, B: Cirrhosis, C: Multiple myeloma, D: AIDS - -### Response: -The Child-Turcotte-Pugh (CTP) score was originally developed to evaluate the risk of poacaval shunt procedures secondary to poal hypeension and subsequently has been shown to be useful in predicting surgical risks of other intra-abdominal operations performed on cirrhotic patients. Numerous studies have demonstrated overall surgical moality rates of 10% for patients with class A cirrhosis, 30% for those with class B cirrhosis, and 75 to 80% for those with class C cirrhosis. Ref : Tsung A. (2010). Chapter 31. Liver. In T.R. Billiar, D.L. Dunn (Eds), Schwaz's Principles of Surgery, 9e. -### End" -4302,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clozapine therapy should be stopped when WBC count falls lower than, with the following options: A: 3000 / mm3, B: 1500 / mm3, C: 2000 / mm3, D: 1000 / mm3 - -### Response: -Clozapine can lead to agranulocytosis and hence therapy should be stopped if WBC count falls below 3000 / mm3 or neutrophil count falls below 1500 / mm3. -### End" -4303,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spermatazoa with which chromosome is faster?, with the following options: A: X chromosome, B: Y chromosome, C: Both same, D: None - -### Response: -The spermatozoa bearing the Y chromosome swim faster than the spermatozoa bearing X chromosome. -### End" -4304,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child with Acute Myelogenous Leukemia presents with Hyperleukocytosis. Treatment includes all of the following, except:, with the following options: A: IV fluids, B: Allopurinol, C: Alkalinization, D: Immediately sta induction chemotherapy - -### Response: -Immediate treatment of Hyperleukocytosis is leukocyte reduction which is generally achieved by Leukopharesis or administration of Hydroxyurea. Ref: Harrison's Manual of Oncology, 1st Edition, Page 207; Treatment of Acute Leukemias By Ching-Hon Pui, 1st Edition, 259; Hematology-Oncology Therapy, 1st Edition, Page 220; Oncologic Emergencies By Sai-Ching Jim Yeung, Carmen P. Escalante, Page 348 -### End" -4305,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19-year-old female college student presents to the emergency department at 10:30 PM on a Friday night with severe left-sided flank and pelvic pain. While she has never had similar pain, she states that she thinks she has a kidney stone. The pain started in her mid-back about a week ago and then subsided and now the pain has increased and moved interiorly along her flank and also extends down into her labia majora. She is taking birth control pills, but is not currently sexually active. She is having her period, but denies the pain is menstrual. Abdominal and pelvic CT are ordered. What two specific locations will one look for in the CTs for obstructing calculi?, with the following options: A: At the junction of the renal papilla with the minor calyx and junction of the renal papilla with the major calyx, B: As the ureter leaves the kidney and as the ureter forms the infundibulum, C: As the ureter crosses the edge of the false pelvis and as the ureter crosses the edge of the true pelvis, D: As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder - -### Response: -Answer: (d) As the ureter crosses the external iliac artery at the pelvic brim and as the ureter passes through the wall of the bladder.* Renal and ureteric calculi generally are formed in the kidneys and then lodge at one of three locations:o at the junction of the renal pelvis with the ureter;o as the ureters cross the external iliac vessels at the pelvic brim;o as the ureters pass through the wall of the bladder.* Calculi occasionally form in the minor or major calyces or in the renal pelves and infundibula, but those so called ""staghorn""calculi, would produce mid-back pain.* Renal calculi rarely become stuck as the ureter crosses the edge of the false pelvis.* The ureter does not pass through the center of the trigone, but rather opens at the superior lateral edge of the trigone.* The referred pain from ureteric calculi is usually described as from ""loin to groin"" in that it often starts in the mid back then over the kidney and extends in a band toward the labia majora or scrotum (from T11-L2).* Normally the pain is intermittent and comes and goes in waves and may change in location, generally moving interiorly.* Since the ureters undergo peristaltic movement, the calculi often move with time. -### End" -4306,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tumor suppressor genes are all, except:-, with the following options: A: APC, B: p53, C: Rb, D: C-myc - -### Response: -C-myc is a proto-oncogene of transcriptional activator category and is associated with Burkitt's lymphoma. -### End" -4307,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amount of blood in hea, with the following options: A: 250-300 ml, B: 500-600 ml, C: 1-2 litre, D: 100-200 ml - -### Response: -Out of 5000 mL blood in our body 12% is in the hea cavitiesWhich is nearly 600Therefore generally 500-600 mL BLOOD IN HEARef: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:543 -### End" -4308,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Percutaneous vertebroblasty is indicated in all except -, with the following options: A: Tuberculosis, B: Metastasis, C: Osteoporosis, D: Hemangioma - -### Response: -Tuberculous osteomyelitis is a contraindication for percutaneous vertebroplasty. -### End" -4309,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HLA associated with psoriasis, with the following options: A: HLA-B27, B: HLA-DR4, C: HLA-CW6, D: HLA-B8 - -### Response: -Psoriasis is a long-lasting autoimmune disease which is characterized by patches of abnormal skin.] These skin patches are typically red, itchy, and scaly. They may vary in severity from small and localized to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenonType 1 has a positive family history, stas before the age of 40, and is associated with the human leukocyte antigen, HLA-Cw6. Conversely, type 2 does not show a family history, presents after age 40, and is not associated with HLA-Cw6. Type 1 accounts for about 75% of persons with psoriasis. -### End" -4310,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best anaesthesia for status asthamaticus, with the following options: A: Thiopentone, B: Ketamine, C: Ether, D: N20 - -### Response: -B i.e. Ketamine -### End" -4311,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Technique (s) used to detect Gene Mutation is/are, with the following options: A: #NAME?, B: Denaturing gradient gel electrophoresis, C: DNA sequencing and Restriction fragment polymorphism (RFLP) both, D: All - -### Response: -ALL i.e. (-PCR, Denaturing gradient gel electrophoresis, DNA sequencing, Restriction fragment polymorphism (RFLP), Single-strand conformational polymorphism -### End" -4312,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following are side effects of Nimodipine except ?, with the following options: A: Hypotension, B: Flushing, C: Headache, D: Marked changes m GIT motility - -### Response: -Ans. is 'd' i.e., Marked changes in GI motility Hypotension, headache, drowsiness, nausea, ankle edema, palpitation and flushing are common side effects of DHPs (including nimodipine). o Change in GI motility (constipation) is more common with verapamil. -### End" -4313,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Listeria is, with the following options: A: Shows tumbling motility, B: Catalase positive, C: PLET medium is selective medium, D: Anton test +ve - -### Response: -PALCAM medium - Selective medium. -### End" -4314,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 47-year old woman was referred for bone pain and abnormal findings on radiography. The patient repoed that for the past 17 years, she has habitually consumed water from that area. She repoed a 5-years history ofpain in the lower back, arms, legs and hips, Because of brittleness, all her teeth had been extracted. Radiography ofthe forearm revealed interosseous membrane calcification and radiography ofthe spine revealed a rugger-jersey appearance (striated pattern of increased density in the upper and lower zones of the veebrae). The probable diagnosis is, with the following options: A: Silicosis, B: Fluorosis, C: Vitamin B toxicity, D: Hypercalcinosis - -### Response: -Skeletal fluorosis is a bone disease caused by excessive accumulation of fluoride in the bones. In advanced cases, skeletal fluorosis causes painful damage to bones and joints. Symptoms are mainly promoted in the bone structure. Due to a high fluoride concentration in the body, the bone is hardened and thus less elastic, resulting in an increased frequency of fractures. Other symptoms include thickening of the bone structure and accumulation of bone tissue, which both contribute to impaired joint mobility. Ligaments and cailage can become ossified. Most patients suffering from skeletal fluorosis show side effects from the high fluoride dose such as ruptures of the stomach lining and nausea. Fluoride can also damage the parathyroid glands, leading to hyperparathyroidism, the uncontrolled secretion of parathyroid hormones. These hormones regulate calcium concentration in the body. An elevated parathyroid hormone concentration results in a depletion of calcium in bone structures and thus a higher calcium concentration in the blood. As a result, bone flexibility decreases making the bone more susceptible to fractures Mechanism of action The best way to view the mechanism of action by which fluorine breaks down bones and causes skeletal fluorosis is in a stepwise fashion. Fluoride enters the body by two paths: Ingestion or respiration. Both paths lead to corrosion of exposed tissue in high concentrations. Since the most likely form of fluoride to enter the body is hydrogen fluoride (HF) gas, this is what stas the process. Exposed tissues will be utilized by HF in neutralization reactions. This will leave F- free to pass fuher into the body. It reacts with the concentrated HCl in the stomach to form the weak acid, HF. This compound is then absorbed by the gastro-intestinal tract and passes into the liver the poal vein. Since elemental F is one of the strongest oxidizers currently known, the anion F- is immune to phase 1 metabolic reactions, which are generally oxidation reactions, in the liver. These reactions are the body's first line of defense to biotransform harmful compounds into something more hydrophilic and more easily excreted. The HF is now free to pass into the blood stream and be distributed to all tissues including bones. Bones are largely composed of Ca compounds, paicularly carbonated hydroxyapatite (Ca 5(PO 4) 3(OH)); the reaction of Ca2+ ions and HF forms an insoluble salt, CaF 2. This salt must be cleared by the body, which concomitantly leaches out some of the calcium that would be pa of the bone matrix. This process results in increased density, but decreased strength in bones As of now, there are no established treatments for skeletal fluorosis patients. However, it is reversible in some cases, depending on the progression of the disease. If fluorine intake is stopped, the amount in bone will decrease and be excreted urine. However, it is a very slow process to eliminate the fluorine from the body completely. Minimal results are seen in patients. Treatment of side effects is also very difficult. For example, a patient with a bone fracture cannot be treated according to standard procedures, because the bone is very brittle. In this case, recovery will take a very long time and a pristine healing cannot be guaranteed. However, fuher fluorosis can be prevented by drinking defluoridated water. It is recently suggested that drinking of defluoridated water from the ''calcium amended-hydroxyapatite'' defluoridation method may help in the fluorosis reversal. Defluoridated water from this suggested method provides calcium-enriched alkaline drinking water as generally fluoride contaminated water has a low amount of calcium mineral and drinking alkaline water helps in eliminating the toxic fluoride from the body Ref Davidson 23rd edition pg 715 -### End" -4315,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spalding sign is -, with the following options: A: Overlapping of skull bones, B: Hyperflexion of spine, C: Gas in great vessel, D: Over crowding of ribs - -### Response: -Ans. is 'a' i.e., Overlapping of skull bones Radiological signs of 1UFDSignInterval (After Death)Robert sign (gas in great vessels)12 hSpalding sign (overlapping of skull bones)1 weekBlair-Hartley/ Ball sign (hyperflexion/ hyperextension of spine with overcrowding of ribs3-4 weeks -### End" -4316,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The kinetic energy of the body is least in one of the following phases of the walking cycle, with the following options: A: Heel strike, B: Mid-stance, C: Double suppo, D: Toe-off - -### Response: -B. i.e. Mid stance phaseSpeed & so the kinetic energy is maximum in double suppo phase (i.e. heel strike, foot flat, toe flat) & minimum in single suppo phase (i.e. midstance, mid swing, heel off). -### End" -4317,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Medlar bodies"" are seen in, with the following options: A: Sporotrichosis, B: Chromblastomycosis, C: Coccidiomycosis, D: Histoplasmosis - -### Response: -Golden brown coloured fungal cells seen in chromoblastomycosis are called as ""Medlar or copper penny"" bodies. -### End" -4318,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anti IgE monoclonal antibody used in bronchial asthma is:, with the following options: A: Mepolizumab, B: Omalizumab, C: Keliximab, D: Altrakincept - -### Response: -ANTI-IgE ANTIBODY Omalizumab: It is a humanized monoclonal antibody against IgE. Administered i.v. or s.c., it neutralizes free IgE in circulation without activating mast cells and other inflammatory cells. On antigen challenge, little IgE is available bound to the mast cell surface receptors to trigger mediator release and cause bronchoconstriction. It is very expensive; use is reserved for resistant asthma patients with positive skin tests or raised IgE levels who require frequent hospitalization. It is not itself immunogenic; only injection site local reactions have been noted so far. Reslizumab is also used for bronchial asthma ESSENTIALS of medical PHARMACOLOGY SIXTH EDITION -K D TRIPATHI Page:226 -### End" -4319,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the site of Louise's knees disease?, with the following options: A: Proximal femur, B: Proximal tibia, C: Patella, D: Distal femur - -### Response: -Osgood-Schlatter disease: Also known as Tibial tubercle traumatic apophysitis or louise's knees disease is an inflammation of the growth plate at the tibial tuberosity. It is a type of osteochondritis. The disease is most common in active boys aged 10-15 years. It most commonly occurs in just one leg but can occur in both at the same time. The natural history is benign, with almost all cases asymptomatic by skeletal maturity, Surgical excision of residual ossicles has been described with good outcome. Ref: Apley's 8/e, page 101-03 ; B & L 24/e, page 486 ; Turek's ohopedics 6/e, page 582-83 -### End" -4320,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Branch of Pharmacology that deals with medicinal drugs obtained from plants and other natural sources is known as, with the following options: A: Pharmacognosy, B: Pharmacogenomics, C: Pharmacopoeia, D: Chronopharmacology - -### Response: -. -### End" -4321,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Erythema nodosum is seen in all of the following, EXCEPT:, with the following options: A: Pregnancy, B: Tuberculosis, C: SLE, D: Chronic Pancreatitis - -### Response: -Pregnancy, SLE and Tuberculosis are all associated with Erythema Nodosum. Erythema Nodosum are painfully red nodular lesions, occuring bilaterally on the shins. This lesion occur predominantly in woman in the fall and winter months. It is associated with SLE, Leprosy, TB, etc. Ref: Immunology, Immunopathology and Immunity, by Stewa Sell, Edward E. Max, Page 518; Chronic Pancreatitis, by Markus Buchler, Helmutt Friess, Page 29, 30, 37. -### End" -4322,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscle tendon is stretched in patellar tendon reflex?, with the following options: A: Biceps femoris, B: Quadriceps femoris, C: Adductor magnus, D: Quadratus - -### Response: -Quadriceps femoris stretches in patellar tendon reflex. Striking of the patellar tendon with a reflex hammer just below the patella stretches the muscle spindle in the quadriceps muscle. -### End" -4323,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhoea, and severe abdominal pain. Which of the following would immediately alert the nurse that the patient has bleeding from the GI tract?, with the following options: A: Complete blood count., B: Guaiac test., C: Vital signs., D: Abdominal girth. - -### Response: -Option B: To assess for GI tract bleeding when frank blood is absent, the nurse has two options: She can test for occult blood in vomitus, if present, or in stool – through guaiac (Hemoccult) test. -Option A: A complete blood count does not provide immediate results and does not always immediately reflect blood loss. -Option C: Changes in vital signs may be caused by factors other than blood loss. -Option D: Abdominal girth is unrelated to blood loss. -### End" -4324,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following anaesthetic agent is contraindicated in Renal failure:, with the following options: A: d-TubocurarineScoline, B: Scoline, C: Halothane, D: Gallamine - -### Response: -Gallamine -### End" -4325,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child has deficient bone mineralization with low serum calcium, high serum phosphorus, with decreased urinary excretion of calcium and phosphorus and elevated levels of alkaline phosphatase. The most likely diagnosis is:, with the following options: A: Nutritional rickets, B: Renal tubular rickets, C: Renal glomerular rickets, D: Celiac rickets - -### Response: -Ans. c. Renal glomerular rickets (Ref: Nelson 19/e p202)A child has deficient bone mineralization with low serum calcium, high serum phosphorus, with decreased urinary excretion of calcium and phosphorus and elevated levels of alkaline phosphatase. The most likely diagnosis is renal glomerular rickets.""With chronic renal failure, there is decreased activity of 1a-hydroxylase in the kidney, leading to diminished production of 1,25-D. In chronic renal failure, unlike the other causes of vitamin D deficiency, patients have hyyperphosphatemia as a result of decreased renal excretion. Along with inadequate calcium absorption and secondary hyperparathyroidism, the rickets may be worsened by the metabolic acidosis of chronic renal failure. In addition, failure to thrive and growth retardation may be accentuated because of the direct effect of chronic renal failure on the growth hormone axis.""- Nelson 19/e p202Laboratory findings in disorders causing ricketsDisorderSerum CaSerum PiSerum PTH25-OH D1,25-(OH)2 DSerum Alk PO4 aseUrine CaUrine PiVitamin D deficiency (nutritional)N, |||||, N, ||||Vitamin D dependent rickets, Type 1N, |||N||||Vitamin D dependent rickets, Type 2N, |||N|||||Chronic renal failureN, |||N||N, ||Dietary Pi deficiencyN|N, |N||||X-linkedhypophosphatemic ricketsN|NNRelatively ||||Autosomal dominant hypophosphatemic ricketsN|N,NRelatively ||||Hereditaryhypophosphatemic rickets with hypercalciuriaN|N,-NRelatively ||||Tumour-induced ricketsN|NNRelatively ||||Fanconi syndromeN|NNRelatively | or ||| or ||Dietary Ca deficiencyN, |||N|||| -### End" -4326,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an Integrase inhibitor used to treat HIV?, with the following options: A: Maraviroc, B: Ritonavir, C: Raltegravir, D: Enfluviritide - -### Response: -Integrase InhibitorsHIV integrase aids the inseion of viral DNA into host cell DNA. This occurs after the viral reverse transcriptase (RNA/DNA-dependent DNA polymerase) produces double-stranded viral DNA. This step is key to the cell becoming a permanent carrier. Two integrase inhibitors, raltegravir and elvitegravir, are approved for use.Ref: Sherris microbiology; 6th edition; Page no: 158 -### End" -4327,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice in acute congestive glaucoma-, with the following options: A: Pilocarpine, B: Laser iridotomy, C: Timolol, D: Trabeculoplasty - -### Response: -245 Laser iridotomy is the definitive treatnent in acute congestive glaucoma . Gonioscopy should be performed as soon as cornea becomes clear. Laser PI should be performed if PAS are seen in <270degangle . Laser peripheral iridotomy re establishes communication between posterior and anterior chamber, so it bypasses the pupillary block and immediately relieves the crowding of the angle. Ref: Comprehensive Ophthalmology AK Khurana 6th edition chapter-10 page no: -### End" -4328,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common inherited childhood tumor is:, with the following options: A: Leukemia, B: Neuroblastoma, C: Retinoblastoma, D: Wilms tumor - -### Response: -Retinoblastoma is a neuroectodermal malignancy arising from embryonic retinal cells. It is the most common intraocular tumor in pediatric patients and causes 5% of cases of childhood blindness. Retinoblastoma is the prototype of hereditary cancers due to a mutation in the retinoblastoma gene (RB1), which is located on the long arm of chromosome 13 (13q14). Approximately 40% of retinoblastoma are inherited. Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e. -### End" -4329,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surface ectoderm forms:, with the following options: A: Lens of eye, B: Retina, C: Iris, D: Corneal stroma - -### Response: -Ans. (a) Lens of eyeRef: A.K. Khurana 6th ed. /12; Khurana 4th ed/ 10Surface EctodermNeural EctodermMesodermNeural Crest* Conjunctival Epithelium* Corneal Epithelium* Lacrimal gland* Tarsal gland* Lens* Smooth muscle of Iris* Iris Epithelium* Ciliary Epithelium* Retina & its pigment epithelium* Optic nerve fibre* Part of vitrous* EOM* Sclera* Iris* Vascular endothelium* Choroid* Part of vitrous* Corneal stroma* Ciliary ganglion* Schwann cell* Uveal and conj melanocytes* Meningeal sheath of ON* Part of vitrous -### End" -4330,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 yr old female complains of progressive lower limb weakness, spasticity, urinary hesitancy. MRI shows intradural enhancing mass lesion. Most likely diagnosis is -, with the following options: A: Dermoid cyst, B: Intradural lipoma, C: Neuroepithelial cyst, D: Meningioma - -### Response: -Ans. is 'd' i.e. Meningioma Among the given options, only meningioma shows enhancement on contrast scans.""The radiologic image of a dural-based, extraaxial mass with dense, uniform contrast enhancement is essentially diagnostic, although a dural metastasis must also be considered. A meningioma may have a 'dural tail' a streak of dural enhancement flanking the main tumor mass, however the finding may also be present with other dural tumors."" - Harrison -### End" -4331,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In acute sinusitis, the sinus most often involved in children is:, with the following options: A: Maxillary, B: Sphenoid, C: Ethmoid, D: Frontal - -### Response: -Most common sinusitis in children is Ethmoid. Most common sinusitis in adults is Maxillary. -### End" -4332,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common carcinoma of upper 1/3 oesophagus:, with the following options: A: Adenocarcinoma, B: Squamous, C: Squamo columnar, D: Melanoma - -### Response: -Ans. (b) Squamous cell carcinomaRef: Bailey and love 26th Edition, Page 1004* Most common type of cancer in upper 2/3rd is squamous cell carcinoma.* Most common type of cancer in lower third is adenocarcinoma* Most common type in the world, India: Squamous cell cancer* Most common type in western countries: Adenocarcinoma -### End" -4333,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In magil circuit airflow is –, with the following options: A: 1/2 of minute volume, B: equal to M.V., C: 2 x m.v., D: 3 x m.v. - -### Response: -""For Mapleson Type A (Magill) circuit fresh gas flow should be equal to minute volume (5 L/min) to prevent rebreathing when patient is spontaneously breathing"". -### End" -4334,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Although more than 400 blood groups have been identified,the ABO blood group system remians the mostimpoant in clinical medicne because :, with the following options: A: It was the first blood group system to be discovered, B: It has four different blood groups A,B, AB, O (H)., C: ABO(H) antigens are present in most body tissues and fluids., D: ABO(H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen - -### Response: -. ABO(H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen -### End" -4335,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with cough and fever. On X-ray examination, a homogenous opacity silhouetting the right hea border with ill-defined lateral margins is seen. What would be the most probable diagnosis?, with the following options: A: Pneumonia affecting medial zone of right middle lobe, B: Pneumonia affecting superior zone of right lower lobe, C: Loculated pleural effusion, D: Pneumonia of anterior zone of right middle lobe - -### Response: -Ans. a. Pneumonia affecting medial zone of right middle lobe Homogeneous paracardiac opacity in right lung, near right cardiac silhouette with ill-defined lateral border is suggestive of pneumonia affecting medial zone of right middle lobe. Silhoutte sign is very useful in localizing lung lesions as all structures forming cardiac silhouette (hea border, ascending, descending aoa, aoic knob and hemidiaphragm) are in contact with a specific poion of lung. Silhoutte Structure Lung Poion in Contact Ascending aoa, upper right hea border and upper pole of hilum Anterior segment of right upper lobe Right hea border Right middle lobe Aoic knob Apical poion of left upper lobe (posterior) Upper left hea border Anterior segment of left upper lobe Left hea border Lingula (anterior) Anterior hemidiaphragm Position of oblique fissure is best index of lower lobe volume Lower lobe (anterior) -### End" -4336,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about digoxin except:, with the following options: A: Causes bradycardia due to increased vagal tone, B: Acts by inhibiting Na+K+ ATPase in myocardial fibres, C: It is 95% plasma protein bound, D: Primarily excreted unchanged by glomerular filtration - -### Response: -Ans. (C) It is 95% plasma protein bound(Ref: KDT 8th/e p559)Plasma protein binding of digitoxin is high (95%) whereas it is low (70-80%) for digoxin. -### End" -4337,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In splenic injury conservative m/n is done in -, with the following options: A: Hemodynamically unstable, B: Young pt., C: Shatterred spleen, D: Extreme pallor and hypotension - -### Response: -Ans is 'b' ie. Young pts Most serious complications after splenectomy is OPSI (Oppounistic Post Splenectomy Infections) it is most common in young children and immunocompromised adults. ""Therefore it is essential to save the spleen in children."" Now spleen salvage methods is the management of choice even in adults. Splenectomy is usually indicated under the following circumstances (Ref: Sabiston 18/e p1639 (17/e, p 1694) 1) the pt. is unstable 2) the spleen is extensively injured with continuous bleeding 3) bleeding is associated with hilar injury 4) other injuries require prompt attention ""Splenectomy is indicated for hilar injuries, pulverized splenic parenchyma, or any injury of grade II or higher in a patient with coagulopathy or multiple injuries.""-Schwaz 9/e -### End" -4338,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are present in Superficial perineal pouch except:, with the following options: A: Sphincter urethrae muscles, B: Bulbospongiosus, C: Posterior scrotal nerves, D: Duct of Bulbourethral glands - -### Response: -A i.e. Sphincter urethral muscles Root, crura & bulb of penis (i.e. 1 bulb/corpus spongiosa & 2 crura/corpora cavernosa), bulbospongiosus muscle, ducts of bulburethral gland, and posterior scrotal nerve/aery4 are contents of superficial perineal pouch.Deep perineal pouch contains bulbourethral glands, membranous urethra, sphincter urethrae muscle (internal urethral sphincter) and dorsal nerve of peris -### End" -4339,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Physiological response to smoking, are all, except, with the following options: A: Decreased HDL, B: Increased hematocrit, C: Increased hea rate and increased catecholamine release, D: Decreased carboxyhemoglobin - -### Response: -Carboxyhemoglobin increases in smokers Ref: guyton and hall textbook of medical physiology 12 edition page number:353,354,355 -### End" -4340,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bacillus used to test efficacy of Sterilisation by Autoclave is?, with the following options: A: Bacillus subtilis., B: Bacillus pumilis., C: Bacillus stearothermophilus, D: Coxiella burnetti. - -### Response: -ANSWER: (C) Bacillus stearothermophilusREF: Basic medical laboratory techniques 4th edition by Barbara H. Estridge, Anna P. Reynolds,Norma J. Walters Page 70Various bacilli are used to check efficacy of sterilisation methods are:Autoclave- Bacillus stearothermophilusHot air oven- Bacillus subtilis subspecies nigerIonising radiation- Bacillus pumilis -### End" -4341,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Piaget's theory of cognitive development 'out of sight, out of mind' and 'here and now' is seen in the stage of:, with the following options: A: Sensory-motor stage, B: Preoperational stage, C: Concrete operational stage, D: Formal operational stage - -### Response: -Ans. a. Sensory-motor stage (Ref: Niraj Ahuja 6th/156)In Piaget's theory of cognitive development 'out of sight, out of mind' and 'here and now' is seen in Sensory-motor stage.Jean Piaget Theory of Intellectual DevelopmentIntellectual development goes hand-in-hand with the development of physical and behavioral characteristics.According to Jean Piaget, it can be divided into the following stages:Sensori-Motor stage:Extends from birth to 2 years of ageCharacterized by:Actions related to suckling, orality and assimilation of objectsAbility to think of only one thought at a timeInanimate objects are given human qualities'Out of sight' means ceasing to existConcrete Thinking stage:Lasts from 2 years to 7 yearsCharacterized by:Egocentric thought with a unique logic of its own, involving a limited period of view and lacking introspectionInability to generalize from specific events and to specify from general eventsAbstract or Conceptual Thinking stage:Begins at 7 years of age and lasts till 11 years of age, although it may be said to continue throughout life.Characterized by:Ability to focus on several dimensions of a problem at one time, mentally.The thought process is flexible and reversibleAbility of abstraction, i.e. ability to generalize from specific and ability to find similarities and differences among specific objects.Adolescent thinking or Formal Operational Stage:Begins at 11 years of age and continues lifelong.Characterized by:Ability to imagine the possibilities inherent in a situation, thus making the thought comprehensiveAbility to develop complete abstract hypotheses and to test themBy the end of adolescence, the individual's intellectual ability is nearly completely developed, although learning and intellectual growth go-on throughout the life span of individual. -### End" -4342,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30-year-old patient presents with severe upper abdominal pain with increased serum lipase. The CECT is repeated after 2 months and is shown. The next line of management., with the following options: A: Conservative, B: Internal drainage, C: External drainage, D: ERCP - -### Response: -Ans. (b) Internal drainage.The image of CECT shows presence of Pseudopancreatic cyst and warrants an internal drainage. -### End" -4343,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mites are the vectors of the following disease except:, with the following options: A: Scabies, B: Scrub typhus, C: Rickettsial pox, D: Kyasanur forest disease - -### Response: -- Vector is an ahropod or inveebrate which can transmits an infection. - Mites are the vectors of: Scabies Scrub typhus Rickettsial pox Rickettsial Diseases Disease Cause Vector Reservoir Epidemic typhus R. Prowazeki Louse Man Endemic typhus R. Typhi flea Rodents Indian tick typhus R. conori Tick Rodents RMSF R. rickettssi Tick Rodents Q fever Coxiella - Cattle Trench fever Baonella louse man KFD is transmitted by Hard ticks (Hemophysalis) -### End" -4344,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Interval cholecystectomy surgery is, with the following options: A: Clean, B: Clean contaminated, C: Contaminated, D: Dirty - -### Response: -When there is no information but entry to genitourinary or gastrointestinal systems it is clean contaminated. -### End" -4345,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Radiation therapy is employed for many cancers, including irradiation of the central nervous system to destroy lymphoblasts in leukemia. Which of the following accounts for the destruction of rapidly growing cells?, with the following options: A: Cross-linking of DNA, B: Demethylation of DNA, C: Cleavage of DNA double strands, D: Disruption of DNA-RNA transcription complexes - -### Response: -Disruption of DNA-RNA transcription complexes. The major effects of radiation are to damage cellular DNA by opening purine rings and rupturing phosphodiester bonds. Chemical agents such as formaldehyde can cross-link DNA, and inhibitors of DNA methylation, such as methotrexate (an inhibitor of folic acid), were the first anticancer drugs. Experimental gene therapies for cancer include the inhibition of oncogene expression and the enhancement of tumor suppressor gene activity. These therapies target paicular DNA-RNA transcription complexes or signal transduction cascades that are active in cancer cells. -### End" -4346,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Activation of which of the following causes constriction of pulmonary arteries?, with the following options: A: Histamine H2, B: Muscarinic M3, C: Endothelin ETA, D: Adrenergic Alpha-2 - -### Response: -Ans. c. (Endothelin ETA) (Ref. H-17th/pg. 233, 1580; Ganong 22nd/pg.602, 666, Ref. Q. 21 of MH-2007)# Endothelin is endothelial cells released potent peptide vasoconstrictor; its concentration is elevated in heart failure and contributes to renal vasoconstriction, Na+ retention, and edema in heart failure. Nitric oxide, which induces vascular relaxation, promotes erection and is opposed by endothelin-1 (ET-1) and Rho kinase, which mediate vascular contraction.# Increased calcium entry into the vascular smooth- muscle cells mediates hypoxic pulmonary vasoconstriction. Pulmonary vascular remodeling in response to chronic hypoxia is also mediated by a reduction in nitric oxide production; an increase in endothelin 1; and increased expression of platelet-derived growth factors, vascular endothelial growth factor, and angiotensin II.# Note: The nonselective endothelin receptor antagonist bosentan is an approved treatment of PAH for patients who are NYHA functional classes III and IV. -### End" -4347,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In congestive cardiac failure all are used except -, with the following options: A: Spironlactone, B: Nitrates, C: Nesiritide, D: Trimetazidine - -### Response: -Trimetazidine ""Trimetazidine is .a novel antianginal agent that is used mostly as an add on medication to conventional therapy in angina and post M.I. patients"". K.D.T. 6th/e p. 535-36 Nesiritide It is a recombinant ,form of human brain natriuretic peptide that has been approved by the FDA for treatment of dyspnoea due to congestive hea .failure. The natriuretic peptides, atrial natriuretic peptide (ANP), brain natriuretic peptide and C type natriuretic peptide are a family of endogenous neurohormones that posess natriuretic, diuretic and vasodilator propeies. They are secreted in response to stretch of ventricular myocytes. Nesiritide lowers right and left side cardiac filling pressures without a direct chronotropic or inotropic action. - The hemodynamic response to nesiritide is characterized by decreased right atrial, pulmonary aerial and pulmonary capillary wedge pressure. - Systemic vascular resistance is reduced and cardiac index is increased. - There is improvement in global clinical status, attenuation of dyspnoea and fatigue and enhanced diuretic responsiveness have been repoed and corroborated. In acute hea failure the two primary hemodynamic determinants that produce symptoms are ? a) Elevated left ventricular, filling pressure b) Depressed cardiac output. - The depressed cardiac output is frequently accompanied by increase in systemic vascular resistance as a result of excessive neurohormonal activation. Management of acute hea failure The drugs used in acute hea failure mainly acts to improve these two hemodynamic parameters. -### End" -4348,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pulmonary hypeension may occur in all of the following conditions except-, with the following options: A: Toxic oil syndrome, B: Progressive systemic sclerosis, C: Sickle cell anemia, D: Argemone mexicana poisoning - -### Response: -Category 1. Pulmonary aerial hypeension (PAH) Key feature: elevation in pulmonary aerial pressure (PAP) with normal pulmonary capillary wedge pressure (pcwp) Includes: Idiopathic (IPAH) * Sporadic * Familial Exposure to drugs or toxins * Persistent pulmonary hypeension of the newborn * Pulmonary capillary hemangiomatosis (PCH) Associated with other active conditions * Collagen vascular disease * Congenital systemic-to-pulmonary shunts * Poal hypeension * HIV infection Category 2. Pulmonary venous hypeension Key feature: elevation in PAP with elevation in pcwp Includes: * Left-sided atrial or ventricular hea disease * Left-sided valvular hea disease * Pulmonary venous obstruction * Pulmonary venoocclusive disease (PVOD) Category 3. Pulmonary hypeension associated with hypoxemic lung disease Key feature: chronic hypoxia with mild elevation of PAP Includes: * Chronic obstructive lung disease * Interstitial lung disease * Sleep-disordered breathing * Alveolar hypoventilation disorders * Chronic exposure to high altitude * Developmental abnormalities Category 4. Pulmonary hypeension due to chronic thromboembolic disease Key feature: elevation of PA pressure with documentation of pulmonary aerial obstruction for >3 months Includes: * Chronic pulmonary thromboembolism * Nonthrombotic pulmonary embolism (tumor, foreign material) Category 5. Miscellaneous Key feature: elevation in PAP in association with a systemic disease where a causal relationship is not clearly understood. Includes: * Sarcoidosis * Chronic anemias * Histiocytosis X * Lymphangiomatosis* Schistosomiasis ref:Harrison&;s principles of internal medicine,ed 18,pg no 2078 -### End" -4349,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following extrapyramidal effect is seen on chronic use of antipsychotic -, with the following options: A: Dystonia, B: Akathisia, C: Tardive dyskinesia, D: Parkinsonism - -### Response: -Ans. is 'c' i.e., Tardive dyskinesia Neurological side effects of Neuroleptic DrugsReactionFeaturesTime of Maximal RiskProposed MechanismTreatmentAcute dystoniaSpasm of muscles of tongue, face, neck, back, may mimic sei- zures; not hysteria1 to 5 daysUnknownAntiparkinsonian ages are diagnostic and curativeAkathisiaMotor restlessness; not anxiety or ""agitation""5 to 60 daysUnknownReduce dose or change drug; antiparkinsonian agents, benzodiazepines or propranolol may helpParkinsonismBradykinesia, rigidity, variable tremor, mask facies, shuffling gait5 to 30 days; can recur even after a single doseAntagonism of dopamineAntiparkinsonian agents helpfulNeuroleptic malignant syndromeCatatonia, stupor, fever unstable blood pressure myoglobinemia; can be fatalWeeks; can persist for days after stopping neuro- lepticAntagonism of dopamine may contri- buteStop neuroleptic immediately; dantrolene or bromocriptine may help; antiparkinsonism agents not effectivePerioral tremor ""rabbit syndrome""Perioral tremor (may be a late variant of parkin- sonism)After months or years of treatmentUnknownAntiparkinsonian agents often helpTardive dyskinesiaOral-facial dyskinesia; widespread choreo- athetosis or dystoniaAfter months or years of treatment (worse on withdrawal)Excess function of dopamine hypothesizedPrevention crucial; treat- ment unsatisfactory -### End" -4350,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dependency ratio includes -, with the following options: A: Less than 15 years, B: Less than 85 years, C: 30-50 years, D: None - -### Response: -Numerator in dependency ratio is age group less than 15 years (0-14 years) and more than 65 years. -### End" -4351,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 yr old girl with non productive cough, mild stridor for 3 months duration following a lower respiratory tract infection. Patient is improving but suddenly developed wheeze productive cough mild fever and hyperlucency on CXR and PFT shows obstructive curve. Diagnosis is:, with the following options: A: Bronchiolitis obliterans, B: Hemosiderosis, C: Pulmonary alveolar microlithiasis, D: Follicular bronchitis - -### Response: -Bronchiolitis obliterans is a rare chronic obstructive lung disease characterized by complete obliteration of the small airways following a severe insult. The most common form in children is postinfectious, following a lower airway tract infection with adenovirus, although influenza, rubeola, Bordetella, and Mycoplasma are also implicated. Persons with bronchiolitis obliterans usually experience dyspnea, coughing, and exercise intolerance. This diagnosis should be considered in children with persistent cough, wheezing, crackles, or hypoxemia persisting longer than 60 days following a lower respiratory tract infection. Chest radiograph abnormalities include evidence of heterogeneous air trapping and airway wall thickening.Ventilation-perfusion scans show a pattern of ventilation and perfusion mismatch. Pulmonary angiograms reveal decreased vasculature in involved lung, and bronchograms show marked pruning of the bronchial tree. Classic findings on chest high-resolution CT include a mosaic perfusion pattern, vascular attenuation, and central bronchiectasis. Suppoive care including supplemental oxygen for hypoxemia, routine vaccination, avoidance of environmental irritant exposure, exercise, and nutritional suppo should be provided. Ongoing airway damage due to problems such as aspiration should be prevented. Inhaled bronchodilators may reverse airway obstruction if the disease has a reactive component. Coicosteroids (inhaled, daily, or pulse dosing) may help reverse the obstruction or prevent ongoing damage. Ref: Federico M.J., Stillwell P., Deterding R.R., Baker C.D., Balasubramaniam V., Zemanick E.T., Sagel S.D., Halbower A., Burg C.J., Kerby G.S. (2012). Chapter 19. Respiratory Tract & Mediastinum. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e. -### End" -4352,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Correlation in height & weight are measured by-, with the following options: A: Coefficient of variation, B: Range of variation, C: Correlation coefficient, D: None - -### Response: -Ref:Parks 23rd edition pg 852 In order to find out whether there is significant association or not between the two variables , coefficient or Corelation is calculated . r lies between -1 and +1 r near -1 : indicates strong negative correlation . r = 0 : indicates no association r near +1: indicates strong positive correlation. Note: correlation does not necessarily prove causation . . -### End" -4353,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sites notorious for incised looking wound are all except:, with the following options: A: Chest, B: Zygoma, C: Iliac crest, D: Shin - -### Response: -A i.e. Chest -### End" -4354,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Knudson's two stage hypothesis is for-, with the following options: A: Glaucoma, B: Retinoblastoma, C: Optic glioma, D: Meningioma - -### Response: -*Deletion or inactivation of RB gene by two mutations (knudson's two hit hypothesis) results in occurence of retinoblastoma. Ref: Khurana 7th/e p.314. -### End" -4355,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a direct renin inhibitor?, with the following options: A: Aliskrein, B: Losartan, C: Perindopril, D: Vernakalant - -### Response: -Ref. GG I2!h edp.799 Explanation: Direct Renin Inhibitor DRIs are a novel class of antihypertensive drugs that inhibit the RAS at its origin. Angiotensinogen is the only specific substrate for renin, and its conversion to AngI presents a rate-limiting step for the generation of downstream components of the RAS. Aliskiren is a low-molecular-weight non-peptide that is a potent competitive inhibitor of renin. It binds the active site of renin to blocks the conversion of angiotensinogen to Ang I, thus reducing the consequent production of Ang II. Aliskiren has a 10.000-fold higher affinity to renin than to any other aspartic peptidases. The till is 20-45 hours. Plasma protein binding is 50% and is independent of concentration. Aliskiren is a substrate for P-glycoprotein (Pgp). which accounts for low absorption. Adverse Events- diarrhea, nasopharyngitis, cough (cough was much less common than with ACE inhibitors), elevated uric acid, renal stones, and gout. Like other RAS inhibitors, aliskiren is not recommended in pregnancy. Aliskiren reduces absorption of furosemide by 50%. Note: Vernakalant is an investigational multi-channel blocker that was developed for the treatment of atrial fibrillation. Adverse effects of vernakalant include dysgeusia (disturbance of taste), sneezing, paresthesia, cough, and hypotension. -### End" -4356,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A wave in ERG is due to activity of:, with the following options: A: Pigmented epithelium, B: Rods and cones, C: Ganglion cell, D: Bipolar cell - -### Response: -Ans. Rods and cones -### End" -4357,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of burns includes, with the following options: A: No bandage to head & neck, B: Immediate application of ice cold water, C: Superficial burns without blister-no need of dressing, D: Escharotomy done for peripheral circumscribed lesions - -### Response: -.SRB&;s manual of surgery,4th edition Initial Management of burns: Clothing should be removed Cooling of the pa by running water for 20minutes Cleaning the pa to remove dust,mud,etc Chemoprophylaxis-tt,antiseptics,etc Covering with dressings Comfoing with sedation amd pain killer -### End" -4358,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Axillary nerve is a branch of which pa of brachial plexus ?, with the following options: A: Trunk, B: Medial cord, C: Lateral cord, D: Posterior cord - -### Response: -Supraclavicular branches of brachial plexus Branches of brachial plexus which are above the clavicle are called supraclavicular branches. These arise from roots and trunks. -### End" -4359,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sporulation occurs in which phase of bacterial growth curve:, with the following options: A: Stationary phase, B: Lag phase, C: Log phase, D: Decline phase - -### Response: -Lag phase - Adaptation phase to culture media |sed Accumulate nutrient size Log(2)n - Exponential es in number Stationary phase - Sta of Accumulation of toxic metabolites = Dead Live -Sporulation occur in stationary phase (S-S) Decline: Complete accumulation of Toxin metabolites -### End" -4360,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Angiod streaks in the eyes are seen in -, with the following options: A: Pseudoxanthoma elasticum, B: Tendinous xanthoma, C: Xanthelasma, D: Eruptive xanthoma - -### Response: -Ans. is 'a' i.e., Pseudoxanthoma elasticum Angioid streaksAngioid streaks are dark brown pigmented streaks that radiate from the peripapillary retina into the macular and peripheral fundus.The streaks represent linear crack like dehiscences in Bruch's membrane.These are due to changes in the elastic tissue of Bruch's membrane and are frequently associated with more widespread degeneration of similar nature as in the elastic tissue of skin (pseudoxanthoma elasticum) or arterial walls.Nearly 50% of patients with angioid streaks have an associated systemic disease.Most common association of Angioid streaks is with age related degeneration of Bruch's membrane.Other diseases associated arePseudoxanthoma elasticumPaget's disease of boneEhler's Danlos syndromeSeveral hemoglobinopathies such as sickle cell disease.Complications associated with Angioid streaksRisk of choroidal rupture from even relatively mild eye trauma.Older patients with this disease are at risk of developing serous and hemorrhagic detachments of the retina as a consequence of subretinal neovascularization.T/TLaser photocoagulation of extra foveal neovascular membranes. -### End" -4361,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common pure germ cell tumour of the ovary :, with the following options: A: Choriocarcinoma, B: Dysgerminoma, C: Embryonal cell tumor, D: Malignant Teratoma - -### Response: -- dysgerminoma is the most common among the malignant germ cell tumors accounting for 40%. - affects children and young women. Reference : Textbook of gynaecology Sheila balakrishnan, 2nd edition, pg no: 283 -### End" -4362,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DOC for listeria meningitis:, with the following options: A: Ampicillin, B: Cefotaxime, C: Cefotriaxone, D: Ciprofloxacin - -### Response: -Ans. is 'a' i.e., Ampicillin Treatment of listeria infectiono The antibiotic of choice for listeria infection is ampicillin or penicillin G.Antibiotic regimens for listeria infection||||First line regimensPenicillin allergic patientsAlternative drugso Ampicillin or Penicillin is the drug of choiceo Trimethoprim sulphame- thoxazoleo Imipenem and meropenemo Other antibiotic that are less effective# Vancomycin# Erythromycin# Chloramphenicol -### End" -4363,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Design of the study aimed to assess the maximum tolerable dose of a new drug is?, with the following options: A: Case Control study, B: Phase II Randomized control trial (RCT), C: Phase I trial, D: Phase III Randomized control trial (RCT) - -### Response: -The highest dose of a drug that does not cause unacceptable side effects. It is determined in phase 1 clinical trials by testing increasing doses on different groups of people until the highest dose with acceptable side effects is found. Also called MTD. Pg.no.80 K D Tripathi Seventh edition -### End" -4364,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antibody found in patients of myaesthenia gravis is directed against, with the following options: A: Acetycholine, B: Acetycholine receptors, C: Acetycholine vesicles in nerve terminal, D: Actin-myosin complex of the muscle - -### Response: -*myasthenia gravis is an autoimmune disease,most commonly caused by antibodies to acetylcholine receptors in the post junctional membrane of the neuromuscular junction ,which are found in around 80%of affected patients. Ref Harrison20th edition pg 2378 -### End" -4365,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best therapy suited to teach daily life skill to a mentally challenged child-, with the following options: A: CBT (Cognitive Behaviour Therapy), B: Contigency, C: Cognitive reconstruction, D: Self instruction - -### Response: -B. i.e. Contingency -### End" -4366,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All can be executive magistrate except -, with the following options: A: Collector, B: Subcollector, C: Tehsildar, D: SSP - -### Response: -The executive magistrate is appointed by the state government; usually officers of Revenue Dept, District collector, Sub-collector or Tahasildar. REF: The Synopsis of Forensic Medicine and Toxicology 29th edition page no: 3. -### End" -4367,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following fluorinated anaesthetics corrodes metal in vaporizers and breathing systems ?, with the following options: A: Sevoflurane, B: Enflurane, C: Isoflurane, D: Halothane - -### Response: -In the presence of moisture halothane attacks metals (tin, brass and aluminum) in vaporisers and circuits. -### End" -4368,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urban malaria scheme is based on -, with the following options: A: Epidemiology surve, B: Anti-adult measures, C: Anti-larval measures, D: None - -### Response: -Ans. is 'c' i.e., Anti-larval measures The Urban malaria scheme was launched in 1971 under National Malaria Eradication programme with the aim to reduce the vector population in urban area through recurrent antilarval measures. o The main aim is the reduction of the disease to a tolerable level in which the human population can he protected from malaria transmission with the available means. o The urban malaria scheme aims at ? a) To prevent death due to malaria. b) Reduction of transmission and morbidity. o Norms include ? a) Town should have a minimum population of 50,000. b) The API should be 2 or above. c)The towns should promulgate and strictly implement the civic by laws to prevent/eliminate domestic and peridomestic breeding places. o Under the scheme, malaria control strategy comprise of - 1) Prasite control :- Treatment through passive agencies, e.g. hospitals, dispensaries both in private & public sectors. 2) Vector control :- It includes a) Source reduction :- Reduction of breeding places. b) Use of larvicides. c) Use of larvivorous fish Gambusia fish d) Space spray. -### End" -4369,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rain drop pigmentation is caused by -, with the following options: A: Clofazimine, B: Dapsone, C: Minocycline, D: Arsenic - -### Response: -Ans. is 'd' i.e., ArsenicDrugs causing hyperpigmentationDrugsType of pigmentationo Clofazimineo Psoralenso Minocyclineo Bleomycino Busulfano Cyclophosphamideo Dapsoneo ArsenicOrange pigmentationBrown pigmentationBlue black discoloration in healing acnelesions, shins & mucosaGeneralized hyperpigmentationGeneralized hyperpigmentationGeneralized hyperpigmentationRain drop pigmentation -### End" -4370,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Marfans Syndrome affecting eyes, skeletal system, and the cardiovascular system is caued by the mutation in the gene, with the following options: A: Fibrillin 1, B: Fibrillin 2, C: Fibulin, D: Elastin - -### Response: -Marfan Syndrome Is Caused by Mutations in the Gene for Fibrillin-1. It is inherited as an autosomal dominant trait. It affects the eyes (eg, causing dislocation of the lens, known as ectopia lentis), the skeletal system (most patients are tall and exhibit long digits and hyperextensibility of the joints), and the cardiovascular system (eg, causing weakness of the aoic media, leading to dilation of the ascending aoa). Abraham Lincoln may have had this condition. Most cases are caused by mutations in the gene (on chromosome 15) for fibrillin-1.Mutations in the fibrillin-1 gene have also been identified as the cause of acromicric dysplasia and geleophysic dysplasia, which are characterized by sho stature, skin thickening, and stiff joints. Congenital contractural arachnodactyly is associated with a mutation in the gene for fibrillin-2.Ref: Harper&;s Biochemistry; 30th edition; Chapter 50; The Extracellular Matrix -### End" -4371,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common location of hypeensive intracranial hemorrhage is, with the following options: A: Subarachnoid space, B: Basal ganglia, C: Cerebellum, D: Brainstem - -### Response: -The most common locations of hypeensive ICH are: 1) Basal ganglia (putamen or caudate), 2) Thalamus, 3) Pons and 4) Cerebellum. Within the basal ganglia region, it is rare for an ICH to specifically affect one area; Ref Harrison20th edition pg 2345 -### End" -4372,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 year old man develops hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration. An MRI of the brain demonstrates widespread areas of abnormal T2 signal in the white matter. An electroencephalogram is remarkable for diffuse slowing over both cerebral hemispheres. Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions. This patient's condition is most closely related to which of the following diseases?, with the following options: A: AIDS, B: Chickenpox, C: Measles, D: Syphilis - -### Response: -The condition is progressive multifocal leukoencephalopathy, which is a rapidly progressive demyelinating disorder in which the JC virus (a papovavirus) infects oligodendroglial cells in the brain. The eosinophilic inclusions represent accumulations of JC virus. PML occurs in about 1% of AIDS patients, and is the AIDS-defining illness in half of the patients who develop the condition. There is no effective treatment for this disorder. Shingles and post-infectious encephalitis can follow chickenpox, but varicella is not associated specifically with demyelination. Measles can cause an encephalitis, and in some cases, subacute sclerosing panencephalitis (SSPE) may follow previous measles infection. These disorders would affect not only white matter, but gray matter as well. Also, SSPE usually occurs before the age of 18. Syphilis can cause meningitis, encephalitis, and spinal cord damage, but the disease process would not be limited to the white matter. Ref: Brooks G.F. (2013). Chapter 44. AIDS and Lentiviruses. In G.F. Brooks (Ed),Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e. -### End" -4373,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best way to join cast titanium components, with the following options: A: Laser Welding, B: Oven Soldering, C: Torch Soldering, D: Infrared Soldering - -### Response: -Laser welding in an argon gas atmosphere is a method of choice for joining titanium components of dental prostheses, because the coherent, high-intensity laser pulse of light can be focused in a small region and melt the substrate without extensive microstructural damage to the surrounding areas. An advantage of welding is that the joint will be composed of the same pure titanium as the substrate components, thereby preserving the excellent biocompatibility potential of CP Ti.  -Phillip’s 12th edition page 392 -### End" -4374,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following act as a means of transmission of HIV infection in newborn –, with the following options: A: Transplacental, B: Breast feeding, C: During delivery, D: All of these - -### Response: -Maternal-fetal / infant transmission                                                           - -The probability of transmission of HIV from mother to infant/fetus ranges from 15 to 25% in industrialized countries and from 25 to 35% in developing countries. -HIV can be transmitted from mother to fetus/infant in the following ways : - -a) In utero (During pregnancy) -b) During delivery (Perinatal) → Most common -c) After birth by breastfeeding → Least common. - -Firstborn twin is more commonly infected than the second twin. -Cesarean section results in decreased transmission to the infant. -Vit. A deficiency increases the risk of transmission. -The major risk factor of transmission is the presence of a high maternal level of plasma viremia. -### End" -4375,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fournier's gangrene is seen in: September 2008, with the following options: A: Scrotum, B: Shaft of penis, C: Base of penis, D: Glans penis - -### Response: -Ans. A: Scrotum Idiopathic scrotal gangrene/Fournier's gangrene is an uncommon condition of the scrotum. Hemolytic streptococci are associated with other organisms (Staph., E.coli etc.) in a fulminating inflammation of the subcutaneous tissues, which results in obliterative aeritis of the aerioles to the scrotal skin. -### End" -4376,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following nerves shows the presence of pseudoganglion near its termination?, with the following options: A: Ulnar nerve, B: Anterior interosseous nerve, C: Posterior interosseous nerve, D: Superficial terminal branch of radial nerve - -### Response: -Pseudoganglion is one in which there is no nerve cells but only nerve fibres are present. Pseudoganglia have been noted most often along nerve to teres minor, posterior interosseous nerve, lateral terminal branch of deep peroneal nerve. Posterior interosseous nerve, on the dorsum of hand terminates in a pseudoganglion, from which branches are given off to distal radioulnar joint, wrist joint, intercarpal and carpometacarpal joints. -### End" -4377,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tongue muscles develops from:, with the following options: A: Occipital somites, B: Hypobranchial eminence, C: Neural crest cells, D: Pharyngeal pouches - -### Response: -Tongue muscles develop from occipital myotomes and are innervated by the hypoglossal nerve. -One tongue muscle (palatoglossus) develops in pharyngeal arch mesoderm. -### End" -4378,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are characteristics of complex febrile seizures EXCEPT?, with the following options: A: Focal seizures, B: Recurrent seizures within the same febrile illness, C: Generalised seizures, D: Duration > 15 minutes - -### Response: -Types of febrile seizures: -### End" -4379,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are essential criteria for defining perinatal asphyxia EXCEPT?, with the following options: A: Persistence of APGAR score of 5-7 for >5 minutes, B: Prolonged umbilical aerial blood pH <7.0, C: Presence of neurological manifestations in the immediate neonatal period, D: Evidence of multiorgan dysfunction in the immediate neonatal period - -### Response: -Essential criteria for defining perinatal asphyxia include: Persistence of APGAR score of 0-3 for >5 minutes Prolonged acidemia (pH <7.0) on an umbilical aerial blood sample Neurological manifestations, e.g. seizures, coma, hypotonia or hypoxic ischemic encephalopathy (HIE) in the immediate neonatal period Evidence of multiorgan dysfunction in the immediate neonatal period -### End" -4380,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In this child Which of the following enzymes is likely to be deficient?, with the following options: A: HGPRTase, B: Adenosine deaminase, C: APRTase, D: Acid maltase - -### Response: -Ans. A. HGPRTaseSlide 1 showing nibbling of lips and fingers; slide 2 showing bite marks on hand inflicted by self. Self-mutilation seen in Lesch Nyhan Syndrome; characteristic of the disease in children.Clinical signs and symptoms seen in Lesch Nyhan Syndrome:a. Biochemical: Hyperuricemia, can result ini. Gout (Joint pains)ii. Nephrolithiasis (abdominal pain, may be radiating in nature)iii. Tophib. Neurological:i. Mental Retardation (Poor performance in school)ii. Dystonia, variablec. Neuropsychiatric:i. Aggressive Behaviour (frequent fight, quarreling with siblings)ii. Self-Mutilation Tendency (associated with muscle loss; biting, chewing, etc.)d. Inheritance is XLR, enzyme absent is HGPRTase; in some patient, where the enzyme is not absent, but only diminished, have a less severe condition called Kelley Seegmiller Syndrome, where neurological and neuropsychiatric symptoms are either absent or very mild. -### End" -4381,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Binocular single vision is tested by ?, with the following options: A: Amsler grid, B: Synoptophore, C: Maddox rod, D: Cardboard test - -### Response: -Ans. is 'b' i.e., Synoptophore Grades of binocular single vision There are three grades of binocular single vision, which are best tested with the help of a synoptophore. 1. Grade-I - Simultaneous perception It is the power to see two dissimilar objects stimultaneously. It is tested by projecting two dissimilar objects (which can be joined or superimposed to form a complete picture) in front of the two eyes. For example, when a picture of a bird is projected onto the right eye and that of a cage onto the left eye, an individual with presence of simultaneous perception will see the bird in the cage. 2. Grade-II - Fusion It consists of the power to superimpose two incomplete but similar images to from one complete image. The ability of the subject to continue to see one complete picture when his eyes are made to converge or diverge a few degrees, gives the positive and negative fusion range, respectively. 3. Grade-III - Stereopsis It consists of the ability to perceive the third dimension (depth perception). It can be tested with stereopsis slides in synoptophore. -### End" -4382,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about glomangioma -, with the following options: A: Usually subungal, B: More common in hands and feet, C: Thrombosis can occur, D: Most common type of glomus tumor - -### Response: -Glomangioma or glomus tumor is most common in the distal poion of digits that is subungal. ROBBINS BASIC PATHOLOGY. 7th edition. Chapter Blood vessels. page no. 547. -### End" -4383,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stimulant purgatives are contraindicated in the following:, with the following options: A: Bed ridden patients, B: Before abdominal radiography, C: Subacute intestinal obstruction, D: All of these - -### Response: -(Ref: KDT 6/e p655) Stimulant (or irritant) purgatives are contra-indicated in pregnancy and intestinal obstruction (both subacute as well as chronic). -### End" -4384,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle of neck with dual nerve supply, with the following options: A: Sternohyoid, B: Thyrohyoid, C: Digastric, D: Stylohyoid - -### Response: -Digastric muscle Digastric has two bellies United by an intermediate tendon. NERVE SUPPLY; anterior belly by nerve to mylohyoid, facial nerve. ACTIONS; 1. Depresses mandible is opened widely or against resistance it is secondary to lateral pterygoid. 2. Elevates hyoid bone. Ref BDC volume 3;6th edition -### End" -4385,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6-year-old presented to the clinic with scaly patches on the scalp. Primary smears and culture of the skin ,hair were negative. A few weeks later. She returned and was found to have inflammatory lesions. The hair were fluoresced under Wood's light. Primary smears of skin and hair demonstrated Septate hyphae. On speaking with the parent, it was discovered that there were several pets in the household. Which of the following is the most likely agent?, with the following options: A: Epidermophyton floccosum, B: Microsporum audouinii, C: Microsporum canis, D: Trichophyton rubrum - -### Response: -The reservoir host is the animal in the above mentioned case-Zoophilic - Microsporum canis On the basis of natural habitat, dermatophytes are classified into three groups: Geophilic: Found in soil Zoophilic: found in domestic or wild animals Anthropophilic: found exclusively in humans Dermatophytes Geophilic Zoophilic Anthropophilic T. ajelloi T. equinum T. mentagrophytes var interdigitale t. terresre T. mentagrophytes var. mentagrophytes T. rubrum M. gypseum T. verrucosum T. schoenlenii M. nanum M. canis T. tonsurans E. stockdaleae T. violaceum -### End" -4386,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best investigation for multiple osteoblastic bone metastases is-, with the following options: A: MRI, B: CT, C: Bone Scan, D: X Ray - -### Response: -Ans. is 'c' i.e., Bone scan o Bone scan (scintigraphy) is the investigation of choice for multiple osteoblastic bone metastasis. Investigations in musculoskeletal system o Investigation of choice for AVN Hip - MRI o Best initial test for osteomyelitis - Plain x-ray o Best second line test for osteomyelitis (if there is high clinical suspician and x-ray is negative) - MRI o Most accurate diagnostic test for osteomyelitis - Bone biopsy and culture, o Best view for scaphoid fracture - Oblique (scaphoid) view of wrist. o Best view for C1-C2 vertebrae & junction - Open mouth odontoid (Pegs) view. o Investigation of choice for ACL & PCL injury' - MRI o Investigation of choice to detect calcification - CT scan o Investigation of choice for prolapsed intervertebral disc - MRI o Investigation of choice for spinal tuberculosis - MRI o Investigation of choice for traumatic paraplagia - MRI o Investigation of choice in intramedullary space occupying lesion (SOL) - MRI o Investigation of choice for bone metastasis - Bone scan o Gold standard and investigation of choice for osteoporosis (Bone density') - Dual energy x-ray absorptiometry (DEXA) . -### End" -4387,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metabolically most active layer of cornea is:, with the following options: A: Endothelium, B: Stroma, C: Descemet's membrane, D: Epithelium - -### Response: -Ans. Epithelium -### End" -4388,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Procelain gallbladder except, with the following options: A: May be seen on plain X-Ray, B: More commonly diagnosed on CT, C: It is an indication for cholecystectomy, D: Always denotes benign etiology - -### Response: -Procelain Gallbladder Characterized by extensive encrustation of GB wall. Term Procelain gallbladder has been used to emphasise the blue discolouration and brittle consistency of GB wall at surgery Clinical features : Most(90%) are associated with gallstones Mean age of patients is 54 years (38-74 years) Patients are usually asymptomatic and the condition is usually found incidentally on plain abdominal radiographs, sonograms or CT images High frequency association (10%) is with GB adenocarcinoma Surgery should not be delayed even if patient is asymptomatic, because the occurrence of carcinoma is remarkably high Ref: Sabiston 20th edition Pgno :1512 -### End" -4389,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female 35 years P3 L3 with CIN III on colposcopic biopsy what would you do?, with the following options: A: LEEP, B: Conization, C: Hysterectomy, D: Cryotherapy - -### Response: -Ans. is a, i.e. LEEPRef: CGDT 10th/ed, p840; Jeffocate 7th/ed, p421Loop Electrosurgical Excision Procedure (LEEP) has now become the procedure of choice for treating CIN II and CIN III in all age groups. Therefore in this patient we will go for LEEP. -### End" -4390,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which hormone is secreted from stomach that control intake of food, with the following options: A: Orexin, B: Insulin like growth hormone, C: Cholecystokinin, D: Ghrelin - -### Response: -Ghrelin inhibits the satiety centre and is released from stomach and hypothalamus. It also stimulates release of Growth hormone. -### End" -4391,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ranitidine differs from cimetidine in the following respec:, with the following options: A: It is less potent, B: It is shoer acting, C: It does not have anti-androgenic action, D: It produces more CNS side effects - -### Response: -(Ref: KDT 6/e p629) Cimetidine is rarely used now because: It is the leat potent H2 blocker It is a sho acting agent It is a potent inhibitor of microsomal enzymes It can cause gynaecomastia It produces more CNS adverse effects -### End" -4392,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the coagulation factor is least affected in a patient with vitamin K deficiency?, with the following options: A: Factor 10, B: Factor 9, C: Factor 8, D: Factor2 - -### Response: -Factor VIII Patient with vitamin K deficiency will have mostly involvement of dependent clotting factors. I.e. Factors II, VII, IX & X -### End" -4393,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The line joining ant. sup iliac spine to ischial tuberosity and passes a greater trochanter, with the following options: A: Nelaton's line, B: Showmakers line, C: Chiene's line, D: Perkins line - -### Response: -Ans. is 'a' i.e Nelaton's line Maheshwari 3/e p 310(2/e, p299)] Nelaton's line : With the hip in 90 degrees of flexion, a line joining the ASIS and ischial tuberosity passes through the tip of the greater trochanter on that side. In cases of subtrochanteric shortening, the trochanter will be proximal to this line. Shoemaker's line: With the patient lying supine, the line joining AS1S and tip of the greater trochanter is extended on the side of the abdomen on both sides. Normally these lines meet in the middle above the umbilicus. In case one of the greater trochanters has migrated proximally the lines will meet in the opposite side of the abdomen and below the umbilicus. Chiene's line : With the patient lying supine, lines are drawn joining the two AS1S and the two greater trochanters. Normally these make two parallel lines. In case one of the trochanters has moved proximally the lines will converge on that side. Perkin's line : When the cong. Dislocation of the hip is mild in nature, the Perkins lines are drawn to detect it. A horizontal line is drawn through the triradiate cartilage and a vertical line is drawn down from the outer edge of the acetabulum on both sides. The upper femoral epiphyses normally lies medial to the vertical line and below the horizontal line. But in cong. dislocation of hip the epiphyses will lie on the outer aspect of the vertical line and above the horizontal line. Bryant's triangle : The patient lies supine. The tips of the greater trochanter and ASIS on both sides are marked. A perpendicular is dropped from each ASIS on to the bed. From the tip of the greater trochanter, another perpendicular is dropped on to the first one. The tips of the greater trochanter are joined to the ASIS on the respective side. This forms a triangle ABC. The side BC of the triangle measures supra trochanteric shortening of hip. -### End" -4394,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Politzer bag maneuver used to test:, with the following options: A: Eustachian tube, B: Larynx, C: Esophagus, D: Nasal cavity - -### Response: -Politzer bag maneuver used to test Eustachian tube Designed for those who can`t perform Valsalva test Politzer bag is connected to rubber tube- Tube is placed in one nostril and other is closed-Air is blown with pressure by pressing the bulb-Air enters nasopharynx - opens eustachian tube & enters middle ear- pops out TM -### End" -4395,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: a patient of age 23 yrs who is studying abroad visited his hometown , after 3days patient developed high grade fever of 103F for which he took acetaminophene .next day patient complained of myalgias ,cough and mild sob grade 1 . he was taken to nearest hospital where a nasopharyngeal swab is taken and patient tested covid positive , which of the folowing false regarding the patints next step of management ?, with the following options: A: sta on DOXYCYCLINE 100MG, B: Sta on IVERMECTIN 12MG, C: DEXAMETHASONE IS USED, D: HCQ + AZITHROMYCIN - -### Response: -DIAGNOSIS : COVID""19 POSITIVE management : mild = doxycycline 100mg bd 5 days, ivermectin 12 mg stat, multivitamin and vitamin c and zinc moderate = doxycycline 100mg bd 5 days, ivermectin 12 mg 3days , multivitamin and vitamin c and zinc,dexamethasone 4mg ,O2 insufflation if spo2 is less than 90% severe : all the above with remedisivir and icu NIV management is done ref: ncbi.gov.in / www.fda.gov/ -### End" -4396,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Genetic studies of a patient is positive for products of mic-2 gene. He may have the following condition:, with the following options: A: Ewing's sarcoma, B: Osteosarcoma, C: Dermatofibroma protuberans D. Alveolar cell sarcoma, D: Alveolar cell sarcoma - -### Response: -The presence of p30/32, the product of the mic-2 gene (which maps to the pseudoautosomal region of the X and Y chromosomes) is a cell-surface marker for Ewing's sarcoma (and other members of the Ewing's family of tumors, sometimes called PNETs). Glycogen-filled cytoplasm detected by staining with periodic acid-Schiff is also characteristic of Ewing's sarcoma cells. The classic cytogenetic abnormality associated with this disease (and other PNETs) is a reciprocal translocation of the long arms of chromosomes 11 and 22, t(11;22), which creates a chimeric gene product of unknown function with components from the fli-1 gene on chromosome 11 and ews on 22. Ref: Patel S.R., Benjamin R.S. (2012). Chapter 98. Soft Tissue and Bone Sarcomas and Bone Metastases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -4397,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The number of tonsillar crypts is usually:, with the following options: A: 5-Feb, B: 15-Dec, C: 50-100, D: 1500-3000 - -### Response: -Tonsillar crypts are pockets or folds that occur naturally in the tonsils. The average adult tonsil has anywhere from 10 to 20 crypts. Crypts in the tonsils are usually small and debris free -### End" -4398,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A thiy year old male presents to the emergency depament with symptoms of epigastric pain radiating to back. He gives a history of epigastric pain that wakes him up at nights and is relieved by consuming food. His past history reveals past 2 episodes of perforated duodenal ulcers which were treated with omental patch surgeries. Pain before and after the surgery has been controlled with proton pump inhibitors and analgesics. The likely diagnosis on this occasion is:, with the following options: A: Gastric ulcer, B: Atrophic gastritis, C: Duodenal ulcer, D: Chronic pancreatitis - -### Response: -Ans is 'c' i.e. Duodenal ulcer Epigastric pain that awakens the patient at nights, and is relieved by food suggests a diagnosis of duodenal ulcer. Gastric ulcer pain is usually exacerbated by food and does not awaken the patient at nights. ""Traditionally pain relieved by food is duodenal and pain exacerbated by food is gastric""- Clinical history taking and examination by Wels 2/e p49. ""Two thirds of patients with duodenal ulcers will complain of pain that awakens them from sleep. The pain of gastric ulcer more commonly occurs with eating and is less likely to awaken the patient at night.""- Schwaz 9/e p913 The pain of peptic ulcer disease is typically non radiating, burning in quality and located in epigastrium. Radiation to back, as in this patient, is usually a sign of penetration of posterior wall ulcer into the pancreas. This patient gives a history of perforated duodenal ulcers for which he was operated and omental patching done. He is having recurrence as adequate treatment has not been done. He should have been treated for H. pylori infection; either empirically or after confirmation of infection. If despite adequate H. pylori infection or in absence of H. pylori infection if patient is having recurrence, he should be put on lifelong proton pump inhibitors. Schwaz writes - ""Patients hospitalized for ulcer complications should receive PPI by continuous IV infusion and, when discharged, should be considered for lifelong PPIs unless the definitive cause is eliminated or a definitive operation performed."" -### End" -4399,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are the effects of gestational diabetes on fetus EXCEPT:, with the following options: A: Macrosomia, B: Hypoglycemia, C: Congenital malformations, D: Increased Perinatal Moality - -### Response: -Hypoglycemia REF: Current Diagnosis & Treatment Obstetrics & Gynecology, 10th edition chapter 18, Willians 22nd edition Table 52-8, http://en.wikipedia.org/wiki/Gestational diabetes (Note: Chromosomal abressions are not seen in gestational diabetes but congenital malformations are seen) Neonates of diabetic mother are at an increased risk of low blood glucose (hypoglycemia), jaundice, high red blood cell mass (polycythemia) and low blood calcium (hypocalcemia) and magnesium (hypomagnesemia) The fetus continues to experience the effects of hyperglycemia beyond the period of organogenesis. Whereas glucose crosses the placenta, insulin does not, leading to increased fetal production of insulin to compensate for its hyperglycemic environment. Higher insulin levels promote increased fetal somatic growth, leading not only to macrosomia and central fat deposition but also to enlargement of internal organs such as the hea. CONGENITAL MALFORMATIONS IN INFANTS OF WOMEN WITH DIABETES Anomaly Ratios of Incidencea Caudal regression Situs inversus Spina bifida, hydrocephaly, or other central nervous system defect Anencephaly 252 84 2 3 Hea anomalies Atrial septal defects Ventricular septal defects Transposition of the great vessels Coarctation of the aoa Tetralogy of Pallot Truncus aeriosus Dextrocardia Cardiomegaly 4 Anal/rectal atresia 3 Renal anomalies 5 Agenesis 4 Cystic kidney 4 Duplex ureter 23 'Ratio of incidence is in comparision with the general population. -### End" -4400,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following genes is associated with Xp11 translocation carcinoma variant of renal cell carcinoma?, with the following options: A: VHL, B: TFE3, C: MET, D: TSC1 - -### Response: -Xp11 translocation Carcinoma: It is a rare genetically distinct subtype of renal cell carcinoma. More common in children. TFE3 gene located at Xp11.2 locus is involved The neoplastic cells consist of clear cytoplasm with a papillary architecture. VHL is associated with clear cell RCC. MET is associated with hereditary papillary RCC. TSC1 is associated with renal angiomyolipoma. -### End" -4401,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eisenmenger syndrome is characterized by all except -, with the following options: A: Return of left ventricle & right ventricle to normal size, B: Pulmonary veins not distended, C: Pruning of peripheral pulmonary aeries, D: Dilatation of central pulmonary aeries - -### Response: -Ans. is 'a' i.e., Return of left ventricle and right ventricle to normal size Eisenmenger syndrome is associated with severe pulmonary aerial hypeension and right ventricular hyperophy. The right ventricular size will ceainly not return to normal once eisenminger syndrome develops. Chest X-ray in Eisenmenger syndrome o Dilated and prominent central aeries. o Rapid tapering (pruning) of the peripheral pulmonary vasculature. o The hilar (central) area suggests pulmonary plethora whereas the peripheral lung fields suggest pulmonary oligemia. Clinical manifestations of Eisenmenger syndrome o Symptoms ---> Cyanosis (Differential cynosis in PDA), fatigue, effo intolerance and dyspnea. o Physical examination Cyanosis and clubbing Parasternal impulse (more in ASD) Palpable P2 Wide and fixed splitting of S, in ASD Pulmonary regurgitation murmur. Normal splitting of S2 in PDA Ejection systolic murmur (pulmonic). Single S2 or paradoxical splitting in VSD ECG Right ventricular hyperophy with right axis detion. 'P' pulmonale. -### End" -4402,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Salivary gland stone is most common in which salivary gland?, with the following options: A: Parotid gland, B: Submandibular gland, C: Sublingual gland, D: Minor salivary gland - -### Response: -Ans is 'b' i.e., Submandibular gland * Eighty per cent of all salivary stones occur in the submandibular glands because their secretions are highly viscous.* Eighty per cent of submandibular stones are radio-opaque and can be identified on plain radiography -### End" -4403,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve involved in fracture surgical neck humerus is which of the following?, with the following options: A: Axillary nerve, B: Ulnar nerve, C: Musculocutaneous nerve, D: Radial nerve - -### Response: -Ans. a (Axillary nerve). (Ref. Maheshwari, Orthopaedics, 2nd ed., 75)Axillary nerve may be damaged by dislocation of the shoulder or by the fracture of surgical neck of humerus causing:# Deltoid is paralysed with loss of power of abduction at shoulder.# The rounded contour of shoulder is lost & greater tubercle of humerus becomes prominent.# There is sensory loss over, the lower half of deltoid.Also remember:Posterior interosseous nerve (PIN) passes around the radial neck and supplies the extensor compartment. PIN supplies all extensors except brachioradialis, ECRB, ECRL. PIN injury may occur after management of radial head fractures. -### End" -4404,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of dementia is :, with the following options: A: Vitamin B12, B: Parkinsonism, C: Alzheimer's disease, D: Road traffic accidents - -### Response: -Alzheimer's disease is the most common cause of dementia. -### End" -4405,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Osler's nodes are typically seen in which one of the following:, with the following options: A: Chronic candida endocarditis, B: Acute staphylococcal endocarditis, C: Pseudomonas endocarditis, D: Libman sack's endocarditis - -### Response: -Osler's nodes and subungual hemorrhage in infective endocarditis are caused by septic embolisation, and septic embolisation is more common in patients with acute S. aureus endocarditis. In endocarditis caused by S. aureus, vegetations are >10 mm in diameter and infection involving the mitral valve are independently associated with an increased risk of embolization. Ref: Harrisons principles of internal medicine, 18th edition, Page: 1054 -### End" -4406,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common development cyst of jaws is, with the following options: A: Periapical cyst, B: Eruption cyst, C: Calcifying odontogenic cyst, D: Dentigerous cyst - -### Response: -Most common odontogenic cyst is periapica/l Radicular cyst -Most common developmental odontogenic cyst is dentigerous cyst -### End" -4407,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which case pneumococcal vaccine is most effective:, with the following options: A: When given preoperatively, B: When given post operatively, C: Against all strains of bacteria, D: Against gram negative bacteria - -### Response: -Ans is 'a' ie When given preoperatively ""Timing of vaccination generally is accepted as a minimum of 2 weeks before planned elective splenectomy and within 7 to 10 days after unplanned or emergent splenectomy, although data supporting this practice are lacking."" -- Schwartz 9/e ""Pneumococcal vaccine should be administered to all patients 2 weeks before elective splenectomy. Harrison 17/eIf the spleen is removed in emergency (eg. following trauma), vaccination should be given as soon as possible following surgery.Booster injection of pneumococcal vaccine should be given every 5 to 6 years.Other vaccines advisable in splenectomy pts: vaccines to Neisseria meningitides, Haemophilus influenza type b -### End" -4408,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Elevated CA-125 are seen in -, with the following options: A: Abdominal TB, B: Ca cervix, C: Endometriosis, D: Ovarian ca - -### Response: -Harshmohan textbook of pathology 7th edition. *ca 125 is a tumor marker for ovarian cancer. -### End" -4409,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The sigma (s) subunit of prokaryotic RNA polymerase, with the following options: A: Binds the antibiotic rifampicin, B: Is inhibited by a-amanitin, C: Specifically recognizes the promoter site, D: Is pa of the core enzyme - -### Response: -prokaryotic RNA polymers contain 2 alpha subunit, 2 beta subunit, 1 omega subunit, 1 sigma subunit and 2 zinc molecules Beta subunit fixes at the initiation siteThe sigma factor recognizes the promoter site and the affinity of the holoenzyme to the promoter siteRef: DM Vasudevan, 7th edition, page no: 589 -### End" -4410,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about Rheumatoid Factor is true -, with the following options: A: It is an IgM antibody directed against IgG, B: It is an IgG antibody directed against IgM, C: It is more specific than Anti-CCP antibodies, D: It is positive in all cases of Juvenile Rheumatoid Arthritis - -### Response: -Rheumatoid factor in Rheumatoid Arthritis is an IgM antibody directed against the Fc fragment of IgG -Anti CCP antibodies are most specific blood test for rheumatoid arthritis (specificity ∼ 95%). -Rheumatoid factor is positive in only 10% of patients with JRA. -### End" -4411,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is live attenuated vaccine, with the following options: A: OPV, B: DT, C: TAB, D: TT - -### Response: -Ans) a (OPV) Ret Park 20th ed p 180Another simple question regarding immunization.OPV is a live attenuated vaccine. DT and TT are toxoidTAB is a heat killed Typhoid bacillus vaccine -### End" -4412,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a population of 5000, incidence of disease is 100 in 1 year duration of disease studied for is 2 years calculate Prevalence -, with the following options: A: 20/1000, B: 40/1000, C: 80/1000, D: 400/1000 - -### Response: -Incidence = No. of disease person / Population at risk x 1000 = 100/5000 = 1000 = 20 per one thousand per year  -Prevalence = I x D = 20 x 2 = 40 per one second -### End" -4413,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: S100 is a marker used in the diagnosis of all Except, with the following options: A: Melanoma, B: Schwannoma, C: Histiocytoma, D: Basal cell cancer - -### Response: -Acidic protein, 100% Soluble in ammonium sulfate at neutral pH (derivation of name) S100 protein family is multigenic group of nonubiquitous cytoplasmic EF-hand Ca2+-binding proteins, sharing significant structural similarities at both genomic and protein levels; S100 protein family has 24 known human members each coded by a separate gene; at least 19 on chromosome 1q21 Helps regulate cell contraction, motility, growth, differentiation, cell cycle progression, transcription and secretion Structurally similar to calmodulin -### End" -4414,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Waves seen in EEG during stage 4- NREM period of sleep is:, with the following options: A: Alpha, B: Beta, C: Delta, D: Theta - -### Response: -- REM sleep shows - b waves - so, called as paradoxical sleep. (because even though the person is asleep, the waves of ale wakefulness-b waves are recorded)- NREM sleep - 4 stages* Stage I - Superficial stage - eyes closed & person is in sleep latency - a waves are seen* Stage II - Sleep spindles & large K - complexes are seen * Stage III - Theta waves are seen. * Stage IV - Deeper stages of sleep - delta waves are seen -### End" -4415,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of alpha thalassemia:, with the following options: A: Deletion of alpha genes, B: Deletion of beta genes, C: Excess of alpha genes, D: Single amino acid substitution in alpha chain - -### Response: -Ans. a. Deletion of alpha genesCause of alpha thalassemia is deletion of alpha genes.""The a-thalassemias are caused by inherited deletions that result in reduced or absent synthesis of a-globin chains.Normally, there are four a-globin genes, and the severity of a-thalassemia depends on how many a-globin genes are affected. As in b-thalassemias, the anemia stems both from a lack of adequate hemoglobin and the effects of excess unpaired non-a. chains (b, g, and d), which vary in type at different ages. In newborns with a-thalassemia, excess unpaired g-globin chains form g4 tetramers known as hemoglobin Barts, whereas in older children and adults excess b-glohin chains form b4 tetramers known as HbH. Since free b and g chains are more soluble than free a chains and form fairly stable homo tetramers, hemolysis and ineffective erythropoiesis are less severe than in b-thalassemias. A variety of molecular lesions give rise to a-thalassemia, but gene deletion is the most common cause of reduced a -chain synthesis. ""- Robbins 9/e p64Ia-THALASSEMIASClinical SyndromesGenotypeClinical FeaturesMolecular GeneticsSilent carrier-/a a/aAsymptomatic; no red cell abnormalityMainly gene deletions0a-Thalassemia trait-/- a/a (Asian)Asymptomatic, like b-thalassemia minor -/a -/a (black African, Asian) HbH disease-/- -/aSevere; resembles b-thaiassemia intermedia Hydrops fetalis-/- -/-Lethal in utero without transfusions -### End" -4416,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common site of osteoma is( REPEAT QUESTION), with the following options: A: Maxillary sinus, B: Ethmoidal sinus, C: Frontal sinus, D: Sphenoid sinus - -### Response: -Most osteomas are asymptomatic and are found incidentally when imaging the sinuses either for sinonasal symptoms or for unrelated complaints. Osteomas are frequently seen elsewhere in the head and neck paicularly the mandible and outer table of the skull vault. There is a paicular frequency distribution within the paranasal sinuses: frontal sinuses: 80%; ethmoid air cells: ~15%; maxillary sinuses: ~5 %; sphenoid sinus: rare. Osteomas are most commonly seen in the frontal sinus followed in turn by those of ethmoid and maxillary. They may remain asymptomatic, being discovered incidentally on X rays. Treatment is indicated when they become symptomatic, causing obstruction to the sinus sodium, formation of a mucocele, pressure symptoms due to their growth in the orbit, nose or cranium. (Ref: Textbook of Diseases of ENT, PL Dhingra, 7th edition, pg no. 231) -### End" -4417,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45-year-old man is admitted to the hospital for the evaluation of diplopia, weakness of his lower extremities, and gait difficulties. During the interview, the patient reveals that he has been forcing himself to vomit after almost every meal over the last 6 weeks. He denies associated eye pain and discomfo, headache, or dysphagia. He has never experienced such symptoms in the past. Examination of the patient demonstrates slight disorientation, veical nystagmus worse on downgaze, diffuse weakness of the lower extremities, bilateral dysmetria, and hypothermia. Laboratory analyses reveal mild dehydration and hypokalemia. The patient's status has improved after an administration of a vitamin. The physiologically active form of this vitamin acts as a coenzyme for which of the following enzymes?, with the following options: A: Glycogen phosphorylase, B: L-methylmalonyl-CoA mutase, C: Methionine synthase, D: Pyruvate dehydrogenase - -### Response: -Thiamine (vitamin B1) is conveed intracellularly to its active form, thiamine pyrophosphate, which is an essential cofactor in intermediate carbohydrate metabolism. Thiamine acts as a coenzyme for enzymes involved in the tricarboxylic acid cycle, which plays a critical role in the production of energy from food, and the pentose-phosphate pathway, which produces an impoant intermediate, ribose-5-phosphate, required for the synthesis of ATP, GTP, DNA, RNA, and NADPH. The brain is paicularly vulnerable to thiamine deficiency because it relies exclusively on carbohydrates for immediate energy demands. The selective vulnerability of ceain structures accounts for the specific clinical manifestations of Wernicke encephalopathy. Thiamine pyrophosphate (TPP), the physiologically active form of thiamine, is required for the activity of pyruvate dehydrogenase (PDH). PDH catalyzes oxidative decarboxylation of pyruvate to acetyl-CoA, regulating entry into the citric acid cycle for metabolites leaving glycolysis. The PDH complex is comprised of 3 separate enzymes: pyruvate dehydrogenase (decarboxylase), dihydrolipoamide transacetylase and dihydrolipoamide dehydrogenase. Besides TPP, the complex also requires CoA, NAD, FAD, and lipoic acid as coenzymes. The mechanism of TPP action includes formation of a carbanion that can attack the electron-deficient keto carbon of pyruvate. In addition, TPP functions as a coenzyme for alpha-ketoglutarate dehydrogenase and transketolase. Pyridoxal phosphate serves as a coenzyme for glycogen phosphorylase. Vitamin B12 acts as a cofactor of L-methylmalonyl-CoA mutase, which catalyzes conversion of L-methylmalonyl-CoA to succinyl-CoA. Methionine synthase activation leads to synthesis of methionine from homocysteine with folic acid as a coenzyme. -### End" -4418,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MCHC criteria to diagnose iron deficiency anemia:, with the following options: A: <32, B: <34, C: <28, D: <30 - -### Response: -MCHC - average concentration of hemoglobin in a given volume of packed red cells Normal MCHC is 34-37g/dl Value <34g/dl indicate that red cells are hypochromic, which can occur in iron deficiency anemia. -### End" -4419,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Barr body is not present in female having- (PGMEE 2012-13), with the following options: A: 46 XX genome, B: 45 XO genome, C: 47 XXX, D: All of the above - -### Response: -In Turner syndrome (45, XO),one of the X-chromosome is missing in a female. This is the most lethal karyotype. It is only monosomy of sex chromosome in humans. There are 45 chromosomes instead of 46 in a normal individual. Phenotype Genotype Barr bodies Normal Male XY 0 (Normal) Normal Female XX 1 (Normal) Turner Syndrome X0 0 (Female with no Barr Body) Klinfelter Syndrome XXY 1 (Male with Barr Body) Super Female XXX 2 (Female with two Barr Bodies) No. of Barr bodies = no. of x chromosome - 1 Since in XO genotype there is 1 x chromosome. Therefore, no. of barr bodies is 1-1=0 -### End" -4420,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following statements regarding water re-absorption in the tubules is True?, with the following options: A: The bulk of water re-absorption occurs secondary to Na+ re-absorption, B: Majority of facultative re-absorption occurs in proximal tubule, C: Obligatory re-absorption is ADH dependent, D: 20% of water is always re-absorbed irrespective of water balance - -### Response: -Changes in sodium re-absorption significantly influence the re-absorption of water. Ref: Textbook of Medical Physiology By Guyton, 10th Edition, Page 299 -### End" -4421,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for acute severe migraine is, with the following options: A: NSAID, B: Beta blockers, C: Sumatriptan, D: Caffeine - -### Response: -Acute migraine is a general term for migraines that aren't diagnosed as chronic. Another name for this type is episodic migraine.People who have episodic migraines have headachesup to 14 days a month. Thus, people with episodic migraines have fewerheadaches a month than people with chronic ones. Triptans are drugs of choice for severe migranes along with NSAIDs . Ref: KD Tripathi 8th ed. -### End" -4422,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Complications of diabetes in pregnancy Includes all except, with the following options: A: Macrosomia, B: Shoulder dystocia, C: Hyperglycemia in newborn, D: lUGR - -### Response: -FETAL AND NEONATAL HAZARDS Fetal Macrosomia (40-50%) due to Maternal Hyperglycemia and Elevation of maternal free fatry acids. Congenital malformation(6-10%) Bih injuries are associated with prolonged labour and shoulder dystocia due to macrosomic baby. Growth Restriction is less commonly observed and is associated with maternal vasculopathy. Fetal Death has got multifactorial pathogenesis but the final event being hypoxia and lactic acedemia. Neonatal complications- a) Hypoglycemia (<35mg/dL) is due to Hyperinsulinemia b) Respiratory Distress syndrome due to excess level of fetal insulin that blocks the action of coisol. c) Hyperbilirubinemia d) Polycythemia e) Hypocalcemia(<7mg/dL) f) Hypomagnesemia (<7mg/dL) g) Cardiomyopathy Long term effects- childhood obesity, metabolic syndrome, Neuropsychological effects and diabetes. PERINATAL MOALITY: Overall perinatal moality is increased 2-3times. Reference: DC.Duttas textbook of OBG, 9th edition, page 265 266 -### End" -4423,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with Hodgkin&;s lymphoma is having a single cervical lymphnode. Biopsy showed lymphocyte: predominant variant Which of the following is the treatment of eboke -, with the following options: A: Chemotherapy with Radiotherapy, B: Chemotherapy only, C: Radiotherapy only, D: No treatment needed - -### Response: -Historically ,radiotherapy to lymph nodes is used to treat localised stage 1A(involvement of a single lymph node region) or stage 2 A(involvement of two or more lymph node regions) effectively , with no adverse prognostic features . Reference :Davidson &;s principles & practice of medicine 22nd edition pg no1043 -### End" -4424,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is an immune-privileged site?, with the following options: A: Area postrema, B: Loop of Henle, C: Optic nerve, D: Seminiferous tubules - -### Response: -Ans. d. Seminiferous tubules (Ref: Gray's 40/e p52; Robbins 9/e p214; Ganong 24/e p420)Seminiferous tubule of testis is an immune-privileged site.Some antigens are hidden (sequestered) from the immune system, because the tissues in which these antigens are located do not communicate with the blood and lymph. As a result, self-antigens in these tissues fail to elicit immune responses and are essentially ignored by the immune system. This is believed to be the case for the testis, eye, and brain, all of which are called immune- privileged sites because it is difficult to induce immune responses to antigens introduced into these sites. If the antigens of these tissues are released, for example, as a consequence of trauma or infection, the result may- be an immune response that leads to prolonged tissue inflammation and injury. This is the postulated mechanism for post-traumatic orchitis and uveitis.""-- Robbins 9/e p214""The fluid in the lumen of the seminiferous tubules is quite different from plasma; it contains very little protein and glucose but is rich in androgens, estrogens, K+, inositol, and glutamic and aspartic acids. Maintenance of its composition depends on the blood-testis barrier. The barrier also protects the germ cells front blood borne noxious agents, prevents antigenic products of germ cell division and maturation from entering the circulation and generating an autoimmune response. and may help establish an osmotic gradient that facilitates movement of fluid into the tubular lumen. ""--Ganong 24/e p420""Endogenous derangements of the immune system may also contribute to the loss of immunologic tolerance to self-antigens and the development of autoimmunity. Some autoantigens reside in immunologically privileged sites, such as the brain or the anterior chamber of the eye. These sites are characterized by the inability of engrafted tissue to elicit immune responses. Immunologic privilege results from a number of events, including the limited entry of proteins from those sites into lymphatics, the local production of immunosuppressive cytokines such as transforming growth factor B, and the local expression of molecules (including Fas ligand) that can induce apoptosis of activated T cells. Lymphoid cells remain in a state of immunologic ignorance (neither activated nor anergized) with regard to proteins expressed uniquely in immunologically privileged sites. --Harrison 19/e p377e-2immune- Privileged Sites* Some antigens are hidden (sequestered) from the immune system, because tissues in which these antigens are located do not communicate with blood & lymph.* As a result, self-antigens in these tissues fail to elicit immune responses and are essentially ignored by the immune system.Immune- Privileged Sites* TestisQ* Eye (Anterior camber)Q* Placenta & fetusQ* BrainQ Circumventricular Organs* These organs have fenestrated capillaries & because of their permeability they are said to be outside the blood brain barrier.* Some of them function as neurohemal organ (areas in which polypeptides secreted by neurons enter the circulation). Circumventricular Organs includes (SAMPO) * Subfornical organQ* Area postremaQ* Median eminence of hypothalamusQ* Posterior pituitary (neurohypophysis)Q* Organum vasculosum of lamina terminalisQ -### End" -4425,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following anti-gout drugs can precipitate an attack of acute Gouty ahritis?, with the following options: A: Colchicine, B: Probenecid, C: Allopurinol, D: Sulfinpyrazne - -### Response: -Allopurinol -### End" -4426,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are cytokines except, with the following options: A: Monoclonal antibody, B: Interleukins, C: Chemokines, D: TNF - -### Response: -ref Robbins 9/e p86 Monoclonal antibodies (mAb or moAb) are antibodies that are made by identical immune cells that are all clones of a unique parent cell. Monoclonal antibodies can have monovalent affinity, in that they bind to the same epitope (the pa of an antigen that is recognized by the antibody). -### End" -4427,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paraneoplastic manifestation of Bronchogenic carcinoma includes all, except -(, with the following options: A: Dermatomyositis, B: Acanthosis nigricans, C: Cerebellar degeneration, D: Hyperkeratosis of palm and soles - -### Response: -hyperophic pulmonary osteoahropathy, hyperkeratosis of palms and soles, erythema annulare centrifugum, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and ectopic andrenocoicotrophic hormone (ACTH) and calcitonin production.these are all paraneoplastic manifestations of bronchogenic carcinoma Ref Harrison 20th edition pg 536 -### End" -4428,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Largest cranial nerve is:, with the following options: A: Trochlear, B: Trigeminal, C: Oculomotor, D: Vagus - -### Response: -Trigeminal -### End" -4429,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following factors increase the risk of aminoglycoside renal toxicity, except:, with the following options: A: Elderly person, B: Hypokalemia, C: Simultaneous use with penicillin, D: Aminoglycoside administration in recent past - -### Response: -Administration of penicillin along with aminoglycoside does not increase the risk of aminoglycoside renal toxicity. Aminoglycosides are highly effective against gram negative bacteria whereas penicillins are effective against gram positive bacteria. Penicillins also increase the bactericidal activity of aminoglycosides. Combination of penicillins/cephalosporins and aminoglycosides is the treatment of choice for pseudomonas infections. Ref: The Spinal Cord Injured Patient By Bok Y. Lee, 2nd Edition, Page 82 -### End" -4430,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following has a single ossification centre only?, with the following options: A: Clavicle, B: Carpals, C: Metacarpals, D: Metatarsals - -### Response: -Carpals have only one ossification centre while about 3 centers are present for clavicle BD CHAURASIA HUMAN ANATOMY Vol 1 -### End" -4431,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inferior rib notching is present in, with the following options: A: TAPVC, B: Coarctation of aorta, C: Fallot's tetralogy, D: Ventricular septal defect - -### Response: -Causes of rib notching ae: - A) Inferior surface -1) Arterial -i) Coarctation of aorta Bilateral Rib notching is seen on the lower border of 3 rd to 8th ribs. Rib notching is absent in the 1st & 2nd ribs. Rib notching is usually present after the age of 7 years. -ii) Aortic thrombosis (aortic obstruction) or aortitis. -iii) Subclavian obstruction after Blalock operation for Fallot’s tetralogy (Taussig Blalock operation). -iv) Pulmonary oligemia Pulmonary atresia, -1)TOF, absent pulmonary artery. -2) Venous : - SVC obstruction -3) Arteriovenous : - Pulmonary arteriovenous malformation, chest wall arteriovenous malformation. -4) Neurogenic : - Neurofibromatosis. -B) Superior surface -1) Connective tissue diseases: - SLE, Scleroderma, RA, Sjogren’s syndrome. -2) Metabolic : - Hyperparathyroidism -3) Miscellaneous : - Neurofibromatosis, Restrictive lung disease, Poliomyelitis, Marfan’s syndrome, progeria, Osteogenesis imperfecta. -### End" -4432,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pinna develops from, with the following options: A: 1st pharyngeal arch, B: 1st and 3rd pharyngeal arch, C: 1st and 2nd pharyngeal arch, D: 2nd pharyngeal arch - -### Response: -Pinna - -It develops from both 1st and 2nd brachial arches -Period of development starts from 4–6 weeks and adult configuration is attained by 20th week -From the -### End" -4433,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of Traveller's diarrhoea :, with the following options: A: Enterotoxigenic E. coli, B: Enterohemorrhagia E. coli, C: Enteropathogenic E. coli, D: Enteroinvasive E. coli - -### Response: -Ans. is 'a' i.e. Enterotoxigenic E. coli Most common cause of traveller's diarrhoea - Enterotoxigenic E. coli Harrison states ""The most frequently identified pathogen causing traveller's diarrhoea is toxigenic Escherichia coli."" Most common cause of traveller's diarrhoea - Toxigenic E.coli Most common cause of traveller's diarrhea in - CampylobacterSouth East Asia and Africa Most common viruses associated with traveller's - Rotavirus and Norovirus diarrhea -### End" -4434,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The principle of 'seeing is believing' and 'learning by doing' is up held by which method of communication, with the following options: A: Workshop, B: Demonstration, C: Lecture, D: Group discussion - -### Response: -Demonstration is presentation to show how to perform a skill or procedure. - -Eg : Oris technique, Environmental sanitation. - -Demonstration up holds principle of ""seeing is beliving"" and ""learning by doing"". -### End" -4435,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10-month-old child presents with 2 weeks history of fever, vomiting and alteration of sensorium. Cranial CT scan reveals basal exudates and hydrocephalus, the most likely etiological agent is:, with the following options: A: Mycobacterium tuberculosis, B: Cryptococcus neoformans, C: Listeria monocytogenes, D: Streptococcus pneumoniae - -### Response: -- History suggests the diagnosis of Tuberculous meningitis caused by Mycobacterium tuberculosis - It is one of the most severe forms of TB Pathogenesis: Primary infection - Bacillemia - Seeding of meninges (RICH's FOCI)- Rupture -Tubercular meningitis Clinical features: Stages: 1. Prodromal stage (fever, anorexia, vomiting, irritability) 2. Focal deficits, seizures, meningeal signs 3. Coma, neurological sequelae Investigations: CNS IMAGING (CT Head) Basal exudates Image showing basal exudates Hydrocephalus Tuberculoma with perilesional edema CSF STUDY: Opening pressure elevated Cell count - 500/mm3 (lymphocytic predominance) Elevated proteins & Low glucose Cob-web coagulum Diagnosis is confirmed if CSF culture / PCR is +ve for mycobactacterium tuberculosis / acid fast bacilli TREATMENT - ATT + Steroids -### End" -4436,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Decreased teeth enamel is seen in all except:, with the following options: A: Hyperparathyroidism, B: Cushing syndrome, C: Fluorosis, D: Ostcomalacia - -### Response: -Ans. Fluorosis -### End" -4437,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Relaxation of mesangial cells of kidney is brought about by ?, with the following options: A: cAMP, B: Endothelin, C: PGF2, D: Vasopressin - -### Response: -A i.e. C-Amp -### End" -4438,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major signs according to the AIDS case definition of the WHO are all, except:, with the following options: A: Prolonged fever more than 1 month, B: Generalized lymphadenopathy, C: Chronic diarrhoea > 1 month, D: Weight loss > 10% of body weight - -### Response: -WHO case definition for AIDS: In an adult or adolescent (>12 years) Major Signs: Prolonged fever more than 1 month Chronic diarrhoea > 1 month Weight loss > 10% of body weight Ref: Park, 20th Edition, Page 298. -### End" -4439,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum radiation exposure, with the following options: A: X-ray abdomen, B: Chest X ray, C: IV pyelography, D: Barium Enema - -### Response: -X-ray abdomen- Single spot film, therefore comparatively less radiation exposure. Chest X ray- Single spot film, therefore comparatively less radiation exposure. IV pyelography- Sequential/ multiple imaging but covers less area,* therefore, comparatively less radiation exposure. Barium Enema- Sequential/ multiple imaging, covers larger area. therefore comparatively maximum radiation exposure. PET CT - Has highest radiation exposure. Diagnostic Procedure Typical Effective Dose Chest Radiograph(PA) 0.02msv Extremities /limbs 0.01msv Skull 0.07msv pelvis 0.7msv Abdomen 1.0msv Mammography (bilateral in 2 planes) 0.5msv Intravenous pyelography 2.5msv Head Ct 2.3msv Chest CT 8 Abdominal CT 10 PET 7.2msv Barium Enema 7-8msv -### End" -4440,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 55-year-old farmer develops recurrent cough, dyspnea, fever, and myalgia several hours after entering his barn. He has had similar reactions several times previously, especially when he feeds hay to his cattle. Which of the following statements is true?, with the following options: A: The presence of fever and myalgia indicates that this is an infectious process., B: Immediate-type IgE hypersensitivity is involved in the pathogenesis of his illness., C: The causative agents are often thermophilic actinomycete antigens., D: Demonstrating precipitable antibodies to the offending antigen confirms the diagnosis of hypersensitivity pneumonitis. - -### Response: -Hypersensitivity pneumonitis is characterized by an immunologic inflammatory reaction in response to inhaled organic dusts, the most common of which are thermophilic actinomycetes, fungi, and avian proteins. In the acute form of the illness, exposure to the offending antigen is intense. Cough, dyspnea, fever, chills, and myalgia typically occur 4 to 8 hours after exposure. Patients are often suspected of having an infection, especially pneumonia, but the history of previous similar symptoms on antigen exposure should suggest hypersensitivity pneumonitis. In the subacute form, antigen exposure is moderate, chills and fever are usually absent, and cough, anorexia, weight loss, and dyspnea dominate the presentation. In the chronic form of hypersensitivity pneumonitis, progressive dyspnea, weight loss, and anorexia are seen; pulmonary fibrosis is a permanent and sometimes fatal complication.Almost all patients have IgG antibody to the offending antigen, although positive serology is common in asymptomatic patients and is therefore not diagnostic. While peripheral T-cell, B-cell, and monocyte counts are normal, a suppressor T-cell functional defect can be demonstrated in these patients. IgE does not play a role, so the symptoms begin hours (not minutes) after antigen exposure. Inhalation challenge with the suspected antigen and concomitant testing of pulmonary function can confirm the diagnosis but are seldom used. Therapy involves avoidance; steroids are administered in severe cases. Bronchodilators and antihistamines are not effective. -### End" -4441,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Energy expenditure iu resting state depends on:, with the following options: A: Lean body mass, B: Adipose tissue, C: Resting heart rate, D: Exercise - -### Response: -. Ans. a. Lean body mass Energy expenditure in resting state is almost equal to basal metabolic rate ie. the minimum energy expenditure for the body to exist. Basal metabolic rate is related to both body surface area and lean body mass. However, it appears to be more closely related to Lean body mass (Lean body mass = Total mass of the body - Fat).Factors Affecting the Basal Metabolic Rate* Lean body mass:- Higher the lean body mass more the BMR- Females have lower BMR compared to men of die same weight as they have tower proportion of lean body mass and have more fat.- Lean body mass diminishes with age slowing the BMR* Body surface area:- More the body surface area, higher the BMR* Gender: Males BMR > females BMR* Age: BMR decrease with age* Fasting/ Starvation/ Malnutrition decreases the BMR* Sleep decrease the BMR* Growth: BMR is more in growing children* Pregnancyflactation: BMR is higher* Stress/Emotional state: increases metabolic rate* Environmental temperature: Decreased environmental temperature increases the BMR* Fever raises the BMR* Thyroid hormones raises the BMR* Growth hormone increase the BMR* Exercise increases the metabolic rate* Ingestion of food increases the metabolic rate* Smoking and Caffeine increases the metabolic rate -### End" -4442,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Koebner's phenomenon is not seen in:, with the following options: A: Vitiligo, B: Psoriasis, C: Dermatitis herpertiformis, D: Lichen planus - -### Response: -Ref: Thappa DM. The isomorphic phenomenon of Koebner. Indian J Dermatol Venereal Leprol 2004;70:187-9.Explanation:The Koebner phenomenon is the development of isomorphic pathologic lesions in the traumatized uninvolved skin of patients who have cutaneous diseases.Koebner phenomenon signifies activity of the disease.Types of Koebner phenomenon:1. True isomorphic phenomenon:There appear to be three disease processes that display the true isomorphic response of Koebner:PsoriasisLichen planusVitiligo.2. Pseudoisomorphic phenomenon:The Koebner phenomenon also seen in infectious diseasesWartsMolluscum contagiosumBehcet's diseasePyoderma gangrenosum.3. Occasionally occurring isomorphic phenomenon:In this category, diseases occasionally localize to sites of trauma, e.g.Cancer (gastric, testicular or mammary )Darier's diseaseErythema multiformeHailey-Hailey diseaseKaposi's sarcomaKyrle's diseaseLichen sclerosus et atrophieusPellagraPerforating folliculitisReactive perforating collagenosis.Koebner response in psoriasis:The reported incidence of Koebner response in psoriasis varies from 11-75%.The latent period between injury to uninvolved skin and appearance of disease is usually 10-14 days, but it may range from 3 days to several years.The ""reverse"" Koebner response:The reverse Koebner reaction is seen when an area of psoriasis clears following injury. -### End" -4443,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an absolute indication for surgery in cases of benign prostatic hyperplasia -, with the following options: A: Bilateral hydroureteronephrosis, B: Nocturnal frequency, C: Recurrent urinary tract infection, D: Voiding bladder pressures > 50 cm of water - -### Response: -Absolute indications for surgical treatment of BPH 1) Refractory urine retention (failing at least one attempt at catheter removal 2) Recurrent UTI from BPH 3) Bladder stones d/t BPH 4) Renal insufficiency d/t BPH 5) Large bladder diveicula secondary to BPH 6) Recurrent gross hematuria from BPH Ref : Cambell's Urology 8/e p1340 -### End" -4444,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following terms are used to describe bacterial chromosome Except, with the following options: A: Haploid, B: Diploid, C: Nucleoid, D: Circular - -### Response: -The NucleoidProkaryotes have no true nuclei; instead, they package their DNA in a structure known as the nucleoid. The nucleoid of most bacterial cells consists of a single continuous circular molecule ranging in size from 0.58 to almost 10 million base pairs.In bacteria, the number of nucleoids, and therefore the number of chromosomes, depending on the growth conditions. Rapidly growing bacteria have more nucleoids per cell than slowly growing ones; however, when multiple copies are present, they are all the same (ie, prokaryotic cells are haploid).Ref: Jawetz; 27th edition; Page no: 15 -### End" -4445,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following pencil is used to trace a cephalogram?, with the following options: A: 2H, B: 4H, C: 7H, D: 5H - -### Response: -The following armamentarium is required for a good tracing to be performed: - -An X-ray illuminator/mounted on a tracing table with soft light. The tracing table should be mounted in a room with minimal brightness. The tracing table should also have a control switch for controlling the intensity of light. -Tracing paper of good quality. Pre-cut sheets are available in 8X10 inch size from orthodontic suppliers. -Sharp 7H pencil and HB pencil. -Geometric set squares and protractor. -Tooth templates, usually supplied by orthodontic suppliers. -Good quality dust free eraser and transparent adhesive tape. - -The cephalogram is usually traced with a tracing paper mounted, keeping the face profile on the right side of the operator. Mount the tracing paper using adhesive tape, on the left-hand border of the cephalogram. -Ref: Orthodontics: Diagnosis and Management of Malocclusion and Dentofacial Deformities, 3e, Om P. Kharbanda pdf no 956 -### End" -4446,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 hrs old snake bite patient come to emergency with mild local oedema at the injury site on examination no abnormality detected, laboratory investigation shows normal report, most appropriate management, with the following options: A: Intravenous antisnake venom, B: Incision and suction, C: Wait & watch, D: Locally subcutaneous antisnake venom - -### Response: -Ans. is 'c' i.e Wait & Watch Most of the snake bites are from non-venomous snakes. Even in venomous snakes bites, inadequate snake venom is injected in more than half of the cases, producing mild symptoms.If the snake is poisonous signs and symptoms appear within 10 minutes to half an hour in case of Elapids (Cobras, Kraits) and vipers and within 1 hr in cases of sea snakes.Here 6 hrs have passed symptomless so the snake must be a nonpoisonous one.Remember :Elapids are Neurotoxic*Vipers are Vasculotoxic*Sea snakes are Myotoxic* -### End" -4447,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient of glaucoma with bronchial asthma presents to the emergency with status asthamaticus, causative agent might have been), with the following options: A: Pilocarpine eye drop, B: Timolol eye drop, C: Betaxolol eye drop, D: Levobunolol eye drop - -### Response: -Ans. is 'b' i.e. Timolol eye drops Timolol maleate is the most widely used drug for open angle glaucoma.It is non-selective B blocker (Blocks both B1 and B2B2 is responsible for bronchodilation, therefore blocking B2 would aggravate asthma.Instead of Timolol, Betaxolol can be used because it is a selective B1 blocker and causes less respiratory side effects. -### End" -4448,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In right lateral rectus palsy, head is turned to ?, with the following options: A: Right, B: Left, C: Up, D: Down - -### Response: -Ans. is 'a' i.e., Right In paralysis of an extraocular muscle head is turned towards the direction of the muscles as the action of muscle is lost and the patient tries to compensate by turning the head in the direction of the action of the paralysed muscle. In this question, right lateral muscle is paralysed, therefore the head will be turned towards right as abduction of right eye is not possible Muscle paralysed Detion of eye Maximum diplopia while looking Head position Left lateral rectus Right sided (nasally) Left lateral gaze Turned to left (Esotropia) Left medial rectus Left side (laterally) Right lateral gaze Turned to right (Exotropia) Left superior oblique Supero-laterally (left side) (Hyperopia) Right (nasal) and inferior to left eye Tilted to the left and turned to the right Left inferior oblique Infero-laterally (left side) (Hypotropia) Right (nasal) and superior to left eye Tilted to the right and turned to the right Left superior rectus infero-medially (Hypotropia) Left (temporal) and superior to left eye Tilted to the right and turned to the left Left inferior rectus Supero-medially (hyperopia) Right (nasal) and superior to left eye Tilted to the left and turned to the left Note :- Right sided muscle parlysis will have opposite effect. -### End" -4449,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Establishment of fetoplacental circulation seen at-, with the following options: A: 11 to 13 days, B: 20 to 22 days, C: 7 days, D: 25 to 26 days - -### Response: -Impoant Events Following Feilization 0' hour Feilization (day-15 from LMP) 30 hours 2 cell stage (blastomeres) 40-50 hours 4 cell stage 72 hours 12 cell stage 96 hours 16 cell stage. Morula enters the uterine cavity 5th day Blastocyst 4-5th day Zona pellucida disappears 5-6th day Blastocyst attachment to endometrial surface 6-7th day Differentiation of cyto and syncytiotrophoblast layers 10th day Synthesis of hCG by syncytiotrophoblast 9-10th day Lacunar network forms 10-11th day * Trophoblasts invade endometrial sinusoids establishing uteroplacental circulation * Interstitial implantation completed with entire decidual coverage REF : DUTTA BOOK OF OBESTETRICS -### End" -4450,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arterial embolization is done in all except -, with the following options: A: Uterine AV malformation, B: PPH, C: Cancer, D: Prevent bleeding in endometriosis - -### Response: -Ans. is 'd' i.e., Prevent bleeding in endometriosis o Indications for embolization in Obstetrics and Gynaecology are the following: Post Partum hemorrhage: Uterine atony/tears. Abnormal placentation Post-abortion/ ectopic Post hysterectomy Uterine AV malformation/ Gestational trophoblastic tumors Gynecological malignancies Fibroids (acute bleeding) -### End" -4451,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A pregnant women, previous LSCS presents with hematuria. What is the likely diagnosis?, with the following options: A: Eclampsia, B: Obstructed labour, C: Ureteral injury, D: Cystitis - -### Response: -In obstructed labour the bladder becomes an abdominal organ and due to compression of urethra between the presenting pa and symphysis pubis, the patient fails to empty the bladder. The transverse depression at the junction of the superior border of the bladder and the distended lower segment is often confused with the Bandl's ring. The bladder wall gets traumatized which may lead to blood stained urine, a common finding in obstructed labour. Ref: D.C.Dutta 6th Ed Page 405. -### End" -4452,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earlier manifestation of Rickets is -, with the following options: A: Craniotabes, B: Rashitic rosary, C: Harrison groove, D: Pigeon chest - -### Response: -Ans. is A Craniotabes (Ref : O.P. Ghai, 6/e, p 127-129 (5/e, p 83), Nelson 17/e, p 187-189).C/f of RicketsUsually manifest in 1st or 2nd year, rare below 3 months.Craniotabes is the earliest manifestation of Rickets.Large Anterior fontanelle*.Bossing of frontal and parietal bones.Rachitic rosary* (Costochondral function prominent).Pigeon Breast* (Sternum projects forward)Harrison's groove *Scoliosis * kyphosis or lordosis can occur.Epiphysis of long bones widened*.Anterior bowing of legs, knock knee and coxa vera*. -### End" -4453,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First sign of pubey in female ?, with the following options: A: Tanner stage I, B: Tanner stage II, C: Pubic hair, D: Axillary hair - -### Response: -Ans. is `b' i.e., Tanner stage 11 Thelarche- first sign of pubey in Girl around age of 10 year in Girl Definition :- Begining of secondary (Post natal) breast development at onset of pubey in girls. Tanner stage 2 breast development. Because of rising level of estradiol Breast development during pubey in male termed as gynecomastia not thelarche. -### End" -4454,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pigbel is caused by:, with the following options: A: Echinococcus, B: T. saginata, C: Clostridium perfringens, D: Clostridium tetani - -### Response: -Pigbel is caused by by Clostridium perfringens. C. perfringens produces clinical syndromes as follows: a) Necrotizing enteritis/Pigbel Due to contaminated meat products. Incubation Period- 8-24 hrs. Involves Heat labile enterotoxin but spores are heat resistant. (b) Food poisoning (c) Soft tissue infections (d) Septicemia NOTE Clostridium perfringens causes stormy fermentation of lactose in litmus milk -### End" -4455,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: String of pearl appearance seen in:, with the following options: A: Clostridium, B: Bacillus anthracis, C: Pneumococcus, D: Staph, aureus - -### Response: -Ans. is 'c' i.e., Bacillus anthracisOn penicillin agar-string of pearl appearance is seen and in Gelatin stab culture inverted fir tree appearance is seen. -### End" -4456,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An asymptomatic male came for USG abdomen for medical fitness. A focal lesion was found in his liver on ultrasound as shown here. The patient was told that this is the most common benign hepatic tumor. Which of the following is a false statement about this lesion?, with the following options: A: The most sensitive and specific investigation CT Triphasic Contrast, B: Most of these lesions are asymptomatic, C: Characteristic Centripetal fill-in appearance is seen on postcontrast study., D: Angiography shows characteristic ""cotton-wool"" appearance. - -### Response: -Ans. A. The most sensitive and specific investigation CT Triphasic ContrastHemangiomas are the commonest benign hepatic tumors with a prevalence at postmortem of between 4 per cent and 20 per cent. Multiple hemangiomas occur in up to 10 per cent of cases. They are composed of vascular channels of varying size (cavernous to capillary), lined with endothelium, often with intervening fibrous tissue of varying amounts. Most hemangiomas are asymptomatic, incidental findings on imaging. Those between approximately 2 and 4 cm in diameter are most likely to possess characteristic features allowing a confident diagnosis by imaging alone. -### End" -4457,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which naevi commonly predispose to malignant melanoma ?, with the following options: A: Dermal, B: Junctional, C: Congenital, D: Lentigo - -### Response: -Malignant transformation is rare and occurs in the following situations: Congenital melanocytic naevi:6% of lesions undergo malignant change , risk of malignant transformation is greater in giant lesions. Dysplastic naevus syndrome: in melanoma prone families. From illustrated synopsis of dermatology and sexually transmitted diseases neena khanna 5th edition page no 382 -### End" -4458,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is most lipogenic carbohydrate:, with the following options: A: Glucose, B: Galactose, C: Fructose, D: Starch - -### Response: -All carbohydrates (if in excess), gets conveed to fat in body (endogenous fat). Sucrose is made up of glucose and fructose. So, when sucrose is taken instead of glucose, it increases lipogenesis because: Fructose is most rapidly metabolised sugar It bypasses PFK-1 step (Rate Limiting Enzyme of glycolysis). So fructose forms acetyl CoA and thus fats. So fructose is regarded as most lipogenic sugar. Fructose | Uses the enzymes of Glycolysis | Finally forms Pyruvate | Acetyl CoA | Fats (TG, Fatty Acids, Cholesterol) Fructose is present in fruits, honey, table sugar. -### End" -4459,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement regarding non-coagulase staphylococci is:, with the following options: A: They are non-pathogenic, B: They commonly infect indwelling prosthesis, C: They may cause scarlet fever, D: They are separated by gram staining - -### Response: -Ans. is 'b' i.e., They commonly infect indwelling prosthesis(Ref: Ananthanarayan, 9th/e, p. 206 and 8th/e, p. 202; Harrison, 18th/e, p. 1167 and 17th/e, p. 878)* Coagulase negative staphylococci (staph epidermidis) has a predilection for growth on the implanted foreign bodies such as artificial heart valves, shunts, intravascular catheters and prosthetic appliances leading to bacteremia. -### End" -4460,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following is not true of Ponderal index -, with the following options: A: It is measure of obesity, B: Is height & weight independent, C: Is height & weight dependent, D: Age independent - -### Response: -Ponderal index= height / cube root of body weight. Ref- Park&;s textbook of Preventive and Social Medicine 24th edition. -### End" -4461,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triangle of ausculatation is seen in, with the following options: A: 5th intercostal space, B: 6th intercostal space, C: 7th intercostal space, D: 8th intercostal space - -### Response: -Triangle of auscultation is seen in 6 the intercoastal space B D CHOURASIAS HUMAN ANATOMY UPPER LIMB THORAX VOLUME, 1 SIXTH EDITION, PAGE NO, 64 -### End" -4462,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Problem of bias is maximum with -, with the following options: A: Coho study, B: Case study, C: Case control study, D: Experimental study - -### Response: -Ans. is 'c' i.e., Case control study -### End" -4463,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sources of NADPH are, with the following options: A: Malic enzyme, B: Cytoplasmic Isocitrate Dehydrogenase, C: Pentose phosphate pathway, D: All of the above - -### Response: -These are the only 3 sources of NADPH that are currently known. -### End" -4464,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pilocarpine is not used in young adults as it causes:, with the following options: A: Retinal detachment, B: Myopia, C: Iris cysts, D: Shallow anterior chamber - -### Response: -Ans. (b) MyopiaRef: Khurana 6/e, p. 449; Kanski 7/e; p. 386Contraction of ciliary muscle results in accommodation and thus also cause transient, fluctuating myopia. -### End" -4465,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following parasitic infections predispose to malignancies -, with the following options: A: Pargibunuasus, B: Guinea worm infection, C: Clonorchiasis, D: None - -### Response: -Ans. is 'c' i.e., Clonorchiasis Parasites associated with malignancy Clonorchis sinensis - Liver, bile duct (cholangiocarcinoma) and Pancreas (adenocarcinoma) Opisthorchis viverrini Bile duct (chalangio carcinoma) Schistosoma haematobium Urinary bladder (squamous cell Ca) Fasciola hepatica Cholangiocarcinoma -### End" -4466,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common organism causing osteomyelitis is, with the following options: A: E, coli, B: Pseudomonas, C: Klebsiella, D: Staph aureus - -### Response: -The most common organism in osteomyelitis in intravenous drug users is staphylococcus aureus. Pseudomonas aeruoginosa an otherwise unusual cause of osteomyelitis, is the second most frequently observed microorganism Refer Maheshwari 6th/e p 168 -### End" -4467,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in asthma except –, with the following options: A: Cyanosis, B: Wheezing, C: Clubbing, D: Dysnea - -### Response: -""Clubbing of fingers is unusual in uncomplicated cases"". - O. P. Ghai. -### End" -4468,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Critical path is showm by, with the following options: A: Money, B: Man power, C: Time, D: Proper sequence - -### Response: -Ref:Park's Textbook of Preventive and Social Medicine 25th Ed -### End" -4469,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Postmoem caloricity is seen in:, with the following options: A: Strychnine poisoning, B: Organophosphorus poisoning, C: Dhatura poisoning, D: Ergot poisoning - -### Response: -(Post Moem Caloricity- Normally temperature falls after death but temp increases (upto 1.5 to 2degC) due to exercise, struggle prior to death. It is seen when- (1) Heat regulation center damaged, due to Sunstroke, some nervous disorders. (2) Increased heat production in muscles, due to convulsions as in tetanus, strychnine poisoning. (3) Excessive bacterial activity, due to septicaemia, cholera.) (Lower temperature than Normal after death- Collapse, CCF. During sleep rate of fall of temperature 0.5 -- 1degC.) -### End" -4470,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common oralinfection in diabetes mellitus?, with the following options: A: Candida, B: Aspergilius, C: Streptococcus, D: Staphylococcus - -### Response: -Ans. is 'a' i.e., Candida Repeat -### End" -4471,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following infections may be transmitted blood transfusion, except:, with the following options: A: ParvoB-19, B: Dengue virus, C: Cytomegalo virus, D: Hepatitis G virus - -### Response: -Infectious complications related with blood transfusion are : Viral causes: HIV, Hepatitis C virus, Hepatitis G virus, Hepatitis B virus, West Nile virus, Cytomegalovirus, Human T lymphotropic virus (HTLV) type-1 and Parvovirus B-19. Bacterial causes: Yersinia, Pseudomonas, Serratia, Acinetobacter and Escherichia species. Other infectious agents: Malaria, Babesiosis and Chagas disease can be transmitted by blood transfusion. Ref: Harrison's Principle of Internal Medicine, 18th Edition, Page 956, Chapter 113 ; CURRENT Diagnosis and Treatment: Pediatrics, 20th Edition, Chapter 43 ; Hemoglobinopathies By Anupam Sachdeva, Chapter 132 -### End" -4472,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The principle that is the spinal cord dorsal roost are sensory and the ventral roots are motor is known as, with the following options: A: Laplace's law, B: Bell-Magendie Law, C: Frank-Starling Law, D: Weber-Fechner Law - -### Response: -Ans. (b) Bell-Magendie Law(Ref: Ganong, 25th ed/p.229)Bell-Magendie law:#This law states that ""Spinal dorsal roots contain sensory fibers and ventral roots contain motor fibers"" -### End" -4473,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Why is Sugar added in ORS?, with the following options: A: Enhance acceptability, B: Enhance salt absorption, C: Enhance shelf life, D: Enhance taste - -### Response: -Adding sugar to ORS, enhances absorption of salt & water. Sugar in the ORS has found to have sym- transpoer mechanism with sodium. Composition Weight Osmolar concentration (mmol/litre) Sodium chloride 2.6 gm Sodium 75 Potassium chloride 1.5 gm Potassium 20 Sodium citrate 2.9 gm Chloride 65 Glucose,anhydrous 13.5 gm Citrate 10 Glucose,anhydrous 75 Total 20.5 gms Total 245 EXTRA-EDGE: ReSoMAL: Rehydration solution for MALnourished Sodium - halved to 45 mmol/L ; Potassium - Doubled to 40 mmol /L SUPER ORS: Rice /starch/ Alanine based -### End" -4474,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are caused by trachoma –a) Entropionb) Ectropionc) Pingueculad) Corneal opacitye) Dry eye, with the following options: A: acd, B: ade, C: abd, D: ad - -### Response: -Trachoma can cause entropion (not ectropion), dry eye (xerosis) and corneal opacity. -### End" -4475,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Digitalis toxicity can cause:, with the following options: A: Hyperkalemia, B: Nausea, C: Arrhythmias, D: All of the above - -### Response: -Ref:KDT 6/e p498 Some early warning signs of overdose are confusion, loss of appetite, nausea, vomiting, diarrhea, or vision problems. Othersigns of overdose are changes in the rate or rhythm of the heabeat (becoming irregular or slow), palpitations (feeling of pounding in the chest), or fainting. -### End" -4476,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The pattern of change of disease trends of moality and morbidity where the pandemics infection are replaced by degenerative and man-made disorders, the main cause of morbidity and the most frequent cause of fatality is known as:, with the following options: A: Cross transition, B: Paradoxical transition, C: Epidemiological transition, D: Demographic transition - -### Response: -Epidemiological transition is a phase of development witnessed by sudden and stark increase in population growth rates brought about by medical innovation in disease or sickness therapy and treatment And followed by a releveling of population growth from subsequent declines in feility. Ref: Health Transition Epidemiological transition theory was originally given by Abdel Orman in 1971. -### End" -4477,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Precancerous lesions of GB are all except, with the following options: A: Procelain GB, B: Typhoid carrier, C: ABPDJ, D: Biliary ascariasis - -### Response: -Risk factors for Carcinoma Gallbladder Gallstones >3cm Procelain gallbladder Anomalous pancreaticobiliary junction (APBDJ) Choledochal cysts Adenomatous polyps Primary sclerosing cholangitis Obesity Salmonella typhi infection Ref: Sabiston 20th edition Pgno :1510 -### End" -4478,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Apoptosis are all except-, with the following options: A: Inflammation is present, B: Chromosomal breakage, C: Clumping of chromatin, D: Cell shrinkage - -### Response: -Ans. is 'a' i.e.,, Inflammation is present The two most striking features of apoptosis are: In contrast to necrosis it does not elicit inflammation Considerable apoptosis may occur in tissues before it becomes apparent in histological section (because it occurs very rapidly). -### End" -4479,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about mesenteric cysta) Moves perpendicular to the line of attachmentb) Teratomatous is most commonc) Chylolymphatic cyst has separate blood supplyd) Surgical removal of bowel along cyst is treatment of choice in all the cyst., with the following options: A: ac, B: bc, C: ad, D: b - -### Response: -Mesenteric cysts are of following types: - - -Chylolymphatic (most common)            -simple (mesothelial) -Enterogenous -Urogenital remnan  -Dermoid (teratomatous cyst) - -Chylolymphatic cyst - -Usually are congenital, resulting from developmental sequestration of lymphatics. -It is found most frequently in the mesentery of the ileum. -Cyst wall is thin, made up of connective tissue; lacks the muscular wall of enteric duplication cyst. -Cyst is not lined by mucosa. -It is filled with clear lymph or chyle. -A chylolymphatic cyst is almost invariably solitary, although in extreme rare cases, multiple cyst may be seen. -Cyst is more often unilocular than multilocular. -A chylolymphatic cyst has a blood supply independent of that of the adjacent intestine, and thus enucleation (resection) is possible without the need for resection of gut. - - -Enterogenous cyst - - -Believed to be derived either from a diverticulum of the mesenteric border of the intestine which has become sequestered from the intestinal canal during embryonic life or from a duplication of the intestine. -An enterogenous cyst has thicker wall than a chylolymphatic cyst, and it is lined by mucous membrane, sometimes ciliated. -The content is mucinous -The enterogenosu cyst and the adjacent bowel wall has a common blood supply therefore enucleation of the cyst is always done along with resection of the related portion of intestine followed by anastomosis. - -Clinical features - -painless abdominal swelling - --     the swelling moves freely in a plane at right angles to the attachment of the mesentery. - -recurrent attacks of abdominal pain with or without vomiting due to obstructive symptoms. -acute abdominal pain due to - - -torsion of the mesentery containing cyst -rupture of cyst -hemorrhage into the cyst -infection of the cyst - -Enucleation is the t/t of choice. Associated segment of bowel is removed along with enterogenous cyst. Other t/t modalities i.e. marsupialization, internal drainage, or aspiration are suboptimal and are almost always followed by recurrence. -### End" -4480,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 56 year old Chronic smoker, mass in bronchusresected. Most useful immunohistochemical marker to make a proper diagnosis would be aEUR', with the following options: A: Cytokeratin, B: Vimentin, C: Epithelial membrane cadherin, D: Leucocyte common antigen - -### Response: -Cytokeratin Immunohistochemistry Immunohistochennstry is an impoant tool for determination of type of tissue by the presence (or absence) of tissue specific lineage markers. Basic principle of immunohistochemistty is to label an antibody with a probe (coloured marker) which is specific to an antigen of a paicular tissue. - This antibody is run on the tissue of unknown origin. If the tissue has that paicular antigen site (epitope), then the antibody will get attached to the tissue. Because this antibody is labeled, it can be seen under a microscope and the origin of the tissue can be diagnosed. Let's begin the discussion with intermediate filaments: Intermediate filaments are cytoskeleton components of both normal and neoplastic tissue. There are the major antigens used in immunohistochemistry. Five broad classes of intermediate filaments exist. Most neoplasms show a predominant expression of one of these: a) Keratins Carcinomas, mesothelioma and non? seminomous GCT b) Vimentin Sarcoma, melanomas, seminomas, lymphomas c) Neurofilament Neural and neuroendocrine tumours d) Glial fibrillary acidic protein (GFAP) Neoplasms of astroglial origin e) Desmin Tumours of muscular origin (leiomyoma and rhabdomyomas) Neoplastic cells can co-express more than one of these intennediate filaments i.e. they may be +ve for 2 markers of different origin. These .findings can also be helpful to diagnose a tumour. After this brief outline let us examine various markers in each neoplasia. Carcinomas Cytokeratins are the most sensitive markers for carcinoma. - These are. fuher subdivided into 20 subtypes based on molecular weight and isoelectric pH. - These individual keratins provide impoant information about site of origin of given carcinoma. CK7+/CK20+ Urothelial transitional cell ca ; Ca pancreas, Ovarian macinous carcinoma CK7+/CK20- Breast, lung, endometrium, thyroid, ovary (serous), thymoma CK7-/CK20+ Colorectal, stomach, Merkel cell CK7-/CK20- Liver, kidney (clear cell), prostate Epithelial markers for determination of site of origin of carcinoma Breast * Estrogen and progesterone receptor (ifpositive, denotes good prognosis) * GCDP (gross cystic disease protein) specific breast marker * (HE2/neu-poor prognosis) * Cadherin is -ye in lobular carcinoma but +ve in ductal carcinoma Liver CAM, AFP Thyroid Thyroglobul in (papillary & follicular) calcitonin (medullary) Prostate PAP, prostate specific antigen Colorectal CEA, CK20, pancreas CA19-9, ovary CA-125 Other epithelial markers Epithelial membrane antigen (EMA) -4 Breast, lung and kidneys, adenocarcinoma are typically +ve. Carcinoma embryonic antigen +ve in carcinomas of GIT, pancreas, lung, breast, uterus and ovary Keratin positive tumours besides carcinomas Mesotheliomas - Usually +ve HMW keratin, CK5/6 should be distinguished from adenocarcinomas which are protective for low molecular weight cytokeratin and carcinoma embryonic origin. Non-seminomatous GCT - These can be distinguished from carcinoma as they are positive for - HCG (choriocarcinoma) - AFP (endothelial sinus tumour), - Placental alkaline phosphatase (PCAP), - Embryonal Ca (choriocarcinoma and endodennal sinus tumour). Sarcomas Vimentin: -Characteristically expressed in normal mesenchymal cells - Such tumours would include tumors derived from - blood vessels, - muscle, - fat, - cailage, - hemopoietic elements, - neural tube & neural crest, and - Seoli & Granulosa cells of testis and ovary. Other markers used in mesenchymal cell tumours. Tumour of myogenous origin, i.e. leio and rhabdomyosarcoma - Muscle specific Actin & Desmin - Myoglobin, myogenin and myo-D1 Tumour of vascular origin, i.e. hemangioma and angiosarcoma - Factor VIII - CD31 Fibrohistiocytic tumors, e.g. malignant fibrous histiocytoma - CD68 - HAM56 Osteosarcoma: - Osteopontin - Osteocalcin - Osteonectin - Bone GIA protein Ewing Sarcoma and PNET (Ewing in soft tissue): - CD99 (antibodies against MIC-2 gene) - besides Ewings this is also positive in few other tumours including ovarian granulosa cell tumour. GIST (gastrointestinal stromal tumours): - CD117 identifies C-KIT gene for tyrosine kinase. - These are normally present on Cajal's interstitial cells. - These tumours respond to drug Glevac/Imatinib, which is also given to patients of CML having (9:22) translocation. Other impoant tumours where immunohistochemistry has a role: Melanomas -S-100 (sensitive but not specific marker) - HMB-45 (melanosome, highly sensitive and specific) Lymphomas -CD-45 - used in screening of lymphomas. - Fuher typing is done by: - B cell markers CD19, CD20, CD23 - T-cell markers CD-2, CD-3, CD-7 - Reedsternberg cells - CD15 & CD30 .for Hodgkin's lymphoma Seminoma -Vimentin & PLAP +ve - AFP and HCG (-ye) Neuroendocrine tumour, e.g. carcinoid tumors -NSE (neuron specific enolase) - Chromogranin - Synaptophysin - Leu-7 Neural tumours of glial origin, e.g. Astrocvtomas -GFAP (Glial fibrillary acid protein) -### End" -4481,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A chronic alcoholic has an elevated serum alpha fetoprotein levels. Which of the following neoplasms is most likely, with the following options: A: Prostatic adenocarcinoma, B: Multiple myeloma, C: Hepatocellular carcinoma, D: Glioblastoma multiforme - -### Response: -Normal adult value less than 40microgram per lt. 2/3rd of liver cancer produce Afp. Screening but not a definitive test. Source: everyday health. Com -### End" -4482,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are contraindications to femoral vein phlebotomy, EXCEPT?, with the following options: A: Venous occlusive disease of the extremities, B: Loss of sensation, C: Previous surgery of the knee, D: Acquired bleeding disorder - -### Response: -Contraindications to femoral vein phlebotomy or catheterization are:Previous surgery in the groinProsthetic graft placement in the groinVenous occlusive disease of the extremitiesAcquired or congenital bleeding disorder &Cellulitis or burn over the proposed site of inseion. -### End" -4483,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with a solitary pulmonary nodule (SPN) on X-ray. The best investigation to come to diagnosis would be –, with the following options: A: MRI, B: CT Scan, C: USG, D: Image guided biopsy - -### Response: -""Thoracotomy with resection represents the most direct and definitive means of diagnosis (and treatment) of solitary pulmonary nodule"".""Thoracotomy is the most definitive method for determining the diagnosis in patients with SNPs"". - -However, a thoracotomy is associated with significant morbidity, complications and mortality. Therefore, CT guided a transthoracic biopsy is the invasive diagnostic procedure of choice. - -Note -If the question would have been about the next investigation of choice (instead of best investigation), then the answer will be CT scan. -### End" -4484,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following method is used to detect semen stains on clothes?, with the following options: A: Infrared rays, B: Magnifying lens, C: Spectrometry, D: Ultraviolet rays - -### Response: -Semen stains on cloth can be identified by ultraviolet light. When examined under UV light seminal stains show a strong bluish white fluorescence. Stains mixed with blood does not fluorescence. If the seminal stain does not fluoresce on account of its being mixed with blood, this can be overcome by spraying the stained area with 1% alpha naphthol phosphate with 1% sodium hydroxide solution two minutes later. Ref: Forensic Medicine By P.V. Guharaj 2nd edn, page 281. -### End" -4485,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The least extrapyramidal side effects are seen with which of the following phenothiazine?, with the following options: A: Clozapine, B: Triflupromazine, C: Fluphenazine, D: Thioridazine - -### Response: -Side effects of impoant CNS drugs Midazolam Ataxia, Blackouts in elderlyTolcapone Hepatotoxic Phenytoin Hirsuitism , Gingival hyperplasia , Osteomalacia , Teratogen , Megaloblastic anemia , Ataxia, Lymphadenopathy, Hyperglycemia , Arrhythmias, Vitamin K deficiency Valproate Irreversible hepatic necrosis in older children, Acute pancreatitis Zonisamide,, Topiramate Renal stones VigabatrineIrreversible visual field defectsFelbamate Aplastic anemia Thioridazine Male sexual dysfunction, Retinal damage, Least extra pyramidal symptomsClozapine Agranulocytosis , Myocarditis Risperidone Extra pyramidal symptoms HaloperidolExtra pyramidal symptoms , Akathisia Olanzapine Risk of stroke and death Ziprasidone , Pimozide QT prolongation Quetiapine Cataract Iloperidone Ohostatic hypotension Lithium in expectant mothers Ebstein's anomalyFormic acid Retinal damage Opioids Tolerance & addiction (Refer: Rang and Dale's Clinical Pharmacology, 7th edition, pg no: 557-559) -### End" -4486,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ideal contraceptive for a couple living in different cities meeting only occasionally:, with the following options: A: Barrier method, B: IUCD, C: OCP, D: DMPA - -### Response: -Ans-A Barrier method Barrier method is a suitable contraceptive option for those who have infrequent sexual intercourse.""Condom are suitable for use in old age, for a couple who have infrequent coitus, during lactation, during holidays, a subject who can not tolerate OCP, IUCD. The practice of Fertility Control by S. K. Chaudhary 7/ep71 -### End" -4487,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cohort study estimates all except-, with the following options: A: Incidence, B: Relative risk, C: Odds ratio, D: Attributable risk - -### Response: -Ans. is 'c' i.e., Odds ratio Epidemiological studyParameter obtained* Case control studyOdds ratio* Cohort studyIncidence rateRelative riskAttributable riskPopulation attributable risk* Cross - sectional studyPrevalence* Ecological studyGroup characteristics -### End" -4488,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4 yr. old boy was brought by his mother to the OPD regarding complaints of cola coloured urine for 8 days. The mother has noticed repeated attacks earlier too. Associated history reveals SNHL and slit lamp examination reveals All of the statements regarding the disease are true EXCEPT?, with the following options: A: It is caused due to Defect in alpha 3 chain of Type IV collagen, B: Bilateral anterior lenticonus can be seen in this condition, C: Electron microscopy of the kidney specimen reveals thinning of GBM and basket weave appearance., D: The mode of inheritance is X linked - -### Response: -Presence of haematuria with SNHL with anterior lenticonus as shown in the slit lamp suggests the diagnosis of Alpo's syndrome. Alpo's syndrome is and X linked disorder characterized by defect in alpha 5 chain of type IV collagen. Electron microscopy reveals thinning of basement membrane (<150nm) as the earliest feature and 'basket weave appearance' is characteristic on EM. -### End" -4489,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of supraventricular tachycardia with hypotension in a patient under general anaesthesia, inludes all of the following treatments, EXCEPT:, with the following options: A: Carotid sinus massage, B: Adenosine 3-12 mg IV, C: Direct current cardioversion, D: Verapamil 5 mg IV - -### Response: -When the patient is hemodynamically unstable DC shock can be given, adenosine is also safe if the patient has no history of asthma and has no AV block. Carotid sinus massage is also effective in most cases. If the patient has no hypotension, verapamil can be given if the patient is stable. But in this case it may aggravate the hypotension and depress ventricular function since the anesthetic itself may cause myocardial depression. Ref: Emergency Management of The Pediatric Patient: Cases, Algorithms, Evidence By Kimball A. Prentiss, Page17 ; Clinical Manual of Emergency Pediatrics By Ellen F. Crain, 5th Edition, Page 44 ; In A Page Medicine By Scott Kahan, 2nd Edition, Pages 37-39 -### End" -4490,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Torrential bleed during tonsillectomy is due to, with the following options: A: Facial aery, B: Tonsilar aery, C: Paratonsillar vein, D: None - -### Response: -Generally bleeding occurs due to injury to aeries but in tonsillectomy it&;s mainly due to paratonsillar vein. 2- Paratonsillar vein. Ref: Dhingra 7e pg 489. -### End" -4491,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lary ngoscopes are sterilized by -, with the following options: A: Glutaraldehyde, B: Formalin, C: Betadine, D: Boiling - -### Response: -Ans. is 'a' i.e., Glutaraldehyde o Laryngoscope should be cleaned before and after use with spirit.o Disinfection can be done once a day by removing the bulb and immersing the blade in 2% cidex (glutaraldehyde) for 10 minutes.o They should be sterilized once a week by immersing in cidex for 10 hours or by autoclaving. -### End" -4492,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wernicke's aphasia is seen due to lesion in?, with the following options: A: Precentral gyrus, B: Inferior frontal gyrus, C: Superior temporal gyrus, D: Inferior temporal gyrus - -### Response: -ANSWER: (C) Superior temporal gyrusREF: Gray's anatomy 39th edition, page 415See previous question -### End" -4493,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renal aery stenosis may occur in all of the following except:, with the following options: A: Atherosclerosis, B: Fibromuscular dysplasia, C: Takayasu's aeritis, D: Takayasu's aeritis - -### Response: -Answer is D (Polyaeritis nodosa): Amongst the options provided renal aery stenosis is least likely to he seen in association with Polyaeritis nodosa. Atherosclerosis and Fibromuscular disease - Renal aery stenosis is produced predominantly by atherosclerotic occlusive disease (80% to 90% of patients) or fibromuscular dysplasia (10-15% of patients).- CMDT'06 p 460 - The common cause of renal aery stenosis in the middle aged and elderly is an atheromatous plaque at origin of renal aery. Harrison In younger women stenosis is due to intrinsic structural abnormalities of the aerial wall caused by a heterogenous group of lesions called 'fibromuscular dysplasia'. - Harrison 16th/1707 PAN or Takayasu aeritis ? Harrison, CMDT do not mention PAN or Takayasu aeritis as a cause for renal aery stenosis. However, Takayasu aeritis is ceainly a more common cause of renal aery stenosis than PAN. Takayasu aeritis (Aoo-aeritis) is beleiveds to he the most common of renovascular hypeension in India and China. -- Diseases of Kidney and Urinary Tract 8117/1279 -### End" -4494,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When heparin is given in pregnancy, which of the following is to be added ?, with the following options: A: Iron folic acid, B: Copper, C: Calcium, D: Zinc - -### Response: -side effects of heparin haemorrhage heparin induced thrombocytopenia osteoporosis fat necrosis and hematomas elevated transaminases to counteract osteoporosis calcium is added TEXTBOOK OF OBSTETRICS,SHEILA BALAKRISHNAN,PG NO:577,2ND EDITION -### End" -4495,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paedophile is having anal intercourse with -, with the following options: A: Older women, B: Children, C: Homosexual adult, D: Hijra - -### Response: -In sodomy with children :- - - -The act → 4 Pederasty -Active agent → 4 Paedophile -Passive agent (i.e. child) →Catamite. -### End" -4496,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common organism amongst the following that causes acute meningitis in an AIDS patient is a:, with the following options: A: Streptococcus pneumoniae, B: Streptococcus agalactiae, C: Cryptococcus neoformans, D: Listeria monocytogenes - -### Response: -Ans. is 'c' i.e., Cryptococcus neoformans(Ref: Harrison, 18th/e, p. 1559, 1560; 17th/e, p. 1182)* Most common cause of seizures - Toxoplasma* Most common cause of meningitis - Cryptococcus* Most common cause of focal neurological deficit - Toxoplasma -### End" -4497,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Simple Cuboidal Epithelium is present in, with the following options: A: Trachea, B: Bronchioles, C: Terminal Bronchiole, D: Alveoli - -### Response: -The mucosal lining of the trachea is composed of pseudostratified ciliated columnar (respiratory) epithelium.The epithelial lining of bronchioles ranges from ciliated simple columnar with occasional goblet cells in larger bronchioles to simple cuboidal (many with cilia) with occasional club cells (also known as Clara cells) and no goblet cells in smaller bronchioles. The epithelium of terminal bronchioles is composed of club cells and cuboidal cells, some with ciliaRespiratory bronchioles are similar in structure to terminal bronchioles, in that their epithelium is a simple cuboidal epithelium rich in club cells and some ciliated cells, but this epithelium is broken up by the presence of thin-walled, pouch-like structures, known as alveoli, composed of an attenuated simple squamous epithelium, where gaseous exchange (O2 for CO2) can occur.Reference: Krishna Garg Histology; 5th edition; Page no: 130 -### End" -4498,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraindication of liver transplant?, with the following options: A: Acute fulminant hepatic failure, B: Metabolic Disease, C: Metastasis, D: Primary liver malignancy - -### Response: -Ans. (c) MetastasisRef: Sabiston 19th edition, Page 657* Contraindications for Liver transplant:# Metastatic liver disease# Poor cardio-pulmonary reserve# Systemic infections (HIV is not a contraindication now)# Porto pulmonary hypertension with pulmonary artery pressure >50mmHg # Hepatopulmonary syndrome when PaO2 does not show improvement with 100% oxygen. -### End" -4499,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Parasympathetic postganglionic fibres are carried by the, with the following options: A: Long ciliary nerves, B: Greater petrosal nerves, C: Auriculotemporal nerve, D: Deep petrosal nerve - -### Response: -Long ciliary nerves are mixed sensory and sympathetic. Greater petrosal nerves carries preganglionic parasympathetic fibers from the facial nerve to the pterygopalatine ganglion. The deep petrosal nerve carries mainly sympathetic fibres from the superior cervical ganglion and internal carotid plexus. -### End" -4500,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tensile strength of wound becomes normal after:-, with the following options: A: 6 weeks, B: Never, C: 4 months, D: 6 months - -### Response: -At the end of the first week, wound strength is approx. 10% of that unwounded skin. Strength increases rapidly over the next 4 weeks The rate of increase then slows at approximately the third month after the original incision,reaches a plateau at about 70-80 % of the tensile strength of the unwounded skin, a condition that may persist for life. The tensile strength of wound never equals that of unwounded skin -### End" -4501,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following biomarkers useful for acute kidney injury? 1. KIM-1 2. NGAL 3. IL-18 4. FABP, with the following options: A: Only 1, B: 1 and 2, C: 1,2 and 3, D: 1,2,3 and 4 - -### Response: -Biomarkers useful for acute kidney injury Kidney injury molecule-1 (KIM - 1) Sensitive as well as specificmarker forAKI Neutrophil gelatinase associated lipocalin (NGAL) AKI (cardiopulmonary bypass) IL-18 AKI ( critically ill ) FABP (Fatty acid binding protein ) Diabetic Nephropathy,chronic kidney disease. -### End" -4502,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following factors is responsible for deciding whether an antibody/immunoglobulin will remain membrane-bound or get secreted?, with the following options: A: RNA Splicing, B: Class Switching, C: Differential RNA Processing, D: Allelic Exclusion - -### Response: -Differential RNA processing is responsible for deciding whether an antibody/immunoglobulin will remain membrane-bound or get secreted.Ref: AIPGMEE 2011: Rapid review by Dr. Paresh Koli, page; 5 -### End" -4503,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ductopenic cholestasis is seen in all, EXCEPT:, with the following options: A: Carbamazepine, B: Chlorpromazine, C: Tricyclic antidepressant agents, D: Methyldopa - -### Response: -Disappearance of bile ducts, ""ductopenic"" cholestasis is seen with carbamazepine, chlorpromazine, tricyclic antidepressant agents. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 2560 -### End" -4504,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Legionnaire disease causes?, with the following options: A: Respiratory disease, B: U.T.I, C: Retroperitoneal fibrosis, D: Acute gastroenteritis - -### Response: -Ref: Page 1138: Harrison 20th edition* The bacterium L. pneumophila leads to legionnaire disease.* The most common form of transmission of Legionella is inhalation of contaminated aerosols produced in conjunction with water sprays, jets or mists.* It has 2 distinct clinical syndromes: Legionnaires disease, which most often manifests as severe pneumonia accompanied by multisystemic disease, and Pontiac fever, which is an acute, febrile, self-limited, viral-like illness -### End" -4505,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest gastric polyp is, with the following options: A: Hyperplastic polyp, B: Inflammatory polyp, C: Adenomatous polyp, D: Pa of familial polyposis - -### Response: -.Metaplastic/hyperplastic Polyp -* Metaplastic- indicates a difference in appearance from normal mucosa. * Very minute in size- 1-2 mm. Multiple. * Common in rectum. Also occurs in other pas of colon. * Contains columnar epithelium, cystic dilatation, goblet cells, and lymphocytes. * Not a pre-malignant entity. ref:SRB&;s manual of surgery,ed 3,pg no 831 -### End" -4506,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: X-Ray feature of pyloric stenosis is, with the following options: A: Single bubble appearance, B: Double bubble appearance, C: Triple bubble apperance, D: Multiple air fluid levels - -### Response: -A i.e. Single bubble appearance -### End" -4507,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In internal auditory meatus, with the following options: A: The cochlear nerve is medial to inferior vestibular nerve, B: The facial nerve is lateral to superior vestibular nerve, C: The inferior vestibular nerve is inferior to the cochlear nerve, D: The superior vestibular nerve is medial to the inferior vestibular nerve - -### Response: -The facial nerve lies lateral to superior vestibular nerve. The IAM on either side face each other across the posterior fossa -### End" -4508,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of seronegative spondyloahropathies except -, with the following options: A: Uveitis, B: PA factor positive, C: HLA-B27 positive, D: Occur in young age - -### Response: -Ans. is 'b' i.e., PA factor positive Seronegative spondvloahropathies The seronegative spondyloahropathies are a group of disorders that share ceain clinical features and genetic associations. The word seronegative referes to the absence of rheumatoid factor in this group of disorders. The seronegative spondyloahropathies include ? Ankylosing spondylitis Reactive ahritis --> Reiter syndrome and enteritis associated ahritis Psoriatic ahritis Ahritis associated with inflammatory bowel disease, i.e. enteropathic ahritis Features of seronegative spondyloahropathies Onset usually before 40 years Absence of RA factor HLA - B27 positive Presence of uveitis -### End" -4509,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rhinosporidium seeberi belongs to:, with the following options: A: Fungus, B: Bacteria, C: Aquatic protistan protozoa, D: Virus - -### Response: -Ans. (a) Fungus Ref Ananthanaravan' 7/e; p 603 Rhinosporiduim seeberi Lower aquatic fungi forming spores Natural habitat is reservoir water and perhaps soil contaminated with that water. Once infected organism produce a polypoidal mass lesion in the affected area, commonest site being nose, nasopharynx, tonsil, eye. Diagnosis: Can not be cultivated in aificial media. Histologically the lesion is composed of large number of fungal spores embeded in stroma of connective tissue and capillaries. Treatment: Excison of the polyp is the treatment of choice. -### End" -4510,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most potent antigen presenting cell, with the following options: A: Fibroblasts, B: Dendritic cells, C: Macrophages, D: B Cells - -### Response: -Dendritic cells are most potent and most effective antigen presenting cells. -### End" -4511,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The wood's lamp filter is made of -, with the following options: A: Tin and chromium oxied, B: Nickel oxide and silica, C: Copper oxide and Barium oxide, D: Zinc oxide - -### Response: -B i.e. Nickel oxide and silica -### End" -4512,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The organ most vulnerable to ischaemia due to shock-, with the following options: A: Lungs, B: Adrenals, C: Kidney, D: Heart - -### Response: -The susceptibility of a tissue to hypoxia influences the likelihood of infarction. -Neurons are most sensitive to hypoxia (irreversible changes develop in 3-4 minutes) followed by myocardial cells (irreversible changes develop in 20-40 minutes). -Fibroblasts are amongst the most resistant cells to hypoxia. -### End" -4513,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A medical student after finishing his final year exams went on a cruise ship to Singapore. While on the ship he had sea food including shellfish such as clams and oysters. After 2 days, he developed fever, nausea, vomiting and diarrhoea. What is the causative agent?, with the following options: A: Adenovirus, B: Norwalk virus, C: Entero virus, D: Rota virus - -### Response: -The clinical scenario describes a case of norwalk infection. The most common cause of diarrhea in older children and adults is the Norwalk virus (Norovirus). They occur in group settings such as banquet halls, cruise ships, dormitories, and campgrounds, where outbreak sources are usually contaminated food and/or water. Potential sources of contaminated food include shellfish such as clams and oysters, which are contaminated by water at source. Clinical features are nausea, vomiting, watery diarrhea, abdominal pain. A person usually develops symptoms of gastroenteritis 12 to 48 hours after being exposed to norovirus. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition -### End" -4514,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true about the anal canal is:, with the following options: A: Completely lined by stratified squamous epithelium, B: Supplied by pudendal nerve, C: Drained by veins forming poosystemic anastomosis, D: Pa below pectinate line is spupplied by inf. Rectal aery - -### Response: -A. i.e. Completely lined by stratified squamous epithelium -### End" -4515,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10-year-old child presented with a swelling and mild pain around knee joint along with muscle wasting. X ray: there was a lesion arising from epiphysis. Biopsy was done from the lesion and HPE examination was done. What is the diagnosis?, with the following options: A: Chondrosarcoma, B: Codman's Tumour, C: Osteosarcoma, D: Osteoblastoma - -### Response: -The age being less than 18yrs (age of skeletal fusion), epiphyseal lesion with internal speckled calcification, chicken wire calcification and giant cells suggest chondroblastoma. Chondrosarcoma is seen in adults arising from flat bones like pelvis. It shows speckled or popcorn or arc and ring calcification. Osteosarcoma has diffuse calcification, arises from metaphysis and is usually seen in 2nd decade. Osteoblastoma usually arises from posterior column if spine. -### End" -4516,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Quincke's disease is, with the following options: A: Norwegian scabies, B: Angioneuritic edema, C: Seborrhea olessa, D: Saddle nose - -### Response: -Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes.The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. Often it is associated with hives, which are swelling within the upper skin.Onset is typically over minutes to hours Ref Harrison20th edition pg 1567 -### End" -4517,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Growth rate is calculated by?, with the following options: A: Crude birth rate/Crude death rate, B: Net reproduction--Crude death rate, C: Total fertility rate--Crude death rat, D: Crude birth rate - Crude death rate - -### Response: -ANSWER: (D) Crude birth rate - Crude death rateREF: Park 20th ed p. 412When crude death rate is substracted from crude birth rate, the net residual is the annual growth rate, exclusive of migration.Relation between growth rate and populationRatingAnnual rate of growth %Number of years required for population to double itselfStationary populationNo growth Slow growth<0.5>139Moderate growth0.5 -1.070-139Rapid growth1.0-1.547-70Very rapid growth1.5-2.035-47Explosive growth2.0-2.528-35 2.5-3.023-28 3.0-3.520-23 3.5-4.018-20 -### End" -4518,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady died due to unnatural death within seven years after her marriage. The inquest in this case will be done by, with the following options: A: Forensic medicine expe, B: Deputy Superintendent of Police, C: Sub-divisional Magistrate, D: Coroner - -### Response: -C i.e. Sub divisional magistrate -### End" -4519,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraindication of induction of labour :, with the following options: A: PIH, B: Bad obstetrical history, C: Diabetes, D: Hea disease - -### Response: -Hea disease -### End" -4520,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is not true about gout:, with the following options: A: Abrupt increase in serum urate levels is more common a cause for acute gout than an abrupt fall in urate levels., B: Patient may be asymptomatic with high serum uric acid for years, C: Development of ahritis correlates with level of serum uric acid, D: Uric acid crystals are best seen by polarising light microscope - -### Response: -A i.e. Abrupt increase in serum urate levels is more common a cause for acute gout than an abrupt fall in urate levels -### End" -4521,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true regarding after pains except, with the following options: A: Most common in multiparous females, B: Pain worsens when infant suckles, C: Decreases in intensity by 7th day, D: They become more pronounced as parity increases - -### Response: -After pain: It is infrequent, spasmodic pain felt in the lower abdomen after delivery for a variable period of 2-4 days. Presence of blood clots or bits of after bih leads to hypeonic contractions of the uterus in an attempt to expel them out. For more information, refer page no 176 of Dutta&;s textbook of obstetrics, 8th edition. -### End" -4522,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is present intracellularly in muscle cells -, with the following options: A: Insulin, B: Coicosteroid, C: Epinephrine, D: Glucagon - -### Response: -Ans. is `b' i.e., Coicosteroids o Insulin, epinephrine and glucagon act on membrane receptors. o Coicosteroids act on intracellular (cytoplasmic receptors). -### End" -4523,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most characteristic anomaly in infant of a diabetic mother:, with the following options: A: Caudal regression, B: VSD, C: Spina bifida, D: Anencephaly - -### Response: -Caudal regression -### End" -4524,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Functional impression technique can be applied in:, with the following options: A: Uniformly firm ridge consistency, B: All variety of residual ridges, C: Knife edge ridge, D: Displaceable alveolar ridge - -### Response: -Functional impression using tissue conditioners is a closed mouth, patient-driven impression technique, indicated for well-formed and firm ridges in patients with good dexterity and neuromuscular control. -### End" -4525,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carbamoyl phosphate is used in-, with the following options: A: Urea, B: Uric acid, C: Pyruvic acid, D: Stearic acid - -### Response: -Ans. is 'a' i.e., Urea o Carbamoyl phosphate is used in the synthesis of urea (urea cycle).Aspartate - NH. (or NH4+) + CO, + H,0 + 3 ATP - Fumarate + Urea + 2 ADP + 2Pi + AMP + PPio Kidney and intestine contribute to most of body arginine because they posses all the urea cycle enzymes except arginase.o Brain can synthesize urea from citrulline (AMU 93,AMC 90) but lacks enzyme for formation of citrulline from orthithine, i.e., ornithine transcarbamylase.o Thus neither brain nor kidney can form urea in significant amount. -### End" -4526,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incisal liability on an average in the maxillary arch is:, with the following options: A: 3 mm, B: 6 mm, C: 4 mm, D: 7.5 mm - -### Response: -The exchange of incisors: -During the first transitional period, the deciduous incisors are replaced by the permanent incisors. The mandibular central incisors are usually the first to erupt. The permanent incisors are considerably larger than the deciduous teeth they replace. This difference between the amount of space needed for the accommodation of the incisors and the amount of space available for this is called incisal liability. The incisal liability is roughly about 7 mm in the maxillary arch and about 5 mm in the mandibular arch. -Ref: Textbook of orthodontics 5th ed Bhalaji pg no 59 -### End" -4527,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Heliox – a) Helium is an inert gasb) Less viscous than airc) Higher density than aird) Reduces work of breathinge) Mixture of He & O2, with the following options: A: acd, B: ade, C: abd, D: ad - -### Response: -Heliox is a mixture of helium (80%) and oxygen (20%). Heliox has a similar viscosity to air but a lower breathing and lowers airway resistance. -Helium is an inert gas. -### End" -4528,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old man who is a known hypeensive complains of fever, migraine, loss of appetite, myalgia and presented with ulcerations on the calf and near the malleoli. On examination, splinter haemorrhages and palpable purpura were noted. On CT angiography, aneurysm and stenosis of medium sized vessels were observed. The type of hypersensitivity to this condition is, with the following options: A: Type 1 hypersensitivity, B: Type 2 hypersensitivity, C: Type 3 hypersensitivity, D: Type 4 hypersensitivity - -### Response: -The most likely diagnosis is polyaeritis nodosa which is an example of Type III hypersensitivity reaction. In type III hypersensitivity, immune complexes may deposit in tissues or blood vessels, and elicit an acute inflammatory reaction by activating the complement system. The inflammatory reaction causes tissue injury. The pathogenesis of systemic immune complex disease can be divided into three phases: Formation of immune complexes Deposition of immune complexes Inflammation and tissue injury. Type III hypersensitivity reactions Post-streptococcal glomerulonephritis SLE Polyaeritis nodosa Reactive ahritis Serum sickness Ahus reaction Farmer's lung Hypersensitivity pneumonitis Type II lepra reaction Henoch Schonlein purpura Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition -### End" -4529,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are analytical epidemiological studies except -, with the following options: A: Coho study, B: Case-control study, C: Ecological study, D: Field trial - -### Response: -Ans. is `d' i.e., Field trialAnalytical epidemiology (Analytical study) o Analytical studies are the second major type of epidemiological studies (after descriptive studies).o It contrast to descriptive studies that look at entire population, in analytic studies, the subject of interest is the individual within the population (except in ecological study).o The object is not to formulate, but to test hypothesis.o There are four major types of analytical observational studies -i) Case control study Longitudinal studiesii) Coho studyiii) Cross sectional studyiv) Ecological studyo Simplest form of observational Study --> Cross-sectional Studyo Most preferable observational/analytic Study design --> Coho Studyo Least preferable observational/analytic study design ----> Ecological Study. -### End" -4530,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 70-year-old male presented to the OPD with progressive jaundice for 6 weeks, fever, pruritis along with abdominal pain and significant weight loss. Lab findings reveal, Total S. bilirubin - 22 mg/dL Minimally elevated SGOT/SGPT Increased alkaline phosphatase CT abdomen was done along with ERCP. What is the most common site of this pathology: -, with the following options: A: Intrahepatic bile duct, B: Distal CBD, C: Proximal CBD, D: Hilum - -### Response: -This is a case of Cholangiocarcinoma. CT scan shows dilated intrahepatic biliary ducts. Cholangiocarcinoma is a malignant tumor arising from cholangiocytes in the biliary tree. It tends to have a poor prognosis and high morbidity. Most common presentation - Painless jaundice > Pruritis > Abdominal pain, weight loss and fever. Most common site - Hilum > Distal CBD > Intrahepatic bile ducts. -### End" -4531,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chalazion oflid is -, with the following options: A: Caseous necrosis, B: Chronic nonspecific inflammation, C: Chronic lipogranulomatous inflammation, D: Liposarcoma - -### Response: -Ans. is 'c' i.e., Chronic lipogranulomatous inflammation Chalaziono Chalazion is chronic non-infective (non-suppurative) lipogranulomatous inflammation of sebaceous glands called meibomian glands.o It results from obstruction of a meibomian gland duct.3 Extravasated lipid material produces a surrounding chronic lipogranulomatous inflammation.o Obstruction is induced by low grade infection that causes proliferation of meibomian gland duct epithelium and infiltration of the wall of ducts.o Patients present with painless, non-tender swelling of the lid. Signs of acute inflammation are not present.o Swelling is slightly away from lid margin.o Occasionally, it may present on the intermarginal strip, i.e. marginal chalazion.o Often chalazion slowly increases in size to become very large and causes blurred vision from induced astigmatism (due to compression on cornea) or eversion of the punctum. Rarely, complete resolution may occur.o Recurrence may occur in seborrhoeic dermatitis, acne rosacea and malignant change.o Secondary malignancy caused by chalagion is Meibomian gland adenocarcinoma (sebaceous cell carcinoma). Secondary infection may cause hordeolum internum. -### End" -4532,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Subarachnoid hemorrhage blood is collected mostly in which pa of the skull -, with the following options: A: Basal cistern, B: Around Fah carebri, C: Near cerebellum, D: Tentorium - -### Response: -Answer- A. Basal cisterncausative factor-Exclude underlying aneurysmal ruptureTypical location-Basal cisternsClinical profileHeadache,meningismusdelayed manifestations,vasospasm -### End" -4533,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is most frequently associated with the typical form of carcinoid syndrome ?, with the following options: A: Foregut carcinoid, B: Midgut carcinoid, C: Hindgut carcinoid, D: None of the above - -### Response: -Midgut carcinoids are argentaffin-positive and have a high serotonin content. They most frequently cause the typical carcinoid syndrome when they metastasize. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 3058 -### End" -4534,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60 year old male presented with skin hyperpigmentation, central obesity, violet striae & proximal myopathy. His BP is 160/90 mmHg. Lab studies show hypokalemic metabolic alkalosis. Which of the following statements is true regarding this condition?, with the following options: A: Basal ACTH level is likely to be low., B: Circulating coicotropin-releasing hormone is likely to be elevated., C: Pituitary magnetic resonance imaging (MRI) will visualize all ACTH-secreting tumors., D: Serum potassium level <3.3 mmol/L is suggestive of ectopic ACTH production - -### Response: -The given scenario suggests the diagnosis of Cushing syndrome. Basal ACTH levels are elevated in pituitary tumors & ectopic ACTH secretion Coicotropin-releasing hormone is rarely the cause of Cushing syndrome. MRI of the pituitary gland will not visualize lesions <2 mm Serum potassium level <3.3 mmol/L is suggestive of ectopic ACTH production Also, hypeension, hypokalemic metabolic alkalosis & glucose intolerance are more prominent in ectopic ACTH secretion than in pituitary tumors -### End" -4535,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Insulin contains which trace element -, with the following options: A: Cobalt, B: Copper, C: Zinc, D: Selenium - -### Response: -Ans. is 'c' i.e.. ZincMicro minerals or trace elementsElementMetabolic funtionDeficiency manifestionChromiumPotentiate the effect of insulinImpaired glucose metabolismCobaltConstituent of vitamin Bi:Macrocytic anemiaCopperConstituent of oxidase enzymes, e.g., tyrosinase, lysyl oxidase, superoxide dismutase, cytochrome oxidase, ferroxidse and ceruloplasmin, involved in iron absorption and mobilization'Microcytic hyporchromic anemia, depigmentation of skin, hair. Excessive deposition in liver in Wilson's disease, Menkes disease (""Kinky"" or ""steely"" hair disease) due to copper-binding P-type ATPase gene mutationFluorideConstituent of bone and teeth, strengthens bone and teethDental cariesIodineConstituent of thyroid hormones (T3 and T4)Cretinism in children and goiter in adultsIronConstituent of heme and non-heme compounds and transport, storage of O2, cytochrome oxidase, xanthine oxidase, catalase, peroxidaseMicrocytic anemiaManganeseCofactor for number of enzymes, e.g., arginase, carboxylase, kinase, enolase, glucosyl transferase, phosphoglucomutaseNot well definedMolybdenumConstituent of xanthine oxidase, sulfite oxidase and aldehyde oxidaseXanthinuriaSeleniumAntioxidant, cofactor for glutathione peroxidase, protects cell against membrane lipid peroxidationCardiomyopathyZincCofactor for enzymes in DNA, RNA and protein synthesis, constituent of insulin, carbonic anhvdrase, carboxypeptidase, LDH, alcohol dehydrogenase, alkaline phosphatase, glutamate dehydrogenase. Porphobilinogen synthase, superoxide dismutase.Growth failure, impaired wound healing, defects in taste and smell, loss of apetite -### End" -4536,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: _______________ is the major excitatory neurotransmitter in the brain., with the following options: A: Ach, B: Aspaate, C: GABA, D: Glutamate - -### Response: -Glutamate is the major excitatory neurotransmitter; 60% of brain synapses are glutamatergic. GABA is the major inhibitory neurotransmitter and can be localized by using glutamic acid decarboxylase as a marker. A delta fibers which carry sharp pricking pain also release Glutamate. -### End" -4537,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Joule burn is seen with :, with the following options: A: Electrocution, B: Scalds, C: Lighting, D: Vitriolage - -### Response: -A i.e. Electrocution -### End" -4538,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zero orded kinetics in following drug with high dose, with the following options: A: Phenytoin and propranolol, B: Digoxin and prapranolol, C: Amiloride and propranolol, D: Alcohol and theoplylline - -### Response: -Zero order kinetics is seen in alcohol and theoplylline Ref-KDT 7/e p31 -### End" -4539,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Video assisted thoracoscooic surgery for better vision the space in the operative field is created by?, with the following options: A: Self retaining retractor, B: CO2 insufflations, C: Collapse of ipsilateral lung, D: Rib spacing - -### Response: -Ans is 'c' i.e. collapse of ipsilateral lung In contrast to most laparoscopic techniques, the working space for VATs is created not by adding an insuffalation gas but rather by removing air from the ipsilateral lung parenchyma causing collapse of the ipsilateral lung. -### End" -4540,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common malignancy after cholecystectomy is of, with the following options: A: Colon, B: Stomach, C: Pancreas, D: Ileum - -### Response: -Bile acids can induce hyperproliferation of the intestinal mucosa a number of intracellular mechanisms Cholecystectomy, which alters the enterohepatic cycle of bile acids, has been associated with a moderately increased rise of proximal colon cancers It cannot be ruled out, however, that it is less the effect of the cholecystectomy than the impact of other, not yet identified factors in the lithogenic bile of such patients A number of cofactors have been identified that may enhance or neutralize the carcinogenic effects of bile acids, e.g., the amount of dietary fat, fibre or calcium Calcium, in fact, binds bile acids and this may reduce their negative impact Ref: Maingot 11th edition Pgno : 628 -### End" -4541,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: External cephalic version is contraindicated all of the following except: September 2006, with the following options: A: Antepaum hemorrhage, B: Multiple pregnancy, C: Breech presentation, D: Ruptured membranes - -### Response: -Ans. C: Breech Presentation External cephalic version is a process by which a breech baby can sometimes be turned from buttocks or foot first to head first. It is usually performed after about 36 weeks. It is often reserved for late pregnancy because breech presentation greatly decreases with every week. It can be contrasted with ""interal cephalic version"", which involves the hand inseed through the cervix Contraindications include antepaum hemorrhage,pre-eclampsia, ruptured membranes,uterine scarring, and multiple pregnancies or fetal abnormality. -### End" -4542,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Initial amino acid in prokaryotic protein synthesis, with the following options: A: Arginine, B: Methionine, C: Formyl-methionine, D: Alanine - -### Response: -Activation of amino acid is the first phase of translation, among which initiation of protein synthesis is the first step. It is divided into 4steps .1st one is recognition steps. In eukaryotes, the first amino acid incorporated is methionine(AUG codon). But in prokaryotes, the same codon stands for N-formyl methionine, which is the first amino acid.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 600 -### End" -4543,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rabies vaccine for pre exposure prophylaxis is given at?, with the following options: A: 0, 3, 7 days, B: 0, 3, 7, 14 days, C: 0, 3, 7, 14, 30 days, D: 0, 7, 28 days - -### Response: -

pre exposure prophylaxis (PrEP) in rabies:- Performed with any of the modern cell derived vaccine. PrEP is recommended to anyone who is at continual,frequent or at increased risk of exposure to rabies either as a result of their occupation or residence( veterenerians, lab workers). Travellers with extensive outdoor exposure and children living in rural high risk areas are at paicular risk. Schedule:- intramuscular 1ml/0.5ml or intradermal 0.1 ml one site each day on days 0, 7, 21/28. Booster doses of rabies are not required for individuals living in or travelling to high risk areas who have recieved a complete primary series of pre exposure/post exposure prophylaxis with CCV. Periodic booster injections are recommended as an extra precaution only for people whose occupation puts them at continual/ frequent risk of exposure. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.280}

-### End" -4544,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After 28 weeks of gestation true is/are :, with the following options: A: Viable, B: > 1000 gm, C: Type II pneumocytes present, D: All - -### Response: -Ans. is a, b and d i.e. Viable: >1000 gm: and Type II pneumocytes present -### End" -4545,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dorsal scapular nerve supplies:, with the following options: A: Teres minor, B: Trapezius, C: Serratus anterior, D: Levator scapulae - -### Response: -Ans. D. Levator scapulaeThe dorsal scapular nerve arises from the brachial plexus, usually from the plexus root (anterior/ventral ramus) of the cervical nerve C5. Once the nerve leaves C5 it commonly pierces the middle scalene muscle, and continues deep to levator scapulae and the rhomboids.It provides motor innervation to the rhomboid muscles and levator scapulae muscle. -### End" -4546,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal voice heard from 1 meter, intensity of sound reaching ear is -, with the following options: A: 20 dB, B: 40 dB, C: 60 dB, D: 80 dB - -### Response: -Normal conversation produces 60-70 dB. Whisper 20-30 dB. Mechanical damage at 150-160 dB REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 22nd EDITION. PAGE NO - 688 -### End" -4547,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Redleg disease is caused by-, with the following options: A: Pseudomonas, B: Moudly sugar cane fibre, C: Coniosporium, D: Aeromonas - -### Response: -Red-leg' Syndrome in Amphibians. ""Red-leg"" syndrome is a widespread infection seen in frogs, toads, and salamanders. It is recognized by the redness on the underside of the amphibian's legs and abdomen, and is generally due to Aeromonas hydrophila, an opportunistic bacterial pathogen -### End" -4548,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rich source of IgG is:, with the following options: A: Stomach, B: Visceral peritoneum, C: Small intestine, D: Large intestine - -### Response: -C i.e. Small intestine (Most probably) Most abundant immunoglobin in blood --> IgG. -### End" -4549,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about brown sequard syndrome, with the following options: A: Ipsilateral loss of joint sensation, B: Contralateral loss of joint sensation, C: Ipsilateral loss of pain & temperature, D: Segmental sign are bilateral - -### Response: -In Brown sequard syndrome, a hemisection of the spinal cord results in --        Sensory - - Loss of Ipsilateral dorsal column sensations- Proprioception, vibration, fine touch, Kinesthesia. - Loss of contralateral lateral column sensations- Pain, temperature - --        Motor - -Loss of ipsilateral corticospinal action- results in UMNL- Weakness, spasticity, Extensor plantar response. -### End" -4550,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are affected in Erb's palsy EXCEPT, with the following options: A: Upper trunk of brachial plexus, B: Lower trunk of brachial plexus, C: Dorsal scapular nerve, D: Suprascapular nerve - -### Response: -(B) Lower trunk of brachial plexus # Erb's palsy: Most common type when the 5th and 6th cervical nerve roots are involved as in the upper trunk of brachial plexus.> Resulting paralysis causes the arm to lie on the side with extension of the elbow, pronation of the forearm and flexion of the wrist (waiter's tip).> Moro reflex & biceps jerks are absent on the affected side> Treatment consists of use of a splint so as to hold the arm abducted to a right angle and externally rotated> Forearm is flexed at right angle and supinated and the hand is dorisflexed.> Massage and passive movements are advocated.> Fully recovery takes weeks or even months.> Severe injury may produce permanent disability.# Upper root lesions (Erb's palsy): Due to injury of C5, C6 and (sometimes) C7. Abductors and external rotators of the shoulder and the supinators are paralysed. Arm is held to the side, internally rotated and pronated. There may also be loss of finger extension, Sensation is intact. -### End" -4551,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60 years old patient was brought to the emergency after A. NCCT head was performed and the findings are given below. All of the following are true about this condition except:, with the following options: A: Blood collects between dura and arachnoid, B: Caused by disruption of coical veins, C: Evacuation should be done in all the cases, D: Associated with a significant primary brain injury - -### Response: -The given NCCT head show Subdural Hematoma which is concavo-convex or crescentic shaped. It occurs due to rupture of Bridging Veins. Happens due to significant trauma to brain Craniotomy is done. But small SDH can be managed conservatively. -### End" -4552,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Otic barotrauma results due to -, with the following options: A: Ascent in air, B: Descent in air, C: Linear acceleration, D: Sudden acceleration - -### Response: -Otitic barotrauma or Aero otitis media results due to rapid descent during air flight, underwater divising or compression in pressure chamber. -### End" -4553,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Principal Actions of prostacyclin in Inflammation is, with the following options: A: Vasodilation, B: Vasoconstriction, C: Increased vascular permeability, D: Chemotaxis, leukocyte adhesion - -### Response: -Principal Actions of Arachidonic Acid Metabolites in InflammationActionEicosanoidVasodilationProstaglandins PGI2 (prostacyclin), PGE1, PGE2, PGD2VasoconstrictionThromboxane A2, leukotrienes C4, D4, E4Increased vascular permeabilityLeukotrienes C4, D4, E4Chemotaxis, leukocyte adhesionLeukotrienes B4, HETERef: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 3; Inflammation and Repair; Page no: 84; Table 3-5 -### End" -4554,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2hyr old women who had home delivery 2wks back now presents with complete perineal tear whats the next line of the management, with the following options: A: repair immediately, B: repair after 3wks, C: repair after 3months, D: repair after 6 months - -### Response: -complete prineal tear <24HRS= Repair immediately >24HRS - schedule after 3months REF : SHAW GYNECOLOGY -### End" -4555,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about alpha1 antitrypsin deficiency is, with the following options: A: Autosomal dominant, B: Pulmonary emphysema, C: Diastasis resistance hepatic cells, D: Hepatic cells are orcein stain positive - -### Response: -Ref Robbins 9/e p850- 851 Diastase resistant hepatic cells The presence of PAS-positive, diastase-resistant inclusions in the cytoplasm of the hepatocytes is characteristic of alpha-1-antitrypsin deficiency -### End" -4556,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following features are common for both cangrelor & Ticagrelor except, with the following options: A: They are antiplatelet drugs, B: The reversibly inhibit ADP, C: Both drugs can be given orally, D: Both drugs have short half life - -### Response: -Only Ticagrelor can be given orally, cangrelor is given intravenously. -### End" -4557,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the investigation of choice for Reversible Myocardial Ischemia?, with the following options: A: MUGA scan, B: Resting ECHO, C: Thallium scan, D: Coronary angiography - -### Response: -Thallium 201 is a photon-emitting substance with biologic propeies similar to potassium. It can concentrate inside cells that function normally. Regions that are ischaemic or dead do not concentrate thallium and appear as defects on the scan. Reversible ischemia, such as that induced by exercise, is marked by defects seen at peak exercise that later fill on the delayed scans (reversible defects). In contrast, dead or infarcted regions appear as defects in both exercise and delayed scans (fixed defects). Ref: Medicine By Mark C Fishman, 5th Edition, Page 12; Harrison's Principles of Internal Medicine, 16th Edition, Pages 1324-26 -### End" -4558,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Moon's molars seen with ?, with the following options: A: Syphilis, B: Leprosy, C: Amyl oidosi s, D: Actinomycosis - -### Response: -Ans. is 'a' i.e., Syphilis Moon's- or Mulberry Molar is a condition where the first lower molar tooth has become dome-shaped due to malformation by congenital syphilis. -### End" -4559,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased Aldosterone leads to all of the following, except:, with the following options: A: Hypokalemia, B: Hypeension, C: Hypernatremia, D: Metabolic acidosis - -### Response: -Increased Aldosterone is associated with metabolic alkalosis and not metabolic acidosis. Other findings associated with it includes hypokalemia (potassium excretion), hypernatremia (sodium conservation) and hypeension (characteristically diastolic). Ref: Endocrine Physiology, 3rd Edition, Chapter 6; CURRENT Diagnosis and Treatment in Family Medicine, 3rd Edition, Chapter 36 -### End" -4560,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gamna-Gandy bodies contains hemosiderin along with?, with the following options: A: Na+, B: Ca++, C: Mg ++, D: Cl- - -### Response: -Gamna-Gandy bodies Yellow-brown siderotic bodies seen commonly in fibrocongestive splenomegaly. Contains hemosiderin along with Ca++. Seen in: Poal hypeension Sickle cell anemia Hairy cell leukemia -### End" -4561,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following statements are true regarding neutrophil extracellular trap, with the following options: A: Produced by neutrophils in response to infectious pathogens and inflammatory mediators, B: Provide a high concentration of antimicrobial substances at sites of infection, C: Prevent the spread of the microbes by trapping them in the fibrils, D: All the above - -### Response: -Ans. (d) All the above(Ref: Robbins 9th/pg 81)Neutrophil extracellular traps (NETs) are extracellular fibrillar networks that provide a high concentration of antimicrobial substances at sites of infection and prevent the spread of the microbes by trapping them in the fibrils. They consist of a viscous meshwork of nuclear chromatin that binds and concentrates granule proteins such as antimicrobial peptides and enzymes -### End" -4562,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hetch Giant cell pneumonia is caused by, with the following options: A: Mumps virus, B: Rubella, C: Rubeola, D: Varicella - -### Response: -Hetch Giant cell pneumonia is caused by Rubeola or Measles virus. -### End" -4563,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If a patient has herpes zoster involving the tip of the nose, eye is most likely to get affected due to the involvement of:, with the following options: A: Frontal nerve, B: Lacrimal nerve, C: Nasociliary nerve, D: Supratrochlear nerve - -### Response: -Nasociliary is a branch of ophthalmic division of trigeminal nerve. It passes through the superior orbital fissure within the annulus tendon between the the divisions of the third cranial nerve. Anterior ethmoidal nerve is a branch of nasociliary nerve. It enters the anterior cranial fossa and reaches the tip of the nose as the external nasal nerve. So if a patient has herpes zoster and tip of the nose is affected it means the nasociliary nerve is affected and eye will definitely get involved. This is known as the Hutchison's rule. Ref: Textbook of Ophthalmology edited by Sunita Agarwal, page 346 -### End" -4564,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for sputum positive pulmonary tuberculosis detected in 1st trimester of pregnancy:, with the following options: A: Defer till second trimester, B: Start cat. I immediately, C: Start cat. II immediately, D: Start cat. Ill immediately - -### Response: -Ans is 'b' i.e. Start cat. I immediately Repeat May 09Sputum positive pulmonary tuberculosis falls under category I.Active tuberculosis in pregnancy must be treated. ""Untreated tuberculosis represents a far greater hazard to a pregnant woman and her fetus than does treatment of the disease. CDC (2003, 62).Treatment of active tuberculosis disease should be initiated as soon as the diagnosis is made.So Cat. I ATT should be started promptly as maternal tuberculosis is associated with:increased risk of spontaneous abortionperinatal mortalitysmall for gestation agelow birth weightFirst line drugs can be safely used in pregnancy except streptomycin which is contraindicated because of its associated with fetal ototoxicity.Second line drugs are not recommended in pregnancy (They are used only if benefit outweighs the risk, as in case of MDR tuberculosis)Pyrazinamide is not recommended by CDC (USA) in absence of sufficient safety data, however many tubercular authorities all over world support its use. CDC recommends an alternative 9 month regimen containing isoniazid and rifampin throughout (supplemented by ethambutol, until drug susceptibility results are available).Breastfeeding is not contraindicated in women using antituberculosis drugs. -### End" -4565,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are anti coagulants .. except, with the following options: A: Antithrombin 3, B: Protein S, C: VWF, D: Nitric oxide - -### Response: -Ref Robbins 7/e p125-126;129-130;9/e p121-118 Von Willebrand Factor's primary function is binding to other proteins, in paicular factor VIII, and it is impoant in platelet adhesion to wound sites. It is not an enzyme and, thus, has no catalytic activity. VWF binds to a number of cells and molecules. The most impoant ones are: Factor VIII is bound to VWF while inactive in circulation; factor VIII degrades rapidly when not bound to VWF. Factor VIII is released from VWF by the action of thrombin. In the absence of VWF, factor VIII has a half-life of 1-2 hours; when carried by intact VWF, factor VIII has a half-life of 8-12 hours. VWF binds to collagen, e.g., when collagen is exposed beneath endothelial cells due to damage occurring to the blood vessel. Endothelium also releases VWF which forms additional links between the platelets' glycoprotein Ib/IX/V and the collagen fibrils -### End" -4566,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skin biopsy of a patient shows evidence of malignant melanoma. Which is the common type of malignant melanoma?, with the following options: A: Superficial spreading, B: Lentigo maligna melanoma, C: Nodular, D: Acral lentiginous - -### Response: -Superficial spreading melanoma comprises approximately 60% to 70% of melanomas and represents the most common melanoma subtype. They often arise in a preexisting nevus and typically develop as a spreading pigmented plaque with irregular borders and variation in color and surface contour. They often exhibit the classic clinical features of melanoma. Areas of regression may result in pink to white areas within the black or brown tumor. They may progress to a veical growth phase faster than lentigo maligna. Ref: Ludgate M.W., Wang T.S. (2009). Chapter 100. Skin Cancer. In J.B. Halter, J.G. Ouslander, M.E. Tinetti, S. Studenski, K.P. High, S. Asthana (Eds), Hazzard's Geriatric Medicine and Gerontology, 6e. -### End" -4567,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are minor Jones Criteria except ?, with the following options: A: Ahragia, B: Fever, C: Prolonge PR Interval, D: Chorea - -### Response: -Jones minor criteria include ahralgia,prolonged PR interval,fever. Ref : Ghai essential of pediatrics, eighth edition, p.no:434 -### End" -4568,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Population covered by CHC, with the following options: A: 5000, B: 20,000, C: 30,000, D: 100,000 - -### Response: -Ans. (d) 100,000Ref : K. Park 23rd ed. / 907* CHC is community health Centre. It covers 120,000 population in plain areas and 80,000 population in hilly areas.* Since, 120,000 is not in option, 100,000 is the closest and best answer.Also Know* PHC is considered as Primary level of health care is. It is considered as 1st level of contact.* CHC is considered as secondary level of health care and first referral unit.* Tertiary level of health care is delivered through medical colleges and hospitals.Health Care UnitPopulation coveredPlainHilly/Tribal/BackwardCHC120,00080,000PHC30,00020,000MPW50003000AWW400-800300-800ASHA/VHG/TBA1000 -### End" -4569,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pregnenolone is not in the biosynthetic pathway of which substance?, with the following options: A: Coisol, B: Estrogen, C: DHEA, D: 1,25(OH)2D - -### Response: -All the steroids listed include pregnenolone early in their biosynthetic pathway. 1,25(OH)2D is derived from vitamin D and does not include pregnenolone in its biosynthetic pathway. -### End" -4570,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The parvocellular pathway, from the lateral geniculate nucleus to the visual cortex, carries signals for the detection of, with the following options: A: Movement, depth and flicker, B: Color vision, shape and fine details, C: Temporal frequency, D: Luminance contrast - -### Response: -The parvocellular pathway, from the lateral geniculate nucleus (Layers 3-6) to the visual cortex, carries signals for the detection of colour vision, texture, shape and fine details. -### End" -4571,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preauricular sinus develops due to-, with the following options: A: Faulty fusion between hillocks of 1st and 2nd pharyngeal arches, B: Chronic suppurative otitis media, C: Acute Parotitis, D: Lupus vulgaris - -### Response: -Ans. is 'a' i.e., Faulty fusion between hillocks of 1st and 2nd pharyngeal arches Preauricular sinuso During embryogenesis, the auricle arises from the first and second branchial arches.o During sixth week of gestion, six tubercles (hillocks) appear, 3 arise from the caudal border of the first branchial arch, and 3 arise from the cephalic border of the second brachial arch. These tubercles (hillocks) should unite during the next few weeks of embryogenesis to form auricle.o Preauricular sinuses are thought to occur as a result of incomplete fusion of these hillockso A preauricular sinus occurs either sporadically or is inherited. Unilateral cases are more often sporadic and occur more frequently on right side. Bilateral cases are more likely to be inherited with incomplete autosomal dominance pattern of inheritance.o Preauricular sinus is commonly seen at the root of helix. It may get repeatedly infected causing purulent discharge. Abscess may also form. Treatment is surgical excision of the track if the sinus gets repeated infection. -### End" -4572,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of lepra type II reaction are all except, with the following options: A: Clofazimine, B: Thalidomide, C: Coicosteroids, D: Cessation of anti leprosy treatment - -### Response: -Treatment of lepra type 2 reaction: Continue the antileprosy treatment. Mild/ moderate (fever with few skin lesions): - Rest - Chloroquine - Aspirin - Antimonials (when associated with bone and joint problem) Severe ENL (neuritis/ ahritis/ uveitis/ orchitis): - Steroid - Clofazimine (in large doses) - Thalidomide: Thalidomide is of no value in Type I reaction It is used in management of type II reaction It is teratogenic hence contraindicated in women -### End" -4573,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AVN is seen in:, with the following options: A: Navicular fracture, B: Talus fracture, C: Calcaneal fracture, D: Cuboid fracture - -### Response: -Ans. B i.e. Talus fracture Fracture through neck of femur, neck of talus and waist of Scapho d can lead to AVN -### End" -4574,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following best methods of urine collection is associated with least contamination :, with the following options: A: Suprapubic aspiration, B: Mid stream collection, C: Catheterization, D: Urine Bag specimen - -### Response: -Answer is A (Suprapubic aspiration) Urine obtained from suprapubic aspiration is least likely to be contaminated- Suprapubic aspiration avoids potential contamination but is rarely used because of its invasiveness It may be indicated in children2 (and selected other patients) Desirable propeies of a voided sample It is best to collect a clean voided mid stream urine sample (First 15-30 ml are discarded and the next 50- 100 ml are collected) The midstream clean catch method reduces the likelihood of contamination with meatal or urethral secretions Freshly voided specimen should be tested (Within one hour of voiding) Urine specimen should not be collected immediately after the patient has eaten (Should be obtained a few hours after the patient has eaten) First voided morning specimen should be obtained for qualitative protein testing (Patients with possible ohostatic proteinuria) and for specific gravity testing. -### End" -4575,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brain is preserved in all of the following, except: AIIMS 06, with the following options: A: OPC poisoning, B: Alkaloid poisoning, C: Heavy metal poisoning, D: Volatile organic poisoning - -### Response: -Ans. Heavy metal poisoning -### End" -4576,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The velocity of blood is maximum in the:, with the following options: A: Large veins, B: Small veins, C: Venules, D: Capillaries - -### Response: -Ans. is 'a' ie large veins (Ref: Ganong, 22/e, p584).The velocity of blood is inversely proportional to the total cross-sectional area at that point.Thus the velocity of blood is high in aorta, declines steadily in the smaller arteries and is lowest in the capillaries (The capillaries have 1000 times the total cross- sectional area of the aorta) The velocity of blood flow increases again as the blood enter the veins and is relatively high again in the vena cava, although not so high as in the aorta. -### End" -4577,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pellagra like clinical syndrome is found in, with the following options: A: Homocystinuria, B: Histidinuria, C: Cystinosis, D: Hartnup disease - -### Response: -Hartnup disease is an autosomal recessive disorder caused by impaired neutral aminoacid transport. -Presents with pellagra Like skin eruptions , Cerebellar ataxia , and gross aminoaciduria. -### End" -4578,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bulkeley membrane is seen in :, with the following options: A: Psoriasis, B: Pemphigus, C: Tinea, D: Pityriasis - -### Response: -A. i.e. Psoriasis -### End" -4579,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a component of Lofgren syndrome, with the following options: A: Erythema nodosum, B: Bilateral hilar enlargement, C: Joint symptoms, D: Facial palsy - -### Response: -Lofgren's syndrome consists of erythema nodosum and hilar adenopathy on chest roentgenogram. In some cases, periaicular ahritis may be identified without erythema nodosum. Lofgren's syndrome is associated with a good prognosis, with >90% of patients experiencing disease resolution within 2years.Heerfordt - Uveoparotid fever with facial palsyReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 390; Sarcoidosis -### End" -4580,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A man has just received his fourth DUI citation. The judge orders an alcohol dependency program complete with a medication that makes him have nausea and vomiting if he drinks alcohol while taking the medication. The drug-induced illness is caused by the buildup of which one of the following?, with the following options: A: Ethanol, B: Acetaldehyde, C: Acetate, D: Acetyl-CoA - -### Response: -The court-ordered medication is disulfiram. Disulfiram inhibits ALDH, which greatly reduces the amount of acetaldehyde that is converted to acetate. This causes an accumulation of acetaldehyde, which is the substance responsible for the symptoms of a ""hangover,"" including nausea and vomiting. Alcohol dehydrogenase reduces ethanol to acetaldehyde. Acetyl-CoA synthetase converts acetate to acetyl-CoA. -### End" -4581,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ulnar nerve injury in the arm leads to all except -a) Sensory loss of the medial 1/3rd of the handb) Weakness of the hypothenar musclesc) Claw handd) Adduction of thumb, with the following options: A: cd, B: bc, C: bd, D: ac - -### Response: -High ulnar nerve injury (injury above the elbow), does not cause claw hand. Adduction of thumb is lost. Injury does not lead to adduction of thumb. -### End" -4582,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The ocular features of retinitis pigmentosa include –, with the following options: A: Bony corpuscular appearance, B: Waxy pallor of the optic disc, C: Attenuation of the retinal arterioles, D: All of the above - -### Response: -Clinical features of retinitis pigmentosa - -Retinal pigmentary changes (Bone spicule intraneural retinal pigmentation) : - Retina studded with small, jet-black spots resembling bone corpuscles with a spidery outline. These pigmentary changes are typically perivascular and retinal veins (never arteries) have a sheath of pigment for part of their course. These changes affect equatorial region initially sparing the posterior pole and periphery. Later in the course of disease whole retina is involved. -Attenuated and thread like retinal arterioles and veins. -Pale and waxy optic disc (consecutive optic atrophy). -Thinning and atrophy of retinal pigment epithelium (RPE) in mid and far peripheral retina with relative sparing of RPE at macula. -### End" -4583,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The key cell types involved in the acquired immunity include all EXCEPT:, with the following options: A: B lymphocytes, B: Erythrocytes, C: T lymphocytes, D: Antigen presenting cells (APC) - -### Response: -The main physiological role of red blood cells (RBCs), or erythrocytes is to transport gases (O2, CO2) from the lung to the tissues and to maintain systemic acid/base equilibria.  -In addition, RBCs are well equipped with antioxidant systems, which essentially contribute to their function and integrity. -They are not involved in acquired immunity. -### End" -4584,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are impoant pathological features noted in ATP 7B gene mutation, EXCEPT:, with the following options: A: Low serum ceruloplasmin, B: Low serum free copper, C: Low serum copper, D: Positive copper balance - -### Response: -ATP7B protein deficiency impairs Biliary copper excretion resulting in positive copper balance Hepatic copper accumulation Copper toxicity from oxidant damage It leads to low serum ceruloplasmin due to excess catabolism of apoceruloplasmin. Low serum copper is due to low ceruloplasmin level. Non ceruloplasmin bound copper level will be high-free copper. Ref: Harrison, E-18, P-3188. -### End" -4585,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Seddon grading is used for -, with the following options: A: Classification of nerve injuries, B: Grading of open fractures, C: Classification Potts paraplegia, D: Grading of severity of malignant bone tumours - -### Response: -Ans. is 'a & c' i.e., Classification of nerve injuries & Classification Potts paraplegia o Seddons classification is used in :i) Peripheral nerve injuryii) Potts paraplegiaSeddon's classification of nerve injurieso Seddon identified three types of injuries :1) Neuropraxia# There is contusion of the peripheral nerve which causes reversible physiological nerve conduction block. The axis cylinder (i.e., axon with its endoneurium) is preserved. Thus, there is physiological conduction block without anatomic disruption. The injury is temporary and recovery is complete. It is seen in crutchpalsy, tourniquet palsy, and Saturday night palsy.2) Axonotemesis# There is injury to axon but endoneurium is preserved. Spontaneous recovery is expected in some cases. This is seen in closed fractures and dislocations.3) Neurotemesis# There is complete anatomical section of nerve. No recovery possible. It is seen in open wound.Seddon's classification for potts paraplegiaEarly onset paraplegiaLate onset paraplegiaActive diseaseHealed diseaseOccurs within 2 yearsAfter 2 yearsCauseso Inflammatory edemao Granulation tissueo Tubercular abscesso Caseous tissueo Tubercular debrisCauseso Stenosis of vertebral canalo Internal gibbuso Infective endarteritiso Prolonged stretching of cord over deformityo Pathological dislocation -### End" -4586,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Charcots/neuropathic joints are most commonly seen in September 2007, with the following options: A: DM, B: Syringolmyelia, C: Leprosy, D: Rheumatoid ahritis - -### Response: -Ans. A: DM Any condition that causes sensory or autonomic neuropathy can lead to a Charcot joint. Charcot ahropathy occurs as a complication of diabetes, syphilis, chronic alcoholism, leprosy, meningomyelocele, spinal cord injury, syringomyelia, renal dialysis, and congenital insensitivity to pain. Diabetes is considered to be the most common cause of Charcot ahropathy Acute Charcot ahropathy almost always presents with signs of inflammation. Profound unilateral swelling, an increase in local skin temperature (generally, an increase of 3-7 degrees above the nonaffected foot's skin temperature), erythema, joint effusion, and bone resorption in an insensate foot are present. These characteristics, in the presence of intact skin and a loss of protective sensation, are often pathognomonic of acute Charcot ahropathy. Pain can occur in more than 75% of patients; however, the pain's severity is significantly less than would be expected based on the severity of the clinical and/or radiographic findings. Instability and loss of joint function also may be present. Passive movement of the joint may reveal a ""loose bag of bones."" Approximately 40% of patients with acute Charcot ahropathy have concomitant ulceration, which complicates the diagnosis and raises concerns that osteomyelitis is present. -### End" -4587,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Check each of the following statements concerning intracellular fluid that is true: 1.It contains morethan50% of the body water 2.It has a higher osmotic pressure than extracellular fluid 3.It has a higher concetration of organic anions than extracellular fluid Which if the following best summarizes your conclusion?, with the following options: A: Statement 2 is true, B: Statement 1 & 2 are true, C: Statement 1 & 3 are true, D: Statement 1, 2 & 3 are true - -### Response: -Intracellular fluid contains 2/3 of body water.Under steady-state conditions the intracellular osmolarity and extracellular osmolarity are equal. If there was a difference ,water would diffuse until they were equal .The intracellular compament does have a higher concentration of organic anions, mainly proteins, then the extracellular fluid. -### End" -4588,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The technique of home bleaching prescribed by dentist, with the following options: A: Walking bleach, B: Night guard, C: Both, D: None. - -### Response: -Although a 3% ether and peroxide mouthwash used for bleaching in 1893 has been reported in the literature, the “dentist-prescribed, home-applied” technique (also referred to as nightguard vital bleaching or at-home bleaching) for bleaching vital teeth outside the oice began around 1968, although it was not commonly known until the late 1980s. -Walking bleach is a non vital bleaching procedure. -### End" -4589,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about pleomorphic adenoma except ?, with the following options: A: Most common tumor of salivary glands, B: Has a tendency to invade perineural space, C: Most commoly involves the parotid gland, D: It is also called a mixed tumor - -### Response: -Pleomorphic adenoma This is the Commonest neoplasm of Salivary glands. The most Common salivary gland involved is Parotid - represent about 60% tumors in the parotid. o Submandibular and minor salivary glands may also be involved rarely. Pleomorphic adenoma - Parotid > Submandibular > minor salivary glands. They are derived from a mixture of ductal (epithelial ) and myoepithelial cells and therefore they show both epithelial and mesenchymal differentiation - Also called mixed tumor. -### End" -4590,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of origin of pleomorphic adenoma is:, with the following options: A: Parotid gland, B: Submandibular salivary gland, C: Minor salivary glands of soft and hard palate, D: Minor salivary glands of lip - -### Response: -Pleomorphic adenoma most commonly arises from the parotid gland. Ninety per cent are located in the superficial lobe while 10% involve deep lobe and present as parapharyngeal tumours. -### End" -4591,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a Nonsense codon :, with the following options: A: UAG, B: AUG, C: AGG, D: UUA - -### Response: -Non-sense codons/Terminator Codons/Punctuator codons Codons which do not code for any paicular amino acid. Mark end of protein synthesis. These codons are UAA UAG UGA UGA is a stop codon; But in special circumstances, it stands for seleno-cysteine (""21st"" amino acid). UAG is a stop codon; But in special circumstances, it stands for pyrrolysine (22nd amino acid) -### End" -4592,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior cord of brachial plexus is formed by, with the following options: A: Ventral division of upper trunk, B: Dorsal division of upper trunk, C: Ventral division of upper, middle and lower trunk, D: Dorsal division of upper, middle and lower trunk - -### Response: -Cords of brachial plexus are formed by : (i) The lateral cord - It is formed by the union of the ventral divisions of the upper and middle trunks. (ii) The medial cord - It is formed by the ventral division of the lower trunk. (iii) The posterior cord -It is formed by union of the dorsal divisions of all the three trunks. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 1 , pg. no., 57. -### End" -4593,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Half life of Rn-222 is:, with the following options: A: 3 days, B: 3-6 days, C: 4 days, D: 5 days - -### Response: -Ans. 3-6 days -### End" -4594,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding medical termination of pregnany, all of the following are true except-: September 2007, with the following options: A: Professional secrecy has to be maintained, B: Woman has the right to abo his fetus without consent of husband, C: In an emergency,termination of pregnancy can be done by a single doctor, D: Termination of pregnancy up to 20 weeks can be done by medical practitioner without consulting specialist - -### Response: -Ans. D: Termination of pregnancy up to 20 weeks can be done by medical practitioner without consulting specialist If the period of pregnancy is: Below 12 weeks, it can be terminated by on the opinion of a single doctor. If the period is between 12-20 weeks, two doctors must agree, though only one can do it once the opinion is formed In an emergency, even after 20 weeks a single doctor can perform it. Consent of the husband for MTP is not required -### End" -4595,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pellagra is due to deficiency of: September 2006, 2009, with the following options: A: Riboflavin, B: thiamine, C: Niacin, D: Pyridoxine - -### Response: -Ans. C: Niacin Pellagra is caused by a chronic lack of niacin (vitamin B3) in the diet. It can be caused by decreased intake of niacin or tryptophan, and possibly by excessive intake of leucine. It may also result from alterations in protein metabolism in disorders such as carcinoid syndrome. A deficiency of the amino acid lysine can lead to a deficiency of niacin as well, meaning that another potential cause of pellagra is lysine deficiency -### End" -4596,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When a cell transforms itself into different lineage the ability us known as -, with the following options: A: De-differentiation, B: Re-differentiation, C: Trans-differentiation, D: Sub-differentiation - -### Response: -Ans. is 'c' i.e., Trans-differentiation Transdifferentiationo Transdifferentiation takes place when a non-stem cell transform into a different type of cell, or when an already-differentiated stem cell creates cells outside its already established differentiation.o Remember very important fact that it is the non-stem cell or already differentiated stem cell (i.e. mature cell) that is transformed into other type of cell. It is not stem cell that is transforming,o Transdifferentiation is a type of metaplasia.o Then, what is the difference between transdifferentiation and metaplasia.In Transdifferentiation only differentiated stem cell is transformed into other cell type, while in metaplasia any of the two, either stem cell or differentiated cell can transform into other cell type.So, all transdifferentiation processes are metaplasia, but not all metaplasia are transdifferentiation. -### End" -4597,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following muscle of the larynx acts as abductor of vocal cords?, with the following options: A: Lateral cricoarytenoid, B: Posterior cricoarytenoid, C: Anterior cricoarytenoid, D: Cricothyroid - -### Response: -Posterior cricoarytenoid is the sole abductor of vocal cords. Therefore bilateral paralysis may lead to adduction of vocal cords and suffocation. They are called safety muscles of larynx. It arise from the posterior surface of lamina of cricoid on either side of midline, and is inseed on back of the muscular process of arytenoid cailage of its side. It acts on cricoarytenoid joint to rotate the arytenoid with its vocal process laterally so that muscular process turns posteriorly resulting in abduction of vocal cords and widening of rima glottis. Adductors of vocal cord: Lateral cricoarytenoid Transverse arytenoid -### End" -4598,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the pattern of inheritance in the given pedigree chart, with the following options: A: Holandric inheritance, B: Mitochondrial inheritance, C: X linked dominant inheritance, D: Autosomal donminant inheritance - -### Response: -Mitochondrial DNA is inherited only by Mother. So mother trammits disease related to Mitochondria to all her children. -### End" -4599,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inferior pancreaticoduodenal aery is a branch of which of the following aery?, with the following options: A: Splenic aery, B: Left gastric aery, C: Gastroduodenal aery, D: Superior mesenteric aery - -### Response: -Inferior pancreaticoduodenal aery is a branch of superior mesenteric aery. It supplies the pancreas and adjoining pa of the duodenum. Its anterior and posterior branches anastomose with the branches of superior pancreaticoduodenal aery. This anastomosis is the only communication between the aeries of foregut and midgut. Branches of superior mesenteric aery are: Inferior pancreaticoduodenal aery Jejunal and ileal branches Ileocolic aery Right colic aery Middle colic aery Ref: Gray&;s anatomy text book of anatomy BD chaurasia 21st Ed. -### End" -4600,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common postprandial motility is seen in, with the following options: A: Ascending colon, B: Transverse colons, C: Descending colon, D: Sigmoid colon - -### Response: -It&;s sigmoid colon Tonic and phasic colonic motility and compliance of the transverse and sigmoid colon were therefore assessed using a combined barostat-manometry assembly in 22 healthy subjects. Measured colonic compliance was corrected by subtraction of the compliance of the closed barostat system. The mean (SEM) preprandial colonic volumes in the transverse and sigmoid colon were similar (150 (12) and 128 (13) ml, p = NS), corresponding to calculated mean (SEM) colonic diameters of 4.3 cm and 4.0 cm respectively. The mean increase in colonic tone postprandially was significantly greater in the transverse (24.1% (3.5)) than in the sigmoid colon (13.1% (3.0), p < 0.01). The mean increase in phasic contractility was significantly greater, however, in the sigmoid than in the transverse colon (1270 (210) and 425 (60) mm Hg/90 min respectively, p < 0.01). Compliance was greater in the transverse than sigmoid colon (7.6 (0.44) and 4.1 (0.15) ml/mm Hg, p < 0.001). The fasting volume of the colon was significantly correlated with the magnitude of the tonic response to the meal in the transverse and sigmoid colon (p < 0.001 for both). In conclusion, there are quantitatively different but qualitatively similar phasic and tonic responses to the meal in the two colonic regions. Differences in the viscoelastic and luminal dimensions may paly account for these differences in tonic responses.Ref: Ganong&;s review of medical physiology 23rd edition Page no: 475 -### End" -4601,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Streptococcus pneumonia produces which type of hemolysis -, with the following options: A: Alpha, B: Beta, C: Gamma, D: Any of the above - -### Response: -Ans. is 'a' i.e., Alpha [Ref: Ananthanarayan 9th/e p. 220-221 & 8th/e p. 218, 219)o Streptococci have been categorised into three varieties based on their growth in 5% blood agar pour plate cultures:-StreptococciAlpha (a)Beta (b)Gamma (g)Greenish discolouration with partial hemolysis around colonies eg - Str. Pneumonia Str. viridansColourless zone of complete hemolysis eg - Str-pyogenes Str. agalactiae Str. equisimilisNo hemolysis eg- Enterococci -### End" -4602,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The DTPB approach is included under which program?, with the following options: A: National AIDS control programme, B: National Programme for Control of Blindness, C: National Strategic Plan for TB, D: National malaria elimination programme - -### Response: -National Strategic Plan (2017-2025) for TB Elimination The aim of the National Strategic Plan is to achieve elimination of TB by 2025. During plan period, targets for TB are:1. 80% reduction in TB incidence (i.e . reduction from 211 per lakh to 43 per lakh)2. 90% reduction in TB moality (i.e. reduction from 32 per lakh to 3 per lakh3 . 0% patient having catastrophic expenditure due to TB The requirements for moving towards TB elimination have been integrated into the four strategic pillars of ""Detect - Treat - Prevent - Build"" (DTPB) -### End" -4603,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hecht's pneumonia is typically seen in -, with the following options: A: Measles, B: Malaria, C: RSV, D: Pneumococcus - -### Response: -Ans. is 'a' i.e., Measles Primary giant cell Pneumonia or Hecht's Pneumoniao Refers to a Primary Giant cell type of Pneumonia typically seen in patients with measles.o It is a rare but often fatal form of interstitial pneumonia typically seen in immune-compromised patients with measles. The diagnosis of Hecht's Pneumonia is made on histological examination by demonstration of an interstitial type pneumonia with variable number of Giant cells.Sequelae/Complicationso Secondary bacterial infections; Giant cell pneumonia (1 in 25); meningitis/encephalitis (1 in 1,000)o Subacute sclerosing panencephalitis (SSPEI: Develops 1 to 10 years after the initial infection# Progressive, usually fatal CNS disease and those who survive are severely impaired mentally and physically.# First signs are behavioral, followed by loss of motor control and coordination.# Risk factors include acquiring primary measles at an early age (usually under two years).And# Associated with defective forms of the virus in the brain-difficult to isolate infectious virus from such patients. Certain viral proteins are often not expressed, the viral M protein (viral matrix protein) being frequently absent (not the same as M protein on streptococcus pyogenes). -### End" -4604,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bronchiectasis means..............of bronchi -, with the following options: A: Inflammation, B: Dilatation, C: Cavitation, D: All - -### Response: -Ans. is 'b' i.e., Dilatation Bronchiectasis Bronchiectasis is a disease characterized by permanant dilatation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue, resulting from or associated with chronic necrotizing infections. Bronchiectasis is associated with ?Congenital conditions Cystic fibrosis o Primary ciliary dyskinesia (Kaagener syndrome) o Intralobar sequestration of the lung. Post infectious necrotizing pneumonia o Bacteria --> M. Tuberculosis, staph. aureus. H. influenzae, Pseudomonas. o Viruses Adenovirus, HIV, influenza virus. o Fungus --> Allergic bronchopulmonary aspergillosis. Bronchial obstruction ---> Tumor, foreign body, mucus impaction. Other conditions --> RA, SLE, IBD, post-transplantation. -### End" -4605,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The attitude of limb in traumatic dislocation of hip joint is, with the following options: A: Flexion, adduction, external rotation, B: Flexion, adduction, internal rotation, C: Flexion and adduction only, D: Flexion, adduction, and external rotation - -### Response: -B i.e. Flexion, adduction, internal rotation -### End" -4606,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A five day old, full term male infant was severely cyanotic at bih. Prostaglandin E was administered initially and later ballooned atrial septosomy was done which showed improvement in oxygenation. The most likely diagnosis of this infant is :, with the following options: A: Tetralogy of Fallot, B: Transposition of great vessels, C: Truncus Aeriosus, D: Tricuspid Atresia - -### Response: -Answer is B (Transposition of great vessels) Transposition of Great vessels is a condition chracterized by aoa arising from the right ventricle and pulmonary aery from the left ventricle. This results in complete separation of systemic and pulmonary circulation. Since systemic and pulmonary circulations are separate, survival depends on mixing of oxygenated pulmonary blood and deoxygenated systemic blood which can Occur' At Atrial level - Through ASD At Ventricle level - Through VSD At Great vessel level - Through Patent ductus aeriosus Oxygenation is normal in foetus but after bih as ductus aeriosus closes severe hypoxia occurs and in the absence of V.S.D, or ASD child presents with cyanosis and tachypnea at bih. -### End" -4607,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most lateral deep cerebellar nucleus is?, with the following options: A: Emboliform nucleus, B: Dentate nucleus, C: Globose nucleus, D: Fastigial nucleus - -### Response: -Dentate nucleus REF: Gray's anatomy 39th edition page 398, http://en.wikipedia.org/wiki/Deep_cerebellar_nuclei Repeat in June 2011From lateral to medial, the four deep cerebellar nuclei are the Dentate, Emboliform, Globose, and Fastigial. An easy mnemonic device to remember their names and positions relative to the midline is the phrase ""Don't Eat Greasy Food"" -### End" -4608,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which type of malarial parasite is the exoerythrocytic stage absent -, with the following options: A: P ovale, B: P vivax, C: P falciparum, D: P malariae - -### Response: -P.falciparum Forms in peripheral blood-ring forms and gametocytes (crescent shaped) A) Most pathogenic B). No relapses in P.falciparum-exo-erythrocytic schizogony is absent C). Complications-pernicious malaria,black water fever D)pernicious malaria-1). Cerebral malaria-hyperpyrexia, coma,paralysis.Brain is congested.Capillaries of the brain are plugged with parasitised erythrocytes 2). Algid malaria-cold clammy skin leading to circulatory failure 3). Septicaemic malaria- high continuous fever with involvement of various organs Black water fever * Previously infected * Intravascular haemolysis fever and haemoglobinuria * Autoimmune mechanism * Bilious vomiting+prostration+black urine(refer pgno:60 baveja 3 rd edition) -### End" -4609,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The intensity of sound that does not cause ear damage-, with the following options: A: 80, B: 100, C: 120, D: 150 - -### Response: -Ans. is 'a' Le., 80 o Intensity is the strength of sound which determines its loudness. It is usually measured in decibels (dB). o Following are intensities when a person is at a distance of one meter from a sound source. Whisper 30 dB Normal conversation 60 dB Shout 90 dB Discomfort of ear 120 dB Pain in ear 130 dB o A daily exposure up to 85 dB is the about the limit people can tolerate without substantial damage to their hearing. -### End" -4610,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person is brought to you with suspicion of driving under the influence of alcohol. Assuming that all the facilities are available for alcohol level estimation, which of the following is the MOST desirable test for alcohol estimation?, with the following options: A: Breath analysis, B: Kozela Hinc method, C: Gas chromatography, D: Cavett test - -### Response: -Though all of the above are methods of estimation of alcohol levels, gas chromatography is the most specific. Breath analysis is the method commonly used by highway police. Cavett test involves distillation of the alcohol which is oxidised to acetic acid. It is also used for estimation of blood alcohol levels. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page - 484, 485. -### End" -4611,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is exact period for HSG (hysteronsalpingography)?, with the following options: A: Just before Menstruation, B: During Menstruation, C: Between end of menstruation and ovulation, D: On 28th day of menstrual cycle - -### Response: -Ans. c (Between end of menstruation and ovulation) (Ref. Grainger & Allison's Diagnostic Radiology, 5th ed., Ch. 54)HYSTEROSALPINGOGRAPHY (HSG)# Hysterosalpingography (HSG) plays an important role in the evaluation of abnormalities related to the uterus and fallopian tubes.# Uterine abnormalities that can be detected at HSG include -- Congenital anomalies,- Polyps,- Leiomyomas,- Surgical changes,- Synechiae, and- Adenomyosis.# Tubal abnormalities that can be detected include -- Tubal occlusion,- Salpingitis isthmica nodosum,- Polyps,- Hydrosalpinx, and- Peritubal adhesions.# HSG remains a valuable tool in the evaluation of the uterus and fallopian tubes.Indications for HSG# Infertility# Recurrent spontaneous abortions# Postoperative evaluation following tubal ligation or reversal of tubal ligation# Preoperative evaluation prior to myomectomyContraindications for HSG# Pregnancy# Active pelvic infection.Timing of study# The examination should be scheduled during days 7-12 of the menstrual cycle (day 1 being the first day of menstrual bleeding).# The endometrium is thin during this proliferative phase, a fact that facilitates image interpretation and should also ensure that there is no pregnancy.Educational Points:Comparison of hysterosalpingography with laparoscopy:HysterosalpingographyLaparoscopy and dye hydrotubationOutpatient procedureDay surgery procedureAnalgesia adequateGeneral anesthesia requiredSimple, inexpensiveExpensiveGives uterine cavity informationShows outer contour of the uterus only (unless with hysteroscopy)Tubal patency testedShows appearance of tubes and their patency; also of ovaries and pelvic peritoneumScreening testDefinitive testNot particularly sensitive for - mild distal tubal disease or endometriosisDistal tubal disease or endometriosis can be diagnosed and treated.# HSG is the best method for visualizing and evaluating the fallopian tubes. -### End" -4612,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rashtriya Swasthya Bi ma Vojna is:, with the following options: A: Government run insurance scheme for its employees, B: Government run insurance scheme for all citizens, C: Government run insurance scheme for all poor, D: Private insurance company run scheme thrall poor - -### Response: -Ans is 'c' i.e. Government run insurance scheme for all poor Rashtriya Swasthya Bima Ynj ana (RSBY) is a Government sponsored scheme for the BPL population of India. 75% by Central Government o 25% by State Governments (Government ofindia's contribution is 90 percent in case of Noh-eastern states and Jammu and Kashmir.) o RSBY scheme is under the Ministry of Lahour and Employment o The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization. o RSBY provides for cashless insurance of Rs. 30,000 per family per year for hospitalisation in public as well private hospitals. a Coverage extends to five members of the family which includes the head ofhousehold, spouse and up to three dependents. o Pre-existing conditions are covered from day one and there is no age limit. o Beneficiaries need to pay only Rs. 30 as the registration fee. -### End" -4613,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Growth hormone secretion is decreased by ?, with the following options: A: Hypoglycemia, B: Exercise, C: REM sleep, D: Stress - -### Response: -Ans. is 'c' i.e., REM sleep REM sleep decreases the secretion of GH. Other three stimuli increase GH secretion. -### End" -4614,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following does not cause exaggerated jaw jerk:, with the following options: A: Multiple sclerosis, B: Motor neurone disease, C: Pseudobulbar palsy, D: Syringomyelia - -### Response: -Answer is D (Syringomyelia): Jaw jerk is exaggerated in supranuclear lesions that are above the mid pos. Suringomyelia is a lesion of the spinal cord placed distal to the brainstem (or mid pons) and hence does not lead to an exaggerated jaw jerk. Exaggerated Jaw Jerk Jaw jerk is exaggerated in supranuclear lesions that are above the mid pons Jaw Jerk is helpful in localization of the lesion to the brainstem. It depends on the mesencephalic tract of the 5th cranial nerve which mediates proprioceptive information from jaw muscles. Common cause of exaggerated jaw jerk include Neurodegenerative diseases with generalized loss of coical inhibition Pseudobulbar palsy Motor neuron disease Multiple sclerosis -### End" -4615,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme most commonly deficient in congenital adrenal hyperplasia is, with the following options: A: 21 beta hydroxylase, B: 5 alpha reductase, C: 11 beta hydroxylase, D: 17 alpha hydroxylase - -### Response: -Ans. (a) 21 beta hydroxylaseRef: Bailey and love, 27th ed & Campbell 11th Ed consolidationCongenital adrenal hyperplasia or Adrenogenital syndrome: Features* Salt wasters + virilizers (due to aldosterone deficiency)* Simple virilizers (Aldosterone normal)* Non classified (no virlization, no salt wasting)# Virilization and adrenal insufficiency in children are pathognomonic of congenital adrenal hyperplasia (CAH).# Autosomal recessive disorder# The most frequent defect (95 per cent) is the 21 bhydroxylase deficiency, which has an incidence of 1 in 5000 live births.# Excessive ACTH secretion is caused by the loss of cortisol and this leads to an increase in androgenic cortisol precursors and to CAH.# CAH may present in girls at birth with ambiguous genitalia or as late-onset disease at puberty.# Little Hercules: Hypertension and short stature, caused by the premature epiphyseal plate closure, are common signs.# In female causes Female hermaphrodite# Diagnosed antenatally by 9-11 weeks by chorionic villus sampling# Antenatally mother should be treated with IV Dexamethasone# Affected patients are treated by replacement of Hydrocortisone +- fludrocortisone.# Large hypoplastic adrenals may need to be removed if symptomatic. -### End" -4616,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pisiform bone articulates with?, with the following options: A: Triquetral, B: Lunate, C: Scaphoid, D: Trapezoid - -### Response: -Ans. (a) TriquetralRef: Snell's 8th ed / 402 -### End" -4617,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NOT seen in Narcolepsy, with the following options: A: Sleep paralysis, B: Ataxia, C: Catalepsy, D: Abnormal REM sleep - -### Response: -(C) Catalepsy # CATAPLEXY is present not catalepsy.> The classic symptoms of the disorder, often referred to as the ""tetrad of narcolepsy,"" are cataplexy, sleep paralysis, hypnagogic hallucinations, and excessive daytime sleepiness.> Night-time sleep may be fragmented with frequent awakenings.> A second prominent symptom of narcolepsy is abnormal REM sleep.> Narcoleptics are unique in that they enter into the REM phase of sleep in the beginnings of sleep, even when sleeping during the day. -### End" -4618,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Schizophrenia with late onset and good prognosis, with the following options: A: Simple SZP, B: Hebephrenic, C: Catatonic SZP, D: Paranoid SZP - -### Response: -C i.e. Catatonic SZP -### End" -4619,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Second intermediate host of Diphyllobothrium latum is -, with the following options: A: Cylops, B: Man, C: Snail, D: Fresh water fish - -### Response: -Definitive host : Man (optimal) First intermediate host:Freshwater copepod, mainly of genera cyclops or Diaptomus second intermediate host: freshwater fish Ref; panikers textbook of Medical parasitology 8th edition page 118 -### End" -4620,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patients with C5 through C9 complement deficiencies would be most likely to have which of the following infections?, with the following options: A: AIDS, B: Meningococcal infection, C: Pneumococcal infection, D: Giardiasis - -### Response: -Patients with complement deficiencies such as C5 through C9, which form the membrane attack complex (MAC), are predisposed to disseminated meningococcal disease. These patients may also be susceptible to gonococcal infection. There appears to be no disposition to AIDS or to fungal, parasitic, or pneumococcal infections. -### End" -4621,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Golgi tendon apparatus conveys message to CNS, depends upon:, with the following options: A: Tension in muscle, B: Length of muscle, C: Rapidity of contraction, D: Blood supply - -### Response: -Golgi tendon organs are in series with the muscle fibers, they are stimulated by both passive stretch and active contraction of the muscle, when  tension increases inside muscle. -### End" -4622,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fracture mandible with edentulous jaw is best treated with:, with the following options: A: External fixator, B: Minerva-plaster, C: Interdental wiring, D: Intermaxillary elastic traction - -### Response: -Fracture mandible with edentulous jaw is best treated with external fixator. FRACTURE OF THE MANDIBLE TREATMENT As in midface fractures, restoration of dental collusion forms the foundation for fracture management. Intermaxillary fixation before fracture exposure and plating is necessary. Condylar and subcondylar mandible fractures are most often treated by IMF alone. Medical management of mandibular fractures involves a puree-type diet, interdental fixation for several weeks, 1% chlorhexidine mouth rinses, and antibiotics. -### End" -4623,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ulnar nerve supplies all except -, with the following options: A: FCU, B: 1st lumbrical, C: 4th lumbrical, D: Dorsal interossei - -### Response: -Ans. is 'b' i.e., 1st lumbrical o Various branches of ulnar nerve areA) In arm: No branch.B) In forearm: There are following branches :-Muscular: In proximal part of forearm it supplies flexor carpi ulnaris and medial half of flexor digitorum profundus.Cutaneous : There are two cutaneous branches in forearm:-Palmar cutaneous branch : Supplies skin over the hypothenar eminence.Dorsal (posterior) cutaneous branch : Supplies skin over medial 1/3 of dorsum of hand and dorsal surface of medial 1V2 fingers.C) In hand : Ulnar nerve enters the palm by passing superficial to flexor retunuculum and divides into two terminal branches :-Superficial terminal branch : It supplies palmaris brevis and skin of palmar surface of medial 1 1/2 fingers.Deep terminal branch : It supplies adductor pollicis, all interossei, medial two (3rd & 4th) lumbricals and all hypothenar muscles except palmaris brevis (i.e. abductor digiti minimi, flexor digiti minimi, opponens digiti minimi). -### End" -4624,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Histogram is used to describe, with the following options: A: Quantitative data of a group of patients, B: Qualitative data of a group of patients, C: Data collected on nominal scale, D: Data collected on ordinal scale - -### Response: -Histogram: - Is graphical presentation for 'continuous quantitative data' Continuous groups are marked on X-axis (abscissa) while frequencies are marked on y -axis (ordinate). -### End" -4625,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statements about alpha -1 - anti-trypsin deficiency-a) Autosomal dominant diseaseb) Emphysemac) Fibrosis of Portal tractd) Diastase resistant positive hepatocytese) Orcein positive granules, with the following options: A: abc, B: acd, C: bcd, D: bd - -### Response: -Fibrosis of portal tract develop when there is cirrhosis. -### End" -4626,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the next best management for the patient with following CT scan report?, with the following options: A: Burr hole surgery, B: Elective hyperventilation, C: Mannitol, D: Ventriculoperitoneal shunting - -### Response: -Ans. (a) Burr hole surgery.The biconvex hyperdensity is extradural hemorrhage which is causing a midline shift. Hence to relieve the impending brain herniation burr hole surgery followed by hemicraniectomy should be done.Image Source: style=""font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif; margin: 0 0 8pt 8px; text-indent: 0""> -### End" -4627,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about primary aldosteronism, with the following options: A: Pedal oedema, B: Increased rennin, C: Increased Na+, D: All - -### Response: -Answer is C (Increased Na+) Primary Aldosteronism (Conn's syndrome) is associated with Hypeension, Hypernatremia ( tNa+) and Hypokalemia (iK+) -### End" -4628,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are absolute contraindication of neuraxial anaesthesia except:, with the following options: A: Patients refused, B: Local infection of site, C: Raised Intracranial pressure, D: Spinal deformity - -### Response: -Absolute C/ I of central neuraxial Blockade 1. Patient's refusal. 2. Local infection of site 3. Raised Intracranial pressure 4. Severe hypovolemia Two more which was earlier in absolute but now relative contraindication. 5. Coagulation disorder 6. Severe hea diseases -### End" -4629,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Delirient poison is, with the following options: A: Dhatura, B: Alcohol, C: Opium, D: Arsenic - -### Response: -Ans. is 'a' i.e. Dhatura ]Dhatura is a deliriant poison (These poisons are characterized by a well-marked deliriant stage)Alcohol is an inebriant (Inebriant poison are characterized by 2 sets of symptoms viz. Excitement & narcosis)Opium is a somniferous poison (they are used therapeutically to lessen pain & induce sleep)Arsenic is an irritant.Classification of poisons* (according to the mode of actions)Corrosives :A corrosive poison is simply a highly active irritant and not only produces inflammation but also actual ulceration of the tissues.Eg. Strong acids, Strong alkaliesIrritants :They produce symptoms of pain in the abdomen, vomitting and purging.Inorganic : P,Cl,Br,I,Ar,Sb,Hg,Cu,Pb,Zn,Ag.Organic:Vegetable poisons: Castor, croton CalotropisAnimal poisons : Snake & insect bites, cantharides.Mechanical: Powdered glass, hairs etc.Neurotics:They act chiefly on the nervous system.Cerebral: act mainly on the cerebrum. Further 3 types are:Somniferous: Opium*.Barbiturates*.Inebriant: Alcohol*. Anesthetics, Sedatives & hypnotics, kerosene, Organophosphates*.Deliriant: Dhatura*., Atropa belladonna, Hyoscyamus, cannabis*. CocaineSpinal: Nux Vomica*.Peripheral: Curare, coniumCardiac:Act on the hearteg. Digitalis*, Oleander*, Nicotine*. Aconite*.Asphyxiant:Act mainly in lungeg. CO, CO2, war gases. -### End" -4630,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Superficial reactive unit consists of all except :, with the following options: A: Epidermis, B: Dermoepidermal junction, C: Reticular dermis, D: Superficial vascular plexus - -### Response: -Superficial reactive unit consists of: Epidermis Dermoepidermal junction Papillary dermis Superficial vascular plexus Deep reactive unit consists of: Reticular dermis Deep vascular plexus -### End" -4631,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In congenital dystrophic variety of epidermolysis bullosa, mutation is seen in the gene conding for –, with the following options: A: Laminin 4, B: Collagen type 7, C: Alpha 6 integerin, D: Keratin 14 - -### Response: -Dystrophic epidermolysis bullosa (dermal type EB) there is defect in the enzyme collegenase and type 7 collegan. -### End" -4632,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Passavants ridge is formed by ?, with the following options: A: Palatoglossus, B: Superior constrictor, C: Salpingopharyngeus, D: Palatopharyngeus - -### Response: -Ans. is 'd' i.e., Palatopharyngeus Pharynx has two group of muscles :? Intrinsic muscles :- Stylopharyngeous, salpingopharyngeous, palatopharyngeous. Extrinsic muscles :- Superior constrictor, middle constrictor, inferior constrictor. All muscles of pharynx are supplied by cranial accessory through branches of vagus pharyngeal plexus except stylopharyngeus which is supplied by glossopharyngeal. Inferior constrictor muscle has two pas :- (i) Thyropharyngeous with oblique fibres, and (ii) Cricophatyngeous with transverse fibres. Between these two pas of inferior constrictor exists a potential gap called Killan's dehiscence. It is also called the gateway to tear as perforation can occur at this site during esophagoscopy. It is also the site for herniation of pharyngeal mucosa in case of pharyngeal pouch. Upper fibers of palatopharyngeus constitute the Passavant's muscle which on contraction raises a ridge called Passavant's ridge on posterior wall of nasopharynx. -### End" -4633,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acrodermatitis entropathica is seen with deficiency of -, with the following options: A: Zinc, B: Iron, C: Copper, D: Vit A - -### Response: -Ans. is 'a' i.e.. Zinc Acrodermatitis cnteropathicao Zinc absorption in young patients with acrodermatitis cnteropathica is low.o Typically starts after weaning or earlier if the infant is not given breast milk.o The child turns peevish, withdrawn and photophobic, and develops a vesicobullous dermatitis on hands, feet and periorificial areas.o The scalp hair is lost. Diarrhoea is often present. Growth is stunted and there is a decreased resistance to infectious.Wound healing is poor and skin lesions do not heal,o Oral zinc in a dose of about 2 mg,'kg,''day. -### End" -4634,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the positions best describes the location of celiac plexus -, with the following options: A: Anterior or anterolateral to Aorta, B: Posterolateral to Aorta, C: Anterolateral to sympathetic chain, D: Anteromedial to sympathetic chain - -### Response: -Celiac ganglia --        Located near to the origin of the celiac artery from the abdominal aorta. --        Mainly formed by two ganglia. --        Receives preganglionic sympathetic fibers from greater and lesser splanchnic nerves. -### End" -4635,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 year old child presents with pallor & history of blood transfusion 2 months back. On investigation, Hb -4.5gm, total count 60000, platelet count- 2lakhs and CD 10(+) ve, CD 19 (+)ve, CD 117 (+) ve, MPO (+) ve & CD 33(-)ve. What is the most likely diagnosis?, with the following options: A: ALL, B: AML, C: Undifferentiated leukemia, D: Mixed phenotypic acute leukemia - -### Response: -Ans. is 'd' i.e., Mixed phenotypic acute leukemia o Immunological markers in this question are :- o CD 10 (+) ye, CD 19(+) ye --> B cell lineage Myeloperoxidase (MPO) ( +)ve, CD117 (+)ve Myeloid lineage o Immunological markers of two lineage are present. Therefore,it is a case of biphenotypic leukemia (mixed phenotypic leukemia). o Biphenotypic leukemia is a subtype of ""leukemia of ambiguous lineage"" (a new class of AML which has been added in 18th/e of Harrison. But in Harrison, detailed description of this class has not been given.. Acute leukemia with Ambiguous lineage 3 Human acute leukemias are broadly classified as myeloid or lymphoid according to the expression of surface and/or cytoplasmic antigens. o Uncommonly, the lineage of origin is not clear ; either two separate blast populations are encountered, one myeloid and other lymphoid, or a single blast population demonstrating evidence of both myeloid and lymphoid differentiation concurrently. o Acute leukemia with ambiguous lineage has following subtypes :-. A) Acute undifferentiated leukemia In this leukemia, the blast cells express none of the antigen that are useful in lineage attribution but rather express only markers that are linked to high stages of immaturity such as CD 34, CD 38 and HLA-DR and at times CD 7. B) Mixed phenotypic acute leukemia In this type of leukemia, immunological marker of more than one lineage are present. This is classifed intoi) Bilinear acute leukemia o In this, two separate blast populations are encountered. o For example blast cells of lymphoid and myeloid lineage are present simultaneously. n) Biphenotypic acute leukemia o Bipheotypic acute leukemia is also called "" hybrid acute leukemia"" or "" acute mixed lineage leukemia"" or ""simultaneous leukemia'. o In this leukemia, a single blast population demonstrates marker of more than one lineage (in contrast to bilinear leukemia where blasts of two different lineage are present). o Coexpression of myeloid with B lymphoid lineage is most common type (65%). Co-presence of myeloid with T-lymphoid lineage is second most common type. Co-expression of T and B cells phenotype or trilineage phenotype (T, B and myeloid cells) is rare. o According to the 2008 WHO classification, the requirements for lineage attribution are as follows :? a) Myeloid lineage :- Presence of myeloperoxidase or at least 2 markers of monocytic differentiation CD11c, CD 14, CD64, lysozyme, non-specific esterase b) T lineage :- Cytoplasmic or surface CD3 c) B lineage :- Strong CD19 expression with at least one of the following weakly expressed CD 10, CD 79a, cytoplasmic CD22; or weak CD 19 expression with at least 2 of the following strongly expressed CD 10, CD 79a, cytoplasmic CD22. Clinical presentation o Similar to other acute leukemias, acute leukemia with ambiguous lineage presents with symptoms related to depression of marrow function, i.e., cytopenia i.e. anemia, leukopenia, thrombocytopenia or pancytopenia. Coming back to question o Expression of B lineage (CD19 with CD 10) and myeloid lineage ( myeloperoxidase) confirms the diagnosis of biphenotypic leukemia. -### End" -4636,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about blood flow in various organs, with the following options: A: Liver > Kidney > Brain > Heart, B: Liver > Brain > Kidney > Heart, C: Kidney > Brain > Heart > Liver, D: Liver > Heart > Brain > Kidney - -### Response: -Total blood flow through various organs (whole organ) - -Liver - 1500ml/min - 27.8% of cardiac output -Kidney - 1260ml/min - 23.3% of cardiac output -Skeletal muscle - 840ml/min - 15.6% of cardiac output -Brain - 750ml/min - 13.9% of cardiac output -Skin - 462ml/min - 8.6% of cardiac output -Heart - 250ml/min - 4.7% of cardiac output - -Blood flow per unit mass in decreasing order –ml/100gm/min (Highest to lowest) - -Kidney -Heart -Liver -Brain -Skin -Skeletal muscle -### End" -4637,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3-year-old child presented to the OPD for the first time with complaints of abdominal mass, polyuria and polydipsia. The child was born at 39 weeks gestation spontaneous vaginal delivery outside the hospital. IVP reveals streaky appearance of the kidneys. USG and CT abdomen were done. The gene involved in the above condition is present on which chromosome: -, with the following options: A: 6p, B: 6q, C: 14p, D: 14q - -### Response: -This is a case of autosomal recessive polycystic kidney disease. Both the USG and CT reveal multiple cysts in the kidney. CT scan also shows caroli's disease in liver. Results from a mutation in the PKHD1 (polycystic kidney and hepatic disease) gene location on chromosome 6p.T The age of presentation is variable and is divided into perinatal, neonatal, infantile and juvenile forms. On imaging, it usually presents on ultrasound with enlarged echogenic kidneys with multiple small cysts. Liver involvement with coarse echotexture, biliary tract cystic changes, and poal hypeension may be evident, depending on the age and stage of hepatic fibrosis. -### End" -4638,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following viruses may be transmitted by blood transfusion Except:, with the following options: A: Parvovirus B-19, B: Hepatitis G, C: Epstein Bar virus, D: Cytomegalovirus - -### Response: -Answer is None or C (None >> EBV) Parvovirus B-I9, Hepatitis G, Cytomegalovirus and Epstein Bar virus may all be transmitted by blood transfusion. Transfusion transmitted EBV is however a rare event and may hence be selected as the single best answer by exclusion. EBV and Blood Transfusion (Morbidity following EBV Transfusion is Rare) `EBV infection may also follow blood transfusion or marrow transfusion but these are rare events'-Ananthanarayan 8th/131 `Although transfusion associated EBV is rare, it is neveheless well documented' -### End" -4639,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 46 years old male Ashwath, comes to your OPD and while giving history suddenly becomes blank and blames that your stole his thoughts. Diagnosis, with the following options: A: Thought block, B: Thought withdrawal, C: Neologism, D: Perseverration - -### Response: -It is a disorder of thought possession. -### End" -4640,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The absorption of glucose from the gut into intestinal mucosal cells is coupled to Na+,K+ ATPase. In contrast, the movement of glucose from the intestinal epithelial cells into the submucosal bloodstream occurs through passive transpo. Given these facts, which of the following statements can be true at one time or another?, with the following options: A: Levels of plasma glucose are approximately equal to levels in the cytosol of intestinal epithelial cells, B: Free glucose levels in the lumen of the intestine can never be higher than levels in intestinal cells, C: Plasma glucose levels are much higher than intestinal cell cytosolic levels of glucose, D: Levels of glucose in the intestinal lumen are always higher than those in the cytosol of intestinal epithelial cells - -### Response: -The plasma membranes of intestinal epithelial cells contain a sodium gradient that drives the active transpo of glucose. The rate and amount of glucose transpoed depend upon the sodium gradient maintained across the plasma membrane. Sodium ions entering the cell in the company of glucose are pumped out again by Na+,K+-ATPase. Once in the cytosol of the intestinal cell, the glucose moves across the cell and diffuses out of the cell into the interstitial fluid of the submucosa and then into the plasma of the capillaries underlying the intestinal epithelium. This occurs for the following reason: while glucose is maintained in blood plasma at an approximately constant level, it is always slowly moving out of the plasma into the cells of tissue that use it. Given that the diffusion from the intestinal cells into the plasma is passive, the intestinal cells and the plasma try to maintain an equilibrium. Thus, plasma glucose levels are always approximately equal to or slightly less than levels in the intestinal cells. Due to the passive maintenance of this equilibrium, it is highly unlikely that the concentration of glucose in the plasma can get much higher than that in the intestinal cell cytosol. It is also unlikely that the levels of glucose in other tissues of the body (for example, muscle) will have any bearing on those found in the intestinal cells -### End" -4641,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rinne test is negative in:, with the following options: A: Sensorineural deafness, B: Acoustic neuroma, C: Tympanosclerosis, D: Meniere's disease - -### Response: -(c) Tympanosclerosis(Ref Cummings, 6th ed., 2203)Tympanosclerosis being a conductive pathology so BC > AC so Rinne will be negative.All the other options being SN deafness so AC > BC so Rinne will be positive. -### End" -4642,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following malignancies are associated with HIV, except -, with the following options: A: Kaposi's Sarcoma, B: Non Hodgkin's lymphoma, C: Astrocytoma, D: Gastric adeno Carcinoma - -### Response: -Neoplastic disease in AIDS  - -Kaposi sarcoma (most common tumor) -Non-Hodgkin lymphoma - -Immunoblastic lymphoma (most common lymphoma) -Primary CNS lymphoma (associated with EBV) -Burkitt's lymphoma -Other less common neoplasm are: Hodgkin's disease, Leukemia, Multiple myeloma, Melanoma -### End" -4643,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cillia can transport radiolabelled particle in antrum with:, with the following options: A: 1-20dm/min, B: 20-30mm/sec, C: 1-20mm/ min., D: 20-30mm/min - -### Response: -Cilia can transport radiolabeled particles an average of 6mm/min, with a range of 1-20mm/min. Thus this transport can clear inhaled particles from nasal cavity in 10-20 min. -### End" -4644,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is cholera vaccine -, with the following options: A: Ty21 A, B: HGD - 103, C: WC-rBS, D: None - -### Response: -

Dukoral(WC-rBS) is one of the oral cholera vaccine. Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:233 <\p> -### End" -4645,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a nulliparous woman, the treatment of choice in ruptured ectopic pregnancy is :, with the following options: A: Salpingectomy and end to end anastomosis, B: Salpingo-oophorectomy, C: Wait and watch, D: Linear salpingostomy - -### Response: -Ans. is d i.e. Linear salpingostomy In the question the patient is presenting with ruptured ectopic pregnancy therefore surgical management is a must (option ""c"" ruled out) Since, the patient is a nulliparous woman so we will avoid radical surgery in the form of salpingectomy or salpingo-oophorectomy as far as possible. Now the only option of conservative surgery given in the options is--Linear salpingostomy, so we will go with it. ""The woman who is hemodynamically stable and strongly desires to preserve feility is an appropriate candidate for salpingostomy."" -### End" -4646,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Usually bacterial infection causes :, with the following options: A: Neutropenia, B: Neutrophilia., C: Lymphocytosis., D: Eosinophilia - -### Response: -Note: Usually - -Bacterial infections cause Neutrophilia, -Viral infections cause lymphocytosis, -Parasitic infections cause eosinophila, -T-cell lesions causes viral and fungal infections, -B-cell lesions cause bacterial infections. -### End" -4647,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Davidson body is used to determine -, with the following options: A: Age, B: Sex, C: Race, D: All of the above - -### Response: -Davidson body is a small nuclear appendage of drumstick in six per cent of neutrophils in females. It is used to determine the sex of the individual. REF: Dr Narayana Reddys Synopsis of Forensic Medicine & Toxicology 29th edition pg: 33 -### End" -4648,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient of exudative retinopathy of coats presents with leukocoria, needs to be differentiated from -, with the following options: A: Retinoblstoma, B: Retinitispigmentosa, C: Retinal detachment, D: Congenital cataract - -### Response: -Ans. is 'a' i.e., Retinoblastoma EXUDATIVE RETINOPATHY OFCOATSo Coats' disease is a severe form of retinal telengiectasia (idiopathic congenital vascular malformation), which typically affects one eye of boys in their first decade of life.o In early stages it is characterised by large areas of intra and subretinal yellowish exudates and haemorrhages associated with overlying dilated and tortuous retinal blood vessels and a number of small aneurysms near the posterior pole and around the disc.o It may present with visual loss, strabismus or leukocoria (whitish pupillary reflex) and thus needs to be differentiated from retinoblastoma. The condition usually progresses to produce exudative retinal detachment and a retrolental mass.o In late stages complicated cataract, uveitis and secondary' glaucoma occur, which eventually end in phthisis bulbi.Treatmento Photocoagulation or cryotherapy may check progression of the disease if applied in the early stage. However, once the retina is detached the treatment becomes increasingly difficult and success rate declines to 33 percent. -### End" -4649,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding disinfectants except -, with the following options: A: Gluteraldehyde is sporicidal, B: Hypochlorites are virucidal, C: Ethylene oxide is intermediate disinfectant, D: Phenol usually requires organic matter to act - -### Response: -Ethylene oxide : it is highly inflammable and explosive. it is especially used used forsterilisation hea-lung machines ,respirators ,sutures,dental equipments ,books and clothings it has been used for sterilising wide range of materials REF:Ananthanarayan & Panicker's Textbook of Microbiology 9th edition pg no:35 -### End" -4650,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of Plumbism except, with the following options: A: Buonian lines, B: Cabot's ring, C: Lead osteopathy, D: Kayser-Fleisher ring - -### Response: -Features of Plumbism: Facial pallor Cabot's ring, basophilic stippling Buonian lines Lead colic Lead palsy Lead encephalopathy Optoc atrophy. Retinal stippling Lead osteopathy Peripheral neuritis Alopecia Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 425,426 -### End" -4651,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carcinosarcoma may arise in -, with the following options: A: Uterus, B: Cervix, C: Vagina, D: Ovary - -### Response: -Carcinosarcoma of uterus - -Carcinosarcomas consist of endometrial adenocarcinoma in which malignant sarcomatous (stromal) differentiation takes place. -Carcinosarcoma has two components : - - - -Adenocarcinoma → Therefore called carcinosarcoma -Sarcomatous component → Therefore called carcinosarcoma - - -Sarcomatous component may be striated muscle cells, cartilage, adipose tissue and bone. -### End" -4652,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During delivery, the baby's head was delivered but shoulders not delivered after one minute. What's the next step ?, with the following options: A: Emergency LSCS, B: Cleidotomy, C: Lateral traction, D: Mc Robe's Maneuver - -### Response: -Diagnosis - shoulder dystocia Shoulder dystocia is when, after delivery of head, the baby's anterior shoulder gets caught above he mother. Pubic bone Risk factors 1) Gestational diabetes 2) > 35 age 3) Small or abnormal pelvis 4) wt. of baby > 4500 g Complications Damage to upper brachial plexus Klumpke paralysis Erb's palsy Fetal hypoxia Fetal death Cerebral palsy Management - Mc. Robe's -### End" -4653,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Marker for ovarian cancer is, with the following options: A: CA 125, B: Ca 19 - 19, C: Ca 15 - 5, D: Hypercalcemia - -### Response: -CA 125 -### End" -4654,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maternal serum Alpha Feto Protein (MSAFP) is raised in ail the following conditions except :, with the following options: A: Spina bifida, B: Multiple pregnancy, C: Omphalocele, D: Down's syndrome - -### Response: -Down's syndrome -### End" -4655,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lift -off test is done to assess the function of, with the following options: A: Supraspinatus muscle, B: Infraspinatus muscle, C: Teres minor, D: Subscapularis muscle - -### Response: -In this test,the patient is asked to stand and place one arm behind his her back with the dorsum of the hand resting against the mid-lumbar spine. The examiner then lifts the patient&;s hand off the back and the patient is told to hold it there. Inability to do this signifies subscapularis weakness,possibly due to rupture. A drawback is that the test calls for full passive internal rotation,so it cannot be used if internal rotation is painful or restricted. Ref: Maheshwari and Mhaskar 6e pg 95 -### End" -4656,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are direct signs of Lung collapse seen on the Chest X-ray except:, with the following options: A: Mediastinal shift, B: Displacement of the fissure, C: Crowding of the vessels, D: Loss of aeration - -### Response: -Ans. A. Mediastinal shift. (Ref. Sutton radiology 7th ed. 161)Direct signs of lung collapse includeIndirect signs are:i) opacity of the affected lobe(s)ii) crowding of the vessels and bronchi within the collapsed area:iii) displacement or bowing of the fissures.i) compensatory hyperinflation of the normal lung or lobes resulting in an increase in transradiancy with separation of the vascular marking;ii) displacement of the mediastinal structures toward the affected side.iii) displacement of the ipsilateral hilum which changes shape.Special signs of Lung Collapse:1.Rounded atelectasis""Comet tail"" sign (vascular shadows seen radiating from opacity). Known in Asbestosis.2.Golden's 'S' signRight hilar/central mass with upper lobe collapse seen as convexity at the medial aspect of pulled up major fissure.3.Broncholobar signLower lobe bronchus is displayed within the opacity of the collapsed left lower lobe.4.Luftsiche! signGerman words luft = air, sichel = sickle, literally describes an 'air crescent' which may be seen between the aortic arch and the medial border of the collapse .The hyperextended superior segment of the ipsilateral lower lobe accounts for the paramediastinal lucency outlining the medial surface of the collapsed right or left upper lobe. -### End" -4657,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Modified Bloom Richardson criteria for Carcinoma Breast includes -, with the following options: A: Desmoplasia, B: Lymphovenous embolism, C: Mitotic rate, D: All - -### Response: -Ans. is 'c' i.e. mitotic rateGrading of breast cancero Presently, most methods for grading use the previously cited three-tiered systems for describing tumor structure in terms of tubule formation, nuclear grade and mitotic count, with the latter usually expressed as the number of mitosis per 10 high- magnification field.o Each element is scored on a scale from 1 to 3 according to criteria of the specific grading system, and the final grade is determined by the sum of mitosis.o Totals of 3 to 5 indicate a well-differentiated or low-grade tumor; 6 to 7, a moderately differentiated or intermediate-grade tumor; and 8 to 9 , a poorly differentiated or high-grade tumor.o This method of scoring is known as the Nottingham combined histologic grade of Elston-Ellis modification of the Scarff-Bloom-Richardson grading system, often repoed as a modified Scaff-Bloom-Richardson grade.Modified Bloom-Richarson histological grading Tubule formationo Score 1 :- >75% of tumor has tubulesScore 2 :- 10-75% of tumor has tubuleso Score 3 :- < 10% of tumor has tubulesNuclear size ( nuclear polymorphism)o Score 1 :- tumor nuclei similar to normal duct nuclei (2-3 x RBC)Score 2 :- Intermediate size nucleiScore 3 :- very large nuclei, usually vesicular with prominent nucleoliMitotic counto Score 1 :- 0-7 mitosis o Score 2 :- 8-14 mitosis o Score 3 :- > 15 mitosis -### End" -4658,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most severely affected child in Rh-isoimmunisation patients :, with the following options: A: Rh negative mother with Rh positive in 2nd child, B: Rh positive mother with Rh negative in 2nd child Rh positive mother with Rh negative in 15' child, C: Rh positive mother with Rh negative in 15' child, D: Rh positive mother with Rh positive in 2""'d child - -### Response: -Rh negative mother with Rh positive in 2nd child -### End" -4659,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the normal weight gain in normal pregnancy?, with the following options: A: 6-Apr, B: 8-Jun, C: 10-11 kg, D: 18-20 - -### Response: -The total weight gain during the course of a singleton pregnancy for a healthy woman averages 11 kg. This has been distributed to 1kg in first trimester and 5 kg each in second and third trimester. Ref: Textbook of Obstetrics by DC Dutta, 6th edition, Page 50. -### End" -4660,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The mechanism by which pyruvate from cytosol is transpoed to mitochondria is?, with the following options: A: Chloride antipo, B: Proton sympo, C: ATP dependent antipo, D: Facilitated unipo - -### Response: -The transpo of pyruvate into the mitochondria is the transpo protein pyruvate translocase. Pyruvate translocase transpos pyruvate in a sympo fashion with a proton, and hence is active, consuming energy.Ref: DM Vasudevan, 7th edition -### End" -4661,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are branches of lumbar plexus except :, with the following options: A: Obturator nerve, B: Sub costal nerve, C: Iliohypogastric, D: Ilioinguinal - -### Response: -Subcostal nerve is an anterior division of 12 the thoracic nerve which is larger than other intercostal nerves. Ref: Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 1371. -### End" -4662,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: New drug for increasing sensitivity of cells to insulin?, with the following options: A: Glibenclemide, B: Venalafaxine, C: Pioglitazone, D: Glipizide - -### Response: -Ans. is 'c' i.e., Pioglitazone Thiazolidinediones (Pioglitazone, Rosiglitazone) has insulin sensitizing action. -### End" -4663,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shoulder pain post laparoscopy is due to:, with the following options: A: Subphrenic abscess, B: CO2 retention, C: Positioning of the patient, D: Compression of the lung - -### Response: -CO2 retention [Ref: J Shoulder pain is although a minor complication is exceedingly common and is due to the presence of a significant amount of residual carbon dioxide in the peritoneal cavity, trapped under the diaphragm and causing irritation of the diaphragm and thus referred pain to the shoulder through the phrenic nerve. -### End" -4664,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: QRS complex indicates-, with the following options: A: Atrial repolarization, B: Atrial depolarization, C: Ventricular repolarization, D: Ventricular depolarization - -### Response: -Answer is D (Ventricular depolarisation) QRS complex is due to ventricular depolarization Q -### End" -4665,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug causes pain on injection:-, with the following options: A: Rocuronium, B: Vacuronium, C: Rapocuronium, D: Atracurium - -### Response: -Rocuronium causes pain on injection, like propofol. Unlike propofol however it is given after patient is induced. Pain associated with injection of rocuronium is commonand can be very distressing. Tracheal intubation with rocuronium using the 'timing principle'. the described pain is a 'burning' in nature and occurred immediately on administration. We do not know the exact mechanism for the pain, although the immediate onset rapid precurarization technique using rocuronium probably reflects a direct irritant effect and not an indirect effect on the kinin cascade. -### End" -4666,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adenomyosis is -, with the following options: A: Tumor of the uterus, B: Malignant change of the endometrial glands invading the myometrium, C: Pre - malignant condition, D: Ectopic endometrial glands within the myometrium - -### Response: -Ans. is 'd' i.e., Ectopic endometrial glands within the myometrium o Adenomyosis is a benign disease of the uterus characterized by ectopic endometrial glands and stroma within the myometrium.o Most common site : Corpuso Rarely involves one of the walls of uterus or the cervixo Associated conditions:a) Leiomyomab) Pelvic endometriosisc) Endometrial hyperplasiad) Endometrial carcinomae) Endometrial polypsf) Salpingitis isthmica nodosao Microscopic pathophysiology:# There is no submucosal layer between the endometrium and myometrium; hence normally the endometrial glands in the basal layer penetrate into the myometrium to some extent. This poses a difficulty in diagnosis of adenomyosis, which is a pathological invasion of the endometrium.# Novak and Woodruff criteria: presence of heterotopic endometrium atleast 1 high power field (HPF) below the basal endometrium.# Bensen and Sneeden's criteria: Presence of ectopic endometrium (glands and stroma) at least two standard low power fields (= 4 mm) beneath the myometrial junction, and associated with adjacent myohyperplasia.o Grading of Adenomyosis:# Molitor's criteria: According to the depth of penetration:i) Grade I Inner 1/3 rd of myometriumii) Grade II Middle 1/3 rd of myometriumiii) Grade III: Outer 1 /3 rd of myometriumo Grading of Bird et al:# Mild: 1-3 glands/ LPF# Moderate: 4-9 glands / LPF# Severe: > 9 glands / LPFo Treatment# Medical management :Danazol, GnRH agonists# Surgical management: Endometrial resection, Uterine artery embolization, MRI - guided focused ultrasound surgery (MRIgFUS). -### End" -4667,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least malignant thyroid cancer is, with the following options: A: Papillary carcinoma, B: Follicular carcinoma, C: Medullary carcinoma, D: Anaplastic carcinoma - -### Response: -Ans is (a) i.e. Papillary Cancer -### End" -4668,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epley's manoeuvre is used in, with the following options: A: Positional veigo, B: Otosclerosis, C: ASOM, D: CSOM - -### Response: -Epley's manoeuvre : This is to reposition the otoconial debris from the posterior semicircular canal back into utricle. Done in benign paroxysmal positional veigo Ref : Dhingra 7e pg 47. -### End" -4669,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A bird seller developed fever with chills and severe body pain. Investigation confirms the disease as ornithosis. Causative agent is:, with the following options: A: Chlamydia psittaci, B: Burkholderia pseudomallei, C: Coxiella burnetii, D: Borrelia - -### Response: -Psittacosis (parrot fever, parrot disease, or ornithosis) is caused by C. psittaci (formerly Chlamydia psittaci), an organism common to most birds and domesticated fowl. Human acquisition is from the inhalation of dust from dried bird feces, feather dust, or aerosolized an respiratory secretions. Psittacosis is characterized by an incubation period of 5 to 14 days followed by abrupt onset of fever, chills, cephalgia, myalgia, and generalized malaise. Melioidosis is a potentially serious illness caused by the gram-negative, saprophytic bacterium Burkholderia pseudomallei (formerly Pseudomonas pseudomallei). The agent of Q fever is Coxiella burnetii, a small intracellular microorganism that only recently was grown in cell-free medium. C. burnetii, a pleomorphic coccobacillus with a gram-negative cell wall. Relapsing fever is a vector-borne disease caused by spirochetes of the genus Borrelia. Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 27. Chlamydia Spp.. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e. -### End" -4670,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Delivery of the after - coming head in breech presentation following forceps/methods are used EXCEPT:, with the following options: A: Wrigley's forceps, B: Kielland's forceps, C: Das's variety forceps, D: Mauriceau smellie, veit technique - -### Response: -(Wrigley's forceps) (384, 571-78-Dutta's 6th)* Common methods employed for delivery of the after coming head:* Bums - Marshall method* Forceps delivery (Das's, Kielland's)* Molar flexion and shoulder traction (Modified Mauriceau-Smellie-Veit-technique)* Pinard's maneuver - for frank breech extraction* Lovset's maneuver - for extended Arms* Wrigley's forceps - are used exclusively in outlet forceps operations* Commonest indication of mid forceps operation is following mannual rotation of the head in malrotated occipito-posterior position. -### End" -4671,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Koenen's tumor associated with ?, with the following options: A: Tuberous sclerosis, B: Neurofibromatosis, C: Psoriasis, D: Alopecia aerata - -### Response: -Ans. is 'a' i.e., Tuberous sclerosis Koenen's periungual fibroma is seen in tuberous sclerosis -### End" -4672,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When the tension becomes great enough, contraction suddenly ceases and the muscle relaxes, this phenomenon is known as:, with the following options: A: Reciprocal innervations, B: Autocrine innervation, C: Autogenic inhibition, D: Converse stretch reflex - -### Response: -Up to a point, the harder a muscle is stretched, the stronger is the reflex contraction. However, when the tension becomes great enough, contraction suddenly ceases and the muscle relaxes. This relaxation in response to strong stretch is called the inverse stretch reflex or autogenic inhibition. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 9. -### End" -4673,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Café–au–lait spots are not seen in:, with the following options: A: Neurofibromatosis, B: McCune Albright syndrome, C: Bloom syndrome, D: Hyperparathyroidism - -### Response: -Café – au – lait spots are seen in the following conditions: - -Neurofibromatosis -McCune Albright syndrome -Bloom syndrome -### End" -4674,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of a cross sectional study -, with the following options: A: Not expensive, B: Observational study, C: Used for chronic diseases, D: Well suited for establishing interrelationships of diseases - -### Response: -The time sequence which is essential to the concept of causativity can't be deduced from cross-sectional data. (refer pg no:69 park 23rd edition) -### End" -4675,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Female health worker does all except -, with the following options: A: Malaria survey, B: Register bihs and deaths, C: Register preganant females, D: Distributes contraceptives - -### Response: -Some of the duties of health worker females includes; - maintenance of register of bihs and deaths. - register of pregnant women - distribution of contraceptive - assist the health worker male in maintenance of record of malaria, tuberculosis and leprosy cases in that area. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:908,909 <\p> -### End" -4676,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hutchinson’s rule is related to, with the following options: A: Herpes simplex keratitis, B: Mycotic keratitis, C: Herpes zoster ophthalmicus, D: None - -### Response: -Hutchinson's rule is related to herpes zoster ophthalmicus which is an acute infection of Gasserian ganglion of the fifth cranial nerve by the varicella-zoster virus. -Occurs commonly in immunocompromised individuals. Hutchinson's rule implies that ocular involvement is frequent if the side or tip of the nose presents vesicles is useful but not infallibleReference: Comprehensive Ophthalmology, -### End" -4677,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 57 year old recently retired demolitions worker complains of increasing shoness of breath. The patient was a chronic heavy cigarette smoker through his adult life but quit about a year before presentation. A chest CT was performed.Which of the following steps is not appropriate in the evaluation of this patient?, with the following options: A: positron emission tomography (PET scan), B: bronchoscopy, C: computed tomography directed biopsy of the lesion, D: follow-up CT in 3 to 6 months to document stability of the lesion - -### Response: -A. PA chest radiograph shows a large mass in the left upper lobe (arrow). B. Coronal contrast-enhanced CT study shows a left upper lobe lung mass (arrow). C. Axial CT study shows a left upper lobe lung mass (white arrow) and enlarged mediasintal lymph nodes (black arrow). D. Axial CT study shows multiple liver masses (arrows) Answer: (d), follow-up CT in 3 to 6 months to document stability of the lesion is not an appropriate next step in evaluation of this patient, and thus (d) is the correct answer. Positron emission tomography (PET scan) is an appropriate next step, which would be expected to show hypermetabolism in the lesion as well as any metastatic deposits, and thus (a) is not the correct answer. Bronchoscopy with sampling of the lesion is an appropriate next step, and therefore (b) is not the correct answer. Computed tomography directed biopsy of the lesion is also an appropriate next step, and thus (d) is not the correct answer. -### End" -4678,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gastro-colic reflex is related to:, with the following options: A: Mass peristalsis, B: Segmentation contractions, C: Pendular movement, D: irritable bowel - -### Response: -Distension of the stomach by food initiates contractions of the rectum and, frequently, a desire to defecate. This response is called the gastrocolic reflex - related to mass movement (a modified form of peristalsis in large gut) This reflex is seen normally, paicularly in children, and not necessarily related to an irritable bowel. -### End" -4679,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the following is hallmak of CHRONIC INFLAMMATION ?, with the following options: A: tissue destruction, B: mononuclear infiltration, C: wound healing and repair, D: all of the above - -### Response: -Chronic Inflammation Definition: * Inflammation of prolonged duration in which active inflammation, tissue injury and the healing proceed simultaneously * Causes: * Persistent Infections * Ex. Treponema palladium (causative organism of syphilis) * Organism of low toxicity and evoke an immune reaction = delayed hypersensitivity * Prolonged Exposure to toxic Agents * Autoimmunity * Ex. Autoimmune diseases . ref : robbins 10th ed -### End" -4680,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 3 months old infant, no chest indrawing with respiratory rate 52/minute. Diagnosis is -, with the following options: A: No pneumonia, B: Pneumonia, C: Severe pneumonia, D: Very severe disease - -### Response: -

As per the history, the child has fast breathing but no chest indrawing. The features points to pneumonia. classification of pneumonia. Fast breathing is present when the respiratory rate is : 1. 60 breaths/min or more in child < 2 months of age. 2. 50 breaths/min or more in child aged 2-12 months. 3. 40 breaths/min or mote in child 12 months - 5 yrs. VERY SEVERE DISEASE:- 1. Not able to drink 2. Convulsions, abnormally sleepy/ difficult to wake. 3. Stridor in calm child 4. Severe malnutrition Treatment- Refer urgently to hospital. Give first fose of antibiotics. Treat fever and wheeze , if present. If cerebral malaria possible, give antimalarial. SEVERE PNEUMONIA Most impoant sign to consider when deciding if the child has pneumonia are the RR and chest indrawing. A child with chest indrawing may not have fast breathing if the child becomes exhausted. Then the breathing slows down. Un such cases chest indrawing may be the only sign in a child with severe pneumonia. Other signs: 1. Nasal flare 2. Grunting 3. Cyanosis 4. Wheezing Treatment:- Refer urgently to hospital. Give first dose antibiotics. Treat fever and wheeze if present. PNEUMONIA:- 1. Fast breathing 2. No chest indrawing Treatment:- Advice mother to give home care. Give an antibiotic. Treat fever and wheeze if present. Advice mother to return eith child in 2 days for reassessment, or earlier if child gets worse. No pneumonia:- 1. Simple cough or cold. Treatment:- Assess and treat ear problems or sore throat. Assess and treat other problems. Advice mother to give home care. Treat fever and wheeze if present. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.170}

-### End" -4681,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Steroid suphatase deficiency is seen in, with the following options: A: Ichthyosis vulgaris, B: Lamellar Ichthyosis, C: 'X' linked recessive icthyosis, D: None of the above - -### Response: -X-linked ichthyosis (abbreted XLI) is a skin condition caused by the hereditary deficiency of the steroid sulfatase (STS) enzyme that affects 1 in 2000 to 1 in 6000 males. XLI manifests with dry, scaly skin and is due to deletions or mutations in the STS gene. Ref Harrison20th edition pg 1332 -### End" -4682,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Grade I lymphedema means, with the following options: A: Pitting edema upto the ankle, B: Pitting edema upto the knee, C: Non pitting edema, D: Edema disappearing after overnight rest - -### Response: -. -### End" -4683,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wood's light can be used for evaluation of -, with the following options: A: Tinea capitis, B: Freckles, C: Vitiligo, D: All - -### Response: -Ans. is 'a' i.e., Tinea capitis; 'b' i.e., Freckles; 'c' i.e., Vitiligo . A wood's lamp generates 360-nm UV light. . It is used in the evaluation of : - Tinea capitis - Freckles - Erythrasma - Tinea versicolor - Wounds colonized by Pseudomonas - Ash leaf spots in patients with tuberous sclerosis. - Vitiligo -### End" -4684,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Remnant of rostral neuropore is -, with the following options: A: Septum transversum, B: Ligamentusteres, C: Lamina terminalis, D: Cerebellum - -### Response: -Ans. is 'c' i.e.,Lamina terminalisThe cranial open end of neural tube is called as rostral (anterior) neuropore which closes on or before day 26 giving rise to lamina terminalis of brain. -### End" -4685,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Granuloma venereum is caused by -, with the following options: A: Donovania granulomatis, B: Chlamydia, C: Hemophillus ducrey, D: None - -### Response: -Granuloma venereum is caused by Chlamydia Trachomatis, serovars L1, L2, L3. From illustrated synopsis of dermatology and sexually transmitted diseases neena khanna 5th edition page no 330 -### End" -4686,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Root value of medial cutaneous nerve of thigh, with the following options: A: L1L2, B: L2L3, C: L4L5, D: L5S1 - -### Response: -The medial cutaneous nerve of the thigh (L2, L3) - It is a branch of the anterior division of the femoral nerve. It divides into anterior and posterior divisions. The nerve supplies the skin on the medial side of the lower two thirds of the thigh, and of the upper one-third of the leg. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 2, pg. no., 45. -### End" -4687,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Symptom of neuroleptic malignant syndrome -, with the following options: A: Hypotension, B: Hypothermia, C: Increased Magnesium level in blood, D: Catatonia and stupor - -### Response: -Ans. is 'd' i.e., Catatonia and stupor Features of neuroleptic malignant syndromeo Marked muscular rigidityo Disturbed consciousnesso Increased CPKo High fevero Catatonia & stuporo Myoglobinemia & Myoglobinuriao Autonomic instability(| HR & BP, Sweating)o Leucocytosis -### End" -4688,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Worst prognosis in Melanoma is seen in the subtype?, with the following options: A: Superficial spreading, B: Nodular Melanoma, C: Lentigo Maligna Melanoma, D: Amelanotic Melanoma - -### Response: -Ans. is 'd' i.e., Amelanotic Melanoma -### End" -4689,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 11-month-old child presents with complaints of respiratory distress. On examination there is bilateral crepitation and wheezing. Which of the following is the most likely cause?, with the following options: A: Pneumonia, B: Adenovirus, C: RSV, D: Rhinovirus - -### Response: -c. RSV(Ref: Nelson's 20/e p 2044-2047, Ghai 8/e p 381-382)The clinical features are suggestive of Acute Bronchiolitis, for which the most common causative agent is RSV. -### End" -4690,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In newborn, cold stress implies, with the following options: A: 35 - 35.4 oC, B: 36 - 36.4 oC, C: 34 - 34.6 oC, D: 37 - 37.6 oC - -### Response: -Classification of Neonatal hypothermia -Cold stress 36 - 36.4o C -Moderate hypothermia 32 - 35.9o C -Severe hypothermia < 32o C -### End" -4691,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true regarding clasp design, with the following options: A: Each retentive terminal should be opposed by reciprocal arm, B: Amount of retention should always be maximum necessary, C: Path of escapement should not be equal to path of insertion, D: Unless guiding planes are employed, retentive tips should be bilaterally opposed. - -### Response: -The amount of retention should always be the minimum necessary to resist reasonable dislodging forces. -### End" -4692,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following conditions are known to cause diabetes insipidus, except :, with the following options: A: Multiple sclerosis, B: Head injury, C: Histiocytosis, D: Viral encephalitis - -### Response: -Answer is A (Multiple sclerosis) : Multiple sclerosis has not been mentioned as a cause for diabetes insipidus. Diabetes insipidus is a syndrome caused by either deficiency of vasopressin or resistance to action of vasopressin in passage of abnormally large volume of urine of low specific gravity. Causes of diabetes insipidus Pituitary form of DI (Neurohypophysial or central) Deficient secretion of vasopressin from pituitary Nephrogenic DI (Renal D.I.) Resistance to action of vasopressin on kidney Primary polydispisa Congenital malformations Genetic Acquired Genetic Acquired Psychogenic Acquired Drugs Schizophrenia Head trauma (closed and penetrating) Lithium Obsesive-compulsive Neoplasms Demeclocyline disorder Primary Methoxyflurane Dipsogenic (abnormal thirst) Craniopharyngioma Amphotericin B Granulomas: Pituitary adenoma (suprasellar) Aminoglycosides Neurosarcoid Dysgerminoma Cisplatin Infectious: Tuberculous Meningioma Rifampin meningitis Metastatic (lung, breast) Foscarnet Head trauma (closed and Hematologic (lymphoma, leukemia) Metabolic penetrating) Granulomas: Neurosarcoid Hypercalcemia, hypercalcinuria Demyelimation: Multiple Histiocytosis Hypokalemia sclerosis Xanthoma disseminatum Obstruction (ureter or urethra) Drugs: Infectious: Chronic meningitis Vascular Lithium Viral encephalitis Sickle cell disease and trait Carbamazepine Toxoplasmosis lschemia (acute tubular necrosis) Idiopathic Inflammatory:Lymphocytic Granulomas Iatrogenic Infundibuloneurohypophysitis Neurosarcoid Wegener's granulomatosis Neoplasms Lupus erythematous Sarcoma Scleroderma Infiltration Chemical toxins: Tetrodotoxin, Snake venom Amyloidosis Vascular:Sheehan's syndrome Pregnancy Aneurysm (internal carotid) Idiopathic Aoocoronary bypass Hypoxic encephalopathy Pregnancy (vasopressinase) Idiopathic -### End" -4693,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chromosomal anomalies and cardiac anomalies are more frequently associated with the following disorder:, with the following options: A: Gastroschisis, B: Omphalocele, C: Spina Bifida, D: Cleft Palate - -### Response: -Omphalocele has 60 to 70% incidence of associated anomalies, especially cardiac anomalies (20 to 40% of cases) and chromosomal abnormalities. Chromosomal anomalies are more common in children with smaller defects. Omphalocele has an incidence of approximately 1 in 5000 live bihs and occurs in association with special syndromes such as, Exstrophy of the cloaca (vesicointestinal fissure) Beckwith-Wiedemann constellation of anomalies (macroglossia, macrosomia, hypoglycemia, visceromegaly, and omphalocele) Cantrell pentalogy (lower thoracic wall malformations such as cleft sternum, ectopia cordis, epigastric omphalocele, anterior midline diaphragmatic hernia, and cardiac anomalies) Ref: Hackam D.J., Grikscheit T.C., Wang K.S., Newman K.D., Ford H.R. (2010). Chapter 39. Pediatric Surgery. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e. -### End" -4694,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The collapse of the lung is called, with the following options: A: Emphysema, B: Bronchiectasis, C: Atelectasis, D: Bronchitis - -### Response: -Atelectasis (collapse) - -Atelectasis refers to:- - - -Incomplete expansion of lungs → Neonatal atelectasis. - or -The collapse of previously inflated lung → Acquired atelectasis. - - -This results in areas of relatively airless pulmonary parenchyma. -Acquired atelectasis may be divided into - -1.   Resorption (obstruction) atelectasis - -It is a consequence of complete obstruction of an airway. -With time trapped oxygen in the affected alveoli is resorbed and collapse occurs. -Resorption atelectasis is caused principally by obstruction due to excessive secretions (mucus plug) or exudates within small bronchioles as seen in Bronchial asthma, chronic bronchitis, Bronchiectasis and foreign body aspiration. - -2.   Compression atelectasis - -The collapse of lung occurs due to external pressure on the lung. -It is seen most commonly in patients with cardiac failure who develop pleural effusion and in patients with neoplastic pleural effusion. - -3.   Contraction atelectasis - -The collapse is due to contracture in the lung because of fibrotic changes. -Except for contraction atelectasis, atelectasis is a reversible disorder, i.e. collapsed lung parenchyma can be re-expanded. -### End" -4695,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Erythropoietin is secreted by: March 2009, with the following options: A: Interstitial cells of kidney, B: Extraglomerular mesangial cells, C: Macula densa, D: Renal tubular epithelial cells - -### Response: -Ans. A: Interstitial cells of kidneyIn adults, about 85% of the erythropoietin comes from the kidneys and 15% from the liver. Both these organs contain the mRNA for erythropoietin. Erythropoietin can also be extracted from the spleen and salivary glands, but these tissues do not contain the mRNA and consequently do not appear to manufacture the hormone.When renal mass is reduced in adults by renal disease or nephrectomy, the liver cannot compensate and anemia develops. Erythropoietin is produced by interstitial cells in the peritubular capillary bed of the kidneys and by perivenous hepatocytes in the liver. It is also produced in the brain, where it exes a protective effect against excitotoxic damage triggered by hypoxia; and in the uterus and oviducts, where it is induced by estrogen and appears to mediate estrogen-dependent angiogenesis. -### End" -4696,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Myocardial oxygen demand depend upon all except:, with the following options: A: Preload, B: Afterload, C: Intramyocardial tension, D: Blood Hb concentration - -### Response: -Hb concentration determines the O2 supply to myocardium, not myocardial O2 demand. -### End" -4697,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most dangerous variant of diphtheria, with the following options: A: Facial, B: Nasal, C: Laryngeal, D: Cutaneous - -### Response: -The most common complication of diphtheria is laryngeal diphtheria causes Asphyxia Asphyxia due to mechanical obstruction of the respiratory passage by the pseudomembrane, for which an emergency tracheostomy may be necessary. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg: 241 -### End" -4698,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A fire worker presented with ""Phossy jaw"" (glass jaw). Which of the following can cause this condition on chronic exposure?, with the following options: A: Red phosphorus, B: White phosphorus, C: Sulphur, D: Mercury - -### Response: -Red phosphorus is not absorbed and is essentially nontoxic. Chronic inhalation of white phosphorus (over at least 10 months) may result in osteomyelitis and mandibular necrosis (""phossy jaw""). There will be multiple sinuses discharging foul-smelling pus. Ref: Kreshak A. (2012). Chapter 129. Phosphorus. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e. -### End" -4699,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Integrase inhibitors approved for HIV is:, with the following options: A: Raltegravir, B: Indinavir, C: Lopinavir, D: Elvitegravir - -### Response: -Ans. is 'a' i.e., Raltegravir o Raltegravir is an integrase inhibitor which is used in combination with other antiretroviral agents in treatment of patients with ongoing HIV-1 replicaiton. o Elvitegravir is also an integrase inhibitor. But it is in phase-3 trial (not approved). -### End" -4700,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gerota's fascia is:, with the following options: A: Renal fascia, B: Fibrous capsule, C: Layer of perirenal fat, D: Layer of pararenal fat - -### Response: -Ans. A: Renal fascia -### End" -4701,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A new born with recurrent vomiting, cynosis after each feed is likely to be suffering from, with the following options: A: Tracho oesophageal fistula, B: Tetrology of fallot, C: Congenital hyperophic pyloric stenosis, D: ARDS - -### Response: -Clinical features : The presence of maternal polyhyramnios and single umbilical aery should ale the pediatrician to look for atresia of the upper GIT.Association of congenital anomalies of veebrae, anorectal region,hea,kidneys or limbs should arouse suspicion.The newborn baby has excessive drooling ,saliva is frothy and there is choking and cyanosis with first feed.Overflow of milk and saliva from oesophagus, and regurgitation of secretions through the fistulous tract into the lungs is present. Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:151,7th edition -### End" -4702,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Myringotomy is indicated in -, with the following options: A: Coalescent mastoiditis, B: Cholesteatoma, C: ASOM, D: External otitis media - -### Response: -Myringotomy - -Myringotomy is also known as myringocentesis, tympanostomy or tympanotomy. Myringotomy is a surgical procedure in which a small incision is made in the eardrum (tympanic membrane). Myringotomy is done to drain suppurative or nonsuppurative fluid (effusion) of the middle ear or to provide aeration in case of the nonfunctional eustachian tube. - -Indications -1) Acute suppurative otitis media - -A severe earache with bulging tympanic membrane -Incomplete resolution with opaque drum and persistent conductive deafness -Complications of acute otitis media, e.g. facial paralysis, labyrinthitis or meningitis with bulging tympanic membrane - -2)   Serous otitis media -3)   Aero-otitis media (to drain fluid and ""unlock"" the eustachian tube) -4)   Atelectatic ear (grommet is often inserted for long-term aeration) -### End" -4703,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zinc acts as co-factor in, with the following options: A: Lactate dehydrogenase, B: Carbonic anhydrase, C: Glutathione peroxidase, D: Alkaline phosphatase - -### Response: -More than 300 enzymes are zinc-dependent. Some impoant ones are carboxypeptidase, carbonic anhydrase, alkaline phosphatase, lactate dehydrogenase, alcohol dehydrogenase and glutamate dehydrogenase. RNA polymerase contains zinc and so it is required for protein biosynthesis. Extracellular superoxide dismutase is zinc-dependent and so, zinc has antioxidant activity.Ref: DM Vasudevan, page no: 429 -### End" -4704,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First antibody to appear in blood in Acute Hepatitis B is:, with the following options: A: IgM anti-HBc, B: Anti HBs, C: Anti HBe, D: IgG anti HBc - -### Response: -IgM anti-HBc -### End" -4705,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tube agglutination test is used for serological diagnosis for, with the following options: A: Enteric fever, B: Rabies antigen, C: HIV, D: Syphilis - -### Response: -Tube agglutination test is useful for serological diagnosis of enteric fever, typhus fever, infectious mononucleosis Ref: Textbook of Microbiology Baveja 5th ed Pg 120 -### End" -4706,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wood workers are associated sinus Ca-, with the following options: A: Adeno Ca, B: Sq. cell Ca, C: Anaplastic Ca, D: Melanoma - -### Response: -Ans, is 'a' i.e.. Adeno Ca o Paranasal sinus cancer is uncommon and represents only 0.2 to 0.8% of all malignancies,o Cancer of paranasal sinus constitutes 3% of all carcinomas of the aerodigestive tract.o The majority of paranasal sinus malignancies (50-80%) originate within the maxillary sinus antrum. Malignancies rarely occur within the other sinuses and originate in the ethmoid, frontal, and sphenoid sinuses in 10%, l%and 1% respectively.o The cause of parasinus malignancy is unknown. However several risk factors have been associated and therefore it is seen more commonly in people working in hardwood furniture industryt, nickel refining, leather work, and manufacturer of mustard gas.o More than 80% of the malignant tumours are of squamous cell variety. Rest are adenocarcinoma, adenoid cystic carc inoma, melanoma, and various type of sarcomas.o Workers of furniture industry develop adenocarcinoma of the Ethmoidsand upper nasal cavity. While those engaged in Nickel refining get squamous cell and Anaplastic carcinoma. -### End" -4707,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preganglionic parasympathetic nerve fiber which supply pelvic viscera is/are;, with the following options: A: Ventral rami of S2,3,4, B: Hypogastric plexus, C: Pudendal nerve, D: All - -### Response: -A. i.e. Ventral rami of Sz, S3 and S4 -### End" -4708,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old man consults you because he has been having transient periods of rapid hea beat accompanied by sweating, flushing, and a sense of impending doom. Examination is unrevealing, with no evidence of arrhythmia at the time of the exam. However, the man&;s wife is a nurse, so the physician asks that she take vital signs the next time one of the episodes occurs. She does, and demonstrates a BP of 195/140 with hea rate 160/min during the episode. She promptly brings him to you, but the spell is over by the time that he is seen. Urinary measurement of which of the following would most likely be diagnostic in this case, with the following options: A: Dehydroepiandrosterone (DHEA), B: Human chorionic gonadotropin (hCG), C: 17-ketosteroids, D: Vanillylmandelic acid VMA - -### Response: -This patient's history suggests pheochromocytoma. This rare (but often considered diagnostically) tumor is most often found in the adrenal medulla, although it can also be found in other tissues derived from neural crest cells. The tumor cells secrete catecholamine hormones or their precursors, which can cause either paroxysmal (as in this case) or persistent hypeension. Urinary metabolites of epinephrine and norepinephrine are vanillylmandelic acid (VMA) and homovanillic acid, so screening 24 hour urine collections for these substances can be helpful in establishing or excluding these diagnoses even in cases in which a physician does not observe one of the paroxysms and thus blood cannot be drawn for serum catecholamine levels at that time. DHEA is the adrenal androgen dehydroepiandrosterone (made by the adrenal coex rather than the adrenal medulla), and is measured in serum in cases where adrenal virilism is suspected. hCG is human chorionic gonadotropin, and both serum and urine levels can increase in pregnancy or trophoblastic disease. 17-ketosteroids are measured in urine during evaluation of congenital adrenal hyperplasia (a disorder of the adrenal coex rather than medulla).. -### End" -4709,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are known risk factors for the development of ovarian carcinoma EXCEPT:, with the following options: A: Family History of ovarian carcinoma, B: Use of oral contraceptive pills, C: History of infeility, D: BRCA-1 positive individual - -### Response: -Oral contraceptive use reduces the risk of epithelial ovarian cancer. Risk factors for ovarian carcinoma * Age--between 45 and 60 years* Nulliparous or of low parity* Woman with history of infeility, previous PCOS, or on tamoxifen* High-calorie, high-fat diet* Genetic predisposition BRCA-1 and BRCA-2 genes* Late menopause* Breast and gastrointestinal cancer* Prolonged H in menopausal woman -### End" -4710,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On an OPG evaluation of a child, the following features were noted. - - -Completion of the roots of the mandibular incisor teeth and near completion of the roots of the maxillary lateral incisors. -Great amount of root resorption of the primary canines and molars and root development of their permanent successors. -Approximately one half of the roots of the mandibular canine and mandibular first premolar have been completed. -Nearly half the root of the upper first premolar was complete. -Significant root development of the mandibular second premolar, maxillary canine, and maxillary second premolar. - -What is the dental age of this patient ?, with the following options: A: 7 years, B: 9 years, C: 10 years, D: 12 years - -### Response: -Dental age 10 is characterized by a greater amount of both root resorption of the primary canines and molars, and root development of their permanent successors. At dental age 10, approximately one half of the roots of the mandibular canine and mandibular first premolar have been completed; nearly half the root of the upper first premolar is complete; and there is significant root development of the mandibular second premolar, maxillary canine, and maxillary second premolar. Teeth usually emerge when three fourths of their roots are completed. Thus a signal that a tooth should be appearing in the mouth is root development approaching this level. It takes 2 to 3 years for roots to be completed after a tooth has erupted into occlusion. Another indicator of dental age 10, therefore, would be completion of the roots of the mandibular incisor teeth and near completion of the roots of the maxillary laterals. -### End" -4711,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zinc deficiency leads to all except, with the following options: A: Delayed skeletal maturation, B: Impaired Immune system, C: Skeletal abnormalities, D: Excessive appetite - -### Response: -Zinc deficiency : Growth failure Sexual infantilism Loss of taste Delayed wound healing Loss of integrity of immune system Spontaneous aboions Congenital malformation Low bih weight IUGR Preterm delivery Skin lesions Depressed appetite Skeletal abnormalities Ref: Park 25th edition Pgno : 663 -### End" -4712,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antigen-antibody complex mediated hypersensitivity is -, with the following options: A: Type -1 hypersensitivity, B: Type -2 hypersensitivity, C: Type -4 hypersensitivity, D: Type -3 hypersensitivity - -### Response: -a) Type I reactions (immediate hypersensitivity) → Involve immunoglobulin ‘E’(IgE) mediated release of Histamine and other mediators from mast cells and basophils. -b) Type II reactions (Antibody-mediated) → Involve immunoglobulin G or Immunoglobulin M bound to cell surface antigen, with subsequent complement fixation. -c) Type III reactions (Immune complex-mediated) → involve circulating antigen-antibody complexes that deposit in postcapillary venules, with subsequent complement fixation. -d) Type IV reactions (delayed hypersensitivity cell-mediated) → Mediated by T-cells. -### End" -4713,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following is a marker of acute hepatitis B infection-, with the following options: A: DNA polymerase, B: Hepatitis core antigen, C: Anti HBs, D: IgG to core antigen - -### Response: -HBV-DNA can be measured by PCR in the blood. Viral loads are usually in excess of 105 copies/mL in the presence of active viral replication, as indicated by the presence of e antigen. In contrast, in individuals with low viral replication, who are HBsAg- and anti-HBe-positive, viral loads are less than 105 copies/mL. The exception is in patients who have a mutation in the pre-core protein, which means they cannot secrete e antigen into serum . Such individuals will be anti-HBe-positive but have a high viral load and often evidence of chronic hepatitis. These mutations are common in the Far East, and those patients affected are classified as having e antigen-negative chronic hepatitis. They respond differently to antiviral drugs from those with classical e antigen-positive chronic hepatitis. Measurement of viral load is impoant in monitoring antiviral therapy and identifying patients with pre-core mutants. Specific HBV genotypes (A-H) can also be identified using PCR. In some settings, these may be useful in guiding therapy, as genotype A tends to respond better to pegylated interferon-alfa compared to genotypes C and D. Ref Davidson edition23rd pg 875 -### End" -4714,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gloves, syringes, needles etc., used for patients whose HIV test results is not known, should be immersed in -, with the following options: A: Povidone - iodine 1%, B: Boiling water, C: 1% solution of sodium hypochlorite, D: None - -### Response: -Ans. is 'None' . For contaminated medical instruments 2 % solution of glutaraldehyde is used. -### End" -4715,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bacillary angiomatosis is caused by, with the following options: A: Bartonella henselae, B: Hansen’s bacillus, C: Koch’s bacillus, D: H. ducreyi - -### Response: -Henselae causes bacillary angiomatosis, a condition resembling Kaposi’s sarcoma in patients with AIDS. The skin, lymph nodes or liver and spleen are primarily involved in this condition. The bacteria also cause sub acute bacterial endocarditis. -### End" -4716,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following can cause endometrial cancer:, with the following options: A: Metropathia hemorrhagica, B: Gynandroblastoma, C: Dysgerminoma, D: All of the above - -### Response: -Endometrial cancer is mainly caused by excessive estrogen - -Metropathia hemorrhagica is the same as cystic glandular hyperplasia and is a causative factor for endometrial cancer. Ref Dutta Gynae 5th /ed p 184 -Gynandroblastoma is a virilising tumor which secretes androgens (not estrogens) and so does not lead to endometrial cancer  Ref. Shaw 14th /ed p 34 -Dysgerminoma is a neutral tumor which does not secrete either male or female sex hormones but secretes placental alkaline phosphates, LDH and BHCG and therefore does not lead to endometrial cancer. - Ref Shaw 14th /ed 3386 -### End" -4717,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In drinking water, recommended fluoride level is_____ ppm, with the following options: A: 0.5, B: 0.5-0.8, C: 1.5, D: 1.1 - -### Response: -Ans. b (0.5-0.8 ppm) (Ref. Park's textbook of PSM - 22nd/511, 582)# The permissible concentration of fluorides in drinking water is0.5 to 0.8 mg/L# Drinking water is known to protect gainst dental caries with Fluoride content at about1 mg/litre# ""Mottling of dental enamel"" reported at levels above1.5 mg/L intake.# Endemic fluorosis has been observed when the drinking water contain excess fluorine i.e.3-5 mg/L# Skeletal Fluorosis/Genu valgum is observed when the lifetime daily intake of fluorine is of>3.0-6.0 mg/L.ENDEMIC FLUOROSIS# Certain parts e.g., Andhra Pradesh, Punjab, Haryana, Karnataka, Kerala, and TN are known for endemic flurosis.# Dental Fluorosis: Ingested during the years of tooth calcification essentially during the first 7 years of life.# Mottling is best seen on the incisors of the upper jaw.# Prevention: Changing the water source.# Nalgonda technique for defluoridation of water.The presence of following chemicals in excess of prescribed limits may constitute ground for rejection of the water as a source of public water supply:A. Inorganic constituents:# Arsenic: recommended maximum limit of concentration is 0.01 mg/L.# Cadmium 0.003 mg/L maximum limit.# Chromium# Cyanide: maximum limit 0.07 mg/L.# Fluoride Should not be more than 1.5 mg/L# Lead# Mercury: 0.001 mg/L minimum upper limit. Bacterial plate count on yeast extract agar after incubation at 22degC for 7 days might serve as the best general-purpose indicator of microbiological quality.# Selenium# Nitrite and Nitrate: When nitrate level in drinking water exceeds 50 mg/L, methemoglobinemia may occur; most susceptible are bottle-fed infants of less than 3 months. Nitrate is good indicator for past contamination.B. Organic constituents# Polynuclear aromatic hydrocarbons and Pesticides -### End" -4718,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major sources of androgen in females are all except :, with the following options: A: Adrenals, B: Ovaries, C: Peripheral conversion to androgen precursors in the liver, gastrointestinal tract and adipose tissue, D: Corpus luteum - -### Response: -Androgen Production in Females Testosterone Androstenedione DHEA DHEA-S Ovary 25% 50% 20% Adrenal Coex 25% 50% 50% 100% Androstenedione 50% DHEA-S 30% 50% of Androstenidione is peripherally conveed to testosterone Testosterone is 80% bound to SHBG and 19% to Albumin, hence only 1% is free and active In Hirsute women 2% free and active In Men 3% free and active Ref: Clinical Gynecologic Endocrinology and Infeility; Eighth Edition; Chapter 13 -### End" -4719,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: lactose in per 100 grams of breast milk -, with the following options: A: 3.4, B: 4.4, C: 5.1, D: 7.5 - -### Response: -Ans. is 'd' i.e., 7.5 Nutritive value of milks compared (value per 100 grams) BuffaloCowGoatHumanFat(g)6[?]54[?]14[?]53[?]4Protein(g)4-33[?]23[?]31[?]1Lactose(g)51444[?]67[?]4Calcium(mg)21012017028Iron(mg)0[?]20[?]20[?]3 Vitamin C(mg)1213Minerals(g)0[?]80[?]80[?]80[?]1Water(g)81[?]08786[?]888Energy(kcal)117677265 -### End" -4720,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs that should be avoided in G-6-PD deficiency are, with the following options: A: Nalidixic acid, B: Dapsone, C: Sulfamethoxazole, D: All of the above - -### Response: -G-6-PD deficiency is responsible for hemolysis with primaquine and other oxidizing drugs like sulfonamides, dapsone, quinine, nalidixic acid, nitrofurantoin, and menadione, etc. Ref ;KD Tripathi Pharmacology 7th edition (page no; 65) -### End" -4721,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of hernia in females is:, with the following options: A: Direct inguinal hernia, B: Indirect inguinal hernia, C: Femoral hernia, D: Umbilical hernia - -### Response: -MC type of hernia in males: Indirect inguinal hernia Femoral hernia is more common in females than in males but in females most common is indirect inguinal hernia. MC type of hernia in females: Indirect inguinal hernia Direct inguinal hernia is more common in the elderly -### End" -4722,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is known to decrease recurrence rate of bacterial vaginosis, with the following options: A: Treatment of male sexual partner, B: Introduction of lactobacilli, C: Acidifying vaginal gels, D: None of the above - -### Response: -There is no effective treatment to reduce recurrence rate of bacterial vaginosis. -### End" -4723,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Multiple punched out lesions on X-ray is seen in:, with the following options: A: Paget's disease, B: Craniopharyngioma, C: Multiple myeloma, D: Eosinophilic granuloma - -### Response: -Ans. Multiple myeloma -### End" -4724,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Buspirone acts on:, with the following options: A: 5HT1A, B: 5 HT2, C: 5 HT3, D: 5 HT4 - -### Response: -Ans. (A) 5HT1A(Ref: Goodman and Gilman 13th/234)Drugs acting on serotonergic receptors 5-hydroxytryptamine (serotonin) is synthesized from tryptophan. It acts by activation of several serotonin receptors (5-HT1 to HT7).5-HT1A (presynaptic receptor) modulates the release of serotonin. Partial agonists of this receptor (buspirone, ipsapirone, gepirone) are useful as anti-anxiety drugs.5-HT1B/1D (presynaptic receptor) cause constriction of cranial vessels and agonists at this receptor (sumatriptan, naratriptan) are useful for the treatment of acute migraine attacks.5-HT2A/2C receptor is responsible for most of the direct actions of serotonin. Ketanserin and ritanserin are antagonists at this receptor and are useful as antihypertensive agents. Clozapine and risperidone are atypical antipsychotic agents that act through antagonistic activity at this receptor.5-HT3 receptor is an ionotropic receptor (other 5 HT receptors are GPCRs) and mediates most of the reflex and indirect actions of serotonin. Stimulation of this receptor is responsible for vomiting induced by anticancer drugs. 5-HT3 receptor antagonists like ondansetron are the drug of choice for chemotherapy induced vomiting.5-HT4 receptor is present in GIT and is responsible for increase in peristalsis. Agonists at his receptor (cisapride, tegaserod) are useful as prokinetic agents in the treatment of gastroesophageal reflux disease. -### End" -4725,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amniocentesis is done at, with the following options: A: 12 - 14 weeks, B: 14 - 16 weeks, C: 8 - 10 weeks, D: 18 - 20 weeks - -### Response: -Amniocentesis normally done at 14 - 16 weeks. -Early Amniocentesis 12 - 14 week. -### End" -4726,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Microfilaria endemicity index is -, with the following options: A: % of a persons showing MF in blood and diseased individual, B: % of persons showing MF in blood only, C: Number of MF in the blood, D: Average no. Persons with positive slides - -### Response: -

filarial indices 1. Microfilaria rate: percentage of persons showing microfilaria in their peripheral blood (20 cu. mm) in sample population, one slide being taken from each person. 2. Filarial endemicity rate: percentage of persons examined showing microfilaria in their blood/disease Manifestation / both. 3. Microfilarial density: number of microfilaria per unit volume of blood in samples from individual person. 4. Filarial disease rate. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.274}

-### End" -4727,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The term ""Guyon&;s canal"" is in relation to which of the following?, with the following options: A: Anterior interosseus nerve, B: Ulnar nerve, C: Median nerve, D: Radial aery - -### Response: -Guyon's canal or ulnar tunnel is an osseofibrous tunnel formed by the pisohamate ligament bridging the concavity formed by the pisiform bone and hook of the hamate. The ulnar a nerve passes through this tunnel in the wrist and its compression here lead to ulnar tunnel syndrome characterised by hypoesthesia of medial 1 and 1/2 fingers and weakness of intrinsic muscles of the hand. Ref: Textbook of anatomy upper limb and thorax, Vishram Singh, 2nd edition, page no.150, 180 -### End" -4728,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2 year old child comes with ear discharge, seborrheic dermatitis, polyuria and hepatos- plenomegaiy. Which of the following is the most likely diagnosis -, with the following options: A: Leukemia, B: Lymphoma, C: Langerhan's cell histiocytosis, D: Germ cell tumor - -### Response: -Ans. is 'c' i.e., Langerhan's cell histiocytosis o Langherhans cells histiocytosis is a histocvtic. disorder most commonly characterized bv a single or multiple osteolytic bone lesions demonstrating infiltration with histiocytes.o Histiocytic disorders are derived from mononuclear phagocytic cells (macrophages) and dendritic cells which have several different originl and locations.o The generic term histiocyte refers to several types of cells including langherhan cells, monocytes/macrophages and dermal/interstitial dendritic cells.o Langherhans cells histiocytosis is so named because the morphology and the immunophenotype of the abnormal cells is similar to that of langherhans cells which are specialized dendritic cells found in skin and mucosa.o Gene expression array data have shown that skin langherhan cells is not the cell of origin for LCH rather it is a myeloid dendritic cell that express the same antigen (CDla, CD207) as the skin langherhans cells.o For now 'langherhan cell histiocytosis remains the preferred nomenclature, although new termanology may evolve when the precise origin of CD 207 cells in LCH is fully understood.o The historical terms histiocytosis X, letterer siwe disease, hand schuller Christian disease and diffuse reticuloendotheliosis should be abandoned.o The term eosinophilic granuloma can sometimes be used to describe pathology of langherhan s cells histiocytosis.Diagnosis of LCHo LCH is diagnosed upon biopsyo A biopsy of an osteolytic bone lesion or skin lesion is generally preferred.# Langherhan cells are recognized on the basis of morphological criteria# The identity must then be confirmed by either positive immunohistochemical staining for CD1a and CD207 by the identification of Birbeck granules.o Biopsy of involved tissue usually demonstrates heterogenous collection of langherhan cells with eosinophils, neutrophils, small lymphocytes and histiocytes.Morphology of the langherhan cells# Langherhan cells are large oval mononuclear cells with few cytoplasmic vacuoles, little or no phagocytic material and slightly eosinophilic cytoplasm.# Nucleus is prominent with fine chromatin and thin nuclear membranes with grooved folded or indented nuclear contours imparting twisted towel.# Unlike dermal langherhan cells these cells do not have dendritic cell processes.# Similar to dermal langherhan cells, those in LCH express the histiocyte marker CDla. S100 and CD207 and contain Birbeck granules.Birbeck granules# Intracytoplasmic rod shaped organelles with central striations that can be demonstrated on electron microscopy.# Occasionally there is terminal vesicular dilatation giving the Birbeck granules the appearance of ""tennis racket"". | ||||||||Bone (77%)Skin (39%)LyphnodesLiverSpleenOral mucosaLung (10%)CNS (16%)o Occurs in majority of patientso Usually asymptomatico Lytic 'punched' out lesiono Usually present as eczematous rasho Ulcerative lesions in axilla inguinal folds genitalia or perianal regiono Seborrhic dermatitiso Lymphadenopathyo Enlarged thymus or mediastinal nodeso Hepatic dysfunctiono Hepatomao Sclerosing cholangitiso Massive Splenomegalyo Cytopeniaso Intra oral masso Gingivitiso Mucosal ulcerso Loose teetho Non productive cough dyspnoea chest pain or constitutional symptomso Risk of CNS invol- ment varies with bone involvemento CNS inolve- ment occurs more with involvement of facial and anterior middle cranial fossao Diabetes insipidus and symptoms of neuro- degeneration -### End" -4729,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient of depression is stabilized on selective in reuptake inhibitor (SSRI). This group of drugs produced withdrawal Symptoms when stoppe(d) Which of the following drugs has minimum risk of causing drug discontinuation symptoms?, with the following options: A: Paroxetine, B: Fluoxetine, C: Seraline, D: Fluvoxamine - -### Response: -Fluvoxamine and paroxetine produce discontinuation reaction than with other SSRIs. Fluoxetine produces slower onset of anti depressant effect hence less did continuation symptoms. REF: KD TRIPATHI 8TH ED. -### End" -4730,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Early mediators of allergic rhinitis are:, with the following options: A: Leukotriene, B: IL-4, C: IL-5, D: All - -### Response: -Ans. is All -### End" -4731,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following agents is not used to provide induced hypotension during surgery?, with the following options: A: Esmolol, B: Hydralazine, C: Mephentermine, D: Sodium nitroprusside - -### Response: -Mephenteramine is an indirect acting sympathomimetic drug. It is used to treat the hypotension induced by ganglion blockers or spinal anaesthesia. Therefore not used to induce hypotension. Esmolol, hydralazine and sodium nitroprusside are commonly used agents to provide induced hypotension during surgery. Cerebral blood flow remains constant in an intact brain over a mean aerial blood pressure range 50-150mmHg. Induced hypotension is employed to reduce blood loss. Ref: Textbook of Neurosurgery By Prakash Narain Tandon, Volume 1, Page 927; Medical Toxicology By Richard C. Da, 3rd Edition, Page 551. -### End" -4732,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The important feature of psoriasis is –, with the following options: A: Crusting, B: Scaling, C: Oozing, D: Erythema - -### Response: -Psoriasis is a papulosquamous disorder characterized by papule and scales. -### End" -4733,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atrial depolarization in ECG is represented by, with the following options: A: 1, B: 2, C: 3, D: 4 - -### Response: -1 (Description: P wave in EC6) -### End" -4734,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is maximally associated with hea disease-, with the following options: A: HDL, B: LDL, C: VLDL, D: CHYLOMICRONS - -### Response: -REF:-PARK 25TH EDITION,PG NO-399 HIGH LEVELS OF CHOLESTEROL THAT IS MOST DIRECTLY ASSOCIATED WITH CHD. VERY LOW LEVELS OF CHOLESTEROL MORE STRONGLY ASSOCIATED WITH PERIPHERALVASCULAR DISEASE HDL >40mg/dl lowers the incidence of CHD -### End" -4735,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following cause hypeension except, with the following options: A: NSAID, B: L-Dopa, C: Cyclosporine, D: Erythropoietin - -### Response: -NSAIDS- Cause retention of sodium and water causing edema and also decreases the effects of antihypeensive drugs. Hypeension is more common in coxib users than NSAIDS. Cyclosporine- May cause hypeension in 50% of renal transplants and in almost all cardiac transplants. L-Dopa- Peripheral decarboxylation of L-Dopa releases dopamine which in circulation may activate vascular dopamine receptors and cause ohostatic hypotension. Administration of Ldopa with nonspecific MAO inhibitors may precipitate a hypeensive crisis and hyperpyrexia. Drugs Causing Hypeension a. Clonidine withdrawal b. Coicotropin c. Cyclosporine d. Erythropoietin e. MAO inhibitors with sympathomimetic f. NSAIDS (some) g. OCP h. Sympathomimetic i. TCA with sympathomimetics -### End" -4736,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which electrolyte abnormality occurs during TURP-, with the following options: A: Hypokalemia, B: Hyponatremia, C: Hyperkalemia, D: Hypernatremia - -### Response: -Ans- B Hyponatremia Ref Introduction Trans Urethral Resection of Prostate (TURP) is the second most common surgical procedure (after cataract extraction) done in men over the age of 65 years. Advancement in technology has enabled the urologists to reach all corners of the urinary system using endoscopes, causing minimum trauma to the patient. Endoscopic procedures in the urinary system require the use of irrigating fluids to gently dilate the mucosal spaces, remove blood, cut tissue and debris from the operating field and enable better vision. In spite of the best of efforts to understand and prevent the various complications of endoscopic procedures, incidence of some of the inherent complications have remained the same and still daunt the urologists. Aberrations in the Central Nervous System (CNS), Cardio Vascular System (CVS) and other systems which manifest due to the absorption of irrigating fluids during TURP are together known as TURP Syndrome. Though it is called TURP Syndrome, this complication can occur during other endoscopic procedures also namely Uretero-Renoscopy (URS), Percutaneous Nephrolithotomy (PCNL), Trans Cervical Resection of Endometrium (TCRE), etc. Despite improvements in the current surgical and anesthetic management, 2.5 - 20% of patients undergoing TURP show one or more manifestations of TURP syndrome and 0.5% - 5% die perioperatively. Signs and Symptoms TURP syndrome may occur at any time perioperatively and has been observed as early as few minutes after surgery has started and as late as several hours after surgery has been completed. When under regional anesthesia, the patient characteristically complains of Dizziness Headache Nausea Tight feeling in the chest and throat Shortness of breath Restlessness Confusion Retching Abdominal pain Both systolic and diastolic blood pressures rise and the heart rate decreases. If not treated promptly, the patient may become cyanotic and hypotensive and go in for cardiac arrest. Some patients present with neurological symptoms. Initially they become lethargic and then unconscious. Their pupils dilate and react sluggishly to light. This may be followed by short episodes of tonic-clonic seizures leading to a state of coma. Under General Anesthesia (GA), the diagnosis of TURP Syndrome is difficult and often delayed. The usual signs are unexplained rise and then a fall in BP and refractory bradycardia. ECG changes such as nodal rhythm, ST changes, U waves and widening of QRS complexes may be observed. Recovery from GA and muscle relaxants may be delayed. Irrigation Solutions Irrigating fluids are used during endourological procedures for better vision. Ideally the irrigation solution should be isotonic, non hemolytic, electrically inert (so that diathermy can be used), non toxic, transparent, easy to sterilize and inexpensive. Unfortunately, a solution having all these qualities is not yet available. Electrolyte solutions such as normal saline or Ringer Lactate do least harm when absorbed into the circulation. However they cause dispersion of high frequency current from the resectoscope and hence abandoned. A variety of other irrigating fluids have been in use, each having its own merits and demerits. Sterile water: Though sterile water has many qualities of an ideal irrigating fluid, the disadvantage is its extreme hypotonicity, causing hemolysis, dilutional hyponatremia, shock and renal failure. Glycine 1.2%, 1.5%. 2.2%: Glycine, an endogenous amino acid has been suggested as a suitable irrigating fluid considering its many advantages, including the low cost, though not as cheap as sterile water. Glycine is isotonic with plasma only at a concentration of 2.2%, but the side effects of glycine at this concentration are more. The osmolality of 1.5% glycine is 230 mosm/1 compared to serum osmolality of 290 mosm/l and hence cardiovascular and renal toxicities can occur at this concentration also. Further lowering of the concentration of glycine can lead to more complications due to hypotonicity and hence cannot be used for irrigation purposes. The distinct advantage of 1.5% glycine over sterile water is its tendency to cause less hemolysis and renal failure. Mannitol 3%: Mannitol, though does not have the toxicities of glycine, drives water out of cells and may enhance circulatory overloading. The cost of mannitol is also higher compared to glycine. The elimination of mannitol through kidney will be decreased in patients with impaired renal function. Glucose 2.5% - 4%: This is not a widely used irrigating fluid since glucose produces tissue charring at the site of resection and associated hyperglycemia produced when glucose is absorbed into the circulation. It also causes stickiness of surgeons' gloves and instruments. Cytal: Cytal, a mixture of sorbitol 2.7% and mannitol 0.54% widely used in USA as an irrigating fluid, has not gained popularity in India due to its high cost and nonavailability. In the body, sorbitol is metabolised to fructose, which may present problems in a patient with hypersensitivity to fructose. Urea 1%: This produces urea crystallisation on the instruments during resection and hence not preferred. 1.5% glycine and sterile water are the most widely used irrigating fluids in urological endoscopic surgeries. Pathophysiology 1. Circulatory Overload The uptake of small amounts of irrigating fluids has been shown to occur during almost every TURP and TCRE , through the venous network of prostatic bed and endometrium respectively. Spontaneous leakage through Fallopian tube More Detailss increases fluid absorption during TCRE. The fluid absorption has been studied by the expired breath ethanol tests after the addition of ethanol up to a concentration of 1 % to the irrigating fluid. The uptake of I litre of fluid within one hour, which corresponds to an acute decrease in the serum sodium concentration of 5-8 mmols/l, is the volume above which the risk of absorption related symptoms is statistically increased. , The average rate of fluid absorption during TURP is 20 ml/min. Due to circulatory overload, the blood volume increases, systolic and diastolic pressures increase and the heart may fail. The absorbed fluid dilutes the serum proteins and decreases the oncotic pressure of blood. This, concurrent with the elevated blood pressure, drives fluid from the vascular to interstitial compartment causing pulmonary and cerebral edema. In addition to direct absorption into the circulation, a significant volume (upto 70%) of the irrigation solution has been found to accumulate interstitially, in the periprostatic and retroperitoneal spaces. For every 100 ml of fluid entering the interstitial compartment, 10-15 meq of sodium also moves with it. Though the duration of surgery has not been conclusively proved to be the determinant for the volume of fluid absorbed, morbidity and mortality were found to be definitely higher when surgery was prolonged over 90 minutes. Intravascular absorption correlates well with the size of the prostate, while interstitial absorption depends primarily on the integrity of prostatic capsule. Circulatory overload occurs when the weight of the gland is more than 45 grams. Another important factor that determines the rate of absorption of fluid is the hydrostatic pressure at the prostatic bed. This pressure depends on the height of irrigating fluid column and the pressure inside the bladder during surgery. The ideal height of irrigating fluid is 60 cm so that approximately 300 ml. of fluid is obtained per minute during resection for good vision. 2. Water Intoxication Some patients with TURP syndrome present symptoms of water intoxication, a neurological disorder caused by increased water content of the brain. The patient becomes first somnolent and then incoherent and restless. Seizures may also develop leading on to coma in decerebrate position. There will be clonus and positive Babinski responses. Papilloedema, with dilated, sluggishly reacting pupils can occur. The EEG will show low voltage, bilaterally. The symptoms of water intoxication appear when serum sodium level falls 15 - 20 meq/l below normal level. 3. Hyponatremia Sodium is essential for proper function of excitatory cells, particularly those of heart and brain. Several mechanisms lead to hyponatremia in TURP patients. ,,, Dilution of serum sodium through excessive absorption of irrigation solution. Loss of sodium into the stream of the irrigation fluid from the prostatic resection site. Loss of sodium into pockets of irrigation solution accumulated in the periprostatic and retroperitoneal spaces. Larger amounts of glycine stimulate the release of atrial natriuretic peptide in excess of that expected by the volume load, which further promote natriuresis. The symptoms of hyponatremia are restlessness, confusion, incoherence, coma and seizures. When serum sodium falls below 120 meq/1, hypotension and reduced inyocardial contractility occur. Below 115 meq/1, bradycardia and widening of QRS complexes, ventricular ectopics and T wave inversion occur. Below 100 meq/1 generalised seizures, coma, respiratory arrest, Ventricular Tachycardia (VT), Ventricular Fibrillation (VF) and cardiac arrest occur. Sodium requirement is calculated by the following formula: Sodium Deficit = Normal serum Na - Estimated serum Na x Volume of body water (Body water is usually 60% of body water) 4. Glycine Toxicity Excess of glycine absorbed into circulation is toxic to heart and retina and may lead to hyperammonemia. Experimentally glycine has been found to reduce the vitality and survival of isolated cardiomyocytes. In patients, glycine 1.5 % has been associated with subacute effects on the myocardium, manifested as depression or inversion of the T wave on the electrocardiogram 24 hr after surgery. Absorption exceeding 500 ml has been shown to double the long-term risk of acute myocardial infarction. This may be one of the reasons for the higher long-term mortality after transurethral versus open prostatectomy, which has been a debate among urologists for some years. TURP seems to depress myocardial function, particularly when the operative duration exceeds 1 hr and when glycine is used at room temperature. About 0.5% of patients develop acute myocardial infarction during TURP, though transient myocardial ischemia has been detected during 20% of TURPs. Dilutional hypocalcemia has also been implicated as a source of acute cardiovascular disturbances when glycine is absorbed.,However calcium is restored more rapidly, probably due to mobilisation of calcium from bone tissues. Glycine is known to be a major inhibitory neurotransmitter in the spinal cord and in the brain stem, probably acting in the same manner as gamma amino butyric acid on the chloride ion channel. Too high a concentration may therefore cause severe depressant effect on the CNS and visual disturbances. Glycolic acid, formate and formaldehyde are other metabolites of glycine and these too can cause visual disturbances. The signs of glycine toxicity are nausea, vomiting, slow respiration, seizures, spells of apnoea and cyanosis, hypotension, oliguria, anuria and then death. When arginine, another nonessential amino acid is added to the glycine infusion, the toxic effect of glycine on the heart is blunted. The mechanism by which arginine protects the heart is unknown. The normal value of serum glycine in man is 13-17 mg/l. Glycine toxicity is very uncommon in TURP patients probably because most of the absorbed glycine is retained in the periprostatic and retroperitoneal spaces, where it has no systemic effect. 5. Ammonia Toxicity Ammonia is a major by-product of glycine metabolism."" High ammonia concentration suppresses norepinephrine and dopamine release in the brain. This causes the encephalopathy of TURP syndrome. Fortunately ammonia toxicity is rare in man. Characteristically the toxicity occurs within one hour after surgey. The patient develops nausea and vomiting and then lapses into coma. Blood ammonia rises above 500 micromols/1 (normal value is 11-35 micromols/1). Hyperammonemia lasts for over ten hours postoperatively, probably because glycine continues to be absorbed from the periprostatic space. It is not clear why hyperammonemia does not develop in all TURP patients. Hyperammonemia implies that the body cannot fully metabolize glycine through the glycine cleavage system, citric acid cycle and conversion to glycolic acid and glyoxylic acid. Another possible explanation is arginine deficiency. Ammonia is normally converted to urea in the liver via the ornithine cycle. Arginine is one of the intermediary products necessary for this cycle. When a patient has arginine deficiency, ornithine cycle is not fuelled and thus ammonia accumulates. 6. Hypovolemia, Hypotension The classical hemodynamic signs of the TURP syndrome, when glycine is used as irrigating fluid, consist of a transient arterial hypertension, that may be absent if the bleeding is profuse, followed by more prolonged hypotension. , Release of prostatic tissue substances and endotoxins into the circulation and associated metabolic acidosis might contribute to this hypotension. ,, Blood loss during TURP leads to hypovolemia, causing significant loss in oxygen carrying capacity leading to myocardial ischemia and infarction. Blood loss correlates with the size of prostatic gland resected, duration of surgery and skill of the surgeon. The average blood loss during TURP is 10 m1/gram of prostate resected. 7. Visual Disturbances One of the most alarming complications of TURP syndrome is transient blindness, foggy vision and seeing halos around objects. ,,The pupils may be dilated and unresponsive. The optic disc appears normal. The symptom can coexist with other features of TURP syndrome or can be an isolated symptom. The vision returns to normal in 8-48 hours after surgery. TURP blindness is caused by retinal dysfunction probably due to glycine toxicity. Hence perception of light and blink reflexes are preserved and pupillary responses to light and accommodation are lost in TURP blindness, unlike in blindness due to cerebral cortical dysfunction. 8. Perforations Perforation of urinary bladder can occur during TURP due to surgical instrumentation, in difficult resections, overdistension of bladder and rarely explosion inside the bladder. Instrumental perforation of the prostatic capsule has been estimated to occur in 1% of patients undergoing TURP., An early sign of perforation, which often goes unnoticed, is a decreased return of irrigating fluid from the bladder. Abdominal pain, distension, nausea and distress follow. Bradycardia and arterial hypotension are profound. There is also a high risk of failure to diurese spontaneously. In intraperitoneal perforation, symptoms develop faster. Referred shoulder pain due to irritation of diaphragm and hiccoughs are characteristic symptoms. , Pallor, diaphoresis, abdominal rigidity, nausea, vomiting and hypotension can occur. In extraperitoneal perforation, reflex movements of lower limbs may occur. Explosions inside the bladder are fortunately rare. Cauterisation of prostatic tissue is believed to liberate flammable gases. Normally not enough oxygen will be available inside the bladder to permit an explosion. But when air enters with the irrigant, explosions can occur. 9. Coagulopathies Disseminated Intravascular Coagulation (DIC) or consumption coagulopathy can occur due to release of prostatic particles rich in tissue thromboplastins into the circulation causing secondary fibrinolysis. Dilutional thrombocytopenia can aggravate the situation. DIC can be detected in the blood by a decrease in platelet count, high levels of fibrin degradation products (FDP, >150 mg/dl) and low plasma fibrinogen levels (400 mg/dl). 10. Bacteremia, Septicemia and Toxemia About 30% of all TURP patients have infected urine preoperatively. When prostatic venous sinuses are opened preoperatively and high pressure irrigation is used, bacteria enter the circulation. In about 6% of patients, the bacteremia is complicated by septicemia. Absorption of bacterial endotoxins and toxic byproducts of tissue coagulation may lead to a toxic state in some patients postoperatively. Severe chills, fever, capillary dilatation and hypotension can occur temporarily in these patients. 11. Hypothermia Hypothermia is a frequent observation in patients undergoing TURP. A drop in the body temperature alters the hemodynamic situation, results in shivering and markedly increases oxygen consumption. Bladder irrigation is an important source of heat loss and the use of irrigating fluids at room temperature results in a decrease in body temperature of 1-2deg C. This is aggravated by the cold atmospheric temperature of operation theatre. Elderly patients are particularly susceptible to hypothermia because of possible autonomic dysfunction. The associated vasoconstriction and acidosis can adversely affect the heart and can contribute to CNS manifestations. Shivering can also enhance bleeding from the resection site. Prophylaxis Against TURP Syndrome Identification of early symptoms of TURP syndrome and prevention is essential to retard the onset of severe and fatal manifestations in patients undergoing endoscopic surgeries. Pre-existing hyponatremia should be identified and corrected, especially in patients on diuretics and low salt diet. Prophylactic antibiotics may have a role in the prevention of bacteremia and septicemia. Central Venous Pressure (CVP) monitoring or pulmonary artery catheterisation is necessary in patients with cardiac illness. The ideal height of irrigating fluid is 60 cm. The duration of TURP should be restricted to 1 hour , and in cases requiring more duration of resection, staged TURP should be performed. Prostatic capsule should be preserved as far as possible and distension of bladder avoided. Continuous flow methods have been claimed to decrease fluid absorption, whereas some authors have found no such reduction. Serum sodium should be estimated every 30 minutes and necessary corrections should be made. The fluid therapy should be restricted to maintain optimum hemodynamics. Prophylactic frusemide should be given to avoid fluid overload. Whenever possible, packed cells should be preferred to whole blood for transfusion to avoid circulatory overload. Increasing the atmospheric temperature of operation theatre, use of warm blankets, mattresses and intravenous fluids and using irrigating fluids prewarmed to 37deg C help to avoid hypothermia. General Anesthesia vs Regional Anesthesia in TURP TURP performed under regional anesthesia without sedation (Awake TURP) is preferable to general anesthesia due to the following reasons: Early manifestations of TURP syndrome are better detected in awake patients. Peripheral vasodilatation helps to minimize circulatory overloading. Provides some degree of postoperative analgesia. Blood loss will be less. However the possible sudden hemodynamic fluctuations of spinal or epidural anesthesia should be taken into consideration before administering regional anesthesia. Treatment The treatment of TURP syndrome involves correction of various pathophysiological mechanisms operating in body homeostasis. ,,,, Ideally the treatment has to be instituted before serious CNS or cardiac complications occur. When TURP syndrome is diagnosed, surgical procedure should be terminated as early as possible. Frusemide should be administered in a dose of 1 mg/kg intravenously. However, the use of frusemide to treat TURP syndrome has been questioned because it increases sodium excretion. Hence 15% mannitol has been suggested as a better choice, due to its action independent of sodium excretion and its tendency to increase extracellular osmolality. Oxygen should be administered by nasal cannula. Pulmonary edema should be managed by tracheal intubation and positive pressure ventilation with 100% oxygen. Arterial blood gases, hemoglobin and serum sodium are to be estimated. Correction of hyponatremia should be done by diuresis and slow administration of 3-5% hypertonic saline at the rate of not more than 0.5 meq/1 per hour or not faster than 100 ml/hr. Approximately 200 ml of hypertonic saline is needed for correction of hyponatremia. Rapid administration of saline leads to pulmonary edema and central pontine myelinolysis. Two-thirds of the hypertonic saline restores serum sodium and osmolality, while one-third redistributes water from cells to the extracellular space, where it becomes available to diuretic treatment with frusemide. Intravenous calcium may be used to treat acute cardiac disturbances during surgery. Seizures should be managed by diazepam/midazolam/barbiturate/dilantin or a muscle relaxant depending on the severity. Significant blood loss should be managed by administering packed red cells. In cases of DIC, fibrinogen 3-4 gms should be given intravenously followed by heparin infusion 2000 units bolus (and then 500 units per hour). Fresh Frozen Plasma (FFP) and platelets may also be used depending on the coagulation profile. Surgical drainage of retroperitoneal fluid in cases of perforation can reduce the morbidity and mortality significantly. -### End" -4737,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true about nocturnal penile tumerscence is, with the following options: A: Totals about 100 min / night, B: Normal phenomenon, C: Occurs in NREM sleep, D: Can be used to distinguish between psychological or organic impotence. - -### Response: -B i.e. Sleep walking -### End" -4738,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Grievous injury includes all the following except-, with the following options: A: Emasculation, B: Permanent privation of hearing, C: Privation of any member/joint, D: Disability to follow one's ordinary pursuits for a period of a week - -### Response: -It should be for 20 days (not for a week). -### End" -4739,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Optic nerve is -, with the following options: A: Second order neuron, B: First order neuron, C: Fouh order neuron, D: Third order neuron - -### Response: -each optic nerve stas from optic disc and extends up to optic chiasma where the two nerves meet. It is the backward continuation of the nerve fibre layer of retina , which consists of the axons originating from the ganglion cells ie second order neuron. Reference: textbook of comprehensive Opthalmology by AK Khurana. -### End" -4740,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Propofol infusion syndrome is characterized by, with the following options: A: Hypokalemia, B: Hypolipidemia, C: Bradycardia, D: Tachycardia - -### Response: -Propofol infusion syndrome occurs when propofol infusion is continued for more than 48 hours - -Severe metabolic acidosis -Acute cardiacfailure -Hyperkalemia -Hyperlipidemia -Skeletal myopathy -Refractory bradycardia. -### End" -4741,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true Anti phospholipid Syndrome EXCEPT, with the following options: A: Associated with SLE (343, 636- Dutta 6th), B: Thrombosis of uteroplacental vessels, C: Recurrent placental haemorrhage, D: Give false positive results in syphilis - -### Response: -(Recurrent placental hemorrhage) (343, 6360 Dutta 6th)* There is no bleeding defect unless a second disorder such as thrombocytopenia, hypoprothrombinemia or a prolonged bleeding time is presentANTI- PHOSPHOLIPID SYNDROMEIn SLE two antiphospholipid antibodies eg Lupus anti coagulant and anticardiolipid are important. These antibodies act by dysregulation of coagulation pathways. This causes thrombosis of uteroplacental vessels and poor placental perfusionCommon obstetric complications1. Recurrent fetal loss2. 1UGR3. Pregnancy induced hypertension4. Placental abruption5. Recurrent thrombotic events6. ThrombocytopeniaPathological changes like placental vascular atherosis, intervillous thrombosis and decidual vasculopthy with fibrinoid necrosis leads to inadequate maternal blood supply to fetus* An anti phospholipid, the lupus anticoagulant will cause false positive VDRL test for syphilis -### End" -4742,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In 1st week of parenteral nutrition, patient becomes: March 2013 (f), with the following options: A: Overweight, B: Underweight, C: Normal weight, D: Variable - -### Response: -Ans. B i.e. Underweight Total parenteral nutrition TPN is used as a primary therapy in: - Severe burns, - Sho bowel syndrome etc. Complications of TPN: - Air embolism, - Weight loss in 7 days etc. Metabolic changes in TPN: - Essential fatty acid deficiency, - Electrolyte disorder etc. -### End" -4743,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Two strands of the DNA are joined by:, with the following options: A: Glycosidic bond, B: Hydrogen bond, C: Covalent bond, D: Ionic bond - -### Response: -Ans. B. Hydrogen bondBonds in the DNABetween nucleotides- 3' to 5' Phosphodiester bondBetween the DNA Hydrogen bondBetween base and Sugar beta N Glycosidic bond, Nucleoside and Phosphate Ester bondBase stacking by van der Waals forces -### End" -4744,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Crystalline lens develops from -, with the following options: A: Mesoderm, B: Endoderm, C: Surface ectoderm, D: Neuroectoderm - -### Response: -Ans. Is 'c' i.e., Surface ectoderm PrecursorDerivativesNeural ectodermSmooth muscle of the iris, opticle vesicle and cup, iris epithelium, ciliary epithelium, Part of the vitreous, Retina, Retinal pigment epithelium, fibres of the optic nerve.Surface ectodermConjunctival epithelium, Corneal epithelium, Lacrimal glands, Tarsal glands, Lens.MesodermExtraocular muscles, comeal stroma, sclera, iris. Vascular endothelium, Choroid, Part of the vitreous.Neural crestCorneal stroma, keratocytes and endothelium, Sclera, Trabecular meshwork endothelium, Iris stroma, Ciliary muscles, Choroidal stroma, Part of the vitreous, Uveal and conjunctival melanocytes, Meningeal sheaths of the optic nerve, Ciliary ganglion, Schwann cells, orbital bones, Orbital connective tissue, Connective tissue sheath and muscular layer of the ocular and orbital blood vessels. -### End" -4745,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First increase of reticulocyte count occurs after how many hours of iron therapy, with the following options: A: 48 - 72 hrs, B: 24 hrs, C: 96 hrs, D: 6 hrs - -### Response: -Ans: a (48 - 72 hrs) Ref: OP Ghai, 6th ed, p. 302Rise in reticulocyte count occurs by 48 - 72 hrs after start of Iron therapy.Course of events after starting iron therapy :1. Child becomes less irritable and appetite improves within 24 hrs2. Bone marrow response is observed within 48 hrs3. Rise in reticulocyte count by 2nd to 3rd day4. Elevation of hemoglobin occurs next which may take upto 2 months depending on the severity of anaemiaNote:Dosage for parentral iron (iron dextran)Iron (mg) = Wt (kg) x Hb deficit (gm/dl) x 4 -### End" -4746,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chromophobe variant of Renal cell carcinoma is associated with :, with the following options: A: VHL gene mutations, B: Trisomy of 7 and 17 (+7, +17), C: 3 p deletions (3p-), D: Monosomy of 1 and Y (-1, -Y) - -### Response: -Answer is D (Monosomy of 1 and y): Chromophobe variants of renal cell carcinoma are charachterized by widespread / extensive chromosomal losses resulting in monosomy or hypodiploid DNA index. This includes loss of chromosome 1 and V. 'The abnormalities most consistently observed have been multiple losses of whole chromosomes, most frequently 1, 2, 6, 10, 13, 17, 21 and the Y chromosome' - Urological Surgical Pathology Classification of epithelial neoplasms arising from the kidney Carcinoma Type Cell of Origin Cytogenetics Clear cell Proximal tubule 3p deletions (3p-), VI IL gene mutations, 5q gains Papillary Proximal tubule Trisomy of chromosome 7 and 17 (+7, +17) Loss of Y chromosome (-Y) Chromophobe Coical collecting duct Hypodiploid / Monosomy Loss of multiple chromosomes 1, 2, 6, 10, 13, 17. 21 & Y Oncocytic Coical collecting duct Undetermined Either karyotypically normal or contain limited number of karyotypic abnormalities including -1, -Y and translocations involving chromosme II Collecting duct Medullary collecting duct Undetermined Losses of multiple chromosomes 1, 6, 14, 15 & 22 -### End" -4747,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 65-year old male is brought to the outpatient clinic with one year illness characterized by marked forgetfulness, visual hallucinations, suspiciousness, personality decline, poor self care and progressive deterioration in his condition. His Mini Mental Status Examination (MMSE) Score is 10. His most likely diagnosis is:, with the following options: A: Dementia, B: Schizophrenia, C: Mania, D: Depression - -### Response: -A i.e. Dementia -### End" -4748,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most sensitive investigation of pancreatic carcinoma is, with the following options: A: Angiography, B: ERCP, C: Ultrasound, D: CT scan - -### Response: -Investigation of choice for carcinoma pancreas is MDCT Currently CT is probably the single most versatile and cost effective tool for diagnosis of pancreatic cancer Ref: CSDT 11th edition Pgno :645 -### End" -4749,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intraocular muscle supplied by Edinger Westphal nucleus is, with the following options: A: Superior oblique, B: Ciliary muscle, C: Lateral rectus, D: Medial rectus - -### Response: -All pas of the muscle are supplied by parasympathetic nerves. The pathway involves the Edinger-Westphal nucleus, oculomotor nerve, and the ciliary ganglion. The nerve to inferior oblique gives a branch for the ciliary ganglion. This branch brings the fibres of Edinger-Westphal nucleus (GVE) to the ganglion for relay. The postganglionic fibres end up in supplying the ciliaris for enhancing the anterior curvature of the lens and the sphincter pupillae for narrowing the size of the pupil. Both these are intraocular muscles required for accommodation. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition -### End" -4750,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pre-Renal Azotemia is characterized by all of the following. Except :, with the following options: A: Fractional Excretion of Na < 1%, B: Urinary osmolality > 500 mosm/kg, C: Urinary sodium concentration > 40 meq/1, D: Reversible with replacement fluids - -### Response: -Answer is C (Urinary sodium concentration > 40 meq/l) Prerenal Azotemia (Prerenal ARF) is associated with a urinary sodium concentration < 20 meq/1. A urinary sodium concentration > 40 meq /1 suggests intrinsic type of A RF. Differentiating features between Pre-renal and Intrinsic ARF Prerenal Azotemia is the most common form of ARF and is caused by renal hypoperfusion either from generalized hypovolemia or from altered renal hemodynamics resulting in hypoperfusion By definition Renal parenchymal tissue is not damaged in prerenal ARF and prerenal ARF is rapidly reversible upon correction of the primary hemodynamic abnormality Analysis of urine and blood biochemistry provides several useful 'Renal failure Indices' to distinguish prerenal ARF from intrinsic ARF (Ischemic /Nephrotoxic ARF) -### End" -4751,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hereditary nephritis is seen in -, with the following options: A: Analgesic nephropathy, B: Balkan nephropathy, C: Alport syndrome, D: Eosinophilic nephritis - -### Response: -Hereditary Nephritis refers to a group of heterogenous hereditary familial diseases associated primarily with glomerular injury. These are: Alport’s syndrome and Thin membrane disease. -### End" -4752,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ulnar nerve root is, with the following options: A: C4 C5, B: C5 C6, C: C7 C8, D: C8 T1 - -### Response: -Root value of Ulnar Nerve - Ventral rami of C8 and T1. It also get fibres of C7 from the ventral root of median nerve. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 1 , pg. no, 181 Fig Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 1 , pg. no,57 (FIG. 4.14 ) -### End" -4753,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following ECG findings is associated with acute myocardial Infarction, with the following options: A: Elevation of S wave, B: Prolonged QT interval, C: Tall T waves with increased amplitude, D: Prolonged PR interval - -### Response: -Answer is C (Tall T waves with increased amplitude) Acute myocardial infarction is associated with 'ST segment' elevation and tall, positive, hyperacute T waves (increased amplitude of T waves). 'When the acute ischemia is transmural, the ST vector usually is shifted in the direction of outer layers (epicardial), producing ST elevation and sometimes in the earliest stages of ischemia, tall, positive so called hyperacute T waves over the ischemic zone' -### End" -4754,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not form a filtration barrier in nephrons, with the following options: A: Podocytes, B: Mesangium, C: Endothelial cell, D: Basement membrane - -### Response: -Filtration barrier --        Glomerular capillary endothelium --        Basement membrane --        The visceral epithelium of Bowman’s capsule with podocytes -### End" -4755,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are transaminated EXCEPT:, with the following options: A: d- amino group of ornithine, B: a- amino group of proline, C: a- amino group of serine, D: a- amino group of cysteine - -### Response: -Only a amino group takes pa in transamination. Except:- d -amino group (non-a) of ornithine takes pa in transamination, where enzyme is OAT (Ornithine Amino Transferase). Out of the 20 amino acids, 3 amino acids do not take pa in transamination. Proline Lysine Threonine -### End" -4756,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Severe hypovalemic shock occurs when blood volume less is -, with the following options: A: > 10%, B: > 20 %, C: >30 %, D: > 40 deg,10 - -### Response: -Ans. is 'd' i.e., > 40% Hvpovolemic shock Hypovolemic shock is the most common form of shock. This is due to decrease in blood volume either by loss of blood or plasma. Grading of hypovolemic shock o Mild hypovolemia --> When volume loss is less than 20%. There is generally mild tachycardia but relatively few external signs. o Moderate hypovolemia --> When volume loss is between 20-40%. Normal blood pressure is maintained in supine position, but there is postural hypotension and tachycardia on erect posture. o Severe hypovolemia -> When volume loss is > 40%. The classical signs of shock appear i.e., marked tachycardia, hypotension, disorientation. o This is due to decrease in blood volume either by loss of blood or plasma. Grading of hypovolemic shock o Mild hypovolemia --> When volume loss is less than 20%. There is generally mild tachycardiabut relatively few external signs. o Moderate hypovolemia --> When volume loss is between 20-40%. Normal blood pressure is maintained in supine position, but there is postural hypotension and tachycardia on erect posture. o Severe hypovolemia -> When volume loss is > 40%. The classical signs of shock appear i.e.,marked tachycardia, hypotension, disorientation. -### End" -4757,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of Failure to thrive include (s):, with the following options: A: Malabsorption, B: Child abuse, C: GFRD, D: All - -### Response: -Ans is 'a' i.e., Malabsorption; 'b' i.e., Child abuse;'c' i.e., GERD Failure to thrive o Failure to thrive refers to children whose current weight or rate of weight gain is significantly lower than that of other children of similar age and gender. Cause of failure to thrive A) Organic causes o Gastrointestinal :-gastroesphageal reflux, malabsorption, inflammatory bowel disease, pyloric stenosis. o Neurological :-mental retardation, cerebral palsy o Renal :-renal tubular acidosis, chronic renal failure o Cardiopulmonary :-congential hea disease, cystic fibrosis, asthma. o Endocrine :-Hypothyroidism, diabetes mellitus, adrenal insufficiency o Infection :-chronic parasitic or bacterial infections of gastrointestinal tract, tuberculosis, infection with human immunodeficiency virus. Genetic :-Inborn errors of metabolism, chromosomal anomalies Miscellaneous :-Lead poisoning, malignancy, collagen vascular disease B) Non-organic causes Povey o Misperceptions or lack of knowledge about diet and feeding practices Lack of breastfeeding, feeding diluted formulae o Dysfunctional parent-child relationship with child abuse and neglect. Clinical features o Children that fail to thrive seem to be much smaller or shoer than other children of the same age. Teenagers may not appear to have the usual changes that occur at pubey. Symptoms of failure to thrive include: (i) Height, weight, and head circumference do not match standard growth chas. (ii) Weight is lower than 3rd percentile (as outlined in standard growth chas) or 20% below the ideal weight for their height. (iii) Growth may have slowed or stopped after a previously established growth curve. o In general, the child's rate of change in weight and height may be more impoant than the actual growth measurements. o Children who fail to thrive may have the following delayed or slow to develop: Physical skills such as rolling over, sitting, standing and walking Mental and social skills Secondary sexual characteristics (delayed in adolescents) o Other symptoms that may be seen in child that fails to thrive include: Constipation Excessive crying Excessive sleepiness (lethargy) Irritability -### End" -4758,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For antenatal fetal monitoring in a diabetic pregnancy all of the following are useful except:, with the following options: A: Non-stress test, B: Biophysical profile, C: Doppler flow study, D: Fetal kick count - -### Response: -Fetal surveillance in gestational diabetes: -“Low risk gestational diabetic patiens who achieve adequate control with diet alone and do not develop macrosomia, polyhydramnios or preeclampsia do not requre antepartum fetal surveillance testing before 40 weeks. In fact, the risk of fetal distress in those patients is as low as in non diabetics and fetal well being can be assessed by teaching the patients about fetal movements and asking them to fill up a chart for kick counts. On the other hand, high risk gestational diabetics and patients on glyburide and/or insulin should have antepartum fetal surveillance testing starting at 32-34 weeks of gestation. There is no conscensus as to what is the best test for these patients. -Weekly or twice weekly NST are the most popular. However biophysical profile (BPP) the modified biophysical profile and CST are also used.” -Fernando Arias 3/e, p 449 -According to COGDT 10/e, p 315 -“Surveillance for fetal well being often begins at 32 weeks gestation in patients with end organ disease using a twice weekly NST or modified BPP done twice weekly by measuring the fetal heart rate an the amniotic fluid volume. A weekly BPP is similarly useful. Women without end organ disease who requrie insulin often begin fetal monitoring at 32-34 weeks. Women with diet controlled gestational diabetes usually begin testing at 36-40 weeks until delivered. Maternal fetal movement monitoring check count using a count to 10 or similar method is recommended for all pregnant -women, including those with diabetes to reduce the stillbirth rate. -COGDT 10/e, p 315 -So from above 2 texts it is very clear that: - -Fetal kick count -NST – Non stress test -CST – Contraction stress test -BPP – Biophysical score/profile - -are done for anteratal fetal surveillance in diabetes. -As far as Doppler is concerned “The current evidence suggests the use of Doppler flow studies in patients with diabetes mellitus who have pregnancies complicated by hypertensive disease, fetal growth restriction or vasculopathy. It is not recommended as a routine method of fetal surveillance”. -Management of High Risk Pregnancy, SS Trivedi and Manju Puri, p 338 -### End" -4759,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following traumatic peripheral nerve transection, regrowth usually occurs at which of the following rates?, with the following options: A: 0.1 mm per day, B: 1 mm per day, C: 5 mm per day, D: 1 cm per day - -### Response: -Transection of a peripheral nerve results in hemorrhage and in retraction of the severed nerve ends. Almost immediately, degeneration of the axon distal to the injury begins. Degeneration also occurs in the proximal fragment back to the fist node of Ranvier. Phagocytosis of the degenerated axonal fragments leaves a neurilemmal sheath with empty cylindrical spaces where the axons were. Several days following the injury, axons from the proximal fragment begin to regrow. If they make contact with the distal neurilemmal sheath, regrowth occurs at about the rate of 1 mm per day. However, if associated trauma, fracture, infection, or separation of neurilemmal sheath ends precludes contact between axons, growth is haphazard and a traumatic neuroma is formed. When neural transection is associated with widespread soft tissue damage and hemorrhage (with increased probability of infection), many surgeons choose to delay re-approximation of the severed nerve end for 3-4 week. -### End" -4760,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In anklyosing spondylitis joint involvement is least in?, with the following options: A: Wrist and hand, B: Sacroiliac joint, C: Acromio-clavicular joint, D: Costochondral junction - -### Response: -Ans. is 'a' i.e., Wrist and hand Ankylosing spondylitis (marie - strumpell disease) Ankylosing spondylitis is a chronic progressive inflammatory disease of the sacroiliac joints and the axial skeleton. Prototype of seronegative (absence of rheumatoid factor) spondyloahropathies. Inflammatory disorder of unknown cause. Usually begins in the second or third decade with a median age of 23, in 5% symptoms begin after 40. Male to female ratio is 2-3 : 1 Strong correlation with HLA-B27 90-95% of cases are positive for HLA - B27. Joints involved in ankylosing spondylitis Primarily affects axial skeleton. The disease usually begins in the sacro-iliac joints and usually extends upwards to involve the lumbar, thoracic, and often cervical spine In the worst cases the hips or shoulders are also affected. o Hip joint is the most commonly affected peripheral joint. o Rarely knee and ankle are also involved. Pathology Enthesitis i.e. inflammation of the inseion points of tendons, ligaments or joint capsule on bone is one of the hallmarks of this entity of disease. Primarily affects axial (spinal) skeleton and sacroiliitis is often the earliest manifestation of A.S.. Involvement of costoveebral joints frequently occur, leading to diminished chest expansion (normal 5 cm) Peripheral joints e.g. shoulders, and hips are also involved in 1/3rd patients. Extraaicular manifestations like acute anterior uveitis (in 5%); rarely aoic valve disease, carditis and pulmonary fibrosis also occur. Pathological changes proceed in three stages? Inflammation with granulation tissue formation and erosion of adjacent bone. Fibrosis of granulation tissue Ossification of the fibrous tissue, leading to ankylosis of the joint. Inflammatory bowel disease (CD, UC) may also be seen. Clinicalfeatures (symptoms) Low back pain of insidious onset Duration usually less than 3 months Significant morning stiffness and improvement with exercise Limited chest expansion Diffuse tenderness over the spine and sacroiliac joints Loss of lumbar lordosis, increased thoracic kyphosis Decreased spinal movements (especially extension) in all directions. Radiological features of an kvlasing spondylitis Radiographic evidence of sacroiliac joint is the most consistent finding in ankylosing spondylitis and is crucial for diagnosis. The findings are :- D Sclerosis of the aiculating surfaces of SI joints Widening of the sacroiliac joint space Bony ankylosis of the sacroiliac joints Calcification of the sacroiliac ligament and sacro-tuberous ligaments Evidence of enthesopathy - calcification at the attachment of the muscles, tendons and ligaments, paicularly around the pelvis and around the heel. X-ray of lumbar spine may show :- Li Squaring of veebrae : The normal anterior concavity of the veebral body is lost because of calcification of the anterior longitudinal ligament. Loss of the lumbar lordosis. Bridging 'osteophytes' (syndesmophytes) Bamboo spine appearance In the early disease process, plain x-rays may be read as normal. More accurate and early diagnosis can be done by using MR1 and/or CT scan. Dynamic MRI with fat saturation, either sho tau inversion recovery (STIR) sequnece or TI weighted images with contrast enhancement is highly sensitive and specific for identifying early intra-aicular inflammation, cailage changes, and underlying bone marrow edema in sacroilitis. Magnetic resonance imaging allows for visualization of acute sacroilitis, spondylitis, and spondylodiscitis, and can also detect acute inflammation of the entheses, bone and synovium. The ability to detect early inflammatiion and acurately visualize cailaginous and enthesal lesions makes magnetic resonance imaging a useful assessment tool in the spondyloahropathies. -### End" -4761,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient develops hypoglycemia. He was on insulin and acarbose. For treatment of above what is to be given?, with the following options: A: Glucose, B: Maltose, C: Sucrose, D: Starch - -### Response: -Ans. a. Glucose Hypoglycemic reactions are the most common complication of insulin therapy. All the manifestations of hypoglycemia are relieved by glucose administration. Since the patient is on acarbose, the absorption of complex polysaccharides would be delayed. For this reason, simple sugars like glucose should be administered.""Hypoglycemic reactions are the most common complication of insulin therapy. It commonly result from inadequate carbohydrate consumption, unusual physical exertion and targe dose of insulin.""Management of Hypoglycemia* All the manifestations of hypoglycemia are relieved by glucose administration* To increase absorption, simple sugar or glucose should be given preferably in liquid form.Management of Hypoglycemia Depends upon the Condition of the PatientMild to Moderate(Patient is conscious, able to swallow)Severe(Patient is unconscious, not able to swallow)* Glucose gel* Dextrose tablets* Any sugar containing beverage* 20-50 ml of 50% glucose solution by IV infusion over a period of 2-3 minutes* If IV therapy is not available, 1 mg of glucagon injected either subcutaneously or IM* If glucagon unavailable, honey syrups* Oral feeding contraindicated -### End" -4762,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Electrically shockable rhythm is, with the following options: A: Ventricular Fibrillation, B: Asystole, C: Pulseless electrical activity, D: Bradycardia - -### Response: -Shockable Rhythms Fibrillation V.Tachycardia TDP. PSV. Asystole= DC shock is C/I Pulseless electrical activity= Tension pneumothorax , Cardiac tamponade. Bradycardia=Rx- Atropine, Trans Cutaneous pacing, TVP (Trans Venous Pacer) Non shockable rhythms 1. Asystole 2. Electromechanical Dissociation -### End" -4763,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The nerve which is most frequently involved in herpes zoster ophthalmicus is:, with the following options: A: Frontal nerve, B: Nasociliary nerve, C: Lacrimal nerve, D: Facial nerve - -### Response: -Ans. Frontal nerve -### End" -4764,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The fascia separating rectum form coccyx is called, with the following options: A: Scarp's fascia, B: Waldeyer's fascia, C: Denonvillier's fascia, D: Colles fascia - -### Response: -The lower third of the rectum is separated by a fascial condensation - Denonvilliers' fascia - from the prostate/vagina in front, and behind by another fascial layer - Waldeyer's fascia - from the coccyx and lower two sacral veebrae (Table 68.1). These fascial layers are surgically impoant as they are a barrier to malignant invasion Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1219 -### End" -4765,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following are criteria to say substance dependence except, with the following options: A: Tolerance, B: Withdrawal symptoms, C: Unable to quit the drug, D: Use of illegal substances - -### Response: -Usage of illegal drugs doesn't come under substance dependence as per WHO definition. Remaining 3 options make up the definition Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 326 -### End" -4766,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thyroid hormone formation involves many steps. Which of the following amino acid is the precursor for thyroxine?, with the following options: A: Glycine, B: Tyrosine, C: Phenylalanine, D: Iodine - -### Response: -Tyrosine: Tyrosine is the precursor of triiodothyronine and thyroxine. Neural cells conve tyrosine to epinephrine and norepinephrine. While dopa is also an intermediate in the formation of melanin, different enzymes hydroxylate tyrosine in melanocytes. Dopa decarboxylase, a pyridoxal phosphate-dependent enzyme, forms dopamine. Subsequent hydroxylation by dopamine -oxidase then forms norepinephrine. In the adrenal medulla, phenylethanolamine-N-methyltransferase utilizes S-adenosylmethionine to methylate the primary amine of norepinephrine, forming epinephrine. Ref: Rodwell V.W. (2011). Chapter 30. Conversion of Amino Acids to Specialized Products. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. -### End" -4767,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs are used in the management of acute severe asthma?, with the following options: A: Epinephrine, B: Ipratropium, C: Terbutaline, D: All of the above - -### Response: -Ans. D. All of the aboveAcute exacerbations of asthma are acute episodes of progressively worsening shortness of breath, cough, wheezing, chest tightness or a combination of these symptoms. Management of these children require Oxygen, nebulization with beta 2- agonists. Patients may also require Epinephrine, Terbutaline, Ipratropium, Hydrocortisone, Prednisolone, Aminophylline and Magnesium sulphate. -### End" -4768,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The feature of petit mal epilepsy in EEG is –, with the following options: A: Spike and dome, B: Continuous stunted spikes, C: Waves at the rate of 10/sec., D: Continuous tall spikes - -### Response: -The EEG hallmark of typical absence seizure is a generalized symmetric 3 Hz spike and slow wave discharge. -### End" -4769,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are false regarding polio virus except:, with the following options: A: Most cases are symptomatic, B: Inactivated vaccine given IM, C: Inactivated polio vaccines are given to child less than 3 years of age, D: Only one type exists - -### Response: -Ans. (b) Inactivated vaccine is given IM Inactivated poliovaccine or IPV (salk type) is given subcutaneously or IM. Other options Option L. Most cases of polio are asymptomatic Option c Dose schedule of IPV: First dose when infant is 6 weeks old Additional doses are recommended prior to school entry and then every five years until the age of 18. Option d These are three serotypes of polio virus Most outbreaks of paralytic polio are due to type 1. -### End" -4770,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Withdrawal of heroin produces all the following symptoms except, with the following options: A: Insomnia, B: Piloerection, C: Mydriasis, D: Miosis - -### Response: -Opioids cause miosis, withdrawal-opp. effects so not miosis Other withdrawal symptoms: yawning, insomnia, mydriasis, lacrimation, nausea, vomiting etc. opiod withdrawl is a distressing experience for the patient that makes the patient to take the sunstance again the main clue for opiod withdrawl isALL ORIFICES BLEED there is lacrimation, sweating, vomiting, rhinorrhea, diarrhoea, muscle cramps and stomach ache the piloerection that occurs in opiod withdrawl is called as COLD TURKEY the tratment of opiod withdrawl can be doneby several means SUPPOIVE CARE: clonidine+benzodiazepines+dicyclomine+anti emetic+anti diarrhoeal AGONIST ASSOSIATED DETOXIFICATION: methadone and bupenorphine ANTAGONIST ASSOSIATED DETOXIFICATION: naltrexone Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 338-340 -### End" -4771,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Agents that impair auto-regulation of renal blood flow include all except, with the following options: A: NSAIDs, B: ACE inhibitors, C: Angiotensin-II-receptor blockers, D: Thiazide diuretics - -### Response: -Drugs that Impair renal auto-regulation * NSAIDs * ACE-I/ARB * Cyclosporine Ref: Harrison 19e pg: 1800 -### End" -4772,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A woman presents with amenorrhoea of 2 months duration; lower abdominal pain, facial pallor fainting and shock. Diagnosis is :, with the following options: A: Ruptured ovarian cyst, B: Ruptured ectopic pregnancy, C: Threatened aboion, D: Septic aboion - -### Response: -Ans. is b i.e. Ruptured ectopic pregnancy -### End" -4773,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Roth's spots are seen in:, with the following options: A: Bacterial Endocarditis, B: Trauma, C: coats disease, D: Trachoma - -### Response: -Roth spots are White Centered Hemorrhages causes of Roth spots: Infective Endocarditis (SABE) Anaemia Collagen vascular disease Leukaemia Hypeensive retinopathy Diabetic Retinopathy Pre-eclampsia Human Immunodeficiency virus Extreme hypoxia Shaken baby syndrome -### End" -4774,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In postductal coarctation of aoa, collaterals may be formed by all of the following, except, with the following options: A: Veebral aery, B: Suprascapular aery, C: Subscaular aery, D: Posterior Intercostals aery - -### Response: -In post-ductal coarctation of the aoa, an extensive collateral circulation develops involving the branches of subclan & axillary aeries with the distal aeries given by aoa Veebral aery does not play a significant role in this collateral circulation. Ref: Gray's 40e/p984 -### End" -4775,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: White lesion in oral cavity seen in all except?, with the following options: A: Spongy nevus, B: Lichen planus, C: Candidiasis, D: Erythroplakia - -### Response: -Ans. is 'd' i.e., Erythroplakia White lesions of oral mucosa are:-* Leukoplakia* Lichen planus* Discoid lupus erythematous* White spongy nevus* Candidiasis -### End" -4776,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about MEN-Ia) ↑ VMA in urineb) ↑ Calcitoninc) Hypergastrinemiad) Hyperprolactinaemiae) ↓ Ca2+, with the following options: A: abc, B: ad, C: bc, D: acd - -### Response: -↑ VMA is seen in → pheochromocytoma -Hypergastrinemia seen in → Pancreatic islet cell hyperplasia or adenoma (Gastrinoma) -Hyperprolactinemia is seen d/t → Pituitary adenoma (Prolactinoma) -### End" -4777,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old male presented with a characteristic lesion on the face for 5 years which is slowly increasing in size and bleeds whenever it is scratched. Patient has a history of chronic sun exposure. There is no evidence of pain or itching over the lesion Biopsy from the lesion. Which of the following drugs are approved for the above condition: - 1. 5-FU 2. Imiquimod 3. Itraconazole 4. Azathioprine 5. Vismodegib, with the following options: A: 1, 2 and 5, B: 1, 3 and 5, C: 2, 3, and 4, D: All of the above - -### Response: -This is a case of basal cell carcinoma. Basal cell carcinoma occurs mostly on the face, head (scalp included), neck, and hands. BCC usually appears as a flat, firm, pale area that is small, raised, pink or red, translucent, shiny, and waxy, and the area may bleed following minor injury. BCCs may have one or more visible and irregular blood vessels, an ulcerative area in the center that often is pigmented, and black-blue or brown areas. Large BCCs may have oozing or crusted areas. The lesion grows slowly, is not painful, and does not itch. HPE image shows Nodular aggregates of basalioma cells which are present in the dermis and exhibit peripheral palisading and retraction aifact. Drugs approved are: - 5-FU Imiquimod Vismodegib - Hedgehog pathway inhibitor -### End" -4778,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shoest acting mydriatic is?, with the following options: A: Tropicamide, B: Atropine, C: Phenylephrine, D: Hyoscine - -### Response: -Tropicamide REF: khurana 4th ed p. 68 shoest acting mydriatic - Tropicamide Only mydriatic and not cycloplegic - phenylephrine Used in children - Atropine -### End" -4779,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cytokines are secreted in sepsis and Systemic Inflammatory Response syndrome (SIRS) by -, with the following options: A: Neutrophils, B: Adrenal, C: Platelets, D: Collecting duct - -### Response: -Cytokine release in Sepsis - -The mechanism by which endotoxin causes activation of inflammatory cells and release of cytokines has already been explained earlier. -It is by TL -4 and CD-14 mediated. -Signals from TLR-4 can directly activate vascular endotheliun and leukocytes to release cytokine mediators. -The major cells that secrete cytokines in sepsis area - - -Monocyte/Macrophages       -Neutrophils                     -Endothelial cells - - -Cytokine mediators involved are:- - - -TNF - (The most important cytokine in sepsis)               -IL-1                    -IL-6       -IL-8               -NO. -### End" -4780,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which intubation is preferred in case of bilateral mandibular fractures ?, with the following options: A: Orotracheal intubation, B: Naso tracheal intubation, C: Cricothyrotomy, D: Submental intubation - -### Response: -Answer- B. Naso tracheal intubationTime of surgery should be carefully planned allowing reduction of tissue edema and avoiding development of malunion. Nasal intubation is the choice of intubation by surgeon, providing them with free access to operating field. Blind awake nasal intubation is safe and simple with some experience in difficult airway. -### End" -4781,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tensile strength of wound, with the following options: A: Is 10% after 1 week at the time of suture removal, B: Is 70-80% in 3rd month, C: Achieves plateau in 3rd month, D: All of the above - -### Response: -Tensile Strength: - -1st  wk-Sutures removed - 10%. ↑s over next 4 wks. -3rd month - Plateau 70-80% of unwounded skin (through life). -Collagen - adult skin - type 1; early granulation tissue-type III. -### End" -4782,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 57-year-old woman experiences frequent symptoms of heartburn. She reports no weight loss, diarrhea, or dysphagia symptoms. Past medical history is significant for vitamin B12 deficiency treated with monthly injections. She appears well, and the examination is normal, except for some patches on her arms where she has lost all the skin pigmentation. Her upper endoscopy is normal, except for gastric biopsies commenting on gastritis.For the above patient with gastritis, select the most likely mechanism of injury., with the following options: A: bile acid reflux implicated in pathogenesis, B: immune or autoimmune pathogenesis suspected, C: ischemia of the gastric mucosa implicated in the pathogenesis, D: associated with Helicobacter pylori infection - -### Response: -Type A chronic gastritis may lead to pernicious anemia. Antibodies to parietal cells and to intrinsic factor are frequently seen in the sera, suggesting an immune or autoimmune pathogenesis. These patients can also have autoimmune thyroid disease and vitiligo. -### End" -4783,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hormonal secretion are tightly controlled by the time of day due to an inbuilt biological clock in human body. This rhythmic secretion is controlled by:, with the following options: A: Supra optic nuclei, B: Postero lateral nucleus, C: Ventro-lateral nucleus, D: Supra-lateral nucleus - -### Response: -- Suprachiasmatic nucleus of hypothalamus is said to be the link between external environment and body's biological clock/ circadian rhythm, - We see day & night, this image falls on retina |One set of fibers are sent to suprachiasmatic nucleus | superior cervical ganglionFibers are sent to pineal gland. |Pineal gland accordingly secretes melatonin- Melatonin secretion levels determine hormonal secretions & their circadian rhythm.Eg: steroid levels - highest at early morning & low in evening. -### End" -4784,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spironolactone should not be given with -, with the following options: A: Chlorothiazide, B: b-blocker, C: ACE inhibitors, D: Amlodipine - -### Response: -Ans. is 'c' i.e., ACE inhibitors o Spironolactone is a potassium sparing diuretic, therefore, it can cause hyperkalemia decreasing the potassium diuresis.o ACE inhibitors can also cause hyperkalemia by inhibiting the production of angiotensin I, an inmmediate precursor of angiotensin II. Angiotensin causes excretion of K+ by increasing the secretion of aldosterone (Normally aldosterone enhances absortion of Na+ in distal tubules in exhange of active secretion of K+).o ACE inhibitors decrease potassium excretion by inhibiting the generation of Angiotensin.o Therefore, More pronoundced hyperkalemia can occur in patients receiving ACE inhibitors with sprironolactone -### End" -4785,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adenocarcinoma of the uterus along with rhabdomyosarcoma of the uterus is seen, the condition is called -, with the following options: A: Homologous sarcoma, B: Heterologous sarcoma, C: Mixed Mullerian tumour, D: Carcinoma botryoides - -### Response: -Carcinosarcomas are also referred to as malignant mixed mullerian tumors. -### End" -4786,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 53-year-old woman is being treated for tuberculosis with INH and rifampin.For the above patient with new symptoms, select the most likely acid base disorder., with the following options: A: metabolic acidosis, B: metabolic alkalosis, C: respiratory acidosis, D: respiratory alkalosis - -### Response: -INH can result in impaired oxygen utilization, leading to lactic acidosis (type B), accumulation of lactate, and increased anion gap. -### End" -4787,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is used for deflouridation of water?, with the following options: A: Alum and lime, B: Ozonisation, C: Bromides, D: Potassium permanganate - -### Response: -Ans: a (Alum and lime) Ref: Park, 19ed,p. 512The recommended level of flouridcs in drinking water in India is accepted as 0.5- 0.8 mg/L.The toxic manifestations of flourosis comprise the following:Dental flourosis-Characterised by ''mottling ""of dental enamel, which has been reported at levels > 1.5 mg/1 intake.This is the early sign of dental flourosis. Mottling is best seen on the incisors of the upper jaw. It is almost entirely confined to permanent teeth and develops only during the period of formation.Skeletal flourosis:This is associated with lifetime daily intake of 3.0 to 6.0 mg/1Genu valgum: A new form of flourosis characterised by genu valgum and osteoporosis of the lower limbs in recent years.Intervention:Changing of water source: Running surface water contains lower quantity of flourides than ground water.Chemical treatment:Nalgonda technique for deflouridisation of water. It involves the addition of two chemicals (viz. lime and alum) in sequence followed by flocculation, sedimentation, and filtration.(The Nalgonda technique was developed by the National Environmental Engineering Research Institute ( NEERI, Nagpur.) -### End" -4788,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Farmer's reducer is:, with the following options: A: Potassium sulfite + Sodium sulphate, B: Potassium ferricyanide + Sodium thiosulphate, C: Potassium sulfite + Sodium hydroxide, D: All of the above - -### Response: -Farmer's Reducer is composed of separate solutions of Potassium Ferricyanide and Sodium Thiosulfate (plain hypo). These are usually combined just before use or are used as a two bath treatment. -### End" -4789,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malignant hypehermia is a rare complication of the use of the following anaesthetic:, with the following options: A: Ketamine, B: Thiopentone sodium, C: Halothane, D: Ether - -### Response: -Rarely, Halothane can cause Malignant hypehermia, which is treated with dantrolene Inhalational anesthetic agents and Depolarising NM blockers like succinylcholine can precipitate malignant hypehermia. -### End" -4790,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inferior rib notching is present in -, with the following options: A: Coarctation of aorta, B: TAPVC, C: Fallot's tetralogy, D: Ventricular septal defect - -### Response: -Ans. is 'a>c' i.e., Coarctation of aorta > Fallot's tetralogy o Causes of rib notching ae : -A) Inferior surface1) Arteriali) Coarctation of aorta Bilateral Rib notching is seen on the lower border of 3rd to 8th ribs. Rib notching is absent in the 1st & 2nd ribs. Rib notching is usually present after the age of 7 years.ii) Aortic thrombosis (aortic obstruction) or aortitis.iii) Subclavian obstruction after Blalock operation for Fallot's tetralogy (Taussig Blalock operation).iv) Pulmonary oligemia Pulmonary atresia, TOF, absent pulmonary artery.2) Venous : - SVC obstruction3) Arteriovenous : - Pulmonary arteriovenous malformation, chest wall arteriovenous malformation.4) Neurogenic : - Neurofibromatosis.B) Superior surface1) Connective tissue diseases : - SLE, Scleroderma, RA, Sjogren's syndrome.2) Metabolic : - Hyperparathyroidism3) Miscellaneous : - Neurofibromatosis, Restrictive lung disease, Poliomyelitis, Marfan's syndrome, progeria, Osteogenesis imperfecta. -### End" -4791,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Respiratory alkalosis occur in -, with the following options: A: Excessive ventilation, B: Pyloric stenosis, C: Diabetic ketoacidosis, D: Primary hyperaldosteronism - -### Response: -Excessive ventilation drives out CO2 from the body causing respiratory alkalosis. -Primary hyperaldosteronisni and pyloric stenosis cause metabolic alkalosis -Diabetic ketoacidosis causes metabolic acidosis -Consider the equation -### End" -4792,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Test done at sub Subcentre during pregnancy:, with the following options: A: USG, B: Haemoglobin, C: OGTT, D: Triple test - -### Response: -Tests done at Sub center: Pregnancy detection test Hemoglobin level estimation Urine test for albumin and sugar Rapid malaria test Tests done at PHC/CHC/DH: Blood grouping with Rh HIV testing VDRL, RPR Rapid Malaria test Blood Sugar HBSAg. -### End" -4793,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best prognosis in infertile women is seen in/most reversible form of infertility is:, with the following options: A: Tubal block, B: Anovulation, C: Oligospermia, D: Endometritis - -### Response: -Ans. is b, i.e. AnovulationRef: Kistner's Gynecology 6th/ed, p279; Novak I4th/ed, p1206""Disorders of ovulation account for about 30-40% of all cases of female infertility. These disorders are generally among the most easily diagnosed and most easily treatable causes of infertility."" - Ref: Novak 14th/ed, p1206* In couples with infertility ovulatory disorder have the best prognosis. Relatively poor prognosis is observed in male factor infertility and tubal factor infertility.* Prognosis can be arranged as below in descending order on the basis of cumulative pregnancy.Ovulatory factor > unexplained > Malefactors > Endometriosis > Tubal factors. -### End" -4794,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased AFP level is seen in :, with the following options: A: Down syndrome, B: Molar pregnancy, C: Overestimated gestational age, D: Congenital nephrotic syndrome - -### Response: -Ans. is c i.e. over estimated gestational age -### End" -4795,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lichenisation occurs in which layer of skin-, with the following options: A: Stratum malpighi, B: Stratum corneum, C: Stratum lucidum, D: Stratum granulosum - -### Response: -..Definition of Lichenification With prolonged rubbing or scratching, the outer layer of the skin (the epidermis) becomes hyperophied (overgrown) and this results in thickening of the skin and exaggeration of the normal skin markings, giving the skin a leathery bark-like appearance. The Malpighian layer of the skin is generally defined as both the stratum basale and stratum spinosum as a unit, although it is occasionally defined as the stratum basale specifically,or the stratum spinosum specifically.lichenisation of skin occurs in this layer It is named after Marcello Malpighi. Basal cell carcinoma originates Ref Harrison20th edition pg 2134 -### End" -4796,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about origin and propagation of contractions except, with the following options: A: The right pacemaker predominates over left, B: Intensity of propagation is greatest at cervix, C: The contractiom spreads from pacemaker towards cervix, D: Speed of contraction is 2 cm/sec - -### Response: -Intensity is greatest at fundus of uterus -### End" -4797,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Medial compartment of thigh is supplied by which nerve?, with the following options: A: Tibial nerve, B: Obturator nerve, C: Femoral nerve, D: Common peroneal - -### Response: -Ans. B Obturator nerveRef: Gray's Basic Anatomy E-book, P 205Obturator nerve is a branch of lumbar plexus.Related to ala of sacrum.Forms the lateral boundary of ovarian fossa.Emerges out of the obturator foramen and divides into anterior and posterior.Branches of Obturator NerveA. Anterior division: Gives off:# Muscular branches to 3 muscles: Adductor longus, adductor brevis and gracilis# Articular branch to the hip joint# Cutaneous branch to the skin of the medial side of the thigh.B. Posterior division: Gives off:# Muscular branches to 2 muscles# Obturator externus and adductor magnus (pubic part)# Articular branch to the knee joint. -### End" -4798,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Allosteric inhibition of an enzyme is -, with the following options: A: Binding of inhibitor to catalytic site and inhibition of enzyme, B: Binding of inhibitor to other site and inhibition of enzyme, C: Inhibition of enzyme by inhibitors without binding to enzyme, D: Inactivation by phosphorylation or dephosphorylation - -### Response: -Ans. is 'b' i.e., Binding of inhibitor to other site and inhibition of enzyme o Some enzymes, called allosteric enzymes, posses a site, in addition to substrate binding (catalytic) site, known as the allosteric site.o Binding of allosteric modulator at the allosteric site affects the conformation of catalytic site,o Such enzymes are called allosteric enzymes.o The allosteric modulator (regulator) may facilitate the conformational change of catalytic site, required for substrate binding.o Such regulators are called allosteric activators (positive allosteric modifier); for example, fructose-2,6-bisphosphate is an allosteric activator of Phosphoffuctokinase-I.o Some allosteric regulators prevent the conformational change required for binding of the substrate,o Such regulators are called allosteric inhibitors (negative allosteric modifier); for example, citrate is an allosteric inhibitor of phosphoructokinase-I. -### End" -4799,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following CNS tumor shows increased growth during pregnancy?, with the following options: A: Glioblastoma Multiforme, B: Oligodendroglioma, C: Craniopharyngioma, D: Meningioma - -### Response: -Meningioma expresses progesterone receptors and hence shows increased growth during pregnancy. -### End" -4800,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young female was worked up for examined for her * infertility by hysterosalpingography reveals 'Bead -- like' fallopian tube and clubbing of ampulla. Which of the following is the most likely cause?, with the following options: A: Gonococcus, B: Mycoplasma, C: Chlamydia, D: Mycobacterium tuberculosis - -### Response: -Ans. (d) Mycobacterium tuberculosisRef.: Shaws 15th ed. /158-159; D. C Dutta 8th edj 158-159TB is also an important cause of infertility. Other salient features about TB are as follows:* Most common presentation of genital TB is infertility.* HSG is contraindicated in case of genital TB* Best time to do HSG is within 10 days of LMP.* Vaginal epithelium is resistant to TB.* MC mode of spread of genital TB is hematogenous.* TB salpingitis belong to stage V of PID.* Conception rate even after treatment of genital TB is quite low. -### End" -4801,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Low dose pill contains maximum what amount of progesterone (in microgram), with the following options: A: 15, B: 25, C: 35, D: 45 - -### Response: -Ans. c (35 micrograms). (Ref. K D Tripathi, 4th/pg.319)Preparations Combination pillsCommentsContain both estrogen and progestin.Combination pills are packaged in 21-day or 28-day cycles. The last seven pills of a 28-day pack are placebo pills.Progestin-only pills (""mini-pill"")Monophasic combination pills""Low-dose"" pillsThe 20pg preparationsAssociated with more breakthrough bleeding than combination pills, are rarely prescribed except in lactating women.contain the same dose of estrogen and progestin in each of the 21 hormonally active pills. Current pills contain on average 30 to 35 mg.Pills containing less than 50 mg of ethinyl estradiol.Several preparations containing only 20 mg of ethinyl estradiol are not available.These are often used for perimenopausal women who want contraception with the lowest estrogen dose possible. These preparations provide enough estrogen to relieve vasomotor flashes.Third-generation progestinsMore selective progestins include norgestimate, desogestrel, and gestodene.They have some structural modifications that lower their androgen activity.The new progestins are not much less androgenic than norethindrone.Low dose OC pills# These are defined as OC pills with estrogen content (ethinyl estradiol) of > 50 microgram.# However in developed countries nowadays use low dose OC pills containing 20 microgram estrogen, while in India the estrogen content is 30 micrograms ( Mala-N, Mala-D).# Simple regimen of ""3 weeks on and 1 week off' is followed. -### End" -4802,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fluent Aphasia with preserved comprehension and impaired repetition is, with the following options: A: Broca's Aphasia, B: Wernicke's Aphasia, C: Anomic Aphasia, D: Conduction Aphasia - -### Response: -(D) Conduction COMPREHENSIONREPETITION OF SPOKEN LANGUAGENAMINGFLUENCY* Wernicke'sImpairedImpairedImpairedPreserved or Increased* Broca'sPreserved (except grammar)ImpairedImpairedDecreased* GlobalImpairedImpairedImpairedDecreased* ConductionPreservedImpairedImpairedPreserved* Non fluent (motor) transcorticalPreservedPreservedImpairedImpaired* Fluent (sensory) transcorticalImpairedPreservedImpairedPreserved* IsolationImpairedEcholaliaImpairedNo purposeful speech* AnomicPreservedPreservedImpairedPreserved except for word-finding pauses* Pure word deafnessImpaired only for spoken languageImpairedPreservedPreserved* Pure AlexiaImpaired only for readingPreservedPreservedPreserved# CONDUCTION APHASIA (Associative aphasia), is a relatively rare form of aphasia.> An acquired language disorder, it is characterized by intact auditory comprehension, fluent speech production, but poor speech repetition.> They are fully capable of understanding what they are hearing, but show significant difficulty repeating phrases, particularly as the phrases increase in length and complexity and as they stumble over words they are attempting to pronounce.> Typical lesion location for conduction aphasia is on the supramarginal gyrus of the parietal lobe, posterior to the primary seriscry cortex and just above Wernicke's area.> Classical explanation for conduction aphasia is that of a disconnection between the brain areas responsible for speech comprehension (Wernicke's area) and speech production (Broca's area), due specifically to damage to the arcuate fasciculus, a deep white matter tract. -### End" -4803,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tumour suppressor gene are not involved in?, with the following options: A: Breast carcinoma, B: Multiple endocrine neoplasia, C: Neurofibromatosis, D: Retinoblastoma - -### Response: -The term multiple endocrine neoplasia (MEN) encompasses several distinct syndromes featuring tumors of endocrine glands, each with its own characteristic pattern. In some cases, the tumors are malignant, in others, benign. Benign or malignant tumors of nonendocrine tissues occur as components of some of these tumor syndromes. MEN syndromes are inherited as autosomal dominant disorders. -### End" -4804,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mondor's disease is:, with the following options: A: Thrombophlebitis of the superficial veins of breast, B: Carcinoma of the breast, C: Premalignant condition of the breast, D: Filariasis of the breast - -### Response: -Mondor's disease is thrombophlebitis of the superficial veins of the breast and anterior chest wall, although it may also occur in the arm. Frequently involved veins: Lateral thoracic vein, thoracoepigastric vein, superficial epigastric vein. Benign, self-limited disorder. TREATMENT NSAIDs & application of warm compresses -### End" -4805,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Agnes hunt traction:, with the following options: A: Flexion deformity of hip, B: Trochantric fracture, C: Fracture shaft of humerus, D: Low backache - -### Response: -Ans. A. Flexion deformity of hipRef: Campbell, Ebnezer and MaheshwariExplanationThese are commonly asked memory based questions in orthopedics. These charts are must to memorize.Commonly asked tractions, fractures, splints and castNameUseGallow's tractionFracture shaft of the femur in children below 2 yearsBryant's tractionSameRussell's tractionTrochanteric fracturesBuck's tractionConventional skin tractionPerkin's tractionFracture shaft of femur in childrenAgnes-Hunt tractionCorrection of hip deformityWell-leg tractionCorrection of adduction or abduction deformity of hipDunlop tractionSupracondylar fracture of humerusSmith's tractionSupracondylar fracture of humerusCalcaneal tractionOpen fractures of ankle or legMetacarpal tractionOpen forearm fracturesHead-Halter tractionCervical spine injuriesCrutchfield tractionCervical spine injuriesHalo-pelvic tractionScoliosisSplintsNameUseCramer-wire splintEmergency immobilizationThomas splintFracture femur--anywhereBohler-Braun splintFracture femur--anywhereAluminium splintImmobilization of fingersDenis Browne splintCongenital talipes equinovarus (CTEV)Cock-up splintRadial nerve palsyKnuckle-bender splintUlnar nerve palsyToe-raising splintFoot dropVolkmann's splintVolkmann's ischemic contracture (VIC)Four-post collarNeck immobilizationAeroplane splintBrachial plexus injurySternal occipital mandibular immobilizer (SOMI) braceCervical spine injuryAnterior spinal hyperextension (ASHE)Dorso-lumbar spinal injury braceTaylor's braceDorso-lumbar immobilizationMilwaukee braceScoliosisBoston braceScoliosisLumbar corsetBackacheCastsName of the castUseMinerva castCervical spine diseaseRisser's castScoliosisTurn-buckle castScoliosisShoulder spicaShoulder immobilizationU-slabFracture of the humerusColies' castColies' fractureHip spiceFracture of the femurCylinder castFracture of the patellaPatella tendon bearing (PTB) castFracture of the tibiaA spica is a cast where a limb and a part of the trunk are included, e.g., hip spica, shoulder spica.Disease and locationNameSite affectedPerthes' diseaseFemoral headPanner's diseaseCaplitulumKienbock's diseaseLunate boneOsgood-Schlatter's diseaseTibial tubercleSever's diseaseCalcaneal tuberosityKohler's diseaseNavicular boneFreiberg's diseaseMetatarsal headSchuermann's diseaseRing epiphysis of vertebraeCalve's diseaseCentral bony nucleus of vertebral bodyNamed Fractures# Barton's: Distal radius, intra-articular fracture# Chauffer's: Radial styloid fracture# Colles': Distal radius, extra-articular fracture with dorsal tilt of the distal fragment# Galleazzi: Fracture of distal V2 of the radius with dislocation of distal radio-ulnar joint# Monteggia: Fracture of proximal V2 of the ulna with dislocation of head of the radius# Night-stick: Isolated fracture shaft of the ulna# Smith's: Distal radius fracture, extra-articular with volar tilt of the distal fragment# Bennett's: Fracture of base of the 1st metacarpal, intra-articular# Boxers': Fracture of neck of 5th metacarpal# Mallet: Avulsion of attachment of extensor tendon from base of the distal phalanx# Rolando: Fracture of base of 1st metacarpal, extraarticular# Hangman's: Fracture pedicle-lamina of C2 vertebra# Malgaigne's: Pelvic-ring disruption with both pubic rami and sacro-iliac injury on the same side# Bumper: Comminuted fracture of lateral condyle of the tibia# Cotton's: Trimalleolar ankle fracture# Pott's: Bimalleolar ankle fracture# March: Stress fracture of shaft of 2nd metatarsal# Aviators: Fracture of the neck of the talus# Jone's: Fracture of the base of the 5th metatarsalSigns and Tests# Adson's test: For thoracic outlet syndrome# Allen's test: For testing patency of radial and ulnar arteries# Alli's test: For CDH# Anvil test: For testing tenderness of the spine# Ape thumb: For median nerve injury# Apley's grinding test: For meniscus injury# Apprehension test: For recurrent dislocation of the shoulder# Barlow's test: For CDH# Blue sclera: Osteogenesis imperfect# Bryant's test: For anterior dislocation of the shoulder# Callaways' test: For anterior dislocation of the shoulder# Chovstek's sign: For tetany# Claw hand: For ulnar nerve injury# Coin test: For dorso-lumbar tuberculosis of spine# Cozen's test: For tennis elbow# Drawer test: For ACL and PCL injuries# Anterior: For ACL injury.# Posterior: For PCL injury# Finkelstein's test: For de Quervain's tenovaginitis# Foot drop: For common peroneal nerve injury# Froment's sign: For ulnar nerve injury# Gaenslen's test: For SI joint involvement# Galleazzi sign: For congenital dislocation of the hip (CDH)# Gower's sign: For muscular dystrophy# Hamilton-ruler test: For anterior dislocation of the shoulder# Kanavel's sign: For infection in ulnar bursa# Lasegue's test: For disc prolapsed# Lachmann test: For ACL injury# Ludloff s sign: For avulsion of lesser trochanter# McMurray's test: For meniscus injury# Nagffziger test: Disc prolapsed# Obei^s test: For tight ilio-tibial band (e.g., in polio)# O'Donoghue triad: Triad of MCL, ACL and medial meniscus injuries occurring together# Ortolani's test: For CDH# Pivot-shift test: For ACL injury# Policeman tip: For Erb's palsy# Sulcus sign: For inferior dislocation of the shoulder# Thomas' test: For hip flexion deformity# Trendelenburg's test: For unstable hip due to any reason (e.g., CDH)# Tinel's sign: For detecting improving nerve injury# Volkmann's sign: For ischemic contracture of forearm muscles# Wrist drop: For radial nerve injury# Runner's knee: Patellar tendinitis. -### End" -4806,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heimlich manoeuvre is indicated for, with the following options: A: Gagging, B: Choking, C: Hanging, D: Drowning - -### Response: -Hemilich manoecure is the first aid resque technique for choking. -Choking is usually accidental. -### End" -4807,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a contradiction for use of digitalis?, with the following options: A: Acute rheumatic carditis, B: Thyrotoxicosis, C: WPW Syndrome, D: Hyperkalemia - -### Response: -Ref:KDT 6/e p499 Digitalis compounds arecontraindicated in patients who are hypokalemic, or who have atrioventricular block or Wolff-Parkinson-White (WPW) syndrome. Impaired renal function leads to enhanced plasma levels of digoxinbecause digoxin is eliminated by the kidneys. -### End" -4808,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true regarding epitheliod hemangioendothelioma except, with the following options: A: Most common in males, B: Liver transplant is treatment of choice, C: Associated with vinyl chloride, D: Factor VIII staining is used for diagnosis - -### Response: -Hemangioendothelioma is most common in females Ref: Sabiston 20th edition Pgno :1459 -### End" -4809,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surgical removal of torus is indicated when, with the following options: A: Torus impinges on soft palate, B: It interferes with development of proper PPS, C: Torus is an undercut that traps debris and food, D: All of the above - -### Response: -In addition to above indications, torus should also be removed when it interferes with development of adequately extended denture or when patient is too much concerned about it. -### End" -4810,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Choroidal neovascularization is seen in all except –, with the following options: A: Trauma, B: Angiod streak, C: Myopia, D: Hypermetropia - -### Response: -Causes of choroidal neovascularization - -Age-related macular degeneration (ARMD)-most significant           -Angioid Streaks                                                                                            -Choroidal rupture (trauma)                                                                       -Pathological myopia -Chorioretinal scars -Intraocular inflammation -Chorioretinal dystrophy -### End" -4811,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true of β thalassemia major, except –, with the following options: A: Splenomegaly, B: Target cells on peripheral smear, C: Microcytic hypochromic anemia, D: Increased osmotic fragility - -### Response: -Osmotic fragility test - -Red cells are suspended in a series of tubes containing hypotonic solutions of NaCl varying from .9% to 0.0% incubated at room temperature, for 30 minutes and centrifuged. -The percent hemolysis in the supernatant solution is measured and plotted for each NaCl concentration. -Cells that are more spherical, with a decreased surface/volume ratio have a limited capacity to expand in hypotonic solutons and lyse at a higher concentration of Nacl than do normal biconcave cells. - -These cells are said to have increased osmotic fragility and are seen in hereditary spherocytosis - -Conversely, cells that are hypochronic and flatter have a greater capacity to expand in hypotonic solutions, lyse at lower concentration, are said to have decreased osmotic fragility. -These cells with increased surface/volume ratio are osmotically resistant and are seen in iron deficiency, thalassemia, liver disease and reticulocytosis. -### End" -4812,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The nucleus involved in Papez circuit is, with the following options: A: Pulvinar, B: Intralaminar, C: VPL nucleus, D: Anterior nucleus of Thalamus - -### Response: -The Papez circuit refers to a closed circuit formed by connections between the cingulate gyrus, hippocampus, mammillary bodies and anterior nucleus of thalamus. This circuit is responsible for resting EEG and for those emotions and aspects of behavior that are related to preservation of the individual and speciesref: guyton and hall textbook of medical physiology 12 edition page number: 826,827,828 -### End" -4813,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Buerger's angle that indicates severe ischaemia is, with the following options: A: 120°, B: 80°, C: 60°, D: 30° - -### Response: -If Buerger's angle is < 30°, it indicates severe ischaemia. -### End" -4814,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is an example of Motor Neuropathy?, with the following options: A: Sjogrens syndrome, B: Dapsone neuropathy, C: Tangiers disease, D: Amyloidosis - -### Response: -(B) Dapsone neuropathy NEUROPATHIESPredominantly MotorPure Sensory1. Guillain-Barre syndrome2. Diphtheric neuropathy3. Dapsone-induced neuropathy4. Porphyria5. Lead neuropathy6. Vincristine neuropathy7. Multifocal motor neuropathy.1. Paraneoplastic syndromes2. Autoimmune disorders (Sjogren's syndrome)3. Vitamin E deficiency4. Vitamin B12 deficiency5. Cis-platinum neuropathy6. Pyridoxine toxicity7. Idiopathic sensory neuropathy8. Hereditary sensory neuropathy9. Friedreich's ataxia10. Bassen-Kornzweig disease -### End" -4815,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following muscle have attachment on the marked pa, with the following options: A: pectoralis minor, B: long head of biceps, C: pectoralis major, D: long head of triceps - -### Response: -Attachment on coracoid process of scapula pectoralis minor sho head of biceps coracabrachilis -### End" -4816,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of unconscious patient spinal injury is assessed by, with the following options: A: Absence of response to painful stimulus, B: Absence of deep reflexes, C: Abdominal respiration, D: All - -### Response: -A i.e. Absence of response to painful stimulus > B i.e. Absence of deep tendon reflexes > C i.e. Abdominal respiration -### End" -4817,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding Endotracheal intubation except, with the following options: A: Saturation not more than 90% after 2 min, B: CO2 in expired air, C: ET inseed under direct vision of glottis, D: Bilateral chest movement - -### Response: -Endotracheal Tube Intubation:- - When the expiratory gas passes through the tube (hot & humidified) leaves vapour on the tube (tube has gone into trachea)- Tube has Radiopaque blue line on it which can be seen by X-ray- Earlier 90% saturation,if it continuously stas dropping suspects that tube is not in the Respiratory tract- Best way for confirmation - Capnography -### End" -4818,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Low complement levels are seen in -, with the following options: A: PSGN, B: MPGN, C: Good pasture's syndrome, D: Wegner's granulomatosis - -### Response: -The glomerular lesions appear to result from deposition of immune complexes in the glomeruli. The evidence cited in suppo are as under: i) There is epidemiological evidence of preceding streptococcal sore throat or skin infection about 1-2 weeks prior to the attack. ii) The latent period between streptococcal infection and onset of clinical manifestations of the disease is compatible with the period required for building up of antibodies. iii) Streptococcal infection may be identified by culture or may be inferred from elevated titers of antibodies against streptococcal antigens. These include the following: anti-streptolysin O (ASO); anti-deoxyribonuclease B (anti-DNAse B); anti-streptokinase (ASKase); anti-nicotinyl adenine dinucleotidase (anti-NADase); and anti-hyaluronidase (AHase). iv) There is usually hypocomplementaemia indicating the involvement of complement in the glomerular deposits. v) It has also been possible to identify the antigenic component of streptococci which is a cytoplasmic antigen, Endostreptosin. Ref: Textbook of pathology. Harshmohan 6thediton page 665 -### End" -4819,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alcohol causes hypoglycemia due to -, with the following options: A: Decreased gluconeogenesis, B: Decreased NADH, C: Decreased lipogenesis, D: Decreased glycogenesis - -### Response: -Ans. is 'a' i.e., Decreased gluconeogenesis o Excess intake of alcohol leads to excessive production of NADH with a concomitant decrease in NAD+,o This causes following metabolic alterations :-i) The increase availability of NADH favours the reduction of pyruvate to lactate and oxaloacetate to malate and decreasing its availability for gluconeogenesis and decrease synthesis of glucose. This results in Hypoglycemia.Increased ratio of NADH/Nad+ inhibits b-oxidation of fatty acids and citric acid cycle and promotes lipogenesis, triacylglycerol synthesis and cholesterol synthesis from acetyl CoA.Increased lactic acid production causes lactic acidosis and hyperuricemia.Accumulation of lipid in various tissues causes fatty liver, fatty myocardium etc. -### End" -4820,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cytochrome P450 is name derived from ?, with the following options: A: Molecular weight 450D, B: Produced by 450 genes, C: Absorbs light at 450 nanometres, D: Have 450 isoforms - -### Response: -Ans. is 'c' i.e., Absorbs light at 450 nanometresCytochrome P450 got its name because it strongly absorbs light at 450 nanometres, which is blue is visible spectrum. -### End" -4821,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When a drug is evaluated for its usefulness in controlled conditions, it is termed as a trial signifying:, with the following options: A: Efficacy, B: Effectiveness, C: Efficiency, D: Effect modification - -### Response: -Efficacy is the maximum effect of a drug regardless of dose. It is determined under controlled conditions in clinical trials. -Effectiveness is the response of a drug in Clinical set up. It may not yield the maximum benefit. -### End" -4822,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Of the following changes which happen in the renal system in pregnancy, which is FALSE ?, with the following options: A: The renal calyces and ureters have significant dilatation, B: Pregnancy induced changes are responsible for an increased risk of upper urinary infection,, C: Increased Glomerular filteration rate, D: Kidneys become smaller compared to the pre- pregnant size - -### Response: -The kidneys become larger, its size increase by 1.5 cm. Dilatation of the renal calyces and ureters can be striking. This is due to progesterone-induced relaxation of the muscularis. An impoant consequence of these physiological changes is an increased risk of upper urinary infection. Pregnancy induced intrarenal vasodilatation--both afferent and efferent resistance decreases--leads to increased effective renal plasma flow and glomerular filtration. Hydroureter- right side>left as pregnant uterus is usually dextrorotated and it compresses right ureter on pelvic brim. -### End" -4823,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following pigment s are involved in free radical injury, with the following options: A: Lipofuscin, B: Bilirubin, C: Melanin, D: Hematin - -### Response: -Ref, Robbins 7/ep39,9/e p64 -### End" -4824,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about type-II pneumocytes, EXCEPT:, with the following options: A: provide progenitor cells for the type I cell population, B: Also called septal cells, C: No secretory function, D: Lamellar bodies are formed - -### Response: -Type II alveolar cells (type II pneumocytes or septal cells) are cuboidal cells interspersed among the type I alveolar cells. Type II cells divide to replace their own population after injury and to provide progenitor cells for the type I cell population. Lamellar bodies can be considered markers for type II cells. They contain various lipids, phospholipids, and proteins that are continuously synthesized and released at the apical cell surface. The secreted material spreads over the entire inner alveolar surface as a film of complexed lipoproteins and water that acts as pulmonary surfactant. Ref: Mescher A.L. (2013). Chapter 17. The Respiratory System. In A.L. Mescher (Ed), Junqueira's Basic Histology, 13e. -### End" -4825,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug of choice for managing hyperglycemia in diabetic ketoacidosis is:, with the following options: A: Regular insulin, B: Lente insulin, C: Glyburide, D: 70/30 insulin - -### Response: -Answer is A (Regular insulin): The drug of choice for managing hyperglycemia in diabetic ketoacidosis is regular insulin The drug of choice for managing hyperglycemia in diabetic ketoacidosis is regular insulin because of its rapid but sho- duration actions. Regular (fast-acting) insulin is the primary insulin preparation used in the management of Diabetic Ketoacidosis (DKA) and is the only insulin that should be given intravenously or intramuscularly. Lente insulin is a longer-acting form of insulin than regular and should not be used. Oral Hypoglycaemic agents are never used, for initial management of Diabetic Ketoacidosis. -### End" -4826,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acrodermatitis enteropathica is seen with deficiency of:, with the following options: A: Zinc, B: Iron, C: Copper, D: Vitamin A - -### Response: -a. Zinc(Ref: Nelson's 20/cp 344-345, Ghai B/e p 121-122)Deficiency of zinc leads to acrodermatitis enteropathica, in which rashes shown on skin, especially around the orifices. -### End" -4827,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are features of dishpan digit?, with the following options: A: Reddened finger, B: Exceptionally clean thumb, C: Fibrous rough callus, D: All of the above - -### Response: -Dishpan digit -Finger of the child who indulges in sucking habit. On examination, it will provide valuable information about the habits. They are: - -Reddened. -Exceptionally clean thumb / nail / finger. -Fibrous rough callus. -### End" -4828,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Seminoma corresponds to, with the following options: A: Choriocarcinoma, B: Dysgerminoma, C: Granulosa tumour, D: Luteal cyst - -### Response: -Seminoma A seminoma typically has a cut surface that is homogeneous and pinkish cream in colour. It appears to compress neighbouring testicular tissue. It corresponds to dysgerminoma of ovaries. It consists of oval cells with clear cytoplasm and large, rounded nuclei with prominent acidophilic nucleoli. Sheets of cells resembling spermatocytes are separated by a fine fibrous stroma. Active lymphocytic infiltration of the tumour suggests a good host response and a better prognosis. There are two histological variants, one with a more anaplastic appearance and another that is characterised by cells that closely resemble different phases of maturing spermatogonia (spermatocytic seminoma). Seminomas metastasise mainly the lymphatics and haematogenous spread is uncommon. The lymphatic drainage of the testes is to the para-aoic lymph nodes near the origin of the gonadal vessels. The contralateral para-aoic lymph nodes are sometimes involved by tumour spread, but the inguinal lymph nodes are affected only if the scrotal skin is involved. Ref: Bailey and love 27th edition Pgno : 1506 -### End" -4829,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true about Mucocele, with the following options: A: Most common in frontal sinus, B: Orbit is pushed back wards and downwards in frontal sinus mucocele, C: Complication of chronic sinusitis, D: In ethmoid sinus mucocele orbit pushed laterally - -### Response: -In frontal sinus mucocele - orbit pushed downwards, forwards and laterally. -### End" -4830,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient of closed angle Glaucoma the treatment of choice in other eye is, with the following options: A: Acetolazimide, B: Laser iridotomy, C: Pilocarpine, D: Timolol eye drop - -### Response: -B i.e. Laser iridotomy -### End" -4831,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest feature in Multiple sclerosis is, with the following options: A: Optic neuritis, B: Inter nuclear ophthalmologia, C: Ataxia, D: Weakness - -### Response: -* Initial Symptoms and percent of cases Sensory loss -37% Optic neuritis- 36% Weakness -35% Ataxia-11%. Optic nerve Pain and temporary vision loss in one eye are common symptoms of optic neuritis. Optic neuritis is linked to multiple sclerosis (MS), a disease that causes inflammation and damage to nerves in your brain and spinal cord Ref Davidson edition23rd pg1110 -### End" -4832,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most of the cases of Listeria are due to serovar, with the following options: A: 1, B: 4a, C: 4b, D: 6 - -### Response: -Ans. is 'c' i.e., 4b LISTEROSIS . Mode of transmission; Food borne ---> Most common (most cases are due to serotype 4b) Nosocomial --> In late onset neonatal infection. . Foods implicated in infection include contaminated colesaw, pasteurized milk, soft cheese, pate, ready to eat turkey and pork productes, hot dogs, butter, prepared salads, undercooked chicken. -### End" -4833,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is NOT an alkylating agent?, with the following options: A: 5-FU, B: Chlorambucil, C: Melphalan, D: Cyclophosphamide - -### Response: -Ans. is 'a' i.e., 5 Fluorouracil Alkylating agentsAlkylating agents are antineoplastic agents having alkyl groups in their structure. They exert their cytotoxic effect via transfer of their alkyl group to the various cellular constituents.Alkylation of D.N.A. is the major interaction that leads to cell death.Before transferring their alkyl group, the drugs undergo intramolecular cyclization to form an ethylene immonium ion that may directly or through formation of carbonium ion transfer an alkyl group.The major site of alkylation within the DNA is the N7 position of Guanine with D.N.A.Major types of Alkylating agents used in the chemotherapy of neoplastic diseases B15 (chloro ethylamines), Nitrogen mustardsCyclophosphamideMechlorethamineChlorambucilMelphalanIfosfamide NitrosoureasCarmustineLomustineSemustineStreptozocin AziridinesThiotepaAltretamine Alkyl sulfonateBusulfanIn addition for pedagogical reasons, the methyl hydrazine and platinum complexes are included under alkylating agents even though the latter do not formally alkylate DNA and exhibit a different means to form covalent adducts.Platinum compoundsCisplatinOxaliplatinCarboplatinNedaplatinTriazene, methyl hydrazineProcarbazineAltretamine (hexamethyl melamine)Dacarbazine -### End" -4834,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common cause of Chyluria is:, with the following options: A: Carcinoma, B: Tuberculosis, C: Filariasis, D: Trauma - -### Response: -Answer is C (Filariasis): The most common cause of chyluria is development of fistulous connection between the lymphatics and urinary system from occlusion and subsequent rupture of the lymphatics by filarial infection. Chyluria refers to the passage of chyle in the urine and is characterized by the passage of white coloured, milk-like urine which is often aggravated by a heavy meal. It represents the development offistulous connections between the lymphatic and the urinary system. Etiologically, Chyluria may be parasitic or nonparasitic. Parasitic chyluria is commoner in the tropics it occurs due to occlusion of the lymphatics usually from filarial infections, and rarely from other causes. Non-parasitic chyluria is rare, and typically occurs due to obstruction of the thoracic duct from various causes. Causes of Chvluria Parasitic diseases Wuchereria bancrofti (Filariasis; Most Common) Other Parasitic Infections (Less Common) Eustorngylous gigus Taenia echinococcus Ascaris lumbricoides Hymenolepis nana Schistosoma hemotobium Non-parasitic diseases Chronic infection e.g. tuberculosis Neoplastic infiltration of retroperitoneal region Renal cell carcinoma Ureteric stone Trauma Pregnancy -### End" -4835,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gas used in retinal temponade-, with the following options: A: SF6, B: Ethylene oxide, C: Nitrous oxide, D: CO2 - -### Response: -SF6 Pars plana vitrectomy (PPV) with gas tamponade is widely popular for the treatment of rhegmatogenous retinal detachment . Four different intraocular gases are commonly used in vitreoretinal surgery: air, sulfur hexafluoride (SF6), perfluoroethane (C2F6) and perfluoropropane (C3F8). Indications for tamponades- To drain subretinal hemorrhages/fluid To provide internal tamponade of retinal breaks in postoperative cases -### End" -4836,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Standard treatment of appendicular mass is, with the following options: A: Immediate laproscopic excision, B: Needle aspiration, C: Ochsner - Sheren regimen, D: Appendectomy - -### Response: -[Cl (Ochsner: sherren regimen) (1216-LB) (1215-B &L 25th)Management of a appendix mass* If an appendix mass is present and the condition of the patients is satisfactory, the standard treatment is the conservative Ochsner-Sherren regimen* It is advisable to remove the appendix after an interval of 6-8 weeksAppendicitis During Pregnancy - Appendicitis is the most common non-obstetric surgical disease of the abdomen during pregnancy.* Laparoscopic appendectomy (specifically the pneumoperitoneum) is well tolerated by the mother and fetus (669-CSDT IT) -### End" -4837,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: External laryngeal nerve supplies which muscle?, with the following options: A: Cricothyroid, B: Thyroarytenoid, C: Cricoarytenoid, D: Vocalis - -### Response: -ANSWER: (A) Cricothyroid REF: Dhingra's 4"" ed p. 318* Superior laryngeal nerve: arises from the inferior ganglion of the vagus* Divides into external and internal branches.* External laryngeal nerve supplies cricothyroid* Internal laryngeal nerve pierces the thyrohyoid membrane and gives sensory supply to larynx and hypopharynx. -### End" -4838,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rotation of a distal extension base around longitudinal axis is resisted by, with the following options: A: Rigidity of major connector, B: Rigidity of minor connector, C: Both of the above, D: None of the above - -### Response: -A second movement is rotation about a longitudinal axis as the distal extension base moves in a rotary direction about the residual ridge. This movement is resisted primarily by the rigidity of the major and minor connectors and their ability to resist torque. -### End" -4839,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Retraction of tympanic membrane touching the promontory. It is called ?, with the following options: A: Mild retraction, B: Severe retraction, C: Atelectasis, D: Adhesive otitis - -### Response: -Ans. is 'c' i.e., Atelectasis Tympanic membrane retraction The retracted segment of eardrum is often known as a retraction pocket. The terms ""atelectasis"" or sometimes ""adhesive otitis media"" can be used to describe retraction of a large area of the pars tensa. -### End" -4840,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about clostridium difficile is:, with the following options: A: Gram negative, B: Obligatory aerobic, C: Spore forming cocci, D: None of the above is true - -### Response: -C. difficile: 1. Gram positive 2. Obligately anaerobic 3. Spore-forming bacillus (spores are found widely in nature) -### End" -4841,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neonates differ from adults in the following, except, with the following options: A: Their hepatic metabolizing enzyme activity is faster., B: Their excretory ability of the kidney is less well developed., C: Their gastric emptying is prolonged., D: They can tolerate large doses of ceain drugs on body weight basis. - -### Response: -The gastric emptying is prolonged and the renal function is low in neonates. The capacity of liver to metabolize drugs is also low. However ceain drugs like digitalis, belladonna can be tolerated in large amounts on a body weight basis than adults. -### End" -4842,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The cecum is found to be placed below the stomach and in the midline. Which of the following abnormality must have taken place while rotation of the gut?, with the following options: A: Non rotation, B: Mal rotation, C: Reversed rotation, D: Mixed rotation - -### Response: -In classical intestinal malrotation, this process fails; the duodenojejunal flexure lies to the right of the midline and the caecum is central, creating a narrow base for the small bowel mesentery, which predisposes to mid-gut volvulus (Fig. 6.21). Malrotation with volvulus is life-threatening and typically presents with bilious vomiting. Bile- Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-85 -### End" -4843,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ampicillin prophylaxis is given in -, with the following options: A: Rectal surgery, B: Splenectomy, C: Head and neck surgery, D: Biliary surgery - -### Response: -• Prophylactic antibiotics in biliary surgery are designed to reduce the incidence of postoperative wound infections. -• The efficacy of antibiotics in the prevention of wound infections has been demonstrated with first, second and third generation cephalosporins, ampicillin associated with clavulanate, ureido-penicillins, aminoglycosides, sulfonamides and quinolones. -### End" -4844,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Splenic macrophages in Gaucher's disease differ from those in ceroid histiocytosis by staining, with the following options: A: Lipids, B: Phospholipids, C: Acid Fast Stain, D: Iron - -### Response: -In Gaucher's disease there is an accumulation of Gaucher cells that Contain glucocerebroside which is a lipid (glycolipid) -In ceroid histocytosis, there is an accumulation of lipofuscin (ceroid), a yellow-brown cytoplasmic pigment, in the histiocytes. -### End" -4845,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Relapse in malaria is seen in-, with the following options: A: P.malariae and Rovale, B: P.vivax and P.malariae, C: P.falciparum and Rovale, D: P.vivax Rovale and P.malariae - -### Response: -Malaria relapse. Malaria relapse has a specific meaning in regards to malaria and refers to the reactivation of the infection hypnozoites. Relapse is when symptoms reappear after the parasites have been eliminated from blood but persist as dormant hypnozoites in liver cells . Mostly seen in p.malariae . Ref Harrison20th edition pg 1035 -### End" -4846,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Binding site present on p unit of Na+ - K+ pump is, with the following options: A: Na+, B: K+, C: ATP, D: Glycosylation - -### Response: -D i.e. Glycosylation -### End" -4847,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a SSRI?, with the following options: A: Esclitalopram, B: Sertraline, C: Paroxetine, D: Amitriptyline - -### Response: -ANSWER: (D) AmitriptylineREF: Harrisons 17thed chapter 365List of SSRICitalopramDapoxetineEscitalopramFluoxetineFluvoxamineIndalpine (discontinued)ParoxetineSertralineVilazodone10. Zimelidine (discontinued) -### End" -4848,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common dose limiting toxicity of chemotherapeutic agent, with the following options: A: Myelosuppression, B: G.I. toxicity, C: Neurotoxicity, D: Alopecia - -### Response: -Myelosuppression ""Myelosuppression with depression of both antibody and cell mediated immunity is the single most impoant dose limiting factor with cytotoxic agents and carries life threatening consequences"". Repeated blood monitoring is essential and transfusion of red cells and platelets may be necessary. Cell growth factors e.g. the natural (granulocyte colony stimulating factor (filgrastim) are available to protect against or resolve neutropenia. -### End" -4849,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The nerve involved in anterior dislocation of the shoulder is:, with the following options: A: Radial nerve, B: Axillary nerve, C: Ulnar nerve, D: Musculocutaneous nerve - -### Response: -B i.e. Axillary Nerve -### End" -4850,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following features is not shared between T cells and B cells, with the following options: A: Positive selection during development, B: Class I MHC expression, C: Antigen specific receptors, D: All of the above - -### Response: -Ans. (a) Positive selection during development B cell undergoes negative selection, whereas T cells undergoes both positive and negative selection. Mechanism of central tolerance: B cell: The recognition of antigens by the immature B-cells in the bone marrow is critical to the development of immunological tolerance to self. For proper immunological function it is essential B cell do not recognize self antigen and should recognize antigen derived from pathogens. In the bone marrow the immature B cells bearing surface IgM, if recognizes self molecule undergo negative selection. This self antigen induce loss of cells from the B cell repeoire is called as clonal deletion. Thus only those B cells that do not recognizes self molecules as antigen comes out of bone marrow. T cells tolerance: T cells are selected for survival more rigorously than B cells. They undergo both positive and negative selection to produce T cells that recognizes self MHC but do not recognizes self peptides. T cell tolerance is induced in thymus. (i) Positive selection occurs in thymic coex, if a maturing T cell is able to bind to a surface MHC molecule it is saved from program cells death; whereas cells fails to recognize MHC dies. Positive selection ensures that T cell recognize antigen in association with MHC molecule only. (ii) Negative selection occurs in coex, coico-medullary junction, and the medulla. Here MTEC (modullary thymic epithelial cells) signal self reactive T cells to die apoptosis. Other Options Option b: Class I MHC are expressed by all nucleated cells and platelets. Ref. Robbin's 8/e 190 Option c: Both B cells and T cell possess antigen receptors. On B cells surface Ig acts as antigenic receptor whereas on T cell, TCR along with CD3 acts as antigenic receptors. Ref. AA 8/e 128, 9/e, p 133 -### End" -4851,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AMPLE history involved all except?, with the following options: A: Pregnancy, B: Allergy, C: Last meal, D: Personal history - -### Response: -History: -AMPLE History - -Allergies -Medications -Past Medical History, Pregnancy -Last Meal -Events surrounding injury, Environment - -History may need to be gathered from family members or ambulance service. -### End" -4852,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is non invasive positive pressure ventilation?, with the following options: A: CPAP, B: SLMV, C: CMV, D: IMV - -### Response: -Ans: A (CPAP) Ref: Medscape EmedicineExplanation :Noninvasive ventilation (NIV)It refers to the administration of ventilatory support without using an invasive artificial airway (endotracheal tube or tracheostomy tube).It is divided into two typesNon-invasive Positive pressure ventilationPositive-pressure ventilation delivered through a mask has become the predominant method of providing noninvasive ventilatory supportNon invasive Negative pressure ventilationNegative-pressure ventilators provide ventilatory- support using a device that encases the thoracic cage starting from the neck, and devices range from a whole-body tank to a cuirass shell.The general principal is the same with a vacuum device, which lowers the pressure surrounding the thorax, creating subattnospheric pressure and thereby passively expanding the chest wall with diaphragmatic descent, all leading to lung inflation.Exhalation occurs with passive recoil of the chest wall.Non-invasive Positive Pressure VentilationPatient InterfacesNasal masks andOrofacial masksFull face masksMouthpiecesNasal pillow'sHelmets.Modes of ventilationCPAPBiPAPPAVMost patients who are provided noninvasive ventilation are provided support with pressure ventilation, with continuous positive airway pressure (CPAP), which is the most basic level of support. CPAP may be especially useful in patients with congestive heart failure or obstructive sleep apnea.Bilevel positive airway pressure (BiPAP) is probably the most common mode of support and requires provision of inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). The difference between IPAP and EPAP is a reflection of the amount of pressure support ventilation provided to the patient, and EPAP is synonymous with positive end-expiratory pressure (PEEP).Some noninvasive ventilation is provided using proportional-assist ventilation (PAV), which provides flow and volume assistance with each breath. -### End" -4853,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The femoral hernia - Base of the sac lies at (Saphenous opening - Landmark). Related to pubic tubercle, with the following options: A: Below and lateral, B: Below and medial, C: Above and lateral, D: Above and medial - -### Response: -Ans. (a) Below and LateralRef: Bailey and Love 27th edition Page 1035* Hernia appears below and lateral to Pubic tubercle and lies in upper leg rather than lower abdomen.* Please note Femoral hernia is seen below the inguinal ligament. -### End" -4854,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about sphenoid sinus: (PGI May 2010), with the following options: A: Lined by stratified squamous epithelium, B: Duct open in middle meatus, C: Open in sphenoethmoid recess, D: Present at birth - -### Response: -Ans: C (Open in sphenoethmoid recess) The paranasal air sinuses are lined with respiratory epithelium {ciliated pseudostratified columnar epithelium)""- www.american- rbinologic. orgypatientLnfo.sinusnasalanatomyphtrnlAnatomy of PNS EL Dhingra 5th/201Anterior group: This includes maxillary, frontal and anterior ethmoidal. They all open in the middle meatus/ and their ostia lie anterior to basal lamella of middle turbinate.Posterior groups: This includes posterior ethmoidal sinuses which open in the superior meatus, and the sphenoid sinus which open in sphenoethmoidal recess/.Table These occupy the body ofthe sphenoid boneTrue growth of the sin us occu rs at pubertyZ: -### End" -4855,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trial of labour is given in minimal contraction of :, with the following options: A: Brain, B: Midcavity, C: Inlet, D: Moderate contracted pelvis - -### Response: -Inlet -### End" -4856,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the followi 's true about Penicillin G?, with the following options: A: Broad spectrum, B: It is effective orally, C: Used for treatment of rat bite fever, D: Probenecid given along with Penicillin G decreases duration of its action - -### Response: -Ans. c. Used for treatment of rat bite fever Penicillin G is not given by oral route: Penicillin G is acid labile, destroyed by gastric acid, so not given by oral route. Low oral bioavailability (only useful parenterally) Penicillin C is not a broad-spectrum antibiotic: Penicillin G is 0-lactam antibiotics and is used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. Narrow spectrum Penicillin G is DOC for: Anthrax Actinomycosis Trench mouth Rat bite fever Probenecid is given along with Penicillin G: Increase its action because it has high affinity for the tubular OATP, so it blocks the transpo of penicillin and increase its efficacy. Decreases volume of distribution of penicillin G. Penicillin G MOA: It inhibits cell synthesis by interfering with the transpeptidation reactions Penicillin G is 13-lactam antibiotics and is used in the treatment of bacterial infections caused by suscptible usually Gram-positive organismsQ. Resistance to penicillin G is due to 4 mechanism Inactivation of antibiotic by beta-lactamase: MCQ Modification of target penicillin binding protein (PBP)Q Impaired penetration of the drug to target PQ EffluxQ Pharmacokinetics: enicillin G is acid labile, destroyed by gastric acid, so not given by oral routes Probenecid is given along with Penicillin G, increase its action because it has high affinity for the tubular OATP, so it blocks the transpo of penicillin and increase its efficacyQ. Probenecid also decreases volume of distribution of penicillin Gs. -### End" -4857,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CT scan of the head showing a biconvex hyperdense lesion displacing the grey-white matter interface is seen in which of the following condition?, with the following options: A: Subdural hematoma, B: Diffuse axonal injury, C: Extradural hematoma, D: Hemorrhagic contusion - -### Response: -75% of extradural hematoma occur in the temporo parietal region secondary to the rupture of middle meningeal aery. A lucid interval is seen in 50% patients and precede clinical deterioration. On CT scan: It appear as a biconvex to lenticular, hyperdense, homogenous extracerebral zone adjacent to the inner table of the skull with sharp margins. Ref: Neuroradiology Companion: Methods, Guidelines, and Imaging Fundamentals By Mauricio Castillo, 3rd Edition, Page 46; Handbook of Stroke By David O. Wiebers, Page 108; Neuroscience in Medicine By P. Michael Conn, 3rd Edition, Page 758; Advances and Technical Standards in Neurosurgery By J D Pickard, V. V. Dolenc, J. Lobo Antunes, Volume 27, Page 63; Diseases of the Brain, Head and Neck, Spine: Diagnostic Imaging and ... By J. Hodler, Jurg Hodler, Page 70. -### End" -4858,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Laparoscopic cholecystectomy done in a patient with cholelithiasis. Pathology repo shows adenocarcinoma with invasion of muscular layer. CT was normal. Fuher t/t is:, with the following options: A: Wait and regular follow up, B: Wedge hepatic resection with lymph node dissection, C: Excise all po sites, D: Radiotherapy - -### Response: -Wedge hepatic resection with lymph node dissection The appropriate management for gallbladder cancer depends on the stage of cancer. Let's first see the TNM staging for gallbladder cancer. TNM staging of Gallbladder cancer Definition of TNM Primary tumor (T) TO No evidence of primary tumor Tis Carcinoma in situ T1 TI a Tlb Tumor invades lamina propria or muscle layer Tumor invades lamina propria Tumor invades muscle layer T2 Tumor invades perimuscular connective tissue; no extension beyond serosa or into liver T3 Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, or pancreas, omentum or extrahepatic bile ducts T4 Tumor invades main poal vein or hepatic aery, or invades multiple extrahepatic organs or structures Regional lymph nodes (N) NX Regional lymph nodes cannot be assessed NO No regional lymph node metastasis NI Regional lymph node metastasis Distant metastasis (M) MX Distant metastasis cannot be assessed MO No distant metastasis M1 Distant metastasis Stage grouping Stage 0 Tis NO MO Stage IA T1 NO MO Stage IB T2 NO MO Stage IIA T3 NO MO Stage IIB T1 T2 T3 NI NI N1 MO MO MO Stage III T4 Any N MO Stage IV Any T Any N M1 For stage Ia: Tla staged tumors (tumors confined to lamina propria)? - These tumors are recognized incidentally at the time of pathologic review. No fuher t/t is needed. Simple cholecystectomy is sufficient for them. - In laparoscopic cholecystectomy, recurrent cancer has been seen at the po site. Hence all po sites should be excised. - Patients with preoperatively suspected gallbladder cancer should under go open cholecystectomy to minimize the chances of tumor dissemination. Tlb staged tumors (tumors invading muscular layer)? - Invasion of the muscular layer allows access to lymphatics and vessels. For Tlb staged tumors, an extended cholecystectomy is indicated, as these tumors have been repoed to recur after simple cholecystectomy. For stage Ib, II, selected stage III tumors: - These are managed by extended cholecystectomy. Stage IV tumors: - Should be treated with appropriate palliation as indicated. No randomized data have demonstrated improved survival with either chemotherapy or radiation and its use depends on case to case basis. -### End" -4859,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are acquired causes of hypercoagulability, except:, with the following options: A: Infection, B: Inflammatory Bowel disease, C: Myeloproliferative disorders, D: Prolonged surgery > 1 hour - -### Response: -Infection is not an acquired cause of hypercoagulability. Hypercoagulability represents an exaggerated form that predisposes to thrombosis and blood vessel occlusion. Acquired causes of hypercoagulability includes: ? Cancer ? Immobility ? Lupus anticoagulant ? Nephrotic syndrome ? Estrogens, pregnancy ? Anticardiolipin antibodies ? Congestive hea failure ? Heparin-induced thrombocytopenia ? Paroxysmal nocturnal hemoglobinuria ? Disseminated intravascular coagulation ? Inflammatory disorders, eg, ulcerative colitis ? Myeloproliferative disorder, eg, polycythemia vera, essential thrombocytosis Ref: Harrison Internal Medicine, 18th Edition, Chapter 262 -### End" -4860,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A middle-aged person repoed to Psychiatric OPD with complaints of fear of leaving home, fear of travelling alone and fear of being in a crowd. He develops marked anxiety with palpitations and swelling if he is in these situations. He often avoids public transpo to go to his place of work. The most likely diagnosis is, with the following options: A: Generalised anxiety disorder, B: Schizophrenia, C: Personality disorder, D: Agoraphobia - -### Response: -D i.e. AgoraphobiaAgoraphobiaPatients with agoraphobia rigidly, avoid situations in which it would be difficult to escape or obtain help. They prefer to be accompanied by a friend or family member in busy streets, crowded stores, closed in places (eg. tunnels, bridges, and elevators), closed in vehicles (eg subways, buses, & airplanes).Patients may insist that they are accompanied every time they leave the house. A severely affected patient may refuse to leave the house. The behaviour may result in marital discord.The situations are avoided (eg. travel is restricted) or else are endured with marked distress or anxiety about having a panic attack or panic-like symptoms.The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia (eg. avoidance limited to social situations because of fear of embarrassment), specific phobias (eg. avoidance limited to single situation like elevators), OCD (eg avoidance of di in someone with an obsession about contamination), post-traumatic stress disorder (eg avoidance of stimuli associated with severe stressor), or separation anxiety disorder (eg avoidance of leaving home or relatives), Agoraphobia is usually associated with panic disorder. Agoraphobia without a h/o panic disorder is often incapacitating & chronic, and alcohol dependence often complicates its curse. Treatment is staed with SSRIs (paroxetine, seraline, or fluvoxamine). Benzodiazepines have the most rapid onset of action against panic, within the first week. BDZs can reasonably be used as the first agent while an SSRI is being slowly titrated to a therapeutic dose (after 4 -12 weeks it can be tapered). -### End" -4861,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gluconeogenesis can occur from all except, with the following options: A: Lactic acid, B: Aceto acetate, C: Glycerol, D: Alanine - -### Response: -Substrates for gluconeogenesis are lactate (lactic acid), pyruvate, glycerol, glucogenic amino acids (all amino acids except leucine and lycine), propionate and intermediates of the citric acid cycle. -### End" -4862,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PCR detects, with the following options: A: Antigen, B: Antibody, C: Nucleic acid, D: All of the above - -### Response: -Polymerase chain reaction (PCR) is a technique used in molecular biology to amplify a single copy or a few copies of a piece of DNA across several orders of magnitude, generating thousands to millions of copies of a paicular DNA sequenceRef: DM Vasudevan, 7th edition, page no: 638 -### End" -4863,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Confirmatory test for the diagnosis of Amyloidosis-, with the following options: A: Diagnostic peritoneal lavage, B: Tongue biopsy, C: Rectal biopsy, D: Whole body CT scan - -### Response: -Biopsy and subsequent Congo red staining is the most impoant tool in the diagnosis of amyloidosis. In general, biopsy is taken from the organ suspected to be involved. For example, renal biopsy is useful in the presence of urinary abnormalities. Rectal and gingival biopsy specimens contain amyloid in as many as 75% of cases with generalized amyloidosis Robbins page no. 172 -### End" -4864,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: This patient, previously healthy, came with dyspnea and low grade fever since 4 months. His lungs are clear. JVP is normal. ECG showed low voltage complexes. What is the possible diagnosis?, with the following options: A: Syphilitic aoic aneurysm, B: Hyperophic cardiomyopathy, C: Rheumatic mitral stenosis, D: Tuberculous pericardial effusion - -### Response: -The presence of low grade fever and dyspnea indicates an infective pathology. CXR shows an increased CT Ratio which could be Tuberculous pericardial effusion. The diagnosis is given more credence due to ECG showing low voltage ECG which is seen with an effusion. Disease Features Syphilitic Aoic aneurysm Vasa vasorum undergo hyperplastic thickening of their walls, restricting blood flow and causing ischemia of outer 2/3rd of the aoic wall. 60% of thoracic aoic aneurysms involve the aoic root and/or ascending aoa, 40% involve the descending aoa, 10% involve the arch, and 10% involve the thoraco-abdominal aoa Hyperophic cardiomyopathy Enlarged hea T wave inversion due to sub-endocardial ischemia Deep Q waves in lateral and inferior leads to septal hyperophy Rheumatic Mitral Stenosis History of gradual progression of DOE(dyspnea on exeion), ohopnea. Pulmonary edema is seen on CXR Straightening of left hea border ECG showing: P mitrale or P pulmonale -### End" -4865,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest site of perforation during colonoscopy is -, with the following options: A: Caecum, B: Hepatic flexure, C: Splenic flexure, D: Sigmoid colon - -### Response: -• Risks of colonoscopy: Perforation and hemorrhage -• MC site of bleeding after colonoscopy: Stalk after polypectomy. -• MC site of perforation during colonoscopy: Sigmoid colon -• Perforation can be caused by excessive air pressure, tearing of the antimesenteric border of the colon from excessive pressure on colonic loops, and at the sites of electrosurgical applications -### End" -4866,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice in theophylline poisoning:, with the following options: A: Coisone, B: Propranolol, C: Thyroxine, D: Phenobarbitone - -### Response: -Propranolol -### End" -4867,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is SsRNA unenveloped virus:, with the following options: A: HBV, B: HEV, C: HCV, D: None - -### Response: -Ans. b. HEV -### End" -4868,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CEA is a marker for all except -, with the following options: A: Carcinoma pancreas, B: Carcinoma colon, C: Carcinoma lung, D: Carcinoma prostate - -### Response: -Tumor marker carcinomas CEA colon, pancreas, stomach, breast, liver, lung CA-125 ovary, cervix PSA prostate Thyroglobulin thyroid AFP non-seminomatous testicular tumors,liver, ovary, lung beta-HCG non seminomatous testicular tumors, breast, stomach Alkaline phospatase bone, liver, pancreas, prostate, leukemia CA 19-9 pancreas, stomach, colon TEXT BOOK OF ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE.667 -### End" -4869,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for retinal break is, with the following options: A: Upper temporal, B: Lower temporal, C: Upper nasal, D: Lower nasal - -### Response: -Upper temporal region is most common site for retinal break The mechanism most commonly involves a break in the retina that then allows the fluid in the eye to get behind the retina. A break in the retina can occur from a posterior vitreous detachment, injury to the eye, or inflammation of the eye. Other risk factors include being sho sighted and previous cataract surgery Reference: Aravind FAQS in Ophthalmology; First Edition; Page no: 371 -### End" -4870,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statements about P53 gene are all except ?, with the following options: A: Arrest cell cycle at GI Phase, B: Product is 53 KD protein, C: Located on chromose 17, D: Wild/non-mutated form is associated with increased risk of childhood tumors. - -### Response: -It is mutated form (not non mutated form) of p53 which is associated with increased risk of tumors. o p53 gene is a tumor suppressor gene and non-mutated form of this gene prevent development of malignancy by : (i) Causing cell cycle arrest in late GI phase (ii) Inducing apoptosis (iii) Helping in DNA repair o Mutation in p53 gene causes inactivation of p53 gene and abolishen of above function that results in uncontrolled proliferation of cells and malignant transformation. o Mutation in p53 gene is the most common genetic alteration found in human Cancer. o The name p53 is in reference to its apparent molecular mass; it runs as a 53 kilodalton (Kda) protein on SDS-page. But based on calculations from its amino acid residues, p53 's mass is actually only 43.7 K Da. o p53 prevents neoplastic transformation by three interlocking mechanisms : ? 1. Activation of temporary cell cycle arrest (quiescence) o It is considered as the primordial response to DNA damage. o p53 causes arrest in late GI through p2 I . o This is temporary arrest that gives the cell ""breathing time"" to repair DNA damage. o After DNA repair, cell cycle block is relieved by MDM-3 which degrades p53. 2. Induction of permanent cell cycle arrest (senescence) o p53 induced sencence is a permanent cell cycle arrest characterized by specific changes in morphology and gene expression that differentiate it from quiescence (temporary or reversible cycle arrest). o The mechanisms of senscence is unknown, but involve epigenetic changes that result in the formation of heterochromatin at different loci throughout the genome. 3. Triggering of programmed cell death o p53 directs the transcription of several pro-apoptotic genes such as BAX and PUMA (approved name BBC3) and induces apoptosis. o It has been shown that p53 activates transcription of the mir 34 family of micro RNAs (miRNAs),mir 34a. o mir34 inhibits translation of anti-apoptotic genes such as BCL2 (there by induce apoptosis) and pro-proliferative genes such as cyclins (there by prevent proliferation) p53 induce apoptosis and prevent proliferation through mir34. -### End" -4871,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pagophagia involves eating ?, with the following options: A: Ice, B: Sand, C: Clay, D: Salt - -### Response: -Ans. is 'a' i.e., Ice Geophagia Eating clay Pagophagia Eating ice Plambophagia Eating lead Amylophagia Eating starch Coprophagia Eating feces Cautopyreiophagia Eating burnt matches Tricophagia Eating hair Lithophagia Eating stones Geomelophagia Eating raw potatoes -### End" -4872,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudo isomorphic phenomenon is seen in?, with the following options: A: Vitiligo, B: Lichen planus, C: Psoriasis, D: Was - -### Response: -Was REF: Roxburgh's 17'h ed page 130-132, rook's- 7'h ed p. 35.1-35.63 Isomorphic or kobner's phenomenon is seen in: (Appearance of lesion at the site of minor trauma) Lichen planus Psoriasis Kaposi sarcoma Molluscum contagiosum Was Vitiligo DLE Pseudoisomorphic pheonomenon (is due to autoinoculation and is seen in infections like) Plane was Molluscum contagiosum Eczematous lesions -### End" -4873,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about liver hemangioma except, with the following options: A: CHF is very common, B: Incidental detection, C: Consumptive Coagulopathy can occur, D: Spontaneous regression is seen - -### Response: -Most common benign tumor of the liver Mainly seen in women of 45 years Small capillary hemangiomas(no clinical significance), larger cavernous hemangioma Usually single and <5 cm in diameter, occur equally in right and left liver Giant hemangioma: lesion>5cm Pathology Microscopically: Endothelium-lines, blood filled spaces that are seperated by thin, fibrous septa Enlargement of hemangiomas are by ectasia rather than neoplasia Clinical features Most commonly asymptomatic and incidentally found on imaging studies Large compressive masses may cause vague upper abdominal symptoms Kasabach-Merritt syndrome; syndrome of thrombocytopenia and consumptive coagulapathy Rarely seen LFT's and tumor markers are normal Diagnosis Diagnosis is made radiologically CT and MRI are diagnostic if a typical peripheral nodular enhancement pattern is seen Percutaneous biopsy is potentially dangerous and inaccurate not recommended Treatment Observation for asymptomatic cases Enucleation with inflow control is TOC for symptomatic cases Ref: Sabiston 20th edition Pgno :1456-1457 -### End" -4874,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Difference b w the incidence in exposed and non exposed group is best given by, with the following options: A: relative risk, B: attributable risk, C: population attributable risk, D: odd's ratio - -### Response: -attributable risk : Attributable Risk(AR) (sometimes called Attributable Propoion or Attributable Fraction) is a measure of the prevalence of a condition or disease. Given a group of people exposed to a risk, it&;s the fraction who develop a disease or condition. ref : park 21st ed -### End" -4875,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cyanide poisoning acts by -, with the following options: A: Inhibiting DNA synthesis, B: Inhibiting enzymes of proteins synthesis, C: Inhibiting cellular respiration, D: Inhibiting protein break down - -### Response: -Hydrocyanic acid Cyanide occurs as solid, liquid or in gaseous state as: * Gas form -- Hydrogen cyanide (HCN) * Liquid form -- Hydrocyanic acid (Prussic acid) * Solid form -- occurs as salts such as potassium cyanide/ sodium cyanide. Mechanism of Action Cyanide reversibly inhibits ferric iron containing enzymes. Cyanide attaches to the iron of the prosthetic group of cytochrome oxidase resulting in disturbance of the transpo and utilization of oxygen in cells and causing a cytotoxic anoxia. Fatal Dose * 50 to 100 mg for hydrocyanic acid * 200 to 300 mg for sodium/potassium cyanide * 50 to 80 bitter almonds * Inhalation of 1 pa in 2000 -- hydrogen cyanide Fatal period: 2 to 10 minutes. Clinical Features Inhalation * Constriction about throat * Dizziness * Loss of consciousness * Coma * Death Ingestion * CNS: Headache, anxiety, agitation, dizziness, confusion, convulsions, coma * CVS: Initially bradycardia and hypeension and latter tachycardia and hypotension, arrhythmias * RS: Tachypnea followed by bradypnea * GIT: Nausea, vomiting, abdominal pain, numbness. Skin * Perspiration * Bullae. Chronic poisoning: Chronic low level of exposure leads to: * Headache * Amblyopia * Optic atrophy * Peripheral neuropathy * Ataxia * Deafness * Glossitis * Stomatitis. Management * Ingestion: gastric lavage with 5 percent sodium thiosulfate solution * Antidote- amyl nitrate -- inhaled * Sodium nitrate slowly I.V. * Sodium thiosulfate 25 percent solution I.V. * Mechanism of action of nitrites: nitrates induce methemoglobinemia, which causes detachment of cyanide from the heme group of cytochrome oxidase since methemoglobin has a higher binding affinity for cyanide. Cyanide combines with methemoglobin and form non-toxic cynmethemoglobin. * Mechanism of action of sodium thiosulfate: sodium thiosulfate serves as a substrate for the enzyme rhodanese to catabolise cyanide to non-toxic thiocyanate, which is excreted in the urine. Autopsy Findings * Bitter almond like smell * Cherry red color of postmoem lividity * Cyanosis * Froth at mouth and nose * Bright red color blood9 * Pulmonary edema * Serosal surface may show hemorrhages * Stomach mucosa may be eroded and blackened due to formation of alkaline hematin. Samples to be preserved for chemical analysis * Blood * Routine viscera * Lung * Brain * Hea * Spleen is considered as best specimen due to presence of more RBCs. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 362 -### End" -4876,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urinary ascites is due to -, with the following options: A: Injury to bladder during bih, B: Ureteric obstruction, C: Cong. urethral atresia, D: All - -### Response: -Answer (All) Urinary ascites actually represent a transudation of retroperitoneal urine across thin and permeable peritoneum. Most common lesion associated with urinary ascites is ----> posterior urethral valve Second most common cause hydronephrosis due to tong. pelviureteral jn. obstruction Other causes are - Urethral stricture - Urethral atresia - Other bladder outlet obstructions Ectopic ureterocele Neurogenic bladder Hydrocolpos Sacrococcygeal teratoma Bladder perforation secondary to traumatic delivery Urachal lacerations secondary to umbilical aery catheterisation. -### End" -4877,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of stage III carcinoma ovary: March 2013, with the following options: A: Total hysterectomy, B: Total hysterectomy + bilateral salpingo-oophorectomy, C: Debulking surgery + removal of tumour, D: None of the above - -### Response: -Ans. C i.e. Debulking surgery + removal of tumour Advanced and inoperable cases (stage III, IV) will benefit from debulking surgery and removal of tumour. Postoperative chemotherapy and radiotherapy improve the survival and quality of life Ovarian tumours Meigs syndrome: - Ascites, - Hydrothorax (right side) and - Benign tumour of ovary (fibroma); Malignant ovarian tumour in included in: Pseudomeig syndrome Masculinizing ovarian tumours: Hilus cell tumour, - Seoli cell tumour, - Leydig cell tumour Feminizing cell tumour: - Theca cell tumour, - Granulosa cell tumour MC ovarian tumour (in < 20 years): Dysgerminoma Most radiosensitive ovarian tumour: Dysgerminoma Histological features of ovarian tumours Rokintansky bodies: Teratoma Schiller Duval bodies: Endodermal sinus tumour Reinkes crystal: Hilus cell tumour Call Exner bodies: Granulosa cell tumour Ovarian tumours and markers Placental alkaline phosphatase: Dysgerminoma LDH: Dysgerminoma Inhibin: Granulosa cell tumour CA 125: Ovarian tumours -### End" -4878,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not compatible with a diagnosis of chronic myelomonocytic leukemia?, with the following options: A: Peripheral blood monocytosis more than 1 x 109/L, B: Absence of Philadelphia chromosome, C: More than 20% blasts in blood or bone marrow, D: Myelodysplasia - -### Response: -WHO (2017) Diagnostic criteria of CMML: Persistent peripheral blood monocytosis (>= 1 x 109/L) with monocytes accounting for >= 10% of the leukocytes WHO criteria for BCR-ABL1--positive chronic myeloid leukaemia, primary myelofibrosis, polycythaemia vera and essential thrombocythaemia are not met No rearrangement of PDGFRA, PDGFRB or FGFR1 and no PCM1-JAK2 Blasts (incl. promonocytes) constitute < 20% of the cells in the peripheral blood and bone marrow Dysplasia involving >= 1 myeloid lineages orIf myelodysplasia is absent or minimal, criteria 1-4 are met and:- an acquired, clonal cytogenetic or molecular genetic abnormality is present in haematopoietic cells, or- the monocytosis has persisted for >=3 months and all other causes of monocytosis (e.g. malignancy, infection, and inflammation) have been excluded -### End" -4879,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In central serous retinopathy-, with the following options: A: Often shows focal leakage on fluorescein fundus photography, B: A macular hole is a common end result, C: The image perceived by the patient on the affected side in unilateral cases is bigger than on the normal side, D: A dense central scotoma is the most common presentation - -### Response: -Ans- A Ref- Central serous chorioretinopathy is when fluid builds up under the retina. This can distort vision. The fluid leakage comes from a layer of tissue under the retina, called the choroid. There is another layer of cells called the retinal pigment epithelium (RPE). When the RPE doesn't work as it should, fluid builds up under the RPE. As a result, a small detachment forms under the retina, causing vision to become distorted. This image from an OCT scan shows how central serous retinopathy (also called central serous choroidopathy) causes a blister-like swelling in layers of the retina. -### End" -4880,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 54-year-old clerk complains of having had dysphagia for 15 years. The clinical diagnosis of achalasia is confirmed by a barium study. What is TRUE in this condition?, with the following options: A: The most common symptom is dysphagia., B: In the early stages, dysphagia is more pronounced for solids than liquids, C: The incidence of sarcoma is increased., D: Recurrent pulmonary infections are rare. - -### Response: -Dysphagia in esophageal achalasia is described as paradoxical in that it is more pronounced for liquids than solids. There are numerous reports of an increased incidence of carcinoma in achalasia, ranging from 3% to 10%. In 1975, Belsey reported a 10%. incidence in 81 patients in whom symptoms tended to occur at a younger age. Recurrent lung infections from aspiration of esophageal contents are a troublesome complication. The treatment is surgical myotomy or endoscopic dilatation. -### End" -4881,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wallarian degeneration is seen in -, with the following options: A: Distal to injury, B: Proximal to injury, C: At both ends, D: In cell body (soma) - -### Response: -Ans. is 'a- i.e., Distal to injuryo Part distal to the injury - Wallarian degeneration or secondary degeneration,o Part proximal to the injury - Primary degeneration or retrograde degeneration.Degeneration of the distal part (Antegrade)Degeneration of proximal part (Retrograde)Stage of regenerationo Degeneration of distal part (distal to cut) is called Wallerian degeneration.o Within 24 hours histological and chemical changes occur.o The axon cylinder swells up and breaks down into small rodlets.o Myelin sheath breaks down into oily droplets, It occurs 8-32 days after injury.o Cells of the sheath of Schwann-divide mitotically and form cords of cells lying within the endoneurial tube (neurilemma) - macrophages remove the degenerating myelin and axis cylinder - thus schwann cell cytoplasm gradually fills the neurilemma, this process is completed by 3 months.o Hollow tube of neurilemma remains Intact and known as ghost tube.o Same as distal generation but unto nearest node of ranvier (nearest collateral),o Changes in the cell body:# Within 48 hours of injury the nissl grannies begins to disintegrate (known as chromatolysis).# Golgi apparatus fragments.# Cells swell.# Neurofibril disappear and nucleus displaced to cell margin.o Axis cylinders from stumps grows and sprout out (pseudopod like structure of fibril).o After 2-3 weeks peripheral endoneural tube, contian varying number of developing fibril.oMedullary sheath begins to develop in about 15 days and completed within one year.o Repair of cell body (i.e. Nissl granules and golgi apparatus) - begins about 20 days after nerve section and is completed in 80 days.1st change in cut nerve is - Axonal degeneration2nd change in cut nerv e is - Myelin degeneration -### End" -4882,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IMN, true is all except -, with the following options: A: Caused by EBV, B: Also called kissing disease, C: Diagnosed by Paul Bunnel test, D: RNA virus - -### Response: -EB virus which is classified under gammaherpesvirus group of hepesviridae family is double stranded DNA virus. REF:ANATHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 8TH EDITION PAGE NO:467 -### End" -4883,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During laryngoscopy and intubation procedure, all of these are true, except:, with the following options: A: A slight pressure may be applied at the cricoid cailage, B: The laryngoscope is held in the right hand introduced from the right side of the patient, C: The neck is flexed with extension at the atlanto!occipital joint, D: After inseion of laryngoscope, it is levered on the upper incisor to pull up the tongue and visualize the vocal cords - -### Response: -Ans: D. After inseion of laryngoscope, it is levered on the upper incisor to pull up the tongue and visualize the vocal cords(Ref: Miller 81c, p I 666-7667. 71e p1587).The laryngoscope should never be hinged on the teeth to lift up the epiglottis.The patient is aligned in a ""sniffing"" position, i.e. neck (atlanto-axial joint) flexion and face extension (atlanto-occipital joint), at around 35deg and 15deg respectively -### End" -4884,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eradication of H. pylori has been proved to be beneficial in the following condition except, with the following options: A: Duodenal ulcer, B: Gastric ulcer, C: Low grade MALT lymphoma, D: Hyperophic gastritis - -### Response: -. -### End" -4885,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The treatment of choice for silent gallbladder stones is:-, with the following options: A: Observation, B: Chenodeoxycholic acid, C: Cholecystectomy, D: Lithotripsy - -### Response: -There was no clear cost benefit and no life-years were gained from prophylactic cholecystectomy, indicating no clear-cut advantages of prophylactic cholecystectomy in asymptomatic cholelithiasis. As a result, in patients with asymptomatic gallstones, expectant management is recommended. -### End" -4886,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Symptomatic spinal injury without any radiological evidence most commonly found in:, with the following options: A: Children, B: Elderly, C: Teenagers, D: Young adults - -### Response: -Ans. a. Children (Ref: www.ncbi.nlm.nih.gov/pubmed/17006044 www.orthopaedicsone.com/pages/viewpage action? pageId=27689773)Symptomatic spinal injury without any radiological evidence most commonly found in children.'Following trauma, the commonly used radiological investigations, plain radiographs and computed tomography (CT) studies do nor rule out injury to the spinal cord. This is especially true for children, as an entity known by the acronym SCIWORA (spinal cord injury without radiological abnormality) exists and the changes may be picked up only on magnetic resonance imaging (MRI). Early treatment (within 6 hours) with high dose methylprednisolone improves the outcome.'- www.ncbi.nlm.nih.gov/pubmed/17006044SCIWORA (Spinal Cord Injury Without Radiologic Abnormality)SCIWORA originally referred to spinal cord injury without radiographic or CT evidence of fracture or dislocationQPrognosis of SCIWORA is actually better than patients with spinal cord injury and radiologic evidence of traumatic injuryQ.Defined as 'objective signs of myelopathy as a result of trauma' with no evidence of fracture or ligamentous instability on plain spine radiographs and tomographyQPrevalence:Mostly in pediatric population (range: birth to 16 years old)Inherent elasticity in pediatric cervical spine can allow severe spinal cord injury to occur in absence of X-ray findingsQCommon in cervical and thoracic regionQ; Rare in lumbar regionMechanism of Injury:MVA (motor vehicle accident)FallSports injury: Football, Diving, Wrestling, GymnasticsPathogenesis:Hyperextension injury to spine whose vertebral canal diameter is already compromised by spondylosisQ has a high risk of cord injuryExcessive anterior buckling of ligamentum flavum into canalQ, already compromised by posterior vertebral body osteophytes, probably is the cause of central cord syndromePathophysiologic MechanismsDirect spinal cord injury (traction)Direct spinal cord compression (extreme flexion/ hyperextension)Indirect spinal cord injuryVascular/ischemic injuryDiagnosis:SCIWORA is mainly a diagnosis of exclusion.In children, after trauma, paucity of movement of both legs, inability to bear weight on legs, and inability to pass urine, not able to sit without supportQ.Examination:Gross hypotonia in the lower limbs. 0/5 power and areflexia.Abdominal reflex, cremasteric, and anal reflex are absent.Palpable bladder and urine could be expressed out on abdominal pressure.No meningeal or cerebellar signsWork up:Plain radiographs of the entire spinal column maybe consideredCT scan of suspected level of neurological injuryMRI of the suspected region of neurological injury may show- hemorrhage and edemaQSSEPs (somatosensory evoked potentials):Not used diagnosticallyHelpful for follow up; obtained within 24 hours of admission and compared in follow up analysisTreatmentExternal immobilization of the spinal segment of injury for up to 12 weeksAvoidance of 'high-risk' activities for up to 6 monthsGradually increase range of motion once deficits have resolvedHigh-dose steroids in SCIWORAMethylprednisolone bolus of 30 mg/kg IV within 8 hours of injury, followed by infusion at 5.4 mg/kg/hr for the next 23 hours beneficial in improving the outcomeQOutcome at 6 weeks and 6 months better when drug given over 48 hoursQ, according to recent study.Prognosis:MRl of region of neurologic injury may provide useful prognostic information about neurologic outcome following SCIWORAQ.Poor Prognosis is seen inChildren <8 years old have worse prognosisDelay in onset of neurologic symptomsDeterioration of neurologic symptomsRecurrent injury -### End" -4887,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A six year old child is posted for elective urology surgery under general anaesthesia. He refuses to allow the anaesthesiologist an I.V. access. The best inhalational agent of choice for induction of anaesthesia is –, with the following options: A: Sevoflurane, B: Methoxyflurane, C: Desflurane, D: Isoflurane - -### Response: -Unlike desflurane, sevoflurane poses no problem in induction, acceptability is good even in pediatric patients. -Therefore, sevoflurane is the inhalational agent of choice for induction. -### End" -4888,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In precocious females, menstruation occurs :, with the following options: A: After 13 years of age, B: At 13 years of age, C: Less than 10 years of age, D: Below 12 years of age - -### Response: -Less than 10 years of age -### End" -4889,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 year old woman complains of severe lower abdominal pain, which is worst during menstruation. Laparoscopic examination of the pelvis demonstrates multiple small brown spots on the surface of pelvic structures. Most of these lesions are cauterized, but biopsy of one of the remaining lesions reveals glandular tissue resembling normal endometrium. No cytologic atypia or abnormally shaped glands are seen. Which of the following is the most likely diagnosis?, with the following options: A: Acute endometritis, B: Adenomyosis, C: Chronic endometritis, D: Endometriosis - -### Response: -This benign condition is endometriosis, rather than metastatic endometrial cancer. Endometriosis is defined as a benign growth of endometrium at sites at which it does not normally occur (excluding the myometrium, at which site it is called adenomyosis). Endometriosis is common and is a significant cause of both pain and pelvic scarring. Most of the problems occur because the abnormally located endometrium responds to hormonal control and may menstruate, producing a very irritating fluid. Endometriosis may apparently be staed either by seeding of menstrual cells in the pelvis (entering through the open end of the fallopian tubes) or by metaplasia of mesothelial or other cells (accounting for rare, well-documented cases of endometriosis of bizarre sites such as nasal mucosa or lungs). Acute endometritis is acute inflammation of the endometrium. Adenomyosis is characterized by foci of endometrium deep in the myometrium. Chronic endometritis is chronic inflammation of the endometrium. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 10. Endometriosis. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e. -### End" -4890,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Horner syndrome causes all, except:, with the following options: A: Enophthalmos, B: Mydriasis, C: Anhidrosis, D: Narrowed palpebral fissure - -### Response: -Mydriasis -### End" -4891,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to National Health Policy 2002, which of the following is to he eliminated in 2015 -, with the following options: A: Malaria, B: Yaws, C: Leprosy, D: Filariasis - -### Response: -Ans. is 'd' i.e., Filariasis -### End" -4892,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most of the afferents from lateral geniculate body terminate in which layer of the visual coex, with the following options: A: Layer 1, B: Layers 2 & 3, C: Layer 4, D: Layers 5 & 6 - -### Response: -LCB send information to layer 4 of the visual coex Ref: Ganong 25th ed/page 179 -### End" -4893,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: VIPoma is associated with which syndrome:, with the following options: A: Zollinger Ellison, B: Verner Morrison, C: Carcinoid syndrome, D: Cushing's syndrome - -### Response: -VIPomas are endocrine tumors that secrete excessive amounts of vasoactive intestinal peptide (VIP), -Excessive VIP causes a distinct syndrome characterized by large-volume diarrhea, hypokalemia, and dehydration. This syndrome also is called Verner-Morrison syndrome, pancreatic cholera, and WDHA syndrome for watery diarrhea, hypokalemia, and achlorhydria. -The principal symptoms are large-volume diarrhea (100%) severe enough to cause hypokalemia (80-100%), dehydration (83%), hypochlorhydria (54-76%), and flushing (20%). -In adults 80-90% of VlPomas are pancreatic in location, with the rest due to VIP-secreting pheochromocytomas, intestinal carcinoids, and rarely ganglioneuromas. -### End" -4894,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Conjunctivitis is caused by all except -, with the following options: A: CMV, B: Enterovirus 70, C: Coxsackies A 24, D: Adenovirus - -### Response: -Adenovirus serotypes 3, 7 and 14cause pharyngoconjunctival fever consist of febrile pharyngitis and conjunctivitis. page no-482 E70 causes acute hemorrhagic conjunctivitis. page no-493. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:482,493 -### End" -4895,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with sudden loss of vision with painful ocular movements. The eye is white and there are no obvious signs on ophthalmoscopy. The most likely diagnosis is -, with the following options: A: Optic nerve glioma, B: Retrobulbar neuritis, C: Craniopharyngioma, D: Papillitis - -### Response: -Information in this question are :- - - -Sudden loss of vision -Painful ocular movement -Normal fundus on ophthalmoscopy - - -All are seen in retrobulbar neuritis and last two features are more characteristics of retrobulbar neuritis and differentiate it from papillitis. - -Papillitis vs retrobulbar neuritis - -Papillitis and retrobulbar neuritis have almost same clinical features except : - -i) Painful ocular movement is more common in retrobulbar neuritis than papillis -ii) Fundus is normal in retrobulbar neuritis while papillitis has characteristic fundus abnormalities. -### End" -4896,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MCHC is normal in all of the following conditions except:, with the following options: A: Iron deficiency anaemia, B: Megaloblastic anaemia, C: Hemolytic anaemia, D: Aplastic anaemia - -### Response: -MCHC is the most important absolute value in the diagnosis of anaemia. -### End" -4897,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are bile acids, EXCEPT:, with the following options: A: Lithocholic acid, B: Taurocholic acid, C: Deoxycholic acid, D: Chendeoxycholic acid - -### Response: -The two principal (primary) bile acids formed in the liver are cholic acid and chenodeoxycholic acid. In the colon, bacteria conve cholic acid to deoxycholic acid and chenodeoxycholic acid to lithocholic acid. Since they are formed by bacterial action, deoxycholic acid and lithocholic acid are called secondary bile acids. -### End" -4898,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incudo malleal joint is an example of?, with the following options: A: Saddle joint, B: Pivot joint, C: Plane synovial joint, D: Condylar joint - -### Response: -ANSWER: (A) Saddle jointREF: BDC general anatomySaddle joints* 1st carpometacarpal joints* Sternoclavicular jts* Calcaneocuboid* Incudo malleolar -### End" -4899,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carbapenem with maximum seizure risk is:-, with the following options: A: Imipenem, B: Meropenem, C: Eapenem, D: Doripenem - -### Response: -Carbapenems are synthetic Beta lactam antibiotic. Imipenem is compounded with cilastatin to protect it from metabolism by renal dehydropeptidase. Cilastatin is a dehydropeptidase inhibitor. High level of imipenem may provoke seizure, however other carbapenem like:- Meropenem Eapenem Doripenem Are less likely to do so. -### End" -4900,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following techniques in the best for differentiating recurrence of brain tumour from radiation therapy induced necrosis?, with the following options: A: MRI, B: Contrast enhanced MRI, C: PET scan, D: CT scan - -### Response: -Ans. is 'c' ie PET scan (Ref: Harrison, 16/e, p2460).""MRI or CT scans are often unable to distinguish radiation necrosis from recurrent tumor, but PET or SPECT scans may demonstrate that glucose metabolism is increased in tumor tissue but decreased in radiation necrosis."" - Harrison. -### End" -4901,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mantle cell lymphomas are positive for all of the following, except -, with the following options: A: CD 23, B: CD 20, C: CD 5, D: CD 43 - -### Response: -Mantle cell lymphomas express high levels of cyclin D1.Most tumours also express CD19,CD20 and moderately high levels of surface Ig.It is usually CD5 positive and CD 23 negetive, which helps to distinguish it from CLL/SLL. Reference : Robbins and Cotran Pathologic basis of disease.South Asia Edition volume 1.page no. 603 -### End" -4902,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are feature of primary hyperaldosteronism except:, with the following options: A: Polyuria, B: Hypeension, C: Hypokalemia, D: Hyperkalemia - -### Response: -Answer is D (Hyperkalemia): Primary hyperaldosteronism is associated with Hypokalemia and not Hyperkalemia -### End" -4903,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hep Burn Osteometric board is used to measure-, with the following options: A: Length of long bones, B: Length of flat bones, C: Breadth of long bones, D: Breadth of flat bones - -### Response: -Ans. 'a' i.e., Length of long bones o Hep Bum Osteometric board is used to accurately measure length of long bones.Hepburn Osteometric Boardo It is ait instrument used to measure length oflong bones.o It has a rectangular base with ruler fixed along one of its long sides,o An upright is fixed at one end of the board and a second one slides along the board.o Bone is placed with one of its ends along the fixed upright and the movable upright is brought upto the other end of the bone. The distance between the uprights is the length of the long bone,o Stature can be calculated from the length of long bones and used for identification. Femur and tibia give more accurate values compared to humerus and radius. -### End" -4904,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Monogenic transmission of diabetes mellitus occurs in:, with the following options: A: Insulin Dependent Diabetes Mellitus (IDDM), B: Non-insulin Dependent Diabetes Mellitus (NIDDM), C: Latent Autoimmune Diabetes in Adults (LADA), D: Maturity Onset Diabetes of the Young (MODY) - -### Response: -d. Maturity Onset Diabetes of the Young (MODY)(Ref: Nelson's 20/e p 2760-2780, Ghai 8/e p 541-548)MODY refers to forms of diabetes are associated with monogenic defects in pancreatic b-cell function. -### End" -4905,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug which is NOT contra-indicated in pregnancy: March 2011, with the following options: A: Propyl-thiouracil, B: Radioactive Iodine, C: Valproate, D: Warfarin - -### Response: -Ans. A: Propyl-thiouracil Thioamide drugs (methyl and propyl thiouracil, methimazole and carbimazole) can also be used during pregnancy (the lowest possible dose should be used) The foetal thyroid is extremely susceptible to radiation and may be quickly destroyed. Propylthiouracil/ PTU/ 6-n-Propylthiouracil It is a thioamide drug used to treat hypehyroidism (including Graves' disease) by decreasing the amount of thyroid hormone produced by the thyroid gland. Its notable side effects include a risk of agranulocytosis. PTU inhibits the enzyme thyroperoxidase, which normally acts in thyroid hormone synthesis by oxidizing the anion iodide (I-) to iodine (10), facilitating iodine's addition to tyrosine residues on the hormone precursor thyroglobulin. This is one of the essential steps in the formation of thyroxine (T4). PTU does not inhibit the action of the sodium-dependent iodide transpoer located on follicular cells' basolateral membranes. Inhibition of this step requires competitive inhibitors, such as perchlorate and thiocyanate. PTU also acts by inhibiting the enzyme 5'-deiodinase (tetraiodothyronine 5' deiodinase), which conves T4 to the active form T3. (This is in contrast to methimazole, which shares propylthiouracil's central mechanism, but not its peripheral one) Administration is oral, with peak serum concentrations occurring in one hour, and actively concentrated to the thyroid gland. The drug is approximately 70% protein-bound and significantly ionized at normal physiologic pH, while the antithyroid agent methimazole is substantially less protein bound. However both are equally transferred across the placenta. Less than 10% of the drug is excreted unchanged, with the remaining fraction undergoing extensive hepatic metabolism glucuronidation. One side effect is agranulocytosis, thrombocytopenia A more life threatening side effect is sudden, severe, fulminant hepatic failure occurs in up to 1 in 10,000 people taking propylthiouracil. PTU is preferred over methimazole only in the first trimester of pregnancy and in woman who may become pregnant. In the second and third trimester, methimazole is preferred. -### End" -4906,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a cause for Hamarlopia?, with the following options: A: Polar cataract, B: Congenital deficiency of cones, C: Peripheral coical cataract, D: Central corneal opacity - -### Response: -Peripheral coical cataract causes Nyctalopia. Central vitreous opacity, Congenital deficiency of cones and Central nuclear or polar cataracts can cause Hamarlopia (Day blindness). Ref: A K Khurana, 2nd Edition, Page 11. -### End" -4907,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following factor regulates CSF pressure?, with the following options: A: Rate of CSF formation, B: Rate of CSF absorption, C: Cerebral blood flow, D: Blood pressure - -### Response: -Rate of CSF formation normally remains constant and is independent of CSF pressure. CSF absorption by arachnoid villi is propoionate to CSF pressure. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 33. Circulation through Special Regions. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e. -### End" -4908,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disseminated intravascular coagulation (DIC) differs from thrombotic thrombocytopenic purpura. In this reference the DIC is most likely characterized by:, with the following options: A: Significant numbers of schistocytes, B: A brisk reticulocytosis, C: Significant thrombocytopenia, D: Decreased coagulation factor levels - -### Response: -In DIC, the levels of coagulation factors are decreased. Whereas in TTP, coagulation factor levels are normal. Ref :Harrison's Principles of Internal Medicine 21st ed. -### End" -4909,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spider leg deformity of calyces on 1VP is seen in:, with the following options: A: Hypernephroma, B: Hydronephroses, C: Wilm's tumor, D: Pyelonephritis - -### Response: -Ans. Hypernephroma -### End" -4910,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-years old female complains of discharge of blood from a single duct in her breast. The most appropriate treatment is, with the following options: A: Incision and drainage, B: Microdochectomy, C: Radical mastectomy, D: Antibiotics - -### Response: -This is a case of duct papilloma. Treatment is microdochectomy. -### End" -4911,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of bupivacaine toxicity includes:, with the following options: A: Isoproterenol, B: Epinephrine, C: Bretylium, D: All - -### Response: -B i.e. Epinephrine, C i.e. Bretylium, A i.e. Isoproterenol Bupivacaine (R, +) isomer avidly blocks cardiac sodium channels & dissociates very slowly; its prolonged & high degree of protein binding makes resuscitation difficult & prolonged. At higher doses calcium & potassium channels are also blocked. Bupivacaine is more cardiotoxic than levobupivacaine, ropivacaine and lidocaine, paicularly in presence of acute respiratory acidosis, hypoxemia, hypercapnia in pregnancy (>>) and young children. - Amiodarone and possibly bretylium should be considered as preferred alternative to lidocaine in the treatment of LA induced ventricular tachyarrhythmias. Vasopressors may include epinephrine, norepinephrine and vasopressinQ. IsoproterenolQ may effectively reverse some of electrophysiological abnormalities characteristic of bupivacaine toxicity. - If LA intoxication produces cardiac arrest, the ACLS (advanced cardiac life suppo) guidelines are reasonable; however, I suggest that amiodarone & vasopressin be preferredQ/substituted for lidocaine & epinephrine (ACLS prefers epinephrine) - Morgan/273. With unresponsive bupivacaine toxicity, intravenous lipid infusion (remarkable ability to effect resuscitation from overdose even after 10 min of unsuccessful conventional resuscitation) or cardiopulmonary bypass may be considered. Calcium channel blockers are not recommended as these exaggerate the cardiodepressant effectsQ. -### End" -4912,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Barr body was first detected in: DNB 08, with the following options: A: Buccal mucosa, B: Brain, C: Liver, D: Skin - -### Response: -Ans. Brain -### End" -4913,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phobia is exaggerated form of, with the following options: A: Fear, B: Anger, C: Suspicion, D: Love - -### Response: -When the fear becomes exaggerated or unnecessary, it is called a phobia.A phobia is a type of anxiety disorder.Park 23e pg: 675 -### End" -4914,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following pathways are exothermic?, with the following options: A: Anabolic pathway, B: Catabolic pathway, C: Amphibolic pathway, D: None of the above - -### Response: -Anabolic pathways, which are those involved in the synthesis of larger and more complex compounds from smaller precursors e.g, the synthesis of protein from amino acids and the synthesis of reserves of triacylglycerol and glycogen. Anabolic pathways are endothermic. Catabolic pathways, which are involved in the breakdown of larger molecules, commonly involving oxidative reactions; they are exothermic, producing reducing equivalents, and, mainly the respiratory chain, ATP Ref: Harper 28th edition, chapter 16. -### End" -4915,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Postmoem examination stomach incision done after:, with the following options: A: Double ligation, B: Single ligation, C: Cut open, D: Triple ligation - -### Response: -Since the stomach is connected both to oesophagus and dudoenum so double ligature along the greater curvature of stomach is usually done so that stomach could be taken out for post moem examination. -### End" -4916,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is a part of limbic system:, with the following options: A: Corpus callosum, B: Pineal gland, C: Cingulate gyrus, D: Tegmentum - -### Response: -Ans. C Cingulate gyrusRef: Netter's Correlative Imaging of Neuroanatomy, pg. 147The limbic system is composed of following contents:* Cingulate gyrus* Hippocampus* Fornix* Mammillary bodiesThe limbic system manages the emotional behaviour, sexual behaviour and food habits. -### End" -4917,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fungal infection of human beings is called as:, with the following options: A: Mucorsis, B: Mycosis, C: Fungosis, D: Micromia - -### Response: -Mycosis is a fungal infection of animals, including humans.  -Mycoses are common and a variety of environmental and physiological conditions can contribute to the development of fungal diseases. -### End" -4918,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skull of a male differs from that of a female by all of the following except:, with the following options: A: Capacity greater than 1500 c.c, B: Muscular markings over occiput are less marked, C: Orbits square, D: Frontal eminence small - -### Response: -B i.e. Muscular markings over occipit are less marked -### End" -4919,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urinary incontinence results from all except -, with the following options: A: Neurogenic bladder, B: Vesico vaginal fistula, C: Ectopic ureter, D: Rectovesical fistula - -### Response: -Rectovesical fistula doesn’t cause urinary incontinence, as the level of fistula is above the sphincter mechanism. -### End" -4920,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Insensible daily water loss is -, with the following options: A: 500-600 ml, B: 800-1000 ml, C: 1000-1500 ml, D: 2000 ml - -### Response: -Ans. is 'b' i.e., 800-1000 ml -### End" -4921,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urinary bladder spasmolytic having localanaesthetic propey?, with the following options: A: Tamsulosin, B: Terazosin, C: Oxybutynin, D: Yohimbine - -### Response: -Ans. is 'c' i.e., Oxybutynin Oxybutynin this newer antimuscarinic has high affinity for receptors in urinary bladder and salivary glands alongwith additional smooth muscle relaxant and local anaesthetic propeies. -### End" -4922,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The law stating that ""the relative frequency of each gene allele tend to remain constant from generation to generation"" is known as ?, with the following options: A: Mendel's law, B: Hardy-Weinberg law, C: David-Morgan's law, D: Lamarck's law - -### Response: -Ans. is 'b' i.e., Hardy-Weinberg law Hardly-Weinberg law The hardly-weinberg law states that ""The relative frequencies of each gene allele tends to remain constant from generation to generation"". Thus, the study of gene frequencies, and the influences which operate to alter the ""gene pool"" and their long term consequences is the central theme in population genetics. -### End" -4923,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterolateral lesions of ventral spinal cord leads to, with the following options: A: Pyramidal signs, B: loss of joint sense, C: Loss of pressure,touch, D: Loss of pain temperature - -### Response: -(C) Loss of pressure, touch -### End" -4924,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ananesthetic agent which is explosive in the presence of cautery, with the following options: A: Nitrous oxide, B: Ether, C: Trilene, D: Halothane - -### Response: -Refer Goodman Gilman 11/e p341 KDT 6/e p 371 Ether is an explosive agent Is should not be used with cautery -### End" -4925,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CD-99 is for, with the following options: A: A. Ewing's sarcoma, B: B. Sll, C: C. Dermatofibroma protrubens, D: D. Malignant histocytic fibroma - -### Response: -CD 99 is a marker associated with the diagnosis of Ewing's sarcoma Granulosa cell tumor is also often found to be associated to CD 99 -### End" -4926,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Specific antagonist for benodizaepine is -, with the following options: A: Flumazenil, B: Alprazolam, C: Di - isoprophyl phenol, D: Cremopher-ei - -### Response: -Ans. is 'a' i.e., Flumazenil o Flumazenil is a benzodiazepene analogue which competes with BZD agonists as well as inverse agonists for the BZD receptor and reverses their depressant or stimulant effects respectively.o It also antagonizes the action of Zolpidem, Zopiclone and Zopeplon as these drugs also act on BZD site. -### End" -4927,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gold standard Investigation for Achalasia cardia is :, with the following options: A: Esophageal manometry, B: Barium swallow, C: Endoscopy, D: Endoscopic ultrasound - -### Response: -In long-standing achalasia, the esophagus may assume a sigmoid configuration. The diagnostic criteria for achalasia with esophageal manometry are impaired LES relaxation and absent peristalsis. High-resolution manometry has somewhat advanced this diagnosis; three subtypes of achalasia are differentiated based on the pattern of pressurization in the non peristaltic esophagus. Because manometry identifies early disease before esophageal dilatation and food retention, it is the most sensitive diagnostic test -### End" -4928,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood loss during major surgery is best estimated by:, with the following options: A: Visual assessment, B: Suction bottles, C: Transesophageal USG Doppler, D: Cardiac output by thermodilution - -### Response: -Measurement of blood loss during surgery (Gravimetric Method) - -Blood loss during operation is measured by: Weighing the swabs after use and subtracting the dry weight and fluid used + volume of blood collected in suction bottles (after subtracting irrigating fluid) -### End" -4929,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arrange the following phases of Disaster Cycle in a logical sequence:-, with the following options: A: Disaster impact-Mitigation-Rehabilitation-Response, B: Disaster impact-Response-Rehabilitation- Mitigation, C: Rehabilitation-Response-Disaster impact-Mitigation, D: Response-Disaster impact-Rehabilitation- Mitigation - -### Response: -Disaster impact-Response-Rehabilitation- Mitigation -### End" -4930,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hormonal vitamin is-, with the following options: A: Niacin, B: Pyridoxin, C: Vitamin D, D: Riboflavin - -### Response: -Ans. is 'c' i.e.. Vitamin D o Active form of vitamin D i.e. 1-25 dihydroxy-cholecalciferol is a vitamin produced in kidney,o It acts on intranuclear receptors to regulate gene expressions (transcription factors). -### End" -4931,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for acute anterior uveitis is –, with the following options: A: Local steroids, B: Systemic steroid, C: Local NSAIDS, D: Systemic NSAIDS - -### Response: -Treatment of anterior uveitis -The mainstay of therapy of acute anterior uveitis is eye drops. These usually include:- - -Corticosteroids:- They are used along with mydriatic - cycloplegics. They act by reducing inflammation; and reducing fibrosis. Corticosteroids are the drug of choice for acute anterior uveitis. -Mydriatic - cycloplegic (Atropine 1%):- These are most useful and most effective during acute anterior uveitis (iridocyclitis). They act by:- - - -Gives comfort and rest to the eye by relieving spasm of iris sphincter and ciliary muscle -Prevents the formation of synechiae and may break the already formed synechiae -Reduces exudation by decreasing hyperemia and vascular permeability -Increases the blood supply to anterior uvea by relieving pressure on the anterior ciliary arteries. As a result, more antibodies reach the target tissues and more toxins are absorbed. - - -Symptomatic treatment is given for pain relieves, Eg: hot applications (warm compresses), aspirin (or other NSA1Ds). -Systemic steroids are indicated in severe uveitis or where there is no improvement in maximal topical steroids. -Systemic immunosuppressives (cyclosporin, methotrexate and cyclophosphamide) are indicated in some cases which do not respond to conventional steroid therapy. -Along with the symptomatic treatment of uveitis (described above), the specific treatment of underlying cause is also required, for example, removal of the lens in lens-induced uveitis. -### End" -4932,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are health policy indicators except, with the following options: A: Political commitment to health for all, B: Resource allocation, C: Disability prevalence, D: Community involvement - -### Response: -Crucial factors for realization of goals of a National health policy A political commitment Financial implications. Administrative reforms Community paicipation Basic legislation Ref: Park 25th edition Pgno : 27 -### End" -4933,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common congenital anomaly of the face is:March 2009, with the following options: A: Cleft lip alone, B: Isolated cleft palate, C: Cleft lip and cleft palate, D: All have equal incidence - -### Response: -Ans. C: Cleft lip and cleft palateThe typical distribution of cleft types is:Cleft lip alone-15%Isolated cleft palate-40%Cleft lip and cleft palate-45%Cleft lip alone (hare lip): It is due failure of fusion between the frontonasal (philtrum) and the maxillary processes.Types :- Unilateral 85% usually on the left side 75%, bilateral 15%.- Upper or lower: lower cleft lip is very rare and is due to failure of fusion between the mandibular processes. Complete or incomplete: according to whether it extends to the nostrils or not.- Simple or alveolar: if it involves the bony alveolus.- Complicated or not: If it is associated with cleft palate.Complications:- Disfigurement.- Difficult suckling if it is complicated.Treatment:- Timing of surgery for cleft lip alone:Unilateral-one operation at 5-6 monthsBilateral-One operation at 4-5 months.- (Millard's operation- When the patient is 10 weeks old, Hb = 10 gm% and the weight is 10 pounds (rule of ten)). II. Isolated cleft palate:The palate is developed from- Premaxilla from the frontonasal process.- Two maxillary shelves: from the maxillary processCleft palate occurs due to failure (total or paial) of fusion between the maxillary and frontonasal process or the 2 maxillary processes.Types :- Soft palate only, usually asymptomatic.- Intermaxillary : the cleft is only between the 2 maxillary shelves.- Bipaate : as intermaxillary but extends to one side of the premaxilla. Tripaate : as intermaxillary but extends to both sides of the premaxilla.Complications:- Impaired feeding due to:Difficult suckling.Wide pharynx : so the soft palate can't close the nasopharynx during swallowing leading to nasal regurgitation of food, leading to pharyngitis, rhinitis, otitis media and deafness.Difficult speech : specially consonant e.g. D, P, T, B, K, J.- Teeth malformation.Pierre Ribon syndrom : Cleft palate with receding lower jaw (micrognathia) and posterior displacement of the tongue which obstruct air way.- Malformed nose.Treatment :In cases of cleft palate alone, surgical correction is indicatedSoft palate only-One operation at 6 monthsSoft and hard palate-Two operations. One for soft palate at 6 months and another for hard palate at 15-18 months.- In case of cleft lip and palate, surgical correction is done at;Unilateral- two operations-Cleft lip and soft palate at 5-6 months and hard palate and gum pad with or without lip revision at 15-18 months.Bilateral- two operations-Cleft lip and soft palate at 4-5 months and hard palate and gum pad with or without lip revision at 15-18 months. -### End" -4934,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Athlete's foot is caused by?, with the following options: A: Candida, B: Madurella, C: Actinomycosis, D: Dermatophytes - -### Response: -Tinea pedis is a dermatophyte infection of feet and is also referred as Athlete's foot. Tenia pedis T. Rubrum most common Dull erythema with scales. Diagnosis: KOH exam - Thick scale, no leading edge Rx: Dry Feet Don't wear the same shoes everyday, Absorbent powders Rx Scale- keratolytic agents- Salicylic acid Topical: Allylamines may be more effective than azoles Steroids for severe inflammation. -### End" -4935,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rgarding experimental studies, in a randomized controlled trial (RCT) all are true, EXCEPT:, with the following options: A: Baseline characteristics are comparable, B: Bias can be eliminated by double blinding, C: Sample size depends on the type of study, D: Dropouts are excluded from the study - -### Response: -In randomized controlled trial, some losses to follow-up are inevitable due to factors, such as death, migration and loss of interest. This is known as attrition. If the attrition is substantial, it may be difficult to generalize the results of the study to the reference population. Every effo, therefore should be made to minimize the losses to follow-up. Ref: Park's Textbook of Preventive and Social medicine, 19th edition, Page 76-78. -### End" -4936,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are branches of maxillary artery except, with the following options: A: Artery to pterygoid canal, B: Pharyngeal artery, C: Greater palatine artery, D: Ascending pharyngeal artery - -### Response: -Ascending pharyngeal artery is branch of external cartotid artery. -### End" -4937,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 13 yr old girl from Himachal Pradesh presents with non-healing leg ulcers. Which of the following is likely to be the causative agent?, with the following options: A: Sporothrix, B: Cladophora, C: Aspergillus, D: Bacteroids - -### Response: -Sporothrix infection is prevalent in temperate climate and non-healing leg ulcer is a sign of Sporothrix infection. Ref: CMDT , 2008, Chapter 36 , Page 1337 -### End" -4938,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not give sensory supply to the pinna:, with the following options: A: Auricotemporal Nerve, B: Great Auricular Nerve, C: Lesser Occipital Nerve, D: Tympanic branch of Glossopharyngeal Nerve - -### Response: -D i.e. Tympanic branch of glossopharyngeal nerveTympanic branch of glossopharyngeal (IX) nerve or Jacobson's nerve supplies the medial (inner) surface of tympanic membrane. It does not supply pinnaQ.Main nerves supplying the skin of auricle (pinna) are great auricular nerve (c2, CP and auriculo temporal nerve (V3)(2 with a small contribution from lesser occipital nerve, (C2), auricular branch of vagus (X) nerve or Arnold's nerve and facial nerve.The great auricular supplies the whole of the cranial (medial /back) surface of auricle (C2, with a little overlap from the lesser occipital at the top) and the posterior pa of lateral (front) surface (helix, anthelix, and lobule).The auriculo temporal nerve (br. of CNV3) supplies the upper pa of lateral surface , skin of auricle anterior to external acoustic meatus, tragus, crus & adjacent pa of helix and most of meatal skin.Auricular branch of vagus (Arnold's nerve) supplies skin on the concavity of concha & posterior pa of eminentia , posterior wall & floor of meatus and adjoining tympanic membrane. -### End" -4939,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ground water has the following advantages except ?, with the following options: A: Likely to be free from pathogenic organisms, B: Usually requires no treatment, C: Supply is likely to be ceain even during dry season, D: Likely to be hard - -### Response: -Ans. is 'd' i.e., Likely to be Hard Ground water is hard, but it is a disadvantage (not advantage). Ground Rater o Ground water is the cheapest and most practical means of providing water to small quantities. o Ground water is superior to surface water, because the ground itself provides an effective filtering medium. Advantages It is likely to be free from pathogenic agents. o Requires no treatment (disinfection). o The supply is likely to be ceain even during dry season. o 11 is less subject to contamination than surface water. Disadvantages o It is high in mineral content e.g., salts and magnesium which render the water hard. It requires pumping or some arrangement to lift the water. -### End" -4940,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heparin therapy should be monitored with intermittent estimation of-, with the following options: A: Bleeding time, B: Prothrombin time, C: PTTK, D: All of the above - -### Response: -Ans. is 'c' i.e., PTTK o Monitoring of unfractionated heparin --> aPTT o Monitoring of oral anticoagulants-* PT/INR o Monitoring of LMW heparins --> No monitoring required -### End" -4941,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paraneoplastic syndrome Hypercalcemia of malignancy, is produced due to ectopic production of which hormone by lymphomas ?, with the following options: A: PTHrP, B: 1,25 dihydroxyvitamin D, C: PGE2, D: Parathormone - -### Response: -Ans. is 'b' i.e., 1, 25 dihydroxyvitamin D -### End" -4942,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HIV C subtype is seen in -, with the following options: A: India, B: Europe, C: America, D: Thailand - -### Response: -

HIV-C is most common in India. Reference:HIV/AIDS care and counselling by ACV Dyk,4th edition,page no.21. -### End" -4943,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best diagnostic procedure for ant. Cruciate ligament injury is, with the following options: A: Lachman's test, B: Pivot shift test, C: Anterior drawer test, D: Mc Murray's test - -### Response: -A i.e. Lachman's test -### End" -4944,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following conditions show hypehermia, EXCEPT:, with the following options: A: Neuroleptic malignant syndrome, B: Phencyclidine use, C: Aspirin toxicity, D: None of the above - -### Response: -Causes of Hypehermia Syndromes: Heat Stroke Exeional: Exercise in higher than normal heat and/or humidity Nonexeional: Anticholinergics, including antihistamines; antiparkinsonian drugs; diuretics; phenothiazines Drug-Induced Hypehermia Amphetamines, cocaine, phencyclidine (PCP), methylenedioxymethamphetamine (MDMA; ""ecstasy""), lysergic acid diethylamide (LSD), salicylates, lithium, anticholinergics, sympathomimetics Neuroleptic Malignant Syndrome Phenothiazines; butyrophenones, including haloperidol and bromperidol; fluoxetine; loxapine; tricyclic dibenzodiazepines; metoclopramide; domperidone; thiothixene; molindone; withdrawal of dopaminergic agents Serotonin Syndrome Selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants Malignant Hypehermia Inhalational anesthetics, succinylcholine Endocrinopathy Thyrotoxicosis, pheochromocytoma Central Nervous System Damage Cerebral hemorrhage, status epilepticus, hypothalamic injury Ref: Kruidering-Hall M., Campbell L. (2012). Chapter 27. Skeletal Muscle Relaxants. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e. -### End" -4945,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To decrease PPH, drug used prophylactically is :, with the following options: A: Oxytocin, B: Methergin, C: Progesterone, D: Prostaglandin - -### Response: -Methergin -### End" -4946,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which antihypertensive is not given in pregnancy -, with the following options: A: Ace inhibitors, B: Methyldopa, C: Hydralazine, D: Labetolol - -### Response: -Ans. is 'a' i.e., ACE inhibitorso Ace inhibitors are associated with fetal malformations and thus should he avoided in oresnancv. They are suitable for chronic hypertension in nonprevnant state or post partum. Andhvpertensive DrugsDrugsMechanism of ActionDoseSide effectsContraindications and PrecautionsMethyldopaDrugs of first choice. Central and peripheral antiadrenergic action. Effective and safe for both the mother and the fetus.o Orally-250 mg bid-may be increased to 1 g qid depending upon the response.o IV infusion - 250-500 rrigo Maternal-Postural hypotension, hemolytic anemia, sodium retention, excessive sedation. Coomb's test may be positiveo Fetal - Intestinal ileusHepatic disorders psychic patients congestive cardiac failure.Postpartum (risk of depression)HydralazineActs by peripheral vasodilatation as it relaxes the arterial smooth muscle. Orally it is weak and should be combined with methyldopa or b blockers. It increases the cardiac output and renal blood flow.o Orally - 100 mg/day in four divided doseso IV 5-10 mg every 20 min maximum 20 mg.o Maternal hypotension, tachycardia, arrhythmia, palpitation, lupus like syndrome, fluid retentiono Fetal - reasonably safeo Neonatal - thrombocytopenaiBecause ofvariable sodium retention, diuretics should be used. To control arrhythmias, propranolol may be administered intravenously.LabetalolCombind a and b adrenergic blocking agento Orally - 100 mg tid may be increased up to 2,400 mg dailyo IV infusion (Hypertensive crisis 20-40 mg IV every 10-15 min until desired effect, maximum up to 220 mg.o Tremors, headache, asthma, congestive cardiac failure,o Efficacy and safety with short-term use appear to methyldopa.o Hepatic disorderso Asthma, congestive cardiac failure.NifedipineDirect arteriolar vasodilatation by inhibition of slow inward calcium channels in vascular smooth muscle.Orally 5-10 mg tid maximum dose 60-120 mg/dayRushing, hypotension, headache, tachycardia, inhibition of laborSimultaneous use of magnesium sulfate could behazardous due to synergistic effect.SoudimNitroprussideDirect vasodilator (arterial and venous )IV infusion0.25-8ug/kg/mino Maternal: Nausea, vomiting, severe hypotensiono Fetal toxicity due to metabolites - cyanide and thiocynateDrug of last resortfor acute hypertension. Should be used in critical care unit for very short time (10 minutes).NitroglycerineRelaxes mainly the venous but also arterial smooth muscleGiven as IV infusion 5ug/min to be increased at every 3-5 min up to 100 ug/min.Tachycardia, headache. MethemoglobinemiaUsed in hypertensive crisis for short time only.Contraindicated in hypertensive encephalopathy as it increases blood florand intracranial pressure.ACE inhibitors Angiotensin- II receptor blockers (AARB)ACE inhibitors, inhibit formation of angiotensin II from angiotensin I. ARB-Blocks Angiotensin-II receptorso Captopril orally 6.25 mg bido Telmisartan orally 20-40 mg a dayo Maternal; Hypotension, headache, asthenia arrhythmias.o Fetal: Oligohydramnios IUGR, fetal renal tubular dysgenesis, neonatal renal failure, pulmonary hypoplasiaShould be aboided in pregnancy.Suitable for chronic hypertension in nonpregnant state or postpartum. -### End" -4947,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about gleason’s score except, with the following options: A: Used for grading prostatic ca, B: Maximum score is 10, C: Minimum score is 2, D: It is the most important prognostic factor - -### Response: -Stage of Ca is the most important prognostic factor. -### End" -4948,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spontaneous release of acetylcholine at the neuromuscular junction produces, with the following options: A: Miniature end-plate potential, B: Action potential, C: Post-tetanic potential, D: Resting membrane potential - -### Response: -Spontaneous release of acetylcholine in small amounts normally happens in synapses. This can result in miniature end plate potential. -### End" -4949,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fetishism is a sexual perversion characterized by: COMEDK 08; PGI 12, with the following options: A: Sexual focus on children, B: Sexual focus on genital rubbing, C: Sexual pleasure for pain, D: Sexual pleasure derived from inanimate objects - -### Response: -Ans. Sexual pleasure derived from inanimate objects -### End" -4950,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following diseases, these X-ray findings are seen?, with the following options: A: Gaucher disease, B: Fabry disease, C: Morquio disease, D: Niemann Pick disease - -### Response: -The bony abnormalities seen in the X ray- bullet shaped metacarpals and beaked veebral bodies comprise 'dysostosis multiplex', seen in Mucopolysaccharidosis (MPS)- Morquio disease or type IV MPS. Gaucher disease- X ray of long bones- Erlenmeyer flask deformity -### End" -4951,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major complication of cyst-gastrostomy for pseudo pancreatic cyst is?, with the following options: A: Infection, B: Obstruction, C: Fistula, D: Hemorrhage - -### Response: -Ans. (d) HemorrhageRef : CSDTUthed/638* Serious post-op hemorrhage from cyst occurs from cystogastrostomy.* Most common cause of pseudopancreatic cyst is pancreatitis.* It may resolve spontaneously, so it is followed with serial ultrasonic studies.Indications of Surgical Intervention* Age of cyst more than 6 weeks without resolution* Size of cyst greater than 6 cm* Evidence of secondary infection* Development of any other complicationsSurgical Methods* Internal drainage - most preferred surgical management* There are three options:# Cysto-Jejunostomy# Cysto-gastrostomy# Cysto-Duodenostomy* Excision of pseudocyst* External drainage -### End" -4952,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Local anaesthetics act by, with the following options: A: Effecting the spinal level, B: Effecting the Na+ channel, C: Effecting the K+ channel, D: Blocking axonal transpo - -### Response: -Effecting the Na+ channel -### End" -4953,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve supply of tip of nose is, with the following options: A: Maxillary nerve, B: Ophthalmic nerve, C: Facial nerve, D: Mandibular branch of Vth nerve - -### Response: -The afferent component of corneal reflex is mediated through the ophthalmic branch of the trigeminal nerve. (V1 nerve). -The efferent component is mediate through the facial nerve (VIIth nerve). -### End" -4954,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: There is a mutation of a gene coding for the ryanodine receptors in malignant hyperthermia. Which of the following statements best explains the increased heat production in malignant hyperthermia?, with the following options: A: Increased muscle metabolism by excess of calcium ions, B: Thermic effect of blood, C: Increased sympathetic discharge, D: Mitochondrial thermogenesis - -### Response: -Ryanodine receptors in sarcoplasmic reticulum act as calcium channels. The mutation of Ryanodine receptors causes it to release Ca++ into sarcoplasm uncontrollably resulting in high metabolism by the muscles. This causes malignant hyperthermia. -### End" -4955,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Smack"" is the ""common"" name for, with the following options: A: Heroin, B: Cocaine, C: Opium, D: None - -### Response: -Heroin or di-acetyl-morphine is about two times more potent than morphine in injectable form. Apa from the parenteral mode of administration, heroin can also be smoked or 'chased' ( chasing the dragon), often in an impure form (called ' smack' or ' brown sugar' in India). Heroin is more addicting than morphine and can cause dependence even after a sho period of exposure. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 43 -### End" -4956,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A renal mass seen on prenatal checkup is most probably, with the following options: A: Wilm's tumor, B: Mesoblastic nephroma, C: Neuroblastoma, D: Renal sarcoma - -### Response: -Prenatal renal tumors:Enlargement of a kidney on prenatal imaging is usually due to hydronephrosis or a cystic renal enlargement, such as multicystic dysplastic kidney or polycystic diseaseSolid tumors of the kidneys are rarely seen in the antenatal period but can be diagnosed by ultrasound. Most develop properly as the baby is growing in the womb.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2467) -### End" -4957,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: T/t used for lower ureteric stone is:, with the following options: A: Endoscopic removal, B: Diuretics, C: Drug dissolution, D: Laser - -### Response: -Answer is A (Endoscopic removal): Stones in the lower pa of ureter within 5-6 cm of ureteric orifice (that are small in size) are best managed by Ureteroscopic (Endoscopic) removal. -### End" -4958,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amino-acid expressed maximally in collagen?, with the following options: A: Tyrosine & phenylalanine, B: Alanine & aspaic acid, C: Glycine & cysteine, D: Proline & hydroxyproline - -### Response: -Ans. is `d' i.e., Proline & hydroxyprolineGlycine (33%), proline (10%), hydroxyproline, lysine and hydroxylysine are the predominant amino acids in collagen. Collagen. -### End" -4959,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 year old female presented with MCP and PIP pain. Diagnosis:, with the following options: A: Rheumatoid Arthritis, B: Rheumatic fever, C: Gouty arthritis, D: Psoariatic arthritis - -### Response: -Ans. (a) Rheumatoid ArthritisRef: Harrison's 18th ed. Ch. 321Clinical Features of RA* Incidence of RA increases between 25 and 55 years of age.* Gender: Female > Male* Early morning joint stiffness lasting more than 1 hour and easing with physical activity.* The earliest involved joints are typically the small joints of the hands and feet.* The wrists, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints stand out as the most frequently involved joints. Distal interphalangeal (DIP) joint involvement may occur in RA, but it usually is a manifestation of coexistent osteoarthritis. -### End" -4960,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Potassium concentration in which of the following is responsible for maintenance of cardiac and neural function?, with the following options: A: Intracellular, B: Extracellular, C: Intravascular, D: Extravascular - -### Response: -Potassium is most concentrated inside the cells of the body. The gradient or the difference in concentration from within the cell compared to the plasma, is essential in the generation of the electricial impulses in the body that allow muscles and the brain to function. -### End" -4961,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In acute congestive glaucoma, pupil is:, with the following options: A: Oval and horizontal, B: Oval and veical, C: Circular, D: Slit like - -### Response: -B i.e. Oval & veical In acute congestive glaucoma pupil is veically oval, dilated & nonreacting Q and anterior chamber is very shallow Q; where as in acute anterior uveitis pupil is small, irregular & sluggishly reacting Q and anterior chamber is deep. -### End" -4962,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a derivative of the ectoderm of the trilaminar embryo?, with the following options: A: Bone, B: Germ cells, C: Muscle, D: Spinal cord - -### Response: -The neural plate, a thickened area of ectoderm, gives rise to the nervous system. The first step is the development of a groove in the neural plate. On either side of this groove are the raised neural folds. These neural folds then begin to fuse in the midline at approximately the midpoint of the neural plate. Fusion proceeds in a rostral and caudal direction; once completed, there still remains an open area of the ""tube"" at both the rostral and caudal ends. These openings are referred to as the rostral and the caudal neuropore. The rostral neuropore closes around day 26 and the caudal neuropore closes on approximately day 28. With the closure of the caudal neuropore, closure of the neural tube is completed. It has been convincingly shown that folic acid plays an impoant role in the closure of the neural tube. By giving women of childbearing age folic acid supplements, the rate of neural tube defects can be reduced dramatically. Yet, based on the embryology of the neural tube (with closure of the tube roughly by day 28), it is obvious that in order for folic acid supplementation to work, it should be staed pregestationally. Unfounately, most women do not seek prenatal care until after the neural tube has undergone its period of closure. Bone, muscle, and spleen are all derivatives of the mesoderm. This mesoderm is formed at the end of the second week post-feilization, when some cells of the primitive streak migrate laterally between the endodermal and the ectodermal layer. Germ cells are derived from the endodermal layer of the trilaminar embryo. They migrate as primordial sex cells from the endoderm of the yolk sac to the urogenital ridge. -### End" -4963,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bernoulli's theorem explains -, with the following options: A: Nasal polyp, B: Thyroglossal cyst, C: Zenker's diverticulum, D: Laryngomalacia - -### Response: -The increased speed of the air flowing through the nose decreases the pressure in the nasal cavity (Bernoulli's theorem) which pulls down the polyp. -### End" -4964,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dele Which of the following is not an age-independent criteria for nutritional assessment, with the following options: A: Rao scale, B: Kanawati scale, C: Aiyyar scale, D: Mid arm circumference - -### Response: -Anthropometry is the measurement of physical dimensions such as height or weight, as well as the fat mass composition of the human body to provide information about a person&;s nutritional status. An index is a combination of two anthropometric measurements or an anthropometric measurement plus age. Reference: GHAI Essential pediatrics, 8th edition -### End" -4965,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug has a ourable effect on lipids metabolism, with the following options: A: Atenolol, B: Chlohiazide, C: Clonidine, D: Torsemide - -### Response: -Refer kDT 6/e p545 Clonidine, sold as the brand name Catapres among others, is a medication used to treat high blood pressure, attention deficit hyperactivity disorder, drug withdrawal, menopausal flushing, diarrhea, and ceain pain conditions. It is used by mouth, by injection, or as a skin patch -### End" -4966,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Reactive arthritis, with the following options: A: Precipitated by chlamydia, B: Enthesitis of Achilles tendon, C: Acute purulent arthritis, D: Indomethacin is the initial treatment of choice - -### Response: -Reactive arthritis show acute non-Purulent arthritis. -### End" -4967,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Average weight of spleen in adult:, with the following options: A: 5 ounce, B: 7 ounce, C: 14 ounce, D: 21 ounce - -### Response: -Ans. B 7 ounceRef: BDC, 6th ed. vol. II pg. 294* On an average the spleen is 1 inch or 2.5 cm thick, 3 inches or 7.5 cm broad, 5 inches or 12.5 cm long and 7 ounces in weight.Some Must Know Weights* Weight of liver: 1.5 kg.* Weight of thyroid gland: 25 gm* Weight of prostate: 8 gm. -### End" -4968,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Local excision in CA rectum is done in all, except:, with the following options: A: Within 6 cm of anal verge, B: Lesion <4 cm, C: Involvement of <40% circumference, D: T1 and T2 cancer with or without lymph node involvement - -### Response: -Ans. (d) T1 and T2 cancer with or without lymph node involvementRef: Sabiston 19th Edition, Pages 1356-1360Transanal excision of cancer rectum* T1N0 or T2N0 lesion <4cm in diameter* <40% circumference of the lumen* <10cm from dentate line* Well to moderately differentiated histology* No evidence of lymphatic or vascular invasion on biopsyOn Endo USG:* T1 and T2 lesions without nodes will be opted for Transanal excision -### End" -4969,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest cause of an obliterative stricture of the membranous urethra is -, with the following options: A: Fall-astride injury, B: Road-traffic accident with fracture pelvis and rupture urethra, C: Prolonged catheterization, D: Gonococcal infection - -### Response: -Commonest cause of stricture in posterior urethra → Trauma with fracture pelvis -Commonest cause of stricture in anterior urethra → Straddle injuries (direct trauma to the perineal region). -### End" -4970,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following attains adult size before birth?, with the following options: A: Ear Ossicles, B: Maxilla, C: Mastoid Process, D: Parietal bone - -### Response: -Ans is 'a' i.e. Ear Ossicles Its an indirect repeat from May 2009 paper.""The tympanic cavity and mastoid antrum, auditory ossicles, and structures of the internal ear are all almost fully developed at birth and subsequently alter little. "" -Gray's 40/e p623 -### End" -4971,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A girl with mild von willebrand disease has a previous history of heavy bleeding during tooth extraction. What is the prophylaxis to be given before tooth extraction?, with the following options: A: Desmopressin, B: Blood transfusion, C: Fresh frozen plasma, D: Cryoprecipitate - -### Response: -In patients of von Willebrand disease, DDAVP can be given intra-nasally 2 hours before a procedure like dental extraction- mild to moderate risk of bleeding and can be repeated 12-24 hours. Aminocaproic acid or Tranexamic acid is an impoant therapy either alone or in an adjunctive capacity paicularly for the prevention or treatment of mucosal bleeding. -### End" -4972,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the paial pressure for oxygen in the expired air?, with the following options: A: 116 mm Hg, B: 158 mm Hg, C: 100 mm Hg, D: 0.3 mm Hg - -### Response: -Paial pressure of O2 in expired air (PE O2) - 116 mm Hg Gaseous concentration & its paial pressure in alveoli: 1. Oxygen: Concentration & paial pressure controlled by, Rate of absorption of O2 into blood Rate of entry of new O2 into lungs by ventilatory process. Values: Paial pressure of O2 in inspired air (Pi O2) 158 mm Hg Paial pressure of O2 in alveolar air (PA O2) 100 mm Hg Calculated by ""Alveolar gas equation"". Paial pressure of O2 in expired air (PE O2) 116 mm Hg -### End" -4973,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Macrosomia is seen in all except, with the following options: A: Diabetes mellitus, B: Obesity, C: Hydrocephalus, D: Post maturity - -### Response: -Risk factors associated with macrosomia : Maternal diabetes Multiparity Increased maternal age Maternal obesity Prolonged gestation Male fetus Ref: Dutta Obs 9e pg 263. -### End" -4974,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Animal waste is disposed off by-, with the following options: A: Incineration, B: Autoclave, C: Microwave, D: None - -### Response: -Ans. is 'a' i.e., Incineration Animal wastes (category 2) are disposed by incineration or Deep burial. -### End" -4975,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bite mark is an example of: FMGE 11, with the following options: A: Pressure abrasion, B: Graze abrasion, C: Scratch abrasion, D: Pattern abrasion - -### Response: -Ans. Pattern abrasion -### End" -4976,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following antipsychotic drugs is considered the best in treatment of Resistant Schizophrenia?, with the following options: A: Olanzapine, B: Clozapine, C: Resperidone, D: Chlorpromazine - -### Response: -(B) Clozapine # Clozapine appears to be most effective of atypical members.> Its main side effects are: Agranulocytosis, Seizures, Hyperthermia> Its side effects profile make it appropriate for treatment of resistant cases.# Olanzapine Is chemically similar to clozapine but of leaves efficacy and causes rapid wt gain.> Risperidone - benzisoxazole: It is 5HT, D2 and a-2 antagonist Its a-2 antagonism contribute to its ability to improve mood and increase motor activity> Chlorpromazine - Its is typical antipsychotic anticholinergic highly sedative> Clozapine appears to be the most effective member of this class and has demonstrated superiority to other atypical agents in preventing suicide;however, its side-effect profile makes it most appropriate for treatment resistant cases Olanzapine is similar neurochemically to clozapine but has a significant risk of inducing weight gain.> Risperidone, a benzisoxazole derivative, is more potent at 5HT2 than D2 receptor sites, like clozapine, but it also exerts significant antagonism, a property that may contribute to its perceived ability to improve mood and increase motor activity.> Risperidone is not as effective as clozapine in treatment resistant cases but does not carry a risk of blood dyscrasias. chlorpromazine and thioridazine, are more sedating and anticholinergic and more likely to cause orthostatic hypotension. -### End" -4977,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Radiological hallmark of Osteo SA-, with the following options: A: Soap bubble appearance, B: Sun ray appearance, C: Osteoid formation by neoplastic cells, D: Cotton wool appearance - -### Response: -Ans. is 'b' i.e. sunray appearance .X-ray features of Osteosarcoma.Area of irregular destruction of metaphysesErosion of the overlying cortex.New bone formation in the matrix of the tumor*Periosteal reaction* (which is irregular; periosteal reaction in osteomyelitis is smooth)Codman's triangle*Sun-ray appearance* -### End" -4978,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about choledochal cyst -, with the following options: A: Type II is most common, B: Cyst excision is the treatment of choice, C: Anamolous connection between biliary and pancreatic duct, D: Rupture may lead to biliary peritonitis - -### Response: -Ans. is 'd' i.e., Rupture may lead to biliary peritonitis Choledochal cyst* A choledochal cyst is an isolated or combined congenital dilatation of the extrahepatic or intrahepatic biliary tree.Classification of Choledochal cystType I- a type I cyst is characterized by fusiform dilatation of the bile duct.- this is the most common typeType II- a type II cyst appears as a diverticulum protruding from the wall of the CBD.Type III- a type III cyst is dilatation of the biliary tract within the duodenum; also k/a choledochoceleType IV Type IV A- multiple dilatation of the intrahepatic and extrahepatic bile ducts.Type IV B- multiple dilatation involving only the extrahepatic bile ducts.Type V- consists of multiple dilatation of the intrahepatic bile ducts; also known as Carolis disease.* Choledochal cysts are seen to be frequently associated with an anomalous junction of the pancreatic and biliary duct.Clinical Presentation* More common in females than in males (4:1)* Typically choledochal cysts present in children beyond the toddler age group.* The classical triad presents only in a minority of patients; it consists of:# Abdominal pain# Jaundice# Abdominal mass* If the disorder is left undiagnosed, patients may develop cholangitis or pancreatitis. Cholangitis may lead to the development of cirrhosis and portal hypertension.Complications caused by choledochal cyst* Recurrent cholangitis* Portal vein thrombosis with resultant portal hypertension* Pancreatitis* Cyst rupture with biliary peritonitis (very rarely)* Gall stones* Malignancy* Cirrhosis with portal hypertension Diagnosis* ERCP is the most reliable investigation but is invasive* MRCP is the best noninvasive investigationTreatment* Cholecystectomy + Cyst excision with reconstruction via a biliary-enteric Roux-en-Y anastomosis is the treatment of choice for all choledochal cysts except type III (choledochocele) and intrahepatic cysts of type IV & type V (Carolis disease)* Treatment of type III (Choledochocele)# Transduodenal sphincteroplasty or sphincterotomy# cyst excision* Treatment of intrahepatic cysts of type IV & V# If the intrahepatic cysts are localized, hepatic lobe is resected# If the intrahepatic cysts are diffuse only effective treatment is liver transplantation. -### End" -4979,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not resected in stapedotomy?, with the following options: A: Anterior crus of stapes, B: Posterior crus of stapes, C: Stapedial ligament, D: Lenticular process of incus - -### Response: -Lenticular process of incus is not resected in stapedotomy. -### End" -4980,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to Starling law, force of contraction is directly proportional to:, with the following options: A: Contractility of heart, B: End systolic length of muscle fibres, C: End diastolic length of muscle fibres, D: Muscle tension - -### Response: -Ans: C (End diastolic length of muscle fibres) Ref: Ganong's Review of Medical Physiology, 21st edExplanation:""The Frank-Starling law of heart states that within physblogicai limits the force of cardiac contraction is proportional to its end diastolic volume."" Ref: Khurana""For the heart, the length of the muscle fibers (i.e., the extent of the preload) is proportionate to the end-diastoiic volume. The relation between ventricular stroke volume and end-diastolic volume is called the Frank-Starling curve."" Ref: GanongThe Frank-Starling Law of the HeartAlso known as Starling's law or the Frank-Stariing mechanism or Maestrini heart's law.It states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end diastolic volume) when all other factors remain constant.The increased volume of blood stretches the ventricular wall, causing cardiac muscle to contract more forcefully. -### End" -4981,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A diabetic patient developed cellulitis due to S. Aureus, which was found to be methicillin-resistant on the antibiotic sensitivity testing. All of the following antibiotics will be appropriate except -, with the following options: A: Vancomycin, B: Imipenem, C: Teicoplanin, D: Linezolid - -### Response: -As drug resistance is so common among staphylococci, the appropriate antibiotic should be chosen based on antibiotic sensitivity tests. Benzylpenicillin is the most effective antibiotic if the strain is sensitive. Vancomycin is the drug of choice for MRSA. Imipenem: It is a semisynthetic beta-lactam antibiotic. It has a wide spectrum of antibacterial activity-gram positive organisms like streptococci, staphylococci, enterococci. It is resistant to most beta-lactamases. Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; 10th Edition; Page No: 208 -### End" -4982,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug of choice in digitalis-induced ventricular arrhythmias is, with the following options: A: Lignocaine, B: Phenytoin, C: Quinidine, D: Procainamide - -### Response: -Lignocaine suppresses ventricular arrhythmias. It acts by blocking the sodium channel in the inactivated and active states. It is less toxic and has a rapid onset of action and sho duration of action. It has no action on A-V nodal conduction velocity. 1st DOC is lidocaine, 2nd DOC is phenytoin Lidocaine is class IB antiarrhythmic Ref: Tripati 8th edition -### End" -4983,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 15 year old female presents with primary amenorrhoea. Her breasts are Tanner 4 but she has no axillary or pubic hair. The most likely diagnosis is :, with the following options: A: Turner's syndrome, B: Mullerian agensis, C: Testicular feminization syndrome, D: Premature ovarian failure - -### Response: -Answer is C (Testicular feminization syndrome): Presence of well developed breast (tanner stage 4) with scanty axillary or pubic hair in a phenotypic 'female' with primary amenorrhea (? no uterus) suggests the diagnosis of Testicular feminization syndrome. -### End" -4984,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased anion gap acidosis is caused by all except:, with the following options: A: Diuretics, B: Uremia, C: Ketoacidosis, D: Ethylene glycol - -### Response: -Ans: a (Diuretics) Ref: Harrison, 16th ed, p. 265,17th ed, p. 181Diuretics does not cause increased anion gap acidosisAnion gap - It represents the unmeasured anions in plasma. It helps to identify whether the acidosis is due to retention of H+ or another acid. The normal cations present in plasma are Na+, K+, Ca+, Mg2+The normal anions present in plasma are Cl-, HCO3-, albumin, phosphate, sulphate lactate, and other organic acids.The positive and negative charges are usually equal. But only Na+, K+, Cl- and HCO3' are easily measurable. So if we calculate the difference between the measured cations and anions, there will be a gap - the anion gap, which represents the unmeasured anions.Anion gap = { + } - { + }Normal anion gap is 10-12 mmol/LCauses of normal and high anion gap acidosis: (refer above) -### End" -4985,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 100 gms of soda lime absorbs …………………………………. % of CO2 –, with the following options: A: 15, B: 25, C: 150, D: 1000 - -### Response: -Sodalime is capable of absorbing up to 23 L of CO2 per 100 gm of sodalime. -### End" -4986,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child had pustular lesion on leg. On gram staining gram positive cocci are seen. To establish the diagnosis of Group A beta streptococcal pyoderma, the test used is:, with the following options: A: Bile solubility test, B: Catalase test, C: Optochin sensitivity, D: Bacitracin sensitivity - -### Response: -Group A beta streptococcus produces pyogenic infections with a tendency to spread locally, along lymphatics and through the bloodstream. The growth of Str. pyogenes on agar plates in the laboratory is inhibited by the antibiotic bacitracin, an impoant diagnostic criterion. Sensitivity to bacitracin is a convenient method for differentiating Group A streptococcus from other hemolytic streptococci. Laboratory tests for group A beta streptococcus: Bacitracin sensitive PYR (pyrrolidonyl naphthylamide) test positive Ribose not fermented Ref: Ananthanarayan and Paniker's Textbook of Microbiology By Ananthanarayan And Paniker, 7th edition, Page 205. -### End" -4987,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NOT seen in Tetralogy of Fallot is, with the following options: A: Pulmonary stenosis, B: Right Ventricular hypertrophy, C: Ventricular septal defect, D: Overriding of Aorta - -### Response: -Tetralogy of Fallot is - -Ventricular septal defect -Overriding of Aorta -Infundibular stenosis -Right Ventricular hypertrophy -### End" -4988,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient underwent sleeve gastrectomy, on 3rd postop day, she complains of fever. O/E- patient is febrile & PR- 110/min. CBC shows leucocytosis. What is the next best step in management of this patient?, with the following options: A: Broad spectrum antibiotics, B: Abdominal USG to locate the septic focus, C: CECT abdomen, D: Re-exploration - -### Response: -Given scenario suggests that there is staple line leak at angle of His which is a common complication after laparoscopic sleeve gastrectomy Staple line leak at the angle of His may presents any time after discharge up to 30 days Patients can deteriorate rapidly with sepsis. Management: Urgent re-exploration - source control by drainage Long term nutritional suppo is needed as patients are severely catabolic after complication -### End" -4989,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following coical areas contribute fibers to the coicospinal tract, EXCEPT?, with the following options: A: Primary motor coex (precentral gyrus), B: Premotor coex, C: Inferior temporal coex, D: Primary somatosensory coex (postcentral gyrus) - -### Response: -Coicospinal and coicobulbar tract neurons are pyramidal shaped and located in layer V of the cerebral coex. About 31% of the coicospinal tract neurons are from the primary motor coex. The premotor coex and supplementary motor coex account for 29% of the coicospinal tract neurons. The other 40% of coicospinal tract neurons originate in the parietal lobe and primary somatosensory area in the postcentral gyrus. The inferior or ventral temporal coex does not contribute fibers to the coicospinal tract. -### End" -4990,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cushing ulcers are:-, with the following options: A: Stress ulcers in burns, B: Stress ulcers in head injury, C: Stress ulcers in hiatus hernia, D: Stress ulcers in depression - -### Response: -Cushing ulcers or stress ulcers: Stress induced gastritis (or) Haemorrhagic Gastritis M/C site - stomach M/C site in stomach - Fundus > Body > Antrum As the max. concentration of parietal cells are seen in fundus it is the m/c site of occurrence Two types of stress ulcers: CUSHING ULCERS - Head injury CURLING ULCERS - BURNS -### End" -4991,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug that causes fall in elderly patients with postural hypotension is:-, with the following options: A: Metformin, B: Prazosin, C: Acarbose, D: Nor-adrenaline - -### Response: -The side effect postural hypotension AkA ''First Dose Hypotension"" is observed with drug ending with zosin Prazosin, Terazosin, Doxazosin (d) Acarbose - Inhibition of intestinal absorption of carbohydrate. S/E - flatulence, abdominal discomfo, loose stool. These drugs cause blocking of a1receptors, leading tovasodilation, that can Cause Postural Hypotension. (a)Metformin -Antidiabetic drug which comes under the category of Biguanide. S/E - Abdominal Pain, Anorexia, bloating, nausea, metallic taste mild diarrhea & tiredness. Nor - adrenaline(Press or agent)- stimulates a1 and a2 adrenergic receptors to cause blood vessel contraction, thus increases peripheral vascular resistance and result in increase BP. It acts on b1 adrenergic receptors, causing increase In hea rate and cardiac output. S/E = Transient restlessness, headache, palpitations, Anxiety,tremor. Marked rise in BP leading to cerebral hemorrhage, ventricular tachycardia, angina, MI. -### End" -4992,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A girl from shimla presented to OPD with fever,hypotension, malaise and axillary and inguinal lymphadenopathy. Culture in glucose broth shows stalactite growth. Most likely causative organism is, with the following options: A: Yersinia pestis, B: Francisella tularensis, C: Brucella abous, D: Coxiella burnetti - -### Response: -Yersinia pestis Amongst the given options, only yersinia pestis produces stalactite growth. The girl has: - i) Signs of septicemia --> Fever, hypotension. ii) Axillary and inguinal lymphadenopathy iii) Stalactite growth These features are suggestive of septicaemic plague, which is caused by yersinia pestis. The clinical features mentioned in the question can also occur in rest of the options but the clincher is ""stalactite growth"", which is seen only in yersinia pestis infection. Survival in cold environment (girl lives in slamla) also ours yersinia pestis. Clinical features of plague Y. pestis infection 4, 4, `If Bubonic Pneumonic Septicaemic Uncommon Plague Plague Plague forms . Always primary . Mostly secondry . Mostly secondary . Meningitis . t14, C. type of plague due to metastatic spread due to metastatic . Pharyngitis . LP. 2-7 (hot from Bubonic plague spread from Bubonic . Endoplithalmitis . C/Ps are fever; chills . 1.P. 1-3 days . I.P. -4 2-7 clays. . Lymphadenills enlarged tender & . Highly infectious . Often presents with at multiple sites painful lympnodes; . Initially ore lobe is GI symptoms (nausea papule, pustule or ulcer affected, later it spreads vomiting. diarrhea and at the site of bite to other lobe abdominal paint along . M.C. lymphnode femoral . C/Fs are dyspnea, cough with other signs of and inguinal with sputum chest pain and tachycardia septicemia -### End" -4993,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Distichiasis is -, with the following options: A: Abnormal inversion of eyelashes, B: Abnormal extra row of cilia, C: Abnormal eversion of eyelashes, D: Misdirected cilia - -### Response: -Congenital anomaly in which an extra row of cilia occupies the position of meibomian gland .Distichiasis is a rare disorder defined as the abnormal growth of lashes from the orifices of the meibomian glands on the posterior lamella of the tarsal plate Ref :Ak khurana 6th edition REF IMG -### End" -4994,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior epistaxis is commonly seen in:, with the following options: A: Children with ethmoidal polyps, B: Foreign bodies of the nose, C: Hypeension, D: Nose picking - -### Response: -M/c cause of epistaxis in adults is hypeension M/c site - Woodruff area Causes posterior epistaxis -### End" -4995,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are included in methods based on behavioural sciences, except:, with the following options: A: Personal management, B: System analysis, C: Management by objectives, D: Communication - -### Response: -System analysis -### End" -4996,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bimodality of incidence occurs in all, except, with the following options: A: Cancer penis in males, B: Hodgkin's disease, C: Breast cancer in females, D: Leukemia - -### Response: -Ref Robbins Diseases showing bimodality of age presentation (mnemonic:ABCDEGH) A Aoic stenosis/acute leukemia -ALL,>AML Breast cancer Crohn's disease Dermatomyositis Enthesioneuroblastoma Thyoglossal cyst Hodkin's lymphoma Vulvar carcinoma but not penial cancer -### End" -4997,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Parietal lobe lesion presented with Sensory seizures, motor deficits' visual disorders, no touch perception on opposite side and on simultaneous bilateral touch. This is associated with, with the following options: A: Unilateral parietal lobe dysfunction, B: Dominant parietal lobe dysfunction, C: Non-Dominant parietal lobe dysfunction, D: Bilateral parietal lobe dysfunction - -### Response: -(A) Unilateral parietal lobe dysfunction Unilateral parietal lobe dysfunction (Right or left)Dominant (left) parietal lobe dysfunction (in most right- handed and some left handed patients)Non-dominant (right) parietal lobe dysfunctionBilateral parietal lobe dysfunction* Sensory deficits (asterognosis, agraphesthesia, sensory seizures)* Motor deficits (mild hemiparesis)* Visual disorders (homonymous hemianopia, inferior quadrantanopia, visual inattention)* Contralateral neglect (more obvious for right sided lesions)* Constructional and dressing apraxia* Language disorders (aphasia, alexia)* Gertsmann syndrome (dyscalculia, dysgraphia, finger agnosia, right-left confusion)* Apraxia* Hemispatial neglect* Sensory and visual inattention* Constructional and dressing apraxia (greater severity for right sided lesions)* Visuospatial disorientation* Balint syndrome (optic ataxia, oculomotor apraxia, simultanagnosia)# Symptoms & Signs of Parietal lobe dysfunction: Paroxysmal localized paraesthesia (tingling sensations/'pins and needles'), affecting the contralateral side of the body. Also known as sensory seizures. Sensory deficits to the contralateral side can occur, leading to astereognosis, agraphesthesia, loss of proprioception, vibration and fine touch. Primary sensory modalities may return after a short time, however discrimination between sensations may not. Mild hemiparesis could also occur. -### End" -4998,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19-year-old female presented with fever, cough shoness of breath and diffuse chest pain. She gave a history of reduced water intake since yesterday. On examination, Hypeension Tachycardia SpO2 is 80% on room air B/L wheezing in lower lung zones Lab findings revealed anemia, leukocytosis, reticulocytosis, thrombocytosis, increased serum bilirubin. Peripheral blood smear Chest x-ray CT scan of chest Which is the most appropriate therapy in the above condition: -, with the following options: A: Hydroxyurea, B: Sildenafil, C: IV ceftriaxone, D: Streptokinase - -### Response: -This is a case of acute chest syndrome in a patient of sickle cell anemia. Presents as acute fever, cough, chest pain and wheezing in a background of sickle cell anemia. X-ray and CT are suggestive of subsegmental atelectasis of right lower lobe. Management: - Transfusion to maintain hematocrit > 30% Emergency exchange transfusion Hydroxyurea is the mainstay. -### End" -4999,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Perinerual spread is seen in:, with the following options: A: Adenoid cystic carcinoma, B: Pleomorphic adenoma, C: Mucoepidermoid Ca, D: Warthin's tumor - -### Response: -Ans: A (Adenoid cystic carcinoma) Ref: Robbins and Comm Pathologic Basis of Disease, 8th editionExplanation:""Although slow growing, adenoid cystic carcinomas are relentless and unpredictable tumors with a tendency to invade perineural spaces"" Ref: RobbinsAdenoid cystic carcinomaIt is a relatively uncommon tumor.Found in the minor salivary glands in 50% of cases (especially in Palate ).Among the major salivary glands, the parotid and submandibular glands are the most common locations.MorphologySmall, poorly encapsulated, infiltrative, gray-pink lesions.Microscopically, small cells having dark, compact nuclei and scant cytoplasm.These cells tend to be disposed in tubular, solid, or cribriform patterns reminiscent of cylindromas arising in the adnexa of the skin.The spaces between the tumor cells are filled with a hyaline material which represents excess basement membrane,Has a tendency to invade perineural spaces and are recurrent.>50% disseminate widely to distant sites such as bone, liver and brain.5-vear survival rate is about 60% - 70%. -### End" -5000,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of basal ganglia include, with the following options: A: Emotions, B: Skilled movements, C: Coordination of movements, D: Maintenance of equilibrium - -### Response: -Basal ganglia are involved in planning and programming of movement or more broadly in the process by which an abstract thought is conveed into voluntary action which is required for skilled movements. Ref: Ganong&;s review of medical physiology; 23rd edition; pg:251 -### End" -5001,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hardness of water is said to be beneficial for which disease:, with the following options: A: Cardiovascular disease, B: Renal disease, C: Diabetes, D: All of the above - -### Response: -Studies have shown an inverse relationship between the hardness of drinking water and the death rate from cardiovascular diseases. Diseases believed to be affected include atherosclerotic hea disease, hypeension, sudden deaths of cardiovascular origins etc. Ref: Park 21st edition, page: 672. -### End" -5002,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment modalities for myopia are –a) Radial keratotomyb) LASER Keratomileusisc) Epikeratophakiad) LASER Keratoplasty, with the following options: A: ac, B: a, C: ad, D: ab - -### Response: -Surgeries for myopic are Radial keratotomy, Photorefractive keratotomy, Laser in-situ keratomileusis (LASIK), Extraction of the lens, Phallic intraocular lens (IOL), Intracorneal ring implantation, Orthokeratology. -### End" -5003,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dobutamine differs from dopamine in that, with the following options: A: It has good blood-brain barrier penetrability, B: It causes pronounced tachycardia, C: It does not activate adrenergic b receptors, D: It does not activate peripheral dopaminergic receptors - -### Response: -Dopamine (DA):- It is a dopaminergic (D1 and D2) as well as adrenergic a and b1 (but not b2) agonist. Dobutamine:- A derivative of DA, but not a D1 or D2 receptor agonist. Though it acts on both a and b adrenergic receptors. Ref:- kd tripathi; pg num:-134 -### End" -5004,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is a denaturating substance, with the following options: A: Guanosine, B: Guanidine, C: Glutamate, D: Glycine - -### Response: -8M urea and 6M guanidine hydrochloride are denaturing substances. -### End" -5005,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ova in the stool is not of diagnostic significance in, with the following options: A: Stronyloides, B: Entrobius, C: Trichuris, D: Ankylostoma - -### Response: -Strongyloides stercoralis:A specific diagnosis is based on the finding of the typical rhabditiform larvae in a freshly passed stool. A high eosinophilia is often a feature of strongyloidiasis. In pulmonary infection examination of the sputum will demonstrate the presence of rhabditiform larvae. So ova is not diagnostic of Strongyloides stercoralis.(Ref: K.D Chatterjee13th edition, p211) -### End" -5006,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Splenic macrophages in Gaucher's disease differ from those in ceroid histiocytosis by staining positive for -, with the following options: A: Lipids, B: Phospholipids, C: Acid fast stain, D: Iron - -### Response: -Ans. is 'a' i.e., Lipids -### End" -5007,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following has sporicidal activity-, with the following options: A: 2% Glutaraldehyde, B: 2% Cresol, C: Chlorhexidine, D: Boprophyl alcohol - -### Response: -Ans. is 'a' i.e., 2% Glutaraldehyde Sporicidal agents* Bacterial spores constitute some of the most resistant forms of life. By nature bacterial spores are resistant to extreme physical, chemical and thermal conditions and are second only to prions in their resistance to disinfection. They are resistant to most of the disinfectants. Only a few agents are effective against them.* Sporicidal agents are -1) Glutaraldehyde2) Formaldehyde3) Halogensi) Iodine compounds - Iodine, Iodophorsii) Chlorine compounds - Sodium hypochlorite, chlorine tablets4) Ethylene oxide5) Peroxygens - hydrogen peroxide, peracetic acid.6) Beta propiolactone7) Ozone -### End" -5008,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Supplementary immunisation services for measles immunisation?, with the following options: A: Keep up with > 95% immunised, B: Catch up, C: Follow up, D: All the above - -### Response: -WHO Measles Elimination strategy : Catch up, Keep up, Follow up. Catch up: Nationwide, vaccination targeting all children 9 months to 14 years of age, irrespective of history of Measles disease or vaccination status Keep up: Routine services aimed at vaccinating more than 95% of each successive bih coho. Follow up: Subsequent nationwide vaccination campaigns conducted every 2-4 years targeting usually all children born after the catch-up campaign Ref: Park 25th edition Pgno : 161-162 -### End" -5009,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The use of succinylcholine is not contraindicated in –, with the following options: A: Tetanus, B: Closed head injury, C: Cerebral stroke, D: Hepatic failure - -### Response: -Hepatic failure is not a contraindication. -Tetanus, head injury and cerebral stroke (Hemiplegia) are contraindications. -### End" -5010,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding HIV which of the following is not true ?, with the following options: A: It is a DNA retrovirus, B: Contains Reverse Transcriptase, C: may infect host CD4 cells other than T lymphocytes, D: Causes a reduction in host CD4 cells at late stage of disease - -### Response: -Ans. is 'a' i.e., It is a DNA retrovirus HIV is a RNA virus (not DNA) It contains reverse transcriptase enzyme, which is a characteristic feature of retroviruses. The receptor for the virus is the CD4 antigen on surface. The cells affected are : - CD4 T Cells (major target) - B lymphocytes - Monocytes and macrophages - Langerhans cells in dermis Glial cells and microglia in the CNS - Follicular dendritic cells from tonsils can be infected by HIV without the involvement of CD4 CD4 T cells are reduced and T4:T8 Cell ratio is reversed -### End" -5011,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In cases of burn, which is the fluid of choice in the first 24 hours?, with the following options: A: Ringer Lactate, B: Normal saline, C: 5% Dextrose, D: Blood - -### Response: -Proper fluid management is critical to survival in a burn patient. -The hypovolemic shock in burn patient is special in the sense that the total body water remains unchanged in a burn patient. The thermal injury leads to a massive fluid shift from the intravascular compartment to the extravascular compartment (interstitial + intracellular) leading to edema formation (in both burned parts and non burned parts of the body) -This fluid shift is maximum in the first 24 hrs. -Fluid resuscitation begins with an isotonic crystalloid solution - Ringer's lactate solution (RL) is the preferred solution (Normal saline should be avoided as the volumes required for resuscitation may lead to hyperchloremic metabolic acidosis). The concept behind the continuous fluid resuscitation is that the burn (and/or inhalation injury) drives an inflammatory response that leads to capillary leak; as the plasma leaks into the extravascular space, crystalloid administration would maintain the intravascular volume. -The quantity of crystalloid needed for adequate resuscitation is determined by Parkland formula i.e. 4 mL/kg per % of TBSA burn. (Note that a number of formulas exist for calculating fluid needs during burn resuscitation, suggesting that no one formula benefits all patients. Parkland is one of the most commonly used formulas) -half of the calculated fluid is given in the first 8 hrs and a half in next 16 hrs. -Colloids are given in the next 24 hrs. The reason behind it being the observation that in the initial period, the vascular permeability is so large that even larger protein molecules leak from the capillaries. (But some workers, prefer to use colloids after 8 to 12 hrs, while there are some who use it from the very beginning) -A number of parameters are widely used to assess burn resuscitation, but the most common remains the simple outcomes of blood pressure and urine output. As in any critically ill patient, the target MAP is 60 mmHg to ensure optimal end-organ perfusion. Goals for urine output should be 30 mL/h in adults and 1 to 1.5 mL/kg per hour in pediatric patients. -There is no use of diuretics in burn resuscitation. -Children under 20 kg have the additional requirement that they do not have sufficient glycogen stores to maintain an adequate glucose level in response to the inflammatory response. Specific pediatric formulas have been described, but the simplest approach is to add maintenance IV fluid with glucose supplementation in addition to the calculated resuscitation fluid with lactated Ringer's. -### End" -5012,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Development of spermatozoa (sperm) from spermatogonium takes how much time ?, with the following options: A: 30-35 days, B: 40-45 days, C: 50-55 day, D: 70-75 days - -### Response: -Ans. is 'd' i.e., 70-75 daysSpermatogenesis refers to the process of formation of spermatozoa (sperm) from primitive germ cells (spermatogonia).Spermatogenesis begins at pubey and continues throughout adult life to decline in old age.In humans, it takes an average of 74 days to form a mature sperm from primitive germ cells.Spermatogenesis occurs in seminiferous tubules. -### End" -5013,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Term catatonia was used by:, with the following options: A: Karl Kahlbaum, B: Adolf Meyer, C: Leo Kanner, D: Karen Homey - -### Response: -A. i.e. Karl Kahlbaum -### End" -5014,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following stage of tooth formation is characterized by the commencement of mineralization and root formation:, with the following options: A: Bud stage., B: Cap stage., C: Bell stage., D: Advanced bell stage. - -### Response: -Mineralization and root formation is the characteristic feature of Advanced bell stage. -### End" -5015,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surgical excision is contraindicated in -, with the following options: A: Olecranon process, B: Patella, C: Head of radius, D: Lateral condyle humerus - -### Response: -Lateral condyle of the humerus is never excised. -Excision is used in the treatment of fracture of the radial head, patella and olecranon, for specific indications. -### End" -5016,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A complicated case of diveicular disease is defined as diveicula with?, with the following options: A: Abdominal pain, B: Abscess and perforation, C: Constipation or diarrhea, D: Diveicular bleeding - -### Response: -.DIVEICULAR DISEASE OF THE COLON * They are acquired herniations of colonic mucosa through circular muscles at the points where blood vessels penetrate (points of least resistance). * It is more commonly localised to sigmoid colon (90%) but occasionally seen in full length of the colon. Rectum is not affected. saint's triad (5%) includes *Diveiculitis *Hiatus hernia *Gallstones.Complications of diveiculitis * Perforation and pericolic abscess or peritonitis * Progressive stenosis and intestinal obstruction * Profuse colonic haemorrhage (17-20%) * Fistula formation (5%)--vesicocolic, vaginocolic, enterocolic, colocutaneous. ref:SRB&;s manual of surgery,ed 3,pg no 820 -### End" -5017,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following factors are involved in altered patterns of hormone release except, with the following options: A: Lights on throughout 24 hours of the day, B: Travel across time zones, C: Aging, D: Day time duties - -### Response: -A patient in the intensive care unit, where the lights are on throughout the 24 hours of the day, will have a disrupted cycle of hormone release. Light plays an impoant role in generating the circadian rhythm of hormone secretion. This endogenous rhythm is generated through the interaction between the retina, the hypothalamic suprachiasmatic nucleus, and the pineal gland through the release of melatonin. Melatonin is a hormone synthesized and secreted by the pineal gland at night. Its rhythm of secretion is entrained to the light/dark cycle. Melatonin conveys information concerning the daily cycle of light and darkness to the body and paicipates in the organization of circadian rhythms. Other situations that disrupt the normal cycles of hormone release are travel across time zones, night-shift employment, and aging. -### End" -5018,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 55 year old male presented with angina. Coronary angiography revealed a block in the right coronary aery. The condition is likely to cause a decrease in blood supply through all of the following blood vessels except, with the following options: A: Acute Marginal, B: Posterior interventricular aery, C: Aery to SA node, D: Circumflex aery - -### Response: -Circumflex aery is not a branch of the right coronary aery. It is the branch of the left coronary aery. The branches of the right coronary aery are: Right coronary aery-It is the first branch of the right coronary aery. Aery of the SA node. Acute right marginal aery. Posterior interventricular aery (in 65% population) Atrial and anterior and posterior ventricular branches. Ref: Gray&;s Anatomy 41st edition Pgno: 1016 -### End" -5019,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proper technique of endotracheal intubation involves: March 2012, with the following options: A: Flexion of neck, B: Flexion of the neck and extension of the atlantooccipital joint, C: Extension of the neck, D: Extension of the neck and flexion of the atlantooccipital joint - -### Response: -Ans: B i.e. Flexion of the neck and extension of the atlanto-occipital joint Optimal head and neck positioning while intubation is obtained by flexion of the neck and extension of the atlanto-occipital joint -### End" -5020,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following hormones are secreted by the islet cells in the pancreas, EXCEPT:, with the following options: A: Insulin, B: Somatostatin, C: Glucagon, D: Triacylglycerol hydrolase - -### Response: -The islet cells in the pancreas are the site of endocrine production. The primary hormones produced by these cells are insulin, glucagon, somatostatin, and pancreatic polypeptide all of which function in maintaining homeostasis in nutritional functions. The exocrine pancreas is the site of production of a number of proteases, amylases, and lipases of which triacylglycerol hydrolase is a member. Ref: Molina P.E. (2013). Chapter 7. Endocrine Pancreas. In P.E. Molina (Ed),Endocrine Physiology, 4e. -### End" -5021,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum contraction of gall bladder is seen with, with the following options: A: CCK, B: Secretin, C: Gastrin, D: Enterogastrone - -### Response: -Bile salts are the most important cholerectic or the substance that increases bile secretion. Cholecystokinin (CCK) is the most important cholagogue or substance that increases the contraction. -### End" -5022,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The maxillary sinus open intlo middle meatus at the level of:, with the following options: A: Hiatus semilunaris, B: Bulla ethmoidalis, C: Infundibulum, D: None of the above - -### Response: -Ref: Dhingra 7e pg 151,209. -### End" -5023,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most common central nervous system parasitic infection?, with the following options: A: Echinococcosis., B: Sparganosis., C: Paragonimiasis., D: Neurocysticercosis. - -### Response: -Ans. is 'd' i.e. Neurocysticercosis Cecil writes - ""The most common parasitic infestation to affect the nonimmuno suppressed host is neurocysticercosis, a disorder caused by the larval form of taenia solium""About NeurocysticercosisMode of entry ingestion of eggs from fecally contaminated food.Most common presentationSeizuresTreatment*Praziquantel orAlbendazole (Not Niclosamide)Anticonvulsants for seizure controlGlucocorticoids -### End" -5024,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a complication of infective endocarditis:, with the following options: A: Myocardial ring abscess, B: Suppurative pericarditis, C: Myocardial infarction, D: Focal and diffuse glomerulonephritis - -### Response: -. Suppurative pericarditis -### End" -5025,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If Wernicke's area is damaged in the dominant hemisphere, it will result in?, with the following options: A: Irrelevant and rapid speech, B: No effect on speech, C: Speech with difficulty in aiculation, D: Incomprehension of written language - -### Response: -Wernicke's also called Wernicke's speech area, is one of the two pas of the cerebral coex that are linked to speech(the other is Broca's area). Damage caused to Wernicke's area results in receptive, fluent aphasia. -### End" -5026,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is false about bilirubin?, with the following options: A: Conjugation is rate limiting step, B: Bilirubin has affinity for elastin, C: Total Hb content of body is 750 gm, D: Normal serum bilirubin concentration ranges from 0.3-1.3 mg/dl, about 80% of which is unconjugated - -### Response: -TEXT BOOK OF HARSH MOHAN SIXTH EDITION PAGE.593 Bilirubin is a yellow compound that occurs in the normal catabolic pathway that breaks down heme in veebrates. This catabolism is a necessary process in the body's clearance of waste products that arise from the destruction of aged or abnormal red blood cells -### End" -5027,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following gives a positive reaction with Ferric chloridea) Phenylketonuriab) Alkaptonuriac) Maple syrup urine disease d) None, with the following options: A: ac, B: a, C: ad, D: ab - -### Response: -Ferric chloride test is positive in phenylketonuria and also in alkaptonuria. -### End" -5028,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following have inhibitory effect on secretion of gastrin, except, with the following options: A: Acid in duodenum, B: VIP, C: Epinephrine, D: Glucagon - -### Response: -The gastric secretions arise from glands in the wall of the stomach that drain into its lumen, and also from the surface cells that secrete primarily mucus and bicarbonate to protect the stomach from digesting itself, as well as substances known as trefoil peptides that stabilize the mucus-bicarbonate layer The acid secreted by parietal cells serves to sterilize the meal and also to begin the hydrolysis of dietary macromolecules. Intrinsic factor is impoant for the later absorption of vitamin B12, or cobalamin (Figure 26-6). Pepsinogen is the precursor of pepsin, which initiates protein digestion. Lipase similarly begins the digestion of dietary fats. There are three primary stimuli of gastric secretion, each with a specific role to play in matching the rate of secretion to functional requirements. Gastrin is a hormone that is released by G cells in the antrum of the stomach both in response to a specific neurotransmitter released from enteric nerve endings, known as gastrin-releasing peptide (GRP, or bombesin) and also in response to the presence of oligopeptides in the gastric lumen. Gastrin is then carried through the bloodstream to the fundic glands, where it binds to receptors not only on parietal (and likely, chief cells) to activate secretion but also on so-called enterochromaffin-like cells (ECL cells) that are located in the gland and release histamine. Histamine is also a trigger of parietal cell secretion, binding to H2 histamine receptors. Finally, parietal and chief cells can also be stimulated by acetylcholine, released from enteric nerve endings in the fundus. The three agonists of the parietal cell--gastrin, histamine, and acetylcholine--each bind to distinct receptors on the basolateral membrane. Gastrin and acetylcholine promote secretion by elevating cytosolic free calcium concentrations, whereas histamine increases intracellular cyclic adenosine 3&;,5&;-monophosphate (cAMP).Stimuli that affect gastrin secretion.Stimuli that increase gastrin secretionLuminal Peptides and amino acids Distention 2 .Neural Increased vagal discharge GRP 3 Bloodborne Calcium EpinephrineStimuli that inhibit gastrin secretion 1. Luminal Acid Somatostatin 2. Bloodborne Secretin, GIP, VIP, glucagon, calcitoninREF: GANONG&;S REVIEW OF MEDICAL PHYSIOLOGY, KIM BARRETT, SCOTT BOITANO, HEDDWEN BROOKS, SUSAN BARMANTWENTY THIRD EDITIONPAGE NO:432,445 -### End" -5029,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug causing exanthema -, with the following options: A: Atropine, B: Phenytoin, C: Sulfonamide, D: All of the above - -### Response: -Ans. is 'd' i.e., All of the above \Ref: Rooks ?h/e p. 73.22-73.23]Drugs causing exanthematic reactionsMost commonLess commonAmpicillin and penicillinPhenylbutazone and other pyrazolonesSulphonamidesPhenytoinCarbamazepineGoldGentamicinMeprobamateAtropineCephalosporinsBarbituratesThiazidesNaproxenIsoniazidPhenothiazinesQuinidine -### End" -5030,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are in Norma Basalis except, with the following options: A: Mental foramen, B: Foramen Magnum, C: Formane Ovale, D: Foramen Lacerum - -### Response: -The foramen present in the norma basalis are: 1.Greater palatine foramen 2.Lesser palatine foramen 3.Foramen lacerum 4.Foramen spinosum 5.Emissary sphenoidal foramen 6.Foramen magnum 7.Jugular foramen NOTES: The mental foramen is situated at the outer surface of mandible. The mental foramen lies below the interval between the premolar teeth. Ref.BDC volume 3,sixth edition pg 13 -### End" -5031,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chemical messenger acting at long distance in -, with the following options: A: Autocrine, B: Paracrine, C: Endocrine, D: Auto-para-crine - -### Response: -Ans. is 6c' i.e., Endocrine o Hormones are chemical mediators that control cellular functions. They are secreted into the blood stream by ductless endocrine glands and thereby exert widespread actions.o Hormone may have : -i) Autocrine action: - Acts on the cell from which it is secreted.ii) Paracrine action: - Acts on neighboring cells, e.g., the effect of gastrin on D cells secreting somatostatin.iii) Endocrine action: - Acts on cells distant to the cell from which it is secreted. Most of the hormones act by this mechanism. -### End" -5032,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true regarding the duration of treatment of XDR-Tb?, with the following options: A: Total duration 24-30 months, B: Intensive phase - 6 to 9 months, C: Continuation phase - 15 months, D: All of the above - -### Response: -Regimen for XDR-TB All XOR-TB patients should also be subject to a repeat full pre-treatment evaluation, but also including consultation by a thoracic surgeon for consideration of surgery. MDR-TB patients diagnosed as XOR-TB would be given an outcome of ""Switched to regimen for XOR-TB"". The decision and initiation of regimen for XOR-TB is to be taken by the concerned DR-TB centre committee. The Intensive Phase (6-12 months) consists of 7 drugs - Capreomycin (Cm), PAS, Moxifloxacin (Mfx), High dose INH, Clofazimine, Linezolid, and Amoxyclav The Continuation Phase (18 months) consists of 6 drugs - PAS, Moxifloxacin (Mfx), High dose INH, Clofazimine, Linezolid, and Amoxyclav. RNTCP regimen for XDR-TB: 6-12 Cm, PAS, Mfx, High dose-H, Cfz, Lzd, Amx/Clv/ 18 PAS, Mfx, High dose-H, Cfz, Lzd, Amx/Clv (Reserve/Substitute drugs : Clarithromycin, Thiacetazone) Ref : Park 23rd edition Pgno : 192 -### End" -5033,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 2.Shangai fever is a mild febrile illness caused by which of the following organisms?, with the following options: A: Pseudomonas, B: Burkholderia, C: Acinetobacter, D: Stenotrophomonas - -### Response: -Shangaiever fever is a typhoid resembling fever caused by psedomonas aeruginosa -### End" -5034,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding breath holding spells are all EXCEPT:, with the following options: A: Antiepileptic treatment is necessary, B: Atropine is sometimes used, C: Attacks of cyanosis can occur, D: Occurs between 6 months to 5 years age - -### Response: -BREATH HOLDING SPELLS: --> Behavioral problem, usually affects boys b/w 6 months - 3 yrs of age. Results from immaturity of ANS. --> Triggers: Injury, anger, frustration --> Sequence of events is typical: Child first has long cry --> then, holds his breath --> turns blue & limp --> may be followed by tonic & few clonic movements. --> 2 types PALLID- caused by reflex vagal bradycardia & asystole CYANOTIC - due to prolonged expiration, apnea, intrapulmonary shunting of blood --> Treatment: Parental Reassurance; Treatment of co-existing Iron deficiency anemia Anti-epileptics are usually not indicated for its treatment. -### End" -5035,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Symptoms of Neuroleptic Malignant Syndrome (NMS) are all of the following except?, with the following options: A: Confusion, B: Hypothermia, C: Diaphoresis, D: Hypertension - -### Response: -Ans. B. HypothermiaNeuroleptic malignant syndrome (NMS): Levenson clinical criteriaMajor: Fever, rigidity, elevated creatinine phosphokinaseMinor: Tachycardia, abnormal arterial pressure, tachycardia, altered consciousness, diaphoresis, leukocytosis -### End" -5036,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following blood system have Carbohydrate antigen, with the following options: A: Rh, B: Kell, C: Lewis, D: Duffy - -### Response: -Antibodies to &;Lewis system&; carbohydrate antigens are the most common cause of incompatibility during pretransfusion screening. The Lewis gene product is a fucosyltransferase and maps to chromosome 19. The antigen is not an integral membrane structure but is adsorbed to the RBC membrane from the plasma. Antibodies to Lewis antigens are usually IgM and cannot cross the placenta. Lewis antigens may be adsorbed onto tumour cells and may be targets of therapy.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 138e&; Transfusion Biology and Therapy -### End" -5037,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Putting profit ahead of health as a cause of disease is provided by which theory of sociology:, with the following options: A: Feminist, B: Parsonian, C: Marxist, D: Foucauldian - -### Response: -THEORIES OF DISEASE CAUSATION IN SOCIOLOGY Marxist theory: Is concerned with the relationship between health and illness and capitalist social organization. Cause of disease is putting profit ahead of health. Feminist theory: Disease occurs d/t role of women enforced by men. Parsonian theory: Disease occur d/t social constraints which arise d/t social demands. Foucauldian theory: Disease occurs, population is segregated into groups, making them easier to control. McKneown theory of TB: Whatever reduction of incidence/ prevalence of TB is only d/t Socio-environmental conditions. -### End" -5038,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: T3 Stage in oral cancer is -, with the following options: A: Tumour > 2cm in greatest dimension, B: Tumour > 4cmin greatest dimension, C: Tumour > 6cmin greatest dimension, D: Tumour > 8cmin greatest dimension - -### Response: -Ans. is 'b' i.e., Tumour > 4cmin greatest dimension Primary tumor staging of oral cavity carcinomaT0No evidence of primary tumorT1Tumor is <2 cm in greatest dimensionT2Tumor is > 2 cm and < 4 cm in greatest dimensionT3Tumor > 4 cm in greatest dimensionT4a (lip)Primary tumor invading cortical bone, inferior alveolar nerve, floor of mouth, or skin of face (e.g., nose or chin)T4a (oral cavity)Tumor invades adjacent structures (e.g., cortical bone, into deep tongue musculature, maxillary sinus) or skin of faceT4b (lip & oral)Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery -### End" -5039,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Injury to radial nerve in lower pa of spiral groove may result in all EXCEPT:-, with the following options: A: Spare nerve supply to extensor carpi radialis longus, B: Results in paralysis of anconeus muscle, C: Leaves extension at elbow joint intact, D: Weakens supination movement - -### Response: -Injury to radial nerve in lower pa of radial groove results in paralysis (not sparing) of ECRL (Extensor Carpi Radialis Longus). Injury to radial nerve in lower pa of spiral groove may result in- Elbow extensors are spared(triceps,aconeus) wrist,elbow and finger extensors are paralysed sensory loss in first web space. Triceps receive branches of radial nerve in axilla and radial groove hence it will be spared, and elbow extension is intact. -### End" -5040,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the indication for the usage of mifepristone?, with the following options: A: Ectopic pregnancy, B: Fibroid uterus, C: Molar pregnancy, D: Habitual aboion - -### Response: -Mifepristone, also known as RU486, is an antiprogestin that has been used for treatment of leiomyomas. Mifepristone diminishes leiomyoma volume by approximately half. Mifepristone, in combination with misoprostol or other prostaglandins, is available for the termination of early pregnancy. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 9. Pelvic Mass. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e. -### End" -5041,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Salmonella typhi is the causative agent of typhoid fever. The infective does of S.typhi, with the following options: A: One bacillus, B: 108-1010 bacilli, C: 102-105 bacilli, D: 1-10 bacilli - -### Response: -Ans. is 'c' i.e., 102-105 bacilli In human volunteer experiments, the infective dose was found to be 103-106 bacilli. Organism Infective dose . ETEC . EIEC . EHEC . Shigella . Campylobactor jejuni . Yersinia enterocolitica . Vibrio 106-101deg 108-10m 10-100( 104 108-109 1010 (if source of infection is water) 102-104 (if source of infection is food) -### End" -5042,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal liver histology is seen in -, with the following options: A: Gilbe's syndrome, B: Rotor syndrome, C: Criglar Najjar syndrome, D: All - -### Response: -Ans. is 'a' i.e., Gilbe's syndrome; 'b' i.e, Rotor syndrome; 'c' i.e, Crigler Najor syndrome -### End" -5043,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First symptom in vulval cancer is-, with the following options: A: Pain, B: Pruritus, C: Ulceration, D: Bloody discharge - -### Response: -Ans. is 'b' i.e., Pruritus o Women with VIN and vulvar cancer commonly present with pruritus and a visible lesion.# However, pain, bleeding, and ulceration may also be initial complaints. -### End" -5044,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common tumor to metastasize to brain is:, with the following options: A: Breast, B: Melanoma, C: Lung, D: Prostate - -### Response: -Common malignancies metastasizing to brain: Lung > Breast > Melanoma Brain metastases are the most common brain tumors; they are three times more common than all primary brain tumors combined. Ref : Harrison 18/e p3390 -### End" -5045,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cholangiocarcinoma is associated with -, with the following options: A: Chlonorchis sinensis, B: Schistosoma, C: Plasmodium, D: None - -### Response: -Ans. (a) Chlonorchis sinensisRef: Bailey 26th edition Table page 1115* Opisthorcis vivernii and Clonorchis sinensis are associated with Cholangiocarcinoma. -### End" -5046,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not describe a ""high risk"" infant?, with the following options: A: Third baby, B: Birth weight less than 2.5 kg, C: Premature neonate, D: Twins - -### Response: -a. Third baby(Ref: Nelson's 20/e p 819)Factors that define an infant as being 'high risk':Demographic social factorsPrevious pregnancyPresent pregnancyMaternal age <16 or >40 yrIntrauterine fetal demiseVaginal bleeding (abruptio, placenta previa)Illicit drug, alcohol, cigarette useNeonatal deathSexually transmitted ds (e.g. syphilis, HIV)Past medical historyPrematurityMultiple gestationGenetic disordersIntrauterine growth restrictionPreeclampsiaDiabetes mellitusNeonatePremature rupture of membranesHypertensionBirthweight <2,500 or >4,000gPoly-/oligohydramniosAsymptomatic bacteriuriaBirth <37 or >=42 wk of gestationCongenital malformationRheumatologic illness (SLE)Respiratory distress, cyanosisLabor and delivery Fetal distress Breech presentation Meconium-stained fluid -### End" -5047,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All true about dosing of succinylcholine except-, with the following options: A: In adults, a dose of 1.0 mg/ kg body weight can yield intubating condition, B: Children are resistant to succinylcholine so Between 1 to 2 mg/kg required, C: Infant the dose is Between 2-3 mg/kg, D: In obese , dose in calculated according to lean body weight - -### Response: -In obese individuals, the dose of succinylcholine in milligram per kg of actual body weight is the same as in leaner patients. Calculating the dose per kg ideal body weight (I BETWEEN) might lead to under-dosing. The volume of distribution, expressed per kg of actual body weight of succinylcholine is probably decreased but this is compensated by an increase in plasma cholinesterase activity. -### End" -5048,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 8 year old child has shown of lack of interest in studies for last 6 months. He has frequent quarrels with his parents and has frequent headaches as anexcuse to avoid school. What would be the most appropriate clinical diagnosis in this patient?, with the following options: A: Rule out migraine, B: Rule out depression, C: Rule out an oppositional defiant disorder, D: Leave him as normal adolescent problem - -### Response: -Since the person in the question is showing a hostile behavior which is impairing his academic activities for the last 6 months, the most appropriate next step would be to rule out Oppositional defiant disorder.Oppositional defiant disorder is a recurrent pattern of negativistic, hostile or defiant behavior that lasts longer than 6 months and creates disturbances in at least one of the domains of child functioning including social, academic or occupational impairment. The symptoms of this disorder is usually evident around 6-8 years. Ref: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th Edition, Page 3586, 3580. -### End" -5049,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Indication of aspiration in liver abscess all Except, with the following options: A: Left lobe abscess, B: Deep & less than 5 mm size, C: Multiple, D: Recurrent - -### Response: -Indications of liver aspiration- large abscess (>10%), infected abscess, failure of drug therapy, large left lobe abscess, seronegative abscess, abscess in pregnancy where drug therapy cannot be used. Reference : SRB edition :5 page :599 -### End" -5050,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inversion injury at the ankle can cause all of the following except -, with the following options: A: Fracture tip of lateral melleolus, B: Fracture base of the 5th metatarsal, C: Sprain of Ext. Digitorum brevis, D: Fracture of sustentaculam tali - -### Response: -Structures damaged due to inversion injury - -Peroneal tendon injury. -Avulsion fracture of tip of lateral malleolus. -Avulsion fracture of anterolateral surface of talus & calcaneum (sustentaculum tali). -Fracture of base of 5th metatarsal. -Lateral collateral ligament injury (anterior tato fibular > calcaneofibular > posterior- talofibular ligament). -Medial malleolus fracture. -### End" -5051,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The major clinical use of Nimodipine is in, with the following options: A: Hypeension, B: Angina pectoris, C: Sub arachnoid haemorrhage, D: Raynouds phenomenon - -### Response: -Refer kDT 6/e p532 subarachnoid hemorrhage USES: Nimodipine is used to decrease problems due to a ceain type of bleeding in the brain (subarachnoid hemorrhage-SAH).Nimodipine is called a calcium channel blocker. The body naturally responds to bleeding by narrowing the blood vessel to slow blood flow. -### End" -5052,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for soft tissue sarcoma is -, with the following options: A: CT, B: MRI, C: Ultrasound, D: X-ray - -### Response: -Ans. is 'b' i.e., MRI ""Any patient with a suspected STS should be referred to a diagnostic centre for triple assessment with clinical history, imaging and biopsy. Whilst the preferred method of imaging is MRI, other options including computerized tomography (CT) or ultrasound may be appropriate depending on local expertise. ""Investigations in musculoskeletal systemo Investigation of choice for AVN Hip - MRIo Best initial test for osteomyelitis - Plain x-rayo Best second line test for osteomyelitis (if there is high clinical suspician and x-ray is negative) - MRIo Most accurate diagnostic test for osteomyelitis - Bone biopsy and culture.o Best view for scaphoid fracture - Oblique (scaphoid) view of wrist.o Best view for C1-C2 vertebrae & junction - Open mouth odontoid (Pegs) view.o Investigation of choice for ACL & PCL injury - MRIo Investigation of choice to detect calcification - CT scano Investigation of choice for prolapsed intervertebral disc - MRIo Investigation of choice for spinal tuberculosis - MRIo Investigation of choice for traumatic paraplagia - MRIo Investigation of choice in intramedullary space occupying lesion (SOL) - MRIo Investigation of choice for bone metastasis - Bone scano Gold standard and investigation of choice for osteoporosis (Bone density) - Dual energy X-ray absorptiometry (DEXA). -### End" -5053,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3 year old girl has developed painful elbow after being jerked by the forearm. The next thing to be done is -, with the following options: A: Cuff & collar sling immobilization, B: Reduction setting and AEPOP application, C: X-ray and elevation of limb in posterior slab, D: Fully supinate the forearm - -### Response: -This is case of pulled elbow and a dramatic cure is achieved by forcefully supinating and then flexing the elbow. -### End" -5054,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40 year old male presents with a painless cystic liver enlargement of four years duration without fever or jaundice. The most likely diagnosis is, with the following options: A: Amoebic liver abscess, B: Hepatoma, C: Hydatid cyst of liver, D: Choledochal cyst - -### Response: -Clinical features of hydatid disease Equally common in males and females, age 45 years Most(75%) are singular, located in right liver Mostly asymptomatic until complications occur Most common presenting symptoms - abdominal pain, dyspepsia and vomiting Most common sign- Hepatomegaly Ref:Sabiston 20th edition Pgno :1452 -### End" -5055,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To prevent exercise-induced bronchial asthma drug used is, with the following options: A: Sodium cromoglycate, B: Ipratropium bromide, C: Terbutaline, D: Epinephrine - -### Response: -Sodium cromoglycate (Mast cell stabilizing agent)Inhibit degranulation of mast cells, thereby preventing the release of the chemical mediators of anaphylaxis.Improves lung function, reduce symptoms, and lower airway activity in persons with asthma.Most effective in patients who have either seasonal disease or perennial airway stimulation.Steroids have no role in exercise-induced asthma.(Refer: Harrison's Principles of Internal Medicine, 18thedition, pg no: 2106-2115) -### End" -5056,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zona Pellucida disappears by:-, with the following options: A: Before ferilisation, B: During feilization, C: 5th day after feilization, D: 7th day after feilization - -### Response: -Zona pellucida is thick membranous covering made up of glycoprotein, the microvilli of oocyte and follicular cells project into zona pellucida for nutrition. it prevent polyspermy and implantation. Blastocyst forms at 4th day and by the end of 5th day, zona pellucida disappears and implantation takes place at 6th -7th day after feilization. -### End" -5057,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Differential diagnosis of Nonaccidental injury is all except?, with the following options: A: Osteogenesis imperfecta, B: Scurvy, C: Caffey's disease, D: Osteopetrosis - -### Response: -Ans DD/D of NAI consists all paediatric diseases where there is mostly normal bone pattern and multiple fractures. Osteopetrosis consists of diffuse increase in sclerosis of all bones and pathological fractures can be easily differentiated from NAI. -### End" -5058,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 24 year old unmarried woman has multiple nodular, cystic, pustular and comadonic lesions on face, upper back and shoulders for 2 years. The drug of choice for her treatment would be –, with the following options: A: Acitretin, B: Isotretinoin, C: Doxycycline, D: Azithromycin - -### Response: -The DOC for nodulocystic acne is oral isotretinoin (13-Cis Retinoic acid) -Indications of isotretinoin →   Severe acne (>25 lesions), Nodulocystic lesions, Large nodular lesions, Moderate acne not responding to oral antibiotics (Recalcitrant acne). -### End" -5059,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyperscretory granules seen in with lungCa -, with the following options: A: Adeno Ca, B: Small cell Ca, C: Large cell Ca, D: Bronchoalveolar Ca - -### Response: -Ref:Textbook of pathology (Harsh mohan) 6th edition,page no.500 Small cell carcinoma: Small cell carcinomas are frequently hilar or central in location, have strong relationship to cigarette smoking and are highly malignant tumours. They are most often associated with ectopic hormone production because of the presence of neurosecretory granules in majority of tumour cells which are similar to those found in argentaffin or Kulchitsky cells normally found in bronchial epithelium. By immunohistochemistry, these tumour cells are positive for neuroendocrine markers: chromogranin, neuron-specific enolase (NSE) and synaptophysin. -### End" -5060,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about strychnine poisoning is :, with the following options: A: All muscles affected at the same time, B: Shoulder girdle affected first, C: Pelvic girdle affected first, D: None of the above - -### Response: -A i.e. All muscles affected at same time -### End" -5061,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following test differentiates between diffuse esophageal spasm and GERD, with the following options: A: Barium swallow, B: Manometry, C: Ambulatory 24 hour pH monitoring, D: Biopsy - -### Response: -Symptoms and manometric findings of diffuse esophageal spasm can be caused by GERD. To differentiate between them it is mandatory to do 24 hour pH monitoring. -### End" -5062,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chvostek's sign is elicited by:, with the following options: A: Facial nerve stimulation by tapping over the parotid, B: BP cuff in arm for 5 minutes, C: Tapping over extensor policies brevis, D: Tapping over flexor retinaculum - -### Response: -Chvostek sign This can be elicited by tapping over the facial nerve when it is entering into the parotid gland. This will cause twitching of facial musculature. The sign is referred to as Chvostek sign. It is seen in patients with hypocalcemia due to irritability of nerves But it can be seen in ~10% of normal individuals also -### End" -5063,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is least associated with extra-pyramidal side effects?, with the following options: A: Chlorpromazine, B: Fluphenazine, C: Carbamazepine, D: Haloperidol - -### Response: -Carbamazapine acts on Sodium channel whereas extra pyramidalsymptoms are due to dopamine receptors. Antipsychotic drugs can result in extra-pyramidalsymptoms Typical antipsychotics act by blocking D2 receptors. This leads to two main adverse effects: Hyperprolactinemia Extrapyramidal symptoms Examples of typical antipsychotics are Haloperidol Droperidol Chlorpromazine Thioridazine Fluphenazine -### End" -5064,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following syndrome is associated with Lenticonus?, with the following options: A: Down's syndrome, B: Alpo's syndrome, C: Avellis syndrome, D: Alstrom's syndrome - -### Response: -Bilateral anterior lenticonus is associated with Alpo's syndrome. The lens capsule in Alpo's syndrome is thin and has linear dehiscences. Alpo's syndrome is also associated with deafness and hereditary hemorrhagic nephritis. In lenticonus the surface of the lens has a conical configuration. It could either be anterior or posterior and is caused by the focal thinning of the lens capsule. Anterior lenticonus is associated with Alpo's syndrome. Posterior lenticonus is usually a unilateral sporadic condition that is not associated with other ocular or systemic disease. Ref: Eye Pathology: An Atlas and Text By Ralph C. Eagle 2nd edn page 107. -### End" -5065,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Darkening of urine on standing is associated with –, with the following options: A: Alkaptonuria, B: Cystinuria, C: Fabry's disease, D: Tyrosinemia - -### Response: -Alkaptonuria - -It is an autosomal recessive disorder. -It is due to deficiency of enzyme homogentisic oxidase. -A large amount of homogentisic acid is accumulated in the body and excreted in urine. - -Clinical manifestations - -Clinical features consist of - - - -Ochronosis → Dark spot on the sclera or ear cartilage. -Arthritis → Spine, hip, knee. - - -But both these occur in adulthood. -The only sign of disease in children is a blackening of urine on standing. This is caused by oxidation and polymerization of homogentisic acid. -High incidences of heart disease (mitral and aortic valvulitis, calcification of heart valves, MI) have been noted. -### End" -5066,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of these cells are found in small intestine, EXCEPT:, with the following options: A: Enterochromaffin cells, B: Goblet cells, C: Neck cells, D: Paneth cells - -### Response: -Mucous neck cells are present in clusters or as single cells among the other cells in the necks of gastric glands and include many progenitor and immature surface mucous cells. The major cell types in the epithelium of the small intestine are absorptive enterocytes, mucous cells, Paneth cells, endocrine cells, and M cells. Absorptive enterocytes are responsible for absorption; they arise from continually proliferating undifferentiated cells in the crypts of Lieberkuhn. Mucous cells originate in crypts and migrate to the tips of villi also; mature mucous cells are termed goblet cells. Enterochromaffin cells are the most numerous; N cells (containing neurotensin), L cells (glucagon), and other cells containing motilin and cholecystokinin are also present. Ref: Shelton A.A., Chang G., Welton M.L. (2010). Chapter 29. Small Intestine. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e. -### End" -5067,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30yr female presented with mucosal bleeds on trauma and also has history of menorhhagia. BT and paial prothrombin time are elevated. Ristocetin assay is positive.What shall be the diagnosis?, with the following options: A: Immune thrombotic purpura (ITP), B: Haemophilia A, C: Haemophilia B, D: Von willebrand disease - -### Response: -This is most likely a case of von Willebrand disease The most common inherited bleeding disorder due to deficient / defective von Willebrand factor. Hemophilia A Hemophilia B Von Willebrand Disease Inheritance X linked X linked Autosomal dominant Factor deficiency VIII IX VWF Bleeding site (s) Muscle, joint Surgical Muscle, Joint Mucousal, Skin Activated PTT Prolonged Prolonged Prolonged Bleeding Time Normal Normal Prolonged or normal Factor VIII Low Normal Normal VWF Normal Normal Low Factor IX Normal Low Normal -### End" -5068,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Levels of progesterone indicating unble pregnancy and ble intrauterine pregnancy are:, with the following options: A: 5 ng/ml; 20 ng/ml, B: 10 ng/ml; 20 ng/ml, C: 5 ng/ml; 50 ng/ml, D: 10 ng/ml; 50 ng/ml - -### Response: -Serum progesterone concentration <5 ng/ml suggest a dying pregnancy Level > or = 20 ng/ml suppo the diagnosis of a healthy pregnancy. Ref: Williams Obs 24e pg 355. -### End" -5069,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person with an injury is not able to extend fingers but able to extend the wrist. The nerve which is injured, with the following options: A: Radial nerve, B: Ulnar nerve, C: Median nerve, D: Posterior interosseous nerve - -### Response: -Posterior lnlerosseous Nerve It is marked by joining the following three points. A point 1 cm lateral to the biceps brachii tendon just below the level of the lateral epicondyle . The second point at the junction of the uPPer one third and lower two-thirds of a line joining themiddle of the posterior aspect of the head of the radius to the dorsal tubercle at the lower end of the radius or Lister's tubercle . The third point on the back of the wrist 1 cm medial to the dorsal tubercle. Posterior interosseous nerve supplies the muscles of posterior aspect of the forearm . Extension of wrist joint - .The main extensors are; Extensor carpi radialis longus. Extensor carpi radialis brevis. Extensor carpi ulnaris. It is assisted by the extensors of the fingers and thumb . Ref - bdc 6th edition 153,155 -### End" -5070,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trauma to spleen in a stable patient is best diagnosed by: September 2005, March 2008, with the following options: A: X-ray abdomen, B: USG, C: CT scan, D: diagnostic peritoneal lavage - -### Response: -Ans. C: CT scan Plain radiographs demonstrate a wide variety of abnormal findings. The constitution of findings reflects whether the spleen has sustained capsular rupture. Normal findings on chest and abdominal radiographs do not exclude splenic injury. USG/Focused abdominal sonar for trauma (FAST) is commonly used as the bedside investigation of choice for detection of intra-abdominal blood in abdominal trauma. Diagnostic peritoneal lavage (DPL) is especially useful in the hypotensive, unstable patient with multiple injuries as a means of excluding intrabdominal bleeding. DPL has been largely replaced by FAST. It is extremely sensitive to the presence of intra-peritoneal bleeding, being able to pick up just 20m1 of blood (Sensitivity 85-98%) Relative contraindications to DPL include near term pregnancy (DPL should be carried out supra-umbilically in this situation), presence of a coagulopathy, cirrhosis, and multiple prior abdominal operations. A DPL is deemed positive if blood or bowel contents are aspirated from the abdomen. It is also determined to be positive if on analysis of the dialysate, greater than 100,000 RBC/mml or 5000 WBC/ mm3 are found. False positives on DPL may occur from abdominal wall bleeding from a traumatic catheter placement and from pelvic fractures. CT is the modality of choice for evaluation of blunt abdominal trauma in stable patient because it is not only sensitive, but also has a high specificity. In addition to being able to identify the presence of intra-abdominal fluid, individual organ damage can be identified. Retroperitoneal trauma may be identified and tril trauma not requiring laparotomy may be diagnosed as such. -### End" -5071,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fuctional GI disorders can be differentiated from organic GI disorders by, with the following options: A: Abdominal pain, B: Diarrhea, C: Tenesmus, D: Bleeding PR - -### Response: -Common causes of Bleeding per rectum hemorrhoids anal fissures (tears in the rectal tissue), diveicula (diveiculitis, including Meckel's diveiculum), infections (bacterial and other pathogens) inflammatory bowel diseases (Crohn's disease and ulcerative colitis), angiodysplasia (fragile blood vessels), tumors,polyps, and bowel trauma. Less common causes include upper GI tract problems like ulcers and Mallory-Weiss tears in the esophagus or a dilated vein or varix. Ref: -### End" -5072,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Exclamation mark hairs is seen in :, with the following options: A: Alopecia areata, B: Traumatic alopecia, C: Lichen planus, D: All - -### Response: -A. i.e. Alopecia areata -### End" -5073,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are components of Epidemiological triad except ?, with the following options: A: Environment, B: Agent, C: Host, D: Manpower - -### Response: -Ans. is 'd' i.e., Manpower Epidemiological triad The occurrence and manifestations of any disease, whether communicable or noncommunicable, are determined by the interaction of following three factors. The agent The host The environment -### End" -5074,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30 year old lady is to undergo surgery under intravenous regional anesthesia for her left 'trigger finger'. Which one of the following should not be used for patient?, with the following options: A: Lignocaine, B: Bupivacaine, C: Prilocaine, D: Lignocaine + ketorolac. - -### Response: -B i.e. Bupivacaine -### End" -5075,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year-old woman wishes to donate blood to help alleviate the chronic shortage of blood for transfusion. She is found to be positive for HBsAg and is excluded as a blood donor. She feels fine. There are no significant physical examination findings. Laboratory findings for total serum bilirubin, AST, ALT, alkaline phosphatase, and albumin are normal. Further serologic test results are negative for IgM anti-HAV, anti-HBc, and anti-HCV. Repeat testing 6 months later yields the same results. Which of the following is the most appropriate statement regarding the pathophysiology of this patient's condition?, with the following options: A: Chronic carrier state with no therapy indicated, B: Clinically overt hepatitis will occur within 1 year, C: Erroneous test results that need to be repeated, D: Hepatitis B vaccination series is now required - -### Response: -The persistence of HBsAg in serum for 6 months or more after initial detection denotes a carrier state. Worldwide, most individuals with a chronic carrier state for HBV acquired this infection in utero or at birth. Only 1% to 10% of adult HBV infections yield a chronic carrier state. The carrier state is stable in most individuals, the so-called ""inactive"" carrier state, without an elevation in liver enzymes, and some infected persons may eventually clear the virus. There is currently no therapy to aid this viral clearance Vaccination is useful to prevent infection, not clear the virus, although carriers become a reservoir for infection of others. -### End" -5076,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Beta thalassemia, the most common gene mutation is:, with the following options: A: Intron 1 inversion, B: Intron 22, C: 619 bp deletion, D: 3.7 bp deletion - -### Response: -Ans. is 'a' i.e., Intron 1 inversion The most common mutation causing a thalassemia is intronfinversionThalassemias are autosomal recessive disorder.The most common mutation causing thalassemias is intron/inversionAlso know:o Synthesis of alpha chain is controlled by 2 gene clusters on - Chromosome 16o Synthesis of beta chain is controlled by 2 gene clusters on - Chromosome 11Thalassemia mutations in IndiaMultationsFrequencyo IVS1-5(G-C)o 619 bp delectiono IVS-I (G-T)o FR41/42(TCTT)o FR8/9 (+G )o CodonlS (G-A)o Others48%18%9%9%5%6%100% -### End" -5077,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Window period"" in HIV is defined as -, with the following options: A: Period between infection and appearance of symptoms, B: Period between onset of infection and clinically detectable level of antibodies, C: Time between HIV positivity to AIDS, D: CD4 count <200 - -### Response: -Window period is a period between entry of virus to appearance of detectable Ab in serum -### End" -5078,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to weins modification of the working length determination if bone resorption is there then:, with the following options: A: Reduce the length by 0.5mm, B: Reduce the length by 1mm, C: Reduce the length by 1.5mm., D: Reduce the length by 2mm. - -### Response: -Wein modification of working length determination by radiograph:  -1. Reduce length by 1 mm if NO root + bone resorption  -2. Reduce length by 1.5 mm if bone resorption  -3. Reduce length by 2 mm if both root and bone resorption -### End" -5079,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Scl-70 antibody is characteristics of, with the following options: A: SLE, B: Scleroderma, C: Dermatomyositis, D: Sjogern's syndrome - -### Response: -Ref Robbins 7/e p229 DNA topoisomerase I (anti-Scl 70), is highly specific; it is present in as many as 70% of patients with diffuse scleroderma (and in less than 1% of patients with other connective tissue diseases) and is a marker for the devel- opment of more aggressive disease with pulmonary fibro- sis and peripheral vascular changes. The other ANA is an anticentromere antibody, found in as many as 90% of patients with limited scleroderma (i.e., the CREST syn- drome); it indicates a relatively benign course. -### End" -5080,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following will seen in non- granulomatous uveitis -, with the following options: A: Acqueus flare, B: Iris nodule, C: Krukanberg spindle, D: Broad based posterior synechiae - -### Response: -(A) (Aqueous flare) (155 Nema 6th) (194 Khurana 5th)Distinguishing features between nongranulomatous and granulomatous uveitisFeaturesNongran ulomato usGranulomatousOnsetAcuteInsidiousPhotophobiaMarkedSlightVisualImpairmentModerateMarkedPainMarkedMinimalSiteUsually anterior uveaUsually posterior uveaCiliary injectionMarkedMildKeratic precipitatesFine, white, lymphocytic, multipleLarge, gray, macrophagic, few in numberAqueous flare+++ (Flare predominates)++ (Cells predominate)Iris nodulesAbsentMay be presentPosterior synechiaeThin and weakThick and heavyVitreous hazeSlightModerate to marked -### End" -5081,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: No prior immune suppression is helpful in which type of graft rejection ?, with the following options: A: Acute rejection, B: Hyperacute rejection, C: Chronic rejection, D: None of the above - -### Response: -Answer- B. Hyperacute rejectionHyperacute rejection is caused by ABO incompatibility and preformed cytotoxic antibodies against donor HLA antigens. -### End" -5082,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: TRUE/FALSE statements about achalasia cardia among following is/are: 1. Dysphagia is a presenting problem 2. The cause is absence of Auerbach's plexus 3. Esophagectomy is the treatment 4. Motility improving agents are used in the treatment 5. Barium swallow shows irregular filling defect in lower esophagus, with the following options: A: 1,2,3 true & 4,5 false, B: 1,2,4 true & 3,5 false, C: 1,2,3,4 true & 5 false, D: 1,2,4,5 true & 3 false - -### Response: -Achalasia cardia is motor disorder of the esophageal smooth muscle in which the LES does not relax normally with swallowing, and esophageal body undergoes nonspecific contractions. (peristalsis is absent or reduced). The pathogenesis of achalasia is poorly understood. It involves: Neurologic degeneration either idiopathic or due to infection. The degenerative changes are either intrinsic (degeneration of ganglion cells of auerbach's myenteric plexus) or extrinsic (extraesophageal vagus nerve or the dorsal motor nucleus of vagus nerve) Pharmacological studies suggest dysfunction of inhibitory neurons containing nitric oxide and vasoactive intestinal polypeptide in the distal esophagus. The cholinergic innervation of the LES is intact or affected only in advance disease. As a result of the abnormality, the LES fails to relax, primary peristalsis is absent in esophagus which dilates. As the disease progresses the esophagus becomes massively dilated and touous. Clinical Presentation: Both sexes are equally affected. It may develop at any age but peak years are from 30 to 60 years of age. Classical clinical symptom is progressive dysphagia for both solids and liquids. Dysphagia is worsened by emotional stress and hurried eating. Diagnosis: Chest X-ray shows absence of gastric air bubbles, an air fluid level in the mediastinum in the upright position representing retained food in the esophagus. Barium swallow shows a dilated esophagus with tapering narrowing in the terminal end of esophagus, described as 'BIRD BEAK' appearance. Fluoroscopy shows loss of normal peristalsis in the lower third of the esophagus. Treatment includes heller's cardiomyotomy, forceful dilation by pneumatic balloon, repeated injection botulinum toxins and drugs improving motility of esophagus. Esophagectomy is not a treatment modality for achalasia cardia. Irregular filling defect is a feature of carcinoma esophagus not of achalasia cardia. Ref: CSDT 13/e, Page 428 ; Schwaz 9/e, Page 850 ; Maingot's 10/e, Page 846 ; Manipal manual of Surgery by K. Raj Gopal Shenoy 2/e, Page 312-14 -### End" -5083,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true regarding osteoid osteoma?, with the following options: A: The femur and tibia are the commonest bones involved, B: Radiologically appears as a radiolucent lesion surrounded by dense bone, C: It is a benign bone tumor, presents with severe pain that is typically relieved by aspirin, D: All of the above - -### Response: -Ans. d. All of the aboveOsteoid osteoma is a benign tumor that mainly affects young adults.The femur and tibia are the most common bones involved.Pain is often the presenting feature and relief by aspirin is almost diagnostic.Local surgery is curative.Comparison of osteogenic sarcoma, ewing sarcoma, and osteoid osteoma Osteogenic sarcomaEwing sarcomaOsteoid osteomaPresentationSecond decadeSecond decadeSecond decadeM:FSlightly greater in malesSlightly greater in males3x greater in malesPredispositionRetinoblastoma, radiationNoneMale genderX-raySclerotic destruction: ""sunburst""Lytic with laminar periosteal elevation: ""onion skin""Small round central lucency with sclerotic marginMalignantYesYesNoMetastasesLungs, boneLungs, boneN/ATreatmentChemotherapy, ablative surgeryRadiation and/or surgery*. NSAIDs*. Surgery recommended when associated painPrognosis70% cure without metastasis at diagnosis60% cure without metastasis at diagnosisOver time it may resolve spontaneouslyOutcome If metastasis<20%20-30%N/ARadiology of bone tumorsTumor typeCharacteristicsRadiological findingsOsteochondromaBony exostosis with cartilaginous (chondroid) capTGiant cell tumor""Soap bubble"" appearance on X-rayROsteosarcoma (osteogenic sarcoma)Codman triangle (from elevation of periosteum) Or sunburst pattern on X-ray-Ewing Sarcoma""Onion skin"" periosteal reaction in boneMost common site involved in bone tumorTumor typeSite involvedOsteochondromaMetaphysisGiant cell tumorEpiphysisOsteosarcoma (osteogenic sarcoma)MetaphysisEwing sarcomaDiaphysisOsteoid osteomaDiaphysis Figure -### End" -5084,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Birbereck granules in cytoplasm are seen in-, with the following options: A: Mast cells, B: Langerhan's cells, C: Thrombocytes, D: Myelocytes - -### Response: -Ans. is 'b' i.e., Langerhan's cells -### End" -5085,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements regarding stroke volume is TRUE?, with the following options: A: Decreases by increase in hea rate, B: Determined by pre-diastolic volume, C: Determined by afterload, D: Is equal to cardiac output - -### Response: -Stroke volume = cardiac output/hea rate, i.e it is inversely propoional to hea rate. As a result when hea rate increases the stroke volume decreases. This reduction in stroke volume at high hea rates is due to a decrease in the length of time the hea spends in diastole and thus a reduction in time available to the hea for filling. Stroke volume refers to quantity of blood ejected with each hea stroke. According to Starling's law of hea, stroke volume is determined primarily by the preload. As the preload increases, stroke volume also increases until it reaches a plateau. Stroke volume can also be increased by sympathetic stimulation of the hea. Ref: Physiology Secrets By Hershel Raff, 2nd edn, page 74 -### End" -5086,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old woman in the last trimester of her first pregnancy presents for a routine obstetric evaluation. Her blood pressure is 160/100 mm Hg, and her pulse is 75 per minute. Physical examination shows pitting edema of the extremities. Urinalysis demonstrates 3+ proteinuria. Which of the following is the most dangerous complication of preeclampsia in this patient?, with the following options: A: Amniotic fluid embolism, B: Chorioamnionitis, C: Choriocarcinoma, D: Disseminated intravascular coagulation - -### Response: -Preeclampsia usually begins insidiously after the 20th week of pregnancy with (1) excessive weight gain occasioned by fluid retention, (2) increased maternal blood pressure, and (3) the appearance of proteinuria. As the disease progresses from mild to severe preeclampsia, the diastolic pressure persistently exceeds 110 mm Hg. Proteinuria is greater than 3 g per day, and renal function declines. Disseminated intravascular coagulation (DIC) often supervenes. DIC is a prominent feature of preeclampsia, manifested as fibrin thrombi in the liver, brain, and kidneys. The definitive therapy is the removal of the placenta, hopefully by normal delivery. The other choices are not complications of preeclampsia.Diagnosis: Preeclampsia -### End" -5087,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 year old girl is brought to the dermatologist by her parents. She has many freckles on her face, necks, arms and hands and parents repo that she is unusually sensitive to sunlight. Two basal cell carcinomas are identified on her face. Which of the following processes is most likely to be defective in this patient?, with the following options: A: Repair of double stranded breaks, B: Removal of mismatched bases from the 3' end of Okazaki fragments, C: Removal of pyrimidine dimers from DNA, D: Removal of uracil from DNA. - -### Response: -Xeroderma pigmentosum. The sensitivity to sunlight extensive freckling on pas of the body exposed to the sun Presence of skin cancer at a young age Nucleotide excision repair defect of ultraviolet damaged DNA. -### End" -5088,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adult worm of Echinococcus granulosus is commonly seen in which of the given animals?, with the following options: A: Dog, B: Cat, C: Sheep, D: Pig - -### Response: -(A) Dog[?]Echinococcus granulosus:oOnly found in canine host (Dog or Wolf is Definitive Host)oIntermediate host - sheep or other ruminants. Human is accidental intermediate host.-Eggs ingested-Contaminated food or water-Objects contaminatedoDog becomes infected by eating raw meat containing hydatid cyst.[?]Life Cycle:oDogs are the definitive hosts:-Adult worm develops in the small intestine-Eggs are voided in the feces of the dogs.oSheep are intermediate hosts.oHumans are accidental intermediate hosts: Larval form develops mainly in the liver & lungs.oThe cycle is completed when a dog eats a cyst-infested liver or lungs.[?]Life Cycle: The adult is in the small intestines of the definitive host (dogs). Gravid proglottids release eggs that are passed in the feces.oThe intermediate hosts are infected by ingesting eggs, the egg hatches in the small bowel & releases an oncospherePARTIAL LIST OF ZOONOSESDisease in manAnimal principally involvedA. Bacterial infections*. Anthrax.*. Brucellosis*. Ornithosis*. Q fever*. Leptospirosis*. Tuberculosis*. Plague*. Cattle, sheep, goats, camels, pigs, dogs, horses, buffaloes*. Wild and domestic birds*. Cattle, sheep, goats, wild animals*. Cattle, sheep, goats, pigs, cats, dogsB. Viral infections*. Cowpox*. Monkeypox*. Easternequine encephalitis*. Ross river fever*. Monkeys, rodents*. Horses, rodents*. Horses, cattle, goats, sheep, dogs, rats, bats, pigsC. Protozoan infections*. Leishmaniasis*. Toxoplasmosis*. Trypanosomiasis*. Babesiosis*. D. Helminthic infections*. Clonorchiasis*. Fasciolopsis Schistosomiasis*. Echinococcosis*. Taeniasis, Trichinellosis*. Dogs, cats, swine*. Cats, mammals, birds*. Game animals, cattle*. Dogs, cats, swine, wild mammals, fish*. Swine, dogs*. Dogs, wild carnivores, domestic and wild ungulates*. Swine, rodents, wild carnivores, marine mammals -### End" -5089,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of Osteogenesis imperfecta except:, with the following options: A: Blue sclera, B: Multiple, C: Cataract, D: Hearing loss - -### Response: -Ans. is 'c' i.e. Cataract Osteogenesis imperfecta (firagilitas ossium):This condition is characterised by tendency for frequent fractures because of weak and brittle bones.It results from defective collagen synthesis (type I collagen. Thus also affecting other collagen containing soft tissue such as skin, sclera, teeth, ligaments etc.inheritance is AD or AR*AR is very severe form and the child is bom with multiple fractures and diesClinical features:Blue sclera* (because of thin sclera colour of underlying choroid is visible.)Joint laxity * (b/c of weak ligaments)Hearing loss (b/c of otosclerosis)*Hernias* (because of defective skin)Brittle bones* (because of abnormal synthesis of bone matrix).The fractures unite normally but deformities secondary to malunion or joint contractures may occur.Other causes of 'tendency for easy fractures':Osteoporosis*Osteopetrosis*Osteomalacia*Polio limb -### End" -5090,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mitochondrial DNA (mt-DNA) is known for all except:, with the following options: A: Maternal inheritance, B: Heteroplasmy, C: Leber hereditary optic neuropathy is the prototype, D: Nemaline myopathy results due to mutations in mt- DNA - -### Response: -Nemaline myopathy Autosomal recessive Heterogeneous condition and not a mitochondrial disease. Myopathy d/t 5 genes . All code for thin filament-associated proteins, suggesting disturbed assembly or interplay of these structures as a pivotal mechanism. Mutations of the nebulin (NEB) gene Severe neonatal and early childhood forms -### End" -5091,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corneal endothelium is embryologically derived from:, with the following options: A: Neural crest, B: Ectoderm, C: Mesoderm, D: Endoderm - -### Response: -A. i.e. Neuroectoderm -### End" -5092,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient semiconscious with altered sensorium with visual hallucination and fragmented delusions is suffering from, which of the following disorder -, with the following options: A: Delirium, B: Delusion, C: Schizophrenia, D: Mania - -### Response: -This patient has :- i) Altered sensorium, ii) Visual hallucination, iii) Semiconscious, iv) Fragmented delusions. -All can occur in delirium. -In schizophrenia, mania and demention consciousness and orientation is usually normal. -### End" -5093,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gleason scoring is used for-, with the following options: A: Carcinoma testis, B: Carcinoma colon, C: Carcinoma thyroid, D: Carcinoma prostate - -### Response: -Gleason's microscopic grading system which is based on two features:i) Degree of glandular differentiation.ii) Growth pattern of the tumor in relation to the stroma.These features are assessed by low-power examinationof the prostatic tissue. For clinical staging of prostate cancer,TNM system is considered an international standard. HARSH MOHAN Textbook of pathology 6th edition pg no 720 -### End" -5094,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A ten year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity measured as 200/140 mm Hg. Femaral pulses were not palpable. The most likely diagnosis amongst the flollowing is, with the following options: A: Takayasu aooaeritis, B: Renal parenchymal disease, C: Grandmal seiures, D: Coarcctation of aoa - -### Response: -In coarctation of aoa there will be radiofemoral delay. Ref : Ghai essential of pediatrics, eighth edition,p.no:432 -### End" -5095,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minimally invasive video-assisted thyroidectomy can be done in all except, with the following options: A: Benign solitary nodule, B: Thyroid volume <25mL, C: Prior neck surgery, D: Follicular neoplasm - -### Response: -Minimally invasive video-assisted thyroidectomy involves the use of a 1.5- to 2-cm anterior cervical incision, an endoscopic camera placed into the wound for visualization, self-retaining retractors, and dedicated surgical instruments. This technique is most commonly applied to lobectomy for benign disease, but it has been applied to total thyroidectomy including for malignancy. Prior neck surgery, a large-volume thyroid (>25 mL), a large lesion, and lymphatic metastasis are considered contraindications to this technique. -### End" -5096,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following will cause lathyrism?, with the following options: A: Kesari dhal, B: Mung dhal, C: Jhunjunia seeds, D: Gondhli seeds - -### Response: -Ans: a (Kesari dhal) Ref: Park, 19th ed, p. 512, 524Kesari dhal consumption leads to lathyrism.Toxic principle in kesari dhal is beta oxalyl amino alanine (BOAA).Diet containing over 30% of this dhal if taken over a period of 2-6 month will result in eurolathyrism.The disease mainly affects young males and manifests itself in stages.Interventions:Vitamin C prophylaxisBanning the cropRemoval of toxin - steeping method and parboilingEducationGenetic approachEndemic ascites - Panicum miliare (Gondhli) which gets contaminated with the seeds of crotalaria (Jhunjhunia), which contain pyrrolizidine alkaloids which are hepatotoxic.Epidemic dropsy - Due to ingestion of mustard oil contaminated with argemone oil which contains sanguinarine.Clinical features of epidemic dropsy include:* Swelling of legs* Diarrhoea* Cardiac failure* Glaucoma.The toxic substance interferes with the metabolism of pyruvic acid leading to its accumulation. -### End" -5097,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: New born eye is -, with the following options: A: Myopic, B: Hypermetropic, C: Presbyopic, D: None of the above - -### Response: -Ans. is 'b' i.e., Hypermetropic Eve at birtho Anteroposterior diameter of eye ball is about 16.5 mm (70% of adult size). Adult size is attained by 7-8 years,o Corneal diameter is about 10 mm. Adult size (11.7 mm) is attained by 2 years of age.o Anterior chamber is shallow and angle is narrow,o Lens is spherical at birth.o Retina Apart from macular area, the retina is fully differentiated. Macula differentiates 4-6 months after birth.o Myelination of optic nerve fibres has reached the lamina cribrosa.o New born is usually hypermetropic by +2 to +3D.o Orbit is more divergent (50deg) as compared to adult (45deg).o Lacrimal gland is still underdeveloped and tears are not secreted. -### End" -5098,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which epidemkiological study gives the most accurate result -, with the following options: A: Meta analysis, B: Cross sectional study, C: Randomized control trail with double blinding, D: Coho study - -### Response: -A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Conceptually, a meta-analysis uses a statistical approach to combine the results from multiple studies in an effo to increase accuracy (over individual studies), improve estimates of the size of the effect and/or to resolve unceainty when repos disagree. -### End" -5099,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6-day old neonate presented to NICU with respiratory depression, poor feeding and persistent occurrence of seizures. The child was born at 39 weeks gestation by spontaneous vaginal delivery to healthy parents O/E: - High forehead with unslanting palpebral fissures Hypoplastic supraorbital ridges Epicanthal folds. Depressed nasal bridge with long philtrum Hearing loss Liver dysfunction, polycystic kidneys and patent ductus aeriosus were also present MRI of the brain. Which of the following entity will be found to be increased in the serum of the baby: -, with the following options: A: VLCFAs, B: Phytanic acid, C: Pipecolic acid, D: Pristanic acid - -### Response: -This is a case of Zellweger syndrome (cerebrohepatorenal syndrome) Mutations in peroxisome biogenesis factor (PEX) gene. Peroxisome is involved in oxidative catabolism of VLCFAs Increase of very long chain fatty acids. 1st MRI image shows pachygyria (there are few gyri which are broad and flat) of frontal and parietal lobes. (black arrow) 2nd MRI image shows right parietal pachygyria (black arrow). Present with hypotonia, seizures, liver dysfunction, distinctive facies, polycystic kidneys. OTHER DISORDERS: - Phytanic acid is elevated in neonatal leukodystrophy. Pristanic acid is elevated in infantile refsum disease. Pipecolic acid is elevated in infantile refsum disease. -### End" -5100,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Differentiating features b/w neurosis and psychosis :, with the following options: A: Insight is preserved, B: Lack of insight, C: Personality and behavior preserved, D: None - -### Response: -B i.e. Lack of insight -### End" -5101,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Swan neck deformity seen iri ?, with the following options: A: Osteoarthritis, B: Rheumatoid arthritis, C: Pyogenic arthritis, D: Gout - -### Response: -ANSWER: (B) Rheumatoid arthritis -### End" -5102,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscular rigidity caused by opioids is due to the agonistic effect on which receptor?, with the following options: A: Mu, B: Kappa, C: Delta, D: Sigma - -### Response: -Ans. (A) Mu(Ref: Miller 7th/e p781)Truncal rigidity caused by highly lipid soluble opioids like fentanyl is supraspinal in origin. It is mainly caused by stimulation of mu receptors whereas kappa and delta receptors tend to reduce the rigidity. -### End" -5103,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Concussion injuries to the eye will cause all of the following except, with the following options: A: Sublaxation of lens, B: Soft exudates, C: Macular hole, D: Berlin's oedema - -### Response: -Soft exudates are axoaxonal debris and seen mostly as a result of hypoxia in the retina Refer khurana 6/e -### End" -5104,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following factors contribute to hypothermia in preterm babies except -, with the following options: A: Decreased subcutaneous fat and brown fat, B: Large surface area in relation to body weight, C: Less oxygen consumption, D: Increased muscular activity - -### Response: -Ans. is 'd' i.e., Increased muscular activity -### End" -5105,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of brain death?, with the following options: A: Complete apnea, B: Absent pupillary reflex, C: Absence deep tendon reflex, D: Hea rate unresponsive to atropine - -### Response: -Deep tendon reflexes are of spinal cord origin so they may remain intact, although they are usually absent in a case of brain death. The same applies to Babinski sign. Features of brain death are: Lack of response to internal and external environment Absence of spontaneous breathing movements for 3 minutes, in the absence of hypocarbia and while breathing room air No muscular movements with generalized flaccidity and no evidence of postural activity Falling aerial pressure without suppo by drugs or other means Isoelectric EEG recorded spontaneously and during auditory and tactile stimulation Reflexes and its response: Pupils fixed, dilated and nonreactive Absent corneal reflex Absent supraorbital or other pressure response Absence of snouting or sucking response Absent oculovestibular reflex Absent oculocephalic reflex Absent gag reflex and cough reflex These criteria should be present for at least 2 hours and should be ceified by two physicians other than physician of a potential organ recipient. Ref: Harrison's Principles of Internal Medicine, 15th Edition, Page 139 ; Bailey and Love's Sho Practice of Surgery, 23rd Edition, Page 135 ; The Transplantation and Replacement of Thoracic Organs By David K. C. Cooper, Page 2 ; Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Pages 119-120 -### End" -5106,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following organization is shown below?, with the following options: A: World health organization, B: UNICEF, C: FAO, D: World Bank - -### Response: -Ans. (b) UNICEF -### End" -5107,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sling operation include all except:, with the following options: A: Khanna procedure, B: Shirodkars procedure, C: Abdominocervicopexy, D: Le Fort repair - -### Response: -Ans: d (Le Fort repair) Ref: Shaw, 13th ed, p. 329Le Fort operation is done in old age with procidentia when the patient is unfit for longer duration of surgery.Abdominal sling operations have been designed for young women suffering from 2nd or 3rd degree prolapse, who wish to retain their child bearing and menstrual functions.Sling Operations (Cervicopexy)1. Purandare abdominal sling2. Khanna abdominal sling3. Shirodkar abdominal slingOther surgical procedures for genital prolapse.VH with PFRIndications1. UV prolapse in post menopausal women2. Genital prolapse in perimenopausal age group with DUB. unhealthy cervix or small fibroid3. As an alternative to abdominal hysterectomy or Fothergill operation or LAVHFothergills repair (Manchester operation)Indications* Women below 40 yrs who have completed their family but desirous of retaining their menstrual function* Infra vaginal elongation of cervix.Vault prolapse ManagementConservativePessary treatmentSurgicalTrans vaginal1. Le Fort's operation2. Colpoclesis3. Sacrospinous colpopexyAbdominal1 .Vault suspension (Sacral colpopexy)Prevention of Enterocele while doing AH (Culdoplasty)McCallMoschcowitzHaitianTreatment of procidentia:VH with PFR + right sacrospinous colpopexy. -### End" -5108,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscarinic receptor causes dilatation of vessels-, with the following options: A: M1, B: M2, C: m3, D: m4 - -### Response: -Ans. is 'c' i.e., M3 o M3 receptors are found in vessels (endothelium). Activation of these recepters causes vasodilatation by release of EDRF (NO).o M3 receptors are unique muscarinic receptors in that their activation does not cause release of acetylcholine, rather causes relcease of EDRF (NO). -### End" -5109,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28-year-old male complains of glare in both eyes. The cornea shows whorl like opacities of the epithelium. He also gave a history of long term treatment with amiodarone. The most likely diagnosis is:, with the following options: A: Terrain's marginal degeneration, B: Cornea veicillata, C: Band shaped keratophathy, D: Arcus juvenalis - -### Response: -Ans. Cornea veicillata -### End" -5110,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gartner's duct is present in, with the following options: A: Vaginal wall, B: Broad ligament of uterus, C: Transcervical ligament, D: Perineal body - -### Response: -The content of Broad ligament --        Uterine tube --        Round ligament of the uterus --        Uterine vessels --        Ovarian vessels --        Uterovaginal and ovarian nerve plexus --        Epophoron and its duct (Gartner’s duct) --        Paroophoron --        Lymph nodes and lymph vessels --        Connective tissue -### End" -5111,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arias Stella reaction is not seen in:, with the following options: A: Ovarian pregnancy, B: Molar pregnancy, C: Interstitial pregnancy, D: Salpingitis isthmica nodosa - -### Response: -Ans. is d, i.e. Salpingitis isthmica nodosaRef Novak 14/e, p 608Arias Stella reactionArias Stella reaction is characterized by adenomatous change of the endometrial glands.There is intraluminal budding.Cells loose their polarity, have hyperchromatic nucleus, vacuolated cytoplasm and occasional mitosis.The reaction is seen in ectopic pregnancy (in 10-15% cases) and indicates blightening of conceptus either intra or extra uterine.Arias Stella Reaction is not specific for ectopic pregnancy but for blightening of conceptus either intra uterine or extrauterine.In the options given:OvarianpregnancyInterstitialpregnancy }Are examples of ectopic pregnancy and therefore Arias Stella reaction will be seen in them.Molar pregnancy will lead to blightening of ovum and therefore, Arias Stella reaction may be seen.Salpingitis isthmica nodosa: Salpingitis Isthmica Nodosa (SIN) is a noninflammatory pathologic condition of the tube in which tubal epithelium extends into the myosalpinx and forms a true diverticulum. This condition is found more often in the tubes of women with an ectopic pregnancy than in nonpregnant women. Whether tubal pregnancy is caused by SIN or whether the association is coincidental is unknown.So by itself in SIN, Arias Stella Reaction is not seen. Only when SIN will lead to Ectopic pregnancy then Arias Stella Reaction will be seen. -### End" -5112,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Scrub typhus is cause by, with the following options: A: Rickettsia tsutsugamushi, B: R. prowazekii, C: R. rickettsii, D: R. akari - -### Response: -Ans. a (Rickettsia tsutsugamushi) (Ref Ananthanarayan, Microbiology, 8thfp. 408, 410; Park 20th/263)# Scrub typhus is caused by R. tsusugamushi.# The vector is trombiculide mite.# The microbes are transmitted transovarially in mites.SCRUB TYPHUS (CHIGGER-BORNE TYPHUS)# Causative agent is R. tsutsugamushi.# Important reservoir is trombiculoid mite.# The nymphal and the adult stages of mite are free living in the soil.# They do not feed on vertebrate host.# Larva (chigger) feeds on vertebral host and picks up the rickettsiae.# Infection is maintained in nature transovarially from one generation of mite to next.# Larval stage serves both as reservoir, through ovarian transmission, and as a vector for infecting humans and rodents.# Tertacycline is the only drug of choice.# Sulfonamides should not be given.DiseaseCausative agentsVectorReservoirWF reactionCommentsEpidemicR. prowazekiLouseHuman+++ OX19# Red louse diseasetyphus # Transmitted by Pediculosis corporis and capitis.# Centrifugal rash 5 days after fever# Reactivation leads to Brill-Zinsser diseaseEndemic (Murine) typhusR. typhi (mooseri)Rat fleaRodent+++ OX19# Tunica reaction +# Rash on 4th day of feverScrub typhusR. tsutsugamushiMite (Chiggers)Rodent+++OXK# Punched-out ulcers with eschar# Erythematous rash on 5th day of fever# Lymphadenopathy (Zoonotic tetrad)Indian tick typhusR. conoriiTickRodent Dogs-# Fever boutounneuse# Tachenoir escharRMSFR. ricketssiTickRodent Dogs+++OX19, 2# Most severe ricketssial disease# Rash on wrist, palm and sole 3rd day of fever# Indirect immunofluo-roscence +.Rickettsial poxR. akariMiteMice-# Most mild disease# Eschar seenQ-feverCoxiella burnetti Cattle, sheep and goats-# No rash or local reaction.# No arthropod vector# Vaccine availableTrench feverRochalimaea quintanaLouseHuman-# Only rickettsia that can be culturedEherlichiosisE. senetsu, canlsTick bite--# No eschar/ rash# ""Morules"" diagnostic. -### End" -5113,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ladder pattern of DNA electrophoresis in apoptosis is caused by the action of the following enzyme, with the following options: A: Endonuclease, B: Transglutaminase, C: DNAse, D: Caspase - -### Response: -1.Apoptosis progresses quickly and its products are quickly removed, making it difficult or visualize. 2.During karyorrhexis endonuclease activation leaves sho DNA fragments, regularly spaced in size. 3.this gives a characteristic laddered appearance on agar gel electrophoresis. 4.This laddered pattern is characteristic but not specific for apoptosis..It may seen in necrosis also. Ref Endonuclease. Robbins 7 th /edition, pg 26, 27and 28. -### End" -5114,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following stain is specific for amyloid, with the following options: A: PAS, B: Alizarin red, C: Congo red, D: Von kossa - -### Response: -Ref Robbins 9/e p257; Harrison 17/e p2145 Amyloid is not a structurally homogeneous protein, although it always has the same morphologic appear- ance. In fact, more than 20 (at last count, 23) different pro- teins can aggregate to form fibrils with the appearance of amyloid. Regardless of their derivation, all amyloid deposits are composed of nonbranching fibrils, 7.5 to 10 nm in diam- eter, each formed of b-sheet polypeptide chains that are wound together (Fig. 4-31). The dye Congo red binds to these fibrils and produces a red-green dichroism (birefrin- gence), which is commonly used to identify amyloid deposits in tissues. -### End" -5115,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Ackermans tumor Is, with the following options: A: It is a highly malignant tumor, B: Verrucous carcinoma of the larynx, C: Radiotherapy is the treatment of choice, D: Spreads via lymphatics in early stage itself - -### Response: -It is a low grade locally aggressive malignancy. Well differentiated squaumous cell carcinoma with very low metastasis rate. -Radiotherapy is contraindicated as it can produce anaplastic change. -### End" -5116,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient meets with an accident with resultant transection of the pituitary stalk; what will NOT occur-, with the following options: A: Diabetes mellitus, B: Diabetes insipidus, C: Hyperprolactinemia, D: Hypothyroidism - -### Response: -diabetes mellitus is a multiorgan disorder due to various genetic and environmental factors( Harrison 17 pg 2275) -### End" -5117,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal epidermal - melanin unit is, with the following options: A: 1:32, B: 1:54, C: 1:36, D: 1:38 - -### Response: -Each melanocyte transfers melanin to 36 keratinocytes forming the epidermal melanin unit (1:36). -### End" -5118,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following can aggravate Myasthenia gravis except, with the following options: A: Azathioprine, B: d-Tubocurarine, C: Tetracycline, D: Aminoglycoside - -### Response: -Essentials of medical pharmacology, seventh edition, page no 864, Answer is option 1, Azathioprine This antipurine acts by getting conveed to 6-MP,but has more prominent immunosuppresant action. It mainly supresses cell mediated iimmunity and is mainly used in autoimmune diseases like rheumatoid ahritis, myasthenia gravis, ulcerative collitis etc. -### End" -5119,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In human, fertilization usually occurs in the, with the following options: A: Fimbriated end of uterine tube, B: Ampulla of the uterine tube, C: Isthmus of the uterine tube, D: Uterine cavity - -### Response: -B. i.e. (Ampulla of the uterine tube) (448 - Ganong) (423 - Ganong 23rd)* In humans Fertilization of the ovum by the sperm usually occurs in the ampulla of uterine tube** lined by ciliated columnar epithelium ** (AI - 09), occurs within few hours* Among 200- 300 million of sperms entering female genital tract only few thousand sperms reach the spot near the ovum and only one sperm fertilizes the ovum*** Implantation of the fertilized ovum occurs between 5-7 days after fertilization**.* Spermatogeneis occurs at temperature lower than core body temperature (AI- 09) -### End" -5120,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Macula densa in kidney is located in relation to -, with the following options: A: PCT, B: DCT, C: Afferent aeriole, D: Efferent aeriole - -### Response: -B i.e. DCT -### End" -5121,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common mucocele of the paranasal sinuses involving the orbit arises from:, with the following options: A: Frontal sinus, B: Ethmoidal sinus, C: Maxillary sinus, D: Sphenoidal sinus - -### Response: -Ans. Frontal sinus -### End" -5122,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First in sequence, with the following options: A: Impairment, B: Disease, C: Disability, D: Rehabilitation - -### Response: -Ans. b (Disease). (Ref. Park, PSM, 17th ed., 36)Concept of health and diseaseThe sequence of events leading to disability and handicap is: Disease -impairment -disability -handicap-rehabilitation.WHO definitions:ImpairmentAny loss or abnormality of psychological, physiological or anatomical structure of function.DisabilityAny restriction or lack of ability to perform an activity in manner or within range considered normal for human.HandicapA disadvantage for a given individual resulting from an impairment or disability that limits or prevents fulfillment of role that is normal for that individual.RehabilitationIt is intervention at the level of psychological, vocational and medical. -### End" -5123,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following vascular lesions can be seen commonly in Turner syndrome ?, with the following options: A: Nevus flammeus, B: Cavernous lymphangioma, C: Pyogenic granuloma, D: Capillary hemangioma - -### Response: -Cavernous Lymphangioma: Large,diffuse, poorly defined, fluctuant, soft tissue mass . Found in neck/axilla of children, retroperitoneum (rare) May cause gross deformities of neck, or may fill the axilla. Cavernous lymphangioma of neck can be commonly found in in Turner's syndrome Features : Lesions are composed of dilated lymphatic spaces lined by endothelial cells and separated by intervening connective tissue stroma containing lymphoid aggregates. the tumor margins are indistinct and non-capsulated. -### End" -5124,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the rejection phenomenon after kidney transplant, the primary target for early immunological attack is -, with the following options: A: Vascular endothelium, B: Renal papillae, C: Glomeruli, D: Proximal tubules - -### Response: -Ans. is 'a' i.e., Vascular endothelium -### End" -5125,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with major depressive disorder brought by her mother complaining that she tried hanging herself. She had so many attempts before and she talks more about deaths. Electroconvulsive therapy (ECT) is suggested. Which of the following is the absolute contraindication to ECT?, with the following options: A: Brain rumour, B: Myocardial disease, C: Aoic aneurysm, D: No absolute contraindication - -### Response: -There are no absolute contraindications to the use of electroconvulsive therapy (ECT), but some conditions are relative contraindications, they are:Space-occupying intracerebral lesions (except for small, slow growing tumors without edema or other mass effect)Conditions with increased intracranial pressureUnstable vascular aneurysms or malformationsIntracerebral hemorrhagePheochromocytomaRecent myocardial infarctionRef: Loosen P.T., Shelton R.C. (2008). Chapter 18. Mood Disorders. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e. -### End" -5126,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All enveloped RNA viruses belong to one large group except-, with the following options: A: Influenza, B: Parainfluenza, C: Mumps, D: Herpes - -### Response: -Ans. is 'd' i.e., Herpes . Influenza, paraintluenza and mumps belong to myxovirus. -### End" -5127,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?, with the following options: A: Anterior cruciate ligament, B: Medial meniscus, C: Posterior Cruciate Ligament, D: Lateral lemniscus - -### Response: -Medial meniscus injury is associated with medial collateral ligament injury. Terrible triad: Seen in football players Foot is fixed to ground and knee is in flexion Sustain injury to medial meniscus, anterior cruciate ligament & medial collateral ligament. -### End" -5128,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: `NALGONDA technique' is used in -, with the following options: A: Endemic-fluorosis, B: Epidemic-dropsy, C: Endemic-ascites, D: Ncurolathyrisin - -### Response: -Ans. is 'a' i.e., Endemic fluorosis interventions to prevent fluorosis a) Changing of water source o Running surface water contains lower quantities of fluoride than ground water. b) Chemical treatment Water can be chemically defluoridated in a water treatment plant. The National Environmental Engineering Research Institute, Nagpur has developed a technique for renewing fluoride by chemical treatment, k/a Nalgonda technique. It involves the addition of two chemical (viz lime and alum) in sequence followed by flocculation, sedimentation and f i Iteration. c) Other measures Fluoride toothpastes are not recommended for children in areas of endemic fluorosis. Fluoride supplements should not be prescribed for children who drink fluorinated water. -### End" -5129,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraindications to major hepatic resection for metastatic disease include all of the following Except, with the following options: A: Total hepatic involvement, B: Advanced cirrhosis, C: Extrahepatic tumor involvement, D: Jaundice from extrinsic ductal obstruction - -### Response: -HEPATIC RESECTION Indications * Parasitic and non-parasitic cysts. * Benign and primary malignant tumours of the liver. * A secondary tumour that involves by direct extensions like from carcinoma of the gallbladder or limited secondaries from carcinoma colon/carcinoids. * Trauma to the liver. Contraindication * Advanced cirrhosis Ref: SRB&;s manual of surgery,3 rd ed, pg no 559 -### End" -5130,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Leukocyte migration through capillary wall is called?, with the following options: A: Rolling, B: Diapedesis, C: Migration, D: Pavementing - -### Response: -Ans. is 'b' i.e., Diapedesis o Process of transmigration of leukocytes across the endothelium is called Diapedesis. The most important molecule responsible for diapedesis is called PECAM-1 (Platelet endothelial cell adhesion molecule) or CD-31.About other optionso When leukocytes principally neutrophills accumulate along the vascular endothelium. This is called margination.o The rows of leukocytes move (tumble) slowly along the endothelium a process called rollingo When the endothelium can be virtually lined by white cells called Pavementing. -### End" -5131,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum radiation dose tolerable tissue is -, with the following options: A: Hemopoietic tissue, B: Testis, C: Ovary, D: Bone - -### Response: -Ans. is 'd'i.e., BoneRadio sensitivity of tissuesHighly radiosensitiveModerately radiosensitiveLeast radiosensitive (radioresistant)o Lymphoid tissue o Bone marrowo GIT epithelium o Gonads (Testis, ovary)o Embryonic tissueo Skin o Vascular endotheliumo Stomach, Small intestine, colon. Rectum o Lungo Kidney o Livero Lens (eye)o CNS o Muscleo Pancreas o Bone & cartilageo Connective tissue o Vagina & Uteruso Radiation sensitivity of some human tissues (in discending order)Embryo (most sensitive) > Fetus, lymphatic & hemopoietic organs (lymphocytes > RBCs > platelets) > Bone marrow > intestinal tract > ovaries (ovum) > Testis (sperm cells) > capillaries (vascular endothelium > Mucous membrane & salivary glands > Hair follicles > Bone growth zone (epiphysis) > Breasts > Eye lens > Sweat and sebaceous glands > Epidermis > thyroid > liver and kidneys > Adult bones > Cartilage > Lungs and serous membranes > Vagina > CNS (Brain & spinal cord)> Peripheral nerve > Muscle. -### End" -5132,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: McKneown’s Theory states that reduced prevalence of Tuberculosis occurs due to, with the following options: A: Enhanced knowledge and awareness, B: Medical advancements, C: Behavioural modification, D: Social and environmental factors - -### Response: -• Thomas McKeown attributed the modern rise in the world population, AND DECLINE OF TB from the 1700sto the present to broad economic and social changes (especially diet and nutrition – “Nutritional Determinism”) rather than to targeted public health or medical interventions. -### End" -5133,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cancers are usually associated with:, with the following options: A: Mutations in intronic genes, B: Hypomethylation of oncogenes, C: Methylation of tumor suppressor genes, D: Loss of heterogenicity - -### Response: -Epigenetic changes include:- alterations of chromatin structure mediated by methylation of cytosine residues in CpG dinucleotides modification of histones by acetylation or methylation. The transcriptional regulatory regions of active genes often contain a high frequency of CpG dinucleotides (referred to as CpG islands), which are normally unmethylated. Acetylation of the amino terminus of the core histones H3 and H4 induces an open chromatin conformation that promotes transcription initiation. Hypermethylation of promoter region is common mechanism by which tumor-supressor loci are epigentically silenced in cancer cells. -### End" -5134,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 32-year-old female patient asks you what is the soft, thin ridge of tissue that she can feel running forward across the masseter muscle toward her upper lip. You reassure her that is perfectly normal. Which of the following is the most likely structure she is feeling?, with the following options: A: Facial artery, B: Maxillary artery, C: Parotid duct, D: Marginal mandibular branch of facial nerve - -### Response: -The parotid duct, also known as the Stensen's duct, crosses the masseter muscle transversely and extends to the oral cavity. The facial artery can be palpated in the groove anterior to the mandibular angle. The facial vein lies anterior to the artery, passing toward the angle of the lips, but does not ascend in close proximity to the masseter. All of the other vessels are located more deeply and cannot be palpated. -### End" -5135,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type I membranoproliferative glomerulonephritis is common associated with all except, with the following options: A: SLE, B: Persistent hepatitis c infection, C: Paial lipodystrophy, D: Neoplastic diseases - -### Response: -Secondary MPGN(invariably type 1) is more common in adults and arises in following; Alpha 1 anti trypsin deficiency Malignant diseases paicularly CLL which have formation of autoantibodies Chronic immune complex disorder such as SLE, hepatitis b infection hepatitis c infection . Refer robbins 9/e p922 -### End" -5136,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The nucleus involved in Alzheimer's disease is:, with the following options: A: Basal nucleus of Meyernet, B: Raphe nucleus, C: Superior salivary nucleus, D: Basal lobe of cerebellum - -### Response: -Ans. (a) Basal nucleus of Meyernet(Ref: Harrison 18th ed: 3306, 17th pg 2541)AD is associated with decrease in cerebral cortical level of acetylcholine. This degeneration occurs in nucleus basalis of Meyernet Q -### End" -5137,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: a known case of COPD with acute exacerbation of copd is managed in icu following is not true ?, with the following options: A: NIV is not indicated, B: o2 inhalation, C: salbutamol inhalation, D: iv dexamethasone - -### Response: -Role of NIV in Treating Acute COPD * Preferred therapy for exacerbations of COPD in the acute setting Respiratory acidosis: * PaCO2?_ 45 mmHg (6.0 kPa) * Aerial pH 7.35 * Improves oxygenation, increases pH, and decreases PaCO2 * Decreases respiratory rate, work of breathing (can help overcome auto-PEEP), and severity of breathlessness - Success rates up to 85% ref : willey 10th ed -### End" -5138,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about calcium reabsorption in the kidney?, with the following options: A: Most of the calcium reabsorption occurs in DCT, B: Major regulating factor is Parathormone, C: Parathormone decreases calcium reabsorption, D: Increased plasma phosphate decreases calcium reabsorption - -### Response: -Major regulating factor is parathormone.The primary controller of renal tubular reabsorption is parathormone.It increases calcium reabsorption in Loop of Henle (thick ascending limb) and distal tubules. Most of the calcium (6590) is reabsorbed in PCT. Increased plasma phosphate increases calcium reabsorption. -### End" -5139,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Positive health indicators of nutritional status include all of the following EXCEPT:, with the following options: A: Anthropometric measurements of pre-school children, B: Height of school children at school entry, C: Weight of antenatal mothers, D: Prevalence of low bih weight - -### Response: -(Weight of antenatal mothers) Nutritional status indicators Nutritional status is a positive health indicator. Three nutritional status indicators are considered impoant indicators of health status: a. Anthropometric measurements of pre-school children b. Height of school children at school entry c. Prevalence of low bih weight (< 2.5kg) -### End" -5140,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non enveloped ss - RNA virus is:, with the following options: A: Picornavirus, B: Poxvirus, C: Retrovirus, D: Bunyavirus - -### Response: -Ans. is 'a' i.e., PicornavirusRNA Viruses (+ Stranded)Virus FamilyRNA StructureVirion - Associated PolymeraseEnvelopeShapeMultiplies inMajor VirusesCalicivirusss (+) RNA LinearNo polymeraseNakedIcosahedralCytoplasmNorwalk agent Noro -like virusHepesvirusss (+) RNA linearNo polymeraseNakedIcosahedralCytoplasmHepatitis EPicornavirusss (+) RNA LinearNo polymeraseNakedIcosahedralCytoplasmPolio**ECHOEnterovirusesRhinoCoxsackieHepatitis AFlavivirusss (+) RNA LinearNo polymeraseEnvelopedIcosahedralCytoplasmYello feverDengueSt. Louis encephalitisHepatitis CWest Nile virusTogavirusss (+) RNA LinearNo polymeraseEnvelopedIcosahedralCytoplasmRubellaWEE, EEEVenezuelan encephalitisCoronavirusss (+) LinearNo polymeraseEnvelopedHelicalCytoplasmCoronaviruses SARS - CoVRetrovirusDiploid ss (+) RNA LinearRNA dep. DNA polymeraseEnvelopedIcosahedral or truncated conicalNucleusHIVHTLVSarcomaMnemonic: (+) RNA Viruses: Call Henry Pico and Flo To Come Rightaway** Mnemonic: Picornaviruses: PEE Co Rn A VirusesPolio, Entero, Echo, Coxsackie, Rhino, Hep A -### End" -5141,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50 yr. old woman underwent debulking surgery for advanced epithelial ovarian cancer. What standard adjuvant therapy would be recommended for this woman?, with the following options: A: Paclitaxel and carboplatin for six cycles, B: Paclitaxel and carboplatin for six cycles and radiotherapy, C: Paclitaxel for six cycles and radiotherapy, D: Radiotherapy alone - -### Response: -Ans. A. Paclitaxel and carboplatin for six cyclesAdjuvant therapy for ovarian cancer:a. Stage I, grade 1 = no adjuvant chemotherapy after complete staging laparotomyb. High grade, high risk stage I = carboplatin + paclitaxel for 3 - 6 cyclesc. Advanced ovarian malignancy = treatment is surgical debulking followed by chemotherapy.d. Chemotherapy = carboplatin + paclitaxel for 6 - 8 cycles. -### End" -5142,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Routine Rh typing includes testing?, with the following options: A: A antigen, B: B antigen, C: C antigen, D: D antigen - -### Response: -Ans. is 'd' i.e., D antigen o After ABO, the most important antigen in transfusion practice is D. The D antigen is a member of the Rh system. -### End" -5143,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On vigorous exercise, the respiratory function largely depends upon -, with the following options: A: Available of ADP, B: Available of substrate, C: Glycogen stores, D: Increased IP - -### Response: -During intense, intermittent exercise and throughout prolonged physical activity, muscle glycogen paicles are broken down, freeing glucose molecules that muscle cells then oxidize through anaerobic and aerobic processes to produce the adenosine triphosphate (ATP) molecules required for muscle contraction.The rate at which muscle glycogen is degraded depends primarily upon the intensity of physical activity; the greater the exercise intensity, the greater the rate at which muscle glycogen is degraded. As a result, high-intensity activity, such as repeated sprinting, can quickly lower glycogen stores in active muscle cells, even though the total time of activity might be relatively brief (eg, 10 x 30-s sprints with sho recovery intervals). In comparison, an endurance athlete who trains for hours at a time will also experience a marked decline in muscle glycogen, although at a slower rate of degradation than the sprinter. Ref Davidson 23rd edition pg 730 -### End" -5144,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about proximal fragment In supratrochantric fracture is, with the following options: A: Flexion, B: Abduction, C: External rotation, D: All of the the above - -### Response: -The peritrochanteric fracture is one of the most serious causes of mortality and morbidity in the elderly. -Subtrochanteric fractures account for approximately 10-30% of all peritrochanteric fractures, and they affect persons of all ages. -1,2 The subtrochanteric region of the femur is generally recognized to be the area of the femur below the inferior border of the lesser trochanter, extending distally 7.5 cm to the junction of the proximal and middle third of the femur.3 Most frequently, these fractures are seen in two patient populations, namely older osteopenic patients after a low-energy fall and younger patients involved in high-energy trauma.1-3 In elderly patients, minor slips or falls that lead to direct lateral hip trauma are the most frequent mechanism of injury. -This age group is also susceptible to metastatic disease that can lead to pathologic fractures. -In younger patients, the mechanism of injury is always high-energy trauma, either direct or from axial loading (e.g., a fall from height), which often creates a comminuted fracture. -### End" -5145,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apart from occurring in nucleic acids, pyrimidines are also found in, with the following options: A: Theophylline, B: Theobromine, C: Flavin mononucleotide, D: Thiamine - -### Response: -Usually, purine and pyrimidine are found in nucleic acids (DNA and RNA) as a part of nucleotides. -Pyrimidines also occur in thiamine (vitamin B1) and alloxan. -Purine is also a structural component of a number of essential coenzymes, e.g. coenzyme-A, NAD+, NADP+ and FAD+. -### End" -5146,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: “Tophus” is the pathognomonic lesion of which of the following condition:, with the following options: A: Multiple myeloma, B: Cystinosis, C: Gout, D: Eales disease - -### Response: -Tophi are pathognomonic of gout. They are formed by large aggregations of urate crystals. The urate crystals are surrounded by -a. Macrophages -b. Lymphocytes -c. Large foreign body giant cells - -They are seen in them. - -a. Articular cartilages of joints * -b. Periarticular ligaments* -c. Tendons and soft tissues* -d. Achilles tendon* -e. Earlobes* - -Also, remember these very important points related to Gout- -Hyperuricemia is present in approximately 5% of individuals. Most of them are asymptomatic with regard to their hyperuricemia and are at no clinical risk. -The most recognized complication of Hyperuricemia is Gouty arthritis. The higher the serum level of urate the more likely an individual is to develop Gout. -Acute attack of gout occurs without any precipitating cause or may occur following rapid fluctuations in serum urate levels. -Most common joint involved in Gout is Big toe (First metatarsophalangeal) -Diagnosis of Gout- - By observing monosodium urate crystals in polarized light. These are needle-shaped* and strongly negative birefringent crystal -### End" -5147,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a pyrimidine base ?, with the following options: A: Cytosine, B: Uracil, C: Guanine, D: Thymine - -### Response: -Ans. is 'c' i.e., Guanine Purines Pyrimidines Adenine Cytosine Guanine Uraci I Thymine Both purines (adenine and guanine) are found both in DNA & RNA. Among pyrimidines - Li Cytosine and uracil are found in RNA (thymine is not found in RNA). Cytosine and thymine are found in DNA (uracil is not found in DNA). In DNA, adenine is always paired with thymine by two hydrogen bonds; and guanine always paired with cytosine by three hydrogen bonds. -### End" -5148,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35yr old Chemical factory worker come to Emergency dept. with sudden splash of an unknown chemical over his hand and feet. All are true about this type of burn except ?, with the following options: A: Copious irrigation with water, B: Alkalis are more destructive and dangerous, C: Try to neutralise the chemical, D: Topical Calcium gluconate is used in the treatment of Hydroflouric burn - -### Response: -Management of chemical burn:- Copious irrigation with water or saline Performed for a minimum of 20 minutes Exceptions Elemental metals - Causes exothermic reaction with water * Phenol - leads to deeper infiltration of tissues Treatment should continue - until skin pH is normal Remove the contaminated clothing's & Jewelry Do not try to neutralize the chemical burn Neutralization causes Exothermic reaction - leads to fuher injury Calcium gluconate is used in the treatment of Hydroflouric burn -### End" -5149,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following childhood tumors show extracranial metastasis?, with the following options: A: Glioblastoma multiforme, B: Medulloblastoma, C: Choroid plexus carcinoma, D: Ependymoblastoma - -### Response: -b. Medulloblastoma(Ref: Nelson's 20/e p 2453-2460, Ghai 8/e 612-613)Among the given options, Medulloblastoma is the most malignant brain tumor seen in children. Up to 30% of patients with medulloblastoma present with neuroimaging evidence of leptomeningeal spread. -### End" -5150,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following, intraocular pressure is very high and inflammationis minimum?, with the following options: A: Glaucomatocyclic crisis, B: Acute iridocyclitis, C: Hypetensive uveitis, D: Angle closure glaucoma - -### Response: -(Ref: Khurana 7th/e p.175 & 4th/e p.160) Glaumatocyclic crisis Glamatocyclitic crisis (Posner - Schlossman syndrome) is a unilateral recurrent non-granulomatous iritis that associated with an elevated ocular pressure during the attacks. This self-limiting condition tends to occur in persons. A mild inflammatory reaction is very rarely present as evidenced by a few keratic precipitates on the posterior surface of the cornea. Many patients (55%) subsequently develop open angle glaucoma. -### End" -5151,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A chronic smoker presents with mild haemoptysis. He also gives a history of hypeension and obesity. Lab data showed raised ACTH levels, which were not suppressed by dexamethasone. A diagnosis of Cushing's syndrome is made. Which among the following is the cause of Cushing's syndrome in the patient ?, with the following options: A: MEN I, B: Pituitary adenoma, C: Adrenal coical adenoma, D: Ectopic ACTH secreting tumor - -### Response: -The main clues in this question are that the patient is a smoker with hemoptysis, has high ACTH level which is not suppressed by dexamethasone. Cushings syndrome could be due to ACTH hypersecretion by the pituitary in 40%, non pituitary ACTH producing neoplasm in 10% and in 30% due to excessive autonomous secretion of coisol by the adrenals independent of ACTH. Since this patient has high ACTH levels the underlying cause could be either pituitary adenoma or non pituitary neoplasm producing ACTH like small cell lung cancer. As this patient is a symptomatic smoker the most likely cause would be a small cell lung cancer. And this ACTH cannot be suppressed by dexamethasone. ACTH produced by pituitary neoplasm can be suppressed by dexamethasone. Ref: CURRENT Medical Diagnosis & Treatment 2014 chapter 26. -### End" -5152,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are Neural crest derivatives EXCEPT, with the following options: A: Odontoblasts, B: Sympathetic ganglia, C: Iris muscles, D: C cells of thyroid gland - -### Response: -- Neural crest cells themselves are coming from epiblasts which contribute to numerous structures in body like peripheral nervous system etc. Derivatives of Neural Crest Cells: - Sensory neurons of cranial ganglia - V, VII, VIII, IX, X - Sensory neurons of spinal dorsal root ganglia & their peripheral sensory receptors - Satellite cells in all sensory ganglia - Sympathetic ganglia & plexuses - Neurons & satellite cells - Parasympathetic ganglia & plexuses - Neurons & satellite cells - Enteric plexuses - Neurons & glial cells - Schwann cells of all peripheral nerves - Medulla of suprarenal gland, chromaffin cells - Carotid body type I cells (and type II, satellite type cells) - Calcitonin-producing cells ( c-cells) - Melanocytes - Mesenchymal derivatives in the head - Frontal, parietal, squamous temporal, nasal, vomer, palatine bones, maxillae & mandible - meninges - Choroid, sclera, iris & ciliary body (controversial) (Iris muscles- Sphinctor & dilator pupillae - from neural plate ectoderm) - Connective tissue of lacrimal, nasal, labial, palatine, oral & salivary glands. - Dentine of teeth (odontoblasts - Connective tissues of head, including cailage, ligaments & tendons - Connective tissues of thyroid gland & of pharyngeal pouches i.e, parathyroid glands & thymus - Tunica media of outflow tract of hea & the great vessels. -### End" -5153,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is used for Severe male factor infertility?, with the following options: A: GIFT, B: ZIFT, C: ICSI, D: IVF - -### Response: -(C) ICSI# In cases of severe male factor infertility in which sperm count is low, a sperm cannot fertilize an egg, or the sperm has to be surgically retrieved, intracytoplasmic sperm injection (ICSI) is a highly effective solution.> ICSI involves the insertion of a single sperm directly into a mature egg obtained from the ovary of a woman undergoing in-vitro fertilization (IVF). Often, this procedure results in the fertilization and development of a normal embryo.> If ICSI is combined with IVF to improve the sucess rates.> GIFT (gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer) are modified versions of in vitro fertilization (IVF). -### End" -5154,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The first line of treatment of infertility in PCOD is, with the following options: A: Cabergoline, B: GNRH, C: Clomiphene, D: FSH - -### Response: -Clomifene, also known as clomiphene, is a medication used to treat infertility in women who do not ovulate. -This includes those who have polycystic ovary syndrome. Use results in a greater chance of twins. It is taken by mouth once a day. -### End" -5155,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest complication of extra capsular interochanteric fracture of neck of femur is:, with the following options: A: Non union, B: Ischemic necrosis, C: Malunion, D: Pulmonary complications - -### Response: -C i.e. Malunion -### End" -5156,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The major contribution of the ammiotic fluid after 20 weeks of gestations, with the following options: A: Ultrafiltrate and maternal plasma, B: Foetal urine, C: Foetal lung fluid, D: Foetal skin - -### Response: -(Foetal urine): Ref: 37, 214, 218, 464-D Obstetrics - G. Chamberlain 7thAMNIOTIC FLUIDProduced: In early pregnancy, from amnion over placenta and sacLate pregnancy: from fetal urine as wellVolume: Increase to 38 weeks (500 - 1500 ml)50 ml: 12 weeks500 ml: 24 weeks1000 ml: 36 weeksOsmolality: Decreases in late pregnancyCreatinine: Increases in late pregnancyAcid - base: Normally accumulation of CO2 and fixed acid causes a slight reduction in pH (About 7.15 - 7.20)* The foetus drinks about 400 ml of liquer every day at term and equal amount is excreted in the urine* The water in the amniotic fluid is completely changed and replaced in every 3 hours.* Abnormal colour- Meconium stained (green) - Foetal distress Breech or transverse- Golden colour - Rh. Incompatibility- Greenish yellow (Saffron) - Post maturity- Dark coloured - concealed accidental hemorrhage- Dark brown (tobacco juice) - IUD* Amniotic Fluid Index (AFI) - An AFI between 5 and 25 cm is normal and an AFI less than 5 cm (< 10 centile) indicates oligohydramnios and AFI more than 25 cm (> 95 centile for gestational age) indicates Polyhydramnios (464-D) -### End" -5157,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cullen's sign -, with the following options: A: Bluish disclolouration of the flanks, B: Bluish disclolouration of the flanks, C: Migratory thrombophelebitis, D: Subcutaneous fat necrosis - -### Response: -Ans. is 'b' i.e., Bluish discolouration in the umbilicus Cullen's sign - Bluish discoloration at the umbilicus Grey Turner's sign - Bluish discoloration at the flanks Ct. Mnemonic: GF (Girl Friend) Cullens --> Umbilicus Grey Turner's --> Flanks -### End" -5158,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tear drops formed by all except ?, with the following options: A: Glands of Manz, B: Meibomian, Zeis and Moll glands, C: Lacrimal glands, D: Lacrimal puncta - -### Response: -Ans. is 'd' i.e., Lacrimal puncta The major function of lacrimal apparatus is to secrete and drain the tear. Tear film consists of 3 layers :? Mucous or mucin layer (innermost):- Secreted by conjunctival goblet cells, crypts of Henle, glands of Manz. Aqueous layer (intermediate) :- This forms the bulk of the tear. It is secreted by main lacrimal and accessory lacrimal glands. Lipid layer (outermost) :- Secreted by the Meibomion Zeis, and Moll glands. -### End" -5159,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Under the National Polio Eradication Programme, a case ofAcute Flaccid Paralysis is confirmed as Polio, under the following circumstances except ?, with the following options: A: If a case is lost to follow up, B: If a case could not be confirmed because the patient died before that, C: If a wild strain of polio virus is isolated from stool, D: If a patient develops paralysis 30 days after diagnosis of AFP - -### Response: -Ans. is 'd' i.e., If a patient develops paralysis 30 days after the diagnosis of AFP o The patient checked for residual paralysis 60 days after the diagnosis of AFP. Strategies for polio eradication in India a) Conduct pulse polio immunization days every year for 3-4 years or until poliomyelitis is eradicated. b) Sustain high levels of routine immunization coverage. c) Monitor OPV coverage at district level and below. d) Improve surveillance capable of detecting all cases of AFP due to polio and non-polio aetiology. e) Ensure rapid case investigation, including the collection of stool samples for virus isolation. f) Arrange follow-up of all cases of AFP at 60 days to check for residual paralysis. g) Conduct outbreak control for cases confirmed or suspected to be poliomyelitis to stop transmission. -### End" -5160,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common malignancy of vulva is -, with the following options: A: Squamous cell carcinoma, B: Adenocarcinoma, C: Melanoma, D: Bartolin's gland tumor - -### Response: -Ans. is 'a' i.e., Squamous cell carcinoma Vulvar Carcinomao Squamous cell carcinoma is the most common histologic typeo Most patients are asymptomatic at diagnosis.o If symptoms exist, vulvar pruritis, mass, lump are the most common findingso Bleeding, ulcerative lesion, discharge, pain, dysuria - less frequent symptomso Large metastatic mass in the groin - Occasional symptom.Sites involvedo Labia majora and minora (60%)o Clitoris (15%)o Perineum (10%)o Too extensive to determine the site (10%)o Multifocal (5%)Staging of vulvar carcinomaStage ITumor confined to vulvaIALesions 2cm in size or with stromal invasion > 1mm, confined to the vulva or perineum, with negative nodes.Stage IITumor of any size with extension to adjacent perineal structures (one - third lower urethra, one - third lower vagina, anus) with negative nodes.Stage IIITumor of any size with or without extension to adjacent perineal structures (one - third lower urethra, one - third lower vagina, anus) with positive inguino - femoral lymph nodes.Stage IVDistant metastasis. -### End" -5161,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cryopercipitate is Rich in which of the following clotting factor, with the following options: A: Factor 2, B: Factor5, C: Factor 7, D: Factor 8 - -### Response: -ref Robbins 7/e p664 Cryoprecipitate is prepared from plasma and contains fibrinogen, von Willebrand factor, factor VIII, factor XIII and fibronectin. Cryoprecipitate is the only adequate fibrinogen concentrate available for intravenous use. Cryoprecipitateis available in pre-pooled concentrates of five units. -### End" -5162,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following factors decrease the minimum alveolar concentration (MAC) of an inhalational anesthetic agent except, with the following options: A: Hypothermia, B: Hyponatremia, C: Hypocalcemia, D: Anemia - -### Response: -Factors Decreasing MAC (Minimum alveolar concentration) Drugs Propofol Etomidate Barbiturates Benzodiazepines Ketamine a2Agonists (clonidine, dexmedetomidine) Ethanol (acute use) Local anesthetics Opioids Amphetamines (chronic use) Lithium Verapamil Age Elderly patients Electrolyte Disturbance Hyponatremia Other Anemia (hemoglobin < 5 g/dL) Hypercarbia Hypothermia Hypoxia Pregnancy Ref: Miller 7/e p1243 Table 39-3; Morgan 5/e p164 -### End" -5163,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about peripheral nerve injury in upper limb :, with the following options: A: Radial nerve injury cause anaesthesia over anatomical snuff box, B: Index finger anesthesia is caused by median nerve injury, C: Ulnar nerve injury cause claw hand, D: All - -### Response: -A i.e. Radial nerve injury cause anaesthesia over anatomical snuff box; C i.e. Ulnar nerve injury cause claw hand; B i.e. Index finger anesthesia is caused by median nerve injury -### End" -5164,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum growth spu in boys occurs at, with the following options: A: 8-10yrs, B: 10-12yrs, C: 12-13yrs, D: 14-15yrs - -### Response: -Height velocity curves for male, show maximum growth velocity at 14-15 yrs Height velocity curves for female,show maximum growth velocity at 11-13 yrs Ref: Nelson's 20th edition, page 84-89 -### End" -5165,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the nerve supplying gamellus inferior muscle?, with the following options: A: Nerve to obturator internus, B: Nerve to obturator externus, C: Nerve to quadratus femoris, D: Ventral rami to S1 and S2 - -### Response: -Ans. C Nerve to quadratus femorisRef: BDC, 6th ed. vol. II pg. 69; Grays Anatomy 40th ed. pg. 1384* Quadratus femoris and gamellus inferior muscle are arranged together. Nerve which is bifurcating to supply quadratus femoris muscle, supplies gamellus inferior muscle as wellExtra Mile* Nerve supply of piriformis: Ventral rami to S1 and S2* Nerve supply of obturator externus muscle: Posterior division of obturator nerve -### End" -5166,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On external examination the classical presentation of the body of traumatic asphyxia is -, with the following options: A: Facial abrasions, B: Contused chest, C: Masque ecchymotique, D: Depressed chest - -### Response: -Postmoem finding in traumatic asphyxia External findings: Masque ecchymotique: it refers to classical description in traumatic asphyxia. Florida red or blue congestion of face and neck. There will be congestion of face due to efflux of blood. There may be petechial hemorrhages into the skin of face and neck, eye lids, conjunctiva and mucous membrane of mouth. Deep cyanosis of the face. There may be bleeding from the nostrils and ears Demarcation line: there will be congestion above the level of compression and pallor below the level of compression and form a line of demarcation. This is because of efflux of blood to the pressure exeed on the chest. Pallor: both lower limbs, abdomen and lower pa of chest will be pale ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE NO 259 -### End" -5167,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chemical regulation of respiration is not affected by, with the following options: A: pH, B: BP, C: pO2, D: pCO2 - -### Response: -The chemical control of breathing is aimed at maintaining the PCX and PCO2 of arterial blood at about 95 mm Hg and 40 mm Hg, respectively. -Chemical signals which regulate respiration are sensed by respiratory chemoreceptors. Respiratory chemoreceptors are sensory receptors for detection of PO2 PCO2 and pH of blood. Their location may be central ( within the CNS) or peripheral (in the PNS). They bring about reflex changes in the rate and depth of respiration in response to change in PO2 PCO2 and pH. The response to changes in PO2 (hypoxia) is mediated entirely by peripheral chemoreceptors, whereas the response to hypercapnia ( ↑ PCO2) and academia (↓ pH) is mediated mainly (75%) by central chemoreceptors and partly (25%) by peripheral chemoreceptors. -### End" -5168,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paralysis of 3rd, 4th, 6th nerves with involvement of Ophthalmic division of 5th nerve, localizes the lesion to-, with the following options: A: Cavernous sinus, B: Apex of orbit, C: Brainstem, D: Base of skull - -### Response: -*Paralysis of 3rd, 4th, 6th nerve and involvement of Ophthalmic division of 5th nerve -> cavernous sinus thrombosis. *Paralysis of 3rd, 4th, 6th nerve, Ophthalmic division of 5th nerve plus optic nerve signs -> orbital apex syndrome. Ref: Khurana 7th/e p.428 -### End" -5169,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45yr old presents with paresthesia Hb 6.8 g1dL Peripheral smear shows macrocytes and neutrophils with hypersegmented nuclei Endoscopy reveals atopic gastritis Which of the following defficiency is more likely ?, with the following options: A: VitB 12defficiency, B: Niacin deficiency, C: Riboflavin deficiency, D: Riboflavin deficiency - -### Response: -REF : LIPINCOTT -### End" -5170,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NOT a derivative of midgut:, with the following options: A: Appendix, B: Jejunum, C: Ascending colon, D: Descending colon - -### Response: -Ans. (d) Descending colonRef. Langman's Medical embryology 9th ed./ 298* ""Descending colon is a derivative of Hindgut""PartPart in adultGives rise toArterial supplyForegutOesophagus to first 2 sections of the duodenumOesophagus, Stomach, Duodenum (1st and 2nd parts), Liver, Gallbladder, Pancreas, Spleen, Superior portion of pancreasCeliac trunkMidgutLower duodenum, to the first two-thirds of the transverse colonLower duodenum, jejunum, ileum, cecum, appendix, ascending colon, and first 2/3rd of the transverse colonBranches of the superior mesenteric arteryHindgutLast third of the transverse colon, to the upper part of the anal canalLast third of the transverse colon, descending colon, rectum, and upper part of the anal canalBranches of the inferior mesenteric artery -### End" -5171,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement is:, with the following options: A: Repressor binds operator gene, B: Regulator genes produce repressor subunits, C: IPTG is inducer but not substrate, D: Regulator gene is inducible - -### Response: -Ans. D. Regulator gene inducible(Ref: Harper 31/e page 412)Structural genes are inducible, not the regulator genes.Lac I gene produces Repressor subunits.IPTG is an inducer of lac-operon, but itself is not a substrate. This is called gratuitous inducer. -### End" -5172,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about NK cells are true except -, with the following options: A: They are derived from large granular cells, B: They comprise about 5% of human peripheral lymphoid cells, C: They are MHC restricted cytotoxic cells, D: They express IgG Fc receptors - -### Response: -Ans. is 'c' i.e., They are MHC restricted cytotoxic cells -### End" -5173,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In psychoanalytic terms, obsessive-compulsive disorder is fixed at -, with the following options: A: Oedipal stage, B: Genital stage, C: Oral stage, D: Anal stage - -### Response: -OCD results from a regression from the oedipal phase to anal phase of psychosexual development, i.e. In OCD fixation occurs in anal stage (Note - Regression is reversion from higher level of development to lower level of development). -### End" -5174,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 4-year-old child presents with sudden onest of sore throat, hoarseness and difficulty in breathing. The patient has a high temperature, is drooling and prefers to lean forward. The most likely diagnosis is, with the following options: A: Acute epiglottitis, B: Bronchiolitis, C: Streptococcal pharyngitis, D: Whooping cough - -### Response: -(A) Acute epiglottitis # CLINICAL FEATURES:* Onset of symptoms is abrupt with rapid progression.* Sore throat and dysphagia are the common presenting symptoms in adults.* Dyspnoea and stridor are the common presenting symptoms in children. They are rapidly progressive and may prove fatal unless relieved. Fever may go up to 40degC. It is due to septicaemia. Patient's condition may rapidly deteriorate. -### End" -5175,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A newborn with 46XX has external genitalia of male. All the following are the possible causes except:, with the following options: A: Placental aromatase deficiency, B: Maternal androgen adrenal tumor, C: Anti mullerian hormone deficiency, D: Wnt 4 mutation - -### Response: -The karyotype of the baby is 46 XX and external genitalia are of male, i.e. it is a case of female pseudohermaphroditism. -Causes of female pseudohermaphroditism are: -• Congenital adrenal hyperplasia. (M/C cause) -• Increased androgens in the mother which cross the placenta and cause virilization of the external genitalia. Like -maternal intake of androgenic drugs, maternal adrenal tumor, etc. -• Placental aromatase deficiency. Aromatase enzyme is responsible for conversion of testosterone to estradiol. If this enzyme is deficient there will be excess of testosterone. -• Wnt4 mutation. Wnt4 Mullerian aplasia is a disorder that occurs in females and affects their reproductive system. There is abnormal development of the Mullerian duct, and ovarian dysfunction so females have an underdeveloped or absent uterus and may also have abnormalities of other reproductive organs. Women with this condition have primary amenorrhea, normal breast and pubic hair development and higher than normal levels of androgens in their blood. These high levels of androgens cause acne, hirsutism and virilisation. Kidney abnormalities may also be present in some affected individuals. -### End" -5176,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following are the causes of painless sudden onset of loss of vision except -, with the following options: A: Acute congestive glaucoma, B: Vitreous hemorrhage, C: CRAO, D: Central serous retinopathy - -### Response: -Ans. is 'a' i.e., Acute congestive glaucoma o Acute congestive glaucoma causes sudden painful loss of vision.SuddenGradualPainfulPainlessPainfulPainlesso Acute congestive (angle closure) glaucomao Acute iridocyclitis (uveitis)o Chemical & mechanical injury to eyeballo Endophthalmitiso Optic neuritiso Macular edemao CRAO (central retinal artery' occlusion)o CRVO (central retinal vein occlusion)o Central serous retinopathyo Retinal detachmento Exudative Age-Related Macular Degeneration (ARMD)o Vitreous & retinal hemorrhageo Methyl alcohol amblyopiao Subluxation or dislocation of lenso Corneal ulcerationo Chronic simple glaucomao Chronic iridocyclitis (uveitis)o Progressive pterygiumo Corneal dystrophyo Comeal degenerationo Cataract (development & senile)o Chorioretinal degenerationo Dry type- Age-related macular degeneration (ARMD)o Diabetic retinopathyo Refractive errorso Presbyopia -### End" -5177,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonly used route of administration for general anaesthesia is, with the following options: A: Inhalational, B: Intravenous, C: Intraarterial, D: Subcutaneous - -### Response: -Ans. b (Intravenous). (Ref: Anesthesia by Ajay Yadav 2nd/pg. 71; KD Tripathi, 5th/pg. 342)INTRAVENOUS ANAESTHESIA# The most commonly used route of administration used for general anesthesia is IV for induction of anesthesia and inhalational agents are preferred for maintenance.# The most commonly used IV anesthetic agent for induction is thiopentone,# Ideal characteristics of IV anesthetics are- Compatible with other dugs- High therapeutic index- Inexpensive- Independent of liver/kidneys for metabolism/excretion- No toxic metabolites- Long shelf life and resistance to microbial contamination- Non-cumulative- Non-allergenic- No cardiopulmonary depression- No effect on cerebral blood flow- No endocrinologic effect- No pain on injection- Quick and smooth induction-recovery- Reversible with specific antagonist- Potent, so small volume is required for anesthetic induction/maintenanceIV Anesthetic agents:BarbituratesNon-barbituratesDissociatives- Oxybarbiturate - pentobarbital and methohexital- Thiobarbiturates - thiopental and thiamylal- Propofol- Etomidate- Alphaxalone- PropanididKetamineTiletamine -### End" -5178,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Korsakoff syndrome true is / are -, with the following options: A: Can be seen in chronic alcoholics, B: Absence of intellectual decline, C: Chronic amnestic syndrome, D: All the above - -### Response: -Ans. is 'd' i.e., AH the above Korsakoff syndromeo Korsakoff's syndrome is the chronic amnestic syndrome that follow Wernicke's encephalopathy, and the two syndrome are believed to be pathophysiologically related. Korsakoff's syndrome is characterized by severe and irreversible memory impairments and confabulation behavior in the absence of intellectual decline or attention deficit. Important clinical features are : -Memory : - The Korsakoff syndrome is characterized by both antegrade (i.e., learning) and retrograde (i.e., memory' of past events) amnesia. Antegrade amnesia is severe with lack of insight. Retrograde amnesia is not as severe. New learning and recent memory' is impaired but remote memory' is relatively preserved. Although remote memory' is relatively preserved, patient is unable to organize them in a temporal context and distort the relationship between facts and fill the remote memory' gaps by confabulation. There is profound deficit of explicit {conscious or declarative) type of long term memory, with little impairment of implicit (unconscious or non-declarative) type of long term memory.Personality : - Passive and malleable such that they display lack of initiatives, interest, or concern and diminished spontaneity.Other : - Perseveration, lack of motivation (amotivational syndrome), apathy, passivity.General intellegence, language and motor & perceptual skills are not impaired. -### End" -5179,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Salmonellosis is most common in:, with the following options: A: Sickle cell anemia, B: Thalassemia, C: Hemophilia, D: Cystic fibrosis - -### Response: -a. Sickle cell anemia(Ref: Nelson's 20/e p1386 and 2339, Ghai 8/e p)Children with sickle cell disease are at increased risk for Salmonella septicemia and osteomyelitis. -### End" -5180,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are early complications of tracheostomy except-, with the following options: A: Hemorrhage, B: Pneumothorax, C: Injury to esophagus, D: Trachealstenosis - -### Response: -Ans. is 'd' i.e., Tracheal stenosis Complications of tracheostomyImmediate (at the time of operation)Intermediate (first few hours or days)Late (with prolonged use of tube for weeks or months)o Hemorrhageo Apnea o Pneumothorax o Injury to RLNo Aspiration of blood o Injury to esophaguso Bleeding (reactionary or secondary)o Displacement of tubeo Blocking of tubeo Subcutaneous emphysemao Tracheitis and tracheobronchitiso Atelectasis and lung abscesso Local wound infection and granulationso Hemorrhage, due to erosion of major vesselo Laryngeal stenosiso Tracheal stenosiso Tracheo-esophageal fistulao Problem of decannulationo Persistent tracheocutaneous fistula o Problem of tracheostomy scaro Note : Immediate and intermediate complications are early complications. -### End" -5181,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Multiple punched out lesions on skull X-ray is found in -, with the following options: A: Down's, B: Hyperparathyroidism, C: Multiple myeloma, D: All - -### Response: -Radiological features for multiple myeloma are : Multiple punched lytic lesions of skull with endosteal scalloping. Expansile lytic lesions with associated soft tissue masses Absence of periosteal new bone formation -### End" -5182,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following inborn error of metabolism has porphyria like clinical features?, with the following options: A: Phenylketonuria, B: Tyrosinemia type I, C: Alkaptonuria, D: Metachromatic leukodystrophy - -### Response: -Succinylacetone accumulates in hereditary tyrosinemia type I (fumarylacetoacetate hydrolase deficiency). Succinylacetone is structurally similar to ALA and inhibits ALA dehydratase leading to porphyria like features. -### End" -5183,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which one of the following conditions Dactylitiscan not be seen?, with the following options: A: Sickle - cell anemia, B: Beta thalassemia, C: Congenital syphilis, D: Tuberculosis - -### Response: -Ans. is 'b' i.e., Beta thalassemia Dactylitis is inflammation of the digits. It is seen typically in sickle cell ds. & tuberculosis Other causes are - Sarcoidosis - infection : leprosy, salmonella, yaws, syphillis -### End" -5184,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient who is being treated for leukemia develops unilateral flank pain. Radiologic studies demonstrate a dilated renal pelvis and dilation of the upper one-third of the corresponding ureter. A stone with which of the following compositions is most likely causing this patient's problems?, with the following options: A: Calcium salts, B: Cholesterol, C: Cystine, D: Uric acid - -### Response: -Patients prone to develop uric acid stones include those with gout, leukemia (paicularly during chemotherapy, which releases large amounts of nucleic acids from dying leukemia cells), and acidic urine. Calcium-containing stones are the most common kind in the general population. Cholesterol stones are found in the gallbladder. Cystine stones are a rare form of renal stone seen in patients with cystinuria. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 16. Pathology of the Kidney and Bladder. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture. -### End" -5185,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common ovarian tumour to undergo torsion is :, with the following options: A: Pseudomucinous cystadenoma, B: Brenner's tumour, C: Adenomyoma, D: Dermoid cyst - -### Response: -Dermoid cyst -### End" -5186,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding Na+ ion -, with the following options: A: Responsible for Donnan effect, B: Responsible for Resting membrane potential, C: Responsible for Depolarization, D: Does not help other ions in transport - -### Response: -Depolarization occurs due to sodium ions influx. -Potassium ions maintain the resting membrane potential. -Sodium ions are not responsible for Gibbs-Donnan effect. It is due to the non-diffusible anions. -Sodium ions take part in many co-transports. -### End" -5187,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Non competitive antagonism, with the following options: A: Curve Flattens, B: Irreversible, C: Potency remains same, D: Efficacy remains same - -### Response: -Efficacy decreases -### End" -5188,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inhaled nitric oxide is used:, with the following options: A: For stabilizing systemic heamodynamics, B: In case of jaundice, C: To prevent CNS complication, D: For reducing pulmonary hypertension - -### Response: -Ans. is 'd' i.e. for reducing pulmonary hypertension According to Goodman Gilman ""Inhaled nitric oxide has been approved by FDA for use in newborns with persistent pulmonary hypertension and has become the first line therapy for this disease. In this disease state NO inhalation has been shown to reduce, significantly, the necessity for extracorporeal oxygenation""Nelson reports the effect of NO in pulmonary arterial hypertension ""iNO is a selective and potent pulmonary vasodilator (equivalent to endothelium derived relaxation factor). When it is given at an initial dose of 1-20 ppm it improves oxygenation in patients with persistent primary pulmonary hypertension and it reduces the need for extracorporeal membrane oxygenation "".Response to iNO includes:No improvementinitial improvement but not sustained, so extracorporeal membrane oxygenation is required.initial and sustained improvement, usually weaned by 5th day of therapy.initial response but prolonged dependency, possibly as a result of pulmonary hypoplasia or alveolar capillary dysplasia.Inhale Nitric oxide only affects the pulmonary vasculature i.e. it does not affect the systemic circulation.It does not affect the systemic circulation because on exposure to pulmonary circulation it strongly binds with the oxyhemoglobin and gets inactivated by the oxyhemoglobin.Inhaled nitric oxide improves ventilation perfusion ratio because inhaled nitric oxide is distributed only to the ventilated areas of the lung and dilates only those vessels which are directly adjacent to the ventilated alveoli.Thus inhaled NO will decrease pulmonary artery pressure and pulmonary vascular resistance and often improves oxygenation.More on inhaled nitric oxide :Due to its selective pulmonary vasodilating action, inhaled Nitric Oxide is undergoing intensive study as a potential therapeutic agent for numerous diseases associated with increased pulmonary vascular resistance.Several small studies and case reports have suggested potential benefits of inhaled NO in a variety of conditions includingweeing from cardiopulmonary bypass in adultscongenital heart diseaseprimary pulmonary hypertensionpulmonary embolismacute chest syndrome in sickle cell patientscongenital diaphragmatic herniahigh altitude pulmonary edemalung transplantationBut larger prospective randomized studies have not yet been performed or have failed to confirm any changes in the outcome. At the present time outside of clinical investigation, therapeutic use and benefit of inhaled NO are limited to newborns with persistent pulmonary hypertension. -### End" -5189,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with Hypeension presents with Hypokalemia. Aldosterone levels and Renin levels are both elevated. The most likely diagnosis is:, with the following options: A: Renal AeryStenosis, B: Primary Hyperaldosteronism (Conn's Syndrome), C: Addison's Disease, D: Cushing's Syndrome - -### Response: -Answer is A (Renal Aery Stenosis) The association of High aldosterone and High Renin levels in a hypeensive patient with hypokalemia suggests a diagnosis of Secondary Hyperaldosteronism from Renal Aery Stenosis. Disease Aldosterone Coisol Renin Primary Aldosteronism (Conn syndrome) High Normal Low Secondary Aldosteronism (e.g. Renal Aery Stenosis) High Normal High Adrenal insufficiency (Addison disease) Low Low High Cushing syndrome Low (May be normal) High Low -### End" -5190,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The maximum effect of a drug is defined by-, with the following options: A: Therapeutic index, B: Potency, C: Efficacy, D: Adversity - -### Response: -Ans. is 'c' i.e., Efficacy - Refers to maximal response that can be produced by a drug. Potency - Amount of drug needed to produce a given response. -### End" -5191,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 8-month-old male infant is admitted to the hospital because of a bacterial respiratory infection. The infant responds to appropriate antibiotic therapy, but is readmitted several weeks later because of severe otitis media. Over the next several months, the infant is admitted to the hospital multiple times for recurrent bacterial infections. Workup reveals extremely low serum antibody levels. The infant has no previous history of viral or fungal infections. The most likely diagnosis for this infant is, with the following options: A: Isolated IgA deficiency, B: X-linked agammaglobulinemia of Bruton, C: Chronic granulomatous disease, D: DiGeorge's syndrome - -### Response: -In X-linked agammaglobulinemia of Bruton, B cells are absent but numbers and function of T cells are normal. This abnormality results from defective maturation of B lymphocytes beyond the pre-B stage. This maturation defect leads to decreased or absent numbers of plasma cells, and therefore immunoglobulin levels are markedly decreased. Male infants with Bruton's disease begin having trouble with recurrent bacterial infections at about the age of 9 months, which is when maternal antibodies are no longer present in the affected infant. Therapy for Bruton's disease consists primarily of IV gamma globulin. Isolated deficiency of IgA is probably the most common form of immunodeficiency. It is due to a block in the terminal differentiation of B lymphocytes. Most patients are asymptomatic, but some develop chronic sinopulmonary infections. Patients are prone to developing diarrhea (Giardia infection) and also have an increased incidence of autoimmune disease, such as Hashimoto's thyroiditis. In patients with chronic granulomatous disease (CGD), the neutrophils and macrophages have deficient H2O2production due to abnormalities involving the enzyme NADPH oxidase. These individuals have frequent infections that are caused by catalase-positive organisms, such as S. aureus, because the catalase produced by these organisms destroys the little hydrogen peroxide that is produced DiGeorge's syndrome is a T cell-deficiency disorder that results from hypoplasia of the thymus due to abnormal development of the third and fouh pharyngeal pouches. The parathyroid glands are also abnormal, and these individuals develop hypocalcemia and tetany. Congenital hea defects are also present. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition. -### End" -5192,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with foreign body sensation in eye and swollen knee joint after a leisure trip. Which of the following is the most probable diagnosis?, with the following options: A: SLE, B: Sarcoidosis, C: Reiter's disease, D: Behcet's disease - -### Response: -As the patient in the question has developed ahritis following a recent travel, it could be a reactive ahritis secondary to organisms endemic in the zone of travel. Along with this, patient is showing features of conjunctivitis indicating a diagnosis of Reiter's syndrome. Reactive ahritis (Reiter's syndrome) consists of conjunctivitis, urethritis (or cervicitis in female patients), ahritis, and characteristic mucocutaneous lesions. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 176 -### End" -5193,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscle is contracted as pa of the pupillary light reflex?, with the following options: A: Ciliary muscle, B: Pupillary dilator muscle, C: Pupillary sphincter muscle, D: Radial fibers of the iris - -### Response: -In a normal individual, shining a light in either eye will result in both pupils constricting due to contraction of the pupillary sphincter muscles. In contrast, the pupillary dilator muscle dilates the pupil. The ciliary muscle is involved in focusing the eye (accommodation). -### End" -5194,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The process of programmed gene directed cell death characterized by cell-shrinkage, nuclear condensation and fragmentation is known as -, with the following options: A: Necrosis, B: Chromatolysis, C: Pyknosis, D: Apoptosis - -### Response: -Ans. is 'd' i.e., Apoptosis -### End" -5195,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is false regarding wandering spleen, with the following options: A: Chronic torsion leads to splenomegaly, B: Treatment of choice is splenectomy, C: Infarction and torsion are common, D: Long vascular pedicle is seen - -### Response: -Wandering Spleen Wandering spleen is a rare finding seen in children and in women between the ages of 20 and 40 years. One of two causes is suspected. The first is theorized to result from a failure to formnormal splenic peritoneal attachments that suspend the organ securely within its usual anatomic position. Failure to form these attachments is thought to arise from lack of fusion of the dorsal mesogastrium to the posterior abdominal wall during embryogenesis. The second theory surmises that in multiparous women, hormonal changes and abdominal laxity lead to an acquired defect in splenic attachments. In either case, without these attachments, the splenic pedicle is unusually long and prone to torsion. Intermittent abdominal pain, splenomegaly resulting from venous congestion, and severe persistent pain are suggestive of wandering spleen and tension or intermittent torsion of the splenic pedicle. A mobile mass may be palpable on physical examination. CT of the abdomen with intravenous administration of contrast material provides confirmation of the diagnosis, with the spleen located outside its usual position. A noncontrasted spleen or whorled appearance of the vascular pedicle provides additional evidence for the condition and may be helpful in choosing splenopexy or splenectomy Ref: Sabiston 20th edition Pgno: 1564 -### End" -5196,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Barr body is absent in female having –, with the following options: A: 46 XX genome, B: 45 XO genome, C: 47 XXX, D: All of above - -### Response: -Barr body (Sex - chromatin) - -It is a densely staining inactivated condensed 'X' chromosome that is present in each somatic cells of the female. -It is found in the nucleus. -It is used as a test of genetic femaleness → it is possible to determine the genetic sex of an individual according as to whether there is a chromatin mass present on the inner surface of the nuclear membrane of cells with resting or intermittent nuclei. Remember the following fact and the question will seem very easy. -Chromatid body (Barr body or sex chromatin) is derived from one of the two X-chromosomes which becomes inactivated. -The number of Barr bodies is thus one less than the number of X-chromosomes. - -Note - - -Barr body is found in female But - -Kleinefelter syndrome is male with Barr body. -Turner syndrome is female without Barr body. -### End" -5197,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kerley-B lines are seen when pulmonary venous pressure is:, with the following options: A: 5 mmHg, B: 10 mmHg, C: 20 mmHg, D: 40 mmHg - -### Response: -Ans. 20 mmHg -### End" -5198,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Progestin only pills should not be taken by women with following conditions except, with the following options: A: Unexplained uterine except, B: Breast cancer, C: Migraine headache without aura, D: Severe active liver disease - -### Response: -POPs should not be taken by women. -With unexplained uterine bleeding, breast cancer, hepatic neoplasms, pregnancy or active severe liver disease. -### End" -5199,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements are false about Sprengel's deformity except :, with the following options: A: Dextrocardia, B: Omoveebral bar present, C: Scapula is smaller in its horizontal diameter, D: Congenital low Scapula - -### Response: -Dextrocardia- not associated with Sprengel's deformity Congenital High Scapula (Sprengel's deformity) Permanent elevation of the shoulder girdle due to developmental defect Scapula is smaller in its veical diameter and hence appears broad Omoveebral bar present Horizontal diameter appears broad C/F: Restriction of shoulder movement Associated with Klippel-Feil syndrome (most common association), congenital scoliosis, diastematomyelia, abnormalities of hea. -### End" -5200,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sulphonylureas act by -, with the following options: A: Reducing the absorption of carbohydrate from the gut, B: Stimulating the beta islet cells of pancreas to release insulin, C: Increasing the uptake of glucose in peripheral tissue, D: Reducing the hepatic gluconeogenesis - -### Response: -Ans. is 'b' i.e., Stimulating the beta islet cells of pancreas to release insulin Sulfonylurease provoke a brisk release of insulin from pancreas. -### End" -5201,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle spindle detects, with the following options: A: Tension, B: Length, C: Proprioception, D: Stretch - -### Response: -Muscle spindles are sensory receptors within the belly of a muscle that primarily detect changes in the length of this muscle. They convey length information to the central nervous system sensory neurons. Ref guyton and hall textbook of medical physiology 12/e pg 71 -### End" -5202,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of burning fire in a closed room, death occurs due to:, with the following options: A: CO2 poisoning, B: CO poisoning, C: Cardiac fauilre, D: Respiratory failure - -### Response: -Ans. (b) CO poisoningRef: The essentials of FSM by KS Narayan Reddy 31st ed./582 -### End" -5203,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Toure in which legs or thighs are tied with bamboo and the tourer presses on the two sides of the clamp to cause pain is called ?, with the following options: A: Falanga, B: Telefono, C: Mercelago, D: Chepuwa - -### Response: -Ans. is 'd' i.e., Chepuwa Physical toure Toure is defined as deliberate, systemic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force a person to yield information, to make a confession or for any other reason. Toure may be physical or psychological. Impoant methods of physical toure are :? 1. Beating : Beating may be of following types ? Falanga (Falolka/Baatinada) : Beating of soles of feet with blunt object. Telefono : Simultaneous beating of both ears with palms. Quirofana : Beating on abdomen while upper half of body lying unsuppoed on table. 2. Electric : Electric toure may be - Piacana : Placing electric wires in vagina, mouth, anus or over nipples and testis. Black slave : Heated metal skewer inseed into anus. 3. Near suffocation : These are - Dry submarine : Plastic bag covering head and face. Wet submarine (Labaneva/Latina/Pileta): Forced immersion of victim's head in water, often contaminated with urine or vomit or blood. 4. Suspension : Suspension may be - La-Bandera : By wrist. Mercelago : By ankles. 5. Forced posture : It may be ? Planton : Prolonged standing. Cabellete (Saw horse) : Forced struddling of a bar. Parrot's perch (Jack/paude Grava) : Head down by a horizontal pole placed under knees, with the wrists bound to the ankles. Chepuwa : Tight clamping of thighs or legs with bamboo, and the tourer may press two sides of clamps with his legs or may stand on two sides of clamps (practiced on Bhutanese refugees in Nepal). -### End" -5204,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Highest concentration of potassium is seen in ?, with the following options: A: Jejunum, B: ileum, C: Duodenum, D: Colon - -### Response: -Ans. is 'd' i.e., Colon -### End" -5205,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If mother is donating the kidney to her son, this is an example of:-, with the following options: A: Autograft, B: Allograft, C: Isograft, D: Xenograft - -### Response: -Types of grafts - Autograft: same person - Allograft/Homograft: from one person to another / same species - Isograft: Identical twine - Xenograft/Heterograft: Between different species - Ohotopic graft: Graft placed in normal anatomical site - Heterotrophic graft: Graft in site different from its anatomical location -### End" -5206,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Halocrine secretion is seen in .....gland, with the following options: A: Salivary, B: Mammary, C: Sebaceous glands, D: Gastric - -### Response: -The manner in which their secretions are poured out of the cells: Merocrine: In most exocrine glands secretions are thrown out of the cells by a process of exocytosis, the cell remaining intact, this manner of secretion is described as merocrine, e.g., goblet cell (sometimes also called eccrine or epicrine), Apocrine: In some glands the apical pas of the cells are shed off to discharge the secretion, this manner of secretion is described as apocrine. An example of apocrine secretion is seen in some atypical sweat glands and in mammary glands. Holocrine: In some glands, the entire cell disintegrates while discharging its secretion. This manner of discharging secretion is described as holocrine, and is seen typically in sebaceous glands. REF : Inderbir Singh's Textbook of Human Histology, seventh edition, pg.no., 58. -### End" -5207,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mackler's triad consists all, except?, with the following options: A: Thoracic pain, B: Dyspnea, C: Cervical subcutaneous emphysema, D: Vomiting - -### Response: -Mackler's triad Thoracic pain Vomiting Cervical subcutaneous emphysema Seen in Boerhaave syndrome -### End" -5208,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pinna calcification is seen in all except:, with the following options: A: Gout, B: Ochronosis, C: Frost bite, D: Addison's disease - -### Response: -Ans. a. Gout (Ref: style=""font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"">.com/article.aspx?articleid 332575; Sample of Chapter/1550092413.pdf)Pinna Calcification is seen in* Addison's diseaseQ* OchronosisQ* AcromegalyQ* Hypertension* Diabetes mellitus* HyperthyroidismQ* von Meyenburg's disease (systemic chondromalacia)Late calcification of the auricular cartilage following frostbite.( style=""font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif""> of Chapter/1550092413.pdf)Delayed dystrophic calcification of the underlying auricular cartilage may develop years after the initial frostbite. When this occurs, the pinna is bony and hard to palpation. A radiograph of the pinna will reveal radiodense areas of calcification in the auricular cartilage. -### End" -5209,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following metabolite is a derivative of tryptophan-, with the following options: A: Melatonin, B: Thyroxine, C: Epinephrine, D: Nor epinephrine - -### Response: -Ans. is 'a' i.e., Melatonin Amino acidsBiological important compoundTyrosineCatecholamines (epinephrineQ, norepinephrineQ, dopamineQ), thyroxineQ, triiodothryonine, melanin Q.(Note: - Phenylalanine is the precursor of tyrosine, thus it can also give rise to all these compounds through tyrosine (phenylalanine - TyrosineQ - CatecholaminesQ, thyroxineQ, T3, melaninQ).TryptophanVitamin niacinQ, melatoninQ, SerotoninQGlycineQ,ArginineQ,methionineQCreatineQGlycine, cysteineBile saltsGlycineHeme.Aspartic acid andglutaminePyrimidine basesGlycineQ,aspartic acid,glutaminePurine basesQb-alanineCoenzyme-AArginineNitric oxideQGlutamateGama-amino butyric acid (GABA) -### End" -5210,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carcinoid syndrome produces valvular disease primarily of the -, with the following options: A: Venous valves, B: Tricuspid valve, C: Mitral valve, D: Aoic valve - -### Response: -Carcinoid hea disease, also known as Hedinger syndrome, is rare affecting at least 20% of patients with carcinoid syndrome. Cardiac involvement in carcinoid disease generally results in right-sided valvular lesions, accompanied by tricuspid insufficiency and pulmonary stenosis. Ref Davidson 23rd edition pg 560 -### End" -5211,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: who gave oral stage of development, with the following options: A: freud, B: erikson, C: lorenz, D: bleuler - -### Response: -CONTRIBUTIONS OF FREUD o Father of psychoanalysis He founded a type of psychotherapy called psychoanalysis. It is nothing but analyzing the psych(MIND) o Interpretation of dreams According to Freud dreams are royal road to unconscious In dreams several conflicts that are present in the unconscious comes to the consciousness in the form of dreams Thus by analyzing ones dreams we could understand the unconscious conflicts o Psychosexual stages of life o Freud divided development into 5 stages namely psycho sexual development o It is divivded namely oral , anal , phallic, latent, genital phase. o Conversion disorders conversion disorder is conveing a psychological pain to physical symptoms present physical symptoms which has some connection with unconscious conflict is called SYMBOLIZATION present physical symptoms which has some resemblance with illness in family members, which is called MODELLING patient has illness like neurological deficit but they have apparent in concern towards their own illness which is known as LA BELLE INDIFFERENCE main defense mechanism in conversion disorder is REPRESSION o Repression defence mechanism * REPRESSION is called QUEEN of defense mechanisms o COUCH and FREE ASSOSIATION * He introduced a technique called as a couch technique where he makes the patient lie on the couch, he asks the patient to speak from 'cabbages to kings. This method is called FREE ASSOSIATION. By allowing the patient to speak whatever that comes to their mind randomly so that by analyzing their thoughts we could understand the conflict in the unconscious. o Topographical theory of mind Freud gave topographical theory mind It is divided into pre conscious, unconscious, conscious Later he disregarded topographical theory of mind and gave structural theory of mind o Structural theory of mind It is divided into id, ego, super ego Id= instinctual desires like anger, hunger, sexual instinct Ego= function of mind to work based on ego to avoid guilt from super ego Super ego= based on moral principle, obtained from family members and relatives, teachers Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition pg no. 845 -### End" -5212,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug used in irritable bowel syndrome with constipation is?, with the following options: A: Lubiprostone, B: Loperamide, C: Alosetrone, D: Clonidine - -### Response: -Lubiprostone acts by stimulating cl- channel opening in the intestine increasing liquid secretion in the gut and decresing transit time therefore used for chronic constipation. It has also been approved for constipation dominant irritable bowel syndrome in women.( ref katzung 11/e p1080) -### End" -5213,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Percentage of sucrose solution used for newborn analgesia is:, with the following options: A: 5%, B: 10%, C: 24%, D: 50% - -### Response: -Analgesia in newborn -A. Analgesia for minimally-invasive - -Sucrose analgesia is drug of choice -### End" -5214,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: TSG mutated in familial gastric ca, with the following options: A: APC, B: CDKN2A, C: E-cadherin, D: PTEN - -### Response: -. -### End" -5215,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antiemetic action is produced through:, with the following options: A: Decreased CTZ stimulation, B: H1 agonistic action, C: D1 antagonistic action, D: Olfactory apparatus stimulation - -### Response: -Mechanism of action of antiemetic drugs are: Anticholinergic e.g hyoscine H1 antihistaminics e.g promethazine,diphenyhydramine,cyclizine. 5-HT3 antagonists e.g ondansetrone,granisetron Prokinetics. 5HT4 agonists e.g cisapride. Motilin agonist e.g erythromycin. CTZ contains histamine dopamine,cholinergic,opioid and serotonin receptors.antiemetic acts by inhibiting the receptors at CTZ.( ref KDT 6/e p643) -### End" -5216,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are causes of increased anion gap except?, with the following options: A: DKA, B: Starvation, C: Ethylene glycol poisoning, D: Glue sniffing - -### Response: -Ans. is 'd' i.e., Glue sniffing Causes of High anion gap acidosisLactic acidosisToxinsEthylene glycolMethanolSalicylatesRenal failureKetoacidosisDiabetesAlcoholStarvation -### End" -5217,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transection at mid pons level results in, with the following options: A: Asphyxia, B: Hyperventilation, C: Rapid and shallow breathing, D: Apneusis - -### Response: -Pontine control of respiration involves the modulation of timming and amplitude of muscle activities that execute breathing and air flow in and out of lungs. Ref.text book of physiology by AK Jain7th edition page no.445 -### End" -5218,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Freshwater swimming can lead to, with the following options: A: Brucellosis, B: Leptospirosis, C: Babesiosis, D: Lassa fever - -### Response: -Leptospirosis Leptospires excreted in urine and can survive in water for many months, water is an impoant vehicle in their transmissionBabesiosis Veical transmission, blood transfusion, or tick bitebrucellosisOccupational or domestic exposure to infected animals or their products by ingestion, inhalation, or mucosal or percutaneous exposureLassa feverAerosols from infected rodents, capturing or eating these animals, close person to person contact(ref: Harrison's 18/e p1393) -### End" -5219,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 22-year old software engineer was brought in an unconscious state to the casualty. Clinical examination revealed features suggestive of shock, DIC and multisystem failure. CSF and petechial rashes yielded gram-negative diplococcic, which subsequently grew on modiefied Thayer-Martin medium. This isolation is known to be associated with-, with the following options: A: Waterhouse-Fridericheen syndrome, B: Fitz-Hugh-Curtis syndrome, C: Job's syndrome, D: Toxic shock syndrome - -### Response: -Ans- A Waterhouse-Friderichsen Syndrome This uncommon but catastrophic syndrome is characterized by the following:An overwhelming bacterial infection, which is classically associated with Neisseria meningitidis septicemia but occasionally is caused by other highly virulent organisms, such as Pseudomonas species, pneumococci, Haemophilus influenzae, or staphylococciRapidly progressive hypotension leading to shockDisseminated intravascular coagulation with widespread purpura, particularly of the skinRapidly developing adrenocortical insufficiency associated with massive bilateral adrenal hemorrhage Whatever the basis, the adrenals are converted to sacs of clotted blood virtually obscuring all underlying detail. -### End" -5220,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 years old male patient a known case of Crohn's disease presents with recent flare-ups suggestive of fistulas. He was admitted and treated with immune-suppressive. Unfortunately, he got reactivation of his tuberculosis as a result of the side effects of the treatment. Which of the following immunosuppressive medication is the most likely cause of his TB reactivation?, with the following options: A: Methotrexate, B: Infliximab, C: Azathioprine, D: Mizorbine - -### Response: -Answer: b) InfliximabTREATMENT OF INFLAMMATORY BOWEL DISEASEAminosalicylates* 5-aminosalicylic acid (formulations known as mesalamine): acts topically in the colon.* Sulfasalazine (5-ASA + sulphapyridine), olsalazine (5-ASA+5-ASA) and balsalazide (5-ASA+ amino benzoyl Alanine) are effective for the treatment of ulcerative colitis.* 5-ASA is the first line treatment for mild ulcerative colitis.Glucocorticoids* Prednisone, hydrocortisone, prednisolone and budesonide: in moderate to severe ulcerative colitis and Crohn's disease.Purine analogs* Azathioprine and 6-MP: maintenance for remission of ulcerative colitis and Crohn's disease.Methotrexate: induction and maintenance of remission of Crohn's disease but not ulcerative colitis.Anti TNFa therapy: Infliximab, adalimumab and certolizumab are useful in Crohn's disease.Natalizumab: targeted against a-4 subunit of integrins. Should not be used with other immunosuppressants due to the risk of progressive multifocal leukoencephalopathy.* Infliximab therapy is associated with | incidence of respiratory infections; potential reactivation of tuberculosis or other granulomatous infections with subsequent dissemination.* Candidates for infliximab therapy should be tested for latent tuberculosis with purified protein derivative and chest radiographs, and patients who test positive should be treated prophylactically with isoniozid.* Infliximab also is contraindicated in patients with severe congestive heart failure. -### End" -5221,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are examples of tumors associated with absolute erythrocytosis , EXCEPT:, with the following options: A: Hypernephroma, B: Hepatoma, C: Cerebellar hemangioblastoma, D: Ovarian teratoma - -### Response: -Tumors associated with absolute erythrocytosis Hypernephroma Hepatoma Cerebellar hemangioblastoma Uterine myoma Adrenal tumors Meningioma Pheochromocytoma Familial (with normal hemoglobin function)associated with absolute erythrocytosis Erythropoietin receptor mutation VHL mutations (Chuvash polycythemia) 2,3-BPG mutation Ref: Harrison, E-18,P-902 -### End" -5222,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Privileged communication among the following are all except-, with the following options: A: In court of law when asked by judge, B: Information on communicable diseases, C: In cases of suspected crime, D: Bus driver suffering from hepatitis A - -### Response: -Ans. is 'd' i.e., Bus driver suffering from hepatitis A Professional secrecy and Privileged communicationo Professional secrecy is an implied ethical and legal obligation (or contract), that the doctor will not divulge any thing he comes to know concerning patient during the course of his professional work. Doctor is liable to damages for its breech.o However, it is justified in certain circumstances, to disclose information to proper authority, and this is known as privileged communication. It is defined as a communication made by doctor to a proper authority that has corresponding legal, social, and moral duties to protect the public. Privileged communication is made in certain circumstances where the doctor is justified in disclosing information about his patient. Such communication is regarded as privileged and is an exception to the general rule of professional secrecy between doctor and patient. Example are:-In court of law : When asked by judge.As compulsor duty : Every doctor has to give details of birth, death and communicable disease,As a social duty : If health of a patient can cause danger to society, e.g.Railway engine driver being colour blind.Bus driver being epileptic, drug addict or hypertensive.Pilot having refractive errors.Hotel waiter suffering from TB or being typhoid carrier.Swimming pool user suffering from STD (e.g. syphilis) or infectious disease.Person suffering from STD or HIV infection likely to marry.Cases of food poisoining.Water pollution.4} In cases of suspected crime.In self interest, both in civil and criminal suits by patient.When a servant is sent by master.In negligent suits when doctor is employed by opposite party to cross-examine patient who tiled the suit.In insurance reports, he can report any disease found. But he should not answer queries of insurance company or solicitor without the patient consent.In the interest of patient: If patient is not taking proper care, details can be communicated to the relatives. -### End" -5223,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40 year old male with history of alcohol abuse for 20 years is brought to the hospital emergency with complaints of fearfulness, talking to self, aggressive behavior, tremulousness and saying that there insects crawling under his skin. Physical examination shows tachycardia, palpitations, sweating, and high grade fever. He is unable to recognize few of his family members. There is history of drinking alcohol two days prior to the onset of the present complaints. He is most likely suffering from?, with the following options: A: Delirium tremens, B: Alcoholic hallucinosis, C: Schizophrenia, D: Seizure disorder - -### Response: -Ans. is 'a' i.e., Delirium tremens * This patient hasA. H/O alcohol abuseB. Abstinence from alcohol drinking since two daysC. Tactile hallucination (insects crawling under the skin)D. Disorientation (not able to recognize family members, talking to self)E. Autonomic disturbances: - Tachycardia, sweating, tremors, fever, Anxiety (fearfulness and tremulousness)* All suggest the diagnosis of delirium tremensDelirium tremens* Delirium tremens is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant alcohol abstinence.* It has all the features of delirium : -1. Clouding of consciousness, Confusion or disorientation.2. Poor attention span and distractibility.3. Visual (and also auditory) hallucinations, illusions. Tactile hallucination of insects crawling under the skin (fornication).4. Marked autonomic disturbances: - Tachycardia, sweating, tremors, fever, hypertension, Anxiety and pupillary dilatation.5. Psychomotor agitation, ataxia, Insomnia with disturbed sleep wake cycle.* Benzodiazepines are the drugs of choice for delirium tremens. Chlordiazepoxide is the agent of choice with diazepam as an alternative. -### End" -5224,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Biceps brachii is supplied by -, with the following options: A: Radial nerve, B: Median nerve, C: Musculocutaneous nerve, D: Axillary nerve - -### Response: -Musculocutaneous nerve supplies Biceps brachii. -### End" -5225,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are the indications for PAIR treatment in hydatid cysts, EXCEPT:, with the following options: A: Size > 5cm, B: Multiloculated, C: Cyst in lung, D: Recurrence after surgery - -### Response: -Treatment of the hydatid cysts: The treatment of hydatid disease involve the use of oral anthelmintics such as albendazole. Albendazole therapy is the mainstay of treatment in the majority of patients with hydatid disease. It is given alone and for prolonged periods of time in patients who are poor candidates for cyst-directed interventions. However, liver-directed treatment is prefered. The treatment of hepatic cysts is primarily surgical.In General, most cysts are treated. Packing off of the abdomen is impoant because rupture can results in anaphylaxis and diffuse seeding. Usually the cyst is then aspirated through a closed suction system and flushed with a scolicidal agent such as hypeonic saline. The cyst is then unroofed, which can be followed by a number of possibilities, such as excision (or pericystectomy), marsupialization procedures, leaving the cysts open, draining of the cyst, omentoplasty, or paial hepatectomy to encompass the cyst. Total pericystectomy or formal paial hepatectomy can also be performed without entering the cysts. In patients with anatomically appropriate lesions, PAIR ( puncture,aspiration,injection, and reaspiration) is the preferred initial treatment. The efficacy of PAIR in managing hydatid cysts is greater than 75%. For patients whose disease is refractory to PAIR, laparoscopic or open complete cyst removal with instillation of a scolicidal agent generally is curative. Ref: CSDT 11/e, page 128-29 ; Sabiston 18/e page 494-95 ; L&B 25/e, page 56-59 -### End" -5226,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cystic neoplasm of the pancreas with dismal prognosis is:, with the following options: A: Serous cystadenoma, B: Mucinous cystic neoplasm, C: Solid pseudopapillary neoplasm, D: Ductal adenocarcinoma with cystic degeneration - -### Response: -TYPE of CYSTIC NEOPLASM SEX PREDILECTION MALIGNANT POTENTIAL AND NATURAL HISTORY Serous cystadenoma Female Resection is curative serous cystadenocarcinoma is extremely rare Mucinous cystic neoplasm Female Resection is curative, regardless of degree of epithelial dysplasia; poor prognosis when invasive adenocarcinoma is present Intraductal papillary mucinous neoplasm Equal distribution Excellent prognosis for lesions showing only adenomatous and borderline cytologic atypia; poor prognosis when invasive adenocarcinoma is present Solid pseudopapillary neoplasm Female Indolent neoplasm with rare nodal and extranodal metastases; excellent prognosis when completely resected Cystic endocrine neoplasm Equal distribution Similar to that of solid neuroendocrine neoplasm Ductal adenocarcinoma with cystic degeneration Male predominance Dismal prognosis, similar to that of solid adenocarcinoma Acinar-cell cystadenocarcinoma Male Similar to that of solid type; aggressive neoplasm with slightly better prognosis than ductal adenocarcinoma Ref: Sleisenger and Fordtran's, E-9, P-1027 -### End" -5227,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not consider to be a slow viruse diseases ?, with the following options: A: Kuru, B: Scrapie, C: Creutzfeldt Jakob disease, D: Sarcoidosis - -### Response: -Ans. is `d' i.e., Sarcoidosis SLOW VIRUS DISEASES . A group of infections in animals and human beings characterised by a very long incubation period and a slow but relentless course, terminating fatally . Characteristics of slow virus infections: Incubation period ranging from months to years Course of illness lasting for months or years, with remissions and exacerbations Predilection for involvement of the CNS Absence of immune response A genetic predisposition Invariably fatal termination . Slow virus diseases are classified into three groups. 1. GroupA - Slowly progressive infection of sheep. - Caused by lentiviruses - Examples --> Maedi, Visna 2. Group B -Also known as Prion diseases collectively known as the subacute spongiform viral encephalopathies - Chronic progressive diseases of CNS - Infectious agents are proteins (Prion) devoid of DNA and RNA - Prion proteins are unusually resistant to physical and chemical agents, such as heat, irradiation and formalin. - Pathogenic mechanism : . Proliferation of an abnormal prion protein (Pr PSc) which is derived from the normal prion protein (Pr Pc) . The accumulation of Pr PSc in the CNS as diffuse deposits and in the form of plaques disrupts the architecture and function of the brain, causing disease. - Pathology . Progressive vacuolation in the dendritic and axonal processes of the neurons . Extensive astroglial hyperophy and proliferation . Spongiform degenration in the grey matter. . No inflammation -### End" -5228,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best method to compare protein quality is:(1994), with the following options: A: Net protein utilization, B: Biological value, C: Specific dynamic action of protein, D: Presence or absence of essential amino acids - -### Response: -Ans: aRef: Park, 17th ed, p. 414 & 18th ed, p. 440 -### End" -5229,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum chance of infection in dialysis is by-, with the following options: A: AV fistula, B: Tunnel catheter, C: AV graft fistula, D: Venous catheter - -### Response: -Grafts and catheters are associated with much higher rates of Infection than fistulas Intravenous catheters are often used in patients with ARF or CRF. For patients on maintenance hemodialysis, tunneled catheters(2 seperate catheters or single with 2 lumen) are often used when Av fistula and grafts are not feasible due to anatomical considerations. Tunneled catheters are tunneled under the skin, tunnel reduces bacterial translocation from the skin, so there is lower rate of infection with tunneled catheters than with non tunneled temporary catheters. Most tunneled catheters are placed in Internal jugular vein Other veins used are external jugular, femoral ,subclan(subclan stenosis is a frequent complication ) Ref:Harrison 20th edition pg no. 2123 -### End" -5230,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mediator present in mast cells is, with the following options: A: Histamine, B: Encephalin, C: Calmodulin, D: None of these - -### Response: -Mast cells release several different substances. Among them areHistamineSlow-reacting substance of anaphylaxis (which is a mixture of leukotrienes)Eosinophilic chemotactic factorBradykininRef: Guyton and Hall textbook of medical physiology 13th edition. Page:554 -### End" -5231,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A first rank symptom of schizophrenia is all Except, with the following options: A: Ambivalence, B: Running commentary, C: Thought inseion, D: Somatic passivity - -### Response: -Ku Schneider First Rank Symptoms Second-Rank Symptoms Audible thoughts Voices arguing or discussing(commanding voices) Voices commenting on patient's actions (commenting voices) Made feelings Made impulses or drives Made volitional acts Thought withdrawal Thought inseion Thought broadcasting Delusional perception Somatic Passivity Other disorders of perception Sudden delusional ideas Perplexity Depressive and euphoric mood changes Feelings of emotional impoverishment and several others as well Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 987 -### End" -5232,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are example of apoptosis except?, with the following options: A: Graft versus host disease, B: Menstrual cycle, C: Pathological atrophy following duct obstruction, D: None - -### Response: -Ans. is 'None' -### End" -5233,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pipkin fracture is defined as:, with the following options: A: Head of radius fracture, B: Head of femur fracture, C: Fracture dislocation of ankle, D: Fracture neck of femur - -### Response: -B i.e Posterior dislocation is common Posterior Dislocation Of Hip It is most common type of hip dislocation in adults and childrenQ. Usually this occurs in a road accident when someone seated in car is thrown forwards, striking the knee against the dashboard (dashboard injuryQ). It is the position (direction) of hip at the time of injury that decided the pattern of injury. Position of Hip at the time of Injury Patter of Injury Flexion, adduction, internal rotation Pure posterior dislocation Less flexion, less adduction (neutral or slight abduction), internal rotation Posterior fracture dislocation Hyper abduction + Extension Anterior dislocation Classification Schemes For Posterior Hip Dislocations Thompson & Epstein Type I Dislocations without or with minor fracture Type II Dislocation with a single large fracture of posterior acetabular rim. Type III Dislocation with comminution of posterior acetabular rim. Type IV Dislocation with fracture of acetahular floor. Type V Dislocation with fracture of femoral headQ Stewa And Miford Type I Dislocation without fracture Type II Dislocation with posterior rim fracture (one or more fragments), but the hip is stable after reduction Type III Dislocation with fracture of rim producing gross instability Type IV Dislocation with fracture head or neck of femur So in other words Thompson & Epstein, and Stewa & Milford are posterior dislocation injuries of hip and Pimpkin's fracture is fracture of femoral headQ (& / or neck) in posterior dislocation injuries. In posterior dislocation of hip clinical presentation is - Flexion, adduction and internal (medial) rotation deformity with shoeningQ Femoral head can be palpated posteriorly - Vascular sign of Narath is positiveQ i.e. due to posterior dislocation of hip joint the vessels fall back unsuppoed so femoral aerial pulsation, which is felt against the head of the femur will be feeble or even may not be palpable . - Due to posterior direction of displacement sciatic nerveQ and superior gluteal aery injury may occur. - It is the posterior dislocation that cause maximum shoening of limbo and is most commonly associated with sciatic nerve injuryQ Simple dislocations are mostly managed by close reduction under anesthesiaQ. Few methods of reduction are - Stimsons gravity method, Allis maneuver, Bigelow maneuver and East Baltimore lift. -### End" -5234,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 6 months old infant with Hb of 6 gm% has anaemic features with peripheral blood showing target cells. Family history of similar complaints is (Positive). Diagnosis can be best done with which of the following –, with the following options: A: Hb electrophoresis, B: ELISA, C: Coomb's Test, D: Osmotic fragility - -### Response: -Presence of : - - -Anaemia (Hb < 6%),   -Target cells, -Increase reticulocytes suggests the diagnosis of thalassemia. - - -Thalassemia is a hemoglobin disorder. Hemoglobin disorders are diagnosed by electrophoresis. -Diagnosis of thalassemia is confirmed by serum electrophoresis. -### End" -5235,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Herpes virus, with the following options: A: M/C lesion seen is gingivostomatitis, B: Herpetic gladiatorum is seen in wrestlers, C: Steroids are useful in Acute dendritic ulcers, D: Topical Acyclovir is highly specific for herpes simplex - -### Response: -Steroids are contraindicated in Acute dendritic ulcer. -### End" -5236,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true regarding acute pyogenic osteomyelitis, with the following options: A: Most common site in bone is diaphysis of bone, B: Sequestrum is the new bone formation surrounding involucrum, C: Most common mode of infection is direct inoculation due to trauma, D: Cloacae are discharging sinuses. - -### Response: -Ans. D. Cloacae are discharging sinuses.a. Most common site of osteomyelitis is metaphysis.b. Sequestrum is dead piece of bone surrounded by involucrum (New bone).c. Most common mode of infection of bone is hematogenous. -### End" -5237,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tocolytic of choice in pregnancy with hea disease (OBG), with the following options: A: Nifedipine, B: MgSO4, C: Atosiban, D: Alcohol - -### Response: -Calcium-channel blockers, especially nifedipine, are safer and more effective tocolytic agents than are B-agonists Nifedipine is the best first-line tocolytic agent available at this time. The initial dose should be 30 mg and subsequent doses 20 mg every 6 hours. MgSO4 which is an excellent drug for ecclampsia prevention and management is also used for tocollyis. This has a'Neuroprotective effect' on the preterm fetus and prevent s cerebral palsy instances main subjective maternal complaints to Mgs04 are related to the mental effects (""out of it"" or ""felt like a zombie"") and the overall muscular weakness produced by the drug. The most frequent side effects of magnesium sulfate are pulmonary congestion, respiratory depression,hypothermia, and neuromuscular toxicity. Infants of mothers treated with IV magnesium sulfate sholy before delivery are frequently Hypotonic . neonatal/fetal complications are hypocalcemia & Intraventricular hage NOTE: FDA had denied approval of Atosiban (Oxytocin receptor antagonist) in view of concerns regarding efficacy and fetal-newborn safety. -### End" -5238,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A male 45 years old complains of weakness. He is a chronic alcoholic. General examination reveals elevated transaminases in blood and hepatomegaly. Icterus is visible on sclera and pale coloration of skin is present. On USG examination, fatty liver is revealed. Which of the following substances may be responsible for the condition of liver?, with the following options: A: Orotic acid, B: Pyridoxine and pantothenic acid deficiency, C: Alcohol, D: All of the above - -### Response: -The antibiotic puromycin, ethionine (α-amino-γ-mercaptobutyric acid),  carbon tetrachloride, chloroform, phosphorus, lead, and arsenic all cause fatty liver and a marked reduction in concentration of VLDL in rat blood. -Orotic acid also causes fatty liver; it is believed to interfere with glycosylation of the lipoprotein, thus inhibiting release, and may also impair the recruitment of triacylglycerol to the particles. A deficiency of vitamin E enhances the hepatic necrosis of the choline deficiency type of fatty liver. -Added vitamin E or a source of selenium has a protective effect by combating lipid peroxidation. In addition to protein deficiency, essential fatty acid and vitamin deficiencies (eg, linoleic acid, pyridoxine, and pantothenic acid) can cause fatty infiltration of the liver. - -                                                                                                                                                        Reference: HARPERS ILLUSTRATED  BIOCHEMISTRY 30th ed Page no 261 -### End" -5239,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: FALSE statement about the Streptococcus is:, with the following options: A: M protein is responsible for production of mucoid colonies, B: M protein is the major surface protein of group A streptococci, C: Mucoid colonies are virulent, D: Endotoxin causes rash of scarlet fever - -### Response: -Strains with well marked capsules produce mucoid colonies. Streptococcus pyogenes can be typed based on surface proteins to M,T,R. M protein is most impoant of these. It act as a virulence factor by inhibiting phagocytosis. It is antigenic and antibody to this promotes phagocytosis of coccus. M protein is heat labile and acid stable but susceptible to tryptic digestion. Also know: Pyrogenic exotoxins (erythrogenic, dick, scarlatinal toxin) -dick test is used to identify children susceptible to scarlet fever, a type of acute pharyngitis with erythematous rash. The M protein itself is a fibrillar coiled-coil molecule with structural homology to myosin. Its carboxy terminus is rooted in the peptidoglycan of the cell wall, and the amino-terminal regions extend out from the surface. The specificity of the multiple serotypes of M protein is determined by variations in the amino sequence of the amino-terminal poion of the molecule. Antigenicity and functions differ in domains of the molecule. There are more than 80 M protein serotypes present. Ref: Ray C.G., Ryan K.J. (2010). Chapter 25. Streptococci and Enterococci. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. -### End" -5240,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Allergic BPA which kind of hypersensitivity reaction ?, with the following options: A: Type I, B: Type II, C: Type III, D: Type IV - -### Response: -Ans, is 'a' i.e., Type IIn Immediate hypersensitivity (type I hypersensitivity), the injury is caused by TH2 cells, IgE antibodies, and mast cells and other leukocytes. -### End" -5241,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to Sigmund Freud, primary process thinking is:, with the following options: A: Illogical and bizarre, B: Rational, C: Absent during sleep, D: Logical and unconscious - -### Response: -The primary process thinking is a characteristic of unconscious mind. It is illogical and aims for immediate wish fulfillment. It is illogical and contradictory -### End" -5242,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 38 year old female presents to the physician with complaints of excessive thirst and urination for the past 4 weeks. Her appetite has been normal and she has not had diarrhea. Blood chemistry showed mildly elevated glucose and glucagon. Physical examination reveals tenderness in the left upper quadrant and an erythematous necrotizing skin eruption on her legs. Radiographic studies show a tumor in the pancreas. Which of the following cells is responsible for this lesion?, with the following options: A: Acinar cell, B: Alpha cell, C: Beta cell, D: Delta cell - -### Response: -The symptoms described are typical for a patient with glucagon excess. Glucagon is secreted by alpha cells of the pancreatic islets of Langerhans. Increased levels are rare, usually due to carcinoma (70%) or adenoma (30%) of the islets. Two-thirds of patients with carcinoma have liver metastasis at the time of diagnosis. Increased glucagon causes a syndrome similar to diabetes mellitus, due to antagonism of insulin effects. Patients also have migratory skin rashes, alopecia, hyperpigmentation of the skin, and glossitis. Diagnosis is made by measuring glucagon. The acinar cell , the main exocrine cell of the pancreas, contains digestive enzymes. Increases in the release of these enzymes (especially amylase and lipase) occur with pancreatitis. Acute pancreatitis is considered an emergent medical condition. Chronic pancreatitis is associated with fibrosis and atrophy of the acinar structures. Beta cells are responsible for insulin release. An adenoma of beta cells (insulinoma) would cause hyperinsulinism. 70% are solitary and 10% are multiple. Insulinomas cause hypoglycemia, dizziness, confusion, and excessive sweating. Glucose needs to be given promptly to avoid coma and death. Diagnosis is made by finding increased insulin and hypoglycemia. Delta cells are islet cells that secrete somatostatin. Tumors producing increased somatostatin are usually malignant. Clinically, a diabetes mellitus-like syndrome occurs along with diarrhea. Diagnosis is made from elevated serum somatostatin levels, but can be difficult because of the hormone's sho half-life. Ref: German M.S. (2011). Chapter 17. Pancreatic Hormones and Diabetes Mellitus. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e. -### End" -5243,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Double depression in:-, with the following options: A: Major depressive disorder from 2 years, B: Major depression with OCD, C: Depression with dysthymia, D: Depression with anxiety attack - -### Response: -Double depression: Patient has symptoms of Dysthymia (mild depression symptoms continuing for 2 years) the patient develops superimposed depression episode. Major depressive disorder from 2 years is called chronic depression -### End" -5244,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antibody elevated in parasitic infection -, with the following options: A: IgA, B: IgE, C: IgG, D: IgM - -### Response: -IgE is to identify and neutralize pathogens such as bacteria, parasite, and viruses Ref: Ananthanarayan & Parkers textbook of microbiology 9th edition pg:98 -### End" -5245,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reversible monoamine oxidase inbitors (MAOIs) are:, with the following options: A: Nicorandil, B: Selegiline, C: Moclobemide, D: Fluphenazine - -### Response: -Ans: c (Moclobemide) Ref: Ahuja, 6th ed,p. Katzung Pharmacology, 10th ed,p. 475Moclobemide is a reversible and selective MAO-A inhibitor.MAO is a mitochondrial enzyme involved in oxidative deamination of biogenic amines(Adr,NA,DA,5-HT)ADVERSE EFFECTSHeadache, drowsiness, dry mouth, weight gain, postural hypotension, sexual disturbances, interactions with tyramine containing foods.Serotonin syndrome- It is a condition precipitated when MAO inhibitors are given with serotonin agonists, especially antidepressants of the selective serotonin reuptake inhibitor class (SSRIs). It occurs when overdose with a single drug, or concurrent use of several drugs, results in excess serotonergic activity in the central nervous system .Clinical features are hypertension, hyperreflexia, tremor, clonus, hyperthermia, hyperactive bowel sounds, diarrhoea, mydriasis, agitation, coma.Classification of anti-depressants1.TRICYCLIC ANTIDEPRESSANTS (TCAS)Imipramine, Amitriptyline, Clomipramine, Nortriptyline, Mianserin, Amoxapine2. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)Fluoxetine, Paroxetine, Fluvoxamine, Sertraline, Citalopram, Escitalopram3.SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)Venlafaxine,Duloxetine4.NOREPINEPHRINE SEROTONIN REUPTAKE ENHANCERS (NSREs)Tianeptine5.NOR ADRENERGIC AND SPECIFIC SEROTONERGIC ANTIDEPRESSANTS (NaSSA)Mirtazapine6.NOREPINEPHRINE DOPAMINE REUPTAKE INHIBITORS(NDRIs)Bupropion7.SEROTONIN ANTAGONISTS AND REUPTAKE INHIBITORS (SARIs)T razodone,Nefazodone8. NORADRENERGIC REUPTAKE INHIBITORS ( NARIs)Reboxetine9.MONOAMINE OXIDASE INHIBITORS(MAOIs)REVERSIBLE SELECTIVE MAOIsMAOI-B-Selegiline; MAOI-A- Moclobemide -### End" -5246,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 72-year-old man with COPD develops acute shortness of breath and presents to the hospital. He appears uncomfortable: blood pressure is 120/90 mm Hg, pulse 100/min, oxygen saturation 85% on room air. On examination of the chest, there is absent fremitus, absent breath sounds, and hyper resonant percussion of the right lung. The trachea is shifted to the left.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis., with the following options: A: acute asthmatic attack, B: complete pneumothorax, C: large pleural effusion, D: atelectasis - -### Response: -Careful physical examination can be very useful in diagnosing many common pulmonary disorders. Atelectasis and large pleural effusions both can present with decreased fremitus, dullness or flatness to percussion, and absent breath sounds. In atelectasis, tracheal shift, if present, is toward the affected side, and the opposite for a large pleural effusion. Asthma's most typical manifestations are prolonged expiration and diffuse wheezing. However, impaired expansion, decreased fremitus, hyperresonance, and low diaphragms can also be found. A complete pneumothorax results in absent fremitus, hyperresonance or tympany, and absent breath sounds. Lobar pneumonia is characterized by consolidation with increased fremitus, dullness, and auscultatory findings of bronchial breathing, bronchophony, pectoriloquy, and crackles. -### End" -5247,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are side effect of succinylcholine except, with the following options: A: Myalgias, B: Raised ICP, C: Hyperkalemia, D: Raised BP - -### Response: -The following are the side effects of succinyl choline: Cardiovascular effects: Sinus bradycardia Junctional rhythms Ventricular dysrhythmias Hyperkalemia Myalgia Masseter spasm- Succinyl choline can trigger malignant hypehermia Increased intracranial pressure: Succinylcholine may lead to an activation of the EEG and slight increases in CBF and ICP in some patients. Increased intraocular pressure Increased intragastric pressure -### End" -5248,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are useful in management of severe clostridium difficle-infection, except, with the following options: A: Vancomycin oral, B: Neomycin enema, C: IV metronidazole, D: Tigecycline - -### Response: -Answer- B. Neomycin enemaOral voncomycin plus intravenous metronidazole is the treatment of choice for patients with severe und complicated clostrdium dilificle infection (CDI) -### End" -5249,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Middle-aged diabetic women with tooth extraction had ipsilateral swelling over middle one-third of sternocleidomastoid and displacement of tonsils towards contralateral side. Diagnosis is, with the following options: A: Parapharyngeal abscess, B: Retropharyngeal abscess, C: Ludwigs angina, D: None - -### Response: -The most common aetiology of parapharyngeal abscess in an adult is tooth extraction. The infection produces a triad of symptoms such as prolapse of tonsil and tonsillar fossa, trismus, and external swelling behind the angle of the jaw. Retropharyngeal abscess is commonly seen in children below 3 years. In Ludwig's angina, the floor of the mouth is involved. (Ref: Diseases of ENT, PL Dhingra, 7th edition, pg no. 301) -### End" -5250,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following drugs is an antipeudomonal penicillin ?, with the following options: A: Cephalexin, B: Cloxacillin, C: Piperacillin, D: Dicloxacillin - -### Response: -Ans. is 'c' i.e., Piperacillin -### End" -5251,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type II paralysis in organophosphorous poisoning treatment is ?, with the following options: A: Atropine, B: Oximes, C: Symptomatic treatment, D: No treatment - -### Response: -Ans. is 'c' i.e., Symptomatic treatment Paralysis due to organophosphate (OP) poisoning can be three types ? 1. Type I (cholinergic phase) Treatment of choice is atropine with or without oximes. 2. Type II It is also called as intermediate syndrome. It develops 1-4 days after resolution of acute cholinergic symptoms. It is manifested as paralysis and respiratory distress. It involves proximal muscles with relative sparing of distal muscle groups. The pathogenesis presumed to be dysfunction of neuromuscular junction caused by downregulation of presynaptic and postsynaptic nicotinic receptors due to release of excessive Ach and Ca' respectively. Atropine is ineffective, symptomatic treatment is given. 3. Type III -### End" -5252,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Erlotinib is used in -, with the following options: A: Erlotinib is used in -, B: Pancreatic cancer, C: Gall bladder cancer, D: GIST - -### Response: -Ans. is 'b' i.e., Pancreatic cancer -### End" -5253,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient of exudative retinopathy of coats presents with leukocoria, needs to be differentiated from ?, with the following options: A: Retinoblstoma, B: Retinitis pigmentosa, C: Retinal detachment, D: Congenital cataract - -### Response: -Ans. is 'a' i.e., Retinoblastoma EXUDATIVE RETINOPATHY OF COATS Coats' disease is a severe form of retinal telengiectasia (idiopathic congenital vascular malformation), which typically affects one eye of boys in their first decade of life. In early stages it is characterised by large areas of intra and subretinal yellowish exudates and haemorrhages associated with overlying dilated and touous retinal blood vessels and a number of small aneurysms near the posterior pole and around the disc. It may present with visual loss, strabismus or leukocoria (whitish pupillary reflex) and thus needs to be differentiated from retinoblastoma. The condition usually progresses to produce exudative retinal detachment and a retrolental mass. In late stages complicated cataract, uveitis and secondary glaucoma occur, which eventually end in phthisis bulbi. Treatment Photocoagulation or cryotherapy may check progression of the disease if applied in the early stage. However, once the retina is detached the treatment becomes increasingly difficult and success rate declines to 33 percent. -### End" -5254,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most pulsatile tumor found in external auditory meatus which bleeds on touch?, with the following options: A: Squamous cell ca of pinna, B: Basal cell ca, C: Adenoma, D: Glomus tumor - -### Response: -Glomus tumor is the neoplasm of middle ear, it may perforate the tympanic membrane and appears as a polypus in the external auditory meatus which bleeds profusely if touched. -### End" -5255,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about bilirubin , EXCEPT:, with the following options: A: Hydrophobic and toxic compound, B: It is a tetrapyrrole, C: Daily production is 4 mg/kg, D: Most hemoglobin is derived from ineffective erythropoiesis - -### Response: -Bilirubin Hydrophobic and potentially toxic compound It is tetrapyrrole and an end product of heme degradation. Daily production is 4 mg/kg of bilirubin . Most bilirubin (70% to 80%) is derived from degradation of hemoglobin Minor component arises from ineffective erythropoiesis Ref:Sleisenger and Fordtran's,E-9,P-323 -### End" -5256,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Break bone fever is caused by ?, with the following options: A: Yellow fever, B: Japanese encephlitis, C: Dengue fever, D: KFD - -### Response: -Ans. is 'c' i.e., Dengue fever Break bone fever (Saddle back fever) is caused by dengue virus. Dengue fever Dengue fever is caused by arboviruses (at least 4 serotypes have been recognized) It is transmitted by Aedes (Aedes aegypti is the main vector). The reservoir of infection is both man and mosquito. The transmission cycle is Man-mosquito-man Dengue fever occurs both epidemically and endemically. Epidemics stas in rainy season and are usually explosive. Aedes mosquito becomes infective by feeding on a patient from the day before onset to the 5th day of illness. Various manifestations of Dengue infection A) Classical dengue fever - Also known as break bone fever Incubation period 2-7 days (3-10 days -4 Park) Onset is sudden with chills and fever. Fever is usually between 39degc and 40degc temperature returns to normal after 5-6 days or subside on about the 3rd day and rise again after 5-8 days after onset (saddle back fever). Rashes appear in 80% of cases during remission or during second febrile phase. The rash lasts for 2 hours to several days and may be followed by desquamation. B) Dengue Hemorrhagic fever (DHF)- It is a severe form of dengue fever caused by infection with more than one dengue virus. The severe illness is thought to be due to double infection with more than one dengue virus. Dengue hemorrhagic fever is believed to result from reinfection with a virus of different serotype ( due to enhancing antibodies) DHF usally occurs after sequential infection with any two of the four serotypes of dengue virus. Sequence of infection may be impoant; serotype 1 followed by serotype2 is more dangerous than serotype 4 followed by serotype 2. -### End" -5257,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not included in RNTCP -, with the following options: A: Active case finding, B: Directly observed, C: X-ray is diagnostic, D: All - -### Response: -Ans. is 'a' i.e.. Active case finding Treatment stratvies in RNTCP o Under the RNTCP active case finding is not prusued. o Case finding is passive. o Patients presenting thremselves with symptoms suspicious of tuberculosis are screened through 3 sputum smear examination. o Sputum microscopic examination is done in designated RNTCP microscopy centres. o It is essential to examine 2 sputum specimens of each patient before a conclusive diagnosis can be made. o One sputum sample is not sufficient for diagnosis as the chance of detecting smear positive case is only RO% as compared to 93% with two samples and 100% with 3 samples. o If only 1 sputum smear is positive, chest x-ray helps in diagnosis (see next explanation). o Once the diagnosis is confirmed, treatment is staed according to DOTS (Directly observed therapy sho term). o Patient are expected to collect drugs once a month (not daily) on fixed dates from the nearest treatment centre. -### End" -5258,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true regarding delusional disorder, with the following options: A: Social isolation, B: Occurs at early age, C: Sensory impairment, D: Recent immigration - -### Response: -Risk factors of delusional disorder:- * Advancing age * Sensory loss * Recent immigration * Social isolation * Family history * Personality traits Ref:- Kaplan & Sadock's Synopsis of Psychiatry 10th edition; Pg num:- 432 -### End" -5259,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following tumours metastases to heart?, with the following options: A: Ca breast, B: Ca stomach, C: Ca urinary bladder, D: Osteogenic sarcoma - -### Response: -Ans: a (Ca breast)Ref: Journal of Continuing Medical Education of Radiology, Annals of Oncology; Vol. 15, Issue 3""Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis.Tumours that are most likely to involve the heart and pericardium include cancers of the lung and breast, melanoma, and lymphoma.Tumour may involve the heart and pericardium by one of four pathways: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension.""""In principle, every malignant tumour can metastasize to the heart. To date, only tumours of the central nervous system have not been proven to develop cardiac metastases. The most common tumours with cardiac metastatic potential are carcinomas of the lung, the breast and the esophagus, malignant lymphoma, leukemia, and malignant melanoma""""Carcinoma of the breast, lung, oesophagus, pancreas, malignant melanoma, and malignant lymphoma are mentioned most frequently in the literature as the primary tumor. In fact, almost all types of tumors have occasionally metastasized to the heart.""Ca urinary bladder- vascular spread is most commonly to bone, particularly axial skeleton although liver and lung metastasis do occur, usually at a very late stage. (Cushieri 4th ed. pg. 1251)In summary, metastasis are 100 times more common thanprimary tumors of the heart. Most commonly metastasizingto the heart are lung, breast, malignant melanoma, lymphoma. -### End" -5260,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are components of Dane Paicle except -, with the following options: A: Surface antigen, B: Core antigen, C: C-antigen, D: Delta antigen - -### Response: -Complete hepatitis B virus or Dane paicle -consist of outer envelope inner core. The genome has a 4 overlapping genes -S gene C gene P gene and X gene. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:543 and 544 -### End" -5261,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old female patient presented with swelling of the left upper limb with some characteristic skin lesions. Patient gave history of undergoing MRM followed by chemotherapy and radiotherapy 7 years ago. A skin biopsy was taken. Which of the following markers would be most likely be positive in the above patient: -, with the following options: A: CD31, B: CD30, C: CD117, D: CD45 - -### Response: -This is a case of Stewa-Treves syndrome. Develops in patients many years after mastectomy, more commonly 5-15 years after surgery. Severe chronic edema of an upper extremity The edematous area gradually extends from arm to forearm and dorsal aspect of the hand and fingers. The lesions of Stewa-Treves syndrome typically appear as multiple reddish blue macules or nodules that may become polypoid. Around these nodules, small satellite areas can develop and become confluent, forming an enlarging lesion. HPE image shows the classical picture of a lymphangiosarcoma (spindle shaped neoplastic cells along with RBCs at low power). Positive staining for laminin, CD31, collagen IV, and vimentin can aid in diagnosing the tumors as angiosarcomas. -### End" -5262,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are causes of osteoporosis, except -, with the following options: A: Rheumatoidahritis, B: Hypoparathyroidism, C: Chronic heparin therapy, D: Thyrotoxicosis - -### Response: -Osteoporosis It refers to reduction ofbone mass per unit volume (loss of matrix and defective mineralisation) (Fig. 9.47). Aetiology 1.Involutional 2.Endocrinological 3.Gastrointestinal 4.Haematological 5.Rheumatological 6.Collagen vascular Normal bone Type I (postmenopausal) and Type II (senile) Hypehyroidism Hyperparathyroidism Diabetes mellitus Hypogonadism Cushing's syndrome Malnutrition Malabsorption Anorexia nervosa Multiple myeloma Mastocytosis Rheumatoid ahritis Marfan's syndrome Ehler-Danlos syndrome Osteogenesis imperfecta Osteoporosis Fig. 9.47 Anticonvulsants Steroids Vitamin A Alcohol Heparin Furosemide Thyroid hormone in excessive doses Lithium GnRH agonist Cyclosporin Cytotoxic drugs 8.Cigarette smoking 9.Glucocoicoid therapy 10.Hypogonadism 11.Alcoholism 12.Renal disease 13.GI/Hepatic disorders. Bone forming agents a.Fluoride--75 mg/day b.Anabolic steroids: Testosterone is used in the treatment of osteoporotic man with gonadal deficiency. R ALAGAPPAN MANUAL OF PRACTICAL MEDICINE FOUH EDITION PAGE NO-690 -### End" -5263,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following drugs, which act on H,, receptors have active metabolite except, with the following options: A: Loratidine, B: Mizolastine, C: Azelastine, D: Ebastine - -### Response: -Ans. b (Mizolastine) (Ref KDT 6th/158)KDT 6th/1S9:Mizolastine: is nonsedating antihistaminic is effective in allergic rhinitis and urticaria by single daily dosing despite a t 1/2 of 8-10 hr and no active metabolite.anticholinergic action can be graded as:HighLowMinimal/ AbsentPromethazineChlorpheniramineClemastineDiphenhydramineHydroxyzineTerfenadineDimenhydrinateTriprolidineAstemizolePheniramineCyclizineLoratadineCyproheptadine CetirizineSECOND-GENERATION ANTIHISTAMINICSThe second-generation antihistaminics (SGAs) are H, receptor blockers marketed after 1980with following properties:# Higher H1 selectivity: no anticholinergic side effects.# Absence of CNS depressant property.# Additional antiallergic mechanisms apart from histamine blockade: some also inhibit late phase allergic reaction by acting on leukotrienes or by anti-platelet activating factor effect.# They have poor antipruritic, antiemetic and antitussive actions.Terfenadine (withdrawn by most manufacturers).# It is the first SGA,- highly H1 selective,- rapid onset (1-2 hr) and- moderate duration (12-24 hr) of action - good for short term and intermittent use.# Terfenadine, but not its carboxy metabolite (the active H1 blocker), blocks cardiac K+ channels in overdose and has produced polymorphic v. tach (torsade de pointes).# The risk is markedly increased in liver disease or when inhibitors of CYP 3A4 (which generates the carboxy metabolite) are administered concurrently -Erythromycin, clarithromycin, ketoconazole and itraconazole are the most important drugs precipitating terfenadine cardiotoxicity, while azithromycin and fluconazole are probably safe.# Similar incidences have been reported with astemizole, but not with other SGAs except ebastine.Fexofenadine (active metabolite of terfenadine)# Does not block delayed rectifier K+ channels in the heart--does not prolong QTc interval.# Therefore it has been introduced as a substitute of terfenadine free of arrhythmogenic potential.# But it is not entirely safe in patients with long QT, bradycardia or hypokalemia.# Fexofenadine do not cross BBB- no sedation or impair psychomotor performance and is free of atropinic side effects.# Duration of action 24 hours.# Though erythromycin and ketoconazole increase its blood levels, but no arrhythmias have been observed.Astemizole# Actions of astemizole are similar to terfenadine, but it has slow onset (2-4 hr) and long duration (2-5 days) of action.# It is 97% plasma protein bound and metabolized with a tV2 of 20 hr.# Astemizole is better used for maintenance therapy.# Not suitable for rapid control of symptoms.# In perennial rhinitis it has shown better efficacy than terfenadine and chlorpheniramine.# Increased appetite, weight gain and flatulence occur in some patients. It shares the ventricular tachycardia producing potential of terfenadine. The risk is enhanced by coadministration of selective serotonin reuptake inhibitors, quinidine, some macrolides, azole antifungals and HIV protease inhibitors.Loratadine# Another long-acting selective peripheral H] antagonist that lacks CNS depressant effects; faster acting than astemizole.# It is partly metabolized by CYP3A4 to an active metabolite with a longer t 1/2 of 17 hr, but in contrast to terfenadine/ astemizole, it has not produced cardiac arrhythmia in overdose.# No interaction with macrolides or antifungals has been noted.# Good efficacy has been reported in urticaria and atopic dermatitis.Desloratadine# It is the major active metabolite of loratadine effective at half the dose.# Non-interference with psychomotor performance and cardiac safety are documented.Cetirizine# It is a metabolite of hydroxyzine with marked affinity for peripheral Hl receptors; penetrates brain poorly, but subjective somnolence has been experienced at higher doses.# It is not metabolized; does not prolong cardiac action potential or produce arrhythmias when given with erythromycin/ ketoconazole.# Cetirizine also inhibits release of histamine and of cytotoxic mediators from platelets as well as eosinophil chemotaxis during the secondary phase of the allergic response.# Superior efficacy in urticaria / atopic dermatitis.# It is indicated in upper respiratory allergies, pollinosis, urticaria,atopic dermatitis; also as adjuvant in seasonal asthma.Azelastine# This newer H1 blocker has good topical activity;# Also inhibits histamine release and inflammatory reaction triggered by LTs and PAF; and has bronchodilator property.# After intranasal application it has been shown to down-regulate ICAM-1 expression on nasal mucosa.# Its metabolism is inhibited by CYP 3A4 inhibitors.# Given by nasal spray for seasonal and perennial allergic rhinitis it provides quick symptomatic relief lasting 12 hr.# Stinging in the nose and altered taste perception are the local side effects.# Some somnolence after nasal use and weight gain noted after oral use.Mizolastine# This recently marketed nonsedating antihistaminic is effective in allergic rhinitis and urticaria by single daily dosing despite a t 1/2 of 8--10 hr and no active metabolite.Ebastine# Another newer SGA that rapidly gets converted to the active metabolite carbastine having a t 1/2 of 10-16 hr. It is nonsedating and active in nasal and skin allergies.# Animal studies have found it to prolong Q-Tc interval, which makes it liable to arrhythmic potential and CYP3A4 interaction, but actual reports are still few.H2 antagonist: The first H2 blocker Burimamide was developed by Black in 1972. Metiamide was the next, but both were not found suitable for clinical use. Cimetidine was introduced in 1977 and gained wide usage. Ranitidine, famotidine, roxatidine, and many others have been added subsequently. They are primarily used in peptic ulcer and other gastric hypersecretory states and are described.H3 antagonist: Though a selective H3 antagonist thioperamide has been developed, it has not found any clinical utility. -### End" -5264,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: pH of amniotic fluid at later weeks of gestation :, with the following options: A: 4.5, B: 6.5, C: 7, D: 7.2 - -### Response: -7.2 -### End" -5265,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Homocystein is not associated with ?, with the following options: A: Coronary aery disease, B: Fracture, C: Hearing loss, D: Neuropsychiatric manifestations - -### Response: -Ans. is 'c' i.e., Hearing lossElevated level of homocysteine (hyperhomocysteinemia) is associated with -Thrombosis, coronary aery disease & stroke. Osteoporosis & fracture.Neuropsychiatric manifestations. Developmental delay.Visual disturbances. -### End" -5266,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The element used for intracavitary in carcinoma cervix:, with the following options: A: Caesium, B: Cobalt-60, C: Strontium, D: Radio iodine - -### Response: -Ans. Caesium -### End" -5267,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the statement regarding pseudocyst of pancreas is FALSE?, with the following options: A: Has a fibrous coat, B: Has mucous lining epithelium, C: Not a true cyst, D: Present as epigastric mass - -### Response: -A pseudopancreatic cyst is not a true cyst. It is a chronic collection of pancreatic fluid surrounded by a nonepithelialized wall of granulation tissue and fibrosis. It is seen in 10% of patients with acute pancreatitis and 20-30% patients with chronic pancreatitis. It is the most common complication of chronic pancreatitis. Pateints usually presents with pain, fullness or early satiety. -### End" -5268,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ohgren's line passes from ?, with the following options: A: Medial canthus to angle of mandible, B: Lateral canthus to angle of mandible, C: Medial canthus to mastoid process, D: Lateral canthus to mastoid process - -### Response: -Ans. is 'a' i.e., Medial canthus to angle of mandible Ohngren's classification of maxillary carcinoma: Presented by the ohngren's line which passes from the medial canthus of the eye to the angle of mandible. The growths situated above this plane have a poorer prognosis than those situated below. Ohngren's line (1933) A line from medial canthus of the eye to the angle of the mandible. Anteroinferior/infrastructure : Good prognosis. Superoposterior/suprastructure : Poor prognosis, early extension (eye, skull base, pterygoids, and intratemporal fossa). -### End" -5269,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infection occurring after man&;s bite is, with the following options: A: Spirochetes, B: Staphylococcus, C: Anaerobic streptococci, D: Candida - -### Response: -Staphylococcus infection - human patients and carriers are the commonest sources of infection. About 10- 30% healthy person carry bacterial in the nose, skin, axilla, perineum and throat. Ref: Textbook of microbiology; Ananthanarayan and paniker's 10th edition; Pg:205 -### End" -5270,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the followings are true regarding the pudendal nerve, except NOT RELATED-SURGERY, with the following options: A: Sensory and motor, B: Derived from S2,3,4, C: Comes out through the lesser sciatic foramen, D: Main nerve supply of pelvic organs - -### Response: -. -### End" -5271,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Motile spermatozoa found in wet mount of vaginal secretions are indicative of intercourse within the past:Karnataka 09; LIP 09; MAHE 11, with the following options: A: 6 h, B: 12 h, C: 24 h, D: 48 h - -### Response: -Ans. 12 h -### End" -5272,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antigen-antibody binding occurs at, with the following options: A: Center, B: Inside molecule, C: Anywhere in structure, D: Surface - -### Response: -General features of the antigen-antibody reaction - -The reaction is specific, an antigen combines with only its homologous antibody and vice versa, the specificity however is not absolute. -Antigen-Antibody reaction requires the presence of electrolytes at a specific pH and temperature -Bonds involved in Antigen-Antibody reaction are - Van der Waal's bond, Ionic bonds, and Hydrogen bonding -Covalent bonds are not involved -There is no denaturation of the antigen or antibody during the reaction -Entire molecule of the antigen and antibody reacts -The combination occurs at the surface. Therefore it is surface antigens that are immunologically relevant -The combination is firm and reversible -Both antigen and antibody participate in the formation of agglutinates or precipitates. -### End" -5273,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the location of human leukocyte antigen (HLA)?, with the following options: A: Sho arm of chromosomes 3, B: Sho arm of chromosomes 6, C: Long arm of chromosomes 3, D: Long arm of chromosomes 6 - -### Response: -The human MHC (human leukocyte antigen; HLA) consists of a linked set of genes encoding major glycoproteins involved in antigen presentation. The complex locates to the sho arm of chromosome 6 and divides into three separate regions: class I, class II, and class III genes. The class I ""classic"" region encodes HLA-A, HLA-B, and HLA-C loci; the nonclassic or class I-related region encodes HLA-E, HLA-F, and HLA-G loci and other immunity-related genes such as CD1. The class II region (HLA-D) encodes HLA-DP, HLA-DQ, and HLA-DR loci and other genes related to antigen processing, transpo, and presentation, such as, transpoer associated with antigen processing (TAP). The class III region encodes genes for tumor necrosis factors and (TNF- and TNF-); complement factors C2, C4, and B; and the steroidogenic enzyme 21-hydroxylase. Ref: Jaume J.C. (2011). Chapter 2. Endocrine Autoimmunity. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e. -### End" -5274,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amount of volumetric polymerization shrinkage seen in composites during curing is:, with the following options: A: 0.5-2%, B: 1.7-5.7%, C: 5.2-9.8%, D: 12.8-17.76% - -### Response: -Linear shrinkage is about 0.2 to 2%. -Volumetric shrinkage is 1.7-5.7%. -Shrinkage is seen towards the centre in self cure materials and towards the light source in light cure materials.  -Reference : Nisha Garg 2ND ed Pg: 310 -### End" -5275,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which maturation stage of RBCs is infected by Plasmodium falciparum -, with the following options: A: Reticulocyte stage only, B: Normoblast stage, C: Old RBC, D: RBC of all ages - -### Response: -The causative agent of the deadliest form of malaria, the parasite Plasmodium falciparum, is a protozoan that is transmitted by mosquitoes to humans in the form of stringlike sporozoites that attack the liver, multiply in liver cells, and then invade red blood cells( all stages of rbcs present in blood) in the form of micron-sized, droplet-shaped Ref Harrison20th edition pg 1045 -### End" -5276,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The mechanism of hearing and memory includes all EXCEPT:, with the following options: A: Changes in the level of neurotransmitter at synapse, B: Increasing protein synthesis, C: Recruitment by multiplication of neurons, D: The spatial reorganisation of synapse - -### Response: -Memories are stored in the brain by changing the basic sensitivity of synaptic transmission between neurons as a result of previous neural activity. The new or facilitated pathways are called memory traces. They are important because, once the traces are established they can be selectively activated by the thinking mind to reproduce the memories. Also, long-term memories result from changed synaptic conduction in lower brain centers. -Stereocilia, project upward from the hair cells and either touch or are embedded in the surface gel coating of the tectorial membrane, which lies above the stereocilia in the scala media. These hair cells are similar to the hair cells found in the macula and cristae ampullaris of the vestibular apparatus. Bending of the hairs in one direction depolarizes the hair cells, and bending in the opposite direction hyperpolarizes them. This in turn excites the auditory nerve fibers synapsing with their bases. When the basilar fibers bend toward the scala vestibuli, the hair cells depolarize, and in the opposite direction they hyperpolarize, thereby generating an alternating hair cell receptor potential that, in turn, stimulates the cochlear nerve endings that synapse with the bases of the hair cells. It is believed that a rapidly acting neurotransmitter is released by the hair cells at these synapses during depolarization. It is possible that the transmitter substance is glutamate, but this is not certain. -Reference: GUYTON AND HALL TEXTBOOK OF MEDICAL PHYSIOLOGY, THIRTEENTH EDITION(INTERNATIONAL EDITION ) page no 746,748,676,677 -### End" -5277,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Substance involved in countercurrent mechanism for maintaining medullary gradient -, with the following options: A: NaCl, B: Urea, C: NaCl, urea, D: NaCl, urea, water - -### Response: -D i.e. NaCI, Urea, Water -### End" -5278,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Growth hormone secretion is stimulated by ?, with the following options: A: Increased blood glucose, B: Decreased blood glucose, C: Coisol, D: Somatostatin - -### Response: -Ans. is 'b' i.e., Decreased blood glucose Regulation of GH secretion GH secretion is regulated by GHRH released from hypothalamus. GH is secreted in a pulsatile fashion throughout the life, with elevated rates of secretion immediately after bih and at pubey. Interestingly, large bursts of secretion occur at night during the onset of deep sleep. Stimuli that increase secretion of GH are hypoglycemia, exercise, fasting, protein meals, aminoacids (like arginine), stress, glucagon, pyrogen, lysin vasopressin, apomorphins, L-dopa & a-adrenergics, estrogen, androgens and 2-deoxyglucose. Stimuli that decrease secretion of GH are REM sleep, glucose, Somatostatin, coisol, FFA, GH itself, IGF-1, and medroxyprogesteron. -### End" -5279,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antemoem and postmoem wounds could be differentiated by all, except -, with the following options: A: Eveed margins, B: Blood clots in surrounding, C: Swollen edges, D: Sharp edges - -### Response: -the synopsis of forensic medicine & toxicology ; Dr k.s narayan reddy ; 28 th edition ; Pg.no.106 By sharp edges we can not differentiate between antemoem & postmoem wound . All the other options are applicable . -### End" -5280,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Osgood schlatters disease involves?, with the following options: A: Tibial tuberosity, B: Femoral condyle, C: Lateral malleolus, D: Medial malleolus - -### Response: -Ans. (a) Tibial tuberosityRef.-.Apley's system of orthopaedics and fractures edited by Louis Solomon, dividwarwicky selvadurainayagam 9/e, p 575-576y 887) -### End" -5281,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of UTI in a neonate is, with the following options: A: E.coli, B: S. aureus, C: Enterococcus, D: Anerobes - -### Response: -Causative agents of UTI:Uncomplicated UTIComplicated UTI*E.coli *Klebsiella*Proteus species*Enterobacter*Staphylococcus saprophyticus*Enterococci *Chlamydia , Neisseria *Ureaplasma, Mycoplasma . Adenovirus *E.coli *Klebsiella*Proteus species*Serratia marcescens*Pseudomonas *Enterococci Staphylococci Ref:Harrison's infectious disease 2nd edition, p296 -### End" -5282,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Main source of energy in 1min is, with the following options: A: Glycogen, B: FFA, C: Phosphates, D: Glucose - -### Response: -Why body stores glucose as glycogen and not as glucose itself? Possible Reasons 1. Being insoluble it exes no osmotic pressure, and so does not disturb the intracellular fluid content and does not diffuse from its storage sites. 2. It has a higher energy level than a corresponding weight of glucose (though energy has to be expended to make it from glucose). 3. It is readily broken down under the influence of hormones and enzyme: * Into glucose in liver (to maintain blood glucose level). * Into lower intermediates in skeletal muscle and other tissues for energy. Role of Liver Glycogen * It is the only immediately available reserve store of blood glucose. * A high liver glycogen level protects the liver cells against the harmful effects of many poisons and chemicals, e.g. CCl4, ethyl alcohol, arsenic, various bacterial toxins. * Ceain forms of detoxication, e.g. conjugation with glucuronic acid; and acetylation reactions, are directly influenced by the liver glycogen level. * The rate of deamination of amino acids in the liver is depressed as the glycogen level rises so that amino acids are preserved longer in that form and so remain available for protein synthesis in the tissues. * Similarly, a high level of liver glycogen depresses the rate of ketone bodies formation. Biomedical Impoance * Liver glycogen is largely concerned with storage and supply of glucose-1-P, which is conveed to glucose, for maintenance of blood glucose, paicularly in between meals. * Muscle glycogen on the other hand, is to act as readily available source of intermediates of glycolysis for provision of energy within the muscle itself. Muscle glycogen cannot directly contribute to blood glucose level. * Inherited deficiency of enzymes in the pathway of glycogen metabolism produces ceain inherited disorders called as Glycogen storage diseases (GSD)Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 346 -### End" -5283,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Percentage of scar dehiscence in lower uterine segment caesarean section is: September 2009, with the following options: A: 0.1-2%, B: 2-5 %, C: 5-9%, D: More than 10% - -### Response: -Ans. A: 0.1-2% For women who had a prior cesarean bih the rupture can occur at the site of the previous uterine scar. The risk of uterine rupture is about 1.5% or less with the lower segment scar. It is estimated that between 4 and 9% of classical/ hysterotomy uterine scars are at risk for rupture. -### End" -5284,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What do restriction endonucleases do?, with the following options: A: Cut ds DNA at specific sites, B: Cut RNA at specific sites, C: Cut ss DNA at specific sites, D: Break peptide chains - -### Response: -Restiction Endonucleases (RE) : In order to transfer a gene, it is to be first selectively split from the parent DNA. It is usually achieved by the restriction endonucleases. RE have specific recognition sites where they cut the DNA. There are >800 such enzymes now available commercially. These enzyms recognize specific sequence with palindrome arrangement. REF :DM VASUDEVAN textbook; 8th EDITION; Page no :601 -### End" -5285,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a negative symptom of Schizophrenia?, with the following options: A: Ambivalence, B: Automatic obedience, C: Anhedonia, D: Delusion - -### Response: -Anhedonia- lack of pleasure in a previously pleasurable activity Negative symptoms in Schizophrenia are: Apathy- Lack of concern Avolition- Loss of drive for goal directed activities Asociality- Lack of social interaction Affective flattening or blunting Alogia- Lack of speech output Anhedonia- Lack of pleasure in previously pleasurable activities. The more the negative symptoms in an individual with Schizophrenia, the worse is the prognosis. -### End" -5286,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Zoonosis is/are -, with the following options: A: Anthrax, B: Brucella, C: Leptospirosis, D: Chaga's disease - -### Response: -

Anthrax is an eg for zoonoses. Zoonoses means an infection or infectious disease transmissible under natural conditions from veebrate animals to man. Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:94. <\p> -### End" -5287,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following tumours of skin are radiosensitive, except:, with the following options: A: Cutaneous lymphoma, B: Basal cell carcinoma, C: Malignant melanoma, D: Squamous cell carcinoma - -### Response: -Ans. Malignant melanoma -### End" -5288,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is true regarding the gamma efferent neuron?, with the following options: A: An 'A' group motor neuron with a smaller diameter than that of alpha efferent neurons, B: Innervates intrafusal fibres, C: Innervates muscle fibres that stretch annulospiral bulbar endings, D: All of the above - -### Response: -(D) All of the above # SPINDLES have motor nerve supply of their own and these nerves constitute about 30% of fibers in ventral roots, and belong in Erlanger and Gasser's A g group.> Because of their characteristic 3-6 mm diameter in size or called g efferents of Leksell or small motor nerve system.> Larger b motor neurons innervate both intrafusal and extrafusal fibers. -### End" -5289,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of diarrhea in AIDS patients:, with the following options: A: Salmonella typhimurium, B: Cryptosporidium, C: Candida, D: E. coli - -### Response: -Cryptosporidia, microsporidia, and Isospora belli are the most common oppounistic protozoa that infect the GI tract and cause diarrhea in HIV-infected patients. Diarrhea is accompanied by crampy abdominal pain,nausea and/or vomiting. Diagnosis- stool examination or biopsy of the small intestine. The diarrhea is noninflammatory, and the characteristic finding is the presence of oocysts that stain with acid-fast dyes. Therapy is predominantly suppoive Treatment :- with up to 2000 mg/d of nitazoxanide (NTZ) is associated with improvement in symptoms or a decrease in shedding of organisms in about half of patients. -### End" -5290,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a cytoprotective agent against radiation induced stomatitis?, with the following options: A: Amifostine, B: Metronidazole, C: Misinidazole, D: Acarbose - -### Response: -Ans. is 'a' i.e., Amifostine Amifostine* It is an organic thiophosphate* On activation by alkaline phosphatase it acts as a cytoprotective agent against cancer chemotherapy and radiotherapy.* Mainly used for prophylaxis of cisplatin induced neuro/nephrotoxicity and radiotherapy related stomatitis. -### End" -5291,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 34 years old man came with c/o blurring of vision in bilateral eyes and headache for past 6 months with decrease in libido. On examination, bitemporal hemianopia is seen. MRI was performed and shown below. Diagnosis is-, with the following options: A: Pituitary macroadenoma, B: Pituitary microadenoma, C: Meningioma, D: Hemangioma - -### Response: -Pituitary macroadenoma- size more than 10mm. 'Figure of 8' appearance is seen on MRI. Pituitary microadenoma - size less than 10mm. It shows delayed enhancement on dynamic contrast enhanced MRI as compared to normal pituitary gland . -### End" -5292,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following information is available about the body fluid volumes of a normal male: total body water, 40 liters; intracellular water, 25 liters; plasma water, 4 liters. The volume of the interstitial water is?, with the following options: A: 19 liters, B: 15 liters, C: 21 liters, D: 11 liters - -### Response: -Subtracting the intracellular water from the total body water gives the extracellular water (15 liters). Since the extracellular water exists primarily of the plasma water and the interstitial water, subtracting the plasma water (4 liters) from the extracellular water (15 liters) gives the interstitial water (11 liters). Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 1. General Principles & Energy Production in Medical Physiology. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e. -### End" -5293,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about narcolepsy except:, with the following options: A: Day dreaming, B: Hypnagogic hallucinations, C: Cataplexy, D: Sudden sleep - -### Response: -Ans. (A) Day dreamingNarcolepsy:Disorder characterized by excessive daytime sleepiness often distributed night time sleep and disturbances in REM sleep.Hallmark of this disorder is decreased REM latency, I.e. decreased latent period before the first REM period occurs.Normal REM latency is 90- 100 minutes, in narcolepsy, REM sleep occurs within 10 minutes of the onset of sleep.Classical tetrad of symptoms:Sleep attacks (MC)CataplexyHallucinations at sleep onset (Hypnagogic) and upon waking (Hypnopompic)Sleep paralysis. -### End" -5294,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following supplies lobule of ear pinna, with the following options: A: Auriculotemporal nerve, B: Great auricular nerve, C: Lesser occipital nerve, D: Great petrosal nerve - -### Response: -Nerves supplying pinna GREAT AURICULAR NERVE SUPPLIES MOST OF THE CRANIAL SURFACE AND POSTERIOR PA OF THE LATERAL SURFACE INCLUDING HELIX, ANTIHELIX AND LOBULE. LESSER OCCIPITAL NERVE UPPER PA OF THE CRANIAL SURFACE OF THE AURICLE AURICULOTEMPORAL NERVE TRAGUS, CRUS OF HELIX AND ADJOINING AREA OF HELIX AURICULAR BRANCH OF VAGUS(ARNOLD S NERVE) CONCHA AND EMINENTIA CONCHAE -### End" -5295,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of Conn's syndrome is -, with the following options: A: Adrenal hyperplasia, B: Adrenal carcinoma, C: Adrenal adenoma, D: Pituitary ACTH hypersecretion - -### Response: -Conn's syndrome is primary hyperaldosteronism caused by an adrenal adenoma producing aldosterone. It is characterised by low renin levels. Most people have hypeension due to sodium retention which may cause poor vision or headaches . Occasionally there may be muscular weakness, muscle spasms, tingling sensations , or excessive urination due to hypokalemia. Complications include cardiovascular disease such as stroke, myocardial infarction, kidney failure, and abnormal hea rhythms. Reference : page 780 Davidson's Principles and practice of Medicine 22nd edition -### End" -5296,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following factors in bile juice is responsible for preventing the precipitation of cholesterol and formation of gallstones, with the following options: A: High alkaline condition, B: High concentration of bicarbonates, C: Bile salts, D: Bile pigments - -### Response: -Bile salts (salts of cholic & chenodeoxycholic acids)form micelle which makes cholesterol soluble and prevents formation of gallstones -### End" -5297,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6-year-old girl is referred to you by her pediatrician complaining of a pain in her throat and presenting with an anterior cervical midline mass for several weeks. After a course of antibiotics the inflammation and erythema resolved but the mass still persisted. The mother is concerned. She remembers a time when the child was 3-years-old complaining of similar symptoms, but then it spontaneously resolved. Physical chest exam is normal but the mass appears to rise upward when the girl sticks out her tongue. What is the most common diagnosis?, with the following options: A: Lingual thyroid, B: Branchial cleft remnant, C: Thyroglossal duct cyst, D: Uncomplicated cervical neck abscess - -### Response: -Embryologically the thyroglossal duct cyst (Figure below) runs from the pyramidal lobe of the thyroid to the foramen cecum at the base of the tongue. It needs complete excision including part of the hyoid bone to avoid recurrence. An ectopic lingual thyroid is located at the base of the tongue and virtually never seen in the above described anterior midline location. Cervical lymphadenitis needs to be ruled out and a several microbial stains performed if an abscess develops. Masses caused by atypical mycobacterial do not respond to antibiotic therapy and need to be excised. Brachial cleft remnants are almost always seen in the alter neck and divided in several types depending on their branch origin. They, however, can also get infected in manifest sometimes in form of a lateral neck abscess.Thyroglossal cyst and duct course through the hyoid bone to the foramen cecum of the tongue -### End" -5298,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Synaptic potentials can be recorded by:, with the following options: A: Patch clamp technique, B: Voltage clamp technique, C: Microelectrode, D: EEG - -### Response: -C i.e. Microelectrode Nerve cells have a low threshold for excitation. The stimulus may be electrical, chemical or mechanical. Two types of physio chemical disturbances are produced: I) Local, non propagated potential - synaptic or electrotonic potential II) Propogated disturbance - action potential (nerve impulse) Measurement of electrical activity in nerve * The electric events in neurons are rapid being measured in millisecond (ms) and the potential changes are small, measured in millivolts (my) * The electrical activity can be measured by (I) MicroelectrodeQ with tip diameter of less than 1 micron (II) Electronic amplifier (III) Cathode ray oscilloscope -### End" -5299,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vocal cord abductors is:, with the following options: A: Lateral cricoarytenoid, B: Posterior cricoarytenoid, C: CricothyroidThyroarytenoid, D: Thyroarytenoid - -### Response: -Posterior cricoarytenoid -### End" -5300,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antral puncture is done through-, with the following options: A: Superior meatus, B: Inferior meatus, C: Middle meatus, D: All - -### Response: -Proof puncture (Antral puncture) - -This procedure involves puncturing the medial wall of the maxillary sinus in the region of the inferior meatus and irrigating the sinus. - -Indications -1)   Chronic and subacute maxillary sinusitis with the dual purpose of : - -Confirming the diagnosis and -Washing out the pus - -2)   To collect the specimen of the antral contents for culture and sensitivity, or cytological examination to exclude early malignancy. -Contraindications - -Children less than 12 years of age. -Acute maxillary sinusitis as it may lead to osteomyelitis -Fracture of maxilla as fluid may pass through fracture line. -Diabetes -### End" -5301,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skin hazards of swimming are – a) Verrucaeb) Pyoderma gangrenosumc) M. marinum gangrenosumd) M. ulcerans infection, with the following options: A: a, B: bc, C: ad, D: ac - -### Response: -Important skin problems caused by swimming pool are : Pseudomomonas dermatitis, chlorine irritation, M. marinum swimming pool granuloma, molluscum contagiosum, Plantar warts (verrucae), swimming pool conjuctivitis (adenovirus), swimmer's itch (schistosoma). -### End" -5302,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The sequence of oxygenated blood from the placenta to the fetal hea is ________, with the following options: A: Umbilical aery - Inferior vena cava - ductus venosus - right atrium - left atrium, B: Umbilical aery - Superior vena cava - right atrium - ductus aeriosus - left atrium, C: Umbilical vein - ductus venosus - inferior vena cava - right atrium - left atrium, D: Umbilical vein - ductus aeriosus - superior vena cava - right atrium - left atrium - -### Response: -The sequence of oxygenated blood flow from the placenta to the fetal hea is Umbilical vein - ductus venosus - inferior vena - right atrium - left atrium. Ref: Nelson textbook of pediatrics 21st edition pGno: 2345 -### End" -5303,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which type of shock is seen in burns-, with the following options: A: Cardiogenic, B: Hypovolemic, C: Both of the above, D: None of the above - -### Response: -Ans. is 'b' i.e., Hypovolemic * Following table depicts the types of shock and the clinical situations where each type is seen:Three major types of shockType of shockClinical examplePrincipal mechanismsCardiogenicMyocardial infarction Ventricular ruptureFailure of myocardial pump resulting from intrinsic compression, or obstruction to outflowArrhthmiaCardiac tamponadePulmonary embolismHypovolemicFluid loss (e.g., hemorrhage, vomiting, diarrhea, burns, or traums)Inadequate blood or plasma volumeShock associated with systemic inflammationOverwhelming microbial infections (bacterial and fungal) Superantigens (e.g., toxic shock syndrome) Trauma, burns, pancreatitisActivation of cytokine cascades; peripheral vasodiation and pooling of blood; endothelial activation/injury; leukocyte-induced damage, disseminated intravascular coagulation* In patients with burns both hypovolemic shock and shock associated with systemic circulation can be seen. -### End" -5304,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Ganser's syndrome except:, with the following options: A: Approximate answer, B: Apparent clouding of consciousness, C: Only found in prisoners, D: Hallucinations - -### Response: -Though Ganser's syndrome is usually seen in prisoners but it is not exclusive to them. It consist mainly of three symptoms- Word approximation (Vorbeireden)- Hallmark Auditory / Visual Hallucinations Clouding of consciousness -### End" -5305,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Caloric requirement of adult male worker with moderate levels of activity is:-, with the following options: A: 2320 Kcal /day, B: 2230 Kcal /day, C: 2730 Kcal/day, D: 3490 kcal/day - -### Response: -Caloric requirement of Adult Male worker:- Sedentery levels of activity - 2320 Kcal/day Moderate levels of activity - 2730 Kcal/day Heavy levles of activity - 3490 Kcal/day. Caloric requirement of Adult Female worker:- Sedentery levels of activity - 1900 Kcal/day Moderate levels of activity - 2230 Kcal/day Heavy levles of activity - 2850 Kcal/day. -### End" -5306,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most impoant risk factor for neonatal respiratory, distress syndrome -, with the following options: A: Diabetic mother, B: Asphyxia, C: Prematurity, D: Twin pregnancy - -### Response: -Ans. is 'c' i.e., Prematurity Hyaline membrane disease (HMD) or respiratory distress syndrome (RDS) o HMD always occurs in preterm babies often less than 34 weeks of gestation. o It is the commonest cause of respiratory distress in a preterm neonate. o Predisposing factors for HMD are -4 Prematurity (most impoant), asphyxia, acidosis, maternal diabetes, multiple bih, cesarean section delivery, cold stress and a history of previously affected infants. o Incidence is highest in preterm male and white infant. o Risk is reduced in pregnancies with pregnancy associated hypeension, maternal heroin use, prolonged rupture of membranes, and antenatal caicosteroid prophylaxis -### End" -5307,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carcinoid tumor is diagnosed by -, with the following options: A: Urinary 5 HIAA, B: Serum Chromogranin A, C: Plasma neuro-specific enolase, D: Urinary 5-HTP - -### Response: -Ans. is 'a' i.e., Urinary 5 HIAA Diagnosis of carcinoid syndrome:* The diagnosis of carcinoid syndrome relies on measurement of urinary or plasma serotonin or its metabolites in the urine. The measurement of 5-HIAA is used most frequently.* False-positive elevations may occur if the patient is eating serotonin-rich foods such as bananas, pineapples, walnuts, pecans, avocados, or hickory nuts or is taking certain medications (cough syrup containing guaifenesin, acetaminophen, salicylates, serotonin reuptake inhibitors, or 1-dopa).* The normal range in daily urinary 5-HIAA excretion is 2-8 mg/d.* Most physicians use only the urinary 5-HIAA excretion rate; however, plasma and platelet serotonin levels, if available, may provide additional information.* Platelet serotonin levels are more sensitive than urinary 5-HIAA but are not generally available.* Because patients with foregut carcinoids may produce an atypical carcinoid syndrome, if this syndrome is suspected and the urinary 5-HIAA is minimally elevated or normal, other urinary metabolites of tryptophan, such as 5-HTP and 5-HT, should be measured.* Serum chromogranin A levels are elevated in 56-100% of patients with carcinoid tumors, and the level correlates with tumor bulk. Serum chromogranin A levels are not specific for carcinoid tumors.* Plasma neuron-specific enolase levels are also used as a marker of carcinoid tumors but are less sensitive than chromogranin A, being increased in only 17-47% of patients. -### End" -5308,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hepatotoxic drugs are -, with the following options: A: Chloroform, B: Ether (diethyl), C: N2O, D: All - -### Response: -Ans. is 'a' i.e., Chloroform Hepatotoxic anaesthetic agents are 1. Chloroform 3. Carbon tetrachloride 5. Methoxyflurane 2. Halothane 4. Trichloroethylene -### End" -5309,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following actions of histamine are mediated through H1 receptors EXCEPT:, with the following options: A: Release of EDRF from vascular endothelium resulting in vasodilation, B: Direct action on vascular smooth muscle causing vasodilation, C: Bronchoconstriction, D: Release of catecholamines from adrenal medulla - -### Response: -Both H1 and H2 receptors cause vasodilation. H1 receptors are present in the endothelium and cause vasodilation by releasing NO. However, H2 receptors are present on the smooth muscles and cause direct vasodilation. -### End" -5310,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The vitamin present in the fatty acid synthase complex is, with the following options: A: Thiamine, B: Folate, C: Pantothenate, D: Pyridoxine - -### Response: -Fatty acid synthase: In yeast, mammals, and birds, the synthetase enzyme system is called the fatty acid synthase complex--it is a multienzyme complex. It is made up of an ellipsoid dimer of two identical polypeptide monomeric units (monomer I and II), arranged in a ""head to tail"" fashion. Each monomeric unit contains six enzymes and an ACP molecule (Acyl carrier protein). Active Site * The ACP has an -SH group in the 4-phosphopantetheine moiety, referred as Pantothenic-SH (Pan-SH) * Another active -SH group present in the cysteine moiety of the enzyme ketoacyl synthase (condensing enzyme), referred as cysteinyl-SH (Cys-SH). The ""Pan-SH"" of one monomeric unit is in close proximity to the ""Cys-SH"" group of other monomeric unit and vice-versa.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 414 -### End" -5311,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A primary health center (PHC) repos 40-50 cases in a week in the community. This week there are 48 cases normally, based on previous records. This is called, with the following options: A: Epidemic, B: Sporadic, C: Endemic, D: Outbreak - -### Response: -Endemic: constant presence of a disease or infectious agent within a given geographic area or population group without impoation from outside. (i.e. the disease is occurring at the usual or expected frequency) e.g.: common cold Sporadic: irregularly scattered cases which have no connection with each other. E.g.: tetanus. Epidemic: Occurrence of the disease in a community or region clearly in excess of normal expectancy in a given time period. Outbreak: Outbreak carries the same definition of epidemic, but is often used for a more limited geographic area. -### End" -5312,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stimulates the synthesis of milk proteins., with the following options: A: LH, B: PRL, C: TSH, D: GH - -### Response: -PRL is the only hormone listed that stimulates the synthesis of milk proteins. PRL will induce a-lactalbumin, which will stimulate lactose production. -### End" -5313,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common ovarian tumor in pregnancy is?, with the following options: A: Dermoid cyst, B: Gonadoblastoma, C: Theca cell tumor, D: Serouscystadenoma - -### Response: -Ans. is 'a' i.e., Dermoid cyst Dermoid Cyst (Mature Cystic Teratoma)o It is a benign teratomao It is the most common benign tumor of the ovary in the reproductive age groupo It is the most common benign neoplasm diagnosed during pregnancyo It is the most common germ cell tumoro It is the commonest tumor to undergo torsion.o Lining epithelium is stratified squamous epithelium. Squamous cell carcinoma is seen if the dermoid cyst undergoes a malignant change (0.5 - 2%).o It usually contains derivatives of ectoderm, endoderm and mesoderm. Most common tissue element in dermoid cyst is ectodermal.o Characteristically they are unilocular cyst containing hair and cheesy sebaceous material, teeth, bones, thyroid tissue and cartilage.o On cross section they typically show an area of localized growh from which hair projects, teeth and bone are seen. It is called Rokintansky protruberance or dermoid process. -### End" -5314,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement about dysthyroid eye disease (grave's opthalmopathy) is, with the following options: A: Decreased power of divergence, B: Most common cause of U/L proptosis in, C: Extreme exopthalmos is usually seen in hypothyroidism, D: On looking upwards lower lid does not follow eye movements - -### Response: -C. i.e. Extreme exopthalmos is usually seen in hypothyroidism A mild exopthalmos is associated with thyrotoxicosis and an extreme exopthalmos may be associated with any state of thyroid activity, but usually in hypothyroidism often after thyroidectomy.Q Dysthyroid / Graves-Opthalmopathy or Endocrine / Malignant-Exopthalmos * Etiology Clinical Features Treatment Autoimmune in General (Thyrotoxicosis) Ocular * GuanethidineQ may which there is * SymptomsQ * Dalrympe's Sign- decrease lid antibody - Tiredness Retraction of upper eye lid producing Staring retraction caused by mediated attack - Emotional lability & Frightened appearanceQ over.action of on orbital - Heat intolerance Mn-""D for Dar"" muller's muscleQ fibroblast - Weight loss * Von Graefe's Sign- * Systemic Steroids & primarily, extraocular - Excessive appetite - Palpitation Lid lag i.e on looking downwardsQ (towards Ground) upperlid follows tardily or not at all Radiotherapy (if steroids not muscles being * SignsQ Mn-""Graefe-Lid lag on looking Ground"" effective) 1000 rad secondarily - Tachycardia (persist during * Stellwag's Sign- from each lateral involvedQ sleep)Q Infrequent blinking with deficient closure of po for reducing * Pathology - Hot, moist palms lidsQ orbital edema Mononuclear cell - Agitation Mn-""S for Still"" * Aificial tears & inflammation - Thyroid goiter & bruit * IVRibius Sign- Lateral with presence of - Myopathy of proximal Decreased power of convergenceQ tarsorrhaphy to mucopolysacchri muscles Mn- ""M for On looking Medially"" prevent exposure des * Stages of development of * Enroth's Sign- keratopathy predominantly cardiac arrhythmias Fullness of eylids d/1 puffy Edematous * Prismatic glasses for hyluronic acid - Tachycardia which persist swelling diplopia together with during sleep Mn- ""E for Edematous lid"" * Orbital Interstial edema (characteristic)Q * Gifford's Sign- decompression & inflamatory - Multiple extra systole Difficulty in eversion of upper lid When steroid & cells - Paroxysmal atrial * Exopthalmos (Proptosis) have proved tachycardia * Weakness of extraocular muscles paicularly ineffective two wall - Paroxysmal atrial elevators (inferior oblique)Q causing diplopia (orbital floor & fibrillation * Conjunctival injection over inseion of recti medial wall - Persistent atrial fibrillation * Increased intra ocular pressure removed) not responding to digoxin * Superior limbic keratopathy decompression is done 28) Grade 4 Extraocular muscle involvement Q (limitation of movement & diplopia) Grade 5 Corneal involvement (exposure keratitis) Grade 6 Loss of Sight (d/t optic nerve involvement with disc pallor or papilloedema & visual field defect) "" v:shapes=""_x0000_s1026"">Graves opthalmopathy is most common cause of U/L or B/L proptosis in adults between age of 25-50 yearsQ Werner Classification reflect severity of opthalmopathy and is well known by acronym of NO SPECS. Grade 0 - No signs or symptoms Grade 1 - Only signs (lid retraction with or without lid lag Q & mild proptosis) Grade 2 - Soft tissue involvement (chemosis, grit, lacrimation, photophobia, lid or conjuctival swelling) Grade 3 Proptosis Q (minimal28) Grade 4 Extraocular muscle involvement Q (limitation of movement & diplopia) Grade 5 Corneal involvement (exposure keratitis) Grade 6 Loss of Sight (d/t optic nerve involvement with disc pallor or papilloedema & visual field defect) -### End" -5315,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which differentiating prerenal azotemia with ATN features oring pre-renal azotemia -, with the following options: A: Urine osmolality > 500 mosmol/kg, B: Sodium spot excretion < 10 ml/L, C: Plasma transferrin/Ig ratio, D: All the above - -### Response: -The normal kidney can elaborate urine with a maximum concentration greater than 1,200 mOsm/kg in states of dehydration. A urinary osmolality (Uosm) greater than 500 mOsm/kg,, is highly suggestive of prerenal azotemia Ref Harrison20th edition pg ,299 -### End" -5316,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of following statements about extrapyramidal effects of antipsychotic drugs is FALSE?, with the following options: A: Caused by blockade of dopamine receptors, B: Less likely to be produced by clozapine than by chlorpromazine, C: Can be countered to some degree by antimuscarinic drugs, D: Haloperidol does not cause extrapyramidal syndrome - -### Response: -(Ref: KDT 6/e p430, 431, 432) Extrapyramidal adverse effects of antipsychotic drugs are due to blockade of dopamine receptors. These are less often seen with atypical anti-psychotics like clozapine and risperidone (and more often with classical drugs like haloperidol and chlorpromazine). These effects can be treated with central anticholinergic drugs like benztropine and trihexiphenidyl. -### End" -5317,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the intraepthielial region of the mucosa of intestine the predominant cell population is that of, with the following options: A: B cell, B: T cell, C: Plasma cells, D: Basopils - -### Response: -IEL are6 a distinctive population of T cells dispersed among the luminal epithelial cells. paicularly in the small intestine there is a predominantly of CD8+T cells -### End" -5318,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following condition is most commonly associated with the development of renal vein thrombosis?, with the following options: A: Diabetic nephropathy, B: Membranous glomerulopathy, C: Post streptococcal glomerulonephritis, D: Membrano-proliferative glomerulonephritis - -### Response: -Renal vein thrombosis occur as a complication of nephrotic syndrome, paicularly membranous nephropathy. Patients with renal vein thrombosis presents with flank pain, tenderness, hematuria, rapid decline in renal function and proteinuria or it can be silent. The left renal vein is more commonly involved. Diagnostic screening can be performed with Doppler ultrasound. The most sensitive test is CT angiography. Ref: Smith's General Urology By Emil A. Tanagho and Jack W. McAninch, 17th Edition, Chapter 32; A Color Handbook of Renal Medicine By Fernando Fervenza, Page 31; Harrisons Internal Medicine, 18th Edition, Page 2382 -### End" -5319,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A farmer presents with multiple discharging sinuses in the leg not responding to antibiotics. Most likely diagnosis is :, with the following options: A: Madurella, B: Actino-mycetoma, C: Nocardia, D: Sporothrix - -### Response: -Ans. is 'a' madurella This is a case of Mycetoma (or Madura foot)Mycetoma is of 2 typesAbout the t/t, Harrison states * ""Actinomycetoma may respond to prolonged combination chemotherapy e.g with streptomycin and either dapsone or trimethoprim-sulfamethoxazole ""About t/t of eumycetoma it adds ""eumycetoma rarely responds to chemotherapy in some cases caused by Madurella mycetoma have appeared to respond to ketoconazole or itraconazole ""Thus RememberAlso, RememberThe granules from the draining sinuses are microcolonies of the organism*.The color of the granule may provide information about the agent eg-White to yellow -Actinomycotic mycetoma* Dark red to black granules-Madurella mycetomatis* -### End" -5320,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The obstruction of two or more major hepatic veins is seen in, with the following options: A: Budd-Chiari syndrome, B: Reye's syndrome, C: Rotor syndrome, D: Crigler-Najjar syndrome - -### Response: -Budd-Chiari syndrome It is caused by obstruction of hepatic venous outflow producing intense congestion of the liver Etiology Polycythemia rubra Vera is the most common etiology In the West, thrombosis of the major hepatic veins is more common In BCS all three major hepatic veins usually are occluded Small hepatic veins that join the retro hepatic IVC, paicularly veins draining the caudate lobe are spared Membranous obstruction of IVC is the most common cause of BCS in Japan, China, India and South Africa Infections causing BCS : Filariaisis, amebic liver abscess, aspergillosis, schistosomiasis, syphilitic gumma and hydatid disease Most common cancer associated with BCS : HCC, RCC, adrenal carcinoma and leimyosarcoma of IVC Clinical features Characterized by triad of Ascites+Hepatomegaly+ abdominal pain (Asha) Abdominal pain, abdominal distension, weakness, anorexia and jaundice Signs are massive ascites, hepatomegaly (with hyperophied Caudate lobe), wasting, abdominal venous distension, splenomegaly, jaundice and edema of thighs, legs and feet Jaundice and abdominal venous distension is more common in hepatic vein occlusion Edema of thighs, legs and feet is seen only in IVC occlusion Striking and progressive weakness occur as a manifestation in acute form but not in cirrhotic forms of BCS Ref: Schwaz's principle of surgery 10th edition Pg no : 1283-1284 -### End" -5321,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Although more than 400 blood groups have been identified, the ABO Rh blood group systems remains the most impoant in clinical medicine because:, with the following options: A: It was first identified, B: It has four different types of blood groups, C: Because A, B and Rh antigens are most immunogenic, D: Because they are inherited - -### Response: -Blood group genes are inherited in a Mendelian manner and are mostly located on autosomes. Most of the blood group genes are expressed in a codominant manner. In blood transfusion practice, most impoant blood group systems are ABO and Rh. Because, A, B, and Rh D antigens are the most immunogenic (i.e. capable of eliciting a strong antibody response on stimulation) and their auto antibodies can cause destruction of transfused red cells or induce haemolytic disease of newborn (HDN). ABO antigens are also impoant in organ transplantation. Blood group systems (International Society of Blood Transfusion or ISBT, 2008) Traditional name ABO Yt MNS Xg P1Pk Scianna Rh Dombrock Lutheran Colton Kell Landsteiner-Wiener Lewis Chido/Rodgers Duffy Hh Kidd Kx Diego Gerbich John Milton Hagen Cromer I Knobs Globoside Indian GIL Ok RHAG Raph -### End" -5322,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: FIGLU Test is used for deficiency of ?, with the following options: A: Vitamin B12, B: Riboflavin, C: Niacin, D: Folic acid - -### Response: -Ans. is 'd' i.e., Folic acid -### End" -5323,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tinea incognito is seen with:, with the following options: A: Steroid treatment, B: 1% BHi3, C: 5% permethrin, D: Antibiotics - -### Response: -A i.e. Steroid treatment Tinea incognito is extensive ring worm infection with atypical appearance due to inappropriate use of steroids.Q -### End" -5324,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reflex hallucination is a morbid variety of, with the following options: A: Kinesthesia, B: Paresthesia, C: Hyperesthesia, D: Synaesthesia - -### Response: -Reflex hallucinations,also called Synaesthesia, is the experience of a stimulus in one sense modality producing a sensory experience in another. For example, the feeling of cold in one's spine on hearing a fingernail scratch a blackboard. Reference:Fish's Clinical Psychopathology, 3rd edition, page 27. -### End" -5325,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amount of surfactant in the developing lung increases between the 26th and 32nd weeks of gestation. This increase is related to which of the following developmental events?, with the following options: A: Differentiation of alveoli form embryonic foregut, B: Increased density of pulmonary capillaries, C: Development of ciliated epithelium in airspaces, D: Differentiation of type II alveolar epithelial cells - -### Response: -Surfactant is synthesized by Type II pneumocytes that line the alveolar sacs. They begin to differentiate after the 26th week of Gestation. These cells can be recognized on electron microscopy by the presence of lamellar bodies. Surfactant production increases greatly after 35 weeks' gestation. Other structures in the lung do not synthesize the phosphatidylcholine and phosphatidylglycerol compounds that are impoant in reducing alveolar surface tension. -### End" -5326,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest histoloical finding in Benign Hypeension is:, with the following options: A: Proliferative endaeritis, B: Necrotizing aeriolitis, C: Hyaline aeriosclerosis, D: Cystic Medial Necrosis - -### Response: -Answer is C (Hyaline Aeriosclerosis) : The charachteristic histological finding in Benign Hypeension is Hyaline aeriosclerosis Benign Nephrosclerosis This term is used to describe the changes in kidney associated with associated with benign phase of hypeension malignant or accelerated hypeension Kidney size is either normalQ or may be moderately reducedQ Grain leather appearanceQThe coical surface has a fine even granularity Kidney size is variableQ May be smaller in size() (when superimposed on benign nephrosclerosis) or Larger in size (enlarged)Q than normal (patients who develop malignant hypeension in pure form) Flea bitten appearanceQ: The coical surface may show multiple small peticheal haemorrhagesQ from rupture of aerioles or glomerular capillaries. Microscopic (Vascular Changes & Parenchymal Changes) Hyaline AeriosclerosisQ Narrowing of the lumens of aerioles and small aeries caused by thickenning and hyalnization of the walls Fibroelastic HyperplasiaQ: in the intima (intimal thickenningQ, duplication of elastic lamina and hyperophy of the 'media' Parenchymal changes (due to ischaemic) Variable degree of Atrophy of parenchyma due to ischaemia Microscopic (Vascular Changes & Parenchymal Changes) Fibrinoid necrosis of aeriolesQ (Necrotizing aeriolitisQ The vessel wall shows fibrinoid necrosis. Represents an acute event and necrosis is usually not accompanied by intense inflammation Hyperplastic intimal sclerosisQ Onion -- SkinningQ Concentric laminae of proliferated smooth muscle cells, collagen and basement membrane (producing intimal thickenning) Parenchymal changes (due to ischaemia) Variable degree of atrophy ofparanchyma due to ischaemia. Infarction necrosis distal to abnormal vessels may be seen -### End" -5327,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A nurse was diagnosed to have HBeAg and HBsAg in serum. Most likely she is having, with the following options: A: Chronic hepatitis B, B: Active and infectious Hepatitis B disease, C: HBV + HBE coinfection, D: Recovery from Hepatitis B - -### Response: -HBsAg plus HBEAg in serum -• Acute hepatitis B -• Active and Infectious hepatitis B -• Chronic hepatitis B with Active viral replication (high infectivity) -### End" -5328,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antiandrogen is -, with the following options: A: Mifepristone, B: Clomiphene citrate, C: Flutamide, D: Tamoxifen - -### Response: -Ans. is 'c' i.e., Flutamide -### End" -5329,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is used in gene therapy?, with the following options: A: Electroporation, B: Electrofocusing, C: Selectively targeted recombination, D: Intracytoplasmic injection - -### Response: -Electroporation is used in gene therapy. Gene therapy is a technique that uses genes to treat or prevent disease. Delivery of DNA into patient&;s cells by using recombinant viruses/naked DNA/DNA complexes. Methods used include intranuclear injection, electroporation, gene-gun, sonoporation, and magnetofection Gene therapy was first used for severe combined immunodeficiency disorder (SCID), which is due to adenosine deaminase enzyme deficiency. FDA-approved gene therapy is used for SCID, Leber&;s congenital amaurosis, multiple myeloma and adrenoleukodystrophy Ref: Nelson textbook of pediatrics 21st edition Pgno: 584-586 -### End" -5330,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about blood coagulation, except -, with the following options: A: Factor X is pa of both intristic and extrinsic path ways, B: Extrinsic pathway is activatied by contact with negatively charged surfaces, C: Intrinsic pathway can be activated in vitro, D: Calcium is required in several steps of coagulation - -### Response: -harshmohan textbook of pathology 7 th edition extrinsic pathway is activated only by tissue damage which causes release of thromboplastin where as intrinsic pathway is activated by surface contact. factor x is a pa of common pathway. Ca2+ is required for conversion of 1x -1xa ,prothrombin to thrombin -### End" -5331,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most common fungal Infection in immunocompetent patient?, with the following options: A: Candida, B: Aspergillus, C: Cryptococcus, D: Penicillium - -### Response: -1. Candida is the most common fungal infection in immunocompetent person as well as oppounistic infection in immunocompromised person. 2. Predisposing factors that are associated with increased risk of infection with Candida include - Physiological state: Extremes of age (infancy, old age), pregnancy. Low immunity: Patients on steroid or immunosuppressive drugs, post transplantation, malignancy, HIV. Patients on broad spectrum antibiotics that suppress the normal flora Diabetes mellitus, febrile neutropenia and zinc or iron deficiency. Aspergillus,Cryptococcus,Penicillium are also oppounistic infections but less common than candida -### End" -5332,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug causing decrease in late sodium current -, with the following options: A: Nicorandil, B: Ranolazine, C: Trimetazidine, D: Molsidominc - -### Response: -Ans. is 'b' i.e., Ranolazine o Ranolazine was initially assigned as paial fatty acid oxidation inhibitors. However, now it is believed that it acts by a different mechanism. It acts by blocking a late sodium current that facilitates calcium NCX (Sodium -Calcium exchanger) -4 Calcium overload and decrease left ventricular wall tension --> decreased myocardial oxygen demand. -### End" -5333,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tip diameter of a no. 245 bur is ______mm, with the following options: A: 0.8, B: 1.2, C: 1, D: 1.5 - -### Response: -It is inverted cone shape with diameter .8mm and length 3mm. -### End" -5334,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the shoest acting non-depolarizing muscle relaxant (NDMR) and causes bronchospasm?, with the following options: A: Succinyl choline, B: Rapacuronium, C: Atracurium, D: Pancuronium - -### Response: -Rapacuronium has a rapid onset of action, minimal cardiovascular side effects, and a sho duration of action. It was withdrawn by the manufacturer following several repos of serious bronchospasm, including a few unexplained fatalities. Histamine release may have been a factor. Ref: Morgan, Jr. G.E., Mikhail M.S., Murray M.J. (2006). Chapter 9. Neuromuscular Blocking Agents. In G.E. Morgan, Jr., M.S. Mikhail, M.J. Murray (Eds), Clinical Anesthesiology, 4e. -### End" -5335,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are indicators for air pollution , except ?, with the following options: A: CO2, B: SO2, C: Soiling Index, D: Smoke index - -### Response: -Ans. is 'a' i.e., CO2 o Carbon dioxide is also an air pollutant, but it is not used as an air pollution indicator. o Park writes -- ""It is not commonly regarded as an air pollutant although man generates enormous amount of it in combustion process using coal, oil and gas. Carbondioxide is a natural constituent of the air It does not take pa in any significant chemical reactions with other substances in the air"". o The best indicators of air pollution are Sulphur dioxide Smoke (soiling index) Suspended paicles -### End" -5336,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most impoant function of Major Intrinsic Protein 26 (MIP-26) is:, with the following options: A: Diffusion barrier, B: Capsule of lens, C: Glucose transpo in lens, D: Transpo of water in lens - -### Response: -Major Intrinsic Protein 26 (MIP-26), now known as Aquaporin 0 is found only in the plasma membrane of eye lens fibre cells. Its main function is to maintain transparency of the lens by maintaining a tight cellular junction and/or by water cirulation. Ref: Encyclopedia of Molecular Pharmacology, Volume 1, Springer, 2008, Page 215; Current Medicinal Chemistry Jun 1999, Page 465 -### End" -5337,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In moderate malnutrition, weight for age is -, with the following options: A: 90-110%, B: 75-90%, C: 60-75%, D: 50-60% - -### Response: -parks textbook of preventive and social medicine 23rd edition. * weight for age =(weight of child /weight of a normal child of same age)100 normal nutritional status :90-110% mild malnutrition:75-89% moderate malnutrition:60-74% severe malnutrition:under 60% . -### End" -5338,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are features of Gradenigo's syndrome?, with the following options: A: It causes diplopia, B: It is characterized by retro-orbital pain, C: It is associated with involvement of the Cranial nerves V and VI, D: All of the above - -### Response: -Clinical features of gardenigo syndrome consist of a triad of deep retro orbital pain, paralysis of ipsilateral laeral rectus muscle from the involvement of abducens nerve(diplopia) as it cross the petrous bone and otitic infection with purulent discharge. This syndrome is also associated with features such veigo and hearing loss either from a concomitant bacterial labrynthitis or from involvement of eight cranial nerve in its bony canal. Ref: Companion to Clinical Neurology By William Pryse-Phillips, 2nd Edition, Page 404 -### End" -5339,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A body is brought to you for autopsy. On examination you find a bluish -purple lesion with well defined margin. On incising the wound, blood is seen in the vessels which is easily washed away to reveal pale subcutaneous tissue. What is the lesion described in the scenario?\r\nNote: The entire lesion was confined to to the dermis and is absent at areas under pressure., with the following options: A: Bruise, B: Hypostasis, C: Hematoma, D: Burn - -### Response: -The lesion describe in this case is hypostasis. It occurs in the most dependant pas of the body. It is caused due to distension of blood vessels in the dermis. It is absent in areas under pressure. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page - 154 -### End" -5340,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cell cycle specific anticancer drugs that acts mainly in the M phase of the cycle is, with the following options: A: Cisplatin, B: Etoposide, C: Methotrexate, D: Paclitaxel - -### Response: -Ref-KDT 6/830 Vinca alkaloids (vincristine, vinblastine and vinoerlbine ) and taxanes (pacilaxel and docetaxel) act in M-phase of cell cycle Vinca alkaloids inhibits the formation whereas taxenes inhibit the breakdown of mitotic spindle -### End" -5341,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about febrile convulsions is –, with the following options: A: Recurrent in nature, B: Follows high temperature, C: No spontaneous remission, D: Occurs at 6 years onwards - -### Response: -Febrile seizures - -Febrile convulsions are the commonest cause of seizures during early childhood. -Febrile seizures are defined as seizures which occur during fever. -Mostly occurs between 6 months to 5 years. -The convulsions are not related to the degree of temperature rise but are frequent if the temperature rises abruptly. -Spontaneous remission occurs with no postictal neurological deficit and EEG changes few days after the seizure is normal. -Recurrent febrile seizures occur in 30-50% of cases. -More than 90% of febrile seizures are generalized. -Acute respiratory illness is most commonly associated with febrile seizures. -### End" -5342,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypotension while on dialysis is due to, with the following options: A: Excessive ultrafiltration, B: Hypertensives, C: Renal disease, D: Diabetes - -### Response: -(A) Excessive ultrafiltration # INTRADIALYTIC HYPOTENSION is the presence of a decrease in systolic blood pressure PS20 mmHg or a decrease in mean arterial pressure by 10 mmHg.> Dialysis hypotension is the result of an inadequate cardiovascular response to the reduction in blood volume that occurs when a large volume of water is removed during a short period of time. -### End" -5343,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The virus causing aplastic crises in patients with haemolytic anaemia is, with the following options: A: Parvovirus, B: Coxsackie virus, C: Cytomegalovirus, D: Herpes virus - -### Response: -Parvovirus B19 is implicated in aplastic crisis in patients with hemolytic anemia, paicularly sickle cell disease. Parvovirus virus is the only DNA virus which has single-stranded DNA genome. Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 554 -### End" -5344,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Testis descends the in inguinal canal during - month, with the following options: A: 5th month, B: 6th month, C: 7th month, D: 8th month - -### Response: -Testies descent : - -4th month - itiac fossa. -7th month - deep inginal ring. -7th and 8th month - Inguinal canal. -### End" -5345,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 36 years old factory worker developed itchy annular scaly plaques in both groins. Application of a caicosteroid ointment led to temporarY relief but the plaques continued to extend at the periphery. The most likely diagnosis is -, with the following options: A: Erythema annulare centrifugam, B: Granuloma annulare, C: Annular lichen planus, D: Tinea cruris - -### Response: -Itchy annular lesion in groins with scaling and peripheral spreading and central clearing indicates tinea cruris initially tinea responds to coicosteroids due to masking of infection by steroid effect. iadvl textbook of dermatology, page page 253 -### End" -5346,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The site where myosin heads to action in skeletal muscles are covered by, with the following options: A: Tropomyosin, B: Troponin o, C: Calcium, D: None of the above - -### Response: -In resting muscle, troponin I is bound to actin and tropomyosin covers the site where myosin head interacts with actin. Ref: Ganong&;s Review of medical physiology;25th edition; pg: 104. -### End" -5347,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following muscle relaxant has the maximum duration of action –, with the following options: A: Atracurium, B: Vecuronium, C: Rocuronium, D: Doxacurium - -### Response: -On this, there is controversy in different books :- - - -According to Goodman & Gilman, Pancuronium is the longest acting. -According to Lee Pipecuronium is the longest acting. -Some books have given Doxacurium as longest acting (KDT, Ajay Yadav) - - -You are lucky as you have got only one amongst these three. For this question doxacurium is the answer for sure. -### End" -5348,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The site of lesion in Korsakoff&;s psychosis is -, with the following options: A: Frontal lobe, B: Corpus striatum, C: Hippocampus, D: Cingulate gyrus - -### Response: -Ans. is 'c' i.e., Hippocampus -### End" -5349,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following have defect in DNA repair mechanism except for:, with the following options: A: Xeroderma Pigmentosa, B: Fanconi anemia, C: Huntington's disease, D: Ataxia-telangectasia - -### Response: -Huntington disease (HD) Autosomal dominant disease It is a prototypes of the polyglutamine trinucleotide repeat expansion diseases. The gene for it is located on chromosome 4p16.3, encodes a 348 kD protein known as huntingtin. Xeroderma Pigmentosum Inherited disorder of DNA repair Diseases with Defects in DNA Repair by Homologous Recombination: Bloom syndrome Ataxia-telangiectasia Fanconi anemia -### End" -5350,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Facial skeleton develops from, with the following options: A: Neural crest, B: Paraxial mesoderm, C: Intermediate mesoderm, D: Lateral plate mesoderm - -### Response: -The viscerocranium forms the facial skeleton and the major pa of which develops from mesenchyme derived from 1st and 2nd pharyngeal arches.The lacrimal and nasal bones are derived from neural crest cells. The paraxial mesoderm undergoes segmentation to form somitomeres and somites that fuher differentiate into sclerotome, myotome, and dermatome. The intermediate mesoderm forms most of the genito-urinary system -eg; kidneys, testes, ovaries The lateral plate mesoderm forms body wall and body cavities. Reference: Textbook of clinical embryology, Vishram Singh,1st edition,page no.94,49 -### End" -5351,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oligohydramnios is seen in -, with the following options: A: Renal agenesis, B: Oesophageal atresia, C: Exomphalos, D: Neural tube defect - -### Response: -Ans. is 'a' i.e. Renal agenesis Renal agenesis prevents urine formation which leads to oligohydramnios.Oligohydramnios is condition where amniotic fluid is deficient in amount to the extent of 100ml or entirely absentAetiologyRenal agenesis*Amnion nodosum*IUGR*Post maturity*Obst. of urinary tract (post urethral Valve*) -### End" -5352,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an advantage of immediate dentures, with the following options: A: Excellent esthetics can be achieved on day of insertion, B: Circumoral support is maintained, C: Speech and mastication are less affected, D: Patient's psychological and social well being is preserved - -### Response: -A try in is not possible for immediate dentures. Therefore esthetics would be unpredictable. -### End" -5353,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Hypertrophic Cardiomyopathy except, with the following options: A: Dilated ventricle, B: Increased muscle mass, C: LV outflow obstruction, D: Diastolic failure - -### Response: -(A) Dilated ventricle # Hypertrophic cardiomyopathy (HCM) is characterized by LV hypertrophy, typically of a nondilated chamber, without obvious cause, such as hypertension or aortic stenosis.> It is found in about 1 in 500 of the general population. Two features of HCM have attracted the greatest attention: Asymmetric LV hypertrophy, often with preferential hypertrophy of the interventricular septum; and A dynamic LV outflow tract pressure gradient, related to narrowing of the subaortic area.> About one-third of patients with HCM demonstrate an outflow tract pressure gradient at rest and a similar fraction develop one with provocation.> The ubiquitous pathophysiologic abnormality is diastolic dysfunction, which can be detected by Doppler tissue imaging and results in elevated LV end-diastolic pressures; the latter may be present despite a hyperdynamic, nondilated LV. -### End" -5354,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On electron microscope amyloid characteristically exhibit, with the following options: A: Beta pleated sheat, B: Hyaline globules, C: 7.5-10nm fibrils, D: 20-25nm fibrils - -### Response: -Ref Robbins 6/e 2598/e p24909/e p257 Remember beta pleated structure of amyloid is seen on X Ray crystallography where as it is seen as no branching fibrils of 7.5-10 nm diameter and infinite lenght on electron microscope -### End" -5355,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the commonest type of ectopic pregnancy with presented with rupture?, with the following options: A: Isthmic, B: Ampulla, C: Interstitial, D: Infundibular - -### Response: -Aboion is common in ampullary pregnancies, whereas rupture is the usual outcome with isthmic pregnancies. As a rule, whenever there is tubal rupture in the first few weeks, the pregnancy is situated in the isthmic poion of the tube. When the feilized ovum is implanted well within the interstitial poion, rupture usually occurs later. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 10. Ectopic Pregnancy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. -### End" -5356,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muddy appearance of iris is seen in?, with the following options: A: Glaucoma, B: Iridocyclitis, C: Persistent pupillary membrane, D: Iris cyst - -### Response: -Ans. (b) IridocyclitisRef. Parson's 22/e, p. 122, 236In anterior uveitis (Iridocyclitis) the pupil is constricted, its reactions are sluggish, and the delicate pattern of the iris, instead of being clear and sharphy defined, becomes blurred and indistinct ('muddy' iris) -### End" -5357,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are features of Verrill's sign except:, with the following options: A: Partial ptosis., B: Tingling sensation., C: Blurring vision., D: Slurring speech. - -### Response: -The three features of Verrill’s sign are: - -Partial ptosis (50%). -Blurring vision -Slurring speech that indicate the correct level after Diazepam sedation -### End" -5358,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a primer acting as an acceptor of glucose residues in glycogenesis?, with the following options: A: Carbohydrate, B: Lipid, C: Protein, D: Nucleic acid - -### Response: -Primer for Glycogen biosynthesis: Glycogenin protein-contains tyrosine to which Glucose chain attached. -### End" -5359,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Ramsay Hunt syndrome, most commonly involved nerve is -, with the following options: A: V, B: VII, C: VIII, D: IX - -### Response: -Ans. is 'b' i.e., VII o It is lower motor neuron type of facial palsy due to Varicella (herpes) zoster. Pain is often a prominent feature and vesicles are seen in the ipsilateral ear, on the hard palate and/or on anterior two third of tongue. It may involve other cranial nerves-V, VIII, IX and X and cervical branches (C2, C3 & C4) that have anastomotic communications with facial nerv e. This results in features like :Anaesthesia of faceGiddinessHearing impairment along with VII nerve palsy.o The mechanism of disease is reactivation of the latent varicella zoster virus in the geniculate ganglion. The onset of palsy is preceeded by pain which may persist & become excruciating. When the rash is absent it is known as zoster sine herpete.o The prognosis of Ramsay Hunt syndromr is worse than Bells palsy. Persistent weakness is observed in 30-50% of patients and only 10% recover completely after complete loss of function without treatment.o Treatment recommended is prednisone (steroid) combined with acyclvir. -### End" -5360,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2 year old female child was brough to a PHC with a history of cough and fever for 4 days with inability to dink for last 12 hours. On examination, the child was having weight of 5 kg and respiratory rate of 45/minute with fever. The child will be classified as suffering from -, with the following options: A: Very severe disease, B: Sever pneumonia, C: Pneumonia, D: No pneumonia - -### Response: -As per history, the child has fever, cough and was unable to drink. The history points to very severe disease. classification of pneumonia. Fast breathing is present when the respiratory rate is : 1. 60 breaths/min or more in child < 2 months of age. 2. 50 breaths/min or more in child aged 2-12 months. 3. 40 breaths/min or mote in child 12 months - 5 yrs. VERY SEVERE DISEASE:- 1. Not able to drink 2. Convulsions, abnormally sleepy/ difficult to wake. 3. Stridor in calm child 4. Severe malnutrition Treatment- Refer urgently to hospital. Give first fose of antibiotics. Treat fever and wheeze , if present. If cerebral malaria possible, give antimalarial. SEVERE PNEUMONIA Most impoant sign to consider when deciding if the child has pneumonia are the RR and chest indrawing. A child with chest indrawing may not have fast breathing if the child becomes exhausted. Then the breathing slows down. Un such cases chest indrawing may be the only sign in a child with severe pneumonia. Other signs: 1. Nasal flare 2. Grunting 3. Cyanosis 4. Wheezing Treatment:- Refer urgently to hospital. Give first dose antibiotics. Treat fever and wheeze if present. PMEUMONIA:- 1. Fast breathing 2. No chest indrawing Treatment:- Advice mother to give home care. Give an antibiotic. Treat fever and wheeze if present. Advice mother to return eith child in 2 days for reassessment, or earlier if child gets worse. No pneumonia:- 1. Simple cough or cold. Treatment:- Assess and treat ear problems or sore throat. Assess and treat other problems. Advice mother to give home care. Treat fever and wheeze if present. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.170} -### End" -5361,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carbon dioxide is transported in blood mainly as:, with the following options: A: Free carbon dioxide, B: Bicarbonate, C: Carbamino compound, D: Plasma protein - -### Response: -Ans. B. Bicarbonatea. The solubility of carbon dioxide in blood is about 20 times that of oxygen , so that there is considerably more carbon dioxide than oxygen in simple solution at equal partial pressures.b. The carbon dioxide that diffuses into RBCs is rapidly hydrated to H2 CO3 because of the presence of carbonic anhydrase.c. The H2 CO3 dissociates to H+ and H2 CO3 , and the AH+ is buffered, primarily by hemoglobin, while the HCO3 - enters the plasma 'Some' of the carbon dioxide in the ABCs reacts with the amino groups of proteins principally hemoglobin, to form carbamino compounds. -### End" -5362,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about mycobacterium other than tuberculosis:, with the following options: A: Causes disseminated infection, B: Occurs in persons with normal immunity, C: Causes decreased efficacy of BCG due to cross immunity, D: Person to person transmission is seen - -### Response: -Causes decreased efficacy of BCG due to cross immunity Mycobacteria other than tubercle bacille (MOTT) which occassionally cause human disease resembling tuberculosis have been called atypical 'anonymous' or 'unclassified' mycobacteria. They are also called ""environmental"" or oppourustics as their natural habitat appears to be soil and water and they cause oppounistic infections in human beings. The name ""non tuberculous mycobacteria"" (NTM) has gained wide acceptance in recent years. They have also been called paratubercle' , ""tuberculoid"" and MOTT (mycobacteria other than tubercle bacilli) They are usually referred as MOTT and environmental bacteria in text. Epidemiology MOTT are widely distributed in the environment and are paicularly abundant in wet soil, marshland, streams, rivers and estuaries. Human beings are therefore regularly exposed to mycobacteria as a result of drinking, washing, showering and inhalation of natural aerosols. Such repeated subclinical infection may induce sensitization to tuberculin and other mycobacterial skin testing reagents. There is also evidence that contact with MOTT or the environmental bacteria profoundly affects the subsequent ability of BCG vaccine to induce protective immunity, thereby explaining the great regional difference in the efficacy of this vaccine. They are uncommon in regions where T.B. is endemic while they are common where T.B. is rare. Pathogenesis Compared with Tubercle bacilli, MOTT are of low virulence and although man is frequently infected, ove disease is very uncommon except in those who are profoundly immunosuppressed. Person to person infection does not seem to occur. Four main types of oppounist mycobacterial disease has been described in man Localized lymphadenitis. Skin lesions .following inoculation of bacteria. Tuberculosis like pulmonary lesions Disseminated disease Disseminated disease is seen only in severly immunoconzpromised cases such as H.LV. and in some cases of renal transplant. -### End" -5363,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sacrococcygeal teratoma is associated with:, with the following options: A: Meningocele, B: Cardiac detects, C: Hepatic cysts, D: Cystic adenoid malformation - -### Response: -Ans: A (Menigocele) Ref: Robbins and Cotran Pathologic Basis of Disease: 8th editionExplanation:Sacrococcygeal TeratomasMost common teratomas of childhoodAccounts for 40% or more of casesFour times more common in girlsApproximately 10% of sacrococcygeal teratomas are associated with congenital anomaliesPrimarily defects of the hindgut and cloacal regionMid line defectsMeningocele and spina bifidaApproximately 75% of these tumors are mature teratomas, and about 12% are unequivocally malignant and lethal. The remainder is immature teratomas.Most of the benign teratomas are encountered in younger infants (<4 months), whereas children with malignant lesions tend to be older.Other sites for teratomas in childhood include:TestisOvariesMediastinumRetroperitoneumHead and neck. -### End" -5364,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vasomotor reversal of dale is demonstrated by, with the following options: A: Fall in blood pressure by high dose intravenous Ach, B: Increase in blood pressure following administration of IV propranolol, C: Fall in blood pressure by ganglionic blocker, D: Fall in blood pressure by adrenaline pretreated with phentolamine - -### Response: -Ans. (d) Fall in blood pressure by adrenaline pretreated with phentolamine(Ref: Ganong, 25th ed/p.353)If the subject is given a blocker and then if epinephrine is injected, vasodilation and decrease in BP is seen. This effect is called ""Vasomotor reversal of Dale"" -### End" -5365,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is an absolute contraindication of Hormone replacement therapy ?, with the following options: A: Endometriosis, B: Osteoahritis, C: Hea disease, D: Breast carcinoma - -### Response: -Absolute contraindications of hormone replacement therapy (H): Undiagnosed vaginal bleeding Estrogen dependent cancer in the body Severe liver disease Pregnancy Venous thrombosis Well-differentiated and early endometrial cancer (once treatment for the malignancy is complete, is no longer an absolute contraindication.) -### End" -5366,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malnourished children are at risk for complications of measles, leading to greater morbidity and mortality. Which of the following should be given to children to reduce these risks?, with the following options: A: Vitamin A, B: Vitamin B, C: Vitamin C, D: Vitamin D - -### Response: -High-dose vitamin A (a) given to malnourished children and anyone with vitamin A deficiency reduces the risk of mortality. The World Health Organization recommends that all children with measles receive vitamin A supplementation (not necessarily high-dose). The remaining vitamins listed do not have any effects on the outcome of measles. -### End" -5367,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Insulin resistance state causing hyperglycemia is present in -, with the following options: A: Acromegaly, B: Osteomalacia, C: Liver cellcarcinoma, D: Somatostatinoma - -### Response: -Ans. is 'a' i.e., Acromegaly o Endocrinopathies associated with hvperglvcia and insulin resistance state are:# Acromegaly# Cushing syndrome# Hyperthyroidism# Pheochromocytoma# Glucagonoma -### End" -5368,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement related to expiry date of a drug is:-, with the following options: A: It is the date up to which the drug is likely to be fully potent and safe to take based on scientifically-sound product testing, if stored properly., B: Maximum period of expiry is 3 years from the date of manufacture, C: After expiry period, there is a fall in efficacy of drug, D: After expiry period, drug changes to more toxic compounds. - -### Response: -Expiry date: It is the date up to which the active ingredient is expected to remain within specification if stored correctly. The drug can be used by the last date of that paicular month displayed by expiry date (if exact date is not specified) The drugs may remain potent, efficacious as well as safe after expiry date, but the manufacturer does not give guarantee. There is no maximum period for expiry date. -### End" -5369,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Argon laser trabeculoplasty is done in:, with the following options: A: Angle closure glaucoma, B: Angle recession glaucoma, C: Secondary glaucoma, D: Open angle glaucoma - -### Response: -In Argon Laser Trabeculoplasty (ALT) Laser beam is focused on trabecular meshwork Opens up the pores of trabecular meshwork. So that more Aqueous can flow through it in faster time Lowers Intra ocular pressure Typically done in open angle glaucoma Trabecular meshwork After ALT -### End" -5370,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incubation period of ebola virus is -, with the following options: A: 5-20 hours, B: 20-40 hours, C: 5-20 days, D: 20-40 days - -### Response: -Ans. is 'c' i.e., 5-20 days * Ebola virus is a RNA virus, belongs to Filoviridae.* The virus causes Ebola hemorrhagic fever, a fatal disease.* Incubation period is 2-21 days.* Ebola virus begins to effect infected individuals with flue-like symptoms. There is a quickly oncoming fever, achy muscle, and headache, which are soon followed by bloody vomit and diarrhea. Some days later, victims can begin to bleed through the eyes, nose, or mouth. A hemorrhagic rash can develop on the entire body, which also bleeds. Muscle pain and swelling of the pharynx also most victims.* Patients are diagnosed by testing of urine or saliva with an ELISA test, however the results are not always accurate.* Due to the extensive amount of bleeding, most patients will die of hypovolemic shock and/or systematic organ failure within 2 to 21 days of contracting after about 14 days and rare able to survive the virus. -### End" -5371,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bone pearl's or wax drippings is pathogonomic of:, with the following options: A: Burns, B: Scalds, C: Lightening, D: Electrocution - -### Response: -Ans. (D). Electrocution(Ref: Review of Forensic Medicine & toxicology; Gautum Biswas; 2nd edition; Pg - 275) -### End" -5372,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young female patient came for routine examination.On examination a mid systolic click was found. There is no history of RHD. The histopathologicaI examination is most likely to show, with the following options: A: Myxomatous degeneration and prolapsed of the mitral valve, B: Fibrinous deposition on the tip of papillary muscle, C: Rupture of chordae tendinae, D: Asehoff nodule on the mitral valve - -### Response: -Myxomatous mitral valve most paintents are asymptomatic and the valvular abnormality is discovered only incidently on physical examination. In minority of cases patient complains of palpitation, dyspnea, or atypical chest pain. Auscultation discloses a mid systolic click caused by abrupt tensn on the redundant valve leaflets and chordae tendineae as the valve attempt to close Robbins 9 th edition page no. 390 -### End" -5373,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: With regard to insulin resistance seen in PCOD women false is, with the following options: A: Both lean and obese women with PCOD are insulin resistant., B: β-Cell dysfunction independent of obesity can be seen in PCOD., C: Acanthosis Nigricans and skin tags are dermatologic signs of insulin resistance., D: Though insulin resistance is very common in PCOD, progressing to type-2 diabetes is very rare. - -### Response: -Women with PCOD are at high risk for impaired glucose tolerance and type2 diabetes mellitus. -### End" -5374,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 36 year old male with Cavitatory Lung lesions, Sinusitis, Ulcers in the mouth. RBC casts in the urine can be seen. Diagnosis is, with the following options: A: Granulomatosis with polyganitis, B: Eosinophilic with Polyangitis, C: IgA Vasculitis, D: Microscopic polyangitis - -### Response: -Wegener's also called Granulomatosis with polyangitis. -### End" -5375,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not seen in children ?, with the following options: A: Neuroblastoma, B: Retinoblastoma, C: Hepatoblastoma, D: Seminoma - -### Response: -Ans. is 'd' i.e., SeminomaSeminoma Seminomas are the most common type of germ cell tumor of testes, making up about 50% of these tumors. The peak incidence is the third decade and they almost never occur in infants.An identical tumor arises in the ovary, where it is called dysgerminoma. Seminomas contain isochromosome 12p and express OCT3/4 and NANOG.Approximately 25% of these tumors have KIT activating mutations.,KIT amplification and KIT overexpression. -### End" -5376,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Complications of Zidovudine therapy, with the following options: A: Nausea and vomiting, B: Anemia, C: Steatosis, D: All of the above - -### Response: -*anemia and neutripenia are the most impoant band dose related adverse effects of Zidovudine *nausea anorexia abdominal pain, headache, insomnia and myalgia are common at sta of the therapy bit diminishes later Myoptahy lactic acidosis ,Hepatomegaly, with steatosis, convulsion and encephalopathy ate infrequent Refer KDT6/e p771 -### End" -5377,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Woodworkers are associated with ------- sinus Carcinoma., with the following options: A: Adenocarcinoma, B: Squamous cell Carcinoma, C: Anaplastic Carcinoma, D: Melanoma - -### Response: -Workers of the furniture industry( woodworkers) develop adenocarcinoma of the ethmoids and upper nasal cavity, while those engaged in nickel refining get squamous cell anaplastic carcinoma. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 231) -### End" -5378,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true regarding atropine, with the following options: A: Used as an eye ointment, B: Used in refraction in less than 5 yr of children, C: Fast action, D: Experimentally used in treatment of myopia - -### Response: -Atropine is slow acting and not fast acting ATROPINE( antimuscranic) causes cycloplegia as ciliary muscles are supplied by Parasympthetic sytem sho ciliary nerve , branch of 3rd cranial nerve Used as eye ointment Children < 5 yr, Children with Squint slow action Three times for 3 days Peak Effect- 3 Days Complete cycloplegia, but less potent mydriasis Retinoscopy - 3 Days PMT - 14 Days Tonus - 1 D experimentally used in treatment of myopia. Homatropine=> 5 yr -### End" -5379,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sexually active male comes with complaints of recurrent ulcers over the glans which heals with hyperpigmentation, probable diagnosis is -, with the following options: A: Aphathous ulcer, B: Fixed drug eruption, C: Herpes genitalis, D: Chlamydial infection - -### Response: -Fixed drug eruption manifests as skin lesions at fixed sites following drug intake. The lesions progressively fade over several days often leaving a residual post inflammatory brown pigmentation. Page no.294. Reference IADVL's concise textbook of dermatology -### End" -5380,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following markers has significant association with poor prognosis in traumatic brain injury?, with the following options: A: S-100b Protein, B: b-Amyloid precursor protein, C: Increased CSF levels of three neurofilament H, D: Calpain-derived a-spectrin fragment - -### Response: -After moderate or severe traumatic brain injury, serum S-100b protein concentrations are significantly associated with unourable prognosis in the sho, mid, or long term. Optimal thresholds for discrimination remain unclear. Measuring the S-100b protein could be useful in evaluating the severity of traumatic brain injury and in the determination of long term prognosis in patients with moderate and severe injury. S-100b protein serum concentrations correlate significantly with unourable prognosis in patients with moderate or severe traumatic brain injury, as defined by moality, Glasgow outcome score <=3, or brain stem death, with or without concomitant traumatic injuries. Ref: Predictive value of S-100b protein for prognosis in patients with moderate and severe traumatic brain injury: systematic review and meta-analysis ; BMJ 2013;346:f1757. -### End" -5381,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum chances of HIV transmission are associated with?, with the following options: A: Receptive anal sex, B: Inseive anal sex, C: Receptive oral sex, D: Inseive oral sex - -### Response: -Ans.is'a'i.e.,Receptive anal sex[RefHttp://www.aidsmap.com/HIV-risk-levels-for-the-inseive-and-receptive-paner-in-different-types-of-sexual-intercourse/page/14434904 HIV risk levels for the inseive and receptive paner in different types of sexual intercourseAnal intercourse has highest risk of transmission (anal intercourse > vaginal intercourse > oral sex).Unprotected anal intercourse carries a higher risk of sexual HIV transmission than unprotected vaginal intercourse. Although either sexual paner can acquire HIV from the other during unprotected anal intercourse, HIV is more likely to pass from an HIV-positive inseive paner to his receptive paner than from an HIV-positive receptive paner to his or her inseive paner. -### End" -5382,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stage of falciparum not seen in PBS is -, with the following options: A: Schizont, B: Gametocyte, C: Ring form, D: Double ring - -### Response: -P.falciparum Forms in peripheral blood-ring forms and gametocytes (crescent shaped) A) Most pathogenic B). No relapses in P.falciparum-exo-erythrocytic schizogony is absent C). Complications-pernicious malaria,black water fever D)pernicious malaria-1). Cerebral malaria-hyperpyrexia, coma,paralysis.Brain is congested.Capillaries of the brain are plugged with parasitised erythrocytes 2). Algid malaria-cold clammy skin leading to circulatory failure 3). Septicaemic malaria- high continuous fever with involvement of various organs Black water fever * Previously infected * Intravascular haemolysis fever and haemoglobinuria * Autoimmune mechanism * Bilious vomiting+prostration+black urine(refer pgno:60 baveja 3 rd edition) -### End" -5383,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When a person I asked about his blood sugar level, he answers like ""Diabetics have sweet urine... urine and feces are excreta"".... Before finally telling his blood sugar. It is an example of?, with the following options: A: Tangentiality, B: Circumstantiality, C: Flight of ideas, D: Loosening of association - -### Response: -Ans. is 'b' i.e., Circumstantiality * In the given example, patient's goal is to tell the blood sugar level. But the patient does not reach his goal directly; rather he reaches the goal indirectly through other direction and includes irrelevant details and digressions. But finally he reaches his goal (i.e. he tells his blood sugar level). It is an example of circumstantiality.* In Tangentiality, a person never reaches the goal.* Circumstantiallity : - Overinclusion of trivial or irrelevant details and digressions overwhelm the direction of thought process. The thought reaches its ultimate goal in a long and round about manner; taking too many degressions and irrelevant elaborations on its way. In simple words, thinking is indirect in reaching a goal or getting a point, i.e., it does not reach the goal directly, rather it reaches the goal indirectly through other direction because of irrelevant details and digressions. It is seen in mania, Schizophrenia and anankastic personality disorder.About other optionsi) Tangentiality (Tangential thinking): - In contrast to circumstantiality the goal is not reached in tangentiality. The thought is sidetracked more and more away from the natural end and never returns to its original point. In response to a question, the patient gives answer that is appropriate to general topic without actually answering the original question, e.g., Q:- Do you have trouble sleeping? Ans. I used to sleep in my bed but now I am sleeping on floor.ii) Flight of ideas : - Skipping verbally from one thought to another before completion of first thought causing the speech to become fragmented. It is seen in mania.iii) Loosening of association (Loose association): - Involve shifting of ideas from one subject to another in an oblique or unrelated manner, Example ""I an tired; all people have toes"". Loosening of association is seen in schizophrenia -### End" -5384,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are causes of Pulmonary Infiltrates with Eosinophilia with known etiology, EXCEPT:, with the following options: A: Allergic bronchopulmonary mycosis, B: Eosinophilia-myalgia syndrome, C: Parasitic infestations, D: Loeffler's syndrome - -### Response: -This is really a good question. Need to be very thorough about it to answer. The table in harrison will give the clear answer without doubt: Allergic bronchopulmonary mycosis such as those caused by Penicillium, Candida, Curvularia, or Helminthosporium spp. A. fumigatus is the most common cause of ABPA. Loeffler's syndrome was originally repoed as a benign, acute eosinophilic pneumonia of unknown cause characterized by migrating pulmonary infiltrates and minimal clinical manifestations. Eosinophilia-myalgia syndrome is an incurable and sometimes fatal flu-like neurological condition that is believed to have been caused by ingestion of poorly produced L-tryptophan supplement. Ref: Harrisons Principles of Medicine, 18th Edition, Chapter 255, Table 255-2, Page 2119 -### End" -5385,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Facilitative glucose transpoers (GLUTs) comprise a large family. Which of the following is a glucose transpoer in myocytes?, with the following options: A: GLUT 1, B: GLUT 2, C: GLUT 3, D: GLUT 4 - -### Response: -Major Glucose Transpoers and its locations: GLUT 1 Brain, kidney, colon, placenta, erythrocytes GLUT 2 Liver, pancreatic beta cell, small intestine, kidney GLUT 3 Brain, kidney, placenta GLUT 4 Hea and skeletal muscle, adipose tissue GLUT 5 Small intestine Ref: Harper's Illustrated Biochemistry, 29e > Chapter 20. Gluconeogenesis & the Control of Blood Glucose > Blood Glucose Is Derived from the Diet, Gluconeogenesis, & Glycogenolysis > Metabolic & Hormonal Mechanisms Regulate the Concentration of Blood Glucose > Table 20-2. -### End" -5386,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reduction rhinoplasty is for:, with the following options: A: Hump nose, B: Narrow nose, C: Crooked nose, D: Saddle nose - -### Response: -An operation called Reduction Rhinoplasty reduces the size of the framework of the nose over which the skin is draped. The skin itself is not touched. -The frame of the nose which is made up of bone in its upper half and gristle(cartilage) in its lower half is approached from underneath the skin. -### End" -5387,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are features of Ehler-Danlos syndrome except:, with the following options: A: Blue sclera, B: Long stature, C: Subluxation of lens, D: Epicanthal folds - -### Response: -Ans. Long stature -### End" -5388,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All viruses are oncogenic except -, with the following options: A: HPV, B: HTLV-1, C: HSV-1, D: None of the above - -### Response: -HPV,HTLV1&HSV1 REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.565 -### End" -5389,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What constitutes malpighian layer, with the following options: A: Stratum lucidum, B: Stratum spinosum, C: Stratum granulosum, D: Stratum spinosum and basale - -### Response: -Stratum basale + stratum spinosum = malphigian layer Layers of the epidermis : Stratum basale: Deepest layer. Single layer of columnar cells on the basal lamina aka germinal layer - produces Keratinocytes Stratum spinosum: Several layers of polygonal keratinocytes attached to one another by desmosomes (responsibly for 'Spiny' appearance) Stratum granulosum: Few layers of flattened cells that are characterised by deep staining granules of keratohyalin in their cytoplasm. Stratum lucidum: This layer appears homogenous with indistinct cell boundaries & tracts of flattened nuclei. Present in areas of thick skin. Stratum corneum: Acellular layer made up of flattened scale like elements containing keratin filaments embedded in protein. -### End" -5390,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best irrigating fluid for phacoemulsification is, with the following options: A: Normal saline, B: Glycine, C: Basal salt solution with Glutathione, D: Distilled Water - -### Response: -Best irrigating fluid for phacoemulsification  is Basal salt solution with Glutathione. -### End" -5391,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ureteric constriction in the following sites EXCEPT, with the following options: A: At the pelviureteric junction, B: Crosses the internal iliac artery, C: At bladder wall, D: At mesentery - -### Response: -(At mesentery) (301 - BDC - 2) (370 - Snell 7th)URETERS - The ureter enters the pelvis by crossing the bifurcation of the common iliac artery in front of the sacroiliac joint. Each ureter then runs down the lateral wall of the pelvis infront of the internal iliac artery to the region of the ischial spine and turns forward to enter the lateral angle of the bladder. Near its termination. It is crossed by the vas deferens. The ureter passes obliquely through the wall of the bladder for about 0.75 in (1.9cm) before opening into the bladder.Three Constrictions (Snell)BDC(i) Where the renal pelvis joins the ureter in the abdomen(ii) Where it is kinked as it crosses the pelvic brim to enter the pelvis(iii) Where it pierces the bladder wall(i) At the pelvi ureteric Junction(ii) At the brim of the lesser pelvis(iii) At its passage through the bladder wall. -### End" -5392,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Assessment of the visual acuity in children below 2 years of age can be made by the following tests, except:, with the following options: A: Landolt's chas, B: Pattern visual evoked potential, C: Preferential looking behaviour, D: Optokinetic nystagmus - -### Response: -Ans. Landolt's chas -### End" -5393,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Male breast cancer wrong statement-, with the following options: A: Brca2 seen in 6% cases, B: Lobular carcinoma is common, C: DUCTAL carcimoma is most common subtype, D: Colloid carcinoma can be seen - -### Response: -Ans. (b) Lobular carcinoma is common(Ref: Robbins 9th/pg 1054)From 4% to 14% of cases in males are attributed to germline BRCA2 mutations -OPTION A IS TRUEStructure of the male breast does not have lobules and acini, lobular carcinoma cases are seen infrequently- OPTION B IS FALSEMost common breast cancer in male is ductal carcimnoma NOSColloid carcinoma can be seen. -### End" -5394,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are complications of atherosclerosis except?, with the following options: A: Ulceration, B: Thrombosis, C: Embolism, D: Necrosis - -### Response: -Ans. (d) NecrosisRef: Robbin's pathology 9th ed. /512-15Complications of Atherosclerosis and their ImportanceAneurysm formationAortic aneurysm> 5.5 cm can ruptureCalcificationDystrophic calcificationUlcerationIncreases thrombus formationThrombosisOcclusion of coronary arteriesEmbolismErosion of plaque -### End" -5395,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug not useful in hypeensive emergency is, with the following options: A: IV Hydralizine, B: Indapamide, C: Sublingual nifedipine, D: Sodium nitroprusside - -### Response: -Refer kDT 6/e p554 Indapamide is thiazide like diuretics, having mild diuretic effect, not used in emergency situation Indapamide is a thiazide-like diuretic drug generally used in the treatment of hypeension, as well as decompensated hea failure. Combination preparations with perindopril -### End" -5396,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Endogenous triglycerides in plasma are maximally carried in :, with the following options: A: VLDL, B: Chylomicrons,, C: LDL, D: HDL - -### Response: -A i.e. VLDL -### End" -5397,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female presented with a severe headache of sudden onset. On CT scan a diagnosis of subarachnoid hemorrhage is made. The most common cause of subarachnoid hemorrhage is :, with the following options: A: Middle meningeal artery, B: Berry aneurysm rupture, C: Basilar artery, D: Subdural venous sinuses - -### Response: -Ans. is 'b' ie. Berry Aneurysm (Ref. : Harrison, 17/e pl726 (16/e, p 2387, 15/e, p 238))"" Excluding head trauma the most common cause of SAH is rupture of a saccular aneurysma (Berry aneurysm or congenital aneurysm). ""Berry aneurysms - also k/a as congenital aneurysm although they are not present at birth. There is however a congenital defect of the media of the artery, which becomes the site of aneurysm in later life.Common sites :Junction of the anterior communicating artery with the anterior cerebral artery* (MC).Junction of the post communicating artery with the 1C A* (Internal carotid artery)The bifurcation of MCA* (Middle carotid artery) -### End" -5398,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about myocardial oxygen demand is true?, with the following options: A: Correlates with hea rate, B: Is directly propoional to external cardiac work, C: Is negligible when hea is at rest, D: Depends upon duration of systole - -### Response: -Myocardial oxygen demand is the amount of oxygen that the hea requires to maintain optimal function, and myocardial oxygen supply is the amount of oxygen provided to the hea by the blood which is controlled by the coronary aeries Ref: guyton and hall textbook of medical physiology 12 edition page number:246,247,248 -### End" -5399,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In pelvis fracture, the amount of blood loss is around?, with the following options: A: 1-4 units, B: 2-4 units, C: 2-6 units, D: 4-8 units - -### Response: -In pelvic fracture intrapelvic haemorrhage is by far, the most serious complication. Haemorrhage frequently results from fracture surfaces and small vessels in the retroperitoneum. Amount of blood loss is around 4-8 units. It must be emphasised, however, that these cases may need transfusion of very large quantities of blood. It is not uncommon for the amount of blood transfused to be in excess of the patient's total blood volume. In case of hemodynamic instability, an external fixator should be applied immediately to decrease motion at fracture sites as well as to decrease pelvic volume and generate tamponade of the pelvic venous plexus. Ref: Rockwood & Green's fracture in Adults 6/e, Page 1600-04; Watson Jones: Fracture & Joint Injuries 6/e, Page 866; Campbell's Operative Ohopedics 10/e, Page 2962-63. -### End" -5400,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The internal thoracic veins are tributaries of the :, with the following options: A: Azygos, B: Subclan, C: Internal jugular, D: Brachiocephalic - -### Response: -D i.e. Brachio cephalic vein -### End" -5401,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tc labeled RBCs are used for all except, with the following options: A: LV function, B: GI bleeding, C: Liver adenoma, D: Liver hemangioma - -### Response: -Tc-99m labellee rbc is used in assessment of GI bleeding . -### End" -5402,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ptosis results from trauma to which nerve-, with the following options: A: VII, B: VIII, C: III, D: VI - -### Response: -*Ptosis is due to occulomotor nerve paralysis. Ref: Principles of ophthalmology 4th/e p.1107 -### End" -5403,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following drugs act against HIV-2 Except:, with the following options: A: Ritonavir, B: Tenofovir, C: Eirenz, D: Zalcitabine - -### Response: -Nevirapine (NVP) and Eirenz (EFV): These are nucleoside unrelated compounds which directly inhibit HlV reverse transcriptase without the need for intracellular phosphorylation. Their locus of action on the enzyme is also different. They are more potent than AZT on HIV -1, but do not inhibit HIV -2. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:772 -### End" -5404,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If bile acid pool is small, recycling is:, with the following options: A: Slow, B: Fast, C: Moderate, D: Any of the above - -### Response: -The total bile acid pool of approximately 3.5 g recycles repeatedly via the enterohepatic circulation; it has been calculated that the entire pool recycles twice per meal and 6–8 times per day. -Reference: Ganong’s Review of Medical Physiology T W E N T Y - F I F T H   E D I T I O N page no 464 -### End" -5405,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which poisoning causes 'pink disease'?, with the following options: A: Arsenic, B: Mercury, C: Copper, D: Lead - -### Response: -Ans. is 'b' i.e. Mercury Pink disease or Acrodvniao It is thought to be an idiosyncratic hypersensitivity reaction particularly seen in children. This can be caused by chronic mercury exposure in any form usually in children. The onset is insidious with anorexia, insomnia, sweating, skin rash and photophobia. Hands and feet become puffy, pinkish, painful, paraesthetic with peeling of skin (5Ps). Teeth may be shed. -### End" -5406,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary hypercholesterolemia is ?, with the following options: A: Type I, B: Type Ha, C: Type IIb, D: Type III - -### Response: -Ans. is 'b' i.e., Type Ha -### End" -5407,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Specific θ waves are seen in, with the following options: A: NREM 1, B: NREM 2, C: NREM 3, D: REM - -### Response: -θ waves are seen in both NREM 1 & REM. -But specific θ waves indicate hippocampal activity seen in REM phase of sleep. -### End" -5408,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tumor arising from olfactory nasal mucosa is, with the following options: A: Nasal glioma, B: Adenoid cystic carcinoma, C: Nasopharyngeal carcinoma, D: Esthesio-neuroblastoma - -### Response: -Esthesioneuroblastoma is a rare unique tumor of neural crest origin. Presents as a unilateral polypoidal mass in the upper third of the nasal cavity with symptoms of nasal obstruction, epistaxis and anosmia. -### End" -5409,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sunray appearance and Codmans triangle are radiological features of which of the following tumors?, with the following options: A: Osteosarcoma, B: Ewings Sarcoma, C: Chondrosarcoma, D: Multiple Myeloma - -### Response: -Ans. is 'a' i.e., Osteosarcoma X-ray AppearanceTumourOnion Peel AppearanceEwings SarcomaSoap Bubble appearanceGCTCodmans TriangleOsteosarcomaSun Burst AppearanceOsteosarcomao Codman's triangle and sunray appearance are typical of osteosarcoma.o However, you should keep in your mind following very important facts: -# Sunray (sunburst) appearance and codman's triangle indicates periosteal reaction (periosteal new bone formation).# Both these are typical of osteosarcoma but may also occur in other rapidly growing bone tumors (Ewing's sarcoma), and infection (osteomyelitis).# Similarly, onion peel appearance indicates periosteal new bone-formation and is typical for Ewing's sarcoma. But this can also occur in oseosarcoma and osteomyelitis.# The crux is that, aggresively growing tumors and infection stimulate the periosteum which then react by forming new bone, (therefore it is called periosteal reaction) which may take any of the above form.o Sun-ray (sunburst) appearance and Codman's triangle: -# Typical features of osteosarcoma.# May also be seen in Ewing's sarcoma, osteomyelitis, o Onion-peel appearance# Typical feature of Ewing's sarcoma.# May also be seen in osteosarcoma, and osteomyelitis -### End" -5410,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not included in major Jone's criteria -, with the following options: A: Pancarditis, B: Chorea, C: Arthritis, D: Elevated ESR - -### Response: -Ans. is 'd' i.e., Elevated E.S.R. * The jones criteria for rheumatic fever:Major criteriaMinor criteria* Carditis0Clinical* Migratory polyarthritis0* Fever0* Sydenham's chorea0* Arthralgia0* Subcutaneous nodules0Laboratory* Erythema marginatum0Elevated acute phase reactants0Prolonged PR intervalPLUS Supporting evidence of a recent group A Streptococcal infection (e.g.positive throat culture or rapidantigen detection test; and or elevated or increasing streptococcal antibody test).To fulfill jones criteria either two major criteria or one major and two minor criteria plus evidence of antecedent streptococcal infection is required. -### End" -5411,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60-year-old alcoholic smoker abruptly develops high fever, shakes, a severe headache, and muscle pain. He initially has a dry, insignificant cough, but over the next few days he develops marked shoness of breath requiring assisted ventilation. Chest x-ray demonstrates homogeneous radiographic shadowing that initially involves the left lower lobe but continues to spread until both lungs are extensively involved. Culture of bronchoalveolar lavage fluid on buffered charcoal yeast extract (BCYE) demonstrates a coccobacillary pathogen. Which of the following is the most likely causative organism?, with the following options: A: Legionella pneumophila, B: Listeria monocytogenes, C: Streptococcus pneumoniae, D: Staphylococcus aureus - -### Response: -The patient has a severe, potentially fatal, pneumonia with prominent systemic symptoms. Culture on BCYE is the specific clue that the organism is Legionella pneumophila. The disease is respiratory Legionellosis, also known as Legionnaire's disease, because the disease was first described when it occurred in epidemic form following an American Legion convention at a Philadelphia hotel. Patients tend to be older (40-70 years old) and may have risk factors including cigarette use, alcoholism, diabetes, chronic illness, or immunosuppressive therapy. Listeria monocytogenes causes listeriosis and is not a notable cause of pneumonia. Staphylococcus aureus can cause pneumonia, but is easily cultured on routine media. Ref: Levinson W. (2012). Chapter 19. Gram-Negative Rods Related to the Respiratory Tract. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e. -### End" -5412,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Causes of community-acquired native valve endocarditis are, with the following options: A: Streptocccus viridians, B: Staphylococcus aureus, C: Diphtheriods, D: Staphyloccous epidermidis - -### Response: -Streptococcus viridans is a group which normally resides in the mouth and upper respiratory tract and is alpha hemolytic. In persons with pre-existing cardiac lesions, they may cause bacterial endocarditis, Streptococcus sanguis being most often responsible. Following tooth extraction or dental procedures, they cause transient bacteremia and get implanted on damaged or prosthetic valves or in congenitally diseased hea and grow to form vegetation. Streptococcus mutans is also a member of viridans group which causes endocarditis in individuals with risk factors ( dental extraction in people with damaged valves). Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 220 -### End" -5413,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is not a uricosuric agent?, with the following options: A: Probenecid, B: Sulfinpyrazone, C: Benzbromarone, D: Febuxostat - -### Response: -Drugs increasing the excretion of uric acid (Uricosuric agents) Probenecid Sulfinpyrazone Benzbromarone Lesinurad -### End" -5414,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brush fire appearance of fundus is seen in -, with the following options: A: Toxoplasmosis, B: CMV retinitis, C: Chloroquine toxicity, D: Bacterial endocarditis - -### Response: -Ans. is 'b' i.e., CMV retinitisIMPORTANT FACTSSalt and Pepper fundusCongenita] rubella, Congenital syphilis,Congenital leber amaurosis, Mayous Batten disease,Thioridazine toxicity.o Crumbled chees and ketchup appearance (sauce and cheese appearance)o Pizza pie appearanceo Brush fire appearanceCMV retinitiso Satellite lesiono Head light in the fog appearanceToxoplasmosisHemorrhagic retinal necrosisHSV, toxoplasmosis, Bechet's retinitis, CRVO or branch vein occlusionMost common ocular infection in AIDSMost common cause of chorioretinitis in AIDSCMVBull's eye retinopathy (maculopathv)Chloroquine, Phenothiazine, Bardet-Biedle syndrome,Batten disease, inverse retinitis, pigmentosa, Stargardt disease, Dystrophies, Chronic macular hole.Roth spotsBacterial endocarditis. Puerperal septicemiaSnowball opacities in vitreousPars ptanitis. Candidiasis, Sarcoidosis. Lyme disease -### End" -5415,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Total lung capacity depends on, with the following options: A: Size of airway, B: Closing tidal volume, C: Lung compliance, D: Residual volume - -### Response: -The extent to which the lungs will expand for each unit increase in transpulmonary pressure (if enough time is allowed to reach equilibrium) is called the lung compliance.The total compliance of both lungs together in the normal adult human averages about 200 milliliters of air per centimeter of water transpulmonary pressure. That is, every time the transpulmonary pressure increases 1 centimeter of water, the lung volume, after 10 to 20 seconds, will expand 200 milliliters.The total lung capacity is the maximum volume to which the lungs can be expanded with the greatest possible effo (about 5800 milliliters); It is equal tothe vital capacity plus the residual volume.Ref: Guyton; 13th edition; Chapter 38 Pulmonary Ventilation -### End" -5416,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a disadvantage of anatomic teeth?, with the following options: A: Use of an adjustable articulator is mandatory, B: Eccentric records must be made for articulator adjustments, C: Harmonious balanced occlusion is lost when settling occurs, D: Masticatory efficiency is decreased once balanced occlusion is established - -### Response: -Advantages - -They are more efficient in cutting and grinding food, so, less masticatory effort and forces are needed. -Balanced occlusion can be achieved in eccentric jaw positions (Protrusive, right lateral and left lateral movement). -The cusp-fossa relationship helps to guide the mandible into centric occlusion. -Aesthetically and psychologically acceptable. -The physical contours closely resemble natural teeth and hence, they are more compatible to the oral environment. The disadvantages of these teeth are that they magnify the horizontal forces acting on the ridge and the ‘teeth setting’ is very crucial to obtain proper occlusion (i.e. they should be placed in specified positions). - -Key Concept: -One of the advantages of anatomic teeth is their superior masticatory efficiency over other forms of teeth. -Ref: Textbook of prosthodontics by Nallaswamy Ed 2nd Pg 8 -### End" -5417,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which wall is most often fractured in a blow out fracture of the orbit due to fistcuff injury, with the following options: A: Superior wall, B: Inferior wall, C: Medial wall, D: Lateral wall - -### Response: -Blow out fracture is the floor fracture occurring due to blunt trauma Refer khurana 6/e p 404 -### End" -5418,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug with both antidepressant and antipsychotic propeies is?, with the following options: A: Buspirone, B: Amoxapine, C: Trazodone, D: Minaserine - -### Response: -Ans. is 'b' i.e., Amoxapine o Amoxapine is the only antidepressant which blocks D2 receptors along with inhibition of NA reuptake --> has mixed antidepressant + neurolepic propey. -### End" -5419,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diffuse increase in the parenchymal density of breast is seen in?, with the following options: A: Hormone replacement therapy, B: Lipodystrophy, C: Cachexia, D: All of the above - -### Response: -Ans DBreast density is from fat and glandular tissue. Any pathology that leads to either reduction in fat (cachexia, lipodystrophy) or increased glandular component (hormone replacement therapy) will cause increase in density on imaging -### End" -5420,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sufentanyl is a potent –, with the following options: A: Myocardial depressant, B: Analgesic, C: Antic onvulsnt, D: Hepatotoxin - -### Response: -Sufentanil is a short acting opioid analgesic, which can be used in anaesthesia. -### End" -5421,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a neuron, graded electrogenesis occurs at:, with the following options: A: Soma-dendritic zone, B: Initial segment, C: Axon, D: Nerve ending - -### Response: -Graded electrogenesis is local potential generation of which occurs in dendrite or, soma. -Neurons generally have some important zones: - -A receptor, or dendritic zone, where multiple local potential generated by synaptic connections are integrated; -A site where propagated action potentials are generated (the initial segment in spinal motor neurons, the initial node of Ranvier in cutaneous sensory neurons). -### End" -5422,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not in posterior relationship to rectum:, with the following options: A: Sacral vertebra, B: Superior rectal artery, C: Seminal vesicles, D: Middle rectal artery - -### Response: -Ans. C Seminal vesiclesRef: BDC, 6th ed. vol. II pg. 408* Rectum is a 12 cm structure which is in conitunation of sigmoid colon and terminates at anal canal.Relationship of rectum AnteriorPosteriorLaterallyMales* Base of bladder* Seminal vesicles* Rectovesical pouch* Ileum* Ductus deferens* Terminal ureter* Prostate gland* S3-S5 vertebrae* Coccyx* Median sacral artery and vein* Middle rectal artery* Superior rectal artery and vein* Sigmoid colon* Ileum* Pelvic plexuses* Coccygeus muscle* Levator ani muscleFemales* Uterus* Vagina* Rectouterine pouch* Ileum* Sigmoid colonSame as for maleSame as for male -### End" -5423,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding high-voltage electrical burns to an extremity, with the following options: A: Injuries are generally more superficial than those of thermal burns, B: Intravenous fluid replacement is based on the percentage of body surface area burned, C: Antibiotic prophylaxis is not required, D: Evaluation for fracture of the other extremities and visceral injury is indicated - -### Response: -The treatment of electrical injury should be modified from that of thermal burns because tissue damage is much deeper than is apparent at first inspection. The heat generated is propoional to the resistance to the flow of current. Bone, fat, and tendons offer the greatest resistance. Therefore, the tissue deep within the center of an extremity may be injured while more superficial tissues are spared. For this reason, the quantification of fluid requirements cannot be based on the percentage of body surface area involved, as in the Parkland,Brooke, or Baxter formulas, which are used to calculate fluid replacement after thermal burns. Massive fluid replacement is usually essential. A brisk urine output is desirable because of the likelihood of myonecrosis with consequent myoglobinuria and renal damage. As with deep thermal burns, debridement, skin grafting, and amputation of extremities may be required following electrical injury. However, fasciotomy is more frequently required than escharotomy with electrical injury because deep myonecrosis results in increased intracompamental pressures and compromised limb perfusion. In addition, distant fractures may result owing to vigorous muscle contraction during the accident or if subsequent falls occur. Cardiac or respiratory arrest may occur if the pathway of the current includes the hea or brain. An electrical current can also damage the pulmonary alveoli and capillaries and lead to respiratory infections, a major cause of death in these victims. Owing to the deep myonecrosis that often accompanies high-voltage injury, prophylaxis for clostridia with high-dose penicillin may be considered. -### End" -5424,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Respiratory failure occurs 1) 40 - 50 % of carboxy haemoglobin in blood in carbon monoxide poisoning 2) 70 - 80 % CO2 Concentration in carbon dioxide poisoning, with the following options: A: Both are true, B: Both are false, C: 1 is true, 2 is false, D: 2 is true, 1 is false - -### Response: -In CO poisoning, respiratory failure occurs at 70 - 80% of carboxyhemoglobin in blood In CO2 poisoning, respiratory failure occurs at 40 - 50% of CO2 concentration in blood Patient with 70-80 % of carboxyhemoglobin in blood presents in coma with depressed or absent reflexes, thready pulse, irregular respiration which results in death. EFFECTs OF CO INTOXICATION : 0-10% - No symptoms 10 - 20% - Mild head ache 20 -30% - Emotional instability 30 -40% - increase head ache, confusion 50 -60% - Mimics drunkenness >70% - coma, death -### End" -5425,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The prostatic growth in benign prostatic hypertrophy is due to-, with the following options: A: Testosterone, B: 17 estradiol, C: Dihydrotestosterone, D: Oestrogen - -### Response: -Dihydrotestosterone (DHT), a metabolite of testosterone, is the ultimate mediator for prostatic growth. -### End" -5426,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Electron microscopy is helpful in diagnosis of ?, with the following options: A: Rotavirus, B: RSV, C: Herpesvirus, D: Prion - -### Response: -Ans. is 'a' i.e., Rotavirus -### End" -5427,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about exotoxin -, with the following options: A: Non-antigenic, B: Enzymatic, C: Non-protein, D: Heat stable - -### Response: -Ans. is 'b' i.e., Enzymatic Distinguishing feature of Exotoxins and endotoxinsExotoxinsEndotoxinso Proteinso Heat labileo Secreted by cellso Action enzymico Active in minute doseo Highly antigenico Action specifically neutralised by antibodyo Specific pharmacologic effect for each toxino Can be toxoidedo Upopolysaccharideo Heat stableo Forms part of cell wrallo No enzy mic actiono Active only in large doseo Weakly antigenico Neutralisation of antibody ineffectiveo Effect nonspecifico Cannot be toxoided -### End" -5428,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is 21st amino acid?, with the following options: A: Alanine, B: Cystine, C: Arginine, D: Seleno cysteine - -### Response: -Selenocysteine is recently introduced as 21st amino acid. Selenocysteine occurs at the ""active site"" of several enzymes. Examples include * Thioredoxin reductase * Glutathione peroxidase which scavenges peroxides, * De-iodinase that conves thyroxine to triiodothyronine * Glycine reductase * Selenoprotein P, a glycoprotein containing 10 selenocysteine residues, found in mammalian blood. It has an antioxidant function and its concentration falls in selenium deficiency.Ref: Textbook of medical biochemistry, MN Chatterji, 8th edition, page no: 80 -### End" -5429,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: serum prolactin level are highest, with the following options: A: After 24 hour of paurition, B: After 24 hour of ovulation, C: After REM sleep, D: After running for 1 hour - -### Response: -proactin is more in NREM sleep in ovulation its low ref : dutta 9th ed -### End" -5430,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infantogram shows presence of, with the following options: A: Hemangioma, B: Sacrococcygeal teratoma, C: Myelomeningocele, D: Arnold-Chiari malformation - -### Response: -Ans. (b) Sacrococcygeal teratomaThe image shows a soft tissue mass arising from gluteal region. The low density area on X-ray shows the presence of fat within the lesion. style=""text-decoration: underline; color: rgba(17, 85, 204, 1); font-family: Times New Roman, Times, serif"">rg/articles/sacrococcygeal-teratoma -### End" -5431,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: McNaughton's rule relates to?, with the following options: A: Criminal responsibility of insane, B: Inquest, C: Professional secrecy, D: Medical negligence - -### Response: -The following are the tests for determining criminal responsibility of Insane. -1. McNaughton Rule: “An accused person is not legally responsible, if it is clearly proved,that at the time of committing the crime, he was suffering from such a defect of reason from abnormality of mind, that he did not know the nature and quality of the act he was doing, or that what he was doing was wrong”. -This Legal test has been accepted in India as the Law of criminal responsibility and is included in Sec. - 84 IPC -2. Durham Rule (1954) -3. Currens Rule (1961) -4.The Irresistible Impulse Test  -5. The American Law Institute Test -### End" -5432,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Early age of sex is risk factor for, with the following options: A: Carcinoma cervix, B: Carcinoma vulva, C: Carcinoma vagina, D: Carcinoma ovary - -### Response: -Ans. A. Carcinoma cervixEarly Coitarche (early age of first intercourse) is a risk factor for carcinoma cervix. -### End" -5433,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Methicillin resistant Staphylococcus aureus is not expected to respond to -, with the following options: A: Aminoglycoside, B: Lincosamide, C: Oxazolidinone, D: Carbapenem - -### Response: -Ans. is 'd' i.e., Carbapenem o MRSA do not respond to any beta lactam antibiotic (penicillins, cephalosporins, carbapenems and monobactams) because it has altered penicillin binding sites. -### End" -5434,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are commonly involved in disseminated gonococcal infection except: September 2006, with the following options: A: Joint and tendons, B: Skin, C: Brain, D: Liver - -### Response: -Ans. C: Brain Signs and symptoms of disseminated gonococcal infection (gonococcaemia) include: Joint or tendon pain with decreased mobility. The knee is the most common site of purulent gonococcal ahritis. Skin rash - this is a common complaint in about one quaer of patients with disseminated gonococcal infection. On examination, rash is usually present in all patients with the disease. Usually small papules that turn into pustules on broad erythematous bases and necrotic centres. It occur on the trunk, limbs, palms and soles (usually spares the face, scalp and mouth) Haemorrhagic lesions, erythema nodosum, uicaria, and erythema multiforme occur less frequently. Fever, chills and malaise Other organs involved are liver and hea. It is impoant to remember that patients presenting with disseminated gonococcal infection may not show any localised signs and or symptoms at the primary site of mucosal infection. -### End" -5435,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Remnants of WolFion ducts in a female are in, with the following options: A: Pouch of Douglas, B: Broad ligament, C: Utero vesical pouch, D: iliac fossa - -### Response: -Ganer&;s duct remnants of mesonephric duct in female Located in Broad ligament ref : BD CHAURASIA -### End" -5436,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clinical features of pyloric stenosis in infants are All / Except, with the following options: A: Abdominal lump, B: Constipation, C: Weight loss, D: Metabolic acidosis - -### Response: -Ans. is 'd' i.e. metabolic acidosis Metabolic alkalosis, not acidosis is seen in hyperophic pyloric stenosis due to loss of hydrogen ions in repeated vomiting. As the hyperophic pyloric stenosis progresses, complete gastric outlet obstruction occurs and not even clear fludis are able to pass. This leads to constipation or passage of small green ""starvation"" stools. Rapid weight loss is seen if the condition is not detected early and treated. -### End" -5437,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The last case of small pox was reported in the world, with the following options: A: 1977, B: 1978, C: 1979, D: 1982 - -### Response: -Ans. is 'a' i.e., 1977 * It is the only infectious disease which has been eradicated globally. The world's last case occured in Somalia on 26 October 1977. The WHO declared on 8 may 1980 that smallpox had been eradicated.* In April 1977, India was declared smallpox free. The last idiginous case in India occured on 17 may 1975 in Bihar and India's last known case of smallpox was an importation from Bangladesh, which occured on 24 May 1975. -### End" -5438,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The 35-year-old female patient has a hard nodule about 1 cm in diameter slightly above and lateral to her right areola. A specific dye is injected into the tissue around the tumor, and an incision is made to expose the lymphatic vessels draining the area, for the lymphatic vessels take up the dye-which is visible to the eye. The vessels can then be traced to surgically expose the lymph nodes receiving the lymph from the tumor. Which of the following nodes will most likely first encounter the lymph from the tumor?, with the following options: A: Anterior axillary (pectoral) nodes, B: Rotter interpectoral nodes, C: Parasternal nodes along the internal thoracic artery and vein, D: Central axillary nodes - -### Response: -The anterior axillary (or anterior pectoral) nodes are the first lymph nodes to receive most of the lymph from the breast parenchyma, areola, and nipple. From there, lymph flows through central axillary, apical, and supraclavicular nodes in sequence. Rotter's nodes lie between the pectoral muscles and are, unfortunately, an alternate route in some patients, speeding the rate of metastasis. The parasternal nodes receive lymph from the medial part of the breast and lie along the internal thoracic artery and vein. -### End" -5439,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute Papilloedema present with A/E:, with the following options: A: Post neuritic atrophy, B: Increase blind spot, C: Severe loss of vision, D: Hypermic field - -### Response: -C i.e. Severe loss of vision In papilloedema there is painless gradually progressive loss of vision (negligible ie usually not severeQ) which is usually bilateralQ which occurs after a long time only when optic atrophy sets in. So, Papilloedema ultimately leads to postneuritic optic atrophyQ and visual loss is not a feature of Acute Papilloedema -### End" -5440,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best disease due to a mutation in the BEST1 (VMD2) is best diagnosed by a pathological:, with the following options: A: ERG, B: EOG, C: Dark adaptation, D: Ohoptoscope - -### Response: -Best Disease (Juvenile-Onset Vitelliform Dystrophy): It is an autosomal dominant disorder with variable penetrance and expressivity. Onset is usually in childhood. The fundoscopic appearance is a mild pigmentary disturbance within the fovea to the typical vitelliform or ""egg yoke"" lesion located in the central macula. Visual acuity often remains good, and the ERG is normal. An abnormal electro-oculogram (EOG) is the hallmark of the disease. Ref: Fletcher E.C., Chong N., Augsburger J.J., Correa Z.M. (2011). Chapter 10. Retina. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. -### End" -5441,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 6 months old baby coming with /o increasing difficulty in breathing of 2 days duration and on examination baby is afebrile & B/L wheeze & CXR shows B/L hyperinflation of the lungs with normal WBC count, the diagnosis is –, with the following options: A: Bronchiolitis, B: Asthma, C: Ch. Bronchitis, D: Pneumonia - -### Response: -Clinical manifestations of bronchiolitis - -The usual course of the disease is 1-2 days of → Fever, Rhinorrhea, Cough -This is followed by - -Wheezing   -Cyanosis   -Tachypnea  -Nasal flaring      -The breathing pattern is shallow -Rales, crepitation and Ronchi  - -Respiratory distress → retraction of intercostal space & suprasternal notch. - -Liver and spleen are pushed downward because the hyperinflated emphysematous lungs push the diaphragm downward. -Anteroposterior diameter of the chest is increased and hyper-resonance is noted on percussion. -The leukocyte count is normal or slightly elevated. - -Chest X-ray - -Hyperinflation of the lung -The diaphragm is pushed down                  -Lung fields are abnormally translucent. -### End" -5442,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Flushing occurs following alcohol ingestion in patients taking:(1995), with the following options: A: Metronidazole, B: Penicillin, C: Tetracycline, D: Chloramphenicol - -### Response: -aRef: KDT, 5,h ed, p. 351 -354 & 4lh ed. p. 364, 361 -### End" -5443,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All paicipate in Fatty acid synthesis except, with the following options: A: Hydratase, B: Reductase, C: Transacylase, D: Dehydrogenase - -### Response: -D i.e. Dehydrogenase -### End" -5444,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clinical feature of Bronchiestasis are all except, with the following options: A: Hemoptysis, B: Night sweats, C: Chest pain, D: Productive cough - -### Response: -Bronchiectasis is characterised by chronic,persistent productive cough with copious,continuously purulent sputum.Pleuritic pain is produced when infection spreads to involve pleura,or with segmental collapse due to retained secretions.There will be hemoptysis which can be mild,moderate or massive.General debility and halitosis are also present in bronchiectasis. Ref:Davidson's medicine-22nd edition,page no:679. -### End" -5445,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not seen in virus-induced tumour cells?, with the following options: A: Loss of orientation, B: Loss of contact inhibition, C: Change in size of cells, D: Formation of micro tumour cells - -### Response: -(Refer: Robbins & Cotran's - Pathologic Basis of Disease, SAE, 1st edition, Vol I-pg no: 325-327) -### End" -5446,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Post contusional syndrome includes:, with the following options: A: Headache, B: Nausea & vomiting, C: Delirium, D: All of the above - -### Response: -Due to damage of brain tissue, after recovery from injury, the patient may complain of headache, photophobia, nausea and vomiting, depression, lack of concentration or delirium. This is often called post-contusional syndrome. -### End" -5447,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding Cephalohematoma, all the following are true Except, with the following options: A: It is a Subperiosteal Haemorrhage, B: It may extend across the midline and cross suture lines, C: Occurs in 1-2% of live bihs, D: Underlying skull fracture may be associated with 10-25% cases - -### Response: -Cephalohematoma is a subperiosteal hemorrhage, hence always limited to the surface of one cranial bone. Cephalohematomas occur in 1-2% of live bihs. No discoloration of the overlying scalp occurs, and swelling is not usually visible for several hours after bih because subperiosteal bleeding is a slow process. The lesion becomes a firm tense mass with a palpable rim localized over one area of the skull. Most cephalohematomas are resorbed within 2 wk-3 months, depending on their size. An underlying skull fracture, usually linear and not depressed, may be associated with 10-25% of cases. A sensation of central depression suggesting but not indicative of an underlying fracture or bony defect is usually encountered on palpation of the organized rim of a cephalohematoma. Cephalohematomas require no treatment, although phototherapy may be necessary to treat hyperbilirubinemia. Infection of the hematoma is a very rare complicationReference: Nelson Textbook of Paediatrics; 20th edition; Nervous System Disorders -### End" -5448,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old Alcoholic comes to OPD who is on abstinence since last 10 years.He suddenly develops dysahria, shuffling gait and intention tremors . What shall be the most likely diagnosis ?, with the following options: A: Wilson disease, B: Wernicke's disease, C: Acquired hepatocerebral degeneration, D: Halloverden spatz disease - -### Response: -Disease Features Wilson's ds -Patient will be present at 10 yr age -KF Ring -But here it is alcoholic so ruled out. Wernicke's disease -Global confusion, -Ophthalmoplegia -Ataxia Hepatocerebral degeneration -Rare complication of cirrhosis -Indicates a decompensation in of cirrhosis - Development of Poal HTN - develops poosystemic collateral circulation- | Ammonia (NH3+) in circulation - Neurological c/f. Halloverden spatz disease/NBIA -Degeneration due to iron deposition -Accumulation of iron in putamen * Presentation is in childhood (10-15 yr. age) * It is d/d of Wilson's disease -MRI =iron deposition in putamen given eye of tiger appearance. -### End" -5449,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Splicing is a process of, with the following options: A: Activation of protein, B: Removal of introns, C: Synthesis of protein, D: Replication of DNA - -### Response: -Removal of Introns : The primary transcripts are very long ;they have molecular weights more than 10 power of 7.Molecular weight of mature mRNA is about 1-2 x 10 power of 6.This means large poion of hnRNA are cleaved off. The primary transcript contains coding regions (exons)interspersed with non-coding regions (introns). These intron sequences are cleaved and the exons are spliced (combined together ) to orm the mature mRNA molecule.This processing is done in the nucleus.Splicing is an energy requiring process. REF :DM VASUDEVAN TEXTBOOK ;7th EDITION ; Page no :591. -### End" -5450,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common soft tissue tumor in a child:, with the following options: A: Rhabdomyosarcoma, B: Histiocytoma, C: Fibrosarcoma, D: Liposarcoma - -### Response: -(a) Rhabdomyosarcoma- Rhabdomyosarcoma, the most common childhood soft-tissue sarcoma, is often located in the head and neck (40%) and in the trunk and extremities (25%). -### End" -5451,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sternocleidomastoid is supplied by all of the'following aeries except?, with the following options: A: >Occipital, B: >Posterior auricular, C: >Thyrocervical trunk, D: >Superior thyroid - -### Response: -Posterior auricular According to the aicle-""The Blood Supply of the Sternocleidomastoid Muscle and Its Clinical Implications"" Antonius Kierner, MD; Main Aigner, MD; Inngard Zelenka, MD; Gunther Riedl; Main Burian, MD Upper third - supplied by branches of the occipital aeryMiddle third - supplied by branch of the superior thyroid aery (42%), the external carotid aery (23%),or branches of both (27%)Lower third - supplied by a branch arising from the suprascapular aery According to Gray's Anatomy 40/e p441 upper third is supplied by both the occipital aery and posterior auricular aery; middle third by superior thryroid aery and the lower third by the suprascapular aery. -### End" -5452,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On DSA, typical ""STRING OF BEADS"" appearance of arteries is seen in, with the following options: A: Takayasu's disease, B: Atherosclerotic stenosis, C: Fibromuscular dysplasia, D: Middle aortic syndrome - -### Response: -Ans. c (Fibromuscular dysplasia) (Ref. Harrison's medicine 17th/ 1554; 1569)FMD is identified angiographically by a ""string of beads"" appearance/ ""Pile of plates"" appearance/ ""Beaded"" appearance caused by thickened fibromuscular ridges contiguous with thin, less-involved portions of the arterial wall.FIBROMUSCULAR DYSPLASIA# This is a hyperplastic disorder affecting medium-sized and small arteries.# Usually involves renal and carotid arteries but can affect extremity vessels, such as the iliac and subclavian arteries.# Although fibromuscular dysplasia may occur at any age, it has a strong predilection for young Caucasian women.# F>M.# There are several histologic variants- medial fibroplasia,- perimedial fibroplasia,- medial hyperplasia, and- intimal fibroplasia.# Medial dysplasia is subdivided into- medial fibroplasia,- perimedial fibroplasia, and- medial hyperplasia.# Medial fibroplasia is the most common type and is characterized by alternating areas of thinned media and fibromuscular ridges.# Medial fibroplasia is the most common variant and accounts for approximately two-thirds of patients.0# The lesions of fibromuscular dysplasia are frequently bilateral, and in contrast to atherosclerotic renovascular disease, tend to affect more distal portions of the renal artery.# Patients with FMD have more favourable outcome than atherosclerosis.# The internal elastic lamina is usually preserved. The iliac arteries are the limb arteries most likely to be affected by fibromuscular dysplasia.Few important angiographic appearance.DiseaseAngiographic findings1FMD""String of beads"" appearance/ ""Pile of plates"" appearance/ ""Beaded"" appearance2Thromboangiitis obliterans (Buerger's disease)Smooth, tapering segmental lesions in the distal vessels are characteristic, as are collateral vessels at sites of vascular occlusion.3Takayasu's arteritisIrregular vessel walls, stenosis, poststenotic dilatation, aneurysm formation, occlusion, and evidence of increased collateral circulation.4MeningiomaSpoke-wheel appearance""Mother-in-law"" sign5Moyamoya disease (bilateral supraclinoid ICA block; a cause of paediatric stroke)""Puff of smoke appearance""6Carotid body tumorLyre's sign (splaying of ECA from ICA) JIPMER20127RCC, AngiofibromaTumor blush (Suitable tumors for Pre-Op embolization)8Budd-Chiari syndrome""Spider-web"" collaterals -### End" -5453,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common tumor of thyroid is -, with the following options: A: Papillary, B: Follicular, C: Medullary, D: Hurthle cell - -### Response: -Ans. is 'a' i.e., Papillary o Papillary carcinoma thyroid accounts for 80% of all thyroid maligrancv in Iodine sufficient areas. -### End" -5454,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wernicke's hemianopic pupil is seen in the lesion of, with the following options: A: Optic tract, B: Optic nerve, C: Optic chiasma, D: Occipital lobe (visual coex) - -### Response: -Wernickes hemianopic pupil is seen in the lesion of optic tracts - characterized by contralateral homonymous hemanopia with a characteristic pupillary response. Narrow beam of light when shown into the non-seeing pa of the retina, pupil fails to react while when shown into the seeing pa of the retina, pupillary constriction occurs. Make your concept - Homonymous means same side (i.e. right or left) - Heteronymous means opposite side (i.e. nasal or temporal) - Congruous means same shape or symmetric on both sides - Incongruous means different shape or asymmetric on both sides - Hemianopia means half side is involved - Generally Anterior lesions cause heteronymous, incongruous defects and posterior lesions cause more homonymous and congruous defects Impoant Points on Visual Pathway Lesions 1. Optic nerve lesion - I/l direct and c/ L consensual gone Causes - optic atrophy/ optic neuritis - avulsion optic nerve 2. Proximal pa of optic nerve - I/L blindness C/L hemianopia 1. Saggital chiasma lesion - Bitemporal hemianopia - Paial descending optic atrophy Causes - suprasellar aneurysm - tumors of pitutory craniopharyngioma - suprasellar meningioma 2. Lateral chiasma - Binasal hemianopia of pupillary reflex Causes - Distention of 3rd ventricle Since some fibres of other side there is crossover Binasal Hemianopia 3. Optic tract Lesion- - Contralateral homonymous hemianopia with incongruity - Bow tie pattern of optic atropy 5.Temporal lobe lesion - contralateral homonymous superior quadrantanopia (pie in the sky defect) 6. Parietal Lobe lesion- Pie in the floor. Contralateral homonymous inferior quadrantanopia Homonymous hemianopsia, also referred to as homonymous hemianopia is the loss of half of the field of view on the same side in both eyes. Left superior homonymous quadrantanopia Left inferior homonymous quadrantanopia 7.Keyhole visual field defects: Vascular lesion of Lateral Geniculate body 8. Occipital lobe lesion Congruous homonymous hemianopia with sparing of macula Cause: Occlusion of posterior cerebral aery Congruous Homonymous macular defect Cause: Bullet injury/ head injury Bilateral homonymous macular defect Cause: Bilateral occipital defect -### End" -5455,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: B-Thalessemia trait what is elevated? -, with the following options: A: T HbF, B: T HbA2, C: Microcytosis, D: Severe anaemia - -### Response: -the increase in HbA2 is diagnostically useful, paicularly in induviduals who are at risk for both B thalassemia trait and iron deficiency. Two mechanisms contribute to the anemia in b-thalassemia. The reduced synthesis of b-globin leads to inadequate HbA formation and results in the production of poorly hemoglobinized red cells that are pale (hypochro- mic) and small in size (microcytic). Even more impoant is the imbalance in b-globin and a-globin chain syn- thesis, as this creates an excess of unpaired a chains that aggregate into insoluble precipitates, which bind and severely damage the membranes of both red cells and erythroid pre- cursors. A high fraction of the damaged erythroid precursors die by apoptosis (Fig. 11-6), a phenomenon termed ineffec- tive erythropoiesis, and the few red cells that are produced have a shoened life span due to extravascular hemoly- sis. Ineffective hematopoiesis has another untoward effect: It is associated with an inappropriate increase in the absorption of dietary iron, which without medical intervention inevitably leads to iron overload. The increased iron absorption is caused by inappropriately low levels of hepcidin, which is a negative regulator of iron absorption (see later). Ref: Robbins pathologic basis of disease 9/e . Pg:641 -### End" -5456,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The bases which are present in human DNA?, with the following options: A: Adenine-guanine-thiamine- uracil, B: Adenine-guanine- cytosine-uracil, C: Adenine- guanine-cytosine-thymine, D: None of the above - -### Response: -Double-stranded (ds) Has adenine- guanine-cytosine-thymine Has Deoxyribose DNA does not contain Uracil 2 strands are held together by hydrogen bonds. There are covalent bonds (3' 5' phosphodiester bonds) in sugar-phosphate backbone. -### End" -5457,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A girl on sulphonamides developed abdominal pain and presented to emergency with seizure. What is the probable cause?, with the following options: A: Acute intermittent porphyria, B: Congenital erythropoietic porphyria, C: Infectious mononucleosis, D: Kawasaki's disease - -### Response: -SULFONAMIDES Sulfonamides were the first antimicrobial agents (AMAs) effective against pyogenic bacterial infections. Sulfonamido-chrysoidine (Prontosil Red) was one of the dyes included by Domagk to treat experimental streptococcal infection in mice and found it to be highly effective. Adverse effects to sulfonamides are relatively common. These are: * Nausea, vomiting and epigastric pain. * Crystalluria is dose related, but infrequent now. Precipitation in urine can be minimized by taking plenty of fluids and by alkalinizing the urine in which sulfonamides and their acetylated derivatives are more soluble. * Hypersensitivity reactions occur in 2-5deg o patients. These are mostly in the form of rashes, uicaria and drug fever. Photosensitization is repoed. Stevens-Johnson syndrome and exfoliative dermatitis are more common with long-acting agents. * Hepatitis, unrelated to dose, occurs in 0.1 o c patients. * Topical use of sulfonamides is not recommended because of risk of contact sensitization. However, ocular use is permitted. * Sulfonamides cause haemolysis in a dosedependent manner in individuals with G-6- PD deficiency. Neutropenia and other blood dyscrasias are rare. * Kernicterus may be precipitated in the newborn, especially premature, by displacement of bilirubin from plasma protein binding sites and more permeable blood-brain barrier. Most people with a deficiency of porphobilinogen deaminase never develop symptoms. In some people, however, ceain factors can precipitate symptoms, causing an attack. Factors that can cause an acute porphyria attack include Many drugs (including sex hormones, barbiturates, anticonvulsants, and sulfonamide antibiotics) Premenstrual hormonal changes in women Low-calorie, low-carbohydrate diet Ingestion of alcohol Exposure to organic solvents (for example, in dry cleaning fluids or paints). Emotional stress Infection REFERENCE: www.msdmanuals.com, essentials of medical pharmacology(k.d.tripathi,sixth edition,page no:684) -### End" -5458,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a feature of primary hyperparathyroidism ?, with the following options: A: Reversible growth of parathyroid gland, B: Irreversible growth of parathyroid gland, C: Hypercalcemia and hyperphosphatemia, D: Hypocalcemia and hyperphosphatemia - -### Response: -Primary hyperparathyroidism is caused by autonomous secretion of PTH, usually by a single parathyroid adenoma, which can vary in diameter from a few millimetres to several centimetres. It should be distinguished from secondary hyperparathyroidism, in which there is a physiological increase in PTH secretion to compensate for prolonged hypocalcaemia (such as in vitamin D deficiency, p. 1126), and from teiary hyperparathyroidism, in which continuous stimulation of the parathyroids over a prolonged period of time results in adenoma formation and autonomous PTH secretion (Box 20.39). This is most commonly seen in individuals with advanced chronic kidney disease. DAVIDSON'S PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-769 -### End" -5459,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Post splenectomy sepsis is common in, with the following options: A: ITP, B: Thalassemia, C: Hereditary spherocytosis, D: All - -### Response: -Ans. is 'a' i.e. ITP; 'b' i.e. Thalassemia & 'c' i.e. Hereditary spherocytosis Schwaz writes about Postsplenectomy infections "" Reason for splenectomy is the single most influential determinant of OPSI risk. Case series demonstrate that those who undergo splenectomy for hematologic disease (malignancy, myelodysplasia, or hemoglobinopathy) are far more susceptible to OPSI than patients who undergo splenectomy for trauma or iatrogenic reasons. Age is also an impoant consideration, with children 50 years being at elevated risk."" -### End" -5460,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are TNF alpha inhibitors except, with the following options: A: Infliximab, B: Adalimumab, C: Omalizumab, D: Etanercept - -### Response: -Biological agents TNFa inhibitors:- Etanercept, Infliximab, Adalimumab. Omalizumab is an anti IgE antibody used in bronchial asthma Ref:- kd tripathi; pg num:-878 -### End" -5461,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true about late onset Hemorrhagic disease of newborn (HDN)?, with the following options: A: Begins between 2-7 days of life, B: Intracranial Hemorrhage is common, C: Biliary atresia can predispose, D: Warfarin therapy is associated - -### Response: -Ans. a (Begins between 2-7 days of life) (Ref Care of Newborn by Maherbansingh 6,th/336; Oski's Pediatrics - Pg. 468)As classified by Hathaway, hemorrhagic disease of the newborn (HDN) can occur in early, classic, and late forms.Early HDN presents in first 24 hrs of life generally with catstrophic bleeding. Classic vitamin K deficiency bleeding of the newborn is the most common type of hemorrhagic disease in newborns and classic HDN occurs between 2 and 7 days of life and usually presents as Gl bleeding. Vitamin K (0.5 to 1 mg) given IMIy at birth prevents classic hemorrhagic disease of the newborn, which occurs at 2-7 days of age. Late onset HDN occurs l-3months after birth and is asso with a high incidence CNS hemorrhage and motality.HDN (Hemorrhagic disease of newborn)FeaturesEarly HDNClassical HDNLate HDNOnset< 24 hoursUp to 1-7 days2-16 weeksPresentationConcealed bleedingBleeding from umbilical cord stump, nose, GIT and during surgery (e.g., circumcision)Bleeding more common from sites like intracranial; vessels, skin, mucous membrane, GIT, etcEtiologyIn utero vitamin K deficiency# Most common due to physiologic deficiency of vitamin K in newborns fed with breast milk.# Vitamin K content of human milk (15 mcg/L) is half that of the cow milk.# Predisposing factors are:- Chronic diarrhea,- Malabsorption,- Hepatic cholestasis (e.g. bililary atresia)- Long-term broad-spectrum antibiotics and- Mucovisidosis.- Warfarin therapy- Rare in formula-fed babies and those who have received inj. vitamin K at birth.- Mortality is 20% in late HDN. -### End" -5462,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about oral polio vaccine:, with the following options: A: Poliomyelitis in recipients, B: Poliomyelitis in contact of recipient, C: Guillein Barre syndrome, D: Vomiting and fever - -### Response: -OPV has a rare complication of Vaccine associated paralytic Poliomyelitis (VAPP) -In vaccines: 1 in 1 million -In Close contacts of vaccines: 1 in 5 million -### End" -5463,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Mallory-Weiss syndrome:, with the following options: A: Massive hemorrhage is MC manifestation, B: Alcohol is an associated etiology, C: Conservative treatment is effective in most of the cases, D: Anti-reflux procedure doesn't have added advantage - -### Response: -Massive hemorrage is rare in Mallory Weiss Syndrome. -### End" -5464,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dean's shoe leather survey Comes under:, with the following options: A: Demonstration phase., B: Clinical discovery phase., C: Epidemiological phase., D: Clinical trial phase. - -### Response: -The history of community water fluoridation is categorized into four separate periods or phases. -### End" -5465,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient undergoing surgery suddenly develops hypotension. The monitor shows that the end tidal CO2 has decreased abruptly by 155mm Hg. What is the probable diagnosis?, with the following options: A: Hypothermia, B: Pulmonary embolism, C: Massive fluid deficit, D: Myocardial depression due to anaesthetic agent - -### Response: -Ans. is 'b' i.e. pulmonary embolism Ref: Miller's anesthesia 5th/e p1276First what is end tidal CO2The air exhaled during normal respiration initially consists of the dead space. Then a mixture of dead space air plus alveolar air comes out. The air coming out at the end consists purely of alveolar air.Measurement of concentration of gases in this alveolar air is useful for analysis. The CO2 concentration in the last 10ml. of tidal volume is known as end tidal CO2In pulmonary embolism the blood supply to certain parts of the lung is cut off due to the emboli in circulation. This reduces the exchange of gases between the alveoli and pulmonary capillaries, as a result the cone, of CO2 in alveolar air decreases (CO2 is carried from tissues to the lung by blood and is transferred to the alveoli in exchange of O2). The decrease in alveolar CO2 will lead to decrease in end tidal CO2.Other conditions in which end tidal CO2 decreasesIncrease in dead space (decrease in end tidal CO2 in pulmonary embolism can be explained by this also. Pulmonary embolism causes increase in physiological dead space hence decreases the end tidal CO2)HyperventilationMalignant hyperthermia. -### End" -5466,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chemoprophylaxis is done for all except -, with the following options: A: Cholera, B: Taeniasis, C: Malaria, D: Leprosy - -### Response: -Ans. is b' i.e., Taeniasis Option d' requires some explanation o Dapsone and acedapsone have found to be effective for chemoprophylaxis of leprosy. However the general applicability of chemoprophylaxis as a means of preventing leprosy and its control is still to be determined. -### End" -5467,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In forearm ulnar nerve gives muscular branch to which muscle ?, with the following options: A: Flexor digitorium profundus, B: Palmaris brevis, C: Gastronemius, D: Adductor pollicis - -### Response: -In arm ulnar nerve has no supply, it supplies the muscles in the forearm and in hand. It also gives cutaneous branches and vascular /aicular branches.in the forearm, it supplies medial half of flexor digitorum profundus, flexor carpi ulnaris. BD Chaurasia 7th edition Page no: 182 Figure:13.12,page no:179- vishram singh- textbook of upper limb& thorax- 2nd edition. -### End" -5468,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 12 year old girl complains of pain persisting in his leg for several weeks with a low grade fever. A radiograph reveals a mass in the diaphyseal region of the left femur with overlying cortical erosion and soft tissue extension. A biopsy of the lesion shows numerous small round cells, rich in PAS positive diastase sensitive granules. The most likely histological diagnosis is -, with the following options: A: Osteogenic sarcoma, B: Osteoblastoma, C: Ewing's sarcoma, D: Chondroblastoma - -### Response: -Small round cells rich in PAS positive diastase sensitive granules confirms the diagnosis of Ewings sarcoma. -### End" -5469,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following electrolyte abnormality will be present in a patient who has suffered burns over 56% of his body?, with the following options: A: Hyperkalemic alkalosis, B: Hyperkalemic acidosis, C: Hypokalemic acidosis, D: Hypokalemic alkalosis - -### Response: -The rupture of RBCs in burns causes hyperkalemia. Due to decreased tissue perforation as a result of fluid loss metabolic acidosis will occur (usually in burns > 30%). Thermal burns result in severe electrolytes disturbances which are life-threatening when the percentage of burnt body surface area (BSA) is above 20% in adults and 10% in children. Every organ system is affected by an injury to the skin that involves 25% total BSA. Hypophosphatemia, hypoproteinemia and hypocalcemia will be present in burn patients. An elevation of potassium and a decrease of sodium have been also observed. All urinary parameters were decreased. -### End" -5470,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ultra low volume fogging is done for:, with the following options: A: DDT, B: Malathion, C: Pyrethroid, D: Abate - -### Response: -Ref: Park 'Textbook of Preventive and Social Medicine', 22nd' edition, Pg: 728 -9 A- NVBDCP website available from style=""font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"">.in/Doc dengue_ I20 Director_Desk:20 DGHS: 20 meeting; 20 OCT :2006.pdfExplanation:Under the public health programme, ULV spray (fogging) is undertaken by using 95% or pure technical malathion.As a low volume spray (ULV), Malathion has been widely used for killing adult mosquitoes to prevent or interrupt dengue-hemorrhagic fever and mosquito borne encephalitis epidemicsDDT is used as indoor residual spraying for control of malariaPyrethroids is used as space sprayAbate is used to control vector breading in domestic drinking water containers such as well -### End" -5471,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shoulder pain after laproscopic surgery, next step in management is-, with the following options: A: Oral paracetamol for 2 - 3 days, B: USG of shoulder region, C: Diagnostic shoulder arthroscopy, D: Intraarticular lignocaine injection - -### Response: -Ans. is 'a' i.e.,Oral paracetamol for 2 - 3 days Shoulder tip pain after laproscopic surgery:* The patient should be warned about this preoperatively and told that the pain is referred from the diaphragm and not due to a local problem in the shoulders.* It can be at its worst 24 hours after the operation.* It usually settles within 2-3 days and is relieved by simple analgesics such as paracetamol. -### End" -5472,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which cause of jaundice there is no bilirubin excretion in urine -, with the following options: A: Obstructive jaundice, B: Primary billiary cirrhosis, C: Extrahepatic billiary atresia, D: Hemolytic jaundice - -### Response: -Answer- D. Hemolytic jaundiceAll other options lead to conjugated hyperbilirubinemia. Conjugated bilirubin is water soluble and only loosel y bound to albumin and thus is easily filtered by glomeruli and excreted in urine. -### End" -5473,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about methicillin-resistant Staphylococcus aureus (MRSA) is, with the following options: A: Isoxazolyl penicillin is highly effective, B: All MRSA are multidrug resistance, C: Vancomycin is effective, D: MRSA are more virulent than sensitive strains - -### Response: -Penicillin resistance may also be due to alterations in penicillin-binding protein PBP2a and changes in bacterial surface receptors, reducing binding of beta-lactam antibiotics to cells. This resistance also extend to cover beta lactamase resistant penicillin such as methicillin and cloxacillin(MRSA) -Some of these strains may show resistance to other antibiotics like erythromycin, tetracyclines, aminoglycosides and heavy metals. -### End" -5474,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common CNS neoplasm in HIV patient is, with the following options: A: Medulloblastoma, B: Astrocytoma, C: Primary CNS lymphoma, D: Ependymoma - -### Response: -Ref Robbins 9/e p254_255 It is the most common CNS neoplasia in those with AIDS It is of B cell origin and most have caused by EBV in the immunosuppressant persons Histologically reticulon stains demonstrate that the infiltrating cells are separate from one another by silverstraing material .this pattern referred as hopping is characteristics of primary brain lymphoma -### End" -5475,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vaginal adenocarcinomas in children is caused by?, with the following options: A: Virus, B: Adminstration of DES to pregnant mothers, C: Hormonal changes, D: All of the above - -### Response: -Ans. is 'b' i.e., Administration of DES to pregnant motherso Adenocarcinoma occurs in young women whose mothers had been treated with diethylstilbestrol (DES) during pregnancy. -### End" -5476,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What forms lateral wall of mastoid antrum, with the following options: A: Squamous temporal, B: Tegmen Antri, C: SCC, D: None - -### Response: -Squamous plate of temporal bone (1.5cm) thick in an adult. It is marked externally on the surface of mastoid by supramental triangle. Reference: Dhingra 6th edition -### End" -5477,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lobstein disease is:, with the following options: A: Fibrous dysplasia., B: Achondroplasia., C: Osteogenesis imperfecta., D: Osteopetrosis. - -### Response: -Osteogenesis imperfecta is also known as brittle bone disease or lobstein disease. -### End" -5478,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Formula to calculate sensitivity of a screening test ?, with the following options: A: True positive/true positive + false negative, B: True negative/true positive + false negative, C: True positive/true negative + false positive, D: True negative/true negative + false positive - -### Response: -Ans. is 'a' i.e., True positive/true positive + false negative -### End" -5479,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thiopentone is contraindicated in, with the following options: A: Narcoanalysis, B: Neurosurgery, C: Acute intermittent porphyria, D: Induction of anaesthesia - -### Response: -Being an enzyme inducer (ALA synthetase)  thiopentone precipitates porphyria. -### End" -5480,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child is brought to the paediatric OPD with fever of 24 hours duration. History reveals 3 episodes of chest infection and passage of foul smelling stools. The most probable diagnosis is-, with the following options: A: Cystic Fibrosis, B: Maple Syrup urine Disease, C: Bilirubin Congugation Defect, D: Criggler Najar Syndrome - -### Response: -Ans. is 'a' i.e., Cystic Fibrosis o Recurrent chest infection in a child with evidence of exocrine pancreatic insufficiency (bulky, foul smelling stool) suggest a diagnosis of cystic fibrosis. -### End" -5481,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following maintain the stability of ankle joint, EXCEPT:, with the following options: A: Cruciate ligament, B: Shape of the bones, C: Tendons of muscle which cross the joint, D: Collateral ligament - -### Response: -Cruciate ligaments occur in the knee. There are two cruciate ligaments in the knee: the anterior and the posterior. These ligaments are two strong, rounded bands that extend from the head of the tibia to the intercondyloid notch of the femur. The ACL is lateral and the PCL is medial. They maintain the stability of the knee joint. Ref: Luke A., Ma C. (2013). Chapter 41. Spos Medicine & Outpatient Ohopedics. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013. -### End" -5482,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surfactant is:, with the following options: A: Protein, B: Glycoprotein, C: Sphingolipid, D: Alpha palmitoyl lecithin - -### Response: -D -### End" -5483,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What causes mallet finger?, with the following options: A: Extensor tendon rupture, B: Bony avulsion of distal phalanx at the extensor tendon, C: Strain and subsequent stretching of the extensor tendon, D: All the above - -### Response: -Mallet finger: A finger flexed at the DIP joint due to avulsion or rupture of extensor tendon at the base of the distal phalanx. Mallet finger occur due to forced flextion of the finger tip. Hyper- extension splint is the treatment for atleast 6-8 weeks. -### End" -5484,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a common cause of transverse lie?, with the following options: A: Term fetus, B: Placental abruption, C: Oligohydramnios, D: Placenta pre - -### Response: -Some of the more common causes of transverse lie include: (1) Abdominal wall relaxation from high parity, (2) Preterm fetus, (3) Placenta pre, (4) Abnormal uterine anatomy, (5) Hydramnios, (6) Contracted pelvis -### End" -5485,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Klippel-Feil syndrome EXCEPT:, with the following options: A: Bilateral neck webbing, B: Bilateral shortening of sternocleidomastoid, C: Low hair line, D: Restriction of neck movements - -### Response: -ANSWER: (B) Bilateral shortening of sternocleidomastoidREF: Apley's 8th ep. 161Klippel-Feil syndrome is due to congenital fusion of one or more cervical vertebraeClassical triad:* Short web neck due to prominent trapezius and not short sternomastoidsLow posterior hair lineRestriction of neck movementsOther findings:ScoliosisSprengel's deformityGenitorenal abnormalitiesCongenital heart defectsOcular abnormalities like duane's contractureDeafness -### End" -5486,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acanthosis nigricans can occur due to -, with the following options: A: Increased multiplication of basal cells, B: Cornification of basal cells, C: Keratinisation of epidermal cells, D: All - -### Response: -Hyperplasia of stratum spinosum of the epidermis. -Hyperkeratosis → Thickening of Stratum corneum of epidermis (Cornification of epidermis). -Slight basal cell hyperpigmentation. -### End" -5487,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest side effect of cisplatin in a patient using it for esophageal carcinoma is-, with the following options: A: Acute tubular necrosis, B: Thrombocytopenia, C: Hepatic failure, D: Cardiomyopathy - -### Response: -Ans. is 'a' Acute tubular necrosis Cisplatinum causes Renal Toxicity by damaging tubular epithelial cells. (Tubular necrosis)Other important Adverse effects of CisplatinumTinnitus*Deafness*Neuropathy*Hyperuricemia* -### End" -5488,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hea diseases is most commonly cause of sudden death in young Athletes:, with the following options: A: Aoic Stenosis, B: Mitral Regurgitation, C: Aoic Regurgitation, D: HOCM - -### Response: -Answer is A (HOCM) Syncope and sudden death following competitive spos in young individuals is characteristic of Hyperophic Obstructive Cardiomyopathy (HOCM). The presence of Left ventricular Hyperophy predominantly affecting the Septum, on autopsy confirms the suspected diagnosis of HOCM. 'Syncope and sudden death following competitive spos warrants early diagnosis of this condition in suspected families, Echocardiography should be done to screen their asymptomatic relatives' - API 'Left ventricular Hyperophy predominantly affecting the septum and anterolateral wall is the diagnostic feature '- API -### End" -5489,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In treatment of papillary carcinoma thyroid, radioiodine destroys the neoplastic cells predominantly by, with the following options: A: X-rays, B: Beta rays, C: Gamma rays, D: Alpha particles - -### Response: -RADIOACTIVE IODINE (I131) THERAPY: - -I131 is an effective agent for delivering high radiation doses to the thyroid tissue -It emits mainly beta radiation (90%), which penetrates only 0.5 mm of the tissue and thus allow therapeutic effects on the thyroid without any damage to the surrounding structures, particularly the parathyroids. - -Mechanism of Action: - -I131 emits beta particles and X-rays. -Beta rays are utilized for their destructive effects on thyroid cells. -X-rays are useful for tracer studies. -### End" -5490,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common site of peptic ulcer in duodenum -, with the following options: A: 1st part, B: 2nd part, C: 3rd part, D: 4th part - -### Response: -Ans. is 'a' i.e., 1st part Peptic ulcero Ulcers are defined histologically as a breach in the mucosa of the alimentary tract that extends through the muscular mucosa into the submucosa or deep.o Peptic ulcers are chronic, most often solitary lesions that occur in any portion of the gastrointestinal tract exposed to the aggressive action of acid/peptic juice.Peptic ulcers located in the following sits, in order of decreasing frequency:1.Duodenum, 1st portion2 Stomach, usually antrum3 At the gastroesophageal junction in the setting of gastroesophageal reflux or Barrett's esophagus.4 Within the margins of a gastrojejunostomy.5 In the duodenum, stomach or jejunum of patients with Zollinger -Ellison Syndrome.6 Within or adjacent to Meckel's diverticulum that contains ectopic gastric mucosa. -### End" -5491,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A new born child developed respiratory depression in neonatal ward. Which of the following drug is the cause, with the following options: A: Opioids, B: Barbiturates, C: Diazepam, D: Propofol - -### Response: -Opioids like fentanyl, codeine, pethidine, morphine causes respiratory distress in neonates. Epidural opioid analgesia is commonly employed as a therapeutic modality in the management of pain during labor and can cause neonatal respiratory depression. Reference : page 740 Ghai Essential Pediatrics 8th edition -### End" -5492,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minimum protrusion required for condylar guidance programming on an articulator is:, with the following options: A: 3 mm, B: 4 mm, C: 6 mm, D: 8 mm - -### Response: -The sensitivity of semi-adjustable articulator is minimum of 6 mm to program using a protrusive record. -### End" -5493,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about normal sperm count:, with the following options: A: 60-100 lakh/mm3, B: 4-5 million/mm3, C: 60-120 lakh/mm3, D: 60-120 million/mL - -### Response: -Ans. is d, i.e. 60-120million/mL.Normal values are:Volume 2-6mLpH = Alkaline =7.2-7.8Liquefaction within half an hourCount: 15-200millionpermLMobility and motility 60% progressive forward motilityMorphology 60% normal forms -### End" -5494,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Obesity is associated with decreased risk of -, with the following options: A: Hypeension, B: Hyperuricemia, C: Osteoporosis, D: Hea disease - -### Response: -The major factors considered in past for obesity as protective factor for osteoporosis include increased load on the coical skeleton, direct stimulation of bone formation by leptin, greater aromatase activity, increased estradiol leading decrease bone resorption, and stimulation of bone formation . The ongoing debate regarding the previous concept, that obesity is protective for osteoporosis may not stand same in view of the new concept of obesity of bone (adipogenesis), which is considered detrimental for bone health. ref - ref Davidson 23rd edition pg 987 -### End" -5495,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A subcentre in a hilly area caters to a population of -, with the following options: A: 1000, B: 2000, C: 3000, D: 5000 - -### Response: -The subcentre is the peripheral outpost of the existing health delivery system in rural areas .They are being established on the basis of one subcenter for every 5000 population in general and one for every 3000 population in hilly,tribal and backward areas (refer pgno:903 park 23rd edition) -### End" -5496,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For the following medical conditions, select the associated acid base disturbances.Hepatic cirrhosis complicated by AKI., with the following options: A: metabolic acidosis and respiratory acidosis, B: metabolic acidosis and respiratory alkalosis, C: metabolic alkalosis and respiratory acidosis, D: metabolic alkalosis and respiratory alkalosis - -### Response: -Hepatic cirrhosis frequently results in chronic respiratory alkalosis. AKI with metabolic acidosis is common in patients with cirrhosis. -### End" -5497,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Calcification of soft tissue without any distrubances of calcium metabolism is called, with the following options: A: Inotrophic calcification, B: Monotrophic calcification, C: Dystrophic calcification, D: Calcium induced calcification - -### Response: -Ref Robbins 9/e p65 Dystrophic Calcification Dystrophic calcification is encountered in areas of necrosis of any type. It is viually inevitable in the atheromas of advanced atherosclerosis, associated with intimal injury in the aoa and large aeries and characterized byaccumulation of lipids (Chapter 9). Although dystrophic calcification may be an incidental finding indicating insig- nificant past cell injury, it may also be a cause of organ dysfunction. For example, calcification can develop in aging or damaged hea valves, resulting in severely com- promised valve motion. Dystrophic calcification of the aoic valves is an impoant cause of aoic stenosis in elderly persons (Fig. 10-17, Chapter 10). The pathogenesis of dystrophic calcification involves initiation (or nucleation) and propagation, both of which may be either intracellular or extracellular; the ultimate end product is the formation of crystalline calcium phos- phate. Initiation in extracellular sites occurs in membrane- bound vesicles about 200 nm in diameter; in normal cailage and bone they are known as matrix vesicles, and in pathologic calcification they derive from degenerating cells. It is thought that calcium is initially concentrated in these vesicles by its affinity for membrane phospholipids, while phosphates accumulate as a result of the action of membrane-bound phosphatases. Initiation of intracellular calcification occurs in the mitochondria of dead or dyingcells that have lost their ability to regulate intracellular calcium. After initiation in either location, propagation of crystal formation occurs. This is dependent on the concen- tration of Ca2+ and PO4 - , the presence of mineral inhibitors, and the degree of collagenization, which enhances the rate of crystal growth. -### End" -5498,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following ion plays role in exocytosis?, with the following options: A: Sodium, B: Potassium, C: Calcium, D: Magnesium - -### Response: -Exocytosis For exocytosis to occur, the vesicle containing neurotransmitter must fuse with pre-synaptic membrane - Vesicle membrane is negatively changed & also the cell is negatively charged. Therefore for this fusion to occur a bridge should be formed & a cation can form this bridges. that cation is Ca2+ - Exocytosis, in most cases, is stimulated by the entry of calcium ions into the cell: Calcium ions interact with vesicular membrane in some way that is not understood and its fusion with the cell membrane followed by exocytosis - That is opening of the membrane's outer surface and extrusion of its contents outside the cell. -### End" -5499,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In anoxia of liver, necrosis is seen in -a) Centrilobularb) Around the peripheryc) Around the central veind) Around the bile duct, with the following options: A: ac, B: bc, C: ad, D: b - -### Response: -Architecture of liver lobule - -Liver is divided into hexagonal lobules oriented around the terminal tributaries of the hepatic vein (Terminal hepatic veins), i.e. Terminal hepatic vein is in the centre of the lobule and area around the hepatic vein is called centrilobular zone. -At peripheri of lobule, lies the portal tract containing hepatic artery, bile duct and portal vein. Area around portal tract is called periportal zone. -Area between periportal zone and centrilobular zone is called midzonal area. -So, the blood supply (hepatic artery & portal vein) comes from the peripheral part of the lobule → thus periportal area is nearest to the blood supply and least susceptible to ischemic necrosis, on the other hand centrilobular area is farthest from blood supply and is most susceptible to ischemic necrosis. - -Following information have been added in 8th/e of Robbins - -Acute liver failure is defined as an acute liver illness that is associated with encephalopathy within 6 months after the initial diagnosis. -Fulminant liver failure → when encephalopathy develops rapidly, within 2 weeks of the onset of jaundice. -Subfulminant liver failure → when encephalopathy develops within 3 months of onset of jaundice. -### End" -5500,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true of Hodgkins lymphoma except ?, with the following options: A: Bimodal age pattern, B: Females less common, C: Contiguous spread, D: Osteolytic metastasis - -### Response: -Ans. is 'd' i.e., Osteolytic metastasis -### End" -5501,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Episodic generalized weakness can occur due to all of the following acute electrolyte disturbances, except :, with the following options: A: Hypokalemia, B: Hypocalcemia, C: Hyponatremia, D: Hypophastemia - -### Response: -Answer is B (Hypocalcemia): Episodic generalized weakness is associated with hypercalcemia and not Hypocakemia. -### End" -5502,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 27-year-old sexually active male develops a vesiculobullous lesion on the glans soon after taking tablet paracetamol for fever. The lesion healed with hyperpigmentation. The most likely diagnosis is:, with the following options: A: Behcet's syndrome, B: Herpes genitalis, C: Fixed drug eruption, D: Pemphigus vulgaris - -### Response: -An adverse cutaneous reaction to an ingested drug with characteristic clinical features is fixed drug eruption. Presentation with a solitary lesion in the genital skin that heals with hyperpigmentation. Soon after ingestion of paracetamol, one of the most commonly implicated agents for FDE, leads to the diagnosis of FDE. Ref: Anthony Du Vivier, Phillip H. McKee, Chapter 17, ""Reactive Disorder of The Skin and Drug Eruptions"", In the book, ""Atlas of Clinical Dermatology"", Elsivier Publication, 2002, 3rd Edition, Spain, Page 367 -### End" -5503,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cellular immunitty is induced by -, with the following options: A: Nk-cells, B: Dendritic-cells, C: TH1-cells, D: TH2-cells - -### Response: -TH1 cells, which produce cytokines interferon,gamma& interleukin-2, which activates macrophages & T-cells, promoting cell-mediated immunity, destruction of target cells & killing of intracellular pathogens Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg:135 -### End" -5504,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old man is on a fat free carbohydrate rich diet for a ceain time and he still continues to grow obese. Which of the following lipoproteins is likely to be elevated in his blood?, with the following options: A: Chylomicrons, B: VLDL, C: LDL, D: HDL - -### Response: -Low fat, high carbohydrate diets can reduce HDL cholesterol and increase triglycerides. Especially in obese persons, increased total caloric intake may induce overproduction of VLDL triglycerides while reducing HDL cholesterol levels. Ref: Harper 26th Edition, Pages 211-212 ; Primary Care Medicine: Office Evaluation and Management of the Adult Patient By Allan H. Goroll, Albe G. Mulley, 2009, Page 210 -### End" -5505,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disodium EDTA is used as an antidote for: DNB 10, with the following options: A: Mercury poisoning, B: OPC poisoning, C: Mushroom poisoning, D: Belladona poisoning - -### Response: -Ans. Mercury poisoning -### End" -5506,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The size of the Fenestra vestibule on an average is, with the following options: A: 3.50 mm long and 2.50 mm wide, B: 3.25 mm long and 1.75 mm wide, C: 3.75 mm long and 1.50 mm wide, D: 4.00 mm long and 2.00 mm wide - -### Response: -The size of the Fenestra vestibule on an average is 3.25 mm long and 1.75 mm wide. Ref- Dhingra ENT Textbook 6th edition. -### End" -5507,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epidermoids can be differentiated from arachnoid cyst on MRI by:, with the following options: A: Contrast enhancement, B: Smooth margins, C: Restricted diffusion, D: CSF signal on FLAIR - -### Response: -C i.e. Restricted diffusion Epidermoids can be differentiated from arachnoid cyst characteristically by hyper-intense diffusion weighted images because of restricted diffusion of epidermoid cystQ. FLAIR and proton images are less specific than DWI. -### End" -5508,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Causes of epistaxis are all EXCEPT:, with the following options: A: Nose picking, B: Foreign body, C: Allergic rhinitis, D: Thrombocytopenia - -### Response: -ANSWER: (C) Allergic rhinitisREF: PL Dhingra 4 th edition page 167Causes of Epistaxis:IdiopathicLocal CausesTrauma: Finger nail trauma, injuries of nose, intranasal surgery, fractures of middle third of face and base of skull, hard-blowing of nose, violent sneeze.Infections:Viralrhinitis, nasal diphtheria, acute sinusitis, atrophic rhinitis, rhinitis sicca, tub erculosis, syphilis septal perforation, granulomatous lesion of the nose, e.g. Rhinosporidiosis.Foreign bodies: Rhinolith, Maggots, leechesNeoplasms of nose and paranasal sinuses: Hemangioma, Papilloma, Carcinoma or sarcoma. Atmospheric changes: High altitudes, sudden decompression (Caisson's disease).Deviated nasal septumNasopharyngeal Adenoiditis, Juvenile angiofibroma, Malignant tumorsGeneral CausesCardiovascular: Hypertension, arteriosclerosis, mitral stenosis, pregnancyDisorders of blood and blood vessels: Aplastic anemia, leukemia, thrombocytopenic, vascular purpura, hemophilia, Christmas disease, scurvy, vitamin K deficiency, hereditary hemorrhagic telangiectasia.Liver disease: Hepatic cirrhosis (deficiency of factor II, VII, IX & X)Kidney disease: Chronic nephritisDrugs: Excessive use of salicylates and other analgesics, anticoagulantMediastinal compression: Tumors of mediastinum (raised venous pressure in the nose)Acute general infection: Influenza, measles, chickenpox, whooping cough, rheumatic fever, infectious mononucleosis, typhoid, pneumonia, malaria, dengue fever Vicarious Menstruation -### End" -5509,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Insulin receptors are, with the following options: A: Tyrosine Kinase receptors, B: Phosphodiesterase, C: Calcium calmodulin, D: Lipoprotein - -### Response: -Insulin receptor is a tyrosine kinase which is heterotetrameric glycoproteinRef: Essentials of Medical Pharmacology, 7th edition, KD Tripathi, page no: 261 -### End" -5510,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intravenous anaesthetics are all except., with the following options: A: Propofol, B: Opioids, C: Ketamine, D: Desflurane - -### Response: -Intravenous anesthetics are barbiturates - Thiopentone sodium, methohexitone Non-Barbiturates - Propofol, Ketamine, Etomidate, Opioids. Inhalational anesthetics are halothane, isoflurane, desflurane, sevoflurane. -### End" -5511,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased susceptibility to breast cancer is likely to be associated with a mutation in the following gene:, with the following options: A: p53, B: BRCA-1, C: Retinoblastoma (Rb), D: H-Ras - -### Response: -. p53 -### End" -5512,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triple Assessment for CA Breast includes all except, with the following options: A: Breast self examination, B: USG, C: FNAC, D: Mammogram - -### Response: -In any patient presenting with breast lump or other symptoms auspicious of carcinoma the diagonosis is made by combination of: -clinical assessment -radiological imaging -tissue sample for cytological or histological analysis. These are called Tripple assessment. Bailey and Love'sSho practice of surgery.Edition 23.Pg no:751 -### End" -5513,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Potassium supplementation often is necessary for patients taking which drug?, with the following options: A: Spironolactone, B: Triamterene, C: Furosemide, D: Amiloride - -### Response: -Spironolactone is a competitive antagonist of aldosterone and therefore, may cause hyperkalemia if administered concomitantly with potassium supplements. Likewise, the potassium-sparing diuretics triamterene and amiloride cause potassium retention. Furosemide promotes renal potassium excretion and often requires concomitant supplemental potassium administration. Ref: Reilly R.F., Jackson E.K. (2011). Chapter 25. Regulation of Renal Function and Vascular Volume. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds),Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. -### End" -5514,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child with bouts of laughter, what should be the possible diagnosis ?, with the following options: A: Russel silver syndrome, B: Angelman syndrome, C: Prader willi syndrome, D: Fragile X syndrome - -### Response: -ANGELMAN SYNDROM/Happy puppet syndrome Bouts of laughter, intellectual disability, cerebella ataxia and severe developmental delay, Malformations of the skull and facial bones, seizures RUSSELL SILVER SYNDROME - Sho stature , Triangular facies PRADER WILLI SYNDROME - Obesity, Feeding difficulty, Intellectual disabilities FRAGILE X SYNDROME as- XL dominant ,Elongated face, large ears, large testis -### End" -5515,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 8 year old boy presented with fever and bilateral cervical lymphadenopathy with prior history of sore throat. There was no hepatomegaly. The peripheral blood smear shows >20% lympho plasmacytoid cells. The most likely diagnosis is:, with the following options: A: Tuberculosis, B: Infectious Mononucleosis, C: Acute lymphoblastic leukemia, D: Influenza - -### Response: -Ans. B. Infectious MononucleosisThe given clinical situation suggests Infectious MononucleosisFeatures of Infectious Mononucleosis:* Cervical Lymphadenopathy* Fever* History of sore throat* >20% atypical lymphocytesHepatomegaly may be absent (Occurs only in 30% of cases) -### End" -5516,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A teenager has a long history of ""daydreaming"" in school. EEG reveals evidence of a generalized seizure disorder, but there has never been a history of convulsive muscular activity.For the above patient with clinical symptoms and signs, select the most likely seizure type., with the following options: A: simple partial seizure, B: complex partial seizures, C: tonic-clonic (grand mal) seizures, D: absence (petit mal) seizures - -### Response: -Pure absence seizures consist of the sudden cessation of ongoing conscious activity without convulsive muscular activity or loss of postural control. They can be so brief as to be inapparent but can last several minutes. There is usually no period of postictal confusion. -### End" -5517,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following disease is transmitted by phlebotomus argentipes-, with the following options: A: Epidemic typhus, B: Kala-Azar, C: Relapsing fever, D: Trench fever - -### Response: -Ans. is 'b' i.e., Kala azar -### End" -5518,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The first step for lymphatic vessels to remove excess fluid from interstitial tissue spaces is by:, with the following options: A: Generating a lower intravascular than tissue hydrostatic pressure, B: Contracting and forcing lymph into larger lymphatics, C: Opening and closing one-way valves in the lymph vessels, D: Lowering the colloid osmotic pressure inside the lymph vessel - -### Response: -Ans. A. Generating a lower intravascular than tissue hydrostatic pressureAlthough all of the choices are events that happen in lymph vessels, the first key event is lowering the lymphatic hydrostatic pressure to enable tissue fluid to enter the lymphatic vessel. -### End" -5519,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 14-year-old boy presents for a pre-summer camp physical examination. Routine urinalysis discloses 3+ glucosuria. He admits to thirst and frequent urination, accompanied by a 4-kg (9-lb) weight loss over past few months. His parents note that he had a flu-like illness 5 months ago. His blood glucose is 220 mg/dL. Which of the following best explains the pathogenesis of hyperglycemia in this patient?, with the following options: A: Excess dietary glucose, B: Increased peripheral insulin uptake, C: Irregular insulin secretion, D: Islet cell destruction - -### Response: -Type 1 diabetes mellitus (T1DM) -Lifelong disorder of glucose homeostasis that results from autoimmune destruction of b-cells in islets of Langerhans. - Clinical onset coincides with another acute illness, such as febrile viral or bacterial infection. - Characterized by low or absent insulin secretion. - Most characteristic early finding in pancreas is lymphocytic infiltration in islets (insulitis), - As disease becomes chronic, b-cells of islets are progressively depleted. -### End" -5520,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 47 year old man with a history of sickle cell disease has had numerous hospitalizations requiring the placement of intravenous lines. The patient has poor peripheral venous access, and a catheter is placed in the right subclan vein. The patient subsequently develops right arm discomfo and swelling and a temperature of 40.1 degrees C with chills. Multiple blood cultures are taken, and gram-positive cocci are isolated. The organism is catalase positive and grows on mannitol salt agar, but does not turn the agar yellow; the colonies are gamma-hemolytic on a sheep blood agar plate. Which of the following organisms is the most likely cause of this patient's symptoms?, with the following options: A: Enterococcus faecalis, B: Staphylococcus aureus, C: Staphylococcus epidermidis, D: Streptococcus agalactiae - -### Response: -The patient has developed bacteremia; the description of the causative agent is consistent with a staphylococcal organism (catalase positive, gram-positive cocci that grow on mannitol salt agar). The organism is most likely S. epidermidis as it was not able to ferment mannitol, and was not hemolytic. Both of those characteristics tend to rule out S. aureus. Two other tests that are commonly used are coagulase production and excretion of DNAse from colonies. S. aureus is positive in both tests, S. epidermidis is negative. Enterococcus faecalis might grow on the mannitol salt agar as it is relatively haloduric but these organisms are catalase negative. The enterococci are extremely variable in hemolytic ability so this characteristic is not useful in species identification. Streptococcus agalactiae is catalase negative and beta-hemolytic on sheep blood agar plates. Also, neither would grow on the mannitol salt agar. S. pyogenes is sensitive to growth inhibition by bacitracin while S. agalactiae (group B streptococci) is not. Ref: Brooks G.F. (2013). Chapter 13. The Staphylococci. In G.F. Brooks (Ed),Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e. -### End" -5521,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Periphery of retina is best visualized with :, with the following options: A: Direct ophthalmoscopy, B: Indirect ophthalmoscopy, C: Retinoscopy, D: USG - -### Response: -Indirect ophthalmoscopy can be used to examine the entire retina, even out to its extreme periphery, the ora serrata. This is possible for two reasons. Optical distoions caused by looking through the peripheral lens and cornea interfere very little with the indirect ophthalmoscopic examination compared with the direct ophthalmoscope. In addition, the adjunct technique of scleral depression can be used. Ref : Chang D.F. (2011). Chapter 2. Ophthalmologic Examination. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. -### End" -5522,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Substantia gelatinosa corresponds to, with the following options: A: Rexed laminae I, B: Rexed laminae II, C: Rexed laminae III, D: Rexed laminae IV - -### Response: -The Rexed laminae comprise a system of ten layers of grey matter (I-X), identified in the early 1950s by Bror Rexed to label poions of the grey columns of the spinal cord NOTE: Lamina I: posteromarginal nucleus Lamina II: substantial gelatinosa of Rolando Laminae III and IV: nucleus proprius Lamina V& VI: base of the dorsal horn. Lamina VII: intermediomedial nucleus, intermediolateral nucleus, nucleus dorsalis Lamina VIII & IX: medial and lateral groups of nuclei of anterior grey column Lamina X: Central Zone, grey matter surrounding the central canal ref - vishram singh neuroanatomy 2e pg59 -### End" -5523,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 35 years old man presenting with acute pancreatitis. Ideal fluid of choice, with the following options: A: Isotonic crystalloid, B: Hypertonic crystalloids, C: Hypotonic crystalloid, D: Vasopressin - -### Response: -Ref. API Textbook of Medicine. Pg. 813 -  -Most imp consideration in the management of acute pancreatitis is conservative approach - -Fluids >Pain >Nutrition >Inflammation -Ideal fluid of choice is Isotonic crystalloids -1st line management : NPO , IV Fluids ,IV antibiotics, IV anti inflammatory  + Blood investigations (Amylase and lipase) -### End" -5524,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Calciphylaxis is more commonly seen in, with the following options: A: Primary hyperparathyroidism, B: Secondary hyperparathyroidism, C: Teritiary hyperparathyroidism, D: Pseudo hyperparathyroidism - -### Response: -Calciphylaxis (calcific uraemic aeriolopathy) is a syndrome of disseminated calcification resulting in both vascular calcification and skin necrosis. It accounts for approximately 4% of patients undergoing surgical intervention for secondary hyperparathyroidism. It presents with expanding painful cutaneous purpuric lesions, predominantly on the extremities, although it can also be seen on the lower abdomen.Ref: Bailey and Love 27e pg: 831 -### End" -5525,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preformed toxin is impoant in food poisoning due to all, EXCEPT:, with the following options: A: Staph aureus, B: Clostridium botulism, C: ETEC, D: B.cereus - -### Response: -Food poisoning is of three types: INFECTIVE TYPE: In this type, multiplication of bacteria occurs in vivo when infective doses of microorganisms are ingested with food. Incubation period is generally 8 to 24 hours. The typical example of this type of food poisoning is by Salmonella typhimurium, S. Enteritidis, S. Heidelberg, S. Indiana, S. Newpo, S. Dublin, Vibrio parahaemolyticus, Campylobacter jejuni. TOXIC TYPE: The disease follows ingestion of food with preformed toxin. Incubation period is sho (2 to 6 hours). Eg: Staphylococcus aureus, Bacillus cereus, Clostridium botulinum. INFECTIVE-TOXIC TYPE: In this type, bacteria release the toxin in the bowel. The incubation period is 6 to 12 hours. Eg: Clostridium perfringens ETEC produce a heat-stable enterotoxin (ST) or a heat labile (LT) Cholera toxin, like enterotoxin or both. Toxin production alone may not lead to illness. The organism must initially be able to adhere to the mucosal surface of the epithelial cells of the small intestine. This adhesion is usually mediated by fimbriae that bind to specific receptors in the intestinal cell membrane. These adhesions are called colonization factor antigens (CFAs). Ref: Textbook of Microbiology by Surinder Kumar; Page-701 -### End" -5526,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following drugs does not undergo the first-pass effect?, with the following options: A: Propanolol, B: Lidocaine, C: Insulin, D: Morphine - -### Response: -Insulin bypasses hepatic effect. Pg.no. 260 KD TRIPATHI Seventh edition Drugs that undergo first-pass elimination are opioids, beta-adrenergic blockers, progesterone, isosorbide dinitrate etc. Subcutaneous administration of insulin delivered into the peripheral circulation can lead to near-normal glycemia but differs from the physiological secretion of insulin in two major ways: * The absorption kinetics do not reproduce the rapid rise and decline of endogenous insulin in response to changes in blood glucose. * Injected insulin is delivered into the peripheral circulation instead of being released into the poal circulation. Thus, the poal/peripheral insulin concentration is not physiological, and this may alter the influence of insulin on hepatic metabolism. Pg no 1248 Goodman and Gillmann 12th edition Pg no 17 sathoskar 25th edition -### End" -5527,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of following antibody is pentameric -, with the following options: A: IgM, B: IgG, C: IgA, D: IgD - -### Response: -Ans. is 'a' i.e., IgM * Ig M is a pentameric immunoglobulin with five, four - peptide subunits.* The subunits are joined together by J chain.Remember* J chain is found in IgA and IgM.Also know* I think the following information requires some specific mention here-# There may be confusion about the status of momomer and dimer when applied to antibody as each molecule of an antibody is a dimer of two identical heavy and light chains.# But, the terms monomer , dimer or pentamer are used in context to how many molecules of same class of antibody are bound together-i) IgG is not found to bound to other IgG - Monomerii) IgA is bound to another IgA - Dimeriii) IgM binds four other IgM - Pentamer -### End" -5528,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of Health worker female – a) Perform 50% of deliveriesb) Trains daisc) Enlist dais of the subcentred) Chlorination of watere) Collectors of urine samples, with the following options: A: a, B: c, C: ac, D: bc - -### Response: -Functions of Female health worker -1. Maternal and child health. - -Ensure at least 3 antenatal checkups for pregnant women. -Test urine of pregnant women for albumin, and estimate hemoglobin level. -Conduct deliveries in her area when called for. -Supervise deliveries conducted by dais and assist them whenever called. -Make at least two post-natal visits for each delivery. -7th of each month, will submit accounts of the previous month of beneficiaries under janani Suraksha yojana (JSY). -Refer cases of abnormal pregnancy and cases with medical and gynecological problems to PHC. - -2. Family planning - -Responsible for maintaining eligible couple registers and updating at all times. -Distribute conventional contraceptives and oral contraceptives to couples. - -3. Medical termination of pregnancy -i) Refer the related case to nearest approved institution. -4. Nutrition - -Distribute iron & folic acid tablets to pregnant women. -Administer vitamin A solution to children. - -5. Universal programme of immunization - -Immune pregnant women with TT. -Administer DPT, OPV, measles, vaccine & BCG to all infants & children. - -6. Dai training - -List dais in her area -Help the health assistant in training programme of Dais. - -7. Communicable diseases - -Give ORS to all cases of diarrhea, dysentery/vomiting. -Helps identification & treatment of filariasis, where it is endemic. - -8. Vital events -i) Record & Report vital events (birth, death). -9. Records keeping -i) Register : - - -Pregnant women from 3 months onward. -Infants (0-1 year) -Women aged 15 to 44 year. - -10. Treatment of minor ailments -11. Team activities -i) Meet the health assistant each week and seek her advice and guidance whenever necessary. -Note : About option `e' → FHW tests urine for albumin. -### End" -5529,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stain used for staining fungal elements –, with the following options: A: Acid fast stain, B: Mucicarmic, C: Methenamine, D: Gram stain - -### Response: -For the demonstration of fungal elements in tissue sections following two stains are most commonly used - - -i) Periodic acid Schiff (PAS)         -ii)  Methanamine silver -### End" -5530,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ocular associations of primary open-angle glaucoma include all except:, with the following options: A: Central retinal vein occlusion, B: Central retinal aery occlusion, C: Retinal detachment, D: Retinitis pigmentosa - -### Response: -Ans. Central retinal aery occlusion -### End" -5531,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ssytemic infection is caused by all fungi except, with the following options: A: Cryptococcus, B: Histoplasma, C: Dermatophytes, D: Paracoccidioides - -### Response: -Ans. is 'c' i.e., Dermatophytes Fungus infections Human fungus infections are broadly of two types : Superficial Deep seated (systemic) -### End" -5532,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A multlgravlda with previous 2 normal deliveries presents with unstable Lie of the fetus at 34 weeks Gestation. What could be the most probable cause?, with the following options: A: Placenta pre, B: Oligohydramnios, C: Uterine anomaly, D: Pelvic tunKtur - -### Response: -Placenta prae Defined as a placenta located paly or completely in the lower uterine segment.The bleeding is called inevitable or unavoidable haemorrhage as dilatation of internal os inevitably results in haemorrhage (refer pgno:128 Sheila textbooks of obstetrics 2 nd edition) -### End" -5533,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 13 year old boy presents to OPD with pain in lower right tooth region with no remarkable medical history. On intraoral examination, 85 was found to be carious and did not respond to EPT. Radiographs taken are shown below. What is the most probable diagnosis?, with the following options: A: Apical granuloma, B: Radicular cyst, C: Odontogenic keratocyst, D: Lateral periodontal cyst - -### Response: -Radicular cysts are the most common type of cyst in the jaws. They arise from nonvital teeth  (i.e., teeth that have necrotic pulps because of extensive caries, large restorations, or previous trauma). Radicular cysts often produce no symptoms unless secondary infection occurs. A cyst that becomes large may cause swelling. -### End" -5534,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'Duret hemorrhages' are seen in:, with the following options: A: Brain, B: Kidney, C: Heart, D: Lung - -### Response: -Ans. (a) Brain* Due to increased ICP - there will be downward herniation of brain stem which causes stretching of the Basilar artery and results in Duret hemorrhage.* Duret hemorrhage is a small area of bleeding in Upper brain stem (Midbrain and Pons)* Fatal outcome. -### End" -5535,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pancreatic pseudocysts developing complications are best managed by:, with the following options: A: Conservative treatment, B: Radiologically guided interventions, C: External drainage, D: Surgery - -### Response: -Ans. (c) External DrainageRef: Surgery Sixer 3rd ed; pg. 678* Infection is the MC complication of Pseudocyst* External Drainage is the best method drainage of Infected Pseudocyst -### End" -5536,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Critical pH for initiation of caries in dentin is:, with the following options: A: 4.3-4.5, B: 5.2-5.5, C: 4.9-5.1, D: 6.2-6.5 - -### Response: -Critical pH for initiation of caries in dentin is 6.2-6.5. -In addition, the critical pH for dentin is higher than for enamel, so demineralization is likely to start even before the pH reaches the critical level for enamel (pH = 5.5). -### End" -5537,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Extra axial enhancing lesion on MRI. The most likely diagnosis is:, with the following options: A: Meningioma, B: Ependymoma, C: Arachnoid cyst, D: Lipoma - -### Response: -After glioblastomas, meningiomas are the second most common brain tumor, and the most common extra axial tumor. Ref: Essentials of Clinical MR edited by Val Runge, John Morelli, 2010, Chapter 4 -### End" -5538,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Morphine when used for cancer palliative therapy least likely to cause:, with the following options: A: Nausea & vomiting, B: Constipation, C: Dry mouth, D: Respiratory depression - -### Response: -Ans: c (Dry month)Ref: Tripathi 6th ed., Pg. 456Dry mouth has not been mentioned as an adverse effect of morphine. Other three choices are obvious.MorphineIt is a full agonist of mu receptors.Adverse effectsSedationLethargyVomitingConstipationRespiratory depressionAllergyWithdrawal features:1) Intense craving2) Restlessness and insomnia3) Pain in muscle and joints4) Running nose and eyes5) Abdominal cramps, vomiting, diarrhoeab) Piloerection, sweating, dilated pupils, tachycardia7) Disturbance of temperature control Antidote for morphine poisoning - naloxone -### End" -5539,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congenital Anomaly produced by lithium therapy is, with the following options: A: Limb shoening, B: Anencephaly, C: Hea Block, D: Renal Agenesis - -### Response: -C i.e. Hea block -### End" -5540,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A researcher draws unbiased sample of 100 adult delhites and find that their mean weight is 72 kg with a standard detion of 1.5. 95% of wt of delhites shall be between:, with the following options: A: 66 and 78 kg, B: 69 and 75 kg, C: 70.5 and 73.5 kg, D: None of the above - -### Response: -In the given question, n = 100 adult Delhites, mean weight (u) = 72kg, standard detion (SD) = 1.5 95% wt of delhites = Mean +- 2SD (u +- 2SD) = 72 +- 2 (1.5) = 72 +- 3 =b/w 69 & 75 kg wt -### End" -5541,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person going to temple gets an irresistible sense of idea to abuse God which can't be resisted. Likely diagnosis is :, with the following options: A: Mania, B: Obsessive - Compulsive disorder, C: Schizophrenia, D: Delusion - -### Response: -Irresistible thought to abuse the God suggests the diagnosis of obsession of thoughts. -### End" -5542,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause(s) of retention of urine in reproductive age group:a) Cervical fibroidb) Retroverted gravid uterusc) Unilateral hydronephrosisd) Severe UTIe) Posterior urethral valve, with the following options: A: acd, B: bcd, C: abc, D: abd - -### Response: -Important gynecological causes of acute retention:— -### End" -5543,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about temporal aeritis except-, with the following options: A: Polymyalgia rheumatica, B: Anemia, C: Low ESR, D: Sudden blindness - -### Response: -Ans. is 'c' i.e., Low ESRGiant cell aeritis or temporal aeritis o It is the most common form of systemic vasculitis in adults.o It is an acute and chronic, often granulomatous inflammation of aeries of large to small size.o Giant cell aeritis affects principally the aeries in the head, especially the temporal aeries which is the extracranial branch of carotid aery.o Veebral and ophthalamic aeries may also be involved.o Segment of affected aery develops nodular thickening with narrowing of lumen.o There is granulomatous inflammation in the vessel wall with foreign body and Langhans type multinulated giant cells and fragmentation of internal elastic lamina.Presentation of Giant cell aeritis o Constitutional symptoms Most common nonspecific symptoms Include malaise, fatigue, anorexia and weight loss.These symptoms are due to generalized involvement of the body and are not related to any organ involvement. o HeadacheIt is most common vasculitis related symptom.Most commonly over temporal region.o Jaw claudication It is most specific symptom of GCA.It is manifestated as pain in masseter when eating food that require vigrous chewing because oxygen demand of the masseter exceeds the supply provided by narrowed and inflamed aeries.o Visual symptomsDiplopia and visual loss. Ophthalmic aery involvement can lead to sudden blindness which is the most feared complication of GCA. o Polymylagia rheumaticaAching and stiffness of the shoulder, neck and lip girdle area.o Ahritiso Raised ESRo Normocytic - Normochromic anemia -### End" -5544,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cicatrising trachoma is seen in ?, with the following options: A: Stage-1, B: Stage-2, C: Stage-3, D: Stage-4 - -### Response: -Ans. is 'c' i.e., Stage-3 McCal Ian's classification-McCallan in 1908 divided the clinical course of trachoma into 4 stages Stage 1 (Incipient trachoma) Hyperaemia of palpebral Stage 2 (Established tracoma) Stage 3 (Cicatrising trachoma) Stage 4 (Healed trachoma) Immature follicle Appearance of mature follicle & conjunctiva papillae Scarring of palpebralconjunctiva Disease is cured or is not markable Mild superfecial punctate keratopathy Progressive corneal pannus Scars are easily visibleas white bands Necrosis Sequelae to cicatrisationcause symptoms Stage 2 is fuher subdivided into :- 2a (Ha) :- Presence of mature follicles b (Hb) :- Marked papillary hyperplasia -### End" -5545,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve compressed in Guyon's canal is: September 2003, with the following options: A: Median and ulnar, B: Median, C: Ulnar, D: Radial - -### Response: -Ans. C i.e. Ulnar -### End" -5546,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Isomorphism not seen in:, with the following options: A: Lichen planus, B: Warts, C: Psoriasis, D: Vitiligo - -### Response: -Isomorphism or Koebner phenomenon-It means linear lesions produced by scratching a primary lesion which results in new lesions developing along the line of the scratch. Eg: Lichen planus, warts and psoriasis. But Koebner phenomenon is characteristic for Lichenplanus. -### End" -5547,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If there are 4 nucleotides instead of 3 in codon, how many amino acids may be formed?, with the following options: A: 16, B: 21, C: 256, D: 64 - -### Response: -C i.e. 256 -### End" -5548,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eosin-5-Maleamide flow cytometry is used for diagnosis of:, with the following options: A: G6PD, B: Hereditary spherocytosis, C: Sickle cell anemia, D: Alpha thalassemia - -### Response: -Ans: (b) Hereditary spherocytosisRef: Wintrobe's Hematology, compiledHereditary SpherocytosisAD inheritanceMost common mutation - Ankyrin*Most severe mutation Spectrin*The spherocytes of HS have 2 defects:Reduced deformabilityReduced membrane plasticityPeripheral smearSpherocytesHowell jolly bodies - post splenectomyHemolysis - ExtravascularDiagnosisPeripheral smearOsmotic fragility test - ScreeningGold standard - Flow cytometry - EMA (Eosin-5-Maleamide) Flowcytometry EMA FlowcytometryA flowcytometric test based on eosin-5-maleamide (EMA) which binds to band 3 of red cell membrane is a sensitive and specific test for diagnosis of HS.The mean fluorescence intensity of EMA tagged red cells is lower in HS (MCF<0.80).EMA fluorescence is normal or increased in AIHA (DD for spherocytosis). -### End" -5549,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about papilloma is all except:, with the following options: A: Solitary is more common in adults and most common presentation is change in voice, B: Solitary type is more aggressive, prognosis is bad and malignant transformation is common, C: Multiple type is more common in children and most common presentation is hoarse cry, D: Early treatment leads to better results in multiple type - -### Response: -(b) Solitary type is more aggressive, prognosis is bad and malignant transformation is common(Ref. Cummings, 6th ed., 923)Solitary type which is more common in adults is less aggressive (no stridor) and malignant transformation is rare.Early treatment will prevent stridor and therefore better results in multiple type in children. Rest are true. -### End" -5550,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Persistent diarrhoea is defined as diarrhoea lasting more than?, with the following options: A: 7 days, B: 14 days, C: 21 days, D: 28 days - -### Response: -Ans. (b) 14 days -### End" -5551,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following agents causing acute infectious diarrhea can be paired with the pathogenic mechanism of destruction limited to the mature villus cells of small intestine?, with the following options: A: Vibrio cholerae, B: E. coli, C: Shigella, D: Rotavirus - -### Response: -Rotavirus, a double-stranded RNA virus, infects only the mature villous cells in the duodenum. The virus is a worldwide cause of acute enteritis in infants and children (6 months to 2 years of age). The small intestinal crypt cells and colonic epithelial cells remain intact. Typical symptoms include diarrhea, fever, and occasional vomiting. Interestingly, temporary lactose intolerance is observed in nearly half of the patients with rotavirus diarrhea. After penetration the virus becomes associated with lysosomes whose proteolytic enzymes digest the capsid protein. The virion RNA is transcribed to mRNA which becomes associated with the ribosomes. Ref: Ray C.G., Ryan K.J. (2010). Chapter 15. Viruses of Diarrhea. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. -### End" -5552,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dependant viscera sign is seen in?, with the following options: A: Diaphragmatic rupture, B: Fracture Bronchus, C: Pneumoperitoneum, D: Diaphragmatic hernia - -### Response: -*Dependent viscera sign is seen in Diaphgramatic Injury *Viscera lie against the posterior ribs with obliteration of posterior costophrenic recess on a CT The Dependent Viscera Sign -### End" -5553,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ideal site for myringotomy and grommet insertion-(CUPGEE 02, Kolkata 02. RJ 01, NBE based NEET 2012-13), with the following options: A: Anterior superior aquadrant, B: Anterior inferior quadrant, C: Posterior superior, D: Posterior inferior - -### Response: -Ans-Banteroinferior quadrantExplanationa. As.discussed- Ideal site for incision in ASOM is posteroinferior quadrantb. For serious otitis media/Grommet insertion, idea! the site is anterior inferior quadrant (though Dhingra says it can be posterior inferior also) as is proven by the following lines from Scotts brown:c. The site of insertion of the grommetd. ""Insertion of the ventilation tube posterosuperiorly is not recommended because of the potential for damaging the ossicular chain. It makes no difference to the extrusion rate as to whether the tube is inserted through a radial or circumferential incision and whether sited anterosuperiorly rather than Antero-inferiorly.e. Placement Antero-inferiorly compared with placement posteroinferiorly lengthens the time a ventilation tube is in situ. To maximize the duration of potential tube function, the preferred insertion site is anteroinferior through a circumferential or radial incision. Ref. Scott Brown -### End" -5554,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Massive blood transfusion is defined as -, with the following options: A: 350 ml in 5 min, B: 500 ml in 5 min, C: 1 Litre in 5 min, D: Whole blood volume - -### Response: -Massive Blood Transfusion is defined as- -According to Sabiston- . - -transfusion greater than patient's total blood volume in 24 hrs -or as acute administration of more than 10 units of blood over a few hours. - -According to Schwartz- -Massive transfusion is a single transfusion of 2500 ml or 5000 ml transfused over a period of 24hrs. -### End" -5555,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 yr old boy, unconscious with 2 days h/o fever, comes to pediatric ICU with R.R 46/min, B.P.110/80 and E1 V1 M3 on Glasgow coma scale, next step of Mx includes, with the following options: A: Intubate and ventilate, B: Give 0.9% NaCl, C: Sta dopamine at the rate of 1-2 g/min/kg, D: Dopamine at the rate of 1-2 g/min/kg & furosemide - -### Response: -There is increased respiratory rate.the child must be intubated and venilated to provide suppo . Reference: GHAI Essential pediatrics, 8th edition -### End" -5556,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pachydermia laryngitis - M/C site of involvement, with the following options: A: Vestibular fold, B: Arytenoid cailage, C: Anterior 1/3 commissure, D: Posterior 1/3 and anterior 1/3 commissure - -### Response: -Pachyderma laryngitis affects the medial surface of arytenoid cailage, in paicular the vocal processes. Ref:- Scott&;s Brown 7th edition; pg num:- 2196 -### End" -5557,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Confirmation of the diagnosis of vesicular mole is by :, with the following options: A: Vaginal examination, B: X-rays, C: Abdominal examination, D: Ultrasonogram - -### Response: -Ultrasonogram -### End" -5558,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The best method of evacuation of a missed abortion in uterus of more than 12 weeks:, with the following options: A: Oxytocin infusion, B: Intramuscular prostaglandin (15 methyl PGF2a), C: Prostaglandin El vaginal misoprostol followed by evacuation of the uterus, D: Suction evacuation - -### Response: -In all midtrimester abortion, cervical preparation must be done before performing evacuation, to make the process easy and safe. Intracervical tent, mifeprestone or misoprostol are used as the cervical priming agents. Suction evacuation is not suitable for bigger size of uterus more than 10 weeks as chances of retained products are more. -### End" -5559,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sezary syndrome is included in category of ?, with the following options: A: T cell leukaemia, B: Lymphoma, C: B cell leukaemia, D: Pigmented disorder of skin - -### Response: -Ans. is 'a' i.e., T-Cell leukaemia o Mycosis fungoides & sezary syndrome appear to be a different manifestations of a single neoplastic entity. It is an indolent disorder of pripheral CD4T cells that is characterized by the involvement of skin & therefore belongs to the group of cutaneous T cell lymphoid neoplasms -### End" -5560,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Warthin-Finkeldey giant cells are seen in?, with the following options: A: Mumps, B: Rubella, C: Measles, D: Chicken pox - -### Response: -Modified giant cells present in Measles is known as Warthin-Finkeldey giant cells. -### End" -5561,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reversible cause of dementia is -, with the following options: A: Alzheimer's disease, B: Parkinsonism, C: Hypothyroidism, D: Vascular dementia - -### Response: -Ans. is 'c' i.e., Hypothyroidism Causes of dementiaReversible causesSurgically treatableMedically treatableo Normal pressure hydrocephaluso Brain tumors (frontal lobe tumor)o Meningiomao Subdural hematoma (Head injury)o Hydrocephaluso Hypothyroidismo Depressiono HIV infectiono Alcohol abuseo Vitamin B12, Folate, Niacin deficiencyo Any metabolic or endocrine disturbanceo Neurosyphiliso Hashimoto's encephalopathy o Wilson's diseaseo Celiac disease or Whipple's diseaseo Chronic meningoencephalitiso Drugs and toxin (toxic dementia)Irreversible causeso Alzheimer's diseaseo Huntington's choreao Lewy body dementiao Vascular (Multi-infarct) dementiao Parkinson's diseaseo Creutzfeld Jakob diseaseo Pick's diseaseo Overall Alzheimer's disease is the most common cause. Vascular dementia is the 2nd most common cause. -### End" -5562,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chromosome are visualized through light microscope with resolution of -, with the following options: A: 5 Kb, B: 50 mb, C: 5 mb, D: 500 Kb - -### Response: -. 5 mb -### End" -5563,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a effect of gas formation in putrefaction?, with the following options: A: Blood-tinged froth from nostrils and mouth, B: Blisters in thigh, C: Rigidity, adduction and flexion of limbs, D: Postmoem delivery of fetus - -### Response: -Blood tinged froth exudes from nostrils and mouth (i.e. postmoem purge) due to presence of gas in abdomen Blisters in thigh are termed as postmoem blisters which are also due to gas formation. Rigidity : abduction and flexion of the limbs occurs due to inflation of the tissue with gases. Anus & uterus may prolapse due to gas formation and postmoem delivery of a fetus takes place. -### End" -5564,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In glycogen metabolism, a metabolically active impoant enzyme found in liver is conveed from it's inactive dephosphorylated state to it's active phosphorylated state. Which of the following is true about this enzyme:, with the following options: A: Phosphorylation sometimes activates the enzyme, B: Catecholamines directly stimulate it, C: More commonly seen in fasting state than in fed state, D: Always activated by cAMP dependent protein kinase - -### Response: -The enzyme in concern in this question is Glycogen Phosphorylase: Glycogen Phosphorylase RLE of glycogenolysis Active in phosphorylated state. Phosphorylation always activates this enzyme. (option A is wrong) Catecholamines stimulate this enzyme through cAMP, not directly. (option B is wrong) Glycogenolysis is occurring in fasting state, not in fed state. CAMP activates this enzyme but Calcium & calmodulin directly activates this enzyme without phosphorylation and without cAMP. (option D is wrong as this enzyme is not always activated by cAMP). -### End" -5565,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The earliest markers of renal injury in lead poisoning is the:-, with the following options: A: Elevated lead level in urine, B: Elevated free protoporphyrin in urine, C: Elevated b 2 microglobulin in urine, D: Elevated coproporphyrin in urine - -### Response: -Elevated urinary levels of N-acetyl-3-D-glucosaminidase and b-2-microglobulin may serve as early markers of renal injury. -### End" -5566,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brodie abscess most commonly seen in:, with the following options: A: Epiphysis, B: Metaphysis, C: Diaphysis, D: Epiphyseal cartilage - -### Response: -Ans: b (Metaphysis) Ref: Maheswari, 3rd ed, (Rev)p. 163BRIDGENagging pain worse at night, relieved by salicylates is suggestive of osteoid osteomaBrodies abscess is most commonly seen in metaphysis of bone.Brodie abscess:Age group -10-20 yrsSites - upper end of tibia, lower end of femur- metaphysicSymptoms-Deep boring pain, worse at night relieved by rest.X-raycircular or oval lucent area surrounded by sclerosis.TreatmentSurgical excavation, curettage & packing with cancellous bone chips.Bony lesions with site of originMetaphysisDiaphysisEpiphysisOsteosarcomaOsteomyelitisBrodies abscessEwing sarcomaOsteiod osteomaMultiple myelomaSecondariesLymphomaAdamantinomaOsteoclastomaChondroblastomas -### End" -5567,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sterility is caused by:, with the following options: A: Vinca alkaloids, B: Alkylating agents, C: Antimetabolites, D: Actinomycin D - -### Response: -Sterility and secondary leukemias are distinctive adverse effects of alkylating agents. Other adverse effects of alkylating agents: BM depression Alopecia Mucositis - Diarrhoea Hyperuricemia -### End" -5568,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Confabulation is seen in, with the following options: A: Mania, B: Depression, C: Alcoholism, D: Delirium - -### Response: -Wernickes encephalopathyis a triad of GLOBAL CONFUSION, OPHTHALMOPLEGIA AND ATAXIA It is due to deficiency of thiamine It is 100% reversible Most impoant symptom needed for the diagnosis is confusion If the patients wernickes encephalopathy is not trated it would result in koraskoff's psychosis koraskoff's psychosis is a misnomer it is associated with confabulation that is fluent plausible lying, where the patient fills up with memory gaps with information and she is not aware that wat is she is saying is not truth Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 624 -### End" -5569,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sexual ambiguity may be seen in which of the following conditions ?, with the following options: A: Androgen insensitivity, B: Pure gonadal dysgenesis, C: Sawyer syndrome, D: Mixed gonadal dysgenesis - -### Response: -Genital assymetry is mostly due to mixed gonadal dysgenesis,ovotesticular disorders of sexual differentiation. Figure : Phenotypic characteristics of external and internal genitalia at bih. (A) Eighty-five percent of the patients had a hemiscrotum containing a gonad on one side and hemi-labia on the other side. All patients had a unique orifice (arrow). (B) Vaginal pocket (arrow): 92% of the patients had a hemiuterus (asterisk). Reference: OP Ghai ,essential paediatrics ,8th edition. page no 539 ,table 17.33 -### End" -5570,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the following antidepressent causes hypeensive crisis, with the following options: A: dapoxetine, B: duloxetine, C: clomipramine, D: phenelezine - -### Response: -MAOI * IMPOANCE First class of antidepressant drugs that were introduced * MECHANISM There are three monoamines namely dopamine, adrenaline and serotonin. These mon amines are degraded by monoamine oxidase. MAOI inhibit this enzyme and acts increasing monoamines * DRUGS Phenelezine Tranylcipromine * USE ATYPICAL DEPRESSION, depression with reverse vegetative symptoms * SIDE EFFECTS Hypeensive crisis Cheese reaction When a patient on MAOI takes tyramine rich food like tyramine there will be increased release of monoamines. These excess monoamines cannot be degraded by MAO as it is blocked by MAOI. Thus, this may result in hypeensive crisis. Paresthesia's due to pyridoxine deficiency LIKE IPRONIAZID WEIGHT gain SEXUAL dysfunction Ref. Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no, 955 -### End" -5571,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Substance (s) freely filtered across glomerular capillaries : (PGI Nov 2009), with the following options: A: Glucose, B: Albumin, C: Thyroxin, D: Creatinine - -### Response: -Ans: A (Glucose) Filtereability of SolutesFilterability of solutes is inversely related to their size. Substance are freely filtered by glomerulus as water when filterability is of 1.0QIf the size of molecules approaches to that of albumin, filterability decreases approaching zeroSome low molecular wt. substance e.g. calcium and fatty acids are not freely filtered.Na. Inulin & glucose are freely filteredQ (filterability = 1).* Albumin, myoglobin ore not freely filteredQTable (Guyton) : Filtereability of Substances by Glomerular Capillaries Based on Molecular WeightSubstanceMolecular WeightFilterabiltiyWater181.0Sodium231.0Glucose1801.0Inulin5,5001.0Myoglobin17,0000.75Albumin69,0000.005Also RememberNegatively charged large molecules are filtered less easily than positively charged molecules of equal molecular size[Guyton 11th/ 317) -### End" -5572,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AKT 1 amplification seen in, with the following options: A: CA bladder, B: CA colon, C: Breast cancer, D: Gastric cancer - -### Response: -Answer- D. Gastric cancer AKT 1 amplification- Glioblastoma, gliosarcoma, gastric cancer, lung cancer. -### End" -5573,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Internal thoracic artery is a branch of-, with the following options: A: Common carotid artery, B: Brachiocephalic trunk, C: Subclavian artery, D: External carotic artery - -### Response: -Ans. is 'c' i.e., Subclavian artery Internal thoracic arteryo It arises from 1st part of subclavian artery and descends through anterior ends of upper six intercostal spaces lying 1[?]25 cm lateral to sternal margin.o It divides into two terminal branches, musculophrenic and superior epigastric in (f intercostal space,o Branches of internal thoracic artery are (i) mediastinal branches, (ii) pericardial branches, (iii) sternal branches, (iv) pericardiophrenic branches, (v) anterior intercostal arteries (in upper six spaces), (vi) perforating branches, and (vii) two terminal branches, musculophrenic and superior epigastric. -### End" -5574,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The thyroid angle in male is:, with the following options: A: 60deg, B: 90deg, C: 100deg, D: 120deg - -### Response: -The two laminae of thyroid cartilage meet in the midline forming an angle - the thyroid angle. It is 90deg in male and 120deg in female. The acute angle formed in male is also responsible for Adam's apple. Thyroid on its inner side gives attachment to vocal cords in its middle while just above it is the attachment of epiglottis. -### End" -5575,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Phrenic nerve block, it is best to infiltrate near, with the following options: A: Scalenus anterior, B: Scalenus posterior, C: Posterior border of sternomastoid, D: Anterior border of sternomastoid - -### Response: -Phrenic nerve is blocked 3 cm above the clavicle at the posterior border of sternomastoid. Used for intractable hiccups -### End" -5576,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of posterior staphyloma -, with the following options: A: Trauma, B: Glaucoma, C: Myopia, D: Scleritis - -### Response: -Ans. is 'c' i.e.. Myopia [Ref: Parson 21st/ep. 223)Staphylomao Staphyloma is an abnormal protrusion of uveal tissue through a weak and thin portion of cornea or sclera,o So, a staphyloma is lined internally by uveal tissue and externally by weak cornea or sclera.o Staphyloma is divided anatomically into : -Anterior staphyloma : - Protrusion and adhesion of iris to ectatic cornea. The most common cause is a sloughing corneal ulcer which perforates and heals with the formation of pseudocornea by the organization of exudates and laying down of fibrous tissue. It is lined internally by iris.Intercalary' staphyloma : - It occurs at the limbus. It is lined internally by the root of iris and the anterior most portion of the ciliary'- body. The causes are perforating injuries to limbus, marginal corneal ulcer, anterior scleritis, Scleromalacia perforans, Complicated cataract surgery, secondary angle closure glaucoma.Ciliary staphyloma : - This affects the ciliary zone that includes the region upto 8 mm behind the limbus. The ciliary body is incarcerated in the region of scleral ectasia. Causes arc Developmental glaucoma, Primary or secondary glaucoma end stage, scleritis, trauma to ciliary region.Equatorial staphyloma : - This occurs at the equatorial region of the eye with incarceration of the choroid. Causes are scleritis, degenerative myopia and chronic uncontrolled glaucoma.Posterior staphyloma : - Occurs at posterior pole and is lined internally by choroid. Degenerative high axial myopia is the most common cause. -### End" -5577,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Multibacillary leprosy has -, with the following options: A: 5 lesions, B: Bacteriological index >=2, C: Indeterminate leprosy, D: All of the above - -### Response: -

In MB leprory bacteriological index is more than 2. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:318-319. <\p> -### End" -5578,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following describes cells that are abnormal in appearance and may become premalignant?, with the following options: A: Aplasia., B: Dysplasia., C: Karyomegaly., D: Pleomorphism. - -### Response: -Dysplastic cells are abnormal in appearance and organization. The potential to develop into a malignant tumor is present; however, this risk varies. -### End" -5579,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On membrane removal of a lesion, Sign (Arrows) seen in Psoriasis, with the following options: A: Gottroris sign, B: Darier's sign, C: Auspitzsign, D: Crowe's sign - -### Response: -Auspitz sign (Feature: Bleeding points on removal of membrane in Psoriasis) -### End" -5580,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: You are the medical officer of a PHC in Kerala and you confirm the diagnosis of polio in one of your patients. This can be considered as:, with the following options: A: Endemic, B: Epidemic, C: Sporadic case, D: Pandemic - -### Response: -Here this disease is an unusual occurrence in the community and is clearly in excess of the expected frequency. So even a single case of polio is an epidemic as per definition. A sporadic case means the case occurs irregularly, haphazardly from time to time and generally infrequent. Ref: Park, Edition 21, Page - 89 -### End" -5581,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Green colored urine is seen after ingestion of: Kerala 09; AP 09; PGI 11; JIPMER 10, 11, 12; NEET 13, with the following options: A: Copper sulphate, B: Phenol, C: Organophosphorus, D: Cyanide - -### Response: -Ans. Phenol -### End" -5582,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Example of neuromuscular blocker causing hypotension is:, with the following options: A: Rocuronium, B: Vecuronium, C: Pancuronium, D: Atracurium - -### Response: -The hypotension seen with the use of atracurium and mivacurium is due to release of histamine, whereas dTubocuranine causes hypotension histamine release and ganglion blockade. Ref: Miller's anesthesia-7th ed, Chapter 29. -### End" -5583,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is used in resuscitation -, with the following options: A: Epinephrine, B: Oxygen, C: Lignocaine, D: Magnesium - -### Response: -200 joules are given every 2 minutes after each cycle of cardiopulmonary resuscitation (CPR). During resuscitation, adrenaline (epinephrine, 1 mg i.v.) should be given every 3-5 minutes and consideration given to the use of intravenous amiodarone, especially if ventricular fibrillation or ventricular tachycardia reinitiates after successful defibrillation. Ventricular fibrillation of low amplitude, or 'fine VF', may mimic asystole. If asystole cannot be confidently diagnosed, the patient should be regarded as having 'fine VF' and defibrillated. If an electrical rhythm is present that would be expected to produce a cardiac output, 'pulseless electrical activity' is present. There are several potentially reversible causes that can be easily remembered as a list of four Hs and four Ts. Pulseless electrical activity is treated by continuing CPR and adrenaline (epinephrine) administration whilst seeking such causes. Asystole is treated similarly, with the additional suppo of atropine and sometimes external or transvenous pacing in an attempt to generate an electrical rhythm. ref:harrison&;s principles of internal medicine,ed 18,pg no 2231 -### End" -5584,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tourette syndrome is a type of -, with the following options: A: Tic disorder, B: Mental retardation disorder, C: Seizure disorder, D: None of the above - -### Response: -Ans. is 'a' i.e. Tic disorder Tourette syndromeo Tourette syndrome (also called Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourette's or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical (motor) tics and at least one vocal (phonic) tic.o Average onset between the ages of 3 and 9 years. Males are affected about three to four times more often than females.o Common associations are ADHD and OCD. -### End" -5585,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 73-year-old woman has noticed a 10-kg weight loss in the past 3 months. She is becoming increasingly icteric and has constant vague epigastric pain, nausea, and episodes of bloating and diarrhea. On physical examination, she is afebrile. There is mild tenderness to palpation in the upper abdomen, but bowel sounds are present. Her stool is negative for occult blood. Laboratory findings include a total serum bilirubin concentration of 11.6 mg/dL and a direct bilirubin level of 10.5 mg/dL. Which of the following conditions involving the pancreas is most likely to be present?, with the following options: A: Adenocarcinoma, B: Chronic pancreatitis, C: Cystic fibrosis, D: Islet cell adenoma - -### Response: -The weight loss and pain suggest a malignant neoplasm. Jaundice (a conjugated hyperbilirubinemia) occurs because of biliary tract obstruction by a mass in the head of the pancreas. Such a carcinoma may manifest with ""painless jaundice"" as well, but it is more likely to invade the nerves around the pancreas, causing pain. Islet cell adenoma is not as common as pancreatic carcinoma. An adenoma located near the ampulla could have an effect similar to that of carcinoma; however, weight loss with adenoma is unlikely. Chronic pancreatitis usually does not obstruct the biliary tract. In cystic fibrosis, there is progressive pancreatic acinar atrophy without a mass effect. Most pseudocysts from pancreatitis are in the region of the body or tail of the pancreas, not the head, and they are nonneoplastic. -### End" -5586,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First agent shown to be effective in maniac phase of BPD is, with the following options: A: Lithium, B: Valproate, C: Lamotrigine, D: Carbamazepine - -### Response: -.lithium was the frst agent to be used for mania it has mood stabilizing propey it was introduced by John F Cade it is liver friendly drug it has to be introduced in caution with renal derangements it can cause of hypothyroidim it should be given with caution with ACE inhibitors, NSAIDS, Angiotensin receptor antagonists it has a narrow thereupatic index the optimal level of lithium in blood need for reduction of acute symptoms is 0.8-1.2meq/l when taken in increased amount , it may result in lithium toxicity hemodialysis is the treatment for lithium toxicity -### End" -5587,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Casper's Dictum is used for:, with the following options: A: Identification of Body, B: Estimation of time since death, C: Establishing cause of death, D: Establishing weapon of Injury - -### Response: -Casper's dictum relates to the rate of putrefaction of a dead body and helps to estimate the time since death. Ref: Textbook of Forensic Medicine and Toxicology By Nagesh Kumar Rao, 1999, Page 132; The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Page 150 -### End" -5588,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Misoprostol is a:, with the following options: A: Prostaglandin E1 analogue, B: Prostaglandin E2 analogue, C: Prostaglandin antagonist, D: Antiprogestin - -### Response: -Natural prostaglandin in the body is PGE2 whereas misoprostol and alprostadil are synthetic PGs which are PGE1 analogues. -### End" -5589,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hose pipe appearance of intestine is a feature of:, with the following options: A: Crohn's disease, B: Malabsorption syndrome, C: Ulcerative colitis, D: Hirschsprung's disease - -### Response: -Hose-pipe Appearance (Long stricture extending into Ileocecal valve with Thickened wall) - Corresponds to String sign of Kantor -### End" -5590,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First secondary ossification center appears in -, with the following options: A: Lower end of femur, B: Upper end of humerus, C: Lower end of fibula, D: Upper end of tibia - -### Response: -Ossification centre appears in lower end of femur in 36 weeks.Dr. Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27th edition pg. 46. -### End" -5591,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is acceptable angulation after reducing the fracture tibia - a) 5 b) 10 c) 15 d) 20, with the following options: A: ab, B: bc, C: ad, D: ac - -### Response: -Criteria of acceptable reduction - -Acceptable varus or valgus angulation is 5°. -Acceptable anterior or posterior angulation is 10°. -Acceptable rotational malalignment is 5°. -Acceptable shortening is 10 mm -Ankle and knee joint surfaces should be parallel -### End" -5592,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Foamy liver is seen in:, with the following options: A: Putrefaction, B: Adipocere, C: Mummification, D: Dry drowning. - -### Response: -Ans. (A). PutrefactionHoney comb appearance or foamy liver is seen in putrefaction due to the presence of gas bubbles within the parenchyma. -### End" -5593,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most common functioning tumour of pituitary?, with the following options: A: GH secreting tumor, B: Prolactinoma, C: ACTH producing adenoma, D: Oncocytoma - -### Response: -MC Functioning tumour of pituitary: Prolactinoma MC tumor of pituitary: Non- functioning adenoma -### End" -5594,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Exotropia occurs due to -, with the following options: A: Third nerve palsy, B: Optic neuritis, C: Abducens injury, D: Papilloedema - -### Response: -Ans. is 'a' i.e. Third Nerve Palsy Causes and associations of exotropia (Divegent squint)o Third nerve palsyo Congenitalo Previous strabismus surgeryo Thyroid ophthalmopathyo Iatrogenic trauma following retinal detachment surgery -### End" -5595,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are capsulated EXCEPT:, with the following options: A: Klebsiella pneumonia, B: Hemophilus influenza, C: Bacillus anthracis, D: Escherichia coli - -### Response: -ANSWER: (D) Escherichia coliREF: Anantnarayan 8th ed various chapters, Jawetz 24th edition Chapter 16(Note: Although K strain of E. coli is capsulated it is the best possible answer amongst the optionsprovided)E cob are classifiedby more than 150 different heat-stable somatic O (lipopolysaccharide) antigens, more than 100 heat-labile K (capsular) antigens, and more than 50 H (flagellar) antigens.K antigens are external to O antigens on some but not all Enterobacteriaceae. Some are polysaccharides, including the K antigens of E. coli; others are proteins.Cell envelope (cytoplasmic membrane,peptidoglycan, outer membrane)A common mnemonic used to remember some encapsulated pathogens is:""Even Some Super Killers Have Pretty Nice big Cars""Escherichia coli (K strain), Streptococcus pneumoniae, Salmonella, Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Neisseria meningitidis, Bacillus anthracis and Cryptococcus neoformans. -### End" -5596,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient comes with proptosis and Abducent N palsy. A dark homogenous mass on T2W MRI is seen which shows intense enhancement with contrast. Diagnosis is?, with the following options: A: Cavernous hemangioma, B: Meningioma, C: Astrocytoma, D: Glioma - -### Response: -Ans. A. Cavernous hemangiomaExtraaxial cavernous hemangiomas: Rare and very rarely arise in the cavernous sinus. Although this malformation is categorized as a vascular malformation and has well-defined histologic characteristics, it sometimes presents tumor like behavior, including mass effects, enclosure of neurovascular structures, and proliferation during pregnancy.The lesions are found predominately among women.The onset of symptoms is usually insidious, and symptoms are caused by the large size of the lesions.Patients usually present with headaches and dysfunction of the cranial nerves passing through the cavernous sinus, manifesting particularly as ptosis and diplopia. MRI reveals well-defined masses that are Hypointense or isointense on t1-weighted images and markedly hyper intense on t2-weighted images, which indicates the relationship between the lesion and the intracavernous ICA.The marked hyper-intensity on t2-weighted images and homogenous enhancement seem to distinguish these lesions from other types. Meningiomas often similar signal intensity to gray matter on both t1- and t2-weighted images.Schwannomas tend to give lower signal intensity than gray matter on t1-weighted images and almost uniformly give higher signal intensity on t2-weighted images.Both Schwannomas and meningiomas show prominent contrast enhancement, which tends to be a slightly heterogeneous pattern. -### End" -5597,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are physiological effects of the manoeuvre shown below except:-, with the following options: A: Fall in BP, B: Rise in HR, C: Decreased venous return, D: Increased stroke volume - -### Response: -The function of the receptors can also be tested by monitoring the changes in pulse and blood pressure that occur in response to brief periods of straining (forced expiration against a closed glottis: the Valsalva maneuver). Valsalva maneuvers Occurs during coughing, defecation, and heavy lifting. Blood pressure rises at the onset of straining because the increase in intrathoracic pressure is added to the pressure of the blood in the aoa. It then falls because the high intrathoracic pressure compresses the veins, Decreasing venous return Decreasing cardiac output. The decrease in aerial pressure and pulse pressure inhibit the baroreceptors, causing : Tachycardia Rise in peripheral resistance. -### End" -5598,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 26-years women presents with a palpable thyroid nodule, and needle biopsy demonstrates amyloid in the stroma of the lesion. A cervical lymph node is palpable on the same side as the lesion. The preferred treatment should be:, with the following options: A: Removal of the involved node, the isthmus, a poion of the opposite bone and he enlarged lymph node, B: Removal of the involved lobe, the isthmus, a poion of the opposite lobe, and he enlarged lymph node, C: Total thyroidectomy and modified neck dissection on the side of the enlarged lymph node, D: Total thyroidectomy and irradiation of the cervical lymph nodes - -### Response: -MEDULLARY CARCINOMA THYROID Neuroendocrine carcinoma arising from parafollicular &;C&; cells of thryoid Parafollicular &;C&; cells are derived from the ultimobranchial bodies & secrete calcitonin &;C&; cells are concentrated superolaterally in throid lobes, from where MTC usually develops. Most MTCs (75-80%) arise sporadically Spread is both lymphatic & hematogenous MC site of metastasis Liver. Clinical features High level of serum Calcitonin & CEA Cervical lymph nodes at the time of presentation (LN involvement, thyroid and blood borne metastases occurs early) Diarrhoea at the time of presentation Amyloid in stroma histologically MEN setting: Evidence of Pheochromocytoma/Hyperparathyroidism/Thyroid cancer in Family Discovery of medullary carcinoma thyroid makes family surveillance advisable Diagnosis Diagnosed by FNAC I131 scan is of no use as MTC is TSH independent Tumor marker: Calcitonin is raised in almost all cases of MTC Calcitonin excess in MTC is not associated with hypocalcemia. Treatments : Total Thyroidectomy+ Central LN dissection+/- Ipsilateral MRND if tumor > 1 cm If nodes are positive on ipsilateral side: Bilateral MRND Follow-Up: Level of calcitonin falls after resection and is raises again in cases of recurrence, used for follow-up Prognosis: MTC is associated with poor prognosis Ref: Sabiston 20th edition Pgno: 909 -### End" -5599,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A characteristic electron microscopic feature of minimal change disease:, with the following options: A: Mesangial deposits, B: Splitting of basement membrane, C: Fusion of foot processes & their effacement, D: Subepithelial deposits - -### Response: -Ans. c (Fusion of foot processes & their effacement). (Ref. Robbin's pathologic basis of disease, 5th /935)GLOMERULAR PATHOLOGYGlomerular pathologyFeaturesAcute post-streptococcal glomerulonephritis# Nephritic syndrome# Most frequently seen in children.# Resolves spontaneously.# Peripheral and periorbital edema, hematuria, hypertension Oliguria, azotemia.LM: Glomeruli and hypercellular neutrophils, ""lumpy-bumpy"".EM"": subepithelial humps.IF: granular patternRapidly progressive (crescentic) GNRapid course to renal failure.LM and IF: crescent moon shapeGoodpasture's syndrome (type II hypersensitivity)--Hemoptysis, hematuria.IF; linear pattern, anti-GBM antibodies.Membranoproliferative glomerulonephritisSlowly progresses to renal failureEM: subendothelial humps, ""tram track"".IgA nephropathy (Berger's disease)Mild disease. Often postinfectious.IF and EM: mesangial deposits of IgAAlport's syndromeSplit basement membraneCollagen IV mutation.Nerve deafness and ocular disordersNephrotic syndromeMassive proteinuria, hypoalbuminemia,Peripheral and periorbital edema, hyperlipidemia.Membranous glomerulonephritisA common cause of the adult nephrotic syndromeLM: Diffuse capillary and basement membrane thickening.IF: granular pattern.EM: ""spike and dome""Minimal change disease(lipoid nephrosis)Most common cause of childhood nephrotic syndrome. Responds to steroids.LM: normal glomeruli.EM; foot process effacementFocal segmental glomerular sclerosisMore severe disease in HIV patientsLM: segmental sclerosis and hyalinosis.Diabetic nephropathyLM: Kimmelstiel- Wilson ""wire loop"" lesions, basement membrane thickening.SLELM: In membranous glomerulonephritis.Wire-loop lesion with subendothelial deposits -### End" -5600,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: This ahropod transmits, with the following options: A: T. brucei, B: T. cruzi, C: Leishmania donovani, D: Plasmodium vivax - -### Response: -Image shows - Sandfly . transmits Leishmaniasis Trypanosoma brucei: tse tse fly Trypanosoma cruzi: reduviid bugs (Triatomine). Plasmodium vivax: female anopheles -### End" -5601,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The toure method involving simultaneous beating of both ears with palms of hand, resulting in rupture of tympanic membrane is called?, with the following options: A: Falanga, B: Waterboarding, C: Telefono, D: Dunking - -### Response: -Falanga involves beating on sole of feet. In dunking the victim is immersed in water. In water boarding the victim is immobilised in a supine position with head inclined downwards and water is poured on the face. Ref: Textbook of Forensic Medicine and Toxicology by V.V Pillay, 15th Edition, Page 118. -### End" -5602,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve least likely to be involved in Herpes Zoster Opthalmicus is:, with the following options: A: Chorda Tympani, B: Infraorbital, C: Nasociliary, D: Lacrimal - -### Response: -Chorda Tympani -### End" -5603,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: WHO recommended Sampling method for Immunisation coverage evaluation, with the following options: A: Simple random sampling, B: Cluster random sampling, C: Stratified random sampling, D: Convenience sampling - -### Response: -Cluster random sampling (CRS) Applicable when units of population are natural groups or clusters. Use of CRS in India: Evaluation of immunization coverage. WHO technique used in CRS: 30 x 7 technique (total = 210 children) 30 clusters, each containing 7 children who are 12 - 23 months age and are completely immunized for primary immunization (till Measles vaccine). Accuracy: Low error rate of only +- 5%. Limitation: Clusters cannot be compared with each other. -### End" -5604,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following cement is called as Artificial dentin?, with the following options: A: Type 2 GIC, B: Silicophosphate, C: Amalgam, D: Zinc phosphate - -### Response: -Coefficient of thermal expansion of silicophosphate matches with dentin. -While of type 2 GIC with enamel. -### End" -5605,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Respiratory burst is related to:, with the following options: A: Hyperventilation after a period of apnea, B: Apnea after a period of hyperventilation, C: Sharp increase in O2 uptake and metabolism in neutrophils, D: None of the above - -### Response: -Neutrophil's cell membrane-bound enzyme nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is activated on contact with a pathogen. Activation of NADPH oxidase is associated with a sharp increase in O2 uptake and metabolism in the neutrophil (the respiratory burst) and generation of superoxide (O2-) by the following reaction: The combination of the toxic oxygen metabolites and the proteolytic enzymes from the granules makes the neutrophil a very effective killing machine. -### End" -5606,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old man sustained posterior dislocation of left hip in an accident. Dislocation was reduced after 3 days. He started complaining of pain in left hip after 6 months. X-ray of the pelvis were normal. The most relevant investigation at this stage will be-, with the following options: A: CRP Levels in blood, B: Ultrasonography of hip, C: Arthrography of hip, D: MRI of hip - -### Response: -It is a case of avascular necrosis of the femoral head which is one of the late complications of posterior dislocation of the hip. -If the dislocation is reduced early, avascular necrosis develops in at least 10% of the cases of dislocation. -If reduction is delayed for more then few hours (as with this patient) the figure rise to 40%. -Pain is a common presentation of avascular necrosis of head. -X-ray of the patient is normal because in the early stages bones are usually normal. -The first X-ray signs probably appear only 6-9 months after the occurrence of bone death. -MRI shows characteristic changes in the marrow long before the appearance of X-ray signs. -Therefore MRI is the most reliable way of diagnosing marrow changes and bone ischaemia (Avascular necrosis) at a comparatively early stage. -### End" -5607,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enolase is inhibited by -, with the following options: A: Fluoride, B: Fumarate, C: lodoacetaie, D: Arsenite - -### Response: -Ans. is 'a' i.e., Fluoride In glycolysiso Fluoride inhibitso lodoacetate inhibitso Arsenite inhibits- Enclose- Glvceroldehyde 3-phosphate dehydrogenase.- Phosphoglycerate kinaseIn TCA cycleo Fluoroacetate inhibits aconitase non-competitively.o Arsenite inhibits a-ketoglutarate dehydrogenase non-competitively.o Malonate inhibits succinate dehydrogenase competitively.o This question has been asked either directly or indriectly in all exams, -### End" -5608,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Beck’triad of cardiac tamponade includes all except, with the following options: A: Hypertension, B: Absent heart sounds, C: Raised JVP, D: Hypotension - -### Response: -Cardiac tamponade has hypotension -### End" -5609,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Management of a 6-year-old child with recurrent URTI with mouth breathing and failure to thrive with high arched palate and impaired hearing is:, with the following options: A: Tonsillectomy, B: Grommet insertion, C: Myringotomy with grommet insertion, D: Adenoidectomy with grommet insertion - -### Response: -(d) Adenoidectomy with grommet insertion(Ref. Scott Brown, Vol 2; 288)Recurrent URTI with mouth breathing and failure to thrive in the given 6-year-old child with high arched palate is due to persistently hypertrophied adenoids.The impaired hearing is due to serous otitis media which in turn is because of hypertrophied adenoids blocking the Eustachian tubes.So treatment will be adenoidectomy with grommet insertion. -### End" -5610,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A couple, with a family history of beta thalassemia major in a distant relative, has come for counseling. The husband has HbA2 of 4.8% and the wife has HbA2 of 2.3%. The risk of having a child with beta thalassemia major is:, with the following options: A: 50%, B: 25%, C: 5%, D: 0% - -### Response: -- Normal percentage of HbA2 ranges from 1.5 to 3%. - In thalassemia trait (b thalassemia minor), HbA2 level may be elevated (3.5-7.5%). - Thus, wife in this question has normal genotype (b,b) whereas husband has thalassemia - trait (b+,b). - b-Thalassemia is an autosomal recessive disease. So, None of the offsprings will have thalassemia major (b+ b+), risk of having a child with thalassemia major is 0%. 50% of the offspring (b+,b) will be carriers like father. -### End" -5611,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type of collagen maximum in skin:-, with the following options: A: Type I, B: Type II, C: Type III, D: Type IV - -### Response: -Collagen - the most abundant protein in mammals contains 4-hydroxyproline and 5-hydroxylysine. Vitamin C plays the role of a coenzyme in hydroxylation of proline and lysine while protocollagen is conveed to collagen The hydroxylation reaction is catalysed by lysyl hydroxylase (for lysine) and prolyl hydroxylase (for proline) This reaction is dependent on vitamin C, molecular oxygen and a-ketoglutarate Type Distribution I Noncailaginous connective tissues, including bone, tendon, skin II Cailage, vitreous humor III Extensible connective tissues, including skin, lung, vascular system IV Basement membranes -### End" -5612,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most serious late side effect of treatment of Hodgkins disease?, with the following options: A: Cardiac injury, B: Infeility, C: Hair loss, D: Osteoporosis - -### Response: -Answer- A. Cardiac injuryThe most serious late side effects include second malignancies and cardiac injury. Patients are at risk for the development of acute leukemia in the first 10 years after treatment with combination chemotherapy regimens that contain alkylating agents plus radiation therapy. -### End" -5613,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old woman presents with several days of increasing fatigue and shortness of breath on exertion. She was recently diagnosed with Mycoplasma pneumoniae. Physical examination reveals BP 113/67, HR 114 beats/min, and respiratory rate 20 breaths/min. She appears icteric and in mild respiratory distress. Her hemoglobin is 9.0 g/dL and MCV is 110. Which of the following is the best next diagnostic test?, with the following options: A: Serum protein electrophoresis, B: Flow cytometry, C: Peripheral blood smear, D: Glucose-6-PD level - -### Response: -Macrocytic anemia and indirect hyperbilirubinemia suggest hemolysis, which in this patient is likely due to IgM antibodies which may follow Mycoplasma infections and which cross-react with RBC surface molecules of the I/i system These antibodies are termed cold-reacting antibodies because they react at temperatures less than 37degC (98degF). Examination of the peripheral blood smear is the first step in evaluation of hemolytic anemia. The young red cells (which would show up as reticulocytes when properly stained) are much larger than mature RBCs, accounting for the macrocytosis (the MCV can be as high as 140 with vigorous reticulocytosis). The presence of micro spherocytes suggests immune-mediated hemolysis, while the presence of fragmented RBCs or schistocytes suggests a mechanical cause of hemolysis, as seen in the microangiopathic hemolytic anemias. Serum protein electrophoresis is useful to diagnose multiple myeloma, which is rarely associated with hemolysis, but this would not be the best initial test; the anemia in multiple myeloma is normocytic. Flow cytometry can detect surface proteins such as CD55, CD59 on granulocytes and red blood cells in paroxysmal nocturnal hemoglobinuria (a rare cause of hemolysis), but again is not the best first test. Glucose-6-PD levels might be useful once hemolytic anemia is established by a peripheral smear and negative Coombs test. Bone marrow biopsy would show erythroid hyperplasia but is usually not required to diagnose hemolytic anemia. -### End" -5614,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is:, with the following options: A: NO, B: N1, C: N2, D: N3 - -### Response: -Classification of stage of tumor of oral cavity based on size of lymph node. -### End" -5615,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest risk factor for HCV infection is:, with the following options: A: i.v. drug abuse, B: Multiple sex paners, C: Surgery within last 6 months, D: Multiple contacts with HCV infected person - -### Response: -Most common risk factors for HCV infection are: Intravenous drug abuse (54%) Multiple sex paners (36%) Having had surgery within the last 6 month (16%) Needle stick injury (10%) Multiple contacts with an HCV-infected person (10%) Employment in medical or dental fields (1.5%) -### End" -5616,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Growth spu occurs at __________, with the following options: A: Just before appearance of axillary hair, B: Just before menarche, C: After 16 years, D: Before thelarche - -### Response: -Adolescence: Stage of transmission from childhood to adulthood. During this stage, there will be an appearance of sexual characters with changes in cognition and psychology. Adolescence refers to this entire process, pubey refers to the physical aspect. Age 10-19 year is considered as a period of adolescence and pubey marks the early half of adolescence. Pubey in girls stas with breast development( thelarche) anytime between 8-13 years. This is followed by an appearance of pubic hair (pubarche) and subsequently, menstruation ( menarche), occurring at an average of 12.6 years. Menarche occurs after 2-21/2 years of thelarche. In boys, the earliest change is an increase in testicular size( testicular volume reaching 4 ml) and this occurs between 9-14 years. This is followed by an appearance of pubic hair and lengthening of the penis. Spermarche( sperm production) stas during mid-adolescence. Laryngeal growth, manifesting as cracking of voice, begins in boys in mid-pubey, deepening of voice is complete by end of pubey. During pubey, boys gain 20-30 cm and girls 16-28 cm of height. Peak growth velocity in girls occurs before attainment of menarche. Boys have their peak growth in later stages of pubey. Reference: GHAI Essential pediatrics, 8th edition -### End" -5617,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Premotor area corresponds to?, with the following options: A: Area 6, B: Area 7, C: Area 8, D: Area 12 - -### Response: -Immediately in front of the primary motor coex lies Brodmann's area 6. Area 6 extends onto the medial surface, where it becomes contiguous with area 24 in the cingulate gyrus, anterior and inferior to the paracentral lobule. A number of functional motor areas are contained within this coical region. Lateral area 6, the area over most of the lateral surface of the hemisphere, corresponds to the premotor coex. -### End" -5618,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following determines the speed of recovery from IV anesthetic?, with the following options: A: Liver metabolism of drug, B: Protein binding of drug, C: Redistribution of the drug from sites in the CNS, D: Plasma clearance of the drug - -### Response: -Ans. c. Redistribution of the drug from sites in the CNSAn IV anesthetic completely bypasses the process of absorption, because the drug is placed directly into the bloodstream. Highly perfused organs (vessel rich) including the brain take up disproportionately large amount of drug compared to less perfused areas (the muscle, fat, and vessel-poor groups).Drugs bound to plasma proteins are unavailable for uptake by an organ.After the highly perfused organs are saturated during initial distribution, the greater mass of the less perfused organs continue to take up drug from the bloodstream.As plasma concentration falls, some drug leaves the highly perfused organs to maintain equilibrium.This redistribution from the vessel-rich group is responsible for termination of effect of many anesthetic drugs. -### End" -5619,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is Dohlman's Procedure in Zenker's Diverticulum?, with the following options: A: Endoscopic Stapling of Septum, B: Endoscopic Suturing of Pouch, C: Resection of Pouch, D: Laser excision - -### Response: -Ans. (a) Endoscopic Stapling of septumRef: Surgery Sixer 3rd Edition Page 322* Endoscopic Stapling Technique for Pharyngeal Pouch (Zenker's Diverticulum) is known as Dohlman's Procedure. -### End" -5620,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not true about indication of exchange transfusion ? (Not a criteria for exchange transfusion), with the following options: A: Cord bilirubin is 5 mg% or more, B: Cord Hb is 10 mg% or less, C: Rate of bilirubin increase is > 0.5 mg%, D: Total bilirubin 10 mg/dl - -### Response: -Double volume exchange tranfusion (DVET) should be performed if the total serum bilirubin(TSB) levels reach to age specific cut off for exchange transfusion or th infant shows signs of bilirubin encephalopathy irrespective of TSB levels .For < 28 wk gestation, TSB cut off is 11-14 mg/dl. For 28 to 29 wks, 30 to 31 wks and 32 to 33gestation, cut off is 12-14, 13 - 16 and 15-18 mg/dl respectively . For 34 wks of gestation, cut off is 17-19 mg /dl. Reference : page 172 Ghai Essential Pediatrics 9 th edition -### End" -5621,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lutembacker syndrome - include A/E ?, with the following options: A: Mitral stenosis, B: ASD, C: VSD, D: Left to right shunt - -### Response: -Ans. is 'c' i.e., VSD Lutembacher syndrome is defined as a combination of mitral stenosis and a left-to-right shunt at the atrial level. Typically, the left-to-right shunt is an atrial septal defect (ASD) of the ostium secundum variety. Both these defects, ASD and mitral stenosis, can be either congenital or acquired -### End" -5622,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The term ""balanced anaesthesia"" has been given by, with the following options: A: Simpson, B: Fischer, C: Lundy, D: Moan - -### Response: -Term 'balanced anaesthesia' was introduced by Lundy in 1926Balanced anaestesiaThe cardinal feature of general anaesthetics are:-Loss of all sensations, especially painSleep (unconsciousness) and amnesiaImmobility and muscle relaxationAbolition of reflexesIn the modern practice of balanced anaesthesia these modalities are achieved by using the combination of inhaled and i.v. drugs. -### End" -5623,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following secretes histamine, with the following options: A: Eosinophil, B: Basophil, C: Neutrophil, D: Monocyte - -### Response: -Histamine is produced by many cell types, paicularly mast cells adjacent to vessels, as well as circulating basophils and platelets. ref robbins basicpathology 9th ed page 46 -### End" -5624,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gallbladder bile is different from hepatic bile in that it has, with the following options: A: Less water, B: Less fatty acids, C: More chloride, D: Less solids - -### Response: -Bile is made up of the bile acids, bile pigments, and other substances dissolved in an alkaline electrolyte solution that resembles pancreatic juice. About 500 mL is secreted per day. Some of the components of the bile are reabsorbed in the intestine and then excreted again by the liver (enterohepatic circulation). In addition to its role in digestion and absorption of fats, bile (and subsequently the feces) is the major excretory route for lipid-soluble waste products. Gallbladder bile has more solids and bile acids and less pH than hepatic duct bile.Ref: Ganong&;s review of medical physiology 23rd edition Page no: 482 -### End" -5625,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Differentia] cyanosis occurs in which disease -, with the following options: A: Severe coarctation, B: Inturrupted aortic arch, C: PPHN, D: All of above - -### Response: -Ans. is 'd' i.e., All of above Differential cyanosis -o With normally related great arteries, oxygen saturation may be higher in the upper than lower extremity' in patients if there is right-to-left shunting through the ductus arteriosus.# Seen with severe coarctation or interrupted aortic arch.#. May also occur in patients persistent pulmonaiy hypertension of the newborn.o The differential effect is reduced if there is also right-to-left shunting at the level of the foramen ovale, or if there is left-to-right shunting across coexisting ventricular septal defect -### End" -5626,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lymphatic drainage of oropharynx is mainly through, with the following options: A: Superficial cervical lymph nodes, B: Submandibular nodes, C: Jugulodigastric nodes, D: Jugulo-omohyoid nodes - -### Response: -Lymphatics from oropharynx drain into the upper jugular chain, paicularly the jugulodigastric ( tonsilar) node. Some pas drain to the posterior cervical group also. The base of the tongue may drain bilaterally. Lymphatic drainage of the nasopharynx - upper deep cervical nodes. (Ref: Diseases of Ear, Nose and Throat, PL Dhingra; 7th edition, pg no. 271) -### End" -5627,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The ocular basement membrane is stained with, with the following options: A: Alcaine blue, B: Giemsa stain, C: Methylene blue, D: Periodic acid-Schiff - -### Response: -Not only ocular almost all basement membranes are stained with PAS (Periodic acid-Schiff) Because they have mucopolysaccharides.Periodic acid-Schiff reactive (PAS) method is principally used to demonstrate structures rich in polysaccharides (glycogen), mucopolysaccharides (e.g., ground substance of connective tissues, basement membrane, and mucus), glycoproteins (thyroglobulin), and glycolipids. -### End" -5628,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sacrospinous fixation is for strengthening:, with the following options: A: Apical defect, B: Posterior defect, C: Lateral defect, D: Anterior defect - -### Response: -Ans. A. Apical defecta. Sacrospinous ligament fixation: - The main indication for sacrospinous ligament fixation is to correct total procidentia or post-hysterectomy vaginal vault prolapse with an associated weak cardinal uterosacral ligament complex and to correct post hysterectomy enterocele. The contraindication for the procedure is a short vagina.b. The principle of this procedure is the fixation of the vaginal vault to the sacrospinous ligament with nonabsorbable sutures. The fixation site is typically the right sacrospinous ligament. However, bilateral fixation is performed in patients with recurrent vault prolapse and with the goal of restoring a vaginal axis and sexual life. The routes of entry to the sacrospinous ligament may be posterior and anterior. Usually, a unilateral, right-sided, posterior approach is preferred.c. This procedure has advantages, including success rates comparable to abdominal procedures, the ability to repair concomitant pelvic floor defects, the absence of laparotomy, shorter hospital stays, and the preservation of vaginal length and function.d. The most common problem after this procedure is the high rate of postoperative cystocele, which approaches 20% to 33%, resulting from the deviation of the vaginal axis. Recurrent cystoceles have been reported in 6% to 92% of patients.e. Other disadvantages include difficulty in exposing the ligament, the potential need for excessive tensioning during tying, injury risk to the pudendal or inferior gluteal vessels and sciatic or pudendal nerve, alterations in the vaginal axis, and vaginal narrowing.f. Thomson et al have reported that by placing the sutures through the sacrospinous ligament 2.5cm more medially from the ischial spine along the superior border of the ligament and not through the full thickness of the ligament, the risk of complications is minimal. -### End" -5629,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Narcolepsy is due to abnormality in -, with the following options: A: Hypothalamus, B: Neocortex, C: Cerebellum, D: Medullaoblongata - -### Response: -Ans. is 'a' i.e., Hypothalamus o Narcolepsy is unique in that those who suffer from it typically fall almost instantaneously into REM sleep,o It is thought that narcolepsy is caused by a malfunctioning of the hypothalamus in brain. -### End" -5630,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sudden, transient and painless loss of vision may be complained by the patients with all of the following diseases except:, with the following options: A: Carotid transient ischaemic attacks, B: Papilloedema, C: Papillitis, D: Migraine - -### Response: -Ans. Papillitis -### End" -5631,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rickettsia is treated in all ages by which drug?, with the following options: A: Doxycycline, B: Penicillin, C: Macrolides, D: Quinolones - -### Response: -Ans. A. Doxycycline* The drug of choice for the treatment of both children and adults with rocky mountain spotted fever is doxycycline, except when the patient is pregnant or allergic to the drug.* Because of the severity of RMSF, immediate empirical administration of doxycycline should be strongly considered for any patient with a consistent clinical presentation in the appropriate epidemiologic setting.* Treatment with chloramphenicol, a less effective drug, is advised only for patients who are pregnant or allergic to doxycycline.* Beta-lactam antibiotics, erythromycin, and amino glycosides have no role in the treatment of RMSF, and sulfa-containing drugs are likely to exacerbate this infection. There is little clinical experience with fluoro- quinolones, clarithromycin, and azithromycin, which are not recommended. -### End" -5632,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyponatremia is seen in all of the following except: September 2010, with the following options: A: Congestive hea failure, B: Kidney problems, C: Diabetes insipidus, D: SIADH - -### Response: -Ans. C: Diabetes Insipidus Many possible conditions and lifestyle factors can lead to hyponatremia, including: Syndrome of inappropriate anti-diuretic hormone (SIADH) - In this condition, high levels of the anti-diuretic hormone (ADH) are produced, causing the body to retain water instead of excreting it in urine. Cirrhosis - Liver disease can cause fluids to accumulate in the body. Kidney problems - Kidney failure and other kidney diseases can render the body unable to efficiently remove excess fluids from the body. Congestive hea failure - This condition causes the abdomen and lower extremities to retain fluids. Diuretics, especially thiazide diuretics- Diuretics work by making the body excrete more sodium in urine. Consuming excessive water during exercise (exeional hyponatremia or exercise-associated hyponatremia (EAH)). Because sodium is lost through sweat, drinking too much water during endurance activities, such as marathons and triathlons, can dilute sodium content in blood. Hormonal changes due to adrenal gland insufficiency (Addison's disease). Adrenal glands produce hormones that help maintain the body's balance of sodium, potassium and water. Hormonal changes due to an under active thyroid (hypothyroidism). Primary polydipsia- In this condition, thirst increases significantly, causing a person to drink excessive amounts of fluid. Some medications, paicularly selective serotonin reuptake inhibitors and some pain medications, cause a person to urinate or perspire more than normal. The recreational drug MDMA- This amphetamine causes a ripple effect on the body's ADH and water levels that-- especially in combination with heavy drinking--increases the risk of severe and even fatal cases of hyponatremia. Chronic, severe vomiting or diarrhea- This causes the body to lose fluids and electrolytes, including sodium. Dehydration- In dehydration, the body loses fluids and electrolytes. Diet- A low-sodium, high-water diet can disturb the proper balance between sodium and fluids in the blood -### End" -5633,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28 year old female is posted for in-vitro feilisation. It is indicated in:, with the following options: A: Anovulatory cycles, B: Tubal block, C: Azoospermia, D: Uterine anomalies - -### Response: -The basic concept of IVF-embryo transfer (IVF-ET) initially was to bypass the potential mechanical obstacles of the female reproductive tract. It was first developed for patients with severe tubal disease, for patients with bilateral salpingectomy, or for women whose tubes are so badly damaged that they cannot function. Also know: Indications for assisted reproductive technologies (A) include the following: Male factor infeility Tubal disease (tubal and pelvic adhesions) Absent or damaged fallopian tubes Endometriosis Preimplantation genetic diagnosis (PGD) Need for third-pay reproduction/donor eggs or gestational surrogate Unexplained infeility Age-related infeility Decreased ovarian reserve Recurrent intrauterine insemination failure Ref: Michalakis K.G., DeCherney A.H., Penzias A.S. (2013). Chapter 57. Assisted Reproductive Technologies: In Vitro Feilization & Related Techniques. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds),CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e. -### End" -5634,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gadolinium is a contrast agent used for:, with the following options: A: CT - angiography, B: Bronchography, C: MRI - Imaging, D: Contrast Sonography - -### Response: -Ans. (c) MRI - ImagingRef.: Harrison 19th ed. 1440* The most commonly used compounds for contrast enhancement are gadolinium-based and they improve the visibility of internal body structures in magnetic resonance imaging.* MRI contrast agents alter the relaxation times of atoms within body tissues where they are present after oral or intravenous administration.* This relaxation emits energy which is detected by the scanner and is mathematically converted into an image.* Gadolinium containing MRI contrast agents are used for enhancement of vessels in MR angiography or for brain tumor enhancement associated with the degradation of the blood-brain barrier. -### End" -5635,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For prophylaxis of deep vein thrombosis used is ?, with the following options: A: Warfarin, B: Heparin, C: Pneumatic shocks garment, D: Graded stocking - -### Response: -Answer is 'b' i.e. Heparin -### End" -5636,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spine of Henle is a:, with the following options: A: Coical bone, B: Cancellous bone, C: Sclerotic bone, D: Long bone with Haversian system - -### Response: -Spine of henle is a pa of mastoid bone. Mastoid is a spongy or cancellous bone, hence spine of henle is also cancellous. -### End" -5637,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the initial management of congenital Lens antigen are ?, with the following options: A: Neoantigen, B: Sequestrated antigen, C: Altered antigen, D: Cross reacting - -### Response: -Answer- B. Sequestrated antigenCeain self antigens are present in the close system and never exposed to the immune system during fetal life.These are known as hidden antigen or sequestrated antigens. E.g. Sperm antigen, lens proteins being enclosed in capsule. -### End" -5638,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Guthrie test can be used for the diagnosis of:, with the following options: A: Tyrosinemia, B: Galactosemia, C: Alkaptonuria, D: Phenylketonuria - -### Response: -The bacterial inhibition assay of Guthrie is used for Phenylketonuria. Tyrosinemia- | serum AFP & succinyl acetone in serum & urine Galactosemia- urine: positive Benedict test Alkaptonuria- Gas chromatography & mass spectrometry (GCMS) -### End" -5639,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Point of entry of inferior division of oculomotor nerve in the orbit is-, with the following options: A: Inferior Orbital fissure, B: Superior Orbital fissure, C: Foramen Rotundum, D: Foramen Lacerum - -### Response: -Ans. is 'b' i.e., Superior Orbital fissure Structures passing through superior orbital fissure* Superior and inferior divisions of oculomotor nerve (III)* Trochlear nerve (IV)* Lacrimal, frontal and nasociliary branches of ophthalmic (VI).* Abducens nerve (VI)* Superior and inferior divisions of ophthalmic vein. Inferior division also passes through the inferior orbital fissure.* Sympathetic fibers from cavernous plexus -### End" -5640,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a cutaneous manifestation of tuberculosis: March 2005, with the following options: A: Lupus vulgaris, B: Scrofuloderma, C: Exanthematous lesion, D: Erythema migrans - -### Response: -Ans. D: Erythema migrans Classification of skin tuberculosis Tuberculosis of the skin has different clinical and pathological features depending on the patient's resistance and age. Patients with good resistance - Lupus vulgaris Scrofuloderma. - Tuberculosis verruca cutis - Tuberculids. Exanthematous lesions - Tuberculosis miliaris disseminata - Lupus miliaris disseminatus fasciei - Papulonecrotic Tuberculids - Lichen Scrofuloderma Patients with absent or poor resistance : - Miliary tuberculosis. - Primary tuberculous complex - Erythema migran is associated with lyme borreliosis. -### End" -5641,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an intra-aicular tendon?, with the following options: A: Saorius, B: Semitendinosus, C: Anconeus, D: Popliteus - -### Response: -The popliteus tendon is located within the capsule of the knee joint making it an intra-aicular tendon. Saorius, Semitendinosus and Anconeus are not intra-aicluar tendons. -### End" -5642,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: lntra ocular pressure rises in ?, with the following options: A: Intubation & laryngoscopy, B: LMA, C: Infusion of IV propofol, D: Bag and mask ventilation - -### Response: -Ans. is 'a' i.e., I ntubation & laryngoscopy -### End" -5643,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antipsychotic drug with maximum hypotensive effect is, with the following options: A: Fluphenazine, B: Trifluperazine, C: Thioridazine, D: Haloperidol - -### Response: -low potency antipsychotics like thioridazine and chlorpromazine are associated with lot of systemic side effects as mentioned in the below table. They have side effects like hypotension, sedation, giddiness, dryness of mouth and cardiac side effects. High potency has lot of neurological side effects. Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 972 -### End" -5644,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The highest percentage of polyunsaturated fatty acids are present in -, with the following options: A: Groundnut oil, B: Soyabean oil, C: Margarine, D: Palm oil - -### Response: -

Essential fatty acids: Those that cannot be synthesised by humans.They can be derived from food only. The most impoant essential fatty acid is linoleic acid, which serves as the basis for production of other essential fatty acids( linolenic and arachidonic acid) . Not all PUFA are essential fatty acids. Linoleic acid:- dietary source and per cent content . Safflower oil- 73 Corn oil- 57 Sunflower oil-56 Soyabean oil-51 Sesame oil-40 Ground nut oil-39 Mustard oil -15 Palmoil- 9 Coconut oil- 2 Eichosapentanoic acid: Fish oil: 10 % present. Linolenic acid : Soyabean oil-7 {Reference: Park&;s textbook of community medicine 23 rd edition, pg no. 611} -### End" -5645,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of Hanging, postmoem examination shows tear in carotid aery. This is called?, with the following options: A: Battle sign, B: Amussat's sign, C: Nutcracker sign, D: Ring sign - -### Response: -Ans. is 'b' i.e., Amussat's SignAmussat's sign referes to tear in intima of carotid aery.It is seen in cases of hanging. -### End" -5646,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nuclear bag fibers, with the following options: A: Tinner, B: Flower spray ending, C: Plate ending, D: Trail ending - -### Response: -The intrafusal fibers are positioned in parallel to the extrafusal fibers (the regular contractile units of the muscle) with the ends of the spindle capsule attached to the tendons at either end of the muscle. Intrafusal fibers do not contribute to the overall contractile force of the muscle, but rather serve a pure sensory function. There are two types of intrafusal fibers in mammalian muscle spindles. The first type contains many nuclei in a dilated central area and is called a nuclear bag fiber (Figure 9-2B). There are two subtypes of nuclear bag fibers, dynamic and static. Typically, there are two or three nuclear bag fibers per spindle. The second intrafusal fiber type, the nuclear chain fiber, is thinner and shoer and lacks a definite bag. Each spindle has about five of these fibers. There are two kinds of sensory endings in each spindle, a single primary (group Ia) ending and up to eight secondary (group II) endings. The Ia afferent fiber wraps around the center of the dynamic and static nuclear bag fibers and nuclear chain fibers. Group II sensory fibers are located adjacent to the centers of the static nuclear bag and nuclear chain fibers; these fibers do not innervate the dynamic nuclear bag fibers. Ia afferents are very sensitive to the velocity of the change in muscle length during a stretch (dynamic response); thus they provide information about the speed of movements and allow for quick corrective movements. The steady-state (tonic) activity of group Ia and II afferents provide information on steady-state length of the muscle (static response). The top trace in Figure 9-2C shows the dynamic and static components of activity in an Ia afferent during muscle stretch. Note that they discharge most rapidly while the muscle is being stretched (shaded)Ref: Ganong&;s review of medical physiology 23rd edition Page no: 158 -### End" -5647,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal Cup : disc ratio of optic disc is, with the following options: A: 0.3 to 0.4, B: 0.2 to 0.3, C: 0.5 to 0.6, D: 0.1 to 0.3 - -### Response: -Normal Cup : disc ratio of optic disc 0.3 to 0.4. -### End" -5648,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trigeminal nuclei, with the following options: A: Main sensory nucleus is located in pons, B: Mesencephalic nucleus is made up of unipolar neurons, C: Motor nucleus is located in pons, D: All of the given options - -### Response: -All the three sensory and one motor nucleus of trigeminal nerve arise from pons. Note: Chief sensory nucleus- touch Spinal nucleus-pain, temperature Mesencephalic nucleus- proprioception (Ref: Vishram Singh textbook of clinical neuroanatomy, second edition pg 95,96,100) -### End" -5649,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gas cylinder with single pin index -, with the following options: A: Oxygen, B: Air, C: Nitrogen, D: Entonox - -### Response: -Ans. is 'd' i.e., Entonox GasPin indexOxygen2,5Nitrous oxide3,5Cyclopropane3,6Air1,5Nitrogen1,4Entonox (50% O2 + 50% N2O)Single central (7)Carbon dioxide (< 7[?]5%)2,6Carbon dioxide (>7[?]5%)1,6 -### End" -5650,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a cause of objective tinnitus -, with the following options: A: Palatal myoclonus, B: Glomus tumor, C: Carotid artery aneurysm, D: Presbyacusis - -### Response: -Ans. is 'd' i.e., PresbyacusisTinnituso Tinnitus is ringing sound or noise in the ear.o The characteristic feature is that the origin of this sound is within the patient,o Two types of tinnitus have been describeda) SubjectiveI. OtologicII. Non-otologico Impacted waxo Fluid in the middle earo Acute and chronic otitis mediao Abnormally patent eustachian tubeo Meniere's diseaseo Otosclerosiso Presbyacusiso Noise traumao Ototoxic drugso Tumors of VUIth nerveo Disease ofCNSo Anaemiao Arteriosclerosiso Hypertensiono Hypotensiono Hypoglycaemiao Epilepsyo Migraineo Drugsb) Objectiveo Vascular tumours of middle ear (glomus tumour)o Aneurysm of carotid arteryo Palatal myoclonus -### End" -5651,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The first sign of Volkman's ischemia is -, with the following options: A: Paresthesia, B: Pain on passive extension of fingers, C: Pain on active extension of fingers, D: Swelling of fingers - -### Response: -Stretch pain is the earliest sign of impending compartment syndrome. The ischemic muscles, when stretched, give rise to pain. -### End" -5652,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which hypolipidemic drug acts primarily by decreasing VLDL -, with the following options: A: Fibrates, B: Nicotinic acid, C: Statins, D: Cholestyramine - -### Response: -Ans. is'a'i.e., FibratesRef: KDT 6h/e p. 614; Harrison 18th/e ch. 356Fibrates (e.g. clofibrate) activate lipoprotein lipase, therefore, enhance lipolysis of triglycerides in VLDL.Statins and nicotinic acid also decrease VLDL but it is not their main mechanism of action. -### End" -5653,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kwashiorkor is characterised by all except-, with the following options: A: Dermatitis, B: Edema, C: Flag sign, D: Aleness - -### Response: -Ans. is 'd' i.e., Aleness o There is lethargy and listlessness (not aleness). -### End" -5654,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bone marrow finding in myelofibrosis ?, with the following options: A: Dry tap (hypocellular), B: Megaloblastic cells, C: Microcytic cells, D: Thrombocytosis - -### Response: -Ans. is 'a' i.e., Dry tap (hypocellular)Mvelofibrosis o The hallmark of primary myelofibrosis is rapid development of obliterative marrow fibrosis.o Myelofibrosis suppresses bone marrow hematopoiesis, leading to peripheral blood cytopenias.o This results in extensive extramedullary hematopoiesis in the spleen, liver and lymphnode Splenomegaly and hepatomegaly.o Blood cell production from sites of extramedullary hematopoisis is disordered and ineffective --> Persistent cytopenia. Peripheral blood picturei) Leukoerythroblastosis Presence of erythroid and granulocytic precursors in the peripheral blood.ii) Tear-drop erythrocytes (dacrocytes) --> Fibrotic marrow distos and damages the membranes of erythroid proginators.Bone marrow findingso Initially marrow is hypercellular.o With progression marrow becomes hypocellular and diffusely fibrotic ---> Bone marrow aspiration is a dry tap. o There is increase laying down of reticulin fibril network.o Cellularity of bone marrow is decreased, but megakaryocytes are increased and demonstrate features of dysmegakaryopoiesis.o Dilated marrow sinusoids. -### End" -5655,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Upside down"" stomach on Barium meal study is seen in, with the following options: A: Organoaxial gastric volvulus, B: Large Gastric adenocarcinoma at antral end, C: Rolling type of hiatus hernia, D: Mesenteroaxial gastric volvulus - -### Response: -""Upside down"" stomach on Ba meal study is seen in Mesenteroaxial gastric volvulus. Barium swallow study showing the upside-down appearance of the stomach in the thorax with the subdiaphragmatic location of the gastroesophageal junction before surgery (a) and normal subdiaphragmatic position of the stomach one month after the surgery (b). ref - -### End" -5656,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient of scleroderma who has hypeension is at significant risk of developing, with the following options: A: MI, B: Sudden renal failure, C: Thrombotic stroke, D: Pulmonary hypeension - -### Response: -. -### End" -5657,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is most common side effect of zidovudine?, with the following options: A: Anemia, B: Peripheral neuropathy, C: Lactic acidosis, D: All - -### Response: -Zidovudine: It is a thymidine analogue (azidothymidine, AZT), the prototype NI. After phosphorylation in the host cell-zidovudine triphosphate selectively inhibits viral reverse transcriptase (RNA-dependent DNA polymerase) in preference to cellular DNA polymerase Adverse effects Toxicity is mainly due to paial inhibition of cellular DNA polymerase. Anaemia and neutropenia are the most impoant and dose-related adverse effects. Nausea, anorexia, abdominal pain, headache, insomnia and myalgia are common at the sta of therapy but diminish later. Myopathy, lactic acidosis, hepatomegaly, convulsions and encephalopathy are infrequent. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:770,771 -### End" -5658,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Route of DPT vaccine is -, with the following options: A: Oral, B: Subcutaneous, C: Intramuscular, D: Intravenous - -### Response: -Ans. is 'c' i.e., Intramuscular DPT Vaccineo DPwT : Popularly known as triple antigen, DTwP is composed of tetanus and diphtheria toxoids as well as killed whole cell pertussis bacilli adsorbed on insoluble aluminium salts which act as adjuvants. The content of diphtheria toxoid varies from 20 to 30 Lf and that of tetanus toxoid varies from 5 to 25 Lf per dose. Whole-cell pertussis vaccine is a suspension of killed B pertussis organisms.o DPaT : It is the same diphtheria and tetanus toxoid along with acellular pertussis vaccine. The high rates of side effects to these Pw vaccines directed scientists to develop a second type of vaccine, called the acellular pertussis (Pa) vaccine, composed of inactivated bacterial proteinso Dose is 0[?]5ml intramuscularly. It should be stored at 2-8 degree Celsius -### End" -5659,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nocardia infection is associated most commonly with:, with the following options: A: Liver abscess, B: Lung abscess, C: Brain abscess, D: Subcutaneous abscess - -### Response: -Ans. is 'b' i.e., Lung abscessRef:(Ananthanarayan, 8th/e, p. 393; 9th/e, p. 390-91)Pneumonia, the most common form of nocardial disease in the respiratory tract, is typically subacute; symptoms have usually been present for days or weeks at presentation. The onset is occasionally more acute in immunosuppressed patients. Cough is prominent and produces small amounts of thick, purulent sputum that is not malodorous and infiltrates and nodules tend to cavitate. Empyema is present in one-quarter of cases. -### End" -5660,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intercostal nerve is a branch of ?, with the following options: A: Brachial plexus, B: Dorsal rami of thoracic spinal nerves, C: Ventral rami of thoracic spinal nerves, D: Ventral rami of cervical spinal nerves - -### Response: -Ans. is 'c' i.e., Ventral rami of thoracic spinal nervesVentral rami of upper 11th thoracic spinal nerves are known as intercostal nerves and ventral ramus of T12 is known as subcostal nerve.Upper six intercostal nerves supply thoracic wall whereas lower five intercostal nerves and subcostal nerve supply thoracic and anterior abdominal walls and hence known as thoracoabdominal nerves. Upper two intercostal nerves also supply the upper limb.Thus only 3rd to 6th are called typical intercostal nerves. -### End" -5661,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest site of otosclerosis is -, with the following options: A: Round window, B: Utricle, C: Ossicles, D: Oval window - -### Response: -Ans. is 'd' i.e., Oval window o The most common site of disease is promontory in the region of the anterior margin of oval window, and inadvanced cases the stapes become ankylosed in position by a mass of new spongy bone.Why is it so# This area is involved most commonly because in this area is located the fissula ante fenestram, a vestigial structure which frequently contains cartilaginous remnants and which is particularly prone to otosclerotic changes.o Most common type of otosclerosis - Stapedial otosclerosiso Most common site of otosclerosis - Fissula ante fenestram (i.e, just in front of oval window)o Most common site for stapedial otosclerosis - Fissula ante fenestram (i.e, just in front of oval window)o Most common site for cochlear otosclerosis - Round window -### End" -5662,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are common causes of seizures in adults older than 60 years of age except, with the following options: A: Cerebrovascular disease, B: Central nervous system neoplasia, C: Degenerative disease, D: Mesial temporal lobe sclerosis - -### Response: -harrison's principles of internal medicine 17th edition *causes of seizures in older adults include cerebrovascular disease,trauma,CNS tumours and degenerative disease. -### End" -5663,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the critical temperature of N2O, with the following options: A: 118 degrees, B: -88 degrees, C: 26 degrees, D: 36.5 degrees - -### Response: -In thermodynamics, a critical point (or critical state) is the endpoint of a phase equilibrium curve. The most prominent example is the liquid-vapor critical point, the endpoint of the pressure-temperature curve that designates conditions under which a liquid and its vapor can coexist. At higher temperatures, the gas cannot be liquefied by pressure alone. At the critical point, defined by a critical temperature Tc and a critical pressure pc, phase boundaries vanish. critical temperature of N2O: 38.5degC -### End" -5664,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In left sided massive pneumothorax, ECG shows all, except-, with the following options: A: Left axis detion, B: Absent R wave, C: Peaked P wave, D: Precordial T wave inversion - -### Response: -Abnormal left axis detion in left-sided pneumothorax. Relevant QRS abnormalities (incomplete RBBB and T-wave inversion) in(10%). QRS amplitude in V2-V6 leads was significantly decreased in left-sided pneumothorax. Ref Harrison 20th edition pg 1546 -### End" -5665,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surgical scissors left in the abdomen is covered under which doctrine -, with the following options: A: Res ipsaloquitor, B: Medical maloccurance, C: Therapeutic misadventure, D: Novus actusinterveniens - -### Response: -Ans. is 'a' i.e. Res ipsa loquitor o Leaving scissors in the abdomen at the time of surgery is an example of criminal negligence in which the evidence speaks for itself and is thus covered under Res IpsaLoquitorDoctrine related with negligenceResp Ipsa Loquitar (fact speaks for itself): Generally the innocence of doctor is assumed and the patient has to establish the guilt, However, it is not required to prove negligence in a case where the doctrine of resp Ipsa loquitar applies; rather the doctor has to defend himself.Calculated risk doctrine: It is a defense to doctor. It states that 'resp Ipsa loquitar' should not be applied when the complained injury may have occurred even through proper care has been taken.The doctrine of common knowledge: Is a variant of res ipsa loquitar in which patient has to prove the negligence but he need not produce evidence to establish the standard of care (in res ipsa loquitar both are not required). It is based on assumption that the doctor will be held responsible for negligence in particular case which is within the common knowledge of medical practitioner e.g. not giving fluids in dehydrated or ATS in injuries.Diagnostic or Therapeutic misadventure: It is the occurrence of misadventure causing injury' or death of the patient due to the inherent risk of procedure or drug, e.g. adverse effects of a drug. It is unintentional.Medical maloccurance (inevitable accident or Act of God): On certain occasions, despite all proper care given by doctor during treatment, the patient may fail to respond properly or may suffer adverse reactions of the drug. It is due to biological variations in different people.Novus Actus interventions : A person is responsible for his actions and its consequences. This principle applies to cases of assault or accidental injuries. However, sometime such continuty of events is broken by an entirely new and unexpected happening, due to negligence of some other person, i.e. novus actus intervenient (an unrelated action intervening). For example. If a person has been assaulted due to which he has sustained large liver laceration, for which he is operated by a surgeon. If the patient dies intraoperative ly or postopratively due to complications related to surgery or injury, the person who has assaulted the patient will be held responsible. But, if the doctor has done some negligent act during surgery', e.g. left the swab or instrument in abdomen during surgery-; and patient dies because of that act (sepsis due to swab), then the response may pass from original incident to later negligent act of doctor by principle of 'novus actus intervention' (an unrelated action intervening). This doctor is responsible for the negligent act, i.e. criminal negligence(PGI 93,AP and the assailant will not be fully responsible for the ultimate harm.Contributory' negligence : It is defined as concurrent or simultaneous negligence of doctor and patient so as to lead to damage to the patient. Normally it is only a partial defence and court has right to fix liabilities between doctor and patient (doctrine of comparative negligence) and damages awarded may be reduced accordingly. Contributory' negligence can be used as defence by the doctor, but in civil cases only. It cannot be used as defence in followingCriminal negligenceLast clear chance doctrine ; i.e. if doctor has discovered it before causing injury' and failed to avoid that,Avoidable consequences rule ; i.e. due to negligence of doctor, there occurs damage to patient, but due to later damage of patient, damage becomes more.Good samartion doctrine : One who assisted another in serious need cannot be charged for contributory' negligence, provided that the assistance is not rash and reckless.Vicarious responsibility (Liability): It means master is liable for negligent acts of his serv ants, even inspite of absence of blame-worthy conduct on his part. Thus hospital and senior medical staff are responsible for negligent act of junior medical staff (interns and resident doctors). This responsibility is there because of master servant relationship, i.e. the senior can dictate the line of treatment to be followed. However, hospital is not responsible for senior medical staff as master servent relationship does not exist. The vicarious responsibility is there only in civil negligence cases and not in criminal cases.Borrow ed servant doctrine (captain of the ship doctrine): The private practitioner, who is not a staff of a private hospital, will be held responsible for all the negligent acts by any of the hospital staff on the patient admitted by him. The hospital will not be held here liable, because all the instructions for the patient admitted is carried on by hospital staff as told by private practitioner (i.e. he is the captain of the ship).Product liability : Manufacturer is liable for quality of drug and medical equipment. -### End" -5666,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Woody feeling of the external nose (Hebra nose) is observed in, with the following options: A: Rhinophyma, B: Rhinoscleroma, C: Rhinosporidiosis, D: Rhinitis sicca - -### Response: -. -### End" -5667,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Conversion of lactate to glucose requires all except ?, with the following options: A: Pyruvate carboxylase, B: Phosphofructokinase, C: PEP carboxykinase, D: Glucose-6-phosphatase - -### Response: -Ans. is `b' i.e., PhosphofructokinaseConversion of lactate to glucose is nothing else but gluconeogenesis.Seven of the reactions of glycolysis are reversible and are used in the synthesis of glucose by gluconeogenesis. Thus, seven enzymes are common to both glycolysis and gluconeogenesis: (i) Phosphohexose isomerase;ii) Aldolase; (iii) Phosphotriose isomerase, (iv) Glyceraldehyde 3-phosphate dehydrogenase; (v) Phosphoglycerate kinase; (vi) Phosphoglycerate mutase; (vii) Enolase.Three reactions of glycolysis are irreversible which are circumvented in gluconeogenesis by four reactions. So, enzymes at these steps are different in glycolysis and gluconeogenesis.Reactions Enzyme in glycolysis Enzyme in gluconeogenesisGlucose - Glucose-6-P Hexokinase/glucokinase Glucose-6-phosphataseFructose-6-P - Fructose-1,6-BP Phosphofructokinase Fructose-1-6-bisphosphatasePhosphoenolpyruvate - Pyruvate Pyruvate kinase Pyruvate carboxylase PEP carboxykinase -### End" -5668,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following anti-hypeensive drug is contraindicated in the treatment of hypeension during pregnancy?, with the following options: A: Nifedipine, B: Captopril, C: Methyldopa, D: Hydralazine - -### Response: -Captopril is an ACE Inhibitor, which is contraindicated in pregnancy. Fetal and neonatal complications associated with its use during pregnancy are hypotension, growth retardation, oligohydramnios, anuria, acute renal failure, malformations, stillbih, and neonatal death. Ref: COBGDT, 9th Edition, Pages 850-852 -### End" -5669,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The blood gas parameters: pH 7.58, pCo2 23 mm Hg pO2 300 mm Hg and oxygen saturation 60% are most consistent with-, with the following options: A: Carbon monoxide poisoning, B: Ventilatory malfunction, C: Voluntary hyperventilation, D: Methyl alcohol poisoning - -### Response: -Answer is B (Ventilatory malfunction) Ventilatory malfunction is the single best answer of exclusion This is consistent with a diagnosis of ventilatory mal function. None of the other three condition satisfy the given parameters of the patients. The answer of exclusion therefore is some form of ventilatory malfunction. In carbon monoxide poisoning ABG analysis would reveal acidosis and nollnal PO2 In voluntary hyperventilation oxygen saturation would be normal. In methyl alcohol poisoning ABG would reveal acidosis and not alkalosis. -### End" -5670,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Good prognosis of ALL -, with the following options: A: Hyperdiploidy, B: Hypodiploidy, C: T cell line, D: Philadelphia chromosome - -### Response: -Hyperdiploidy is a good prognostic indicator. -Hypodiploidy, TALL and philadelphia (BCR-ABL fusion) chromosome are poor prognostic indicators. -### End" -5671,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The diluent used for BCG is ?, with the following options: A: Distilled water, B: Normal saline, C: Dextrose solution, D: Ringer - lactate - -### Response: -Ans. is 'b' i.e., Normal saline -### End" -5672,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inspissation is used to sterile?, with the following options: A: Needles, B: Endoscopes, C: Scissors, D: Culture medium - -### Response: -They are moist heat method of sterilization Below 100degC The medium is rendered sterile by heating at 80-85degC for half an hour on three successive days in an inspissator REF: Ananthanarayan and paniker's textbook, of microbiology 9 the edition pg no 30 -### End" -5673,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with headache, high fever and meningismus. Within 3 days he becomes unconscious. Most probable causative agent ?, with the following options: A: Naegleria fowleri, B: Acanthamoeba castellani, C: Entamoeba histolytica, D: Trypanosoma cruzi - -### Response: -Ans. is 'a' i.e., Naegleria fowleri Amongst the given options Naeglaria and Acanthamoeba cause amoebic encephalitis. ""The prognosis of Naeglaria encephalitis is uniformaly poor, most patients die within a week"". ""Acanthamoeba encephalitis follows a more indolent course"". -### End" -5674,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest cause of primary amenorrhea with ambiguous genitalia in a female with 46XX chromosome :, with the following options: A: 21 hydroxylase def., B: 17 hydroxylase def., C: 11 hydroxylase def., D: Desmolase hydrolase def - -### Response: -A i.e. 21- hydroxylase deficiencyClassic 21 - hydroxylase deficiency is most common cause of ambiguous genitalia in new born (virilization) and primary amenorrheaQ. i.e. Pseudohermaphroditism of female childPrimary amenorrhea with VirilizationQ in females is in:- 21 - hydroxylase deficiency- 11 - Hydroxylase deficiencyTypesMain function ofenzymeMineralococoid(M)Glucocoicoid(G)AndrogenFeatures21- OH-deficiencyGlucocoicoid &Mineralocoicoidproduction U""l'* HypotensionQ(salt losing virilization)* VirilizationQ in females* Precocious pubey in femalesQ.11 hydroxylase-deficiencyGlucocoicoidproductionT.1.1,T* HypeensionQ* VirilizationQ in females* Precocious pubey in femalesQ.17- hydroxylasedeficiencyGlucocoicoid &Androgen production'1'.1,14* Male hermaphroditeQ* Primary atnenorrhea infemalesQ.* HypeensionQ3 - p-hydroxylasedeficiencyMineralcoicoid &glucocoicoidproduction..1,.1,T* Male hermaphrodite. -### End" -5675,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following radioisotopes are used as systemic radionucleide, except:, with the following options: A: Phosphorus -- 32, B: Strontium -- 89, C: Iridium -- 192, D: Samarium -- 153 - -### Response: -Ans. Iridium -- 192 -### End" -5676,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On per vaginal examination, anterior fontanelle and supraorbital ridge is felt in the second stage of labor. The presentation is:, with the following options: A: Brow presentation, B: Defiexed head, C: Flexed head, D: Face presentation - -### Response: -Ans. is a, i.e. Brow presentationRef. Dutta Obs. 9/e, p 367Palpation on per vaginal examinationPresentation* Occiput and posterior fontanelle (Anterior fontanelle not felt easily)Vertex (Occipitoanterior position)* Both fontanelle felt easilyVertex (Occipito-posterior position)* Anterior fontanelle (bregma) is felt at one end and root of nose (nasion) and orbital ridges at the other end of an oblique or transverse diameterBrow* Mouth with hard alveolar margins with nose, malar eminence, superior orbital ridges and mentumFaceAlso Know:Face and Breech are often confused on palpationOn palpation, difference between face and breech presentations:FaceBreech* Mouth and malar eminences form a triangle* Alveolar margins hard* Sucking effect of mouth* No meconium staining* Ischial tuberosities and anus are in a line* Anal margins soft* Grip of anal sphincter* Meconium staining on finger -### End" -5677,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 50 yr old smoker, obese , hypeension patient is having loud snoring . He has > 5 episodes of apnea per hour of sleep. What is the next best management for improvement of his symptom ?, with the following options: A: Uvulopalatoplasty, B: C.P.A.P, C: Weight reduction and diet control, D: Mandibular reposition surgery - -### Response: -C.P.A.P is the best management out of all . It has better outcomes in comparison to other techniques in terms of apneas ,hypoapneas , nocturnal oxygenation , symptoms and quality of life . -### End" -5678,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Widened anionic gap is not seen in -, with the following options: A: Acute renal failure, B: Diarrhea, C: Lactic acidosis, D: Diabetic Ketoacidosis - -### Response: -Causes of High-Anion Gap Metabolic Acidosis *Lactic acidosis *Ketoacidosis Diabetic Alcoholic Starvation *Renal failure (acute and chronic) *toxins: ethylene glycol methanol salicylates propylene glycol pyroglutamic acid (Ref: Harrison's principles of internal medicine,18E , pg 365) -### End" -5679,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are associated with cardiac looping, EXCEPT:, with the following options: A: Lefty, B: PITX2, C: HAND1, D: None of the above - -### Response: -Cardiac looping is dependent in pa upon the laterality-inducing genes nodal and left. These genes induce expression of the transcription factor PITX2 in lateral plate mesoderm on the left side and later in mesoderm on the left side the hea. PITX2 may play a role in the deposition and function of extracellular matrix molecules during looping. In addition, NKX2.5 upregulates expression of HAND1 and HAND2, transcription factors that are expressed in the primitive hea tube and that later become restricted to the future left and right ventriclesRef: LANGMAN'S EMBRYOLOGY 11TH ED Chapter 12. -### End" -5680,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mass media communication -, with the following options: A: Television, B: Lectures, C: Symposium, D: Radio - -### Response: -Mass media are a one way communication.They are useful in transmitting messages to people even in the remotest places . The number of people who are reached usually count in millions.Their effectiveness can give high returns for the time and money involved (refer pgno:866 park 23 rd edition) -### End" -5681,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient has been given penicillin 48 hours ago, with no history of drug allergy. Now he develops wheeze and -hemolysis. Antibody for penicillin is positive. Type of hypersensitivity is which of the following, with the following options: A: Type I, B: Type II, C: Type III, D: Type IV - -### Response: -Administration of penicillin causing no symptoms in 48 hours with no previous history of allergy rules out type I hypersensitivity reaction. -The patient presented with hemolysis which can be because of antibody formation against red cells. The formation of autoantibody is a feature associated with type II hypersensitivity reaction. -Thus, it becomes the answer over here. Clinically, antibody-mediated cell destruction and phagocytosis occur in multiple situations: - -Transfusion reactions, in which cells from an incompatible donor react with and are opsonized by preformed antibody in the host -Hemolytic disease of the newborn: antigenic difference between the mother and fetus -Autoimmune hemolytic anemia, agranulocytosis, and thrombocytopenia, in which individuals produce antibodies to their own blood cells, which are then destroyed. -Certain drug reactions, in which a drug acts as a “hapten” by attaching to plasma membrane proteins of red cells and antibodies are produced against the drug-protein complex. -### End" -5682,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following toxin acts by inhibiting protein synthesis?, with the following options: A: Cholera toxin, B: LT of enterotoxigenic E.coli, C: Peusis toxin, D: Shiga toxin - -### Response: -Shiga toxin also known as verotoxin, was first identified in a major cause of dysentry called Shigella dysentriae. Shiga toxin contains an enzymatic domain and 5 binding domains which bind to globotriaosylceramide (Gb3), a glycosphingolipid on the surface of cells and the complex is internalized. The internalized shiga toxin hydrolyse the ribosomes, preventing fuher protein synthesis. Shiga toxin is composed of two distinct peptide subunits: The first located on the larger A subnit is an N-glycosidase that hydrolyzes adenine from specific sites of ribosomal RNA of the mammalian 60s ribosomal subunit, irreversibly inhibiting protein synthesis. The second is a binding site on the B subunit that recognizes glycolipids of target cell membranes (glycolipid Gb 3). Ref: Toxins and Hemostasis: From Bench to Bedside By R.Manjunatha Kiri, Page 642-643 ; Textbook of Pathology By V. Krishna, Page 178 ; Interaction of Pathogenic Bacteria with Host Cells By Virginia L. Clark, Volume 236, Page 67 ; Microorganisms in foods 5: Microbiological Specifications of Food Pathogens By International Commission on Microbiological Specifications for Food, Page127 -### End" -5683,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pralidoxime is not useful in poisoning with -, with the following options: A: Edrophonium, B: Malathion, C: Parathion, D: DFP - -### Response: -Oximes (e.g. pralidoxime) are not used in carbamates poisoning (edrophonium is a carbamate). -### End" -5684,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Equivalent to macrophages are -, with the following options: A: Keratinocytes, B: Histiocytes, C: Mast cells, D: Microphages - -### Response: -Ans. is 'b' i.e., Histiocytes Monocyte/Macrophageso Mononuclear phagocytes (MP) also known as macrophages or histiocytes are distributed throughout virtual all tissues. The macrophage is the dominant cellular player in chronic inflammation. MP arise from monoblast in the marrowy and they are released into the circulation as monocytes. The monocytes then migrate to tissues and become part of the tissue (fixed) macrophages.# Blood macrophages - Monocytes# Tissue macrophages - Histiocyteso Tissue macrophages (histiocytes) in different tissue are mentioned in following table -# Lung : 'Alveolar macrophages' or 'Dust' cells# Brain ; Microglia# Liver : Kupffer cells# Bone: Osteoclasts# Skin : Langerhans cells# Connective tissue : Histiocytes (tissue macrophages)# Placenta : Hoffbauer cells# Kidney : Mesangial cells# Spleen : Littoral cells# Synovium : Type-A lining cells# Spleen : Red pulp sinusoidal lining cells -### End" -5685,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which needle is shown below?, with the following options: A: Vim silverman needle, B: Tru-Cut needle, C: Lumbar puncture needle, D: Abraham's pleural biopsy needle - -### Response: -Ans.(B) Tru-cut needle.20mm sample notchScalpel-sharp surgical steel cutting edge retrieves cleanly cut, high-quality specimensRemovable stylet allows multiple sampling capabilitiesA thin-wall cannula for large core sampleCentimeter depth markings assist in needle placement -### End" -5686,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The active principle of abrus precatorius is:, with the following options: A: Abrin and abrine, B: Calotoxin and Calotropin, C: Ricin and Ricinoleic acid, D: Semicarpol and Bhilawanol - -### Response: -Ans. (A). Abrin and abrineThe seed shown in the picture is abrus precatorius (Rati seeds), a plant irritant.Abrin and abrine - abrus precatoriusCalotoxin and Calotropin - calotropis giganteaRicin and Ricinoleic acid - ricinus communisSemicarpol and Bhilawanol- semicarpus anacardium (marking Nut) -### End" -5687,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for depression with suicidal attempt:, with the following options: A: TCA's, B: TCA's + Antipsychotics, C: SSRI's + Antipsychotics, D: ECT - -### Response: -Electroconvulsive therapy is the treatment of choice for severe depression or depression with suicidal attempts. -### End" -5688,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chronaxie minimum in?, with the following options: A: Mixed nerves, B: Unmyelinated nerve, C: Myelinated nerve, D: Sensory nerves - -### Response: -ANSWER: (C) Myelinated nerveREF: Pediatric Anesthesia By Bruno Bissonnette page 758Chronaxie (or chronaxy) is the minimum time over which an electric current, double the strength of the rheobase, needs to be applied, in order to stimulate a muscle fiber or nerve cell.Rheobase is the minimal current amplitude of indefinite duration (practically, a few hundred milliseconds) that results in the depolarization threshold of the cell membranes being reached (i.e. an action potential or the contraction of a muscle).In the case of a nerve or single muscle ceil, rheobase is half the current that needs to be applied for the duration of chronaxie to result in an action potential or muscle twitchRemember chronaxie is the measure of excitability of the nerve. Hence chronaxie is inversely proportional to the myelination of the nerves.Order of neurons in order of increasing chronaxie: A alpha > A delta > C -### End" -5689,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Twelve year old boy with vesicle over lip. Investigation to be done is, with the following options: A: Tzank smear, B: Woods lamp, C: Diascopy, D: KOH mount - -### Response: -Tzanck smear is a bed side test made by scrapping either floor of bulla( after deroofing). Or floor of erosion ( after removing crust). Or mucosal ( usually oral ) erosion . Stained with Giemsa stain. Acantholytic cells - rounded keratinocytes with relatively large nucleus and a condensed cytoplasm- seen in pemphigus group of disorders-pemphigus vulgaris and pemphigus foliaceous balloning degeneration and multinucleated gaint cells - seen in herpes simplex, herpes zoster and varicella iadvl textbook of dermatology, page 110 -### End" -5690,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The major function of major intrinsic protein-26 (MIP-26) is:, with the following options: A: Glucose transpo in lens, B: Transpo of water in lens, C: Diffusion barrier, D: Capsule of lens - -### Response: -Ans. Transpo of water in lens -### End" -5691,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not establish a diagnosis of congenital CMV infection in a neonate?, with the following options: A: Urine culture for CMV, B: IgG CMV antibodies in blood, C: Intra-nuclear inclusion bodies in hepatocytes, D: CMV viral DNA in blood by polymerase chain reaction - -### Response: -Active CMV infection is best confirmed by virus isolation from urine, saliva, bronchoalveolar washings, breast milk,cervical secretions,buffy coat,and tissues obtained by biopsy. Rapid identification is possible with PCR.A primary infection is confirmed by seroconversion or simultaneous detection of IgM & IgG antibodies.IgG antibodies persist for life. Reference: Nelson textbook of pediatrics 21st edition Page 1116 -### End" -5692,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which cranial nerve carries parasympathetic fibers?, with the following options: A: Vagus nerve, B: Trigeminal nerve, C: Hypoglossal nerve, D: Abducent nerve - -### Response: -Ans. A. Vagus nerveThe only cranial nerves that transmit parasympathetic fibers are the oculomotor, facial, glossopharyngeal, and vagus nerves.Parasympathetic flow is cranio-sacral flow carried by cranial nerves: 3,7,9,10 and the sacral nerves: S-2,3,4. These nerves carry the preganglionic fibres to their respective ganglia. -### End" -5693,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The operative procedure known as ""microfracture"" is done for the, with the following options: A: Delayed union of femur., B: Non union of tibia, C: Loose bodies of ankle joint, D: Osteochondral defect of femur - -### Response: -D i.e. Osteochondral defect of femur Chondral & osteochondral fractures (osteochondritis dessicans) present clinically with meniscal symptoms of locking, catching & giving way of the knee. Ahroscopy is investigation of choice and preferred way of treatment All loose & overhanging pieces of cailage must be removed back to a stable base. The base may be drilled, abraded or microfracturedQ to bleeding bone that presumably recruit-pleuripotent stem cells to regenerate cailage. Osteochondral autograft transplant should be considered. -### End" -5694,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IgA nephropathy can occur in -, with the following options: A: Membranoproliferative GN, B: Minimal change GN, C: Mesangioproliferative GN, D: RPGN type I - -### Response: -Mesangial proliferative glomerulonephritis - - -It is characterized by the proliferation of mesangial cells -It is classified according to the predominant type of immunoglobulin present in the glomerulus. - -(a) IgG in the mesangium - - -Increased no. of mesangial cells in the glomeruli -Immunoflorescence shows the presence of IgG and C3 in the mesangium. - -(b) IgA in the mesangium (IgA nephropathy or Berger's disease) - -It is characterized by focal segmental or diffuse proliferation of mesangium. -Immunoflorescence shows the presence of IgA deposits in the mesangium C3 is also present. -### End" -5695,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Length of female urethra, with the following options: A: 2cm, B: 4cm, C: 6cm, D: 8cm - -### Response: -The female urethra, about 4 cm in length, is fused with the anterior wall of the vagina. It ends between the clitoris and the vagina. The male urethra, about 20 cm in length, comprises three pas: prostatic, membranous, and spongy Ref - BDC 6e vol2 pg379 -### End" -5696,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Splenunculi:, with the following options: A: It is encapsulated, B: MC site is tail of pancreas, C: Often single, D: Have more red pulp than spleen - -### Response: -Ans. (a) It is encapsulatedRef: Bailey and love, 27th ed; pg. 1178* Splenunculi or Accessory spleen is the most common of all splenic anomalies accounting for 10-30% of population* Formed due to incomplete fusion of embryologic splenic tissue during 5th week leading to the formation of accessory spleen, which is more common or always on the left side of abdomen.* It is encapsulated just like the normal spleen and contains normal splenic tissue and are more commonly identified during radiological investigations and intraoperatively for other conditions* They are mostly multiple, located in the hilum of spleen (50%), tail of pancreas (30%)* They are more prone for torsion and needs emergency resection in such cases. -### End" -5697,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are small round blue cell tumours except, with the following options: A: Ewing's sarcoma, B: Wilms tumour, C: Retinoblastoma, D: Rhabdomyosarcoma - -### Response: -Small round blue cell tumours. -Neuroblastoma. -Ewing's sarcoma. -Wilms tumour. -Medulloblastoma. -Retinoblastoma. -Lymphoma. -Primitive Neuroectodermal tumour. -### End" -5698,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best way to measure the working length of 21, with open apex is, with the following options: A: Radiograph, B: Apex locator, C: Tactile method, D: Paper point - -### Response: -When RCT is indicated in an immature tooth with wide open apex, a relatively reliable means of determining working length is by gently passing the blunt end of a paper point into the canal after profound anaesthesia has been achieved, the moisture or blood on the portion of the paper point that passes beyond the apex may be an estimation of working length or the junction between the root apex and the bone. -### End" -5699,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Korsakoff's psychosis is seen in -a) CRFb) Alcohol withdrawalc) Marasmusd) Cirrhosis, with the following options: A: a, B: ac, C: ad, D: b - -### Response: -Wernicke - Korsakoff syndrome (WKS) is due to deficiency of thiamine which can be precipitated by chronic alcoholism (most common), malnutrition (marasmus) due to prolonged starvation, hyperemesis gravidarum, HIV - AIDS, bariatric surgery, hemodialysis for CRF, prolonged intravenous hyperalimentation, and malignancies (gastric carcinoma). - -Note - It is chronic alcohol abuse that causes WKS (not alcohol withdrawal) :- option b. -### End" -5700,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maldigestion of protein and fat is manifested in chronic pancreatitis only if the damage of pancreatic tissue exceeds?, with the following options: A: 30%, B: 50%, C: 90%, D: 75% - -### Response: -There is a very large reservoir of pancreatic exocrine function. > 90% of the pancreas must be damaged before maldigestion of fat and protein is manifested. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 2629 -### End" -5701,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Angio-fibromas are seen in?, with the following options: A: MEN 1, B: MEN 2, C: MEN 3, D: MEN 4 - -### Response: -- Cutaneous tumours are common in MEN1 and can be easily overlooked due to their subtle appearance. - The cutaneous tumours include: Angiofibromas Collagenoma Lipomas -### End" -5702,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which pathway can use propionic acid:, with the following options: A: Glycolysis, B: Gluconeogenesis, C: Glycogenolysis, D: Glycogenesis - -### Response: -Ans. B. GluconeogenesisOdd chain fatty acids can act as substrates for gluconeogenesis, since Propionyl CoA-the product of their oxidation can enter TCA cycle through formation of Succinyl CoA, hence can contribute towards Glucose production. -### End" -5703,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Forensic entomology is a study of -, with the following options: A: Time of death, B: Mode of death, C: Manner of death, D: Identification of disease - -### Response: -Ans. is 'a' i.e., Time of death * Forensic entomology is the use of insects and other arthropods in legal investigations including, but not limited to, cases of medicolegal, stored product, or urban relevance.* Insect evidence in medicolegal cases is often used to assist in entomology -based estimates of the time of colonization that can be related to myiasis and/or a minimum postmortem interval.* In most instances, forensically relevant inferences are made by the collection, identification, and study of anthropods associated with a decomposing body.* Forensic entomology has evolved considerably since the famous case in 13th century China, where the activity of flies associated with a weapon was used to identify a potential suspect. -### End" -5704,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In calculating Dependency Ratio, the numerator is expressed as:, with the following options: A: Population under 10 years and 60 and above., B: Population under 15 years and 60 and above., C: Population under 10 years and 65 and above, D: Population under 15 years and 65 and above - -### Response: -Ans. is 'd' i.e. population under 15 years and 65 and above The ratio of combined age group 0-14 years plus 65 years and above to the 15-65 years age group is known as total dependency ratio.Total dependency ratio =Age group 0-14 yrs & age group above 65 yrs Age group between 15-65 yrsIt is also referred to as the societal dependency ratio and reflects the need for a society to provide for their younger and older population groups. The proportion of persons above 65 years of age and children below 15 years of age are considered to be dependent on the economically productive age group (15-64 years) -### End" -5705,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Therapeutic exposure is form of_______ therapy., with the following options: A: Psychoanalytical, B: Supportive, C: Cognitive, D: Behavioural - -### Response: -Ans. D. Behavioral.(Ref: Kaplan & Sadockfs Synopsis of Psychiatry, Xth/Ch.35.8, Page no, 954).Therapeutic exposure is form of Behavioral therapy.A behavioral therapist would most likely instruct the patient to change his/her behavior as an antecedent to recovery (such as exercising or another activity).No medication has proven to be effective in treating specific phobias. The Rx of choice for specific phobias is exposure, in vivo or using techniques of guided imagery, pairing relaxation exercises with exposure to the feared stimulus. The patient can be exposed to the feared stimulus gradually or can be asked to immediately confront the most anxiety- provoking situation (flooding).Discussion:LEARNING THEORY & BEHAVIORAL THERAPY# Goals = change behavior & think more accurately# Specific phobia: ex. dogs, flying, heights, snakes- Therapy* Behavioral - Exposure therapy6# Prolonged & frequent (6-10) sessions# Gradual exposure to stimulus# End when anxiety reduced- Learning principles* Conditioning (stimulus elicits maintained response)* Negative reinforcement (behavior repeated to avoid a negative emotion)* Habituation (fear eliminated by prolonged contact w/ phobic stimulus)# Social phobia: ex. public speaking; fear of being scrutinized by others- Therapy* Cognitive - Cognitive restructuring- Correct irrational thinking* Behavioral - Exposure therapy & social skills training# Social distance, eye contact, movement, content- Learning principles* Modeling (observe others)* Shaping (acquire behavior by reinforcement)* Positive reinforcement (behavior ? in frequency by reward)* Punishment (behavior ? in frequency)* Irrational thinking (inaccurate beliefs that others are scrutinizing)i. Psychoanalysis would also use the understanding of the patient and the recreation of the past through clarification, confrontation, and interpretation, but typically the patient comes to the office more frequently than once per week, and often, though not always, the patient lies on a couch facing away from the therapist.ii. An experiential-humanistic therapist would focus on developing a supportive and gratifying relationship with the patient to help provide the empathic responsiveness that was hypothesized as absent in the patient's past.iii. A cognitive therapy would most likely focus on the negative worldview of the patient and attempt to restructure those thoughts. Cognitive therapy is based on the principle that psychopathology derives from the patient's faulty, distorted beliefs about him- or herself and the world (schemas). -### End" -5706,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is not autosomal recessive?, with the following options: A: Cystic fibrosis, B: Wilson's disease, C: Hemochromatosis, D: Neurofibromatosis - -### Response: -(D) Neurofibromatosis INHERITANCE PATTERNEXAMPLESAutosomal dominant* Huntingtons disease, Neurofibromatosis 1, Marfan Syndrome, Hereditary nonpolyposis colorectal cancer* Hereditary multiple exostosesis; Familial Hypercholesterolemia; Heriditary spherocytosis; APKD; Porphyria* Osteogenesis imperfecta; Von Willebrand's disease; Myotonic dystrophy; Otosclerosis; Achondroplasia; CAHAutosomal recessive* Cystic fibrosis, Sickle cell anemia, Tay-Sachs disease, Spinal muscular atrophy, Albinism; Wilson disease* Hemochromatosis; b-thalassemia; Homocystonuria; Friedrich's ataxia; Phenylketonuria* Fanconi syndrome; Gaucher's disease; Down syndromeX-linked dominant* Hypophosphatemia, Aicardi Syndrome, Chokenflok SyndromeX-linked recessive* Hemophilia A, Duchenne muscular dystrophy, Color blindness, Muscular dystrophy* Fragile X syndrome; G6PD deficiency; Sideroblastic anaemia; Androgenetic alopeciaY-linked* Male InfertilityMitochondrial* Leber's Hereditary Optic Neuropathy (LHON) -### End" -5707,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The operation of choice in ulcerative colitis, with the following options: A: Proctocolectomy with ileoanal anastomosis, B: Subtotal colectomy and ileostomy, C: Proctocolectomy and permanent end ileostomy, D: Subtotal colectomy and ileorectal anastomosis - -### Response: -The operation of choice in ulcerative colitis is proctocolectomy (with preservation of the anal sphincter complex) with ileoanal J pouch anastomosis (IPAA).Total proctocolectomy has the advantage of removing all diseased mucosa, thereby preventing fuher inflammation and the potential for progression to dysplasia or carcinoma. ie; Total colon and rectum are removed, ileal pouch is constructed (to function like rectum) and anastomosed to the anal canalRef: Sabiston 20e pg: 1372, Harrison 19e pg: 1962 -### End" -5708,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an adhesive perforation repair material:, with the following options: A: Calcium sulphate., B: Amalgam., C: ZOE., D: Geristone. - -### Response: -Geristore (Rapid setting resin-glass ionomer hybrids)- - -Has good capacity of bonding with the tooth structure - -Recommended for:- - -Root-end filling material -Restoring subgingival surface defects -Root surface caries -External root resorption lesions -Iatrogenic root perforations -Subgingival oblique fractured roots -### End" -5709,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 yr old boy presents with b/1 chronic uveitis. Which investigation should be ordered:, with the following options: A: Hemogram, B: X-ray of sacroiliac jt., C: HIV test, D: All - -### Response: -A i.e. Hemogram; B i.e. X-ray of sacroiliac jt.; C i.e. HIV test -### End" -5710,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About pugilistic attitude, untrue is:, with the following options: A: Due to heat stiffening, B: Antemoem in nature, C: Body assumes a posture of generalized flexion, D: None of the above - -### Response: -None of the above -### End" -5711,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the follow ing are larva control measures except -, with the following options: A: Gambusia, B: Intermittent irrigation, C: DDT, D: paris green - -### Response: -Ans. is `c' i.e., DDT -### End" -5712,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Von Recklinghausen disease is associated with:, with the following options: A: Glaucoma, B: Optic nerve glioma, C: Neurofibroma of the lids, D: All the above - -### Response: -Ans. (d) All the aboveRef: Kanski 7/e, p. 854; Yanoff 2/e, p. 1098NF-1 is the most common phakomatosis. It is Autosomal Dominant (AD).Ocular features# Orbital Optic nerve glioma Spheno-orbita encephalocoele# Eyelid - Ipsilateral plexiform neurofibroma# Glaucoma - unilateral and congenital# Iris lesions Lisch nodules (Hamartomas) Ectropion uveae# Prominent corneal nerves# Choroidal nevi# Posterior subcapsular cataractNF1 (Von Recklinghausen disease)Diagnostic Criteria - 2 or more should be present >=6 cafe-au-lait macules Freckling (Axillary or inguinal) - Pathognomonic>=2 neurofibromas (any) or 1 plexiform neurofibroma (it involves the eyelid, gives the characteristic S- shaped deformity) Optic glioma Osseous lesion (such as sphenoid dysplasia)>=2 Lisch Nodules First degree relative with NF1,Mnemonic: CAN GOLF -### End" -5713,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurofibrillary tangles with senile plaques are seen in :, with the following options: A: Parkinson's disease, B: Alzheimer's disease, C: Schizophrenia, D: Tuberous sclerosis - -### Response: -B i.e. Alzheimer's disease -### End" -5714,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Net reproduction rate is ?, with the following options: A: Number of live bihs per 1000 mid-year population, B: Number of live bih per 1000 women of child bearing age, C: Number of daughters a newborn girl will have during life time, D: None of the above - -### Response: -Ans. is 'c' i.e., Number of daughters a newborn girl will have during life time Net reproduction rate Net reproductive rate is defined as ""The no. of daughters a new born girl will bear during her lifetime assuming fixed age specific feility and moality rates"" It is the only feility related statistics which also takes moality rates into consideration. NRR of one is equivalent to attaining approximately the two child norms. Goal of NRR=1 can be achieved only if atleast 60%* of the eligible couples are effectively practicing family planning. -### End" -5715,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Orthodromic conduction is, with the following options: A: An axon can conduct impulse in one direction only, B: An axon can conduct impulse in both direction, C: The jumping of depolarization from node to node, D: The point at which a runaway spike potential occurs - -### Response: -The conduction of impulses in a single direction, that is from receptor or synapse to the axons and further to the termination, is known as Orthodromic conduction. -### End" -5716,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Precocious puberty is seen in all except -, with the following options: A: Tumor of the hypothalamus, B: Ovarian tumor, C: Tumor of the adrenal gland, D: None of the above - -### Response: -Ans. is 'd' i.e., None of the above [Ref: Nelson 18th/e ch. 563J o Precocious puberty is defined as the onset of secondary sexual characteristics before 8yr of age in girls and 9 yr in boys. o Conditions Causing Precocious Puberty o GONADOTROPIN-DEPENDENT PUBERTY (TRUE PRECOCIOUS PUBERTY) Idiopathic Organic brain lesions Hypothalamic hamartoma Brain tumors, hydrocephalus, severe head trauma, myelomeningocele Hypothyroidism, prolonged and untreated o COMBINED GONADOTROPIN-DEPENDENT AND GONADOTROPENINDEPENDENT PUBERTY Treated congenital adrenal hyperplasia, McCune-Albright syndrome, late Familial male precocious puberty, late o GONADOTROPIN-INDEPENDENT PUBERTY (PRECOCIOUS PSEUDO PUBERTY) Females Isosexual (feminizing) conditions McCune-Albright syndrome Autonomous ovarian cysts Ovarian tumors Granulosa-theca cell tumor associated with Ollier disease Teratoma, chorion epithelioma Sex-cord tumor with annular tubules (SCTAT) associated with Peutz-Jeghers syndrome Feminizing adrenocortical tumor Exogenous estrogens Heterosexual (masculinizing) conditions Congenital adrenal hyperplasia Adrenal tumors Ovarian tumors Glucocorticoid receptor defect Exogenous androgens Males Isosexual (masculinizing) conditions Congenital adrenal hyperplasia Adrenocortical tumor Leydig cell tumor Familial male precocious puberty Isolated Associated with pseudohypoparathyroidism hCG-secreting tumors Central nervous system Hepatoblastoma Mediastinal tumor associated with Klinefelter syndrome Teratoma Glucocorticoid receptor defect Exogenous androgen Heterosexual (feminizing) conditions Feminizing adrenocortical tumor SCTAT associated with Peutz-Jeghers syndrome Exogenous estrogens -### End" -5717,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following poisoning formication and insanity occurs together?, with the following options: A: LSD, B: Amphetamine, C: Cannabis, D: Cocaine - -### Response: -In chronic cocaine users, degeneration of central nervous system will result in hallucinations, convulsions, delirium and insanity. Magnan's symptom or cocaine bugs is characteristic of chronic cocaine users, in which there is feeling as if grains of sand are lying under the skin or small insects are creeping on the skin giving rise to itching sensation (formication, tactile hallucination). Ref: The Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 536. -### End" -5718,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fat necrosis is seen in?, with the following options: A: Breast, B: Brain, C: Kidney, D: Spleen - -### Response: -Ans. a (Breast). (Ref. Robbin, Pathology 6th ed., 17, 18 and Bailey & Love, 24th ed., 545)Fat necrosis is seen in breast, acute pancreatitis, etc. It does not denote a specific pattern of necrosis; rather it is focal area of fat destruction, due to release of pancreatic lipase. -### End" -5719,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The requirement of potassium in a child is ?, with the following options: A: 1-2 mEq/kg, B: 4-7 mEq/kg, C: 10-12 mEq/kg, D: 13-14 mEq/kg - -### Response: -Ans. is 'a' i.e., 1-2 Meq/kg The recommended daily dietary intake of potassium in a child is 1 - 2 meq/kg `Dietary consumption varies considerable even though 1- 2 meq/kg is the recommended intake' -### End" -5720,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with history of high fever for 4 days along with seizures. A rash develops on trunk on the day after the fever subsides. What is the most probable diagnosis?, with the following options: A: Roseola infantum, B: Measles, C: Rubella, D: Varicella - -### Response: -History of high fever & rash appearing as the fever subsides is suggestive of Roseola infantum. -Roseola infantum/sixth disease/exanthema subitum * Caused by herpes virus (HHV6A and 6B) * Clinical features: Sudden onset of high fever Rash appear when the fever subsides Nagayama spots are seen * Lab findings in Roseola infantum Relative Lymphocytosis Leukopenia -### End" -5721,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Crowe-Beck test is positive in, with the following options: A: Stage of 'localization of brain abscess', B: Stage of 'termination of brain abscess', C: Lateral sinus thrombophlebitis, D: Otitic hydrocephalus - -### Response: -Ans. c (Lateral sinus thrombophlebitis) (Ref. PL Dhingra ENT 2nd ed., 89)LATERAL SINUS THROMBOPHLEBITIS (SIGMOID SINUS THROMBOSIS)# A lateral sinus thrombosis may occur with an infected cholesteatoma.Clinical Features# Characteristic high spiking fever with rigors and a ""picket-fence"" pattern; Headache; anaemia and emaciation# Signs and test:- Pappilloedema- Griesinger's sign: Pain, redness, and swelling of tip of mastoid due to involvement of the mastoid emissary veins.- Tobey-Ayer test- Lillie-Crowe-Beck test: is used to diagnose unilateral lateral sinus occlusion (Digital compression of the opposite internal jugular vein causes retinal veins to dilate, as the major venous outflow tracts on both sides now blocked).- Tendreness along jugular vein# CECT: Empty delta sign: CT sign of dural venous sinus thrombosis / superior sagittal sinus, where contrast outlines a triangular filling defect (clot).# MR venogram is the best investigation (IOC) for diagnosis# Rx: It is treated like a lateral sinus thrombosis in association with acute coalescent mastoiditis. If the cholesteatoma is extensive, a CWD mastoidectomy should be performed.OTITIC HYDROCEPHALUS# It is defined as T intracranial pressure secondary to acute or chronic middle ear infection without evidence of meningitis or subdural or brain abscess.# It characteristicallx presents as headache and lethargy in a patient with an ear infection.# MRI easily identifies sigmoid sinus thrombosis with total occlusion.# Papilledema is almost always present; however, papilledema is not always an adequate predictor of - intracranial pressure.# Treatment of otitic hydrocephalus requires:- mastoidectomy appropriate for the disease,- exposure of all diseased dura to normal dura, and- removal of excess extradural granulation tissue.Also Know:ABLE test of fowlerTo test + recruitment as in meneier's diseaseBing test and Chamini moss testTuning fork test to detect hearing lossCrowe Beck testLateral sinus thrombosisTobey Ayer (Queckenstedt's) testLateral sinus thrombosisDoerfier Stewart test, Erhard's test, Gault's testTo detect malingering. -### End" -5722,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Slow wave sleep is known as:, with the following options: A: REM sleep, B: NREM sleep, C: Both of the above, D: None of the above - -### Response: -This is a straight forward memory question. There are two kinds of sleep: rapid eye movement (REM) sleep and non-REM (NREM), or slow-wave sleep. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 15. -### End" -5723,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Predisposing factor for aerial thrombosis:, with the following options: A: AT III deficiency, B: Protein S deficiency, C: Protein C deficiency, D: Homocystenemia - -### Response: -Answer is D (Homocystenemia) Homoeystenemia is associated with increased risk of aerial thrombosis. Deficiency of AT III, Protein C and Protein S predisposes to venous thrombosis and not aerial thrombosis. Abnormality Aerial Venous Factor V Leiden mutation -- + Prothrombin -- + Antithrombin III -- + Protein C -- + Protein S -- + Homorysteinemia + + Antiphospholipid syndrome + + -### End" -5724,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True stereopsis is perceived due to the following -, with the following options: A: Overlay of contours, B: Motion parallax, C: Bi- nasal disparity, D: Linear perspective - -### Response: -Stereopsis is a term that is most often used to refer to the perception of depth and 3-dimensional structure obtained on the basis of visual information deriving from two eyes by individuals with normally developed binocular vision. It is used for binasal disparity Ref khurana 6/e p456 -### End" -5725,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the main site of absorption of vitamin B12?, with the following options: A: Duodenum, B: Jejunum, C: Ileum, D: Colon - -### Response: -Most vitamins are absorbed in the upper small intestine, but vitamin B12 is absorbed in the ileum. This vitamin binds to intrinsic factor, a protein secreted by the parietal cells of the stomach, and the complex is absorbed across the ileal mucosa. Vitamin B12 absorption and folate absorption are Na+-independent. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 26. Digestion, Absorption, & Nutritional Principles. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e. -### End" -5726,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The dangerous paicle size causing pneumoconiosis varies from ?, with the following options: A: 100-150 m, B: 50-100 m, C: 10-50 m, D: 1-5 m - -### Response: -Ans. is 'd' i.e., 1-5 m Pneumoconiosis o Pneumoconiosis is an occupational lung disease caused by the inhalation of dust. o The development of pneumoconiosis depends on - (i) The amount of dust retained in the lungs and airways. (ii) The size, shape of the paicles --> The most dangerous paicle ranges from Ito 5 m in diameter because they may reach the terminal small airway and air sacs and settle in their linings. (iii) Paicle solubility and physiochemical reactivity. (iv) Additional effects of other irritants (e.g. concomitant smoking). Impoant pneumoconiosis o Cool worker's pneumoconiosis (CWP) --> Coal dust o Silicosis (grinder's disease) --> Silica dust o Asbestosis --> Asbestos dust o Beryliosis --> Berylium dust o Siderosis --> Iron dust o Byssinosis --> Cotton dust -### End" -5727,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior dislocation of the femur on the tibia is prevented by, with the following options: A: Anterior cruciate ligament, B: Posterior cruciate ligament, C: Medial collateral ligament, D: Lateral collateral ligament - -### Response: -CRUCIATE LIGAMENTS: Very thick and strong fibrous bands.Direct bonds of union between tibia and fibula.Maintain anteroposterior stability of knee joint. Anterior cruciate ligament:- Begins from anterior pa of intercondylar area of tibia, runs upward, backward and laterally and is attached to the posterior pa of medial surface of lateral condyle of femur. Taut during extension of knee. The anterior cruciate ligament is more commonly damaged than the posterior.It may be injured in violent hyperextension of knee or anterior dislocation of tibia. Posterior cruciate ligament:- Begins from posterior pa of intercondylar area of tibia, runs upwards, forwards and medially and is attached to lateral surface of medial condyle of femur. Taut during flexion of knee. The posterior cruciate ligament is injured in posterior dislocation of tibia. It prevents posterior dislocation of femur on tibia. Both these are supplied by middle genicular nerves and vessels. {Reference: BDC 9 E} -### End" -5728,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The epithelium of incisive Papilla is:, with the following options: A: Pseudostratified columnar epithelium., B: Stratified squamous epithelium-, C: stratified cilliated epithelium., D: None of the Above. - -### Response: -Incisive papilla - The oral incisive (palatine) papilla is formed of dense connective tissue. It contains the oral parts of the vestigial nasopalatine ducts. They are blind ducts of varying length lined by simple or pseudostratified columnar epithelium, rich in goblet cells. Small mucous glands open into the lumen of the ducts. These ducts sometimes become cystic in humans -### End" -5729,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In starvation, glucose is mainly utilized as metabolic fuel by, with the following options: A: Erythrocytes, B: Liver, C: Kidney, D: Skeletal muscle - -### Response: -In the fasting state, as the concentration of glucose in the poal blood coming from the small intestine falls, insulin secretion decreases, and skeletal muscle and adipose tissue take up less glucose. The increase in secretion of glucagon by a cells of the pancreas inhibits glycogen synthetase and activates glycogen phosphorylase in the liver leading to glycogenolysis. The resulting glucose-6-phosphate is hydrolyzed by glucose 6-phosphatase, and glucose is released into the bloodstream for use by the brain and erythrocytes. Reference: Harper; 30th edition; Chapter 14; Page no: 148 -### End" -5730,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congenital infection in fetus with minimal teratogenic risk is:, with the following options: A: HIV, B: Rubella, C: Varicella, D: CMV - -### Response: -Ans. is a, i.e. HIVRef. Dutta Obs. 7/e, p 300Teratogenic effects have not been documented with HIV infectionRubella, varicella and CMV infections have all been linked to a variety of congenital malformation in the fetusEffects of maternal HIV infection in pregnancyOn motherOn fetusThe course of HIV in mother remains unaltered as a result of pregnancyMaternal mortality or morbidity are not increased by HIVMain problems a/w HIV infection during pregnancy are related to preterm birth and IUGR.No teratogenic effects have been reported. Preterm labor, IUGRNo teratogenic effectsHIVMeaslesInfluenzaMumpsInfections causing congenital malformation (teratogenic effect)RubellaVaricellaToxoplasmosisMumpsCMVParvovirus -### End" -5731,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An unidentified dead body is brought to you for autopsy. You notice a faded tattoo mark on the left arm of the body. Which of the following methods can you use to enhance the tattoo mark for identification?, with the following options: A: Application of isopropyl alcohol, B: Infrared photography, C: Bright illumination, D: All of the above - -### Response: -Infrared photography makes old tattoos readily visible. A faded tattoo mark can by visualized by Ultraviolet light. Infrared photography. Rubbing the pa and examining with a magnifying lens. In decomposed bodies, the tattoo marks can be visualized by removing the epidermis by a moist cloth. The lymph nodes near a tattoo mark also show a deposit of the pigment. Reference The Synopsis of FORENSIC MEDICINE and Toxicology 29th Edition -### End" -5732,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of urethral obstruction in male children -, with the following options: A: Posterior urethral valve, B: Meatal stenosis, C: Urinary tract infection, D: Urethral duplication - -### Response: -Ans. is 'a' i.e., Posterior urethral valve * The most common cause of obstructive uropathy in a male child is posterior urethral valve.Posterior urethral valve* These are symmetrical folds of urothelium extending distally from prostatic urethra to external urinary sphincter.* It most commonly lies just distal to the verumontanum or at the verumontanum.* It occurs only in males.* It behaves as flap valves so, although urine does not flow normally a urethral catheter can be passed without difficulty.* Sometimes, the valves are incomplete and the patient remains without symptoms until adolescence or adulthood.* Approximately 30% of patients experience end stage renal disease* Vesicoureteral reflux occurs in 50% of patients. -### End" -5733,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about hemochromatosis is not true, with the following options: A: Hypogonadism may be seen, B: Ahropathy may occur, C: Diabetes mellitus may develop, D: Dimercaprol is treatment of choice - -### Response: -Characteristics of hereditary hemochromatosisThe liver is the first organ to be affected.Excessive skin pigmentation is present.Diabetes mellitus occurs in about 65% of patients.Cardiac involvement may be seen.Hypogonadism may occur Ahropathy may occur.TreatmentThe therapy of hemochromatosis involves removal of the excess body iron and suppoive treatment of damaged organs. Iron removal is best accomplished by weekly or twice-weekly phlebotomy of 500 mL.An effective oral iron chelating agent, deferasirox, has recently become available but is still in clinical trials.Desferrioxamine, when given parenterally, remove 10-20 mg iron per day, which is much less than that mobilized by once-weekly phlebotomy.Ref: Harrison's 18/e p2312, 17/e p1764, 2433 -### End" -5734,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wernicke's hemianopic pupillary response is seen in the lesion of, with the following options: A: Optic tract, B: Optic chiasma, C: Optic radiation, D: Lateral geniculate body - -### Response: -Wernick's hemianopic pupil is caused by the division of the optic tract that results in a contralateral homonymous hemianopiaPrimary lesions of the optic tract are very rare and the tract is usually disturbed by compression. The common causes areChordomasPituitary adenomasTentorial meningiomasTemporal lobe gliomasAneurysms of upper basilar distribution or on the superior cerebellar aeries or posterior cerebral aeriesRef: Parson 19/e p528,120 -### End" -5735,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clostridium difficile diarrhoea is most commonly associated with, with the following options: A: Aminopenicillins, B: Fluoroquinolones, C: Macrolides, D: Carbapenems - -### Response: -Clostridium difficile diarrhea is a super-infection also called Pseudomembranous colitis. Mc cause is 3rd generation Cephalosporins Other causes include Clindamycin, Aminopenicillins (Ampicillin and Amoxycillin), and Fluoroquinolones. DOC for treatment of PMC is oral Vancomycin now. Stool transplant can also be done. MAB against toxin of C.difficile : Bezlotoxumab. -### End" -5736,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Androgen insensitivity syndrome, true statement is :, with the following options: A: Phenotype may be completely female, B: Predominantly ovarian component in gonads, C: Always in female, D: Testes formed abnormally and receptors are normal - -### Response: -Features phenotype is female Karyotype is 46,XY Gonads are testis formed in the inguinal canal lack axillary and pubic hair absent uterus and upper vagina SHAW&;S TEXTBOOK OF GYNAECOLOGY,Pg no:284,15th edition -### End" -5737,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which malignancy postoperative radiotherapy is minimally used –, with the following options: A: Head and neck, B: Stomach, C: Colon, D: Soft tissue sarcomas - -### Response: -There is no role of radiotherapy in carcinoma stomach except for palliation of pain. -In Head & neck, colon & soft tissue sarcomas RT is given as adjuvant therapy to surgery. -### End" -5738,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypercalcemia is seen in all EXCEPT: March 2013, with the following options: A: Bone metastasis, B: Sarcoidosis, C: Pseudohypoparathyroidism, D: Hyperparathyroidism - -### Response: -Ans. C i.e. PseudohypoparathyroidismPseudohypoparathyroidism presents with hypocalcemia, normal to raised PTH, normal 25-(OH)D, and decreased 1,25-(OH),D -### End" -5739,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: all are true regarding lichen planus except ?, with the following options: A: pruritic, B: wickhams striae, C: malignant prediposition, D: purple color - -### Response: -Lichen Planus : Lichen planus is a cell-mediated immune response of unknown origin. It may be found with other diseases of altered immunity, such as ulcerative colitis, lichen sclerosis, myasthenia gravis etc. Lichen planus has been found to be associated with hepatitis C virus infection, chronic active hepatitis, and primary biliary cirrhosis It is most likely an immunological mediated reaction, though the pathophysiology in unclear. Clinical Presentation o The clinical presentation of lichen planus has several variations, as follows: o Hyperophic lichen planes o Atrophic lichen planes 0 Erosive/ulcerative lichen planes 0 Follicular lichen planes (lichen planopilarisl Annular lichen planes Linear lichen planes Vesicular and bullous lichen planes Actinic lichen planes Lichen planes pigmentosus Lichen planes pemphigoides MANAGMENT Treatments and Rationale Treatments may include: Antihistamines Medicines that calm down the immune system, such as cyclosporine (in severe cases) o Lidocaine mouthwashes to numb the area and make eating more comfoable (for mouth sores) o Topical coicosteroids (such as clobetasol) or oral coicosteroids (such as prednisone) to reduce swelling and lower immune responses o Coicosteroids shots into a sore o Vitamin A as a cream (topical retinoic acid) or taken mouth (acitre tin) Dressings placed over skin medicines to protect from scratching Ultraviolet light therapy for some cases ref : thomas habif 7th ed -### End" -5740,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incomplete closure of ectodermal cleft is know to cause, with the following options: A: Retinal detachment, B: Iridodonesis, C: Retinoblastoma, D: Coloboma of iris and retina - -### Response: -Inderbir Singh&;s Human embryology Tenth edition Pg 364 Failure of the choroidal fissure to obliterate completely may lead to deficiencies( coloboma)of various layers of eyeball including iris ciliary body and choroid -### End" -5741,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rhinoscleroma is caused by:, with the following options: A: Klebsiella, B: Autoimmune, C: Spirochetes, D: Rhinosporidium - -### Response: -(a) Klebsiella(Ref. Scott Brown, 8th ed., Vol 1; 1212)Rhinoscleroma is a bacterial granuloma caused by Klebsiella rhinoscleromatis also known as Frisch bacillus.Rhinosporidium seeberi, an aquatic protistan protozoa (unicellular) parasite, causes a granulomatous condition called rhinosporidiosis.Spirochete (syphilis) and autoimmune conditions (e.g. Wegener's granulomatosis) are the other nasal granulomatous conditions. -### End" -5742,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sperm get nutrition from:, with the following options: A: Fructose, B: Glucose, C: Sucrose, D: Amylase - -### Response: -Seminal vessels secrete a mucoid material containing abundance of fructose, citric acid and other nutrient substance. This adds to the bulk of semen & fructose in the seminal fluid is of nutrient value to the sperm GLUT- 5: fructose transpo. -### End" -5743,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fibrinoid necrosis is seen in following except, with the following options: A: Serum sickness, B: Diabetes mellitus, C: Ahus reaction, D: SLE - -### Response: -Fibrinoid necrosis is a special form of necrosis, visible by light microscopy, usually in immune reactions in which complexes of antigens and antibodies are deposited in the walls of aeries. The deposited immune complexes, together with fibrin that has leaked out of vessels, produce a bright pink and amorphous appearance on H&E preparations called fibrinoid (fibrin-like) by pathologists. it is found in Systemic lupus erythematosus; some forms of glomerulonephritis; serum sickness; Ahus reaction. (Robbins Basic pathology,9th edition.pg no.11) -### End" -5744,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Old male came with jaundice, palpable mass in the right hypochondrium not associated with pain., with the following options: A: Carcinoma Ampulla of Vaster, B: Acute cholecystitis, C: Chronic cholecystitis, D: Chronic pancreatitis - -### Response: -Ans. (a) Carcinoma Ampulla of VaterRef: Long cases surgery RRM* As per Courvoisier law""GB palpable is due to cancer-Distal CBD or Periampullary cancer"" -### End" -5745,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most potential route for spread of infection from CNS to inner ear, with the following options: A: Vestibular aqueduct, B: Cochlear aqueduct, C: Endolymphatic sac, D: Hyle fissure - -### Response: -Cochlear aqueduct is most potential route for spread of infection from CNS to inner earQ Cochlear aqueduct & vestibular aqueduct are 2 bony channels (canals) that connect inner ear (cochlea & vestibule respectively) to intracranial sub arachnoid space. Vestibular aqueduct contains endolymphatic duct filled with endolymph, which does not communicate freely with CSF as it ends in a cul de sac and forms a closed space. Whereas perilymph filled cochlear aqueduct is in direct continuation with the CSF which makes it a most potential route of infection. Hyle's fissure is present in early embryonic life that normally obliterates by 24 weeks of gestation. When persistent it provides a connection from middle ear to subarachnoid space. -### End" -5746,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following contain(s) an RNA dependent DNA polymerase as a structural component of the virion -, with the following options: A: Adenoviruses, B: Ohomyxoviruses, C: Rhabodoviruses, D: RNA tumor viruses - -### Response: -Ans. is 'd' i.e., RNA tumor viruses . RNA dependent DNA polymerase (reverse transcriptase) is characteristic of Reteroviridae family. . These are RNA tumor viruses and related agents. -### End" -5747,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How does radiation cause cell death?, with the following options: A: Charring of nucleoproteins, B: Destroying their mitochondria, C: Ionization, D: Disruption of cytosol - -### Response: -Radiation Chemistry -Radiation acts on living systems through direct and indirect effects. When the energy of a photon or secondary electron ionizes biologic macromolecules, the effect is termed direct. Alternatively, a photon may be absorbed by water in an organism, ionizing some of its water molecules. The resulting ions form free radicals (radiolysis of water) that in turn interact with and produce changes in biologic molecules. Because intermediate changes involving water molecules are required to alter the biologic molecules, this series of events is termed indirect. -### End" -5748,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dehydrogenation of succinic acid to fumaric acid requires the following hydrogen carrier:, with the following options: A: NAD+, B: NADP+, C: flavoprotein, D: Glutathione - -### Response: -Succinate is dehydroge nated to fumarate, an unsaturated dicarboxylic acid, by succinate dehydrogenase. The hydrogen atoms are accepted by FAD. The FADH2 then enters into ETC to generate ATPs. The enzyme is a flavoprotein. -Reference: Vasudevan 7th  ed, pg 248 -### End" -5749,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following would MOST likely be found in the Congo red-stained extracellular deposits with the bright green appearance under polarized light?, with the following options: A: Amyloid AA, B: Beta-2-microglobulin, C: Beta protein precursor, D: Immunoglobulin light chains - -### Response: -Amyloidosis occur in a large variety of forms. Primary amyloidosis is one of the more common forms of systemic amyloidosis, and can affect a variety of organs, including the hea, kidney, peripheral nerve, gastrointestinal tract, and respiratory tract. In primary amyloidosis, the amyloid is composed of immunoglobulin light chains, and the disease is now interpreted as a plasma cell disorder closely related to multiple myeloma. This interpretation is clinically significant, as it has led to modern treatments of primary amyloidosis (which formerly had a dismal prognosis) with the chemotherapies designed for multiple myeloma. The treatments are effective only if the disease is recognized and passed to the appropriate specialists as early as possible in the clinical course. Amyloid AA is seen in inflammation-associated amyloidosis and familial Mediterranean fever. Beta-2-microglobulin comprises the amyloid of dialysis-associated amyloidosis. Beta protein precursor comprises the amyloid seen in the brains of patients with Alzheimer's disease and Down syndrome. Ref: Avery T.P., Shah N., Fu W., Weber D.M., Lu G., Lin P., Qazilbash M.H., Wang M. (2011). Chapter 11. Multiple Myeloma and Other Plasma Cell Dyscrasias. In H.M. Kantarjian, R.A. Wolff, C.A. Koller (Eds), The MD Anderson Manual of Medical Oncology, 2e. -### End" -5750,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The earliest feature of tuberculosis is, with the following options: A: Caseation, B: Granuloma formation, C: Formation of giant cells (Langhans), D: Recruitment of lymphocytes - -### Response: -• Macrophages are the primary cells infected by M. tuberculosis. Early in infection, tuberculosis bacilli replicate essentially unchecked, while later in infection, the cell response stimulates macrophages to contain the proliferation of the bacteria. -• About 3 weeks after infection, a T-helper 1 (TH1) response is mounted that activates macrophages to become bactericidal. -• The TH1 response orchestrates the formation of granulomas and caseous necrosis. Macrophages activated by IFN-γ -differentiate into the “epithelioid histiocytes” that characterize the granulomatous response, and may fuse to form giant cells. -### End" -5751,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement about 'instantaneous mean vector' a) Equal & same as mean QRS vectorb) It is drawn through the centre of vector in a direction from base toward apexc) Summated vector of generated potential at particular instant caused by inflowing septal depolarizationd) When a vector is exactly horizontal and directed toward the person's left side, the vector is said to extend in the direction of 0 degrees, with the following options: A: abc, B: acd, C: bcd, D: bd - -### Response: -In a normal heart, the current flows from the base towards apex. So the vector is pointed towards the apex at an angle of +59o. The angle is calculated from a vector running horizontally towards left, which is 0o. Instantaneous mean vector is the summated vector of general potential at a given instant due to septal depolarization. -### End" -5752,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dermatological manifest of IBD:, with the following options: A: Pyoderma gangrenosum, B: Necrolytic migratory erythema, C: Impetigo, D: Psoriasis - -### Response: -Ans. (a) Pyoderma gangrenosumRef: Sabiston 20th edition, Page 1341* Skin manifests in ulcerative colitis:* Most common erythema nodosum (In 10-15% cases)* Pyoderma gangrenosum (Most common site pretibial region--erythematous plaque) -### End" -5753,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Risk factors for the development of critical limb ischemia include all except, with the following options: A: Diabetes, B: Hyperlipidemia, C: Moderate alchol intake, D: Hyperhomocysteinemia - -### Response: -.Critical Limb Ischaemia It is persistently recurring ischaemic rest pain for 2 weeks or ulceration or gangrene of the foot or toes with an ankle systolic pressure < 50 mmHg or toe systolic pressure < 30 mmHg.If patient continues to smoke, disease progresses into the collaterals, blocking them eventually, leading to severe ischaemia and is called as decompensatory peripheral vascular disease. It is presently called as critical limb ischaemia. It causes rest pain, ulceration, gangrene. ref:SRB&;s manual of surgery,ed 3,pg no 152 -### End" -5754,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Kishori Sakthi Yojana, with the following options: A: Money transfer, B: LIterature, C: Vocational training, D: Health planning - -### Response: -Ref:Park's Textbook of Preventive and Social Medicine 25th Ed -### End" -5755,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rate of involution uterus following delivery: FMGE 09, 11, with the following options: A: 1 cm/day, B: 1.25 cm/day, C: 2.25 cm/day, D: 2.5 cm/day - -### Response: -Ans. 1 cm/day -### End" -5756,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cross cylinders is, with the following options: A: One plus cylinder and one minus cylinder of equal strength, B: One plus cylinder and one minus cylinder of unequal strength, C: Two plus cylinders, D: Both minus cylinders - -### Response: -A i.e. One plus cylinder and one minus cylinder of equal strength Cross cylinder is a combination of two cylinders of equal strength but with opposite sign placed with their axis at right angles to each otherQ and mounted in a handle. Jackson's cross cylinder test is used to verify the strength & axis of the cylinder prescribed. The commonly used cross cylinders are of +- 0.25 D and -0.5 D. -### End" -5757,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Predominant constituent of Hyaline membrane disease is :, with the following options: A: Albumin, B: Anthracotic pigment, C: Fibrin rich exudates, D: Phosphatidylcholine - -### Response: -The membranes (in hyaline membrane disease) are largely made up of fibrinogen and fibrin admixed with cell debris derived chiefly from necrotic type-II pneumocytes. There is a remarkable paucity of neutrophilic inflammatory reaction associated with these membranes. -### End" -5758,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lactional amenorrhea is due to, with the following options: A: Prolactin induced inhibition of GnRH, B: Prolactin induced inhibition of FSH, C: Oxytocin induced inhibition of GnRH, D: Oxytocin induced inhibition of FSH - -### Response: -High levels of prolactin inhibits GnRH release from Hypothalamus and thus indirectly FSH and LH secretion from anterior pituitary Reference: Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Page no 27 -### End" -5759,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is false regarding dentate line:, with the following options: A: Glands of Morgagni open below the line, B: Anal glands open at the line, C: Dentate line lies 2 cms above the anal verge, D: Transitional epithelium lies above the dentate line - -### Response: -D. i.e. Transitional epithelium lies above the dentate line -### End" -5760,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thomsen friedensreich phenomenon is ?, with the following options: A: Red cells infection by CMV, B: Red cell agglutination by all blood group sera, C: Hemolysis of transfused blood, D: Due to B antigen - -### Response: -Ans. is 'b' i.e., Red cell agglutination by all blood group sera Thomsen-Freidenreich Phenomenon Red cell suspensions contaminated with ceain bacteria, e.g. pseudomonas aeruginosa, become agglutinable by all blood group sera and even by normal human sera. This is known as Thomsen Friedenreich phenomenon and is due to unmasking of a hidden antigen normally present on all human erythryocytes, i.e. T-antigen. Anti-T agglutinins are normally present in human sera. Such panagglutinability of red cells has occasionally been observed in persons suffering from systemic bacterial infections. -### End" -5761,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: P. carini causes infection primarily in?, with the following options: A: Rats, B: Guinea pig, C: Rabbits, D: Humans - -### Response: -Pneumocystis jirovecii causes infection Primarily in Rats. Pneumocystis jirovecii (previously P. carinii) is the causative organism of Pneumocystis pneumonia paicularly among immunocompromised hosts. P. jiroveci causes PCP in human with HIV if, their CD4+ cells count below 200/uL. -### End" -5762,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mikulicz's disease presents as-, with the following options: A: Enlargment of upper cervical lymph nodes, B: Enargement of parotid, submandibular salivary and lacrimal glands, C: Systemic illness with dary month, joint pain and feger, D: Fever, hepatosplenomegaly and lymphadenopathy - -### Response: -MIKULICZ'S SYNDROME. This is characterised by inflammatory enlargement of lacrimal and salivary glands. The condition may occur with Sjogren's syndrome, or with some diseases like sarcoidosis, leukaemia, lymphoma and macroglobulinaemia. HARSH MOHAN Textbook of pathology 6th edition pg no 511 -### End" -5763,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Merkel cells are present in, with the following options: A: Dermal papillae, B: Papillary dermis, C: Reticular Dermis, D: Epidermis - -### Response: -Merkel cells Touch receptors Type 1 slow adapting Present in stratum basale in epidermis -### End" -5764,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about sublingual gland tumor is, with the following options: A: Mostly Benign, B: Painless swelling, C: Neck dissection is not done, D: All of the above - -### Response: -Sublingual gland tumors are usually malignant (85%) -Present as painless hard mass. -Treated by excision and neck dissection. -### End" -5765,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rate limiting step in facilitated diffusion?, with the following options: A: Availability of contranspo, B: Conformational change in transpoer, C: Synthesis of carrier protein, D: Polarization of solute - -### Response: -Ans. is'b'i.e., Conformational change in transpoer(Ref: Essentials of membrane Biophysics p. 25I).The relative slowness of the rate constant for conformational change reorienting the Solute-unoccupied transpoer (Step-4) makes it the rate-limiting step in the process of facilitated diffusion. -### End" -5766,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In primary spermatocyte chromosome is-, with the following options: A: 22+X, B: 44+XY, C: 22+Y, D: None of Above - -### Response: -Ans. B. 44+XYa. Spermatogenesis - The spermatogonium (44+XY) undergoes mitotic division to form two primary spermatocytes (largest germ cells).b. The primary spermatocytes (44+XY) undergo first meiotic division (reductional division) to form two secondary spermatocytes. The secondary spermatocytes thus have haploid number of chromosomes.c. Each secondary spermatocyte (22+X/Y) immediately undergoes second meiotic division to form two spermatids (22+X/Y).d. Thus, four haploid spermatids are produced from the meiotic division of one primary spermatocyte. The spermatids are small cells of about half the size of the secondary spermatocyte, and have round and darkly stained nuclei.e. Each spermatid gradually changes its stage to become spermatozoon or sperm. This transformation of circular spermatid into an elongated spermatozoon is called spermiogenesis. -### End" -5767,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Socially acquired learned behaviour is?, with the following options: A: Custom, B: Culture, C: Habbit, D: Attitude - -### Response: -ANSWER: (B) CultureREF: Park 20th ed page 584""Culture is defined as learned behaviour which has been socially acquired"" -### End" -5768,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intermediate cell predominance on a vaginal cytology is seen in :, with the following options: A: Pregnancy, B: Menstruation, C: Post ovulatory, D: Premenstrual - -### Response: -Pregnancy -### End" -5769,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common presentation of wilm's tumor -, with the following options: A: Hematuria, B: Asymptomatic abdominal mass, C: Abdominal pain, D: Headache - -### Response: -Ans. is 'b' i.e., Asymptomatic abdominal massWilm's tumor (Nephroblastoma)o Most common malignant tumor of kidney, o 80% of tumor present below 5 year of age.Presentiono Asymptomatic abdominal mass(M.C.).o Haematuria (10-25%).o Hypertension (25%).o Abdominal pain (30%).o Fever (20%). -### End" -5770,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 51-year-old complains of abdominal pain of 2-month duration. A CT scan of the patient's abdomen is shown. An angiogram indicates that several arteries of the gastrointestinal tract are occluded due to atherosclerosis, producing bowel ischemia. Which of the following arteries is most likely occluded in the CT scan?, with the following options: A: Middle colic, B: Right colic, C: Left colic, D: Iliocolic - -### Response: -(c) Source: GAS 336; GA 147, 160 The arrows in the CT scan point to the descending colon. Therefore, the left colic artery, which supplies the descending colon, is the one most likely occluded in the CT scan. The middle colic, right colic, and ileocolic artery supply the ascending colon, and the marginal artery provides an anastomosis between branches of the superior mesenteric artery and inferior mesenteric artery. -### End" -5771,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 7 year old girl presented with three episodes of massive hematemesis and melena. There is no history of jaundice. On examination, she had a large spleen, non-palpable liver and mild ascites. Poal vein was not visualized on ultrasonography. Liver function tests were normal and endoscopy revealed esophageal varices. The most likely diagnosis is:, with the following options: A: Kala azar with poal hypeension, B: Poal hypeension of unknown etiology, C: Chronic liver disease with poal hypeension, D: Poal hypeension due to extrahepatic obstruction - -### Response: -A patent poal vein suggests diagnosis of Intrahepatic poal HTN unless the clinical picture indicates post sinusoid cause. In this patient poal vein is not visualised. Diagnosis of poal hypeension is established by demonstrating the presence of poosystemic collateral and/or raised poal pressure. Ref: Kliegman, Behrman, Jenson, Stanton (2008), Chapter 363, ""Poal hypeension and varices"", In the book, ""NELSON TEXTBOOK OF PEDIATRICS"", Volume 2, 18th Edition, New Delhi, Page 1709; O P Ghai Essential Pediatrics, 6th Edition, Page 294. -### End" -5772,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin A vaccine should be stored in:-, with the following options: A: +2' C to +8' C, B: -15' C to -25' C, C: Outside cold chain, D: In ILR - -### Response: -Vitamin A should be stored outside the cold chain at room temperature. Vit A should be staed at 9months of age & given for every 6months till the child reaches 5yrs of age. Total 9 doses of Vit-A is given. -### End" -5773,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Receptors that are stimulated by a change in the chemical composition of the environment are:, with the following options: A: Mechanoreceptors, B: Chemoreceptors, C: Nocireceptors, D: None of the above - -### Response: -Chemoreceptors are those receptors that are stimulated by a change in the chemical composition of the environment. They include receptors for taste and smell and visceral receptors that are sensitive to change in plasma O2, pH and osmolality. -### End" -5774,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about anopheles mosquito-, with the following options: A: Larvae have siphon tube, B: Larvae are surface feeder, C: Larvae are bottom feeder, D: Larvae tie at an angle to water surface - -### Response: -Anopheles mosquito: Eggs are laid singly, boat-shaped with lateral floaters Larvae rest parallel to the surface and are thus surface feeders, have no siphon tube, palmate hairs are present Adults at rest are inclined at an angle to the surface, wings are spotted, palpi are long in both sexes. Only option 2 is correct. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 831. -### End" -5775,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement about alagille syndrome, with the following options: A: Complete absence of bile ducts, B: Normal liver, C: Mutations in Jagged 1 gene, D: No Risk of hepatocellular carcinoma - -### Response: -Ans. (d) No Risk of hepatocellular carcinoma(Ref: Robbins 9th/pg 853; 8th/pg 854)Alagille Syndrome (Syndromic Paucity of Bile Ducts; Arteriohepatic Dysplasia)An autosomal dominant disorder characterized by absence of bile ducts in portal tracts.Caused by mutations or deletion of gene encoding Jagged 1, on chromosome 20p.Patients can survive into adulthood but are at risk for hepatic failure & hepatocellular carcinomaMajor clinical features:#Chronic cholestasis#Peripheral pulmonary artery stenosis#Butterfly-like vertebral arch defects#An eye defect known as posterior embryotoxon,#A peculiar hypertelic, triangular facies. -### End" -5776,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of superior oblique muscle:, with the following options: A: Intoion, B: Extoion, C: Lateral rotation, D: Upward rotation - -### Response: -A i.e. Intoion -### End" -5777,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most specific symptom of temporal aeritis?, with the following options: A: Visual loss, B: Jaw claudication, C: Temporal headache, D: Polymyalgia rheumatica - -### Response: -Giant cell aeritis ( temporal aeritis ) is a chronic vasculitis of large and medium vessel aeries, usually affecting the cranial branches of aeries arising from aoic arch. Jaw claudication is an underrepoed, yet, a very specific symptom of GCA, with a high positive predictive value. Ref : Harrison's Principles of Internal medicine, 21st edition , Page 2188; NEJM, May 5, 2016, 1794-1795. -### End" -5778,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about glass holding position of cost, with the following options: A: Wrist in Plantar flexion, B: Wrist in ulnar devation, C: Extends upto IP joint of thumb, D: Extends upto IP joints of fingers - -### Response: -Answer- C. Extends upto IP joint of thumbGloss holding position- Cast is given in scaphoid fracture (scaphoid cast)It has following features of the castExtent From proximal 3rd of forearm upto IP joint of thumb and MCP joint of fingersPosition of wrist: Slight (5-15 degree) dorsi flexion and radial detion. -### End" -5779,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most useful investigation in diagnosis of diabetic ketoacidosis -, with the following options: A: Ketonemia, B: pH of blood, C: Urinary sugar, D: Urine ketone - -### Response: -Ref - semantischolar.org -### End" -5780,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: SRY gene is located on ?, with the following options: A: Sho arm of X chromosome, B: Long arm of X chromosome, C: Sho arm of Y chromosome, D: Long arm of Y chromosome - -### Response: -Ans. is 'c' i.e., Sho arm of Y chromosome Y chromosome is necessary for development of Male : The SR Y gene present on the distal sho arm of the Y chromosome is responsible for testicular development. -### End" -5781,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement about clonidine are all except-, with the following options: A: Increases parasympathetic outflow, B: Decreases sympathetic outflow by blocking central alpha receptor, C: Used in Hypertension, D: Prazosin is used to antagonize side effects of clonidine - -### Response: -Ans-D Clonidine is an alpha-2 agonist that acts by decreasing the central sympathetic outflow.Sedation, dry mouth and rebound hypertension are the principal adverse effects associated with clonidine. Prazosin is an a1 selective blocker, therefore it is not able to block alpha-2 mediated actions. -### End" -5782,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are congential myopathies exceptaEUR', with the following options: A: Central Core myopathy, B: Centronuclearmyopathy, C: Z band myopathy, D: Nemalin myopathy - -### Response: -Z band Myopathes Congenital Myopathies are characterized by Onset at bih or in early infancy with muscle Weakness and decreased muscle tone Very slowly progressive or non progressive course & long survival Specific histologic changes on muscle biopsy Congenital Myopathies Disease . Central core disease . Nemaline Myopathy . Centro Nuclear Myopathy Histological Characteristics Amorphous central core in myofibrils with absence of oxidative enzymes Elongated crystalline rods composed of Tropomyosin present beneath sarcolemma : shows periodicity on electron microscopy. Nuclei occupy the central pa of the myofibril. P Secondary Congenital Myopathy associated with Glycogen storage disease Glycolytic enzyme Deficiency Ceain disorders of lipid Metabolism e.g. Carnitine Deficiency Acquired Myopathy Endocrine - Thyrotoxicosis - Cushing disease - Acromegaly Familial periodic paralysis - Potassium deficiency or excess Malignant neoplasm - Paraneoplastic syndromes -### End" -5783,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Use of Siegel's speculum during the examination of the ear provides all except, with the following options: A: Magnification, B: Assessment of movement of the tympanic membrance, C: Removal of foreign body from the ear, D: As applicator for the powdered antibiotic in ear - -### Response: -A normal tympanic membrane is mobile when tested with a pneumatic otoscope or Siegle's speculum. -It is also employed in the magnification as well as an applicator for providing antibiotic of ear. -### End" -5784,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tram track appearance on CT scan of head is seen in –, with the following options: A: Sturge weber syndrome, B: Von Ripple lindau syndrome, C: Tuberous sclerosis, D: Neurofibroma - -### Response: -Train track or rail road calcification is characteristic of sturge weber syndrome. -### End" -5785,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following statements are true of patent ductus arteriosus(PDA) except – a) Spontaneous closure occurs in some term infantsb) Pulmonary hypertension developsc) Bacterial endocarditis is more frequent with small PDAd) Recurrent chest infection and congestive failure may develope) Anatomic existence of PDA is an indication for surgery, with the following options: A: a, B: b, C: ae, D: ad - -### Response: -Spontaneous closure of PDA -1) In premature infants - -In premature infants, spontaneous closure of PDA may occur because in these infants PDA is due to unresponsiveness to oxygen and there is no structural abnormality. - -2) In Full-term infants - -Unlike that in premature infants, spontaneous closure of a PDA does not usually occur in full-term infants. -This is because the PDA in term infants results from a structural abnormality of the ductal smooth muscle. - -Clinical manifestations of PIA - -Patient may be asymptomatic -Symptoms develop early and CHF may develop at 6 to 8th weeks of age. -Common symptoms → Dysnea on exertion, palpitation and frequent chest infections. - -Signs - -Tachypnea & Tachycardia -Bounding pulse with wide pulse pressure (with elevated systolic and lower diastolic pressure). -Hyperkinetic cardiac impulse -Systolic or continuous thrill. -Accentuated S1 -The narrow or paradoxical split of S2 (But it may be masked by continuous murmur since the maximum intensity of continuous murmur occurs at S2). -Continuous (machinery) murmur → Murmur starts after S and reaches the peak at S2. It then diminishes and is audible only during a part of the diastole. Murmur is best heard at second left intercostal space and is also heard below left clavicle. -S3 may occur at apex followed by a delayed diastolic murmur. -### End" -5786,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are caused by Herpes simplex virus except, with the following options: A: CA cervix, B: Gingivostomatitis, C: Mollaret meningitis, D: Herpes labialis - -### Response: -CA cervix is caused by human papilloma virus. -### End" -5787,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All can be prevented by orchiopexy in cryptorchidism Except -, with the following options: A: Testicular tumor, B: Epididymo orchitis, C: Torsion of testis, D: Sexual ambiguity - -### Response: -""All types of malignant testicular tumors are more common in incompletely descended testes even if they have been brought down surgically. However it does improve the prospect of early diagnosis."" - Bailey -Undescended testis - -In undescended testis - the testes is arrested in some part of its path to the scrotum. -In Ectopic testis - the testis is abnormally placed outside its path. -Retractile testis - in infancy 80% of in apparent testis are retractile testis and require no t/t. -Approx 70-77% of cryptorchid testes will spontaneously descend, usually by 3 months of age. -More common in preterm, small for gestational age, LBW & twin neonates. -More common on t. Side* -Secondary sexual characteristics are normal - -Complications of incomplete descent - -Torsion of testis -Epididymo-orchitis -An associated indirect inguinal hernia is frequent -Atrophy -Pain - A testis situated in the inguinal canal is often liable to trauma and give rise to pain in the groin -Sterility - If the condition is bilateral -Malignancy - risk is 40 times more than a normally placed testis. -### End" -5788,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest stomach tumor which bleeds:, with the following options: A: Adenocarcinoma, B: Squamous carcinoma, C: Leiomyosarcoma, D: Fibrosarcoma - -### Response: -Ans. (c) LeiomyosarcomaRef: Sabiston Page 1229, 20th Edition* Leiomyosarcoma is an old termno more used in stomach - Leiomyosarcomas are now renamed as GIST is the most common bleeding tumor cause in stomach. -### End" -5789,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skin and facia of great toe drains into, with the following options: A: Veical group of superficial inguinal lymph node, B: Horizontal group of superficial inguinal lymph node, C: Obturator lymph nodes, D: Deep inguinal lymph nodes - -### Response: -The superficial inguinal lymph nodes form a chain immediately below the inguinal ligament. They lie deep to Camper&;s fascia which overlies the femoral vessels at medial aspect of the thigh. They are found in the triangle bounded by the inguinal ligament superiorly, the border of the saorius muscle laterally, and the adductor longus muscle medially. (Femoral Triangle of Scarpa) There are approximately 10 superficial lymph nodes. The superficial nodes drain to the deep inguinal lymph nodes. -### End" -5790,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pharmacovigilance means:, with the following options: A: Monitoring of drug safety, B: Monitoring of unethical trade of drugs, C: Monitoring pharma students, D: Monitoring drug efficacy - -### Response: -Pharmacovigilance has been defined by the WHO as the ''science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems'' The information generated by pharmacovigilance is useful in educating doctors about the adverse drug reaction and in the official regulation of drug use Ref; KD Tripathi Pharmacology 7th edition (page no:82) -### End" -5791,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of external intercostal -, with the following options: A: Elevation of ribs, B: Expiration, C: Depression of ribs, D: All of the above - -### Response: -Ans. is 'a' i.e., Elevation of ribs Actions of intercostal muscleso The main action of the intercostal muscles is to prevent intercostal spaces being drawn in during inspiration and bulging outwards during expiration.o The external intercostals, interchondral portions of the internal intercostals and the levator costae may elevate the ribs during inspiration.o The internal intercostals except for the interchondral portions and the transversus thoracis may depress the ribs or cartilages during expiration. -### End" -5792,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 21-year-old unmarried woman has premenstrual fullness of breast and pain, the likely diagnosis is:, with the following options: A: Galactocele, B: Fibroadenosis, C: Fibroadenoma, D: Mastitis - -### Response: -It is usually seen in women of 4th and 5th decade of life (also not rare in young females) with complain of an intermittent mammary discomfort or an area of lumpiness or nodularity in the breast. -The changes are generally bilateral. Pain is cyclical with a premenstrual exacerbation. -Most likely the girl in question is suffering from fibroadenosis though her age is not consistent with the fibroadenosis. -### End" -5793,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Seman's squeeze technique is used in treatment of:-, with the following options: A: Erectile dysfunction, B: Premature ejaculation, C: Retrograde ejaculation, D: Antegrade ejaculation - -### Response: -Seman's squeeze technique is used in treatment of premature ejaculation Premature ejaculation - repeated ejaculation in less than 1 minute It is common among young men during first sexual encounters, and usually improves with increasing sexual experience. During orgasm phase of sexual cycle Treatment - SSRI's Clomipramine Tramadol use suugested by some studies Behavioral technique: (1) Squeeze technique (2) Seman's technique (stop and sta technique) -### End" -5794,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Broca's area is present in, with the following options: A: Superior temporal gyrus, B: Precentral gyrus, C: Post central gyrus, D: Inferior frontal gyrus - -### Response: -Broca&;s area 44 is in the frontal lobe immediately in front of the inferior end of motor coex which is the inferior frontal gyrus. Ref: Ganong&;s review of medical physiology; 23rd edition; pg:297 -### End" -5795,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diagnostic test for syphilis: March 2013, with the following options: A: VDRL, B: RPR, C: FTA-ABS, D: IgG ELISA - -### Response: -Ans. C i.e. FTA-ABS -### End" -5796,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 75-year-old man is bought to the hospital because of a syncopal episode. There was no incontinence or post-event confusion. On examination, his blood pressure is 140/80 mm Hg, pulse 72/min with no postural changes. His second heart sound is diminished and there is a systolic ejection murmur that radiates to the carotids. With the Valsalva maneuver, the murmur decreases in length and intensity.For the above patient with a systolic murmur, select the most likely diagnosis., with the following options: A: aortic stenosis, B: hypertrophic obstructive cardiomyopathy (HOCM), C: mitral regurgitation (chronic), D: tricuspid regurgitation - -### Response: -With the Valsalva maneuver, most murmurs will decrease. The location and radiation of this patient's murmur suggests aortic stenosis. The exceptions are the murmurs of HOCM and mitral valve prolapse, which increase.After release of the Valsalva maneuver, right-sided murmurs tend to return to baseline more rapidly. -### End" -5797,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudoeschar formation is seen with, with the following options: A: Silver Nitrate, B: Silver sulfadiazine, C: Sulfamylon, D: Mafenide acetate - -### Response: -Pseudoeschar is thickened burnt skin due to repeated silver sulphadiazine application. -### End" -5798,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for primary syphilis is, with the following options: A: Ampicillin, B: Benzathine penicillin, C: Erythromycin, D: Tetracycline - -### Response: -Ans. b (Benzathine penicillin). (Ref. Pharmacology KD Tripathi 5th/657, 673, 688; Harrison's Medicine 16th/980)Rx of SyphilisEarly & latent syphilisLate syphilis1.2 MU Procaine penicillin x 10 daysOR2.4 MU benzathine penicillin 1-3 weeklyBenzathine penicillin2.4 MU weekly for 4 weeksDrug used for treatment of syphilis# Penicillin# Erythromycin# Tetracycline# Cephalosporins. -### End" -5799,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a child,Purposeful movement is staed at______, with the following options: A: 6 month, B: Infant, C: 8 month, D: 9 month - -### Response: -A child develops head control by 4 months, and attains neck control by 5 months (20 wks) of age. Hence the child flexes his head onto chest i.e moves purposefully when pulled to sit by the age of 5 months. And also the baby moves his feet,and takes his foot to mouth at this age. Ref- Ghai , 9th edition, chapter 3 -### End" -5800,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Methods of learning in psychiatry are all except -, with the following options: A: Modelling, B: Catharsis, C: Exposure, D: Response prevention - -### Response: -Learning in Psychiatry - -Based on principle of classical conditioning → systemic desensitization, exposure with response prevention, Aversion therapy. -Based on operant conditioning :- Positive reinforcement, negative reinforcement, Positive punishment, Negative punishment, modeling. -### End" -5801,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Features of seronegative spondyloahropathy include all of the following, Except:, with the following options: A: Strong association with HLA B27, B: Negative Rheumatoid Factor, C: Symmetrical Polyahritis, D: Enthesitis - -### Response: -Answer is C (Symmetrical Polyahritis): Seronegative spondyloahropathies are usually associated with Asymmetrical Oligoahritsis and not symmetrical polyahritis. The seronegative spondyloahritis have the following in common: Negative RF Strong association with HLA-B27 antigen Oligoahritis (asymmetrical) Enthesitis (inflammation at sites of inseion of fascia, ligament or tendon to bone) Inflammatory ahritis (axial and sacroiliac joints) Extra-aicular features (eyes, skin, genitourinary tract) Familial predisposition -### End" -5802,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disease, does not recur in the kidney after renal transplant is :, with the following options: A: Alpo syndrome, B: Amyloidosis, C: Good Pasteur's syndrome, D: Diabetic nephropathy - -### Response: -Answer is A (Alpo's syndrome): Alpo is syndrome has not been mentioned to recur in kidney after a renal tansplant. -### End" -5803,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are risk factors for Fibroid except, with the following options: A: Obese, B: Multiparous woman, C: Estrogen, D: Red meat eater - -### Response: -Risk factor of Fibroids: Family history Genetic High estrogen exposure: nulliparity, early menarche, use of high dose OCP Red meat eater Obesity Black women Growth factors Transforming growth factor B Platelet derived growth factor Epidermal growth factor Protective factors Smoking Pregnancy, multiparity Excercise Diet: leafy vegetables -### End" -5804,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Citron bodies"" boat or leaf shaped pleomorphic organism in an exudate is, with the following options: A: Cl. welchii, B: Cl. edematiens, C: Cl. septicum, D: Cl. tetani - -### Response: -Citron bodies and boat or leaf shaped pleomorphic bacilli with irregular staining suggest CL septicum"". Clostridium Clostridial species are : Gram positive Anaerobic (obligate anaerobe) Spore forming Bacilli Motile by peritrichate flagella except C perfringens and C. tetani type IV which are non motile. Non capsulated except C. perfringens and C. butyricum which are capsulated Pathogenesis is due to exotoxin not endotoxin. Clostridium botulinum causes botulism not gas gangrene. REF : ananthanarayana 10th ed -### End" -5805,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common symptom of Acute pelvic inflammatory disease:, with the following options: A: Bleeding per vaginum, B: Abdominal pain, C: Vomiting, D: Amenorrhoea - -### Response: -Symptoms of Acute PID Abdominal pain Vomiting Dysuria Vaginal discharge Abnormal uterine bleeding Pain is the most common feature of symptomatic PID. Abnormal bleeding and vomiting may also occur. -### End" -5806,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bleeding is seen with the use of -, with the following options: A: Cefaloridine, B: Cefazolin, C: Moxalactum, D: Ceftazidime - -### Response: -Ans. is 'c' i.e., Moxalactam o Ceftriaxone, cefoperazone, moxalactam & cefamandole can cause hypoprothrmbinemia and bleeding. -### End" -5807,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following features are diagnostic features in barium follow through of ileo coecal tuberculosis, EXCEPT:, with the following options: A: Apple core appearance, B: Pulled up or contracted cecum, C: Widening of ileocecal angle, D: Stricture involving terminal ileum - -### Response: -Apple core appearence is seen in carcinoma of colon. Terminal ileum and cecum are the most common sites of intestinal tuberculosis. Barium follow through findings in ileocecal TB includes: Initially there is intense ileocecal spasm (Stierlin's sign) Later the lumen and size of the cecum are compromised as granulomas form into a mass and undergo fibrosis. Mesocolon of the cecum contracs and cecum is pulled out of the right iliac fossa and shrinks resulting in classical, conical, pyramidal or pear shaped configuration. -### End" -5808,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inhibition of 5–lipoxygenase is useful in :, with the following options: A: Cardiac failure, B: Bronchial asthma, C: Hepatic failure, D: Arthritis - -### Response: -Leukotrienes are potent bronchoconstricting agents. These agents play a major role in the pathogenesis of bronchial asthma. The drugs acting by inhibiting their synthesis (i.e. lipoxygenase inhibitors) or action (Cys-LT receptor antagonists) are useful in the prophylaxis of bronchial asthma. -### End" -5809,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with subarachnoid haemorrhage. NCCT reveals blood in the fouh ventricle. The bleeding is most likely to occur from an aneurysm of which of the following aeries, with the following options: A: Anterior communicating aery, B: Basilar top region, C: AICA, D: PICA - -### Response: -Ans. is 'd' i.e., PICA -### End" -5810,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Feulgen reaction is a cytochemical test for the detection of:, with the following options: A: DNA, B: m-RNA, C: t-RNA, D: All of the above - -### Response: -Feulgen reaction: It is an aldehyde specific reaction based on the formation of a purple coloured compound when aldehyde reacts with fuchsin-sulfuric acid. It is used in histology to identify chromosomal material or DNA in cell specimens. Ref: DNA Cytometric Analysis By Andre's Sampedro, Page 78 -### End" -5811,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The first urge to defecate occurs when rectal pressure is increased to, with the following options: A: 12 mmHg, B: 14 mmHg, C: 16 mmHg, D: 18 mmHg - -### Response: -The first urge to defecate occurs when rectal pressure is increased to 18 mmHg. When this pressure reaches 55 mmHg, the external and the internal sphincter relax, and there is reflex expulsion of the contents of the rectum. Defeacation reflex: Distension of the rectum and colon stimulates stretch receptors in the rectal wall. Then, the defecation reflexes travel from the colon and rectum to the spinal cord and back again to produce the powerful colonic, rectal, and abdominal contractions required for defecation. Ref: Ganong&;s Review of medical Physiology 26th edition Pgno: 488 -### End" -5812,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a feature of paroxysmal nocturnal hemoglobinuria-, with the following options: A: Increased LAP score, B: Thrombosis, C: Thrombocytopenia, D: Hemolysis - -### Response: -The LAP score is usually decreased in chronic myelogenous leukemia and paroxysmal nocturnal hemoglobinuria, while it is increased in leukemoid reaction and polycythemia vera. Numerous other conditions may also increase or decrease the LAP score. PNH is an acquired disorder in which there is a deficiency of GPI linked proteins, which normally protect the red cells against complement-mediated lysis. In PNH, RBCs are very sensitive to complement-mediated hemolysis. Clinical Features Intravascular hemolysis: Hemoglobin in acidic urine is conveed into acid hematin and results in dark brown urine. Thrombosis: In the hepatic, poal or cerebral veins Laboratory Findings PNH: Ham's acidified serum test and sucrose hemolysis test positive. Ref: RAM DAS NAYAK EXAM PREPARATORY MANUAL FOR UNDERGRADUATES 2nd ed. pg no: 283 -### End" -5813,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is used in the treatment of hyperprolactinemia, with the following options: A: Cimetidine, B: Methysergide, C: Bromocriptine, D: Ondansetron - -### Response: -Refer KDT 6/e p 236 It is an ergot alkaloid and is a Dopamine agonist Dopamine acts as prolactin inhibiting hormonal big the brain Agonism of Dopamine receptors by Bromocriptine is responsible for it's use in hyperprolactinemia -### End" -5814,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following structures are pierced by Stenson's duct except, with the following options: A: Buccopharyngeal Fascia, B: Pharyngobasilar Fascia, C: Buccal pad of fat, D: Buccinator - -### Response: -The parotid duct pierces buccal pad of fat, buccopharyngeal fascia, buccinator muscle and the mucous membrane to open into the vestibule of mouth opposite the crown of the upper second molar tooth.Reference: Chourasia; 6th edition; 61 pages -### End" -5815,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Why albumin provides maximum contribution in the generation of oncotic pressure?, with the following options: A: High molecular weight, low concentration, B: Low molecular weight, high concentration, C: High molecular weight, high concentration, D: Low molecular weight, low concentration - -### Response: -The colloid osmotic pressure due to plasma colloids is called the oncotic pressure. It is determined by the number of molecules dissolved in a fluid rather than by the mass of these molecules. Albumin contributes the maximum to oncotic pressure compared to other proteins like globulins and fibrinogen because it has low molecular weight & high concentration. The colloid osmotic pressure of normal human plasma averages about 28mm Hg. 19mm Hg of this is caused by molecular effects of the dissolved protein and 9mm Hg by the cations held in plasma by the proteins, which is called the Donnan effect. Ref: Cellular Proteins and Their Fatty Acids in Health and Disease, Edited By Asim K. Duttaroy, Page 79. -### End" -5816,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fomepizole is antidote of-, with the following options: A: Mushroom poisoning, B: Benzodiazepine poisoning, C: Ethylene glycol poisoning, D: Organophosphorus poisoning - -### Response: -Ans. is 'c' i.e., Ethylene glycol poisoning Fomepizole is used in methanol poisoning and ethylene glycol poisoning. -### End" -5817,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rosettes are characteristically seen in, with the following options: A: Retinoblastoma, B: Melanoma, C: Dysgerminoma, D: Lymphoma - -### Response: -Ref Robbins 7/e p1442; neuropathology for the neuroradiologist : rosette and pseudorosettes by F.J.wipopld and A.perry Rosettes consist of a Halo or spoke wheel arrangements of cells surrounding a central core or hub Rosettes may be considered primary or secondary manifestation of tumor architecture . Primary rosettes form as a characteristics growth pattern of a given tumor type, ahereas secondary rosettes result from the influence of external factors on tumors growth -### End" -5818,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true of Anorexia nervosa, with the following options: A: Loss of 10% of body wt, B: Amenorrhea, C: Over consciousness about body contour, D: Loss of weight according to the patient - -### Response: -(D) Loss of weight according to the patient COMMON CHARACTERISTICS Anorexia NervosaBulimia NervosaClinical CharacteristicsOnsetMid-adolescenceLate adolescence/early adulthoodFemale:Male10:0110:01Prevalence in women0.50%1-3%WeightMarkedly decreasedUsually normalMenstruationAbsentUsually normalBinge eating25-50%Required for diagnosisMortality~5% Per decadeLowPhysical & Laboratory FindingsSkin/extremities* Lanugo* Acrocyanosis* Edema Cardiovascular* Bradycardia* Hypotension Gastrointestinal* Salivary gland enlargement* Slow gastric emptying* Constipation* Elevated liver enzymes* Salivary gland enlargement* Dental erosionHematopoietic* Normochromic, normocytic anemia* Leukopenia Fluid/Electrolyte* Increased BUN, creatinine* Hyponatremia* Hypokalemia* Hypochloremia* AlkalosisEndocrine* Hypoglycemia* Low estrogen or testosterone* Low LH and FSH* Low-normal thyroxine* Normal TSH* Increased cortisol Bone* Osteopenia -### End" -5819,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lift off test is used for which of the following muscles?, with the following options: A: Supraspinatus, B: Subscapularis, C: Infraspinatus, D: Biceps Breachii - -### Response: -Ans. is 'b' i.e., Subscapularis TestMuscle TestedLift off testSubscapularisJobe testSupraspinatusSpeed testBicepsYergason testBicepsBelly press testSubscapularis -### End" -5820,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for detection of syphillis in a patient after 2 course of complete therapy, with the following options: A: FTA ABS, B: VDRL, C: TPI, D: Dark ground microscopy - -### Response: -Ans. is `b' i.e., VDRL To monitor the response to therapy non treponemal serological tests (RPR or VDRL) are used. Features of serological tests . Most senstive serological test in primary syphilis . First test to become positive . The test of choice for rapid serological diagnosis in a clinic or office setting . Tests for monitoring the responce of therapy . Testing of large number of sera for screening or diagnostic purpose . Tests for confirmation of the diagnosis . Measurment of Ig M in a neonate for congenital syphilis . The diagnostic test . Reagin antibodies tests (RPR and VDRL) becomes positive after 3-5 weeks of Infection (7-10 days after the appearance of primary chancre). In Lyme disease VDRL test is negative, but FTA-ABS may be positive. All serological tests may be positive (false positive) in non veneral treponematoses. eg in yaws, Pinta and endemic syphilis. . Presence of Ig M in a neonate confirms syphilis, as IgM can not cross placenta. But Ig G can be passively transfered from the infected mother to newborn. . Reagin antibody in syphilis is Ig G while reagin antibody in atopy (hypersensitivity reaction) is Ig E. -### End" -5821,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 67-year-old patient has been given a course of antibiotics by gluteal intramuscular injections after a major abdominal surgery.To avoid damaging the sciatic nerve during an injection, the needle should be inseed into which of the following areas?, with the following options: A: Over the sacrospinous ligament, B: Midway between the ischial tuberosity andthe lesser trochanter, C: Midpoint of the gemelli muscles, D: Upper lateral quadrant of the gluteal region - -### Response: -To avoid damaging the sciatic nerve during an intramuscular injection, the clinician should inse the needle in the upper lateral quadrant of the gluteal region. The inseed needle in the lower medial quadrant may damage the pudendal and sciatic nerves. The inseed needle midway between the ischial tuberosity and the lesser trochanter may damage the sciatic and posterior femoral cutaneous nerves on the quadratus femoris. The inseed needle over the sacrospinous ligament may damage the pudendal nerve and vessels. -### End" -5822,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In obstruction of second pa of axillay aery, theanostomosis between the following aery will maintain the blood supply of upper limb:, with the following options: A: Deep branch of transverse cervical aery & subscapular aery, B: Anterior & posterior circumflex humeral, C: Posterior circumflex humeral & circumflex scapular aery, D: Suprascapular & anterior circumflex humeral aery - -### Response: -Deep branch of transverse cervical aery & subscapular aery [Ref: BDC 4/e, Vol 1, p 56, 82; Snell's Clinical Anatomy 6/e, p 412-413, 657; Moore Clinical Anatomy 5/a, p 766-7671Axillary aery is the continuation of the subclan aery. It is crossed by pectoralis minor muscle which devides it into three pas.A rich anastomosis exists around the scapula between branches of subclan aery (first pa) & the axillary aery (third pa).This anastomosis provides a collateral circulation through which blood can flow to the limb when the distal pa of subclan aery or the proximal pa of axillary aery is blocked.Anastomosis around the scapula :Formed by branches of-Subclan aery - first pa- Suprascapular aery- Deep branch of transverse cervical aeryAxillary aery - third pa- Subscapular aery & its circumflex scapular branchThere are other smaller anastomoses over the acromion process, which also helps to maintain .flow to arm. (BDC Vol I, 4/e, p 82)Anastomoses over the acromion processFormed by -a)Acromial br. of thoraco-acromial aeryb)Acromial br. of suprascapular aeryc)Acromial br. of posterior circumflex humeral aeryThe subscapular aery also forms anastomoses with intercostal aeries -### End" -5823,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recommended Dietary allowance in pregnancy are, with the following options: A: +100-300 cal, B: 30 mg Iron, C: 4 mg folic acid, D: 2500 mg Mg - -### Response: -Ans. is b i.e. 30 mg Iron -### End" -5824,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minimum time period to diagnose depression with daily manifestation is?, with the following options: A: 1 weeks, B: 2 weeks, C: 4 weeks, D: 8 weeks - -### Response: -Ans. (b) 2 weeks(Ref. Kaplan and sadock's synopsis of psychiatry: behavioral sciences/Clinical psychiatry, 10/e, American psychiatric Association, Diagnostic and statistical menual of mental disorders, 4/e -### End" -5825,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amount of blood in capillary pool at anytime -, with the following options: A: 250 ml, B: 1000ml, C: 2000ml, D: 2500 ml - -### Response: -Ans. is 'a' i.e., 250 mlo Capillaries contain 5% of total blood volume, i.e., 250 ml out of 5000 ml of total blood.VesselPercentage of total blood volume containedAorta2Artery8Arteriale1Capillaries5Venous system54Pulmonary circulation18Heart12 -### End" -5826,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rinne test is positive in:, with the following options: A: CSOM, B: Normal individual, C: Otomycosis, D: Wax in ear - -### Response: -(b) Normal individual(Ref. Shambaugh, 6th ed., 181)Rinne is said to be positive when AC > BC.In normal ear air conduction is more than the bone conduction due to the transformer action of the middle ear.All the other options are conductive deafness conditions so BC > AC, i.e. Rinne will be negative. -### End" -5827,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lines of Blaschko's are related to ?, with the following options: A: Keratinocytes, B: Blood vessels, C: Nerves, D: Bones - -### Response: -Ans. is 'a' i.e., Keratinocytes Blaschko's lines correspond to the pathways followed by keratinocytes migrating from neural crest during embryogenesis. The lines follow a V-shape over spine, an S-shape on abdomen, inveed U-shape from breast area to upper arm and perpendicular down the front and back of the lower extrimities. A number of inflammatory conditions can follow Blaschko's lines - Lichen striatus Linear lichen planus. Inflammatory linear verrucous epidermal naevus (ILVEN). Blaschko dermatitis (Blaschtitis). Incontinentia pigmenti. Goltz syndrome. Linear morphoea. Segmental vitiligo. Focal dermal hypoplasia. CHILD syndrome. Hypomelanosis of Ito. Linear cutaneous lupus erythematosus -### End" -5828,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Decreased motility of fallopian tube is seen in -, with the following options: A: Churg- strauss syndrome, B: Kartagener s syndrome, C: Noonan syndrome, D: Turner syndrome - -### Response: -Ans-B -### End" -5829,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypoglossal nucleus lies on, with the following options: A: Mid brain, B: Pons, C: Medulla, D: Lower pons - -### Response: -Hypoglossal nucleus is an elongated column of grey matter extending throughout the length of medulla oblongata in the paramedian plane. Note: *Midbrain - nuclei of 3,4 cranial nerves *Pons - nuclei of 5,6,7,8 cranial nerves * Medulla- nuclei of 9,10,11,12 cranial nerves (Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg -91, 92) -### End" -5830,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shoest half life is of ?, with the following options: A: Metacholine, B: Acetyl choline, C: Carbachol, D: Bethanechol - -### Response: -Ans. is'b'i.e., Acetylcholine Acetylcholine is very rapidly hydrolyzed; large amounts must be infused intravenously to achieve concentrations sufficient to produce detectable effects.Methacholine is more resistant to hydrolysis, and the carbamic acid esters carbachol and bethanechol are still more resistant to hydrolysis by cholinesterase and have correspondingly longer duration of action. -### End" -5831,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shine-Dalgarno sequence in bacterial mRNA is near, with the following options: A: AUG codon, B: UAA codon, C: UAG codon, D: UGA codon - -### Response: -SD sequence is located-6 to -10 bp from initiating AUG codon on m-RNA molecule near its 5' end. It is seen in prokaryotes only. -Kozak consenses sequence is present in eukaryotes. This sequence surrounds AUG & determines the initiating codon of m-RNA. -### End" -5832,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A preterm baby developed bullous lesion on the skin soon after bih. The X- ray shows periostitis. What should be the next investigation?, with the following options: A: VDRL for mother & baby, B: ELISA for HIV, C: PCR for TB, D: Hepatitis surface antigen for mother - -### Response: -The baby described in the question stem is most likely suffering from the early manifestations of congenital syphilis. As per the choices given VDRL is the test done to diagnose syphilis. Ref: Harrison's Principles of Internal Medicine, 16th Edition, Page 981; Skin Diseases & Sexually Transmitted Infections, Uday Khopkar - 6th Edition, Page 257; Nelson 17th ,COGDT 10th Edition, Page 667;CPDT 18th Edition, Page 56. -### End" -5833,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pulsating varicose vein in a young adult is due to?, with the following options: A: Aeriovenous fistula, B: Sapheno femoral incompetence, C: Deep vein thrombosis, D: Abdominal tumour - -### Response: -Ans. is 'a' i.e., Aeriovenous fistula -### End" -5834,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19 year old boy suffering from chronic schizophrenia is put on haloperidol in the dose of 20 mg/day. A week after the initiation of medication the patient shows restlessness, fidgety, irritability and cannot sit still in one place. The most appropriate treatment strategy is -, with the following options: A: Increase in the dose of haloperidol, B: Addition of anticholinergic drug, C: Addtion of beta blocker, D: Adding another antipsychotic drug - -### Response: -Restlessness, fidgety, irritability and inability to sit still at one place in a patient, one week after initiation of antipsychotic (haloperidol) suggest the diagnosis of Akathisia. - -""The first line drug for akathisia is most commonly a β-blocker"". -### End" -5835,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person is brought to you after an A and on examination there is a lacerated wound in the thigh with some tissue damage. The surgery resident has cleaned and debrided the wound and prescribed antibiotics. History of the patient reveals that he has taken a complete course of tetanus toxoid with a booster dose 4 years ago. What is your line of management to prevent tetanus?, with the following options: A: Give 1 dose of tetanus toxoid, B: Give Human tetanus hyper -immunoglobulin, C: Give 'a' and 'b', D: Tell the patient that no tetanus prophylaxis is required - -### Response: -Since he has completed the course of tetanus toxoid and received a booster dose within 5 years nothing more is needed. If he had taken a booster dose more than 5 years ago and less than 10 years, 1 dose TT should have been given. If his last booster dose was > 10 years ago he needs both toxoid and immunoglobulin. Same is the case if he has not been vaccinated before. Note: - In case of a clean non penetrating injury with minimal tissue damage the treatment is only toxoid if no booster is received within 5 years. Ref: Park, Edition 21, Page 287 -### End" -5836,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 49-year-old woman has a history of peptic ulcer disease for which she has been treated with proton pump inhibitors. She has had nausea with vomiting for the past 2 months. Upper GI endoscopy reveals three circumscribed, round, smooth lesions in the gastric body from 1 to 2 cm in diameter. Biopsies are taken and microscopically show the lesions to consist of irregular glands that are cystically dilated and lined by flattened parietal and chief cells. No inflammation, Helicobacter pylori, metaplasia, or dysplasia is present. What is the most likely diagnosis?, with the following options: A: Fundic gland polyps, B: Gastric adenomas, C: Hyperplastic polyps, D: Hypertrophic gastropathy - -### Response: -There is an association of fundic gland polyps with the use of proton pump inhibitors and also with familial adenomatous polyposis (FAP); increased gastrin may drive glandular hyperplasia. Gastric adenomas are most common in the antrum, have intestinal metaplasia with dysplasia, and are precursors to adenocarcinoma; they may occur with FAP. Hyperplastic polyps are associated with chronic gastritis, often from H. pylori infection. One form of hypertrophic gastropathy is Menetrier disease, which results from excessive secretion of transforming growth factor-alpha (TGF-a) with diffuse enlargement of gastric rugae and protein-losing enteropathy. -### End" -5837,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most rapidly metastasing tumor is, with the following options: A: African burkitt jaw lymphoma, B: Hodgekin’s lymphoma, C: Non Hodgekin’s lymphoma, D: None of the above - -### Response: -Burkitt Lymphoma Variants -### End" -5838,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NERNST's potential of Na+ is, with the following options: A: 61, B: -60, C: 90, D: -80 - -### Response: -Nernst potential -Na+- +60mv -K+- -90mv -Cl- - -70mv -### End" -5839,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disease caused by both Rickettisia and Orientia is transmitted by:, with the following options: A: Rat flea, B: Tick, C: Louse, D: Trombiculid mite - -### Response: -Ans. is (d) Trombiculid mite Trombiculid mite transmit both rickettsia disease (Rickettsial pox) and orientea disease (scrub typhus) Ahropod-borne diseases Ahropod Disease transmitted Mosquito Malaria, filaria, viral encephalitis (e.g. Japanese encephalitis), viral fevers (e.g. dengue, West Nile, viralhaemorrhagic fevers (e.g. yellow fever, dengue haemorrhagic fever) Housefly Typhoid and paratyphoid fever, diarrhoea, dysentery, cholera, gastroenteritis, amoebiasis, helminthicinfestations, poliomyelitis, conjunctivitis, trachomas, anthrax, yaws, etc. Sandfly Kala-azar, oriental sore sandfly fever, oraya fever Tsetse fly Sleeping sickness Louse Epidemic typhus, relapsing fever, trench fever, pediculosis Rat flea Bubonic plague, endemic typhus, chiggerosis, hymenolepis diminuata Blackfly Onchocerciasis Reduviid bug Chagas disease Hard tick Tick typhus, viral encephalitis, viral fevers, viral haemorrhagic fever, (e.g. Kyasanur forest disease), tularemia, tick paralysis, human babesiosis Soft tick Q fever, relapsing fever Mnemonic: QRST Trombiculid mite Scrub typhus, Rickettsial-pox Itch mite Scabies Cyclops Guinea-worm disease, fish tapeworm (D. latus) Cockroaches Enteric pathogens -### End" -5840,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following bacterias are most often associated with acute neonatal meningitis, EXCEPT:, with the following options: A: Escherichia coli, B: Streptococcus agalactiae, C: Listeria monocytogenes, D: Neisseria meningitidis - -### Response: -Neisseria meningitidis usually affects younger children and 1-4 months of age. Neonatal cases are rarely seen. Upon Gram staining, it appears as a Gram-negative diplococcus and cultures of the bacteria test positive for the enzyme oxidase. There are several different groups of meningococcal bacteria including Groups A, B, C, Y and W135. Ref:Kligman, Behrman, Jenson, Stanton (2008), Chapter 190, ""Neisseria meningitidis"", In the book, ""Nelson's Textbook of Pediatrics"", Volume 1, 18th Edition, New Delhi, Page 1164 -### End" -5841,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mental health programme was staed in -, with the following options: A: 1982, B: 1987, C: 1990, D: 1995 - -### Response: -National mental health programme was launched in 1982 with a view to ensure availability of mental health care services for all , especially the community at risk and underprevileged section of the population ,to encourage application of mental health knowledge in general health care and social devalopment. ref; (page no;473) 23rd edition of PARK&;s textbook of Preventive and Social medicine -### End" -5842,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is NOT a feature of adipocere formation?, with the following options: A: Develops in moist clay soil, B: Due to hydrolysis and hydrogenation of fat, C: Cheesy odour, D: First seen in subcutaneous fat deposit of cheek, buttocks etc - -### Response: -Adipocere has a offensive rancid or an unpleasant sweetish smell. It occurs as a result of hydrolysis and hydrogenation of preexisting fats into higher fatty acids which later combines with calcium and ammonium ions to form soluble soap which resists putrefaction. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page - 137, 138. -### End" -5843,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dew-drop on rose petal appearance is characteristic rash of -, with the following options: A: Small pox, B: chikenpox, C: Measles, D: Rubella - -### Response: -Ans. is 'b' i.e., Chickenpox * Varicella zoster virus (VZU) is Herpes simplex virus type III (HSV-III) causative agent of chicken pox and herpes-zoster (shingle).* Varicella (Chicken pox) and Herpes zoster are different manifestations of the same virus infection. The virus is therefore called varicella zoster virus (VZA).* Primary infection with VZV causes chicken pox.* Reactivation of latent VZV, when immunity has fallen to ineffective levels causes-Herpes zoster* The virus remains dormant in sensory ganglion of trigeminal nerve and reaches the eye along one or morebranches of the opthalmic division of the 5th nerve.Chicken pox* The causative agent of chicken pox is Varicella - Zoster virus (Herpes simplex type III).* It is an acute respiratory infection with incubation period 10-21 days.* Infection is acquired through respiratory tract via air droplets or rarely from conjunctiva.* Infectious period (communicable period) for chicken pox is 2 days prior to 5 days after onset of rash, with a very high secondary attack rate of 90%.* Chicken-pox usually affects children of age group 5-9 years.* Clinical features of chicken pox has two stages1) Pre-eruptive stage# Characterized by fever, back pain, malaise and shivering.2) Eruptive stage# It is characterized by a characteristic rash with following features (which must be differentiated from rash of small pox)i) Superficial and unilocular (rash of small pox is deep seated and multilocular).ii) Symmetrical, mostly on flexor surface (rash of small-pox usually affect extensor surface).iii) Centripetal distribution (rash of smallpox has centrifugal distribution).iv) Affects axilla but spares palms and soles (rash of small-pox affects palms and soles but spares axilla).v) Pleomorphic, with appearance of all stages of rash simultaneously (rash is mon-omorphic in nature in small-pox).vi) Dew-drop on rose petal apperance (rash of small-pox has umblicated apperarance).vii) Area of inflammation around the rash (in small-pox there is no inflammation around the rash).viii) Evolution of rash is rapid, scabs begin to form 4-7 days after rash (evolution is slow, scabs begin 10-14 days after rash).* Though the disease affects children commonly, it is more severe in adults than in children.* Most common complication of varicella is secondary bacterial infection of skin, usually caused by streptococci or staphylococci. The most common extracutoneous site of involvement in children is CNS. Varicella pneumonia is the most serious complication following chicken - pox in adults. Important complications of chicken pox are:-i) Pulmonary: Pneumoniaii) CNS: Cerebellar ataxia, encephalitis, meningitis, GB syndrome, Transverse myelitis.iii) Others : Myocarditis, Nephritis, arthritis, hepatitis, corneal lesions, thrombocytopenia, bleeding diasthesis.* Latent infection is established in cranial nerve, sensory ganglia and spinal dorsal root ganglia. The virus may reactivate in immuno suppressive conditions, resulting in herpes zoter in about 10-30% of persons. -### End" -5844,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following spread by auto infection except:, with the following options: A: Taenia solium, B: Strongyloides stercoralis, C: Hymenolepis nana, D: Ascaris lumbricoides - -### Response: -Parasites causing autoinfection are(C2HEST)C- Capillaria philippinensisCryptosporidium parvumH- Hymenolepis nanaE- Enterobius vermicularisS- Strongyloides stercoralisT- Taenia solium(Pork tapeworm) Taenia solium have proglottids responsible for causing autoinfection. -### End" -5845,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The floating tip of the iceberg represents what the physician sees in the community as:, with the following options: A: Clinical cases, B: Latent cases, C: Undiagnosed cases, D: Carriers - -### Response: -Health professionals see only a small part of the illness in the community, just as only a small part of an iceberg is visible above the surface of the water. This is what is called "" the tip of the iceberg"", as information on the submerged portion is not available.  -But the inapparent cases are important for their role in transmission. Since many inapparent infections can be transmitted and can produce disease in others, it is not sufficient to direct disease management procedures solely to clinically apparent cases. -### End" -5846,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thyroid hormone receptor which is predominantly expressed in CNS/Brain -, with the following options: A: a - 1, B: a - 2, C: b - 1, D: b - 2 - -### Response: -Ans- b - 1 Ref- -### End" -5847,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HIV virus primarily effets:, with the following options: A: CD4 + T cells, B: CD 8 cells, C: Lymphocytes, D: Plasma cells - -### Response: -CD4 + T cells -### End" -5848,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chaga's disease is caused by: September 2011, with the following options: A: Trypanosoma brucei gambiense, B: T. cruzi, C: T. rangeli, D: T. brucei brucei - -### Response: -Ans. B: T. cruzi T. cruzi causes American trypanosomiasis or Chaga's disease Chagas disease/American trypanosomiasis It is caused by the flagellate protozoan Trypanosoma cruzi. T. cruzi is commonly transmitted to humans and other mammals by an insect vector, the blood-sucking insects of the subfamily Triatominae (family Reduviidae) most commonly species belonging to the Triatoma, Rhodnius, and Panstrongylus genera. The disease may also be spread through blood transfusion and organ transplantation, ingestion of food contaminated with parasites, and from a mother to her fetus. In the early, acute stage, symptoms are mild and usually produce no more than local swelling at the site of infection. The initial acute phase is responsive to antiparasitic treatments, with 60-90% cure rates. After 4-8 weeks, individuals with active infections enter the chronic phase of Chagas disease that is asymptomatic for 60-80% of chronically infected individuals through their lifetime. The currently available antiparasitic treatments for Chagas disease are benznidazole and nifuimox, which can cause temporary side effects in many patients including skin disorders, brain toxicity, and digestive system irritation. -### End" -5849,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about osteochondromatosis -, with the following options: A: Malignant, B: Manifest at adult, C: Knee is the most common size, D: Common in women - -### Response: -Most of the guides have wrongly explained this question because they have explained synovial chondromatosis in this, question.                                                                         • -First, let me tell you that osteochondromatosis and synovial chondromatosis (synovial- osteochondromatosis) are different diseases. -Osteochondromatosis is the presence of multiple osteochondroma in the body, e.g. in multiple hereditary exostosis. -Osteochondroma is a benign tumour and occurs in teenager and young adults. -So, the answer to this question is b, i.e. manifest at adult. -If the question would have been synovial osteochondromatosis then the answer is b & c. -### End" -5850,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best sonological marker for diagnosis of downs in 1st trimester:, with the following options: A: Nuchal translucency, B: Fetal heart, C: Microcephaly, D: Polyhydramnios - -### Response: -Ans-A Ref: Dutta's Text Book of Obstetrics, 7th edition, pg 106. Williams Obstetrics, 23rd edition. Explanation: Antenatal Screening for Down's syndrome First-trimester screening for down's syndrome includes NT (nuchal translucency), PAPP-A, hCG Nuchal translucency > 3.5 mm is significant. It is done at 11-14 weeks Detection rate- 79-87% Triple test and quadruple tests are done in second trimesier at 15-20 weeks Triple test: hCG, AFP, unconjugated estriol. Quadruple test: triple test + inhibit! Integrated test: first trimester screening + quadruple test MSAFP|, UE3|, HCG|, Inhibin A| in down's syndrome. USG markers of Down's syndrome fetus (soft tissue markers) Nuchal fold thickening Mild renal pelvis dilatation Echogenic intracardiac focus Echogenic bowel Short femur Short humerus DOWN's syndrome around 40% congenital heart disease -Complete atrioventricular septal defect (CAVSD) - 37 percent -Ventricular septal defect (VSD) - 31 percent -ASD - 15 percent -Partial atrioventricular septal defect (PAVSD) - 6 percent -Tetralogy of Fallot (TOF) - 5 percent -PDA - 4 percent -Miscellaneous - 2 percent Reference: Uptodate; largest population based study on Downs done from UK -### End" -5851,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: . Ideal contraceptive for lactating mother is:, with the following options: A: Barrier method, B: Combined OCP, C: Lactational amenorrhoea, D: Progesterone only pill - -### Response: -For newly married couples oral contraceptive pill is the method of choice provided there are no contraindications. -It has many noncontraceptive benefits along with effective contraception. -Barrier and Natural methods have high failure rate. -IUCD are not prescribed in nulliparous females due to increase risk of PID and infertility -In a couple who are living separately in two cities and meet only, occasionally contraception of choice is barrier method. -“Condom are suitable for use in old ager for couple who have infrequiuent coitus, during lactation, during holidays, subject who can not tolerate OCP, IUCD”. -In Breastfeeding Females -For lactating mothers, contraceptive should be chosen in such a way that in addition to providing effective contraception, they do not adversely affect the success of lactation or the health of the infant. Barriers have a high failure rate of 4–14% and not reliable for long-term control. -As estrogens decrease the quality and quantity of milk, COC pills are absolutely contraindicated in lactating mothers. -Lactation Amenorrhea Method (LAM) -• Excessive secretion of prolactin, which controls lactation, inhibits the pituitary. Prolactin inhibits luteinizing hormone (LH) but has no effect on follicle-stimulating hormone (FSH). However, it partially inhibits ovarian respons to both of these gonadotropins. As a result, while the prolactin level remains high, the ovary produces little estrogen and no progesterone. Hence, ovulation and menstruation are affected. -• LAM is effective only till 6 months postpartum. Beyond this, it is not a reliable method. -• Even for the 6 months, it is effective only if there is exclusive breastfeeding. -• It any time in the first 6 months the menses starts, then it cannot be used as birth control. -• POPs are safe with breastfeeding and very effective. They were mainly designed especially for lactating mothers. -### End" -5852,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is associated with PAS positive Macrophages, with the following options: A: Whipple's disease, B: Tropical sprue, C: Celiac disease, D: Crohn's Disease - -### Response: -The hallmark of Whipple&;s disease is the histopathological finding of macrophages that are positive on periodic acid-Schiff (PAS) staining. The main histological features are extensive PAS-positive material in the lamina propria, and villous atrophy. Characteristic Histopathological finding in Whipple&;s DIsease Infiltration of Lamina Propria with PAS-positive macrophages that are resistant to Diastase (Granular foamy macrophages stained purple with PAS) Inclusions of T.whipplei bacilli or its paly digested remnants may be observed. T.whipplei is a gram-positive, non-acid-fast periodic acid-Schiff (PAS)-positive bacillus with a characteristic trilamellar plasma membrane surrounded by a cell wall. Bacilli with a characteristic trilamellar membrane/wall is specific for Whipple&;s disease The disease of the T.whipplei bacillus outside of macrophages is a more impoant indicator of active disease than is their presence within the macrophages. Whipple&;s Disease Tropical Sprue Coeliac Disease Malasorption syndrome with systemic features with infections etiology Malabsorption syndrome of infection etiology without systemic features Malabsorption syndrome of non-infectious etiology without systemic features Etiology Etiology Etiology Tropheryma whippelii is a small gram-positive bacillus in the group Actinobacteria Caused by some strains of E.coli Caused by intolerance to &;gliadin&; gluten a protein found in wheat rye, barley Biopsy Biopsy Biopsy Biopsy is Abnormal and specific/diagnostic Lamina Propria is infiltrated with macrophages containing PAS positive glycoproteins and rod shaped bacilli Villous Atrophy Biopsy is abnormal but not specific/diagnostic Shoened, thickened villi increased crypt depth infiltration by mononuclear cells Biopsy is abnormal but not specific/diagnostic Blunting and flattening surface with villi either absent or broad and sho crypts are elongated. Dense infiltration of inflammatory cells in lamina propria Clinical features Clinical features Clinical features Features of malabsorption + Array of systemic features Features of malabsorption Features of malabsorption Management Management Management Etiology is infectious so treatment is with Antibiotics Trimethoprim + Sulfamethoxazole Etiology is infectious so treatment is with antibiotics (Sulphonamide/Tetracycline) Etiology is not infectious but immune Gluten free diet (no antibiotics) + Glucocoicoids or immunosuppressive agents Ref: Harsh Mohan 7th edition Pgno: 559 -### End" -5853,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Asymptomatic UTI in pregnancy, true is:, with the following options: A: Most are usually asymptomatic in pregnancy, B: If untreated, progresses to pyelonephritis, C: Early and prompt treatment prevents abnormalities in fetus, D: Increase chance of premature infant - -### Response: -Asymptomatic bacteriuria is used when a bacteria count of the same species over 10 5/mL in midstream clean catch specimen of urine on two occasions ia detected without symptoms of urinary infection. E.coli is the offending organism in over 90% cases. * 25% of these women are likely to develop pyelonephritis,usually in third TM if left untreated. * Increased association of premature labour and growth retarded babies is probably related with the underlying chronic renal lesion. * Incidence of HTN and anemia is stated to be high. Reference: Textbook of Dutta,9th edition, page 279 -### End" -5854,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common pancreatic endocrine neoplasm:, with the following options: A: Insulinoma, B: Gastrinoma, C: VIPoma, D: Glucagonoma - -### Response: -M/C NET of Pancreases - Non-Functional (PPOMA) M/C functional NET of Pancreas -Insulinoma MC Functional Enteropancreatic NET in MEN 1 - Gastrinoma > Insulinoma M/C functional & Malignant NET of Pancreas - Gastrinoma IOC for localization of NET - SRS (Somatostatin receptor Scintigraphy) -### End" -5855,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During a year-long training program, a 23-year-old female air force officer falls in class rank from first place to last place. She has also noted a lower pitch to her voice and coarsening of her hair, along with an increased tendency toward weight gain, menorrhagia, and increasing intolerance to cold. Which of the following laboratory abnormalities is expected?, with the following options: A: Increased serum free T4, B: Increased serum T3 resin uptake, C: Increased saturation of thyroid hormone-binding sites on TBG, D: Increased serum TSH - -### Response: -- Given history is strongly suggestive of idiopathic myxedema/ primary hypothyroidism. - Expected laboratory abnormalities in this pt are: decreased serum free T4 & T3 levels increased TSH levels - most appropriate test increased cholesterol decreased saturation of TBG decreased T3 resin uptake -### End" -5856,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common chronic symptoms of pelvic inflammatory disease is :, with the following options: A: Backache, B: Dysuria, C: Fever, D: Discharge - -### Response: -Backache -### End" -5857,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anti-GBM antibody-mediated Rapidly Progressive Glomerulonephritis is seen in, with the following options: A: Postinfectious glomerulonephritis, B: IgA nephropathy, C: Lupus nephritis, D: Goodpasture syndrome - -### Response: -Rapidly progressive glomerulonephritis (RPGN) is a syndrome associated with severe glomerular injury, characterized by rapid and progressive loss of the renal function associated with severe oliguria and signs of the nephritic syndrome.Anti-GBM antibody-mediated disease, characterized by linear deposits of IgG and, in many cases, C3 in the GBM. In some of these patients, the anti-GBM antibodies cross-react with pulmonary alveolar basement membranes to produce the clinical picture of pulmonary hemorrhage associated with renal failure (Goodpasture syndrome). Plasmapheresis to remove the pathogenic circulating antibodies is usually pa of the treatment, which also includes therapy to suppress the underlying immune response.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 20; The Kidney; Page no: 912 -### End" -5858,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The process of coating a paicle, such as a microbe, to target it for phagocytosis is called:, with the following options: A: Opsonization, B: Priming, C: Activation, D: None of the above - -### Response: -Leukocytes express receptors for proteins that coat microbes. The process of coating a paicle, such as a microbe, to target it for ingestion (phagocytosis) is called opsonisation. Substances that do this are opsonins. Ref: Robbins 8th edition Chapter 2. -### End" -5859,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 26 year old patient presents with suspected pneumococcal meningitis. CSF culture is sent for antibiotic sensitivity. Which empirical antibiotic should be given till culture sensitivity result come?, with the following options: A: Penicillin G, B: Ceftriaxone + metronidazole, C: Doxycycline, D: Cefotaxime + vancomycin - -### Response: -Ans. (D) Cefotaxime + vancomycin(Ref: Harrison 18/e p3414)Antibiotics Used in Empirical Therapy of Bacterial Meningitis and Focal CNS InfectionsIndicationAntibioticInfants <3 monthsAmpicillin + Cefotaxime3 months to 55 yearsCefotaxime (Ceftriaxone) + VancomycinAdults >55 yearsAmpicillin + Cefotaxime (Ceftriaxone) + VancomycinHospital-acquired meningitis post-traumatic or post-neurosurgery meningitis, neutropenic patients, or patients with impaired cell-mediated immunityVancomycin + Cefepime -### End" -5860,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are drugs used against HIV, EXCEPT:, with the following options: A: Elvucitabine, B: Bevirimat, C: Maraviroc, D: Tegaserod - -### Response: -New therapies are continually being sought for HIV that exploit new viral targets, have activity against resistant viral strains, have a lower incidence of adverse effects, and offer convenient dosing. New agents of existing classes that are currently in advanced stages of clinical development include the NI agent elvucitabine, the NNI agents TMC-278 and IDX899, the PI agent bracanavir, entry inhibitors such as the CCR5 receptor antagonists vicriviroc and PRO 140, and integrase inhibitors such as elvitegravir. In addition, new drug classes such as maturation inhibitors (bevirimat) and the CD4 receptor inhibitor TNX-355 are under investigation. Ref: Katzung 11th edition Chapter 49. -### End" -5861,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ELISA test has sensitivity of 95% and specificity of 95%. Prevalence of HIV carriers is 5%. The predictive value of positive test is-, with the following options: A: 95%, B: 50%, C: 100%, D: 75% - -### Response: -Ans. is 'b' i.e., 50% -### End" -5862,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Altered sensation over the area of the great saphenous vein in the leg is seen due to an injury to which of the following nerves?, with the following options: A: Femoral, B: Tibial, C: Sural, D: Fibular - -### Response: -Great saphenous vein on its course is accompanied by saphenous nerve which is a branch of femoral nerve. -### End" -5863,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 32-year old male with no past medical history is brought to the emergency depament after being injured in a bomb blast. On examination he is suspected to have a splenic injury and is supposed to undergo an emergency laparotomy. Which of the following is the ideal anaesthetic agent of choice?, with the following options: A: Remifentan, B: Morphine, C: Etomidate, D: Halothane - -### Response: -Ans. c. Etomidate -### End" -5864,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Salvage pathway of purine nucleotide synthesis are used by all except ?, with the following options: A: Brain, B: Liver, C: RBC, D: Leukocytes - -### Response: -Purine nucleotide synthesis occurs by two pathways :- 1.De novo synthesis 2.Salvage pathway Liver is the major site of purine nucleotide biosynthesis (de novo). Ceain tissues cannot synthesize purine nucleotides by de novo patyway, e g. brain, erythrocytes and polymorphonuclear leukocytes. These are dependent on salvage pathway for synthesis of purine nucleotides by using exogenous purines, which are formed by degradation of purine nucleotides synthesized in liver. -### End" -5865,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hanging is defined as :, with the following options: A: Suspension of body a ligature, body weight acting as constricting force, B: Suspension of body by ligature after death, C: Obliteration of air passages by external compression, D: Mechanical interference to respiration - -### Response: -A i.e. Suspension of body, body weight acting as constricting force -### End" -5866,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Melatonin is derived from -, with the following options: A: Tyrosine, B: Tryptophan, C: Glutathione, D: None - -### Response: -Ans. is -b' i.e., Tryptophan Amino acidsBiological important compoundTyrosineCatecholamines (epinephrine Q, norepinephrine Q, dopamine Q), thyroxine Q. triiodothrvonine, melanin Q.(Note : - Phenylalanine is the precursor of tyrosine, thus it can also give rise to all these compounds through tyrosine (phenylalanine - Tyrosine Q - Catecholamines Q, thyroxine Q, T3 melanin Q).TryptophanVitamin niacin Q, melatonin Q, Serotonin QGlycine Q,Arginine Q,methionine QCreatine QGlycine, cysteineBile saltsGlycineHemeAspartic acid and glutaminePyrimidine basesGlycine Q, aspartic acid, glutaminePurine bases Qb-alanineCoertzyme-AArginineNitric oxide QLysine, MethionineCarnitine -### End" -5867,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The term ankyloblepharon means: September 2009, with the following options: A: Smaller appearing palpebral fissure, B: Incomplete closure of palpebral apeure when eyes are shut, C: Adhesions of the margins of the two lids, D: Eversion of the lid margin - -### Response: -Ans. C: Adhesions of the margins of the two lids Paial or complete adhesion of the edge of one eyelid to that of the other is known as ankyloblepharon. It may occasionally result from a cicatrizing lesion of the eyelid margins or following tarsorrhaphy. It may also be congenital in which case the eyelids are joined together by bands of tissue and this condition is called ankyblepharon filiform adnatum. -### End" -5868,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lesions of pityriasis rosea are distributed mostly on the:, with the following options: A: Face, B: Trunk, C: Scalp, D: Palms and soleus - -### Response: -Ans:B.)Trunk -### End" -5869,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old P2C2 female has CIN grade III confirmed on papsmear and Colposcopy. Next step in management is:, with the following options: A: Conization, B: LEEP, C: Cryosurgery, D: Hysterectomy - -### Response: -Ans. is b, i.e. LEEPManagement of CIN-confirmed on colposcopy|||||CIN 1 persisting for >=2 years in female >=25 yearsCIN 2 and 3 at any age and any parityRecurrent CINCIN extending to vagina||||CryosurgeryLEEP/LLETZHysterectomyLaser -### End" -5870,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Causes of neuroregression in a child can be all except ?, with the following options: A: Wilson's disease, B: Vitamin B12 deficiency, C: ADHD, D: Ataxia telengiectasia - -### Response: -Ans. C. ADHDCauses of neuroregressionInheritedA. GreY matter involvement-With visceromegaly :- Niemann pick disease, Sandholf disease (GM2), sialidosis, Goucherdisease, Mucopolyschharidoses (MPS)Without visceromegaly :- TaySach Disease, Rett syndrome, Menke's kinky hair diseaseB. White matter involvement:-Leukodystrophies :- Metachromatic leukodystrophy, Krebbe's disease, Adrenoleukodytrophy, Alexander disease, Cannavan disease .Acquired/Demyelinating:-Multiplesclerosis,schilder'sdisease,DevicdiseaseC. Basal ganglia involvement - Wilson's disease, Dystonia muscular deformans, Huntington's diseaseD. Spinocerebeller :- Friedrich's ataxia, Ataxia telengiectasisE. AcquiredInfections:- SSPE, progressive rubella syndrome, HIVMetabolic:Chronicleadpoisoning,Hypothyoidism,VitB12&Edeficienry,Drugs(anticonvulsants). -### End" -5871,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Schiller duval bodies are seen in:, with the following options: A: Endodermal sinus tumour, B: Embryonal carcinoma, C: Dermoid cyst, D: Brenner tumour - -### Response: -Ref: Dutta Textbook of Gynecology 5th edition pg.368 Explanation: Schiller duval bodies are characteristic histological feature of endodermal sinus tumour. They are tuft of vascular tissue inside cystic spaces lined by flattened epithelium. ENDODERMAL SINUS TUMOUR aka Yolk Sac Tumour Originate from multipotential embryonal tissue as a result of selective differentiation of yolk sac structures Peak - 15 to 20 years of age Second most common malignant germ cell tumour of ovary Unilateral, solid, >10 cms diameter Micro-schiller duval bodies, eosinophilic hyaline bodies containing alphaprotein Associated with dysgerminoma Treatment- surgical staging and unilateral salpingo oopherectomy Combination chemotherapy - POMB-ACE regimen (cyclophosphamide, vincristine, methotrexate, bleomycin, actinomycin D, cisplatin, etoposide) VAC regimen, VBP regimen Tumor marker- alphafetoprotein >20 microgm/ml. Elevated alpha 1 antitrypsin Respond well to chemotherapy and good survival rate -### End" -5872,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Causes of pulmonary-renal syndrome -, with the following options: A: Leptospirosis, B: Hanta virus, C: Paraquat poisoning, D: All - -### Response: -The pulmonary renal syndrome is a dramatic presentation with renal and respiratory failure that is not explained by excess intravascular fluid or by severe pneumonia;it occurs in Good pasture' s disease(anti-GBM) and small-vessel vasculitis.Other causes include leptospirosis leading to Weil's disease,Hanta hemorrhagic fever and poisoning with the herbicide paraquat. Ref:Davidson's medicine-22nd edition,page no:519. -### End" -5873,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ejection click is heard in:, with the following options: A: Early systole, B: Late systole, C: Early diastole, D: Late diastole - -### Response: -The ejection sound is a sharp, high-pitched event occurring in early systole and closely following the first hea sound. Ejection sounds occur in the presence of semilunar valve stenosis and in conditions associated with dilation of the aoa or pulmonary aery. Ref: Harrison's principle of internal medicine 17th edition, chapter 220. -### End" -5874,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Binding of oxygen to haemoglobin reduces its affinity for carbon dioxide, which is known as, with the following options: A: Haldane effect, B: Chloride shift, C: Bohr effect, D: Anion exchanger 1 - -### Response: -Increase in carbon dioxide in the blood causes oxygento be displaced from the hemoglobin (the Bohr effect). The reverse is also true: binding of oxygen with hemoglobin tends to displace carbon dioxidefrom the blood. Indeed, this effect, called the Haldane effect, Ref: Guyton & Hall: Textbook of Medical Physiology page no:946 -### End" -5875,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the muscle relaxant of choice in renal failure?, with the following options: A: Rocuronium, B: Vecuronium, C: Rapacuronium, D: Atracurium - -### Response: -Atracurium and cis-atracurium are inactivated by Hoffman's elimination. It is the spontaneous molecular re- arrangement of these drugs leading to their inactivation without the requirement of liver or kidney. Therefore they are the muscle relaxants of choice for renal and hepatic failure patients. Also know Elimination of muscle relaxants: Renal Hepatic Both None Doxacurium Rapacuronium Pipecuronium Atracurium Tubocurarine Vecuronium Cis-atracurium Pancuronium Rocuronium Mivacurium Succinyl choline Ref: Katzung 9th/pg. 432; KDT 6th/pg. 345. -### End" -5876,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for nasopharyngeal carcinoma is, with the following options: A: Surgery, B: Radiotherapy, C: Surgery & radiotherapy, D: Chemotherapy - -### Response: -Treatment of nasopharyngeal carcinomaIrradiation is the treatment of choice (external radiotherapy)Radical neck dissection is required for persistent nodes when the primary has been controlled and in post-radiation cervical metastasisSystemic chemotherapy is used as palliation for distant metastases or radiation failureFor advanced stages (stage III & IV), the cure rate can be doubled when chemotherapy is combined with radiotherapyRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 279 - 286 -### End" -5877,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false regarding acute conjuctivitis, with the following options: A: Vision is not affected, B: Cornea is infiltrated, C: Topical antibiotics is the treatment of choice, D: Pupil is not affected - -### Response: -Among all four options, option A seems the most appropriate as any corneal infiltration will lead to decreased vision though in conjunctivitis it is commonly reversible Refer: Khurana 6th edition page number 76 -### End" -5878,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 month old child weighing 8 kg has Bitot spots in both eyes. Which of the following is the most appropriate schedule to prescribe vitamin A to this child ?, with the following options: A: 2 lakh units intramuscular (IM) on day 0, 14, B: 1 lakh units IM on day 0,14, C: 2 lakh units TM on day 0, 1 and 14, D: 1 lakh units IM on day 0, 1 and 14 - -### Response: -1 lakh units IM on day 0, 1 and 14 -### End" -5879,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The normal axial length of the eye -, with the following options: A: 18mm, B: 20 mm, C: 28 mm, D: 24mm - -### Response: -The length of the eyeball is approximately 24 mm, So the distances from the cornea / crystalline lens to the retina and the focal length of optical rays focused by the camera/crystalline lens propagating in the vitreous humor and imaging on the retina, are also about 24 mm -### End" -5880,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Woodworkers are associated with ____ type of sinus carcinoma, with the following options: A: Adenocarcinoma, B: Squamous cell carcinoma, C: Anaplastic carcinoma, D: Melanoma - -### Response: -Occupational etiology of paranasal sinus cancers:Wood industry workers- AdenocarcinomaNickel and chrome industry workersLeather industry workers, Coal workersOther etiologies- Chronic sinusitis, Protracted polyposis, Snuff use, Post irradiation, Inveed papilloma.Ref: Hazarika; 3rd ed; Pg 373 -### End" -5881,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a formal thought disorder?, with the following options: A: Delusion, B: Neologism, C: Derailment, D: Tangentiality - -### Response: -Delusion is a disorder of content of thought. Neologism, derailment, and tangentiality are formal thought disorder. -### End" -5882,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Negative Jones-1 and jones-II Dye test indicate, with the following options: A: Primary Hypersecretion of tears, B: Partial obstruction of distal nasolacrimal duct, C: Lacrimal pump failure, D: Partial obstruction of lacrimal canaliculi - -### Response: -Ans. (c) Lacrimal pump failureRef: Kanski 8/e, p. 67, 68* Partial obstruction of proximal lacrimal passages (Punctal or canalicular) or pump failure- Negative Jones 2* Partial obstruction of the nasolacrimal duct distal to the sac-Positive Jones, 2. -### End" -5883,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which may be a consequence of occlusal trauma on implants?, with the following options: A: Widening of the periodontal ligament., B: Soft-tissue sore area around the tooth., C: Bone loss., D: All of the above. - -### Response: -Bone loss is usually seen on the most coronal aspect of the implant in the form of a wedge. There is no periodontal ligament on implants, so there is no feeling of soreness. -### End" -5884,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After blunt trauma to eye a patient develops circumcorneal congestion. The further test done is, with the following options: A: Indirect Ophthalmoscopy, B: Perimetry, C: Intraocular pressure measurement, D: Slit lamp - -### Response: -Blunt or penetrating ocular trauma leads to vision loss through glaucoma. -Thus, next step is to measure IOP -### End" -5885,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are diagnostic criteria of allergic fungal sinusitis {AFS} Except ?, with the following options: A: Areas of high attuenuation on CT scan, B: Orbital invasion, C: Allergic eosinophilic mucin, D: Type 1 Hypersensitivity - -### Response: -CT scan shows mucosal thickening with hyperdense areas in fungal sinusitis. Allergic fungal sinusitis is due to the type 1 hypersensitivity reaction to fungal hyphae. It presents with sinonasal polyposis and mucin. (Ref: Textbook of ENT, Diseases of ENT, Dhingra, 7th edition, pg no. 220) -### End" -5886,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not an anxiolytic -, with the following options: A: Risperidone, B: SSRI, C: Clonazepam, D: Buspirone - -### Response: -Ans. is 'a' i.e., Risperidone -### End" -5887,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The major difference between X–Rays and Light is –, with the following options: A: Energy, B: Mass, C: Speed, D: Type of wave - -### Response: -The major difference between X-Rays and light is the 'energy' in each photon. An X-Ray photon has about 5000 times the energy than an ordinary light photon. -Major difference between X- rays & visible light:- - - -Wavelength -Energy -### End" -5888,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All cause ascending motor paralysis except, with the following options: A: Diabetes mellitus, B: Diphtheria, C: Guillain Barre syndrome, D: Porphyria - -### Response: -Ref: Harrison’s 18/e p3460 -Diphtheria infected individuals present with flulike symptoms of generalized myalgias, headache, fatigue, low-grade fever, and irritability within a week to 10 days of the exposure. -About 20–70% of patients develop a peripheral neuropathy caused by a toxin released by the bacteria. Three to 4 weeks after infection, patients may note decreased sensation in their throat and begin to develop dysphagia, dysarthria, hoarseness, and blurred vision due to impaired accommodation. -A generalized polyneuropathy may manifest 2 or 3 months following the initial infection, characterized by numbness, paresthesias, and weakness of the arms and legs and occasionally ventilatory failure. - CSF protein can be elevated with or without lymphocytic pleocytosis. EDx suggests a diffuse axonal sensorimotor polyneuropathy. Antitoxin and antibiotics should be given within 48 h of symptom onset . Although early treatment reduces the incidence and severity of some complications (i.e., cardiomyopathy), it does not appear to alter the natural history of the associated peripheral neuropathy. The neuropathy usually resolves after several months. -### End" -5889,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Delayed dentition is usually considered when there are no teeth by the age of?, with the following options: A: 18 months, B: 9 months, C: 16 months, D: 13 months - -### Response: -Delayed dentition is usually considered when there are no teeth has erupted by the age of 13 months Normally temporary teeth eruption is completed by 2 to 2.5yr of age -### End" -5890,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for Zollinger-Ellison syndrome is:-, with the following options: A: Cimetidine, B: Omeprazole, C: Misoprostol, D: Aluminium hydroxide - -### Response: -Proton pump inhibitors are the drugs of choice for peptic ulcer disease (PUD) due to any etiology (even NSAID induced). These are also the agents of choice for gastroesophageal reflux disease (GERD) and Zollinger Ellison Syndrome (ZES). Zollinger Ellison syndrome: It is a Pancreatic or duodenal gastrinoma which leads to secretion of large amounts of gastric acid causing severe ulcers and hyperchlorhydria. PPI are better than H2 blockers in this condition. -### End" -5891,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: About Diaphragmatic injury, true statement is -, with the following options: A: T/t is conservative, B: Resolves spontaneously, C: Left side is more common, D: Associated with pneumothorax - -### Response: -Diaphragmatic rupture is more common on the left side. -Cause - -The right diaphragm is protected by two mechanisms: -The liver on the right and the heart in the centre have a buffering effect that diffuses the sudden increase in intraabdominal pressure. -Diaphragmatic Injuries -Diaphragmatic injuries are often caused by penetrating injuries. Patients sustaining penetrating injuries below the nipples and above the costal margins should be investigated to rule out diaphragmatic injury. Blunt injury to the diaphragm is usually caused by a compressive force applied to the pelvis and abdomen. the diaphragmatic rupture is usually large, with herniation of the abdominal contents into the chest. Herniation occurs as a result of the pressure differential between the thoracic and abdominal cavity. Most diaphragmatic injuries are silent and the presenting features are those of injury to the surrounding organs. The most accurate investigation is by video-assisted thoracoscopy (VATS) or laparoscopy. Operative repair is recommended in all cases. All penetrating diaphragmatic injury must be repaired via the abdomen and not the chest, to rule out penetrating hollow viscus injury. -### End" -5892,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following drugs are cell wall synthesis inhibitors except?, with the following options: A: Colistin, B: Fosfomycin, C: Bacitracin, D: Cycloserine - -### Response: -Ans. is 'a' i.e., Colistin -### End" -5893,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Criminal negligence is punishable for a maximum period of, with the following options: A: 1year, B: 2years, C: 3years, D: 5years - -### Response: -304A. Causing death by negligence-- Whoever causes the death of any person by doing any rash or negligent act not amounting toculpable homicide shall be punished with imprisonment of either description for aterm which may extend to two years, or withfine or with both. Ref - Krishan Vij textbook of forensic medicine and toxicology 5e pg - 206 -### End" -5894,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a study it is observed that the right ovary ovulates more than the left, all are possible explanations for the cause except:, with the following options: A: Anatomical asymmetry, B: Difference in blood supply to both sides, C: Right handedness is more common in population, D: Some embryological basis - -### Response: -Ans. is c, i.e., Right handedness is more common in populationRef: humrep.oxfordjournal.org/content/12/8/1730.full.pdf* In the primate it is suggested that ovulations occur with equal frequency in the left and right ovary.* In the humans there is some controversy about the frequency of ovulation on each side.* It is believed that in normally menstruating women ovulation was significantly higher in right ovary.* It is believed that right sided, predominance was either genetically determined or due to difference in the vasculature of the ovaries.* The anatomical asymmetry between the left and right side are also thought to be the reason.* The left ovarian vein drains to the left renal vein and the right ovarian vein to the inferior venacava.* The left renal vein is thought to be under high pressure than the right and therefore drain slower. Because the left ovary drains slower, the collapsed follicle (corpus luteum) takes longer to clean and thereby diminishes the chances that ovulation will occur on that side the following month.- No such condition exists on the right side which is why successive right side ovulation is more common. -### End" -5895,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 42- year old man is undergoing chemotherapy after resection of a cecal adenocarcinoma with positive lymph nodes. Which of the following potentially operable complications is a common occurrence among patients receiving systemic chemotherapy?, with the following options: A: Acute cholecystitis, B: Perirectal abscess, C: Appendicitis, D: Diverticulitis - -### Response: -A surgeon is frequently asked to evaluate patients who are receiving systemic chemotherapy Most complications of chemotherapy do not require surgical therapy. Perirectal abscesses are more common in these immunosuppressed patients. 'Gastrointestinal bleeding occurs secondary to mucosal irritation and thrombocytopenia, Pancreatitis is uncommon, but is associated with L-asparaginase use. Up to 20% of patients treated with floxuridine by continuous hepatic artery infusion develop some degree of inflammation and obstruction of the bile duct. Systemic chemotherapy does not increase the likelihood of acute cholecystitis. appendicitis, incarcerated femoral hernia, or diverticulitis. -### End" -5896,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 years old, multigravida aboed 5 months back at 17 weeks of gestation. She has not got her periods yet. Urine pregnancy test is negative. Estrogen progesterone withdrawal test is negative. The likely diagnosis is:, with the following options: A: Pituitary failure, B: Ovarian failure, C: Anovulation, D: Asherman syndrome - -### Response: -In Patient with secondary amenorrhea, after ruling out pregnancy progesterone challenge test is to be done. Patients with anovulation will get menses with progesterone. (Progesterone acts only on estrogen primed endometrium. In patients with anovulation, estrogen is present but progesterone is absent). Patients with both hypothalamo/ pituitary failure and ovarian failure will get menses with E + P. Absence of withdrawal by E + P indicates end organ failure. The Patient had a second-trimester aboion, following which a curettage may have been done to remove the retained products leading to Asherman syndrome The best diagnostic method is hysteroscopy and this is treated by Adhesiolysis -### End" -5897,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Color of granules in mycetoma caused by Actinomadura pelletierrii -, with the following options: A: Black, B: Yellow, C: Red, D: Brown - -### Response: -Ans. is 'c' i.e., Red Colout of Grains in Mycetomas of Various Etiology White to Yellow Brown to Black Red 1) Nocardia asteroides 1) Madurella mycetomi 1) Actinomadura pelletierrii 2) Nocardia brasilliensis 2) Madurella grisea 3) Actinomadura madurae 3) Phialophora jeanselmei 4) Streptomyces somaliensis 5) Allescheria boydii -### End" -5898,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Test used to differentiate maternal from fetal blood, with the following options: A: Osmotic fragility test, B: Water bulb test, C: Apt test, D: Kleihauer Betke test - -### Response: -The Apt test is most commonly used in cases of vaginal bleeding late during pregnancy (antepaum haemorrhage) to determine if the bleeding is from the mother or the fetus. -### End" -5899,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Partial dissolution of smear layers takes place in:, with the following options: A: 1st generation, B: 2nd generation, C: 3rd generation, D: None - -### Response: -In 1st and 2nd generation, smear layer is preserved. -### End" -5900,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Focal diffuse gall bladder wall thickening with comet tail reverberation aifacts on USG is in ?, with the following options: A: Adenomyomatosis of gall bladder, B: Ca gall bladder, C: Adenomatous polyps, D: Xantho granuloma - -### Response: -Ans is `a' i.e., Adenomyomatosis of gall bladderCholecystoses o Cholecystoses are a group of noninflammatory conditions of gallbladder wall. cholecystoses can be divided into hyperplastic and thesaurismotic (accumulating forms). The hyperplastic forms are characterized by normal growth of the wall components, while thesaurismotic forms accumulate deposite of organic and inorganic material in the gall bladder wall.o The common forms of cholecystoses are Adenomyomatosis, cholesterosis and porcelain gall bladder. 1)Adenomyomatosis : - Ademomyomatosis is the most common form of cholecystoses. It is characterized by segmental or diffuse thickening of mucosa and muscular wall . In the thickened wall, more specifically, small cystic spaces are present, representing the dilated Rokitansky-Aschoff sinus. The most frequent site of the segment form is the gall bladder fundus. The sonographic signs are an irregular profile of the internal mucosa and wall thickening, in which may be seen hypoechoic cyst like zones corresponding to RokitanskyAschoff sinuses. These cystic zones may contain debris or little stones, have an acoustic shadow or, more frequently, a comet tail aefact, which is considered a specific finding. USG findings in brief are : -i) Hyperechoic thickening of bladder wall.ii) Hypoechoic cyst in the walliii) Acoustic shadowiv) Coment tail aefact2)Cholesterosis : - There are deposits of cholesterol in the epithelial cells and in the submucosal macrophages. This gives appearance of multiple small yellow spots on a red hyperplastic muscosa, the straberry gallbladder. Cholesterosis may be : -i) Diffuse & micronodular (Nodule < 1 mm)Focal (nodules > 3 mm)3) Porcelain gallbladder : - Consists of calcification of gall bladder wall; the calcified wall produces shadowing of the acoustic signal. -### End" -5901,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not steroid?, with the following options: A: Estrogen, B: Cholic acid, C: Leukotrians, D: Vitamin D - -### Response: -Leukotrienes are a family of inflammatory mediators produced in leukocytes by the oxidation of arachidonic acid (AA) and the essential fatty acid eicosapentaenoic acid (EPA) by the enzyme arachidonate 5-lipoxygenase.Ref: DM Vasudevan, 7th edition, page no: 190 -### End" -5902,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug of choice for mushroom poisoning is: Al 07, with the following options: A: Atropine, B: Physostigmine, C: Adrenaline, D: Carbachol - -### Response: -Ans. Atropine -### End" -5903,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renal replacement therapy replaces all except -, with the following options: A: Endocrine function, B: Urine output, C: Blood biochemistry, D: Ultrafiltration - -### Response: -Renal replacement therapy does not replace the endocrine and metabolic functions of the kidney . It maintains plasma biochemistry (uraemic toxins, electrolytes acid base) It also removes fluid from the circulation (ultrafiltration) to maintain the plasma volume. Ref Harrison20th edition pg 290 -### End" -5904,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 22 yr old woman underwent routine antenatal tests at 14 weeks pregnancy. Her urine routine showed leucocyte esterase positive and a subsequent culture showed E.coli > 100,000 organisms /mL. Patient has no urinary symptoms. Which of the following is false about her condition ?, with the following options: A: Asymptomatic bacteriuria (ASB) in pregnancy is associated with Preterm delivery and low bih weight., B: There is an increased incidence of ASB in women with sickle cell trait., C: No treatment is warranted as patient is asymptomatic, D: 25 % with ASB will subsequently develop an acute symptomatic urinary infection during the pregnancy if not treated - -### Response: -ASYMPTOMATIC BACTERIURIA Incidence is 2-7% Increased incidence of ASB in women with sickle cell trait and diabetics All pregnant patients are screened and treated for asymptomatic bacteriuria at the initial prenatal visit due to the risk of pyelonephritis, preterm bih and low bih weight associated with untreated asymptomatic bacteriuria. An initial positive urine culture result done as a pa of prenatal care should prompt treatment. After this, less than 1 percent of women develop a urinary tract infection 25 % female with ASB will subsequently develop an acute symptomatic urinary infection during the pregnancy if ASB is not treated Empirical treatment: Tab. Nitrofurantoin 100 mg BD for 7 days -### End" -5905,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about bronchial circulation are true, Except, with the following options: A: Contribute 2% of systemic circulation, B: Contribute to gaseous exchange, C: Cause venous admixing of blood, D: Provide nutritive function of lung - -### Response: -Ans. (b) Contribute to gaseous exchange(Ref: Ganong, 25th ed/p.637)Bronchial circulation supplies oxygenated blood to the lungs through bronchial arteriesBronchial circulation constitutes about 2% of the cardiac outputBronchial arteries supply lung till the level of terminal bronchiolesBronchial circulation doesn't contribute to gaseous exchange -### End" -5906,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is True regarding absence seizures?, with the following options: A: Attack lasts for 60 to 90 seconds, B: Hyperventilation often precipitates an attack, C: Onset of disease in the first year of life, D: Attack followed by postictal confusion - -### Response: -b. Hyperventilation often precipitates an attack(Ref: Nelson's 20/e p 2831-2856, Ghai 8/e p 557-561)Typical absence seizuresUsually start at 5-8 yr of age; They do not have an aura, usually last for only a few seconds and are accompanied by eyelid flutter or upward rolling of eyes and simple automatisms like lip-smacking or picking at clothingAbsence seizures do not have a postictal periodQ and there is immediate resumption of what patient was doingHyperventilation for 3-5min can precipitate seizures & 3Hz spike-and-slow-wave dischargesEarly onset absence seizures (before the age of 4 yr) should trigger evaluation for glucose transporter defect. -### End" -5907,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cardiac or central nervous system toxicity may result when standard lidocaine doses are administered to patients with circulatory failure. This may be due to the following reason –, with the following options: A: Lidocaine concentration are initially higher in relatively well perfused tissues such as brain and heart, B: Histamine receptors in brain and heart gets suddenly activated in circulatroy failure, C: There is a sudden out-burst of release of adreneline, noradreneline and dopamine in brain and heart, D: Lidocaine is converted into a toxic metabolite due to its longer stay in liver - -### Response: -Lidocaine is a rapidly acting drug because of its rapid distribution to well perfused tissues such as brain and heart. -Circulatory failure is characterized by decreased cardiac output and a consequent decrease in hepatic blood flow. As a result metabolic clearance of Lidocaine in liver is diminshed and its elimination is increased. Consequently Lidocaine concentration is initially increased in these relatively well perfused tissues (brain and heart) even with usual doses and toxicity results. -### End" -5908,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of shunt infection following a Ventriculo-Peritoneal shunt is:, with the following options: A: Staph aureus, B: Staph epidermidis, C: Strepto viridans, D: Strepto pneumoniae - -### Response: -V-P Shunt: Medical device that relieves pressure on the brain by draining the extra CSF from brain into peritoneum. Used to treat Hydrocephalus Major complications of V-P shunt: Occlusion --> characterized by headache, papilledema, emesis, mental status changes. Bacterial infection --> characterized by fever, headache, meningismus. MCC --> Staph epidermidis -### End" -5909,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in Thoracic outlet syndrome except -, with the following options: A: Mass in the Neck, B: Wasting of forearm muscles, C: Adson's test positive, D: Pallor - -### Response: -Muscles of hand are wasted, not the forearm muscles. -• Ulnar nerve (C8-T1) involvement is most common. -• It is associated with: -−− Motor weakness and atrophy of the hypothenar and interosseous muscles -−− Pain and paresthesia along the medial aspect of the arm, hand, 5th finger and medial aspect of 4th finger. -### End" -5910,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Healthy Human volunteers pa of which clinical trial phase?, with the following options: A: I, B: II, C: III, D: IV - -### Response: -Ans. is 'a' i.e., I CLINICAL TRAILS Before a new drug comes to the market, it is extensively tested in animals and invitro studies for safety and efficacy. It the drug is found to be promising in these studies, an application called IND (Investigational New Drug) is filed with United States food and drug administration (FDA), which is main regulatory authority. If the permission is granted, then drug is tested in humans. This testing is called clinical trial. These are divided into four phases. -### End" -5911,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about trigone of bladder except:, with the following options: A: Mucosa is loosely attached to the underlying musculature, B: Mucosa is smooth, C: Lined by transitional epithelium, D: Derived from absorbed pa of the mesonephric duct - -### Response: -A i.e. Mucosa loosely attached to the underlying musculature -### End" -5912,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme used in PCR is, with the following options: A: Reverse transcriptase, B: Taq polymerase, C: RNA polymerase, D: None - -### Response: -In step 3 i.e polymerization : New DNA strands are synthesized by Taq polymerase. This enzyme is derived from bacteria Thermus acquaticus that are found in hot springs.Therefore the enzyme is not denatured at high temperature. REFERENCE : DM.VASUDEVAN.TEXTBOOK; SEVENTH EDITION; PAGE NO :638. -### End" -5913,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metaclopramide all are true except -, with the following options: A: Increase gastric emptying, B: D2-agonist, C: Acts on CTZ, D: Long term use can cause parkinsonism, galactorrhoea and gynaecomastia - -### Response: -Ans. is 'b' i.e., D2-agonist o Metaclopramide is D2-antagonist (not agonist).Metoclopramideo Metoclopramide is aprokinetic drug -Promotes gastrointestinal transit and speed gastric emptying by enhancing coordinated propulsive motility.o It has more prominent effect on upper GIT - increases gastric peristalsis, while relaxing the pylorus and the first part of duodenum - speed gastric emptying. Tone of lower esophageal sphincter (LES) is increased and gastroesophageal reflux opposed.o It has less prominent effect on lower GIT - increases intestinal motility to some extent, but has no significant action on colonic motility,o Metoclopramide is an effective antiemetic.o Mechanism of action.1. 5-HT4 agonism - stimulation of 5-HT4 receptor in GIT enhances the release of ACH from myenteric plexus - Main prokinetic action of metoclopropamide is due to this action.2. D2 antagonism - Blockade of D2 receptor in CTZ is mainly responsible for antiemetic effect. D2 receptor blockade in GIT is responsible for some prokinetic action also.3. 5-HT3 antagonism - At higher concentration.o Uses - As an antiemetic, as a gastrokinetic in GERD, in dyspepsia.o Adverse effects - Sedation, dizziness, loose stools, muscle dystonia (especially in children) are the main side effects. D2 - blocking action may cause extrapyramidal symptoms (Akathsia, Parkinsonism) and hyperprolactinemia (galactorrhea, gynacomastia). -### End" -5914,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sound that can be tolerated -, with the following options: A: <200 db, B: 200-250 db, C: 250-300 db, D: 80 db - -### Response: -Sound in dB Effect 20 Whispering 40 Quiet library 60 Normal conversation 70 heavy street traffic 80 printing press 85 Recommended maximum 110 Train passing through station 120 Motor car horn 140 Threshold of pain 150-160 Mechanical damage Park's Textbook of Preventive and Social Medicine, 22nd edition, Page No. 688 -### End" -5915,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following skin disease has a different pathogenesis from the others listed?, with the following options: A: A, B: B, C: C, D: D - -### Response: -A.is Pityriasis rosea           -B.is Pemphigus vulgaris -C.is Vitiligo                           -D.is Bullous penmphigoid -Pemphigus vulgaris, vitiligo, bullous pemphigoid, and dermatitis herpetiformis are all immunologic diseases. Pityriasis rosea is an eruption that develops in children and young adults in the spring and fall. The cause is unknown, but it is often associated with a recent upper respiratory infection or flu. It first presents as a single, scaly pink plaque on the trunk, called a ""herald patch."" Days to weeks later, an eruption of rose-colored pap­ules follows the lines of cleavage in a ""Christmas tree"" distribution. It typically resolves in 4-6 weeks. -### End" -5916,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The myocardial contraction is stimulated by, with the following options: A: Influx of Ca++ ions, B: Influx of Na ions, C: Efflux of K ions, D: Efflux of Na ions - -### Response: -The initial depolarisation is due to Na+ influx through rapidly opening Na+channels. The inactivation of Na+ channels contributes to rapid repolarization phase. Ca2+ influx through more slowly opening Ca2+ channels produces plateau phase, and depolarization is due to net K+ efflux through multiple types of K+ channels. Ref: Ganong&;s review of medical physiology; 23rd edition; pg:491. -### End" -5917,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of choice for nasal synachiae ?, with the following options: A: Surgical removal of adhesions, B: Topical mitomycin, C: Nasal stent, D: None of the above - -### Response: -Ans. is'a'i.e., Surgical removal of adhesionsRemoval of adhesion is the procedure of choice for nasal synechiae. -### End" -5918,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carpal tunnel syndrome involves, with the following options: A: Median nerve, B: Anterior interosseous nerve, C: Ulnar nerve, D: Radial nerve - -### Response: -CARPAL TUNNEL SYNDROME:- - -Injury to median nerve in carpal tunnel. - -Causes:- -Tenosynovitis of flexor tendons. -Myxedema -Retention of fluid in pregnancy  -Fracture dislocation of lunate bone. -Osteoarthritis of wrist. -Symptoms:- -1. Feeling of burning pain or "" pins & needles "" along lateral 3 and half digits especially at night. -2. Weakness of thenar muscles. -3. No sensory loss over thenar eminence. -4. Ape thumb deformity if left untreated. -5. Positive phalens and tinel's sign. -Phalen's sign-flexion of both wrists against each other for one minute reproduces the symptoms. -Tinel's sign- percussion over flexor retinaculum reproduces symptoms. -### End" -5919,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient is diagnosed with Zollinger-Ellison syndrome. Which of the following would be the most appropriate pharmacotherapy?, with the following options: A: Erythropoietin, B: Famotidine, C: Fluorouracil, D: Omeprazole - -### Response: -The patient in this question was diagnosed with Zollinger-Ellison syndrome. One of the most impoant initial measures in the treatment of this condition is to control the acid hypersecretion. Proton pump inhibitors, such as omeprazole, rabeprazole, pantoprazole, and lansoprazole, are given at a dose of 40-120 mg/day, and titrated to achieve a basal acid output of In standard doses, proton pump inhibitors inhibit 90-98% of 24-hour acid secretion. Proton pump inhibitors undergo rapid first-pass and systemic hepatic metabolism and have negligible renal clearance. Also know: Erythropoietin is a glycoprotein, normally produced in the kidneys, that stimulates stem cells to differentiate into rubriblasts, increases the rate of mitosis, increases the release of reticulocytes from the bone marrow and increases hemoglobin (Hgb) formation. EPO is indicated for the treatment of anemia associated with chronic renal failure, zidovudine therapy, chemotherapy, and for reduction of allogeneic blood transfusions in surgery patients. Famotidine is an H2-antagonist that decreases gastric acid secretion by competitively and reversibly inhibiting histamine receptors on parietal cells. Although famotidine could potentially be used in the treatment of Zollinger-Ellison syndrome, a proton pump inhibitor is a more appropriate treatment measure. Fluorouracil or 5-FU, is an example of an antimetabolite that blocks the methylation reaction of deoxyuridylic acid to thymidylic acid. This results in interference with DNA synthesis, and to a lesser extent, RNA synthesis. 5-FU is indicated for the palliative management of colon rectum, breast, stomach and pancreatic carcinoma. Ref: McQuaid K.R. (2012). Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds),Basic & Clinical Pharmacology, 12e. -### End" -5920,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malta fever is caused by :, with the following options: A: Treponema pallidum, B: Borrelia burgdorferi, C: Brucella melitensis, D: Pseudomonas aeruginosa - -### Response: -Brucella melitensis Malta fever in another name for Brucellosis Brucellosis is a zoonosis primarily affecting goats, sheep, cattle, buffaloes, pigs. The human disease was recognized along the mediterranean region from very early times and has been known under various names such as Mediterranean fever, Malta fever and undulant fever. A British army doctor, David Brue isolated a small microorganism from the spleen of fatal cases in Malta and transmitted the disease to monkeys experimentally. This was named Brucella melitensis (Bruella after Bruce, melitetzis after Melita the roman name for malta) More on Brucellosis Brucella is a Grain negative cocobacilli that can infect wide range of mammals from rodents to killer whales. They are of paicular zoonotic and economic impoance as a cause of highly transmissible disease in cattle, sheep, goats and pigs. Humans acquire Brucella from direct contact with infected animal ineat or aboed placentas or ingestion of infected milk products. The patients of Brucellosis will most likely be a worker in the meat packing industry (abettoir worker), a veterinarian, a farmer or a traveller who consumes dairy products. All the names of Brucella species are based on the animals they infect: Brucella melitensis (Goats) Brucella abous (causes aboions in cows) Brucella suis Pigs Brucella Canis Dogs Pathogenesis Brucella penetrates the skin, conj unctiva, lungs or G.I. tract. However neither Buboes, nor primary skin ulcer appear. Penetration is followed by lymphatic spread, facultative intracellular growth in macrophages and blood and organ invasion. The intra cellular parasites localize in reticuloendothelial system forming abscesses or granuloinatous lesion. Clinical feature The symptoms are systemic with fever, chills, sweats, loss of appetite, backache, headache and sometimes lymphadenopathy. The fever usually peaks in the evening and slowly returns to normal by morning. The slow rise in temperature during the day, declining at night has led to its other name undulant fever. These symptoms can last from months to years, but founately the disease is rarely fatal. Diagnosis Diagnosis of active disease is best made by culture of the organism from blood, bone marrow, liver or lymph nodes. Castaneda method of blood culture is commonly used. In the absence of blood culture, the diagnosis of Brucellosis usually depends upon the serological tests, the results of which tend to vary with the stage of the infection. -### End" -5921,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following conditions would the (patient most likely be normotensive?, with the following options: A: Primary hyperparathyroidism, B: Hypothyroidism, C: Cushing syndrome, D: Barter syndrome - -### Response: -Bartter syndrome is a mineralocorticoid excess state caused by a defect in chloride reabsorption in the kidneys. The defect in chloride reabsorption in the ascending tubule also affects the reabsorption of so­dium; therefore, there is an augmented distal delivery of sodium with increased exchange of sodium for po­tassium and hydrogen ions in the distal tubule, produc­ing a hypokalemic metabolic alkalosis. Hypokalemia is a stimulus of renin release from the juxtaglomerular (JG) apparatus, which results in JG apparatus hyper­plasia. Activation of the renin-angiotensin-aldoste­rone system increases the production of angiotensin II and aldosterone. Hypokalemia also increases the synthesis of prostaglandin E2 and 12 in the kidneys. Both of these chemical mediators are potent vasodila­tors. Angiotensin II and aldosterone stimulate the syn­thesis of renal kallikrein, which is then converted into bradykinin, a potent vasodilator. Because of this se­quence of events, patients with Bartter syndrome do not develop hypertension, even in the presence of the excess aldosterone and angiotensin II, because their hypertensive effects are offset by the vasodilatation induced by the prostaglandins and bradykinin. In ad­dition, for unexplained reasons, these patients are resis­tant to the effects of infused angiotensin II. -### End" -5922,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most common arrhythmia in patients with Mitral valve Prolapse?, with the following options: A: Premature ventricular contraction, B: Atrial fibrillation, C: Atrial flutter, D: Ventricular tachycardia - -### Response: -MVP may lead to excessive stress on papillary muscles which will lead to dysfunction and ischemia of papillary muscles. Subjacent myocardium will suffer from ischemia leading to premature ventricular contractions recorded in ECG. Arrhythmias seen in MVP: Premature ventricular contractions(mc) PSVT VT Atrial fibrillation -### End" -5923,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 22 year old woman is evaluated in the emergency for a 3 day h/o dark urine and abdominal distension. O/E: normal mental status, icterus present, hea and lungs normal, Hematocrit: 26, Reticulocytes: 5%, Platelets: 1.3 lakhs, Alk.Phos: 30 units/L, ALT: 110 units/L, AST: 220 units/L, Total bilirubin:13mg% (Direct:4 mg) HBsAg positive and Hepatitis 'A' &'C' negative. Urine drug screen negative. USG abdomen shows a nodular appearing liver and enlarged spleen. Which is the most likely diagnosis?, with the following options: A: Acetaminophen intoxication, B: Acute viral hepatitis, C: Primary biliary cirrhosis, D: Wilson disease - -### Response: -Points in or of diagnosis of Wilson's disease- Low hematocrit of 26% and increased reticulocyte count: hemolysis of RBC due to excess intracellular copper. Unconjugated jaundice due to hemolysis and defective conjugation in liver due to hepatocyte damage. Mild elevation of enzymes unlike acute viral hepatitis where gross elevations in enzyme values Nodular liver with splenomegaly indicating a chronic process. Poal hypeension has already developed in the patient. Hepatitis B positivity in the question was given to confuse you, since it can be an incidental finding. Points against the diagnosis of acute viral hepatitis Jaundice with mild elevation of AST/ALT Nodular enlarged liver Enlarged spleen ALSO KNOW: A prognostic index for wilson diseasecalculated by Nazer (score range 0-12) based on serum bilirubin, serum AST, and prolongation in prothrombin time. KING'S COLLEGE CRITERIA:(were developed to determine which patients with fulminant hepatic failure (FHF) should be referred for liver transplant.) -### End" -5924,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kamla, a 30 yrs old lady examined for infeility by hysterosalpingography, reveals 'Bead-like' fallopian tube & clubbing of ampulla. Most likely cause is:, with the following options: A: Gonococcus, B: Mycoplasma, C: Chlamydia, D: Mycobacterium tuberculosis - -### Response: -Tuberculosis -Changes in the fallopian tube are : Beaded tubes Lead pipe Rigid tubes Calcific changes Hydrosalpinx Tubal obstruction and adhesions -### End" -5925,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient died and relatives complain that it is due to negligence of doctor. According to a recent Supreme cou judgment, doctor can be charged for Medical Negligence under section 304-A, only if -, with the following options: A: If he is from corporate hospital, B: If negligence if from inadveent error, C: Gross negligence, D: Res Ipsa Loquitor - -### Response: -Criminal negligence is dealt with 304-A IPC. It arises when a doctor shows the gross absence of care or skill resulting in serious injury or death of the patient. ELEMENTS OF NEGLIGENCE: Duty dereliction direct causation damage Dr.K.S.Narayan Reddys Synopsis of Forensic Medicine & Toxicology 29th edition Pg.20. -### End" -5926,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is complete sulcus, with the following options: A: Lunate, B: Calcarine, C: Colluteral, D: Central - -### Response: -Complete sulcus is very deep so as to cause elevation in the walls of the lateral ventricle. Examples are the collateral and calcarine sulci. Incomplete sulci are superficially situated and are not very deep, E.g. paracentral sulcus. Ref- sciencedirect.com -### End" -5927,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antiviral drug having dual antiviral activity against HIV and HBV is:, with the following options: A: Enfuviide, B: Emtricitabine, C: Abacavir, D: Entecavir - -### Response: -Emtricitabine (FTC), with trade name Emtriva (formerly Coviracil), is a nucleoside reverse transcriptase inhibitor (NI) for the treatment of HIV infection in adults and children.Emtricitabine is always used in combination with other HIV medicines. Because emtricitabine is also effective against HBV, it may be included in an HIV regimen to treat HBV infection in people with HIV. In addition to emtricitabine, the HIV regimen should include another drug that is effective against both HBV and HIV. Emtricitabine should not be used to treat HBV infection in HIV-infected individuals who are not receiving A. REFERANCE:aidsinfo.nih.gov,en.wikipedia.org -### End" -5928,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following receptor on the neuronal membrane that induces the development of glioma?, with the following options: A: CD45, B: CD133, C: CD33, D: CD24 - -### Response: -Ans. (b) CD133 CD133 is used as a marker for leukaemia and glioblastoma stem cell. It is also used for identifying immature leukemic stem cell in AML and pro B leukaemia. CD45 is required for lymphocyte activation. Its deficiency causes Severe Combined immunodeficiency disease (SCID). -### End" -5929,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Punishment for issuing false certificate-, with the following options: A: 7 years, B: 5 years, C: 6 years, D: 4 years - -### Response: -Sec 197 IPC states that whoever issues or signs any certificate required by law to be given or signed, or relating to any fact of which such certificate is by law admissi­ble in evidence, knowing or believing that such certificate is false in any material point, shall be punished in the same manner as if he gave false evidence. -### End" -5930,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are TRUE about protease activated receptors, EXCEPT:, with the following options: A: Family of three seven transmembrane protein, B: Activated by thrombin, C: Releases PGE2, D: Protects epithelial cells - -### Response: -Protease activated receptors (PARs), a family of four seven-transmembrane G protein-coupled receptors (PAR1, PAR2, PAR3, PAR4), act as targets for signalling by various proteolytic enzymes (thrombin, trypsin). PARs are characterized by a unique activation mechanism involving the proteolytic unmasking of a tethered ligand that stimulates the receptor. They release PGE2 and this inturn protects the epithelium. Ref: Ganong's Review of Medical Physiology, 21st Edition, Page 667 -### End" -5931,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 48-year-old man presents with recurrent headaches and ahritic pain in his knees of 9 months in duration. He notes that his head size has recently increased. Physical examination reveals a blood pressure of 170/100 mm Hg. The patient is observed to have coarse facial features and a goiter. Urinalysis reveals glucosuria and hypercalciuria. Which of the following is the most likely explanation for this patient's clinical presentation?, with the following options: A: Excess growth hormone secretion, B: Excess parathyroid hormone secretion, C: Excess prolactin secretion, D: Hypersecretion of bone morphogenetic protein - -### Response: -- Given clinical features are suggestive of Acromegaly; which is d/t increased growth hormone, produced by pituitary adenomas. - C/F of Acromegaly: Enlargement of terminal poions of extremities & jaw Headaches and visual disturbances d/t compression on optic chiasma. Menstrual irregularities in women Diabetes mellitus. 1/3rd have hypeension. Hypercalciuria & renal stones in 1/5th of patients - Somatotroph adenoma that arises in a child or adolescent before the epiphyses close results in gigantism. -### End" -5932,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug used to perform stress ECHO –, with the following options: A: Thallium, B: Dobutamine, C: Adrenaline, D: Adenosine - -### Response: -Stress echocardiography is done either by Physical stress (Exercise :- treadmill or cycling) or by pharmacological stress (dobutamine). -### End" -5933,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements is true of cardiac development?, with the following options: A: During formation of the heart loop, a single-tube heart remains suspended by a complete dorsal mesocardium, B: The atria are represented by cranial portions of endocardial tubes, C: The heart bends into an S-shape because the caudal regions of the endocardial tubes grow faster than the cranial regions, D: The left and right sides of the heart result directly from the side-by-side apposition - -### Response: -The heart forms during the third week by the apposition of left and right endocardial tubes as the head fold progresses caudally The endocardial tubes fuse to form a single-tube heart. This fusion begins cranially in the region of the bulbus cordis (outflow trunks) and proceeds caudally through the ventricles and the atria to the sinus venosus, which is incorporated into the atrium after loop formation. Rapid proliferation of the ventricular region results in the single-tube heart bending into an S-shaped loop. During this process, the dorsal mesocardium partially breaks down, which leaves the heart suspended only at the cranial and caudal ends; the discontinuity in the mesocardium is the transverse sinus. The left and right sides of the heart are established by the subsequent division of the single tube heart, not by the apposition of left and right endocardial tubes. -### End" -5934,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Troglitazone is the drug used in the treatment of:, with the following options: A: Type 2 diabetes mellitus, B: Petit mal epilepsy, C: Hyperlipidaemia, D: Osteoporosis - -### Response: -Troglitazone - -As a Monotherapy, it is not useful in Type 1 diabetes because it needs the presence of insulin for its action. -Troglitazone is withdrawn from the market because it is known to cause severe fatal hepatic failure. -The newer thiazolidinediones like Pioglitazone and rosiglitazone are known to cause CHF as a result of fluid retention. -Rosiglitazone is found to be associated with increased risk of cardiovascular events. -Pioglitazone can reduce the TG levels by 10- 15% because of its action on PPARA. -### End" -5935,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 70 year old female presents with a lesion on cheek with pearly raised border & telangiectasia on surface of lesion.Diagnosis is:, with the following options: A: Basal cell carcinoma, B: Squamous cell carcinoma, C: Actinic keratosis, D: Wart - -### Response: -Lesion with pearly border associated with telangiectasia suggests of Basal cell carcinoma. -### End" -5936,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First permanent tooth to arise: AP 10; UPSC 11; Delhi 11, with the following options: A: Incisor, B: Canine, C: Premolar, D: Molar - -### Response: -Ans. Molar -### End" -5937,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: NOT used as a post-coital contra-ception, with the following options: A: Danazol, B: Ethinyl estradiol, C: Levonorgesterol, D: Misoprostol - -### Response: -Ans. is 'd' ie Misoprostol All the given options can be used for post coital contraception The books I have mentioned above as reference differ slightly. While Dutta and Novak do not mention Misoprostol. Shaws does not mention Danazol. According to Shaw's Misoprostol can be used for post coital contraception, "" because of their luteolytic effect and increased motility effect on the fallopian tubes'' But, to your relief, I have confirmed this one from a Ilnd yr. Gynae resident whose topic for thesis is ""Therapeutic Uses of Misoprostol"" According to her Misoprostol has no role in post-coital contraception. So, rest assured and go for Misoprostol Also, Remember Other post-coital contraceptives Diethyl stilbestrol* Ethinyl oestradiol* Conjugated estrogen* Ethinyl oestradiol + Norgestrel Danazol* Mifepristone* Copper IUCD's* -### End" -5938,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Protein involved in Alzheimer's disease, with the following options: A: Presel in - II, B: ApoE gene, C: Amyloid portion, D: All of the above - -### Response: -(D) All of the above -### End" -5939,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of glomus tumor is -, with the following options: A: Under fingernails, B: Under toenails, C: Neck, D: Axilla - -### Response: -Ans. is 'a' i.e., Under fingernails Glomus tumor (Glomangioma)o Benign tumor arising from the smooth muscle cells of the glomus body which is an arteriovenous anastomosis involved in thermoregulation.o Most commonly present in the distal portion of the digits (under fingernails).o Histologically, there is presence of branching vascular channels and stroma containing nests aggregates of glomus cells arranged around vessels. -### End" -5940,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Linker DNA is bound to which of the following histone?, with the following options: A: H1, B: H2A, C: H2B, D: H3 - -### Response: -Linker DNA The DNA between two nucleosomes Bound by H1 histone. Made up of 30 base pairs. -### End" -5941,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The major objectives of access preparation include all of the following except which one?, with the following options: A: The attainment of direct, straight-line access to canal orifices., B: The confirmation of clinical diagnosis., C: The conservation of tooth structure., D: The attainment of direct, straight-line access to the apical portion of the root. - -### Response: -The confirmation of clinical diagnosis. Confirmation of clinical diagnosis should be made before treatment is rendered. Access is the first and arguably the most important phase of nonsurgical root canal therapy. The objectives are: - -to achieve straight-line access to the apical foramen or curvature of the canal, -to locate all root canal orifices, and -to conserve sound tooth structure -### End" -5942,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chemotherapeutic Agent of Choice for the treatment of CML is:, with the following options: A: Imatinib, B: Vincristine, C: Cyclophosphamide, D: Methotrexate - -### Response: -Answer is A (Imatinib): Tyrosine Kinase Inhibitors (Imatinib) are the chemotherapeutic agents for choice in the management of CML. Tyrosine Kinase inhibitors target the 'constitutively active tyrosine kinase' implicated in the pathogenesis of CML. Although they do not cure the disease, these agents are able to achieve long term control of CML in the majority of patients. Most recent texts (Including Harrisons) recommend Tyrosine Kinase Inhibitors (Imatinib) as the initial treatment of choice for newly diagnosed CML reserving Allogeneic Stem Cell Transplantation (SCT) for those who develop Imatinib Resistance. -### End" -5943,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is active in dephosphorylated state?, with the following options: A: Glycogen Synthase, B: Pyruvate Carboxylase, C: Glycogen Phosphorylase, D: PEPCK - -### Response: -Glycogen Synthase is enzyme of Glycogen Synthesis, which is an Anabolic pathway. So this enzyme is active in Dephosphorylated state. Rest all enzymes are involved in Catabolic pathways, so they are active in Phosphorylated state. Pyruvate Carboxylase is involved in Gluconeogenesis, which is a Catabolic pathway. Glycogen Phosphorylase is involved in Glycogenolysis, which is a Catabolic pathway. PEPCK- Phospho Enol Pyruvate Carboxy Kinase, is also involved in Gluconeogenesis, which is a Catabolic pathway. Extra Information: Enzyme Active in Dephosphorylated state Enzyme Active in Phosphorylated state Glycogen Synthase Glycogen Phosphorylase Acetyl CoA Carboxylase Phosphorylase Kinase Pyruvate Dehydrogenase Key enzymes of Gluconeogenesis HMG CoA Reductase HMG CoA Reductase Kinase PFK-II (Phosphofructokinase-II) Citrate Lyase -### End" -5944,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 17-year-old girl notices a small, sensitive, gray-white area forming along the lateral border of her tongue 2 days before the end of her final examinations. On examination by the physician's assistant, the girl is afebrile. There is a shallow, ulcerated, 0.3-cm lesion with an erythematous rim. No specific therapy is given, and the lesion disappears within 2 weeks. The history shows that the girl does not use tobacco or alcohol. Which of the following is the most probable diagnosis?, with the following options: A: Aphthous ulcer, B: Herpes simplex stomatitis, C: Leukoplakia, D: Oral thrush - -### Response: -An aphthous ulcer is a common lesion that also is known as a canker sore. The lesions are never large, but are annoying and tend to occur during periods of stress. Aphthous ulcers are not infectious; they probably have an autoimmune origin. Herpetic lesions are typically vesicles that can rupture. Leukoplakia appears as white patches of thicker mucosa from hyperkeratosis. It may be a precursor to squamous cell carcinoma in a few cases. The temperance ditty mentioned in the history is a cautionary note for all young people. Oral thrush is a superficial candidal infection that occurs in diabetic, neutropenic, and immunocompromised patients. Inflammation of a salivary gland (sialadenitis), typically a minor salivary gland in the oral cavity, may produce a localized, tender nodule. -### End" -5945,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding abdominal autonomic plexus are A/E, with the following options: A: Aoicorenal ganglion is pa of celiac ganglion, B: Greater splanchnic is sympathetic root, C: Lesser splanchnic is parasympathetic root, D: Posterior vagal is parasympathetic root - -### Response: -C i.e. Lesser splanchnic is parasympathetic rootCeliac plexus, is a type of aoic plexus located around the origin of celiac aery from abdominal aoa. Because the celiac trunk arises from the front of abdominal aoa at T12-L1 disc level. So the celiac plexus lies retroperitoneally over the anterolateral aspect of abdominal aoa at the level of T12-L1 vetebraeQ.Celiac plexus, renal plexus, superior mesenteric plexus & inferior mesenteric plexus are aoic plexuses situated around the origins of celiac, renal, superior mesenteric & inferior mesenteric aeries from abdominal aoa respectively. -### End" -5946,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2 year old child presents with scattered lesions in the skull. Biopsy revealed Langerhans giant cells. The most commonly associated is marker with this condition will be, with the following options: A: CD 1a, B: CD 57, C: CD 3, D: CD 68 - -### Response: -The history is suggestive of langerhans cell histiocytosis( eosinophilic granuloma ).The tumour cells in addition to birbeck granules express HLA -DR, S- 100 and CD1a Reference : Robbins and Cotran Pathologic basis of disease.South Asia Edition volume 1.page no. 622 -### End" -5947,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ABG of a patient shows following findings Ph 7.0 Pco2 -80 HCO3- 24. What is your inference, with the following options: A: Metabolic acidosis, B: Metabolic alkalosis, C: Respiratory acidosis, D: Respiratory alkalosis - -### Response: -Normal pH is 7.35 - 7.45: So this patient is in acidosis Normal PaCo2 is 35-45 mm of Hg: Increased PaCO2 means respiratory acidosis Normal HCO3- is 22-26 mEq/L: this is in the normal range So the patient has Respiratory acidosis with no metabolic compensation. ** If HCO3- is elevated, then we can say there is metabolic compensation. ref - harrisons internal medicine 20e pg322 -### End" -5948,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Initial method to prevent infection in burn patients:, with the following options: A: Physiotherapy, B: Intravenous antibiotics, C: Hand washing, D: Topical antibiotics - -### Response: -Ans. C: Handwashing Control of infection in burn patient begins with policies on hand-washing and other cross-contamination prevention measures -### End" -5949,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following can be transmitted through placenta?, with the following options: A: Chlamydia, B: Herpes simplex, C: Toxoplasma, D: All - -### Response: -Ans: d (All) Ref: Park, ed, p. 91Vertical transmission means transplacental transmission. This is a form of direct transmission. Eg:* l oxopiasma gonai* Rubella* Cytomegalo vims* Herpes* Varicella virus* Syphilis* Hepatitis B* Coxsackie B* HIV -### End" -5950,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pneumatocele is caused by –, with the following options: A: Staphylococcus, B: Streptococcus, C: Streptococcus pneumoniae, D: P. carnii - -### Response: -Pneumatoceles - -These are multiple thin walled air containing cysts. -Staphylococcus aureus is the most common organism causing pneumatoceles and pneumatoceles are considered pathognomonic of staphylococcal pneumonia. -E.coli and klebsiella pneumonia may have pneumatoceles. __ O.P. Ghai 6th /e 350 -### End" -5951,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Iodine 123 has a half life of?, with the following options: A: 6 hours, B: 8 days, C: 13 hours, D: 14 days - -### Response: -Impoant Radioisotopes Half Life RADIOISOTOPE HALF LIFE IODINE 131 8 DAYS IODINE 125 60 DAYS IODINE 124 4 DAYS IODINE 123 13 HOURS PHOSPHORUS -32 14 DAYS RADIUM (RA-226) 1622 years Cobalt -60 5.2 years Cesium - 137 30 years TC- 99m 6 hours Iridium (Ir-192) 74.5 Days 18F (18FDG) 110 min Strontium 89 50.5 days -### End" -5952,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Extradural haematoma is associated with what % of severe trauma -, with the following options: A: 36%, B: 10%, C: 77%, D: 96% - -### Response: -""Epidural hematoma occur in upto 10% of severe head injury cases and are less often associated with underlying cortical damage than are subdural hematomas."" - Harrison -### End" -5953,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Undescended testis can lead to all of the following complications except: March 2012, with the following options: A: Torsion, B: Sterility, C: Carcinoma, D: Hyperophy of testes - -### Response: -Ans: D i.e. Hyperophy of testes Complications of undescended testes Torsion can be seen in incomplete testicular descent Sterility is seen in bilateral cases (especially intra-abdominal testes) Incomplete testicular descent predisposes to malignant disease; cancer is more common in an incompletely descended testes-orchidopexy may or may not diminish the risk. Atrophy of an inguinal testes before pubey may possibly be caused by recurrent minor trauma. -### End" -5954,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Poal vein is formed:, with the following options: A: By the superior mesenteric vein, B: By the splenic vein, C: At the level of 2nd lumbar veebra, D: All of the above - -### Response: -All of the above -### End" -5955,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For glucose estimation in blood, the mode of transpo from a PHC to lab:, with the following options: A: Sodium fluoride, B: EDTA, C: Citrate, D: 0.9% saline - -### Response: -Zinc finger motiff The specificity involved in the control of transcription requires that regulatory proteins bind with high affinity to the Correct region of DNA. Three unique motifs - The helix-turn-helix - Zinc finger - The leucine zipper accounts for many of this specific protein DNA interactions. So zinc finger motiff helps in binding of regulatory proteins to DNA and not in protein folding. -### End" -5956,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sunray appearance on X - ray is seen in ?, with the following options: A: Osteosarcoma, B: Osteochondroma, C: Osteoclastoma, D: Chondroblastoma - -### Response: -Ans. is 'a' i.e., Osteosarcoma Codman's triangle and sunray appearance are typical of osteosarcoma. However, you should keep in your mind following very impoant facts : - Sunray (sunburst) appearance and codman's triangle indicates periosteal reaction (periosteal new bone formation). Both these are typical of osteosarcoma but may also occur in other rapidly growing bone tumors (Ewing's sarcoma), and infection (osteomyelitis). Similarly, onion peel appearance indicates periosteal new bone-formation and is typical for Ewing's sarcoma. But this can also occur in oseosarcoma and osteomyelitis. The crux is that, aggresively growing tumors and infection stimulate the periosteum which then react by forming new bone, (therefore it is called periosteal reaction) which may take any of the above form. -### End" -5957,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acantholytic cells are seen in, with the following options: A: Pemphigus vulgaris, B: Bullous pemphigoid, C: Cicatricial pemphigoid, D: Dermatitis herpetiformis - -### Response: -Ans. (a) Pemphigus vulgarisHarrison 19th ed. / 370* The rounded keratinocytes with hyperchromatic nuclei and perinuclear halo (due to condensing of cytoplasm in periphery) are called acantholytic cells.* It is seen in case of pemphigus vulgaris* Acantholytic cells can be demonstrated in bed side Tzanck test. -### End" -5958,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 65-year-old patient presented to the medicine OPD with weakness and fatigue for 6 months along with some mild abdominal discomfo.On examination, moderate splenomegaly was noted. Lab findings Severe normocytic normochromic anemia Neutropenia with monocytopenia Thrombocytopenia. Bone marrow aspiration was done to look for the cause of decreased cell counts but the tap came 'dry'. So, a bone marrow biopsy was performed. BM Biopsy All of the following CD markers can be positive in above condition except : -, with the following options: A: CD11c, B: CD103, C: CD117, D: CD25 - -### Response: -This is a case of hairy cell leukemia. Bone marrow biopsy image shows the classical fried egg appearance. Flow cytometry study revealed that the cells were positive for CD11c, CD103, CD123 and CD25 and were also TRAP positive Treatment: - Splenectomy is often associated with prolonged remission. Nucleosides including cladribine and deoxycoformycin are highly active Interferon a is also an effective therapy but is not as effective as nucleosides. Chemotherapy-refractory patients have responded to vemurafenib, a BRAF inhibitor. -### End" -5959,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does NOT present in Auditory Pathway?, with the following options: A: Superior olivary nucleus, B: Medial lemniscus, C: Medial geniculate body, D: Trapezoid body - -### Response: -(B) Medial lemniscus # From cochlear nuclei, the main nuclei in the ascending auditory pathways, sequentially from below upwards.> Superior olivary complex> Nucleus of lateral lemniscus> Inferior colliculus> Medial geniculate body> Auditory cortex> Medial lemniscus does not present in Auditory Pathway -### End" -5960,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An otherwise normal female presents with symptoms of flatulent dyspepsia. She was started on proton pump inhibitors, which controlled her symptoms. The next step in management of this condition should be:, with the following options: A: Immediate laparoscopic cholecystectomy, B: Laparotomy after 1 or 2 month, C: Wait and watch, D: ERCP - -### Response: -Ans. (c) Wait and Watch* This patient has history of Flatulent Dyspepsia relieved by PPI* Flatulent dyspepsia may be caused by both Peptic ulcer disease and gall stones.* Ideal thing is to do Endoscopy to rule out Peptic ulcers.* Wait and watch will be the best option here. -### End" -5961,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of retropharyngeal abscess in adults?, with the following options: A: TB, B: Tooth extraction, C: Tonsillitis, D: Lymphadenitis - -### Response: -Ans. is 'a' i.e., TB Abscess in infants (acute retropharyngeal abscess) Most commonly it results from retropharyngeal lymphadenitis due to an upper respiratory tract infection. Treatment is incision and drainage. Abscess in adults (chronic retropharyngeal abscess) If an adult or an older child has a retropharyngeal infection it is likely to be due to a tuberculous infection of the cervical spine (caries of cervical spine). Sometime it may be secondary to tuberculous infection of retropharyngeal lymph nodes. Treatment includes incision and drainage of abscess along with full course of antitubercular treatment. -### End" -5962,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bag and mask ventilation is absolutely contraindicated in –, with the following options: A: Tracheo-esophageal fistula with esophageal atreasia and esophagus connected to trachea, B: Diaphragmatic hernia, C: Meconium aspiration, D: All of the above - -### Response: -Bag and mask ventilation is contraindicated when there are increased chances of aspiration like :- full stomach, intestinal obstruction, pregnancy, hiatus hernia, Diaphragmatic hernia, Tracheo-esuphageal fistula, Meconium aspiration syndrome. -### End" -5963,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best substitute of esophagus after esophagectomy is:, with the following options: A: Stomach, B: Jejunum, C: Left colon, D: Right colon - -### Response: -Answer is A (Stomach) After a poion of esophagus is removed, or after complete esophagectomy, a conduit must be establishedfbr alimentary continuity. The stomach, colon and jejunum have all been successfully used a esophageal substitutes but the Stomach appears to be the 'conduit' of choice because of ease in mobilization and its ample vascular supply - Sabiston Colon is used if the patient has undergone a paial or total gastrectomy previously, or if tumor involves the stomach to preclude a 5 cm margin. Jejunal loops can also be used, but limited vascular supply restricts mobility. -### End" -5964,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Subependymal Gaint Cell Astrocytoma is commonly associated with which of the following condition?, with the following options: A: Neurofibroma, B: Schwannoma, C: Ependymoma, D: Tuberous sclerosis - -### Response: -Subependymal Giant Cell Astrocytomas are located at Foramen of Monro. Usually associated with patients of Tuberous sclerosis. MRI T1 POST CONTRAST image showing avidly enhancing lesion at septum pellucidum of lateral ventricle with hydrocephalus. -### End" -5965,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Expected change in Vitamin B,2 deficiency, with the following options: A: Increased homocysteine in urine, B: Increased methylmalonic acid in urine, C: FIGLU in urine, D: Phenylalanine in urine - -### Response: -Ans. is 'b' i.e., Increased methylmalonic acid in urine Isomerization of methvlmalonyl CoA to succinyl CoAIn this reaction, active form of vitamin BI2 is deoxyadenosyl cobalamine.Propionyl-CoA is produced as catabolic end product of some alipathic amino acids andb-oxidation of odd chain fatty acids.Propionyl CoA is then conveed to succinyl CoA through methylmalonyl-CoA.Thus methylmalonyl-CoA is accumulated and excreted in urine as methylmalonic acid (methylmalonate) in vitamin B12 deficiency, i.e. methylmalonic aciduria. -### End" -5966,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hydrocution is ?, with the following options: A: Electric shock in water, B: Cold water submersion, C: Submersion in boiling water, D: None - -### Response: -Hydrocution : (immersion syndrome ) Type of atypical drowning Mechanism -sudden dyspnoea and vagal inhibition -->hea stops immediately.( ventricular fibrillation has also been repoed.) -### End" -5967,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renal papillary necrosis is almost always associated with one of the following conditions: March 2004, with the following options: A: Diabetes mellitus, B: Analgesic nephropathy, C: Chronic pyelonephritis, D: Post streptococcal glomerulonephritis - -### Response: -Ans. A i.e. Diabetes mellitus -### End" -5968,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Abdomino-Perineal resection is done in colorectal carcinoma on the basis of: March 2013 (h), with the following options: A: Age of the patient, B: Distance from anal verge, C: Fixity of tumour, D: Hepatic metastasis - -### Response: -Ans. B i.e. Distance from anal verge Colorectal carcinoma MC site: Rectum, MC site in colon: Sigmoid colon MC type: AdenoCa Presentation of right sided tumour: Anemia Left sided tumour presents as: Obstruction/ pain Risk factors: -- Increased dietary fats & oil, -- Elevated serum cholesterol, -- Ulcerative colitis & Crohns disease, -- Familial adenomatous polyps MC site of metastasis: Liver (33% patient may have metastasis) Treatment of choice: Surgery -### End" -5969,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Retromammary abscess arises from?, with the following options: A: Tuberculous rib, B: Infected hematoma, C: Chronic empyema, D: All of the above - -### Response: -Ans. is 'd' i.e. All of the above -### End" -5970,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nasolacrimal duct opens in:, with the following options: A: The mouth opposite upper 2nd molar, B: Middle meatus of nose, C: Superior meatus of nose, D: Inferior meatus of nose - -### Response: -The nasolacrimal duct is about 0.5 in. (1.3 cm) long and emerges from the lower end of the lacrimal sac.The duct descends downward, backward, and laterally in a bony canal and opens into the inferior meatus of the nose. The opening is guarded by a fold of mucous membrane known as the lacrimal fold. This prevents air from being forced up the duct into the lacrimal sac on blowing the nose. -### End" -5971,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PTT is prolonged in all except, with the following options: A: ITP, B: Christmas disease, C: Hemophilia A, D: Hemophilia B - -### Response: -In ITP - -Bleeding time : prolonged -PT and PTT are normal -Clotting time : Normal -### End" -5972,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paternal 15 chromosome deletion is seen in ?, with the following options: A: Angelman syndrome, B: Prader Willi syndrome, C: Down syndrome, D: Turner syndrome - -### Response: -Ans. is 'b' i.e., Prader Willi syndrome Paternal 15 deletion - Prader Willi syndrome. Maternal 15 deletion - Angelman syndrome. Prader Willi syndro-me Angleman syndrome Paternal deletion (Paternal genomic imprinting) Maternal uniparental disomy Maternal deletion (maternal genomic imprinting) Paternal uniparental disomy -### End" -5973,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best investigation for VUR is ?, with the following options: A: IVU, B: MCU, C: Retrograde pyelogram, D: Retrograde urethrogram - -### Response: -Ans. is 'b' i.e., MCUInvestigation of choice for VUR > Voiding/micturating cystourethrogram. -### End" -5974,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On MRI the differential diagnosis of spinal cord edema is, with the following options: A: Myelodysplasia, B: Myelomalacia, C: Myeloschisis, D: Cord tumors - -### Response: -Both cord edema and myelomalacia appear hypointense on T1 and hyperintense on T2 image. -### End" -5975,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Veical crest in fundus of the internal auditary canal is k/a:, with the following options: A: Bill's bar, B: Ponticul us, C: Cog, D: Falciform crest - -### Response: -A ie Bill's Bar Veical crest in fundus of internal auditory canal is K/a Bill's -bar(2. And it is used as a surgical landmark for facial nerve identification. -### End" -5976,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ochsner sherren regimen is used for management of:, with the following options: A: Appendicular mass, B: Appendicular abscess, C: Appendicitis, D: Peritonitis following appendicitis - -### Response: -Ans. (a) Appendicular massRef: Bailey & Love 26th ed. /1211* The appendix that is acutely inflamed may perforate and later wall off from the peritoneal cavity by omentum and adjacent bowel loop to form a tender, palpable right iliac fossa mass. It is a common surgical pathology which occurs in about 2-6% of patients who presented with acute appendicitis.The initial school of thought regards this condition to be managed conservatively, with the famous one being the Ochsner-Sherren regimen. The idea behind this is that, surgery would be hazardous and increase the mortality rate.* The conservative management of appendicular mass can be summarized by mnemonic ""ABCDEF"" which is# A: Analgesic, Antibiotic, antipyretic# B: Bed rest# C: Charting (vital sign, size of the mass)# D: Diet (Keep Nil by Mouth)# E: Exploratory laparotomy KIV.# F: Fluid maintenanceThree methods are proposed for management of appendicular mass which are:1. Conservative management2. Interval appendectomy3. Early surgical intervention. The selection of methods depends on surgeon preference and patients condition. -### End" -5977,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Chandler's index of 312 is considered as:, with the following options: A: The infection is not of much significance, B: Minor public health problem, C: Potential danger, D: Impoant public health problem - -### Response: -Chandler's index: It is the average number of hookworm eggs per gram of faeces for an entire community. Chandler's index < 200 = Hookworm infection is not of much significance Chandler's index 200 - 250 = May be regarded as a potential danger Chandler's index 250 - 300= Minor public health problem Chandler's index >350 = Impoant public health problem Ref: Park, 17 Edition, Page 186 -### End" -5978,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Langerhan's cells are:, with the following options: A: Phagocytic cells, B: Antigen presenting cells, C: Seen in auto immune conditions, D: Seen in chronic infection - -### Response: -Answer is B (Antigen presenting cells) : Langerhan's cells are characteristic Antigen presenting cells Langerhan's cells are clear dendritic Q cells situated among the cells of stratum spinosum (slun). Q They are believed to be antigen processing cells. Q They are S100 positive Q on immunohistochemical studies. On electron microscopy: they lack melanosomesQ contain characteristic organelle, the Birbeck's granule.Q -### End" -5979,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 40 year old lady presented with sudden onset of breathing difficulty. Clinical examination was essentially normal except for tachycardia and tachypnea. She gives history of two episodes of lower limb pain and swelling, first episode was 15 years back during her first pregnancy and second episode 3 months back. What would be the hematological abnormality respoinsible for her condition:, with the following options: A: Protein C excess, B: Resistance to activated protein C, C: Antithrombin mutation causing accelerated effect, D: Polycythemia vera - -### Response: -Here the patient is probably suffering from pulmonary embolism as the major symptom of pulmonary embolism is sudden onset of breathlessness. Chest examination will be normal. As the patient gives history of recurrent episodes of lower limb swelling, she must be suffering from reccurrent deep vein thombosis as a result of some thrombophilic condition. FACTS: Heritable causes of venous thrombosis 1. Antithrombin deficiency and factor V leiden mutation 2. Protein C and S deficiency 3. Activated protein C resistance 4. Polycythemia can cause venous thrombosis but in this patient there are no features to suggest polycythema Ref: Harrison, Edition - 18, Page - 987 -### End" -5980,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The process of increasing the ability for phagocytosis of foreign bodies called as:, with the following options: A: Cross reactivity, B: Opsonization, C: Immune tolerance, D: Immune surveillance - -### Response: -The process of increasing the ability for phagocytosis of foreign bodies is called opsonization or enhanced phagocytosis. Molecules that promote recruitment of bacteria are called Opsonins. For examples are C3b (mainly), Fc poion of IgG, IgM. Immune tolerance, orimmunological tolerance, or immunotolerance, is a state of unresponsiveness of theimmunesystem to substances or tissue that have the capacity to elicit animmuneresponse in a given organism. Immunological surveillanceis a monitoring process of theimmunesystem to detect and destroy virally infected and neoplastically transformed cells in the body -### End" -5981,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cells which remain in Go phase -, with the following options: A: Permanent cells, B: Labile cells, C: Intermitotic cells, D: Quiscent cells - -### Response: -Ans. is 'd' i.e., Quiscent cellsTypes of cellsbased on their proliferative and regenerative capacity, cells are divided into :?1) Labile cells (continuously dividing cells) or intermitotic cellsThese cells have capacity to proliferate and regenerate throughout the life.They always remain in cell cycle and have very sho Go-phase (quiescent phase).2) Stable or quiescent or reversible postimitotic cellsThey have limited capacity to proliferate and regenerate. They remain in Go phase of cell cycle but can enter in GI phase when stimulated i.e., they usually remain quiescent, but proliferate in response to stimuli.3) Permanent or nondividing or irreversible postmitotic cellsThey cannot divide and regenerate. These cells are nondividing and have left the cell cycle, i.e., they do not belong to any phase of cell cycle. -### End" -5982,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The inverse stretch reflex, with the following options: A: Occurs when muscle length changes, B: Is a monosynaptic reflex initiated by activation of the Golgi tendon organ, C: Is a disynaptic reflex activated on change in tension, D: Uses type II afferent fibres from the Golgi tendon organ - -### Response: -Golgi tendons organs are encapsulated stretch receptors located in the tendons that causes muscle relaxation when the tension becomes great enough. Golgi tendon organs, unlike the spindles, are in series with the muscle fibers. The tendon organ, like the primary receptor of the muscle spindle, has both a dynamic response and a static response Stretch reflex is monosynaptic while inverse stretch reflex is a disynaptic with a single interneuron inseed between the afferent and efferent limbs The spindle detects muscle length and changes in muscle length, whereas the tendon organ detects muscle tension Afferent for stretch receptor Ia, while for inverse stretch reflex: Ib -### End" -5983,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Castleman disease is associated with ?, with the following options: A: HSV, B: CMV, C: EBV, D: HHV- 8 - -### Response: -Ans. is 'd' i.e., HHV - 8 Castleman disease is group of lymphoproliferative disorders. Disease is caused by hypersecretion of IL-6. Release of these cytokines may be caused by HHV-8 in HHV-8 associated Multicentric Castleman Disease (MCD). -### End" -5984,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Parenteral direct thrombin inhibitor ?, with the following options: A: Ximelagatran, B: Dabigatran, C: Argatroban, D: Heparin - -### Response: -Ans. is 'c' i.e., Argatroban Parentral direct thrombin inhibitors Argatroban Bivalirudin Hirudin Lepirudino Melagatran Desirudin Oral Direct thrombin inhibitors Dabigatran (recent) Ximelagatran (withdrawn) -### End" -5985,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acinic cell tumor is tumor of, with the following options: A: Parotid gland, B: Breast, C: Parathyroid, D: Thyroid - -### Response: -Ans. a (Parotid tumor). (Ref. LB, 25th/pg. 756)Salivary gland tumor TypeSubgroup1AdenomaPleomorphic (80-90%), Warthin's tumor, Adenolymphoma2CarcinomaAcinic cell carcinoma (LG-low grade), Adenoid cystic carcinoma (LG),Mucoepidermoid (LG and HG), Adenocarcinoma (HG), Squamous cell carcinoma (HG)3Non epithelial tumorsHemangioma, Lymphangioma4LymphomaPrimary, Secondary5SecondariesLocal, Distant (skin and bronchus)6Tumor like lesionsAdenomatoid hyperplasia, Benign lymphoepithelial lesion, Salivary gland cysts -### End" -5986,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cori's cycle is concerned with transport of, with the following options: A: Alanine, B: Glutamate, C: Lactate, D: Aspartate - -### Response: -Cori's cycle (Glucose-Lactate cycle) is concerned with transport of Lactate. -### End" -5987,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following results, if ZOE and Ca(OH)2 liners are used together?, with the following options: A: No reparative dentin formation, B: Exothermic heat released after the reaction will damage the pulp, C: High solubility of combination, D: All of the above - -### Response: -Eugenol and calcium hydroxide cannot be incorporated into the same formulation, because eugenol rapidly chelates calcium ions in a strongly exothermic reaction. -Therefore, the choice of a eugenol-based versus calcium hydroxide-based liner is based on the relative depth of the tooth preparation. -### End" -5988,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Osteoclastoma usually occurs in?, with the following options: A: Epiphysis, B: Metaphysis, C: Diaphysis, D: Can occur anywhere - -### Response: -Giant cell tumor also known as osteoclastoma occurs usually in the epiphysis of long bones. It is benign but locally aggressive. -### End" -5989,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ohobaric oxygen is used in:-, with the following options: A: CO poisoning, B: Ventilation failure, C: Anerobic infection, D: Gangrene - -### Response: -Ans is 'a' i.e., CO Poisoning Ohobaric Oxygen - 100% oxygen at atmospheric pressure. Ohobaric oxygen is used in CO poisoning. It reduces the half life of carboxyhemoglobin complex. About use of hyperbaric oxygen in CO poisoning. - Although hyperbaric oxygen therapy is often recommended for patients with coma, syncope, seizures, and cardiovascular instability, for those who do not respond to ohobaric oxygen therapy, recent data suggest that it is no more effective than ohobaric oxygen therapy - -### End" -5990,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brucella abous primarily affects, with the following options: A: Dog, B: Cattle, C: Swine, D: Goat - -### Response: -Ans. is 'b' i.e., Cattle Human brucellosis is a zoonosis, acquired from animals directly or indirectly. The animals that commonly act as sources Sheep, goat and camel Cattle or Buffalo Swine Dog Br melitensis Br. abous Br suis Br canis -### End" -5991,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Of the Following, most orable breech presentation is, with the following options: A: Extended breech, B: Complete breech, C: Footling, D: Extended Head - -### Response: -Most orable breech presentation is Extended / Frank breech as it has least risk of cord prolapse among all the breech types. Risk of Cord prolapse in Breech - Footling breech > Complete breech > Frank breech -### End" -5992,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Circle of willis is formed by, with the following options: A: Anterior cerebral artery, posterior communicating artery, middle cerebral artery, posterior cerebral artery, internal carotid artery, B: Anterior cerebral artery, posterior communicating artery, internal carotid artery, anterior communicating artery, middle cerebral artery., C: Anterior communicating artery, posterior communicating artery, internal carotid artery, anterior inferior cerebellar artery, anterior cerebral artery., D: Anterior communicating artery, posterior communicating artery, internal carotid artery, posterior cerebral artery, anterior cerebral artery. - -### Response: -Middle cerebral artery doesn’t form circle of willis. -### End" -5993,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Down's syndrome is, with the following options: A: Triploidy, B: Monosomy, C: Trisomy, D: Aneuploidy - -### Response: -Ans. c (Trisomy). (Ref Harrison, Medicine, 18th/Ch. 62. Chromosome Disorders)Clinically, the most important of numerical abnormality is trisomy 21, the most frequent cause of Down syndrome.Depending on the maternal age structure of the population and the utilization of prenatal testing, the incidence of trisomy 21 ranges from 1/600 to 1/1000 livebirths, making it the most common chromosome abnormality in live-bom individuals.Like most trisomies, the incidence of trisomy 21 is highly correlated with maternal age, increasing from about 1/1500 livebirths for women 20 years of age to 1/30 for women 45 years.In addition to trisomy 21, only two other autosomal trisomies, 13 and 18, occur with any frequency in livebirths.Incidence rates for trisomies 13 and 18 in livebirths are 1/20,000 and 1/10,000, respectively. Unlike trisomy 21 that is associated with near-normal life expectancy, both trisomies 13 and 18 are associated with death in infancy, typically occurring during the first year of life.Three sex chromosome trisomies the 47,XXX, 47,XXY (Klinefelter's syndrome), and 47,XYY conditions are quite common, with each occurring in about 1/2000 newborns. Of all the trisomic conditions, three have fewest phenotypic complications. In fact, with the exception of infertility in klinefelter's sundrome, it is likely that most individuals with such trisomies may go undetected.TableNumerical chromosomal abnormalities includePolyploidye.g. triploidy = haploid x 3 (69XYY =23x3 common but lethal)AneuploidyAny chromosome number, which is not an exact multiple of haploid number e.g., Down syndrome 47 XY+ 21 or Klinefelter syndrome 47 XXY.TrisomyState of having three representatives of a given chromosome instead of the usual pair, as in trisomy 21 (Down syndrome). -### End" -5994,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10-year-old boy has multiple tan-colored patches on his skin, and freckle-like skin changes in his armpit area. The rest of clinical examination is normal. Which of the following conditions is also found in patients with this disorder as they get older?, with the following options: A: bilateral eighth nerve tumors, B: irregular small pupils, C: multiple cutaneous and subcutaneous tumors, D: cataracts - -### Response: -The two common forms of neurofibromatosis (NF-1 and NF-2) are genetically distinct. NF-1 is the type with multiple cafe au lait spots and is associated with axillary or inguinal freckling, iris hamartomas (Lisch nodules), peripheral neurofibromas, and bony abnormalities (including kyphoscoliosis). NF-2 is associated with CNS tumors, particularly bilateral eighth nerve tumors. Skin lesions are spare or absent, and early lens opacities can occur. -### End" -5995,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40 years old male after A, attains spinal injury. His lower limb power is greater than that of upper limb and sacral sensations are present. Type of spinal cord lesion is:, with the following options: A: Central cord syndrome, B: Anterior cord syndrome, C: Posterior cord syndrome, D: Complete spinal cord injury. - -### Response: -A i.e. Central cord syndrome Central cord syndrome is defined by American spinal injury Association (ASIA) as a clinical presentation, characterized by ""dissociation"" in degree of motor weakness weakness with lower limbs stronger than upper limbs and sacral sparing presentQ Complete lesion (transection) No motor or sensory function in the lowest sacral segments (S4 - Ss)/ below the level of spinal cord injuryQ in the absence of spinal shock. Patients may gain some root function about the level of injury - a phenomenon called root escape, because this damage to nerve roots is a peripheral nerve injury (& may be neuroprexia). And it should not be taken as potential return of spinal cord function. Incomplete lesion Any evidence of neurological function (sensory or motor) distal to the level of injury. Documentation of sacral nerve !but function (perianal sensation, rectal tone and flexion of great toe) may be the only sign of paially functioning spinal cord or incomplete lesion. Central Cord Syndrome It occurs d/t damage of spinal cord near central canal area. Main causes are hyperextension trauma, Syringomyelia, tumor and anterior spinal aery ischemia. It is most frequent of incomplete cord syndromes and occurs most frequently in elderly people with underlying degenerative spolidylosis. Dissociative motor weakness with arm weakness out of propoion to leg weaknessQ Sacral sensory sparingQ - 'Dissociated sensory loss' signifying a loss of pain and temperature sense (lateral spinothalmic tract) in a cape distribution over the shoulders, lower neck, and upper trunk in contrast to intact light touch, joint position, and vibration sense (posterior column) in these regions. - 50- 75% show some neurological improvement in following order- return of lower extremity strength, return of bladder function, return of upper extremity strength, and return of intrinsic function of the hand. Anterior Cord Syndrome Both spinothalmic & coicospinal tracts (located in the anterior aspect of spinal cord) are injured with preserv-ation of dorsal columns - Variable loss of pain and temperature sensation and motor functions with preservation of proprioceptio n, vibrator sense and deep pressure sensationQ Brown Sequard Syndrome It is functional hemisection of spinal cord 1/t motor weakness on ipsilateral side of lesion & sensory deficit on the contralateral side (in broad terms.) It consist of ipsilateral motor (coicospinal tract) and propriaception (posterior column) loss and contralateral pain & temperature (spinothalmic tract) sensory lossQ. Segmental signs, such as radicular pain, muscle atrophy, or loss of deep tendon reflex, are unilateral. Posterior Cord Syndrome - Posteriorly located dorsal column is injured with intact spinothalmic and coicospinal tracts. - Loss of position and vibratory sense below the level of injury -### End" -5996,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congenital hea lesion (s) in rubella are, with the following options: A: VSD, B: ASD, C: Aoic stenosis, D: Coarctation of aoa - -### Response: -Cardiac abnormalities occur in half of the children infected during the 1st 8 wk of gestation. Patent ductus aeriosus is the most frequently repoed cardiac defect followed by lesions of the pulmonary aeries and valvular disease. Reference: Nelson textbook of pediatrics 19th edition Page 1077 -### End" -5997,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Laryngeal prominence is formed by-, with the following options: A: Cricoid cartilage, B: Hyoid bone, C: Anterior margin of thyroid, D: Angle of the thyroid cartilage - -### Response: -The lower part of anterior borders of right and left laminae of thyroid fuse and form a median projection called laryngeal prominence. -### End" -5998,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a mechanism of action of intra uterine contraceptive devices (IUCD)?, with the following options: A: Increased motility, B: Aseptic inflammation, C: Altered cervical mucus, D: Inhibit ovulation - -### Response: -IUCD acts as a foreign body in the uterus. It has no effect on ovulation. -### End" -5999,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with long-standing multinodular goitre develops hoarseness of voice; also, the swelling undergoes a sudden increase in size. Likely diagnosis is, with the following options: A: Follicular ca, B: Papillary ca, C: Medullary ca, D: Anaplastic ca - -### Response: -History of sudden growth in a long-standing goitre and hoarseness are suggestive of malignant change. -Most common carcinoma to develop in developing in long-standing multinodular goitre is Follicular carcinoma. -### End" -6000,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Astigmatism is due to -, with the following options: A: Irregularity of curvature of cornea, B: Irregularity of curvature of lens, C: Forward displacement of the lens, D: Backward displacement of lens - -### Response: -Astigmatism is a type of refractive error wherein the refraction varies in the different meridia. Consequently, the rays of light entering in the eye cannot converge to a point focus but form focal lines. Broadly, there are two types of astigmatism: regular and irregular Corneal astigmatism is the result of abnormalities of curvature of cornea. It constitutes the most common cause of astigmatism Reference : A K KHURANA OPHTALMOLOGY,Edition 4,Page-34 -### End" -6001,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Liquefactive necrosis is seen in:, with the following options: A: Hea, B: Brain, C: Lungs, D: Spleen - -### Response: -Brain is most common organ to go into liquifactive necrosis due to more amount of soft tissue. REF: ROBBINS pathology 10th edition -### End" -6002,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not given in ophthalmia neonatorum:, with the following options: A: Erythromycin locally, B: Tetracycline 1%, C: Penicillin locally, D: Silver nitrate - -### Response: -D i.e. Silver nitrate 1% AgNO3 (Crede's prophylaxis) used to prevent gonococcal opthalmia in new born is not used now as it leads to opthalmia neonatorum. It is impoant to note here that 1% AgNO3 is used for prophylaxis of gonococcal opthalmia, and it has got no role in treatment of opthalmia neonatorum. In fact it is a cause of opthalmia neonatorum. If Ophthalmia Neonatorum is confirmed then the treatment is staed on the lines of Gonorrhoeal infection and the treatment modified on the microbiological studies and clinical response. -### End" -6003,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After undergoing a partial cystectomy for carcinoma of the rectum, a 76-year-old woman develops a vesicovaginal fistula. The repair will have a higher chance of success if which of the following occurs?, with the following options: A: Scare tissue is not excised, B: The bladder wall is closed under tension, C: Repair is performed more than 6 months after the causative operation, D: Repair is performed within 7-14 days of the onset of symptoms - -### Response: -Repair of vesicovaginal fistula is recommended after enough time has passed, to allow a reduction in the inflammatory reaction and even spontaneous closure to occur. To promote spontaneous closure, a Foley catheter is inserted for bladder drainage. It is advised to perform meticulous repair, excision of previous fistulous tract, and tension-free anastomosis. Frequently an omental interposition helps to separate overlapping suture lines. -### End" -6004,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which acts on nuclear receptors, with the following options: A: Glucocorticoids, B: Thyroxine, C: Progesterone, D: Insulin - -### Response: -Ans. is 'b' i.e., Thyroxine Hormones with intracellular receptors (Group I hormones)* Cytoplasmic :- Glucocorticoids (cortisol/cortisone), mineralocorticoids, androgens, progestins.* Nucleus :- Estrogen, Thyroid hormones (T3, T4), retinoic acid, Vitamin D (Calcitriol or 1,25 (OH)2 D3). -### End" -6005,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following breast tumor is bilateral, with the following options: A: Colloid carcinoma, B: Invasive ductualr carcinoma, C: Invasive Lobular carcinoma, D: Medullary carcinoma - -### Response: -Refer Robbins page no 1059 Invasive ductal carcinoma was repoed to be the most common type found in 10 (71.5%) breasts. Grade III breast carcinoma was revealed in 9 and Grade I cancer in 3 specimens. CONCLUSION: Bilateral breast cancer is invariably advanced when diagnosed. Mammogram is a valuable tool in early detection.. -### End" -6006,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Example of case control study (risk factor and disease/outcome) ?, with the following options: A: Maternal smoking and congenital malformation, B: Vaginal adenocarcinoma and intrauterine exposure to DES, C: Thalidomide exposure and teratogenicity, D: All of the above - -### Response: -Ans. is `d' i.e., All of the above Impoant risk factors and their outcomes/diseases which have been studied by case-control study are :- Cigarette smoking and lung cancer. Maternal smoking and congenital malformation. Radiation and leukemia. OCP used and hepatocellular carcinoma. Herpes-simplex and Bells palsy. Aificial sweeteners and bladder cancer. DES exposure in fetal life and vaginal adenocarcinoma. OCP use and thromboembolic disease. Thalidomide use in pregnancy and teratogenicity. -### End" -6007,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of partner is required in all infections except-a) Candidab) Herpesc) Trichomonasd) Gardnerella, with the following options: A: b, B: c, C: ac, D: ad - -### Response: -Treatment of sexual partner is required for: - -Chlamydia trachomatis -Neisseria gonorrhoea -Trichomonas vaginalis -Herpes simplex virus -Mycoplasma genitalium. - -Treatment of sexual partner is not required: - -Vulvovaginal Candidiasis: Usually treatment of sexual partner is not required, topical treatment if candidal dermatitis of penis is detected -Gardnerella vaginalis: No treatment is required. -### End" -6008,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anterior interventricular aery is a branch of, with the following options: A: Right coronary aery, B: Left coronary aery, C: Circumflex aery, D: Left anterior descending aery - -### Response: -LEFT CORONARY AERY It is larger than the right coronary aery.It arises from the left posterior aoic sinus. Branches A.Large branches 1.Anterior interventricular 2.Branches to the diaphragmatic surface of the left ventricle,including a large diagonal branch. B.Small branches 1.Left atrial 2.Pulmonary 3.Terminal REF.B D Chaurasia's human anatomy vol.1.fifth edition BD CHAURASIA'S HUMAN ANATOMY.VOL.1.FIFTH EDITION.PAGE NO 252 -### End" -6009,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infertility is a common feature in ""Sertoli cell only"" syndrome because, with the following options: A: Too many Sertoli cells inhibit spermatogenesis via inhibin, B: Proper blood-testis barrier is not established, C: There is no germ cells in this condition, D: Sufficient numbers of spermatozoa are not produced - -### Response: -Ans. is 'c' i.e. There is no germ cells in this condition 'Sertoli cell only syndrome is another name for Germ cell aplasia.In this condition seminiferous tubules are smaller than normal and are lined by a single layer of Sertoli cells. There are no germ cells lining the seminiferous tubules.Absence of germ cells leads to absence of spermatogenesis because spermatogenesis begins from primitive germ cells, leading to infertility. -### End" -6010,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Destruction of right labyrinth causes nystagmus to-, with the following options: A: Right side, B: Left side, C: Rotatory nystagmus, D: No nystagmus - -### Response: -Remember the following FUNDA - -In destructive lesions or paretic lesions eg. trauma to labyrinth, the nystagmus is towards the opposite side. -In irritative lesions eg. serous labyrinthitis, fistula of labyrinth, the nystagmus is towards ipsilateral side. -### End" -6011,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Asteroid bodies and cigar shaped globi may be produced by-, with the following options: A: Histoplasmosis, B: Sporotrichosis, C: Candida, D: Aspergillus - -### Response: -Sporotrichosis or Rose Gardner's disease - Chronic subcutaneous pyogranulomatous disease Caused by a thermally dimorphic fungus Sporothrix schenckii. Mould: Flower like sporulation Laboratory Diagnosis: Direct Microscopy by H and E staining of tissue sections reveals cigar shaped asteroid bodies. It is described as central basophilic yeast cell surrounded by eosinophilic mass, composed of antigen-antibody complexes. Such eosinophilic halo is described as Splendore-Hoeppli phenomenon. -### End" -6012,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest sign of laryngeal tuberculosis is, with the following options: A: Erythema of vocal cords and loss of adduction, B: Mouse nibbled appearance, C: Ulceration of vocal cords, D: Swelling in the interarytenoid region - -### Response: -Laryngeal examination of tuberculosis of the larynx Hyperaemia of the vocal cord in its whole extent or confined to posterior pa with impairment of adductor is the first sign. Swelling in the Interarytenoid region giving a manipulated appearance. Ulceration of vocal cord giving the mouse-nibbled appearance. Superficial ragged ulceration on the arytenoids and Interarytenoid region. Granulation tissue in the Interarytenoid region or vocal process of arytenoid. Pseudoedema of the epiglottis "" turban epiglottis "". Swelling of ventricular bands and aryepiglottic folds. The marked pallor of the surrounding mucosa. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 331 -### End" -6013,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Movement across socioeconomic levels is termed as -, with the following options: A: Social equlaity, B: Social upliftment, C: Social mobility, D: Social insurance - -### Response: -social mobility is movement in socio-economic stratus indian society based on caste system, so there is little mobility there are societies known as &;open class societies&; where movement of the social ladder is unrestricted , it is on the basis of achievement or gaining wealth so here social mobility occur ref ;(page no;688) 23rd edition of PARK&;s textbook of Preventive and Social medicine -### End" -6014,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an example of disability limitation?, with the following options: A: Reducing occurrence of polio by immunization, B: Arranging for schooling of child suffering from PRPP, C: Resting affected limbs in neutral position, D: Providing calipers for walking - -### Response: -Resting affected limbs in neutral position Repeat from May 06 & 07 Disability limitation is the mode of intervention used if the patient presents in late pathogenic phase. The objective is to prevent the transition of the disease proecess from impairment to handicap. The sequence of events leading to disability and handicap are: Disease ---> impairment -4 disability -4 handicap Impairment - is defined as any loss or abnormality of psychological, physiological or anatomical structure or function eg. loss of foot, defective vision or mental retardation. Disability - it is inability to carry out ceain activities considered normal for human beings, because of his 'impairment'. Handicap means that the individual with 'disability' is not able to perform his duties and obligations expected of him in the society. For example: Accident is the disease (or disorder) Loss of foot is the impairment Cannot walk is the disability Unemployed is the handicap Lets see other Modes of intervention in the disease process. Modes of Intervention Modes of intervention can be defined as any attempt to interrupt the usual sequence of any disease process (right from the risk factors to handicap) There are 5 modes of intervention: Health promotion Specific protection Early diagnosis Disability limitation Rehabilitation I. Health promotion Health promotion is not directed against any paicular disease, but is intended to improve the health of people through a variety of interventions like: i) Health education ii) Environmental modifications - Like provision of safe water, installation of sanitary latrines, control of insects and rodents etc. iii) Nutritional interventions - Like food foification, child feeding programmes. iv) Lifestyle and behavioural changes 2. Specific protection is directed against specific disease through interventions such as : - Immunization - Chemoprophylaxis - Protection from carcinogens etc. 3. Early diagnosis and treatment It involves detecting and treating the disease while the biochemical morphological and functional changes are still reversible. Thus it prevents ove disease and disablement. Early diagnosis and treatment are the only effective mode of intervention in following diseases. - Tuberculosis - Leprosy - STD 4. Disability limitation - Already described 5. Rehabilitation It is the combined and coordinated use of medical, social, educational and vocational measures for enabling the handicapped persons to achieve social integration (social integration is defined as the active paicipation of disabled and handicapped people in the mainstream of community life) Option 'a' - Reducing occurence of polio by immunization is specific protection Option 'b' - Arranging for schooling of child suffering from PRPP is rehabilitation Option 'c' - Resting affected limbs in neutral position disability limitation Option 'd' - Providing calipers for walking rehabilitation -### End" -6015,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following surgeries for stress incontinence has highest success rate:, with the following options: A: Burch's colposupension, B: Stamey's repair, C: Kelly's stitch, D: Aldridge surgery - -### Response: -As discussed in preceding text SUI is managed basically by performing either of the two surgeries viz- -1. Burch colposuspension -2. Tension free vaginal tapes/tension free obturator tapes. -The rates of success of these two surgeries are comparable, so if either of them is given in options, we will chose it. -So in version II- Answer is Burch colposuspension -### End" -6016,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coracoid process is a kind of epiphysis -, with the following options: A: Atavistic, B: Pressure, C: Traction, D: Aberrant - -### Response: -Atavistic epiphysis - -Phylogenetically an independent bone, which in man becomes fused to another bone -Examples: - -Coracoid process of the scapula Posterior tubercle of talus Os trigonum -TYPES OF EPIPHYSES: -1. Pressure epiphysis  - -Articular and takes part in weight transmission -Examples: Head of femur Condyles of tibia Lower end of radius - -2. Traction epiphysis - -Non articular and does not take part in weight transmission -Provide attachment to a tendon which exerts traction -Examples: Trochanter of femur Tubercles of humerus Mastoid process - -3. Atavistic epiphysis - -Phylogenetically an independent bone, which in man becomes fused to another bone  -Examples:Coracoid process of the scapula Posterior tubercle of talus Os trigonum - -4. Aberrant epiphysis Not always present - -Examples: Head of 1 st metacarpal Base of other metacarpals -### End" -6017,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following antibiotics are safe to treat UTI in pregnancy:a) Aminoglycosidesb) Penicillinc) Cotrmoxazoled) Ciprofloxacine) Cephalosporins, with the following options: A: ab, B: ad, C: be, D: ce - -### Response: -Principles for management of UTI during pregnancy: - -Single dose therapy is preferred -The antimicrobial agent should be appropriate to the mother and fetus, any one of the following drugs could be prescribed: - -– Ampicillin -– Nitrofurantoin – DOC for prophylaxis of recurrent UTI in pregnancy -– Cephalexin Cephalosporin -– Amoxicillin clavulanic acid combination. - -Sulfonamides should not be given in the third trimester because they may interfere with bilirubin binding and thus impose a risk of neonatal hyperbilirubinemia and kernicterus. -Fluoroquinolones are also contraindicated because of their potential teratogenic effects on fetal cartilage and bone. -Tetracyclines, cotrimoxazole and ciprofloxacin are: contraindicated during pregnancy. -### End" -6018,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of orthostatic hypotension is -, with the following options: A: Dopamine, B: Diuretics, C: Fludrocortisone, D: Calcium channel blockers - -### Response: -Ans. is 'c' i.e., Fludrocortisone Management of chronic orthostatic hypotensiono Correct precipitating factors (e.g,, hypovolemia) and withdraw offending drugs (diuretics, vasodilators, tranquilizers and sedatives)Physical measureso Raise the head of the bed by 10 to 20dego Arise slowly, in stages, from supine to seated to standingo Dors (flexion of the feet, handgrip isometric, leg cross ing/squatting before standingo Liberalize salt and fluid intakeo Small meals and coffee only in the early morningo Jobst stockings and pressure suits (often not acceptable)Drugso Fludrocortisone with a high salt diet is the initial treatment of choiceo Sympathomimetic drugs - ephedrine, phenylpropanolamine, pseudoephedrine, phenylephrine, midodrine, methylphenidate, dextroamphetamineo Supplemtary agentsNonsteroidal antiinflammatory drugsCaffeineErythropoietin (if anemic)o Third-line and experimental drugsVasopressin receptor agonistd-dDA VP, lysine vasopressinPyridostigmineYohimbineSomatostatin analogues - octreotide, especially for postprandial hypotension DihydroergotamineFluoxetineDihydroxyphenylserineDopamine antagonists - metocloramide, domperidoneMonoamine oxidase inhibitor with tyramine - can produce severe hypertension. -### End" -6019,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Physiologic Changes of the Thyroid metabolism during Pregnancy includes all except, with the following options: A: Increased levels of total T4 and T3, B: Elevated levels of serum TBG, C: hCG acts at TSH receptor, D: TSH level is highest during the 1st trimester - -### Response: -Pregnancy is a time of increased metabolic needs, and several factors in pregnancy also affect basic thyroid metabolism. hCG is secreted by the placenta, has significant homology with TSH, and is active at the TSH receptor. Pregnancy also results in elevated levels of serum TBG, requiring greater levels of total T4 and T3 to maintain adequate levels of free hormone. Overall, anticipated normal ranges of TSH concentration are lower during pregnancy with the lowest levels seen during the first trimester. Recommended ranges for TSH are 0.1 to 2.5 mIU/liter in the first trimester, 0.2 to 3.0 mIU/liter in the second trimester, and 0.3 to 3.0 mIU/liter in the third trimester. -### End" -6020,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with human immunodeficiency virus (HIV) infection has progressed to developing AIDS (clinical category C). Which of the following conditions is considered an AIDS-defining illness?, with the following options: A: antibodies to HIV, B: palpable lymphadenopathy, C: Kaposi sarcoma, D: oral candidiasis (thrush) - -### Response: -The current case definition of AIDS in a patient with HIV infection is done by symptoms and CD4+ T-lymphocyte cell count. Any category C symptoms (e.g., cervical cancer, mycobacterium avium infection, CMV, retinitis, Kaposi sarcoma, etc.) indicates frank AIDS as does a CD4+ T-cell count <200/mL regardless of symptoms. Shingles and thrush are category B symptoms. -### End" -6021,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary amenorrhea is when :, with the following options: A: Menstruation does not occur even after 18 year, B: Menstruation does not occur even after 15 year of age, C: Imperforate hymen exists, D: None of the above - -### Response: -Menstruation does not occur even after 15 year of age -### End" -6022,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Varicella-zoster virus (VZV), with the following options: A: Cervical tissue, B: Synovial fluid, C: Blood, D: Skin - -### Response: -The diagnosis of a viral infection is made easier by the creation of a greater number of diagnostic virology laboratories during the past few decades. In order for viral diagnosis to be successful, the most appropriate specimen must be collected for the disease in question.VZV and HSV are most often recovered from skin lesions, although varicella IgM antibody detection may be the most rapid way to diagnose acute VZV infection. Detection and identification of these viruses is essential because of the availability of antiviral agents such as acyclovir. Other viruses, such as enteroviruses and paramyxoviruses, cause skin lesions. -### End" -6023,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presented with 2 days history of fever. On examination there was a swelling in the neck and one side tonsil was pushed to midline. What is the most likely diagnosis:-, with the following options: A: Quinsy, B: Parapharyngeal abscess, C: Retropharyngeal abscess, D: Tonsillitis - -### Response: -In the history of the patient it's given that the tonsil is pushed to the midline and there is a swelling in the neck, this is the typical clinical picture of parapharyngeal abscess. Option A: in the case of quinsy H/O seven pain in throat, odynophagia (difficulty in swallowing) is given & the tonsils an enlarged congested reaching midlineHot potato voice/muffled voice- Quinsy- Para pharyngeal abscess- Acute epiglottitis -### End" -6024,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In an outbreak of cholera in a village of 2000 population 20 cases have occured and 5 have died. Case fatality rate is, with the following options: A: 1%, B: 0.25%, C: 5%, D: 25% - -### Response: -Ref: Parks 23rd edition Case fatality rate = (Total no. of deaths due to a paicular case / Total no. of cases due to the same disease) x 100 Here, CFR = (5/20) x 100= 25% -### End" -6025,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common viral infection after Kidney Transplantation is:, with the following options: A: EBV, B: HSV, C: CMV, D: HBV - -### Response: -Answer is C (CMV): CMV is the most common viral infection after Kidney Transplantation. 'CMV is the single most impoant viral infection in renal transplant recipients'- Critical Care Nephrology -### End" -6026,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not seen in urine in obstructive jaundice:, with the following options: A: Urobilinogen, B: Direct bilirubin, C: Both, D: None of the above - -### Response: -Urobilinogen -### End" -6027,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The buccal bifurcation cyst is most commonly associated with:, with the following options: A: Mandibular 1st molar, B: Maxillary 1st molar, C: Mandibular 2nd molar, D: Maxillary 2nd molar - -### Response: -The BBC is associated with multirooted molar teeth with the mandibular first molar being the most commonly associated tooth followed by the second molar. -### End" -6028,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wood lamp is used to diagnose ?, with the following options: A: Psoriasis, B: Tinea versicolor, C: Pityriasis rosae, D: Erysipelas - -### Response: -Ans. is b i.e., Tinea versicolor Diagnosis of TineaVersicolor Examination of scales in 10% KOH shows sho hyphae and round spores (Sphagetti and meat ball appearance). Wood lamp shows apple green fluorescence (blue-green fluorescence). Skin surface biopsy --> A Cyanoacrylate adhesive (Crazy glue) is used to remove the layer of stratum coreum on glass slide and then stained with PAS reagent. -### End" -6029,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the lower limit of normal hemoglobin concentration for the male between 15-17 years of age -, with the following options: A: 12 gm%, B: 13 gm%, C: 14gm%, D: 15gm% - -### Response: -Ans. is 'b' i.e., 13 gm% Normal Mean and lower limits of normal for hemoglobin, hematocrit, and Mean corpuscular volume Hemoglobin (g/dL)Hematocrit (%)Mean corpuscular volume (mm3)Age (Yr)MeanLower LimitMeanLower LimintMeanLower Limit0.5-1.912.511.0373377702-412.511.0383479735-713.011.5395581758-1113.512.04036837612-14 Female13.512.041368578Male14.012.54337847715-17 Female14.012.041368779Male15.013.04638867818-49 Female14.012.042379080Male16.014.047409080 -### End" -6030,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following best describes adenovirus?, with the following options: A: Nonenveloped, double-stranded DNA virus with fibers at its veices, B: Nonenveloped, double-stranded, circular DNA virus, C: Enveloped, single-stranded, negative-sense RNA virus, D: Enveloped, double-stranded, linear DNA virus with glycoprotein spikes - -### Response: -. -### End" -6031,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diffusion capacity of lung is increased by?, with the following options: A: CHF, B: Pulmonary embolism, C: Chronic lung disease, D: Anemia - -### Response: -DLCO increased in mild CHF,alveolar hemorrhage,polycythemia,left to right shunts. -### End" -6032,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme replacement therapy is most commonly used for, with the following options: A: Gaucher's disease, B: Fabry's disease, C: Niemenn pick's disease, D: Pompe disease - -### Response: -Gaucher disease is a multisystemuc lipidosis characterized by hematological abnormalities,organomegaly and,skeletal involvement.It has 3 clinical subtypes . It occurs due to the deficient activity of acid beta glucosidase . Thus glucosylceramide accumulate in reticule end I the loam cells. Treatment is mainly enzyme replacement therapy with recombinant acid beta glucosidase.Most extra skeletal symptoms are reversed by 60 IU/kg enzyme iv infusion every other week. Monthly maintenance improves skeletal manifestations. Reference: Nelsons TB of pediatrics 19th edit,pg 487 -### End" -6033,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 12-year-old boy has sudden onset of fever, headache, and stiff neck. Two days earlier, he swam in a lake that is believed to have been contaminated with dog excreta. Leptospirosis is suspected. Which of the following laboratory tests is most appropriate to determine whether he has been infected with leptospira?, with the following options: A: Agglutination test for leptospiral antigen, B: Counter immune-electrophoresis of urine sample, C: Gram stain of urine specimen, D: Spinal fluid for dark-field microscopy and culture in Fletcher serum medium - -### Response: -Leptospirosis is a zoonosis of worldwide distribution. Human infection results from ingestion of water or food contaminated with leptospirae. Rats, mice, wild rodents, dogs, swine, and cattle excrete the organisms in urine and feces during active illness and during an asymptomatic carrier state. Drinking, swimming, bathing, or food consumption may lead to human infection. Children acquire the disease from dogs more often than do adults. Treatment can include doxycycline, ampicillin, or amoxicillin. Symptoms in humans range from fever and rash to jaundice through aseptic meningitis.Leptospirae are tightly coiled, thin, flexible spirochetes 5 to 15mm long, with one end bent into a hook. It stains best where silver can be impregnated into the organism. The gram stain would not be useful. The organisms derive energy from oxidation of fatty acids, so EMB or TM agar would be inadequate. Agglutination testing and CIE is complicated by the fact that all Leptospirae strains exhibit cross-reactivity in serologic tests. -### End" -6034,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Boxer's fracture is: MP 11, with the following options: A: Fracture of first metacarpal base, B: Fracture of fifth metacarpal neck, C: Fracture of third metacarpal neck, D: Fracture of first metacarpal neck - -### Response: -Ans. Fracture of fifth metacarpal neck -### End" -6035,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Frey's syndrome is caused by, with the following options: A: Post traumatic nerve fibers of facial nerve with parasympathetic of auriculotemporal nerve, B: Greater auricular nerve with auriculotemporal nerve, C: Facial nerve with greater auricular nerve, D: None - -### Response: -Frey&;s syndrome results from parotid surgery due to aberrant regeneration of parasympathetic fibres of the facial nerve and auriculotemporal nerve. Ref: Dhingra 6th edition pg. 98 -### End" -6036,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Attention deficit hyperactivity disorder is seen in?, with the following options: A: Insulin resistance, B: Thyroid hormone resistance, C: Testosterone deficiency, D: Calmodulin deficiency - -### Response: -ADHD: Attention Deficit Hyperactivity Disorder. Difficulty in paying attention, difficulty in controlling behavior and hyperactivity. Etiology- both genetic and environmental factors. Abnormality in dopamine transpoer and thyroid receptor beta genes in some patients. Three subtypes are known: 1. Predominantly hyperactive-impulsive 2. Predominantly inattentive 3. Combined hyperactive-impulsive and inattentive. Diagnosis is primarily clinical, using thorough clinical interview of parents and use of behavior rating scales. Physical examination includes direct observation of the child and ruling out chronic systemic illnesses that affect child&;s attention span. Reference: GHAI Essential pediatrics, 8th edition -### End" -6037,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is used for improving long term prognosis in COPD with resting hypoxemia:March 2011, with the following options: A: Oxygen, B: Beta-2 agonist, C: Inhaled steroids, D: Systemic steroids - -### Response: -Ans. A : OxygenLong term home oxygen therapy improves survival in selected patients with COPD complicated by severe hypoxemia (aerial Pa02 less than 8.0 kPa/ 55 mmHg) -### End" -6038,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Variation in drug responsiveness to a paicular dose of the drug in different individuals can be obtained from:-, with the following options: A: Graded Dose Response Curve, B: Efficacy, C: Potency, D: Quantal Dose response Curve - -### Response: -ED50 : dose at which 50% of subject will responds to drug. Potency :- Measure of amount of drug necessary to produce an effect of a given magnitude. Efficacy: Magnitude of response a drug can cause when it interacts with a receptor. Depends on of drug receptor complex formed. * In this Quantal DRC, x-axis represents the log dose and y-axis represents the percentage of population responding.* It is used when responses are like all or none. The middle point of curve when projected to x-axis gives effective dose and lethal dose in 50% of population. -### End" -6039,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is the most impoant prognostic factor in ALL?, with the following options: A: Hyperploidy, B: Total leucocyte count greater than 50,000, C: Age, D: Response to steroids - -### Response: -Responds to steroids is the most consistent marker in the patients of ALL. (ref Robbins 9th/590-593) -### End" -6040,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ventricles are lined by?, with the following options: A: Oligodendrocytes, B: Ependymal cells, C: Schwann cells, D: Astrocytes - -### Response: -Ventricles are lined by Ependymal cells. The ependymal cells play an impoant role in the production and regulation of CSF. -### End" -6041,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a mode of primary prevention?, with the following options: A: Administration of vit A in children, B: Treating a sputum + ive case of TB, C: Splinting a fractured leg, D: Providing wheel chair for the limbless - -### Response: -Here the vitamin A administration removes the risk factor. Hence it is a primary prevension strategy. -### End" -6042,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hartnup's disease is associated with disturbed metabolism of, with the following options: A: Phenylalaine, B: Tyrosine, C: Tryptophan, D: Valine - -### Response: -(C) Tryptophan # HARTNUP DISEASE:> This disorder is characterized by reduced intestinal absorption & renal reabsorption of neutral amino acids.> The defect involves an amino acid transporter on the brush border of the jejunum & the proximal tubule. Intestinal absorption of free amino acids is reduced, though the neutral amino acids can be absorbed when present in di- & tripeptides.> Degradation of unabsorbed tryptophan by intestinal bacteria produces indolic acids that are absorbed & subsequently excreled at high levels in the urine of these patients.> The disorder is inherited as an autosomal recessive trait with an estimated incidence of 1 in 24,000 live births. Linkage analysis suggests a locus on chromosome 5. -### End" -6043,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Formation of granulation tissue is due to:, with the following options: A: Thrombosed vessels, B: Budding of new capillaries, C: Mucosal proliferation, D: Infiltration of cells. - -### Response: -Ans. is 'b' Budding of new capillaries Granulation tissue is a highly vascularized connective tissue. It is formed when tissue heals by scar formation. It appears pink and granular because of newly formed capillaries present in it.It also consists of:FibroblastsResidual inflammatory cells. -### End" -6044,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A girl with normal stature and minimal or absent pubeal development is seen in, with the following options: A: Kallman syndrome, B: Turner syndrome, C: Testicular feminization syndrome, D: Pure gonadal dysgenesis - -### Response: -Ans. a. Kallman syndrome -### End" -6045,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common phase-2 reaction, with the following options: A: Glucuronide conjugation, B: Acetylation, C: Methylation, D: Sulfate conjugation - -### Response: -Ans. is'a'i.e., Glucuronide conjugationRef: KDT Vh/e p. 24Most impoant metabolizing reaction, overall -### End" -6046,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following are true regarding blood supply to the kidney, except, with the following options: A: Stellate veins drain superficial zone, B: It is site of poosystemic anastomosis, C: The renal aery divides into five segmental aeries before entering the hilum, D: Its segmental aeries are end-aeries - -### Response: -. -### End" -6047,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The current imaging technique of choice for the diagnosis of hydatidiform mole is :, with the following options: A: Computed tomography, B: Ultrasonography, C: Plain X-ray abdomen, D: Magneic resonance imaging - -### Response: -Ultrasonography -### End" -6048,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: From the following neck of femur fractures, which one has the worst prognosis?, with the following options: A: Basicervical, B: Garden's type 4, C: Transcervical, D: Prognosis same in A,B,C - -### Response: -Garden classification Stage Description Image Stage I Incomplete impacted fracture(abduction fracture) Femoral head is tilted into valgus in relation to the neck Stage II Complete but undisplaced fracture Stage III Complete fracture with moderate displacement Stage IV Severely displaced fracture Worst prognosis -### End" -6049,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cricothyrotomy is converted to tracheostomy, with the following options: A: To avoid hypoxia, B: To avoid subglottic stenosis, C: To facilitate oxygenation, D: Easy consumption of food - -### Response: -Ans. (B) To avoid subglottic stenosisRef: Bailey and Love Page 695* To avoid subglottic stenosis if we give ventilation via the cricothyrotomy tube we must change it to Tracheostomy at the earliest. -### End" -6050,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: what is the anticoagulant of choice in electrolyte estimation ?, with the following options: A: lithium heparin, B: trisodium citrate, C: EDTA, D: all of the above - -### Response: -(Anticoagulant) : * Is a substance that prevents blood from coagulation or clotting. * The most common anticoagulants used in hematology are: 1. EDTA: Ethylen Diamine Tetraacetic acid -CBC , RBC MORPHOLOGY 2. Sodium citrate - FOR COAGULATION STUDIES 3. Heparine -ABG (ELECTROLYTES), IMMUNOPHENOTYPING ,LEUKOCYTE FUNCTION DEFECT , OSMOTIC FRAGILITY TEST REF : ROBBINS 10TH ED -### End" -6051,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Greenish black discharge from breast is seen in:, with the following options: A: Duct ectasia, B: Intraductal papilloma, C: Ca breast, D: Paget disease of nipple - -### Response: -Ans: a (Duct ectasia) Ref: Bailey & Love, 24th p. 828Greenish black discharge from breast is seen in duct ectasiaDischarges from nipple 1) Discharges from the surface* Paget's disease* Skin disease (eczema, psoriasis)* Rare causes (e.g.: chancre)3) Discharge from more than one ducta) Blood stained- Carcinoma- Ectasia- Fibrocystic diseaseb) Gmmous- Duct ectasiac) Purulent- Infectiond) Serous- Fibrocystic disease- Duct ectasia- Carcinomae) Milk- Lactation- Rare causes- Hypothyroidism/ pituitary tumour2) Discharge from a single ducta) Blood stained- Intraductal carcinoma- Intraductal papilloma- Duct ectasiab) Serous (any colour)- Fibrocystic disease- Duct ectasia- Carcinoma -### End" -6052,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chang staging is used for:, with the following options: A: Retinoblastoma, B: Medulloblastoma, C: Ewing's sarcoma, D: Rhabdomyosarcoma - -### Response: -Chang staging is used for medulloblastoma. -### End" -6053,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IgE is secreted by -, with the following options: A: Mast cell, B: Basophils, C: Eosinophils, D: Plasma cells - -### Response: -IgE is synthesised by plasma cells. Monomers of IgE consist of two heavy chains (e chain) and two light chains, with the e chain containing 4 Ig-like constant domains Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg:136 -### End" -6054,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not gluconeogenic-, with the following options: A: Acetyl CoA, B: Lactate, C: Glycerol, D: Alanine - -### Response: -Ans. is 'a' i.e., Acetyl CoA o Substrates for gluconeogenesis are lactate (lactic acid), pyruvate, glycerol, glucogenic amino acids (alt amino acids except leucine and lycine), propionate and intermediates of citric acid cycle.. -### End" -6055,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Early stage of carcinoma esophagus is diagnosed by ?, with the following options: A: Barium meal, B: Trans oesophageal USG, C: MRI, D: Endoscopy - -### Response: -Ans. is 'd' i.e. Endoscopy -### End" -6056,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Human Development Index includes all of the following except: March 2009, September 2009, September 2012, March 2013 (a, c, d, f), with the following options: A: Infant moality, B: Income, C: literacy rate, D: Life expectancy at bih - -### Response: -Ans. A: Infant moality The Human Development Index (HDI) is a composite statistic used to rank countries by level of ""human development"" and separate developed (high development), developing (middle development), and underdeveloped (low development) countries. The statistic is composed from data on Life Expectancy, Education and per-capita GDP (as an indicator of Standard of living) collected at the national level The HDI combines three dimensions: Life expectancy at bih, as an index of population health and longevity Knowledge and education, as measured by the adult literacy rate (with two-thirds weighting) and the combined primary, secondary, and teiary gross enrollment ratio (with one-third weighting). Standard of living, as indicated by the natural logarithm of gross domestic product per capita at purchasing power parity. -### End" -6057,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A low risk primigravida underwent vaginal delivery with episiotomy. 2 hours after delivery patient appears pale, PR 110/min BP is 90/60 but there is no apparent PPH. PV examination shows a bulge over episiotomy stitch line. Hb shows a drop in Hb from 9 gm% to 7 gm%. Management is?, with the following options: A: Blood and fluid transfusion with IV antibiotics, B: Blood transfusion and cold compression of episiotomy, C: Immediate exploration of episiotomy and blood transfusion, D: Cervical exploration with uterotonics with blood transfusion - -### Response: -The patient is showing signs of hemodynamic compromise with a significant drop in hemoglobin. This is suggestive of acute haemorrhage. As uterine bleeding is not evident and a bulge is present at site of episiotomy, it appears to be a case of a large hematoma at episiotomy which should be urgently explored, evacuated and bleeder should besecured. -### End" -6058,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carriers are important in all the following except-, with the following options: A: Polio, B: Typhoid, C: Measles, D: Diphtheria - -### Response: -The only source of infection of measles is a case of measles. Carriers are not known to occur. There is some evidence to suggest that sub clinical measles occurs more often than previously thought. -### End" -6059,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Reye's syndrome -, with the following options: A: Microvesicular fatty infiltration, B: Hepatic encephalopathy, C: Brain edema, D: All - -### Response: -Ans. is All -### End" -6060,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Teardrop sign is seen in: Kerala 08; JIPMER 08; Maharashtra 09, with the following options: A: Fracture medial wall of orbit, B: Fracture lateral wall of orbit, C: Fracture floor of orbit, D: Fracture roof of orbit - -### Response: -Ans. Fracture floor of orbit -### End" -6061,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Snowman's heart sign on chest X-ray is seen in -, with the following options: A: Ebstein anomaly, B: Total anomalous pulmonary venous connection (TAPVC), C: Tetrology of Fallot, D: Transposition of great vessels - -### Response: -Ans. is 'b' i.e., Total anomalous pulmonary venous connection (TAPVC) o ""Snowman"" or ""figure of 8"" or ""cottage loaf sign"" is characteristic of supracardiac TAP VC.Cardiac configrationo ""Boot-shaped"" heart (cour en sabot)Fallot's tetralogyo ""Egg on side"" heart (""egg in cup"" heart)Transposition of great arterieso ""Egg in cup"" HeartConstrictive pericarditiso ""Snowman"" sign (""figure of 8, or cottage loaf' sign)Supracardiac TAPVCo ""Ground - glass"" appearance of lungObstructive TAPVCo ""Sitting-duck"" heartPersistent truncus arteriosuso ""Water-bottle"" or flasked shaped or money bag heartPericardial effusion, hypothyroidismo ""Box-shaped"" heartTricuspid atresia, Ebstein's anomalyo Tubular heartAddison's disease, emphysemao ""Tear -drop"" heartChronic emphysemao ""Cor-triatum""Pulmonary vein obstructiono ""Jug handle"" appearancePrimary pulmonary hypertensiono ""Pentagon-shaped"" heartMitral incompetenceo ""Triangular-shaped"" heartConstrictive pericarditis -### End" -6062,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spread of which disease cannot be controlled by isolation -, with the following options: A: Diphtheria, B: Neonataltetanus, C: Cholera, D: Mumps - -### Response: -Ans. is 'b' i.e., Neonatal tetanus Periods of isolation recommendedDiseaseDuration of isolationChickenpoxUntil all lesions cursted; usually about 6 days after onset of rashMeaslesFrom the onset of catarrhal stage through 3rd day of rashGerman measlesNon, except that women in the first trimester or sexually active, non immune women in child-bearing years not using contraceptive measures should not be exposed.Cholera, diphtheria3 days after tetracyclines started, until 48 hours of antibiotics (or negative culturs after treatment)ShigellossisSalmonellosis}Until 3 consecutive negative stool cultures.Hepatitis AInfluenzaPolioTuberculosis (sputum -V)3 weeks3 days after onset2 weeks adult, 6 weeks paediatric.Until 3 weeks of effective chemotherapyHerpes zosterMumpsPertussis6 days after onset of rashUntil swelling subsides4 weeks or until paroxysms ceaseMeningococcalminingtirisStreptococcalPharyngitis}Until the first 6 hours of effective antibiotic therapy are completedo Isolation has failed in the control of disease such as leprosy, TB & STD. In the control of these diseases, the concept of physical isolation has been replaced by chemical isolation, Le., rapid treatment of cases in their own-homes and rendering them non-infectious as quickly as possible. -### End" -6063,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Complement binding immunoglobulin the classical pathway is -, with the following options: A: IgG & IgM, B: IgG & IgA, C: IgG & IgD, D: IgD & IgE - -### Response: -IgM is paicularly effective at complement activation by binding to C1. IgG activates the classical pathway of the complement system, a cascade of immune protein production Ref: Ananthanarayan & Parker's textbook of microbiology 9th edition pf:98 -### End" -6064,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common type of class II mutation in cystic fibrosis is, with the following options: A: Missense mutation, B: Frameshift, C: Non sense, D: Deletion - -### Response: -Ans. D. DeletionClass II mutation : 'Deletion' of phenylalanine amino acid so CFTR protein fails to reach cell membrane -### End" -6065,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Nipah virus are all except -, with the following options: A: Is a paramyxovirus, B: Causes hemorrhagic fever, C: Emerging infection, D: Present in India - -### Response: -Ans. Is 'b' i.e., Causes hemorrhagic fever o Nipah virus is an emerging infectious agent belongs to paramvxoviridae.o It was first isolated in Malaysia in 1998, causing encephalitis in domestic pigs, with direct transmission from pigs to human.o There have been Nipah virus infection outbreaks in pigs in Malaysia and Singapore and human disease in Malaysia, Singapore, India and Bangladesh.o Typically the human infection presents as an encephalitis syndrome marked by fever headache, drowsiness, disorientation, mental confusion, coma and death. -### End" -6066,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Medical treatment for gall bladder stone is amenable for :, with the following options: A: Stones less than 15 mm in size, B: Radioopaque stone, C: Calcium bilirubinate oxalate stone, D: Nonfunctioning stones associated with gall bladder - -### Response: -Answer is A (Size of stone less than 15mm) Medical therapy for gall bladder stone is amenable for stones < 15 mm (preferably Prerequisites for medical therapy : Gall bladder should he functioning Stones should be radiolucent Size should be small preferably < 15 mm Q -Harrison 14'h (<10n/in-Harrison 16th) Stones should be 'cholesterol stones' only Obvious by thier mechanism of action)Q (Newer edition of Harrison has mentioned the size of stone to be preferably < 10 mm rather than < 15 mm but we will go with same answer because the question was framed in older times). Medical therapy for Gall stone dissolution consists of administration of : UDCA (Ursodeoxycholic acid)Q CDCA (Choledeoxycholic acid)Q Mechanism of action: Inhibit HMG-CoA reductase activityQ, which in turn results in decreased hepatic cholesterol synthesis. Allows dispersion of 'cholesterol' from stones by physicochemical means. -### End" -6067,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Turbinate that articulates with ethmoid is:, with the following options: A: Superior, B: Middle, C: Inferior, D: All of the above - -### Response: -(c) Inferior(Ref. Cummings, 6th ed., 754)The superior and middle turbinates are parts of ethmoid bone whereas inferior turbinate is an independent separate bone which articulates with the ethmoid. -### End" -6068,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Strongest interactions among the following -, with the following options: A: Covalent, B: Hydrogen, C: Electrostatic, D: Van der Waals - -### Response: -Ans. is 'a' i.e., Covalent o Strongest bond Covalento Weakest bond - Van der walls forcesMoleucular interactionso There are two types of interactions between molecules that stabilize molecular structuresCovalent bonds, e.g. peptide bonds and disulphide bonds.ii) Non-covalent bondsMolecular interactionNon-covalent bondsCovalent bondsy Electrostatic interactions (salt bridges or ionic bonds)y Hydrogen bondsy Hydrophobic interactionsy Van Der Waal forces Strength of various interactions (in decreasing order)Covalent (strongest)Q> Electrostatic Q (ionic or salt linkage) > hydrogen> hydrophobic> Van der vvaal's (weakest)Q -### End" -6069,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sterile haemorrhagic cystitis is caused by:, with the following options: A: Busulfan, B: Ketoprofen, C: Methicillin, D: Cylclophosphamide - -### Response: -Ans. is 'd' i.e. CyclophosphamideRef: Harrison 16th/e p 583 (15th/ e p 435, 650)Though Harrison includes Busulfan as a causative agent for hemorrhagic cystitis, no other standard text books of Pharmacology mention it (KDT, Goodman Gilman, Katzung and Lawrence). Furthermore in detailed description of Hemorrhagic cystitis it does not mention - BusulfanHarrison states - ""Hemorrhagic cystitis can develop in patients receiving cyclophosphamide or ifosfamide.""Other drugs causing hemorrhagic cystitisCarmustineChlorambucilExtended spectrum penicillins Nitrogen mustard VincristineRemember these following 2 very important points: -Hemorrhagic cystitis due to cyclophosphamide is attributed to the presence of its metabolite ACROLEIN in urine.Hemorrhagic cystitis due to cyclophosphamide can be prevented by -I. V. injection of MESNA* (Sodium - 2 - mercapto ethane sulfonate) and adequate hydration.Also knowHemorrhagic cystitis is also seen in patients who undergo Bone marrow transplantation (BMT)In BMT settingsEarly onset hemorrhagic cystitis - d/t drugs (eg. cyclophosphamide) late onset hemorrhagic cystitis - d/t polyoma virus BKV or adenovirus type II -### End" -6070,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fouh ventricle develops from?, with the following options: A: Telencephalon, B: Mesencephalon, C: Diencephalon, D: Rhombencephalon - -### Response: -Lateral ventricle develops from the cavity of telencephalon. Third ventricle develops from diencephalon. Cavity of mesencephalon remains narrow and forms the aqueduct, while the cavity of rhombencephalon forms the fouh ventricle. -### End" -6071,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During pronation of the foot, the axes of which two joints become parallel?, with the following options: A: Talocrural and subtalar, B: Talonavicular and calcaneocuboid, C: Talonavicular and subtalar, D: Midtarsal and tarsometatarsal - -### Response: -Right colic aery is a small vessel that is highly variable in its anatomy and may be absent.Right colic aery most commonly arises as a common trunk with the middle colic aery.Alternatively, it may arise as a separate branch from the right side of the superior mesenteric aery, or from the ileocolic aery (when it is referred to as an accessory right colic aery), and occasionally it may be absent. The right colic aery is highly variable in its anatomy.Variations in the anatomy of the middle colic aery left colic aery and superior rectal aeries are rarely seen.The middle colic aery usually arises from the anterolateral aspect of the superior mesenteric aery, The principal aerial supply to the upper two-thirds of the rectum is the superior rectal aery. Superior rectal aery is the principal continuation of the inferior mesenteric aery. It divides into two branches at the level of the third sacral veebra.(Refer: Richard S. Snell's Clinical Anatomy by Regions, 9th edition, pg no: 192-194) -### End" -6072,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most appropriate method for collecting urine for culture in a case of vesicovaginal fistula?, with the following options: A: Sterile speculum, B: Foley's catheter, C: Midstream clean catch, D: Suprapubic needle aspiration - -### Response: -Ureteric catheterisation is the best method of collecting urine for culture in a case of vesico-vaginal fistula. Second best method of collection of urine is supra pubic aspiration, which needs a full bladder and is not possible in this case. Collection of urine sterile speculum and midstream clean catch leads to contamination of urine. So by exclusion, the best answer is collection of urine using a foley's catheter. Ref: Textbook of Gynecology By DC Dutta, 4th Edition, Pages 386-8 -### End" -6073,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sociology –, with the following options: A: Study of human relationship, B: Study of behavior, C: Both, D: None - -### Response: -Sociology deals with the study of human relationships and of human behavior. -### End" -6074,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 11 Year old child presented with sore throat since 3 days, which medium is used to culture the throat swab -, with the following options: A: Blood agar, B: L. J. medium, C: Stewart medium, D: Chocolate agar - -### Response: -Ans. is 'a' i.e., Blood agar Sore throat in childreno Sore throat refers to irritation or pain in the throat. The most common and usual cause is acute pharyngitis.o Infection is the most common cause of sore throat and etiological agents are usually respiratory viruseso The causes are -# Viral pharyngitis (70%) The most common being rhinovirus (40%) followed by coronavirus (10-20%), adenovirus (10%), herpesvirus (8%) and other virus (< 5%) like influenza, parainfluenza, EBV etc.# Streptococcal pharyngitis (20-30%) This is the most common bacterial cause.# Other causesH. influenzae, pneumococcus etc.o For diagnosis, the throat culture is performed by culturing the swab for bacteria collected from the back of throat. The bacteria are allowed to grow on special plates called sheep blood agar plateo However, throat culture takes 1 -2 days. Therefore, more rapid test, i.e. rapid antigen test (Quick test) can be used early if suspecting bacterial pharyngitis. -### End" -6075,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A new born child has not passed meconium for 48 hours. What is the diagnostic procedure of choice?, with the following options: A: USG, B: Contrast enema, C: CT, D: MRI - -### Response: -Failure to pass meconium in the first 2 days of life (48 hours) is typically suggestive of a lower GI tract obstruction such as Hirschsprung's diseases, meconium plug syndrome or anorectal malformation. A contrast enema is the most suitable primary investigation to make the diagnosis, amongst the options provided. -### End" -6076,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fear of strangers-, with the following options: A: Algophobia, B: Xenophobia, C: Mysophobia, D: Thanatophobia - -### Response: -Ans. is 'b' i.e., Xenophobiao The common types of phobia are:-1) Agoraphobia# This is an example of irrational fear of situations. It is the commonest type of phobia encountered in clinical practice.# It is characterized by an irrational fear of being in places away from familiar setting of home and patient believes that he cannot escape from these places, to a safer place (usually home). This fear results in avoidance of these places which include public places, stores, crowd, travelling alone in bus, train or plane, Theaters, Tunnels, Bridge, standing in line small enclosed rooms or lifts.2) Social phobia# In social phobia there is irrational fear of one or more social or performance situations in which the person is concerned about negative evaluation or scrutiny by others, for example : Public speaking; writing/drinking/ eating in public; using public lavatories.3) Specific (simple) phobia# These are phobias limited to highly specific situations or objects, for example.i) Claustrophobia:- Fear of closed spacesviii) Mysophobia:- Fear of dirt & germsii) Acro/Aerophobia:- Fear of high placesix) Erythrophobia:- Fear of blushingiii) Zoophobia:- Fear of animalsx) Sitophobia:- Fear of eatingiv) Pyrophobia:- Fear of firexi) Ailurophobia:- Fear of catsv) Xenophobia:- Fear of strangersxii) Sitaphobia:- Fear of dogsvi) Algophobia:-Fears of painxiii) Hydrophobia:- Fear of watervii) Thanatophobia : - Fear of death -### End" -6077,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 55-year old man who has been on bed rest for the past 10 days, presents with sudden onset of breathlessness and chest pain. The chest x-ray is normal. Which of the following represents the next step in investigation?, with the following options: A: Electrocardiogram, B: Echocardiography, C: Lung Ventilation Perfusion Scan, D: Pulmonary aeriography - -### Response: -Ventilation-perfusion scan has a sensitivity and specificity of 90% if results of the scan correlate with clinical risk factor assessment. Lung scanning is the second-line diagnostic test for Pulmonary Embolism, used mostly in patients who cannot tolerate intravenous contrast. The perfusion scan defect is indicated by absent or decreased blood flow. A high-probability scan indicates two or more segmental perfusion defects in the presence of normal ventilation. Echocardiography: Is not a reliable diagnostic imaging tool for acute PE because most patients with PE have normal echocardiograms. It is used to detect conditions that may mimic PE. Pulmonary Angiography: Chest CT with contrast has viually replaced invasive pulmonary angiography as a diagnostic test. Ref: Current Diagnosis and Treatment: Surgery, 13th Edition, Chapter 35 -### End" -6078,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following structures are involved in Buerger's disease?, with the following options: A: Aeries only, B: Veins only, C: Aeries and Veins, D: Aeries, veins and nerves - -### Response: -Buerger's disease is a progressive non-atherosclerotic segmental inflammatory disease that most often affects small and medium-sized aeries, veins, and nerves of the upper and lower extremities. Pathologically, thrombosis occurs in small to medium-sized aeries and veins with associated dense polymorphonuclear leukocyte aggregation, microabscesses, and multinucleated giant cells. It usually affects young male smokers. Patients develop calf claudication and eventually ischemic rest pain and ulcerations on the toes, feet, or fingers. Angiography shows 'cork screw' shaped collaterals. Ref: Schwaz's Principles of Surgery, 9e, Chapter 23. -### End" -6079,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following are adverse effects of use of blood products?, with the following options: A: Urticaria, B: Rash, C: Tachycardia, D: All of the above - -### Response: -Ans. D. All of the aboveCommon adverse effects of use of blood and blood products are: Urticaria rash (mild effects). Flushing, rigors, fever, tachycardia (moderately severe).Life threatening effects include Hypotension, restlessness, hemoglobinuria, DIC -### End" -6080,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a positive tuberculin skin test, helper T cells assist in which of the following ways?, with the following options: A: Autocrine-mediated inhibition of proliferation of helper T cells, B: The down regulation of IL-2 receptors on helper T cells, C: Secretion of interleukins that promote T cell proliferation, D: Secretion of IL-I - -### Response: -In a tuberculin skin test, T cell proliferation is increased by secretion of interleukins. An extract of tuberculin (an antigen of lipoprotein composition obtained from the tubercle bacillus) is injected into the skin of a person who has had tuberculosis or has been immunized against tuberculosis. Merriory helper T cells react to the tuberculin and secrete Il-2, which up regulates Il-2 receptors. Il-2 binding to Il-2 receptors on the same cell is an example of autocrine regulation in which a cell secretes a ligand for a receptor on its own surface. The result of this up regulation and ligand receptor binding is an increase in T cell proliferation. T cell derived cytokines such as tumor necrosis factor-alpha and beta (TN Fα and β) induce leukocyte recruitment. Production of gamma-(γ)-interferon by helper T cells attracts and activates macrophages (monocytes comprise most of the cellular infiltrate). γ -Interferon also converts other cells (such asendothelial cells) to antigen-presenting cells by induction of class II MHC expression, which further augments the response. The result of the activity of helper T cells is a dramatic increase in the number of lymphocytes and macrophages at the test site, which produces swelling. IL-I is synthesized by antigen-presenting cells and macro phages with helper T cells as the targets. -### End" -6081,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady with prolapsed uterus after Fothergill's repair will complain of following except:, with the following options: A: First trimester abortion, B: Cervical dystocia, C: Premature labour, D: Premature rupture of membrane - -### Response: -In Fothergill's repair ceroidical amputation is done which leads to - -Incompetent os -Habitual abortion (second-trimester abortion and not first trimester, as incompetent os, leads to second-trimester abortion) -Preterm deliveries -Premature rupture of membranes                                                                                                       -Other complications are decreased cervical fertility -Excessive fibrosis causes stenosis leading to dystocia during labour. -Hematometra (Very rare) -Recurrence of prolapse - -Note: Since all these complications of Fothergill's are mainly due to amputation of cervix-Shirodkar's modification of Fothergill's operation (also called as Shirodkar's uterosacral ligament advancement surgery), is being done where amputation of the cervix is not done, rest all steps are same as Fothergill's repair. -### End" -6082,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A soft contact lens wearer developed pain and itching of the eye and showed a reticular pattern on the corneal epithelium. The cause could be –, with the following options: A: Corneal dystrophy, B: Acanthamoeba, C: Pseudomonas, D: Virus - -### Response: -Reticular patter of keratitis in a contact lens wearer is seen in Acanthamoeba. -Initially the Acanthamoeba keratitis shows typical reticular pattern due to radial keratoneuritis (Radial perineuritis), i.e. inflitrates along corneal nerves. -Due to this, the pain is very severe (neurological due to perineuritis) which is out of proportion to the degree of inflammation. -Later, reticular superficial keratitis advanced to ring-shaped lesion in central or paracentral region. -### End" -6083,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reiche's cailage derivative is ?, with the following options: A: Malleus, B: Inchus, C: Stapes suprastructure, D: Sphenomandibular ligament - -### Response: -The cailage of second pharyngeal arch (hyoid arch) is known as Reiches cailage and contributes as :- (i) Stapes (except footplate), (ii) Styloid process, (iii) Stylohoid ligament, (iv) Lesser cornu and superior pa of body of hyoid bone. However, footplate of stapes develop from otic capsule. -### End" -6084,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: -30 to-90 degree axis de viatio n ind icates -, with the following options: A: Left Axis Deviation, B: Right Axis Deviation, C: Extrene Right .Axis Deviation, D: Normal Cardiac Axis - -### Response: -Ans. is 'a' i.e., Left Axis Deviation o The normal axis flows down and towards the left lower aspect of the heart between -36 to +90.Cardiac axiso The electrical signal recorded on the electrocardiogram (ECG) contains information relative to direction and magnitude of the various complexes.o The average direction of any of the complexes can be determined.Normal Cardiac Axiso The normal QRS electrical axis, as established in the frontal plane, is between -30 and 90deg (directed downward or inferior and to the left) in adults.Left Axis Deviationo An axis between -30deg and -90deg (directed superior and to the left) is termed left axis deviation.Right Axis Deviationo If the axis is between 90deg and 180deg (directed inferior and to the right), then right axis deviation is present.Extreme Right Axis Deviationo An axis between -90degand-180deg (directed superior and to the right) is referred to as extreme right or left axis.Indeterminateo If the QRS is equiphasic in all leads with no dominant QRS deflection, it is indeterminate axis.Causes of axis deviation include||Right axis deviationLeft axis deviationo Normal variation (vertical heart with an axis of 90deg)o Normal variation (physiologic, often with age)o Mechanical shifts, such as inspiration and emphysemao Mechanical shifts, such as expiration, high diaphragm (pregnancy, ascites, abdominal tumor)o Right ventricular hypertrophyo Right bundle branch blocko Left ventricular hypertrophyo Left posterior fascicular blocko Left bundle branch blocko Dextrocardiao Left anterior fascicular blocko Ventricular ectopic rhythmso Congenital heart disease (primum atrial septal defect, endocardial cushion defect)o Pre-excitation syndrome (Wo iff Pa rki ns on- White)o Lateral wall myocardial infarctiono Emphysemao Secundum atrial septal defecto Hyperkalemia o Ventricular ectopic rhythms o Pre-excitation syndromes (Wolff-Parkinson-White) o Inferior wall myocardial infarction. -### End" -6085,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following pair of drugs are metabolized by same Cytochrome enzyme, with the following options: A: Omeprazole and Clopidogrel, B: Phenytoin and Tacrolimus, C: Paracetamol and Warfarin, D: Omeprazole and Warfarin - -### Response: -Both are metabolized by CYP2C19. -### End" -6086,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Krukenberg spindle"" are seen in -, with the following options: A: Pigmentary glaucoma, B: Sympathetic ophthalmitis, C: Retinitis pigmentosa, D: Retinoblastoma - -### Response: -(A) (Pigmentary glaucoma) (249-Nema 6th) (249 A.K.K. Khurana 5th)PIGMENTARY GLAUCOMA* Type of secondary open angle glaucoma.* About 50% of patients with the Pigment Disperson Syndrome (PDS) develop glaucoma.* Common in young myopic males* Raised IOP, mild-peripheral iris pigment atrophy and dispersion of pigments on the comeal endothelium in a vertical spindle pattern (Krukenberg Spindle)**, trabecular mesh work, Schwalbe's line, iris surface and lens equator characterize the pigmentary glaucoma.* Gonioscopy shows pigment accumulation along the Schwalbe's line especially inferiorly (Sampaolesi's line).* Iris transillumination shows radial slit like transillumination defects in the mid periphery (Pathognomic features).* Dalen Fuch's nodules are seen in sympathetic ophthalmitis**** Flexner Wintersteiner rosette (highly specific of retinoblastoma), Homer Wright rosettes, pseudorosettes and fleurettes formation are histopathological features of Retinoblastoma*** -### End" -6087,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Long thyroid stimulating agent is, with the following options: A: Antibody to thyroid globulin, B: Antibody to thyroid cell receptors, C: Antibody to thyroxine, D: Antibody to thyroid cells - -### Response: -Answer is option 2, antibody to thyroid receptors. Thyrotropin receptor (TSHR) antibodies that stimulate the thyroid (TSAb) cause Graves' hypehyroidism and TSHR antibodies which block thyrotropin action (TBAb) are occasionally responsible for hypothyroidism. Unusual patients switch from TSAb to TBAb (or vice versa) with concomitant thyroid function changes. We have examined case repos to obtain insight into the basis for ""switching."" -### End" -6088,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First test for a couple presenting with infeility: March 2013, with the following options: A: Post coital test, B: Chromosomal studies, C: Sperm penetration test, D: Husband's semen analysis - -### Response: -Ans. D i.e. Husband's semen anaylsis -### End" -6089,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25 year old woman presents with recurrent abdominal pain and anemia. Peripheral blood smear shows basophilic stippling of the red blood cells. What is the most likely diagnosis -, with the following options: A: Coeliac disease, B: Hookworm infestation, C: Sickle cell disease, D: Lead poisoning - -### Response: -Ans. is 'd' i.e., Lead poisoning The diagnosis can easily be made from the presence of Basophilic stippling. None of the causes other than lead poisoning are mentioned the question.Causes of basophilic stippling.Lead poisoningMegaloblastic anemiaThalassemiasSideroblastic anemiaAlcoholismPyrimidine-5-nucleotidase deficiency Features of lead poisoningAcute lead poisoning (rare)The principal manifestations of acute lead poisoning are gastrointestinal and central nervous system disturbances.Higher blood levels are usually associated with impaired neurotransmission and neuronal cell death, at still higher level lead encephalopathy and death may occur.Chronic lead poisoningLead poisoning is nearly always of the chronic typeSign and symptoms of chronic poisoning.Facial pallor - earliest and most consistent sign (due to vasospasm)Hypochromic anemia with punctate basophiliaLead line - Stippled bluish black lines on the gums at the junction with the teeth (not on the teeth)Colic and constipation - It is a late manifestation but constitutes an acute symptom of chronic plumbism.Paralysis - Late manifestation, usually wrist drop or foot drop occurs (motor delays on nerve conduction)Encephalopathy - Lead encephalopathy in some form or the other is said to be present in every case.Renovascular - - Elevated protoporphyrin levelT/T * If astutely toxic- Hospitalization and I.V. or* In highlyI.m.chelation with edentate calcium disodium (CaEDTA). Dimercaprol is also required to prevent encephalopathy.- Chelation with oral DMSAexposed(succimer with symptoms)Also know, Exposure to lead mainly occurs through auto batteries, lead crystal ceramics, fishing weight etc. -### End" -6090,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reiter's syndrome is typically characterised by:, with the following options: A: Urethritis, conjunctivitis and iridocyclitis, B: Ahritis, conjunctivitis and iridocyclitis, C: Urethritis, ahritis and conjunctivitis with or without iridocyclitis, D: All of the above - -### Response: -Ans. Urethritis, ahritis and conjunctivitis with or without iridocyclitis -### End" -6091,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which can cause loose body in the joint -, with the following options: A: RA, B: Ankylosing spondylitis, C: OA, D: SLE - -### Response: -Ans. is 'c' i.e., OA o Causes of loose bodies includei) Osteoarthritisiii) Osteochondral fracture (injury) v) Synovial chondromatosisii) Osteochondritis dessicansiv) Charcot's disease o Among these, osteochondral fracture causes single loose bodies, while all other can cause multiple loose bodies, maximum by synovial chondromatosis (up to hundrades). -### End" -6092,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incidence of which lymphoma is MORE common in females?, with the following options: A: Mantle cell lymphoma, B: Follicular lymphoma, C: Burkitt's lymphoma, D: Diffuse large B cell lymphoma - -### Response: -In follicular lymphoma, percentage of affected males is only 42%, ie 58 % are females. Other lymphomas are more common in males. Ref: Harrisons principles of internal medicine, 18th edition, Page: 926. -### End" -6093,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is the amino acid in Hb that accepts H+ and allows Hb to act as a buffer to acids?, with the following options: A: Alanine, B: Histidine, C: Serine, D: Threonine - -### Response: -The side chain of histidine has a pKa of 6.0, which, of all amino acid side chains, is the one closest to physiologic pH. The local environment of the protein can raise this pKa value closer to 7 such that the histidine side chains within Hb will be the major groups that accept and donate protons when Hb acts as a buffer. The alanine side chain (a methyl group) cannot accept or donate protons. The pKa for the side chains of serine or threonine are above 10.0, so at physiologic pH, these side chains are always protonated and cannot act as a binding site for excess protons generated during an acidotic event. The pKa for the side chain of aspartate is about 4.0, so at physiologic pH, that group is always deprotonated and will not accept protons generated during an acidotic event. -### End" -6094,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Posterior boundary of Carotid Triangle is formed by, with the following options: A: Superior belly of omohyoid, B: Posterior belly of digastric, C: Sterno hyoid, D: Sternocleido mastoid - -### Response: -Boundaries of carotid triangle IN FRONT & ABOVE- Post Belly of Digastric and Stylohyoid Muscle. IN FRONT & BELOW- Superior Belly of Omohyoid. BEHIND- Anterior Border of SternoCleidomastoid. -### End" -6095,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Accessory obturator aery is a branch of, with the following options: A: Femoral aey, B: Obturator aey, C: Profunda femoris, D: Inferior epigastric aery - -### Response: -Accessory obturator aery is the pubic branch of the inferior epigastric aery. It contributes a significant supply through the obturator canal. Ref - semantischolar.org -### End" -6096,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Small for gestational age infants are defined as _______, with the following options: A: Birth weight of child < 3rd percentile for gestational age, B: Birth weight of a child < 10th Percentile for gestational age, C: Birth weight of a child < 15th percentile for gestational age, D: Birth weight of a child < 25th percentile for gestational age. - -### Response: -Small for gestational age (SGA) - Birth weight < 10th percentile for gestational age -Appropriate for gestational age (AGA) - Birth weight 10th - 90th percentile for gestational age -Large for gestational age (LGA) - Birht weight > 90th percentile for gestational age. -### End" -6097,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of action of azoles is, with the following options: A: By altering membrane permeability, B: By blocking nucleic acid synthesis, C: By disrupting microtubules function, D: By inhibiting cell wall synthesis - -### Response: -According to the mechanism of action these can be classified as  - -Drugs altering membrane permeability  - -- Azoles  -- Triazoles e.g. Fluconazole, itraconazole, voriconazole, terconazole, posaconazole. -- Imidazoles e.g. Ketoconazole, miconazole, clotrimazole, econazole, butoconazole, oxiconazole, sertaconazole, sulconazole.  -- Terbinafine, butenafine, naftifine. -- Polyenes e.g. Amphotericin B, nystatin, hamycin  - -Drugs blocking nucleic acid synthesis e.g. Flucytosine  -Drugs disrupting microtubule function e.g. Griseofulvin  -Drugs inhibiting cell wall synthesis e.g. Caspofungin, nikkomycin. -### End" -6098,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: From which of the following routes, bioavailability of the drug is likely to be 100 percent?, with the following options: A: Subcutaneous, B: Intravenous, C: Intramuscular, D: Intradermal - -### Response: -(b) Intravenous,Ref: Lippincott, 6th ed., pg. 3-4 and Sharma & Sharma's Principles of Pharmacology, 3rd ed., pg. 18-20This is very simple question. When we give a drug by Intravenous (iv) route, the drug enters the systemic circulation directly, bypassing the 1st pass metabolism, so there is 100% bioavailability by this route. Absorption is also predictable by Intramuscular (i.m.) route, it is less variable as compared to oral and subcutaneous (s/c) route. But bioavailability is not 100 %. In s/c route, absorption is smooth but slower as compared to iv and i.m. route. Again, bioavailability is not 100 %. By intradermal (id) route, absorption is very slow and only a small volume of drug can be injected. In routes other than iv (i.m., s/c and id), the drug may precipitate at the site of injection, leading to their lesser bioavailability as compared to iv route. -### End" -6099,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following 5-HT receptor is not a G-protein coupled receptor, with the following options: A: 5-HT1, B: 5-HT2, C: 5-HT3, D: 5-HT4 - -### Response: -Mech of action:- All 5-HT receptors (except 5-HT3) are G protein coupled receptors which function through decreasing (5-HT1) or increasing (5-HT4, 5-HT6, 5-HT7) cAMP production or by generating IP3/ DAG (5-HT2) as second messengers. The 5-HT3 is a ligand gated cation (Na+,K+) channel which on activation elicits fast depolarization. Ref:- kd tripathi; pg num:-171 -### End" -6100,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Symmetrical distribution is seen?, with the following options: A: Normal standard detion, B: Bimodal distribution, C: Skewed distribution, D: U-distribution - -### Response: -Ans. is 'a' i.e., Normal standard detion -### End" -6101,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child presents with linear verrucous plaques on the trunk with vacuolation of keratinocytes in S.Spinosum and S.Granulosum. Diagnosis is?, with the following options: A: Incontinentia pigmenti, B: Delayed hypersensitivity reaction, C: Verrucous epidermal nevus, D: Linear darier's disease - -### Response: -Verrucous epidermal nevus is also known as linear verrucous epidermal nevus or linear epidermal nevus. They are characterized by localized or diffuse, closely set, skin-colored, brown, or gray-brown verrucous papules, which may coalesce to form well-demarcated papillomatous plaques. Extensive distribution of a verrucous epidermal nevus is termed systemized epidermal nevus. Epidermal nevi may present in conjunction with other epidermal lesions such as cafe-au-lait macules, congenital hypopigmented macules, and congenital nevocellular nevi. Complete excision of an epidermal nevus to the level of the deep dermis is necessary to prevent recurrences. Ref: Thomas V.D., Snavely N.R., Lee K.K., Swanson N.A. (2012). Chapter 118. Benign Epithelial Tumors, Hamaomas, and Hyperplasias. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick's Dermatology in General Medicine, 8e. -### End" -6102,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most prominent spinous process is of, with the following options: A: C2, B: C5, C: C6, D: C7 - -### Response: -The 7th cervical (C7) veebra is the largest cervical veebra the C7 has a large spinous process that protrudes posteriorly toward the skin at the back of the neck. This spinous process can be easily seen and felt at the base of the neck, making it a prominent landmark of the skeleton and giving the C7 the name veebra prominens Description BD CHAURASIA S HUMAN ANATOMY Vol 3 -### End" -6103,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bechet's syndrome is characterized by all of the following eye manifestations, EXCEPT:, with the following options: A: Posterior uveitis, B: Iritis, C: Optic Neuritis, D: Retinal pigmentation - -### Response: -The eye disease is present in 50% of patients with Bechet's syndrome. It is usually present at the onset but may also develop within the first few years. Iritis, posterior uveitis, retinal vessel occlusions and optic neuritis can be seen in some patients with the syndrome. Note: Scarring and bilateral panuveitis is the most dreaded complication of Bechet's, since it occasionally progresses rapidly to blindness. Ref: Moutsopoulos H.M. (2012). Chapter 327. Behcet's Syndrome. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -6104,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rebreathing systems are A/E –, with the following options: A: To & fro system, B: Circle system, C: Water's system, D: Mapleson F - -### Response: -Closed (rebreathing) circuits are circle system and To and fro (Water's / Mapleson C) system. -### End" -6105,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In dysmenorrhoea indomethacin works by -, with the following options: A: Inhibiting prostaglandin synthetase, B: Suppressing ovulation, C: Reducing inflammation, D: Relaxing smooth muscle - -### Response: -Ans. is 'a' i.e., Inhibiting prostaglandin synthetase Medical measures to relieve dysmenorrheao Analgesics paracetamol and piroxicam.o Antispasmodies hyoscine, camylofin, and drotaverineo Prostaglandin synthetase inhibitors inhibiting cyclo-oxygenaseMefenamic acid, indomethacin, naproxen, ibuprofen.o Smooth muscle relaxantGlyceryltrinitrateo Progestogen containing IUCDMirena and progestasert - reduce pain, provide contraception and reduce bleeding, o Cyclical oral contraceptive drugso Vitamin E -### End" -6106,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin K is a cofactor in, with the following options: A: Carboxylation, B: Hydroxylation, C: Deaminatiom, D: Hydrolysis - -### Response: -Refer Katzung 10/e p 549 Vitamin K is involved in activition if various clotting factors as well as anticlotting clotting proteins It carries out the final step in activation of these ors I. E, gamma carboxylation of glutamate residues in these factors -### End" -6107,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2-year-old boy who missed several scheduled immunizations presents to the emergency room with a high fever, irritability, and a stiff neck. Fluid from a spinal tap reveals 20,000 white blood cells per milliliter with 85% polymorphonuclear cells. Gram stain evaluation of the fluid reveals small pleomorphic gram-negative rods that grow on chocolate agar. If an inhibitor is designed to block its major virulence, which of the following would be the most likely major virulence factor?, with the following options: A: Capsule formation, B: Endotoxin assembly, C: Exotoxin liberator, D: Flagella synthesis - -### Response: -The major determinant of virulence in H. influenzae is the presence of a capsule. There is no demonstrable exotoxin, and the role of endotoxin is unclear. While one would expect that IgA protease would inhibit local immunity, the role of this enzyme in pathogenesis is as yet unclear. Flagella production is not considered a virulence factor. See the table below for a comparison of gram-negative rods associated with the respiratory tract.GRAM-NEGATIVE RODS ASSOCIATED WITH THE RESPIRATORYTRACTSpeciesMajor DiseasesLaboratory DiagnosisFactors X and V Required for Vaccine GrowthVaccine availableProphylaxis for ContactsHaemophilus influenzaeMeningitisa; otitis media, sinusitis, pneumonia, epiglottitisCulture; capsular polysaccharide in serum or spinal fluid++RifampinBordetelh pertussisWhooping cough (pertussis)Fluorescent antibody on secretions; culture-+ErythromycinLegionella pneumophilaPneumoniaSerology; urinary antigen; culture--None -### End" -6108,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Early aerial phase enhancement CECT scan of liver indicates towards -, with the following options: A: Hydatid cyst, B: HCC, C: Hepatic abscess, D: Simple hepatic cyst - -### Response: -Ans. is 'b' i.e., HCC [Rd Kumar and Chrk's Clinical Medicine p. 347) In HCC, the dassic finding on CT imaging is hyper vasclarity/enhancement in the aerial phase with washout in the poal (venous) and delayed phases. -### End" -6109,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What isaccumulated in Gaucher's disease:, with the following options: A: Cerebroside, B: Glucocerebroside, C: Alpha galactoside, D: Noneof the above - -### Response: -Glucocerebroside -### End" -6110,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypeension, proteinuria, and pitting edema are noted in the second month of the first pregnancy in a 25-year-old woman. Pathogenesis of her presenting complaints is most closely associated with:-, with the following options: A: A benign tumor of the chorionic villi, B: Gestational diabetes mellitus, C: Primary endometrial cancer, D: Primary endometrial cancer - -### Response: -Preeclampsia (hypeension, proteinuria, pitting edemA. in the first trimeater is most often secondary to a hydatidiform mole, which is a benign neoplasmof the chorionic villi. The uterus is frequently too large for gestational age, and fetal hea sounds are absent. It is too early in this patient's pregnancy for gestational cancer. Choricarcinomas are malignant trophoblastic tumors that most commonly develop from a preexisting complete mole. A tumor arising from the myomerium (leiomyomA. is not associated with preeclampsiA. -### End" -6111,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shigellosis is best diagnosed by -, with the following options: A: Stool examination, B: Stool culture, C: Sigmoidoscopy, D: Enzyme - -### Response: -Ans. is 'b' i.e., Stool culture Lah diagnosis of shigellosis""Diagnosis is made by isolating the bacillus from feces. ""o Transport media# Sack s buffered glycerol salineo Culture# Specimens are inoculated on :MacConkey mediumDeoxycholate medium (DCA) - Selective mediumHektoen entric agar or salmonella-shigella agar - Selective medium. -### End" -6112,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trootter's triad consists of following, except:, with the following options: A: Conduction deafness, B: Trigeminal neuralgia, C: VII nerve palsy, D: Ipsilateral soft palate immobility - -### Response: -MNEMONICS: Trotter's triad- seen in Nasopharyngeal carcinoma (NPC) N - Neuralgia ipsilateral temporal (CN-5)P - Palatal paralysis (CN-10)C - Conductive deafness -### End" -6113,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 74-year-old woman has noted increasing size and number of darker brown patches on the dorsum of each hand for the past 15 years. They do not change with sun exposure, are nonpruritic, and non-tender. On examination, these 0.5- to 1-cm lightly pigmented lesions are flat. Which of the following is the most likely microscopic finding in these lesions?, with the following options: A: Basal melanocytic hyperplasia, B: Dermal nevus cells, C: Loss of melanin in surrounding skin, D: Mast cell proliferation - -### Response: -Unlike a freckle that darkens upon light exposure, lentigo (pleural:lentigenes) does not. There is a focal increase in melanocytes of the basal layer, along with thinning of epidermis and elongation of rete ridges. Lentigines can occur at any age; those in older persons may be termed senile lentigines or age spots. A nevus typically forms a nodule and likely appears much earlier in life. Loss of melanin is termed vitiligo and is a separate process from melanocyte hyperplasia. A collection of mast cells can produce urticaria pigmentosa, which often has a light brown appearance, but pruritus is common. Some superficial fungal infections (black piedra) may be pigmented, but they typically do not persist for years. -### End" -6114,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a feature of Horner syndrome:, with the following options: A: Exophthalmos, B: Ptosis of upper eyelid, C: Miosis, D: Conjunctival congestion - -### Response: -Ans : A (Exophthalmos) ""The triad of miosis with ipsilateral ptosis and anhidrosis constitutes Horner's syndrome, although anhidrosis is an inconstant feature. Brainstem stroke, carotid dissection, or neoplasm impinging upon the sympathetic chain are occasionally""Horner's syndrome- miosis, ptosis, anhydrosis, enophthalmos & loss of ciliospinal reflex""- BDC 4th/VoI. I 53""Horner's syndrome (also Horner syndrome, Bernard-Horner syndrome, Claude Bernard-Horner syndrome or as oculosympathetic palsy) is the combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis), sometimes accompanied by decreased sweating of the face on the same side; redness of the conjunctiva of the eye is often also present. It indicates a problem with the sympathetic nervous system, a part of the autonomic nervous system""-www.m wMpecfaj.orgSigns and Symptoms www.en.wikipedia.orgSigns that are found in all patients on the affected side of the face include# Partial ptosis (drooping of the upper eyelid from loss of sympathetic innervation to the superior tarsal muscle, also known as Muller's muscleUpside-down ptosis (slight elevation of the lower lid)Anhidrosis (decreased sweating on the affected side of the face)Miosis (small pupils)Enophthalmos (the impression that the eye is sunk in)Loss of ciliospinal reflexBloodshot conjunctiva, depending on the site of less/on.Note:Sometimes there is flushing on the affected side of the face due to dilation of blood vessels under the skin. The pupil's light reflex is maintained as this is controlled via the parasympathetic nervous system.In children, Horner's syndrome sometimes leads to heterochromia: a difference in eye color between the two eyes. -### End" -6115,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The difference between gram +ve and gram -ye organism is the gram -ve organism contains:, with the following options: A: Teichoic acid, B: Muramic acid, C: N-acetyl neuraminic acid, D: Aromatic amino acids - -### Response: -Ans. (d) Aromatic amino acids Ref. Ananthanarayan Cell Wall Features Gram positive Gram negative bacteria Plasmolysis Thickness (Peptidoglycan) Variety of amino acids Aromatic and sulphur containing amino acids Lipids Teichoic acid Late Thicker Few Absent Absent or scant Present Early Thinner Several Present Present Absent -### End" -6116,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pethidine differs from morphine is producing which of the following effect?, with the following options: A: Sedation, B: Tachycardia, C: Euphoria, D: All of the above - -### Response: -Ans. B. Tachycardia.There are some pharmacological differences of pethidine from morphine. Pethidine produces tachycardia, dry mouth and less marked meiosis.Pethidine# It is a synthetic phenylpyperidine derivative and was originally developed as an antimuscarinic agent.# Dose: Pethidine is available as 50 mg tablets and ampoules of different strength (10 mg/ml and 50 mg/ml). For acute pain, it can be administered orally (50-150 mg), SC (50-100 mg), IM (50-100 mg) or IV (25-100 mg). The doses can be repeated every 4 hours.# Pharmacokinetics: Pethidine is 30 times more lipid soluble than morphine. Oral bio-availability is 50%. It is metabolized in the liver by ester hydrolysis to norpethidine and pethidinic acid that are excreted in urine and therefore accumulate in renal failure. At higher concentration, norpethidine can produce hallucination and convulsions. Pethidinic acid is an inactive compound. Pethidine is often used for labour analgesia. It readily crosses placenta, and a significant amount reaches to the foetus over several hours.# Effects: There are some pharmacological differences from morphine. It produces tachycardia, dry mouth and less marked meiosis. However, significant fall in BP may occur when pethidine is administered to elderly or hypovolaemic patients. It may produce less biliary tract spasm than morphine. Pethidine is absolutely contraindicated in patients on monoamine oxidase inhibitors (MAOI), as serious side effects like hypotension or hypertension, hyperpyrexia, convulsion and coma may occur. The underlying mechanism is not clear but may involve reduced metabolism of pethidine by MAOI and pethidine's effect on turnover of 5-hydroxytryptamine in the brain.# Like morphine, pethidine exerts its analgesic effects by acting as an agonist at the mu opioid receptor. It also has a kappa opioid receptor action, which is of unknown clinical significance. It has structural similarities to atropine and other tropane alkaloids and may have some of their effects and side effects. In addition to these opioidergic and anticholinergic effects, it has local anesthetic activity related to its interactions with sodium ion channels.# Pethidine is no more effective than morphine at treating biliary or renal pain, and its low potency, short duration of action, and unique toxicity (i.e., seizures, delirium, other neuropsychological effects)# It is more lipid-soluble than morphine, resulting in a faster onset of action. Its duration of clinical effect is 120-150 minutes although it is typically administered in 4-6 hour intervals.# Pethidine has been shown to be less effective than morphine, diamorphine or hydromorphone at easing severe pain, or pain associated with movement or coughing. It is also used for the treatment of postanesthetic shivering.# Like other opioid drugs, pethidine has the potential to cause physical dependence or addiction. Pethidine may be more likely to be abused than other prescription opioids, perhaps because of its rapid onset of action. When compared with oxycodone, hydromorphone, and placebo, pethidine was consistently associated with more euphoria, difficulty concentrating, confusion, and impaired psychomotor and cognitive performance when administered to healthy volunteers.Morphine# Morphine is a naturally occurring phenanthrene derivative. It is the standard drug against which all other opioids are compared.# Dose: Morphine can be given orally, intramuscularly (IM), intravenously (IV), subcutaneously (SC), rectally, epidurally and intrathecally.# The intramuscular dose is 0.1-0.2 mg/kg, time to peak effect is 30-60 minutes and duration of action is 3-4 hours. Intravenous administration should be titrated to effect (usually l-2mg boluses), but the total dose is similar. The onset of action is slightly more rapid with following IV administration, as the main factor responsible for its latency is low lipid solubility and slow penetration of blood brain barrier. Morphine may be given epidurally at 10% and intrathecally at 1% of the parenteral dose.# Pharmacokinetics: Morphine is extensively metabolised by the gut wall and the liver to morphine-3-glucuronide (M3G) (70%), morphine-6-glucuronide (M6G) (10%) and to sulphate conjugates. M6G is 10-20 times more potent than morphine and is normally excreted in urine. It accumulates in renal failure and accounts for increased sensitivity to morphine. Neonates are more sensitive than adults to morphine due to reduced hepatic conjugating capacity. In the elderly, owing to reduced volume of distribution, peak plasma level of morphine is higher compared to younger patient.# Effects: The main effects are mediated through MOP receptors. It is a potent analgesic with good sedative and anxiolytic properties. It may cause euphoria, dysphoria and hallucination. It produces respiratory depression and cough suppression. It has minimal effect on cardiovascular system and may produce bradycardia and hypotension. Nausea and vomiting are common side effects. Histamine release may lead to rash, itching and bronchospasm (in susceptible patients). Meiosis is common. Tolerance and dependence may develop.Pharmacokinetics of commonly used opioids MorphinePethidineFentanylAlfentanilRemifentanilpKa8.08.58.46.57.1Unionised at pH 7.4 (%)23599068Plasma protein bound (%)3040849070Terminal half life (hrs)343.51.60.06Clearance (ml/min/kg)15-308-180.8-1.04-930-40Volume of distribution (L/kg)3-53-53-50.4-1.00.2-0.3Relative lipid solubility1285809050 -### End" -6117,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following stains are used for fat except?, with the following options: A: Oil red O, B: Congo reds, C: Sudan black, D: Osmium tetroxide - -### Response: -Ans. is 'b' i.e., Congo red * Congo red is not used in lipid staining. It is used in the staining of amyloid protein.* Stain used for lipids (fatty acids)are Oil red O, Osmium tetroxide, sudan black and sudan III & IV. -### End" -6118,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true statements EXCEPT:, with the following options: A: Sirolimus acts by inhibiting the action of 1L-2, B: Tacrolimus inhibits calcineurin pathway, C: Mycophenolate acts by inhibiting GMP dehydrogenase, D: Cyclosporince is an integeral component of transplant rejection regimen - -### Response: -Tacrolimus (FK506)- It is a newer immunosup- pressant chemically different from cyclosporine, but having the same mechanism of action, and is -100 times more potent. It binds to a different cytoplasmic immunophilin protein labelled 'FKBP', but the subsequent steps are the same, i.e. inhibition of helper T cells calcineurin. Tacrolimus is administered orally as well as by i.v. infusion. Oral absorption is variable and decreased by food. It is metabolized by CYP3A4 Section 14 and excreted in bile with a longer tlh of 12 hour. Therapeutic application, clinical efficacy as well as toxicity profile are similar to cyclosporine. It is paicularly valuable in liver transplantation because its absorption is not dependent on bile. Because ofmorepotentaction, itis also suitable for suppressing acute rejection that has set in. Hypeension, hirsutism and gum hyperplasia are less marked than cyclosporine, but tacrolimus is more likely to precipitate diabetes, cause neurotoxicity, alopecia and diarrhoea. Dose limiting toxicity renal toxity. Mycophenolate mofetil- Prodrug of mycophenolic acid which selectively inhibits inosine monophosphate dehydrogenase an enzyme essential for the de novo synthesis of guanosine nucleotides in the T and B cells (these cells, unlike others, do not have the purine salvage pathway). Lymphocyte prolife- ration, antibody production and cell-mediated immunity are inhibited. As 'add on' drug to cyclosporine + glucocoicoid in renal transplan- tation, it has been found as good or even superior to azathioprine, but should not be combined with azathioprine. It can help to reduce the dose of cyclosporine and thus its toxicity. Vomiting, diarrhoea, leucopenia and predisposition to CMV infection, g.i. bleeds are the prominent adverse effects. ESSENTIAlS of MEDICAL PHARMACOLOGY SIXTH EDITION -KD TRIPATHI Page 853 -### End" -6119,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mint Common extranodal site of Lymphoma in HIV is?, with the following options: A: CNS, B: GIT, C: Retroperitoneum, D: Mediastinum - -### Response: -Answer is option 1, CNS Categories of HIV-associated lymphomas (1) Lymphoma also occurring in immunocompetent patients Burkitt and Burkitt-like lymphoma Diffuse large B-cell lymphoma - Centroblastic - Immunoblastic (including primary CNS lymphoma) Extranodal marginal zone lymphoma of MALT type -### End" -6120,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increase in D- dimer levels are noticed in immediate post-op period. Most appropriate cause is, with the following options: A: Deep vein thrombosis, B: Pulmonary embolism, C: Disseminated intra vascular coagulation, D: Normal - -### Response: -Deep vein thrombosis Deep vein thrombosis (DVT) is a well-known and, when complicated by pulmonary embolus, potentially fatal complication of surgery. All hospitals must have a pro cess for screening all surgical patients to identify those at risk and for implementing prophylactic measures. There is inter- national agreement on risk and therapeutic options. Methods of prevention are guided by the risk score and include the use of compression stockings, calf pumps and pharmacological agents, such as low molecular weight heparin. The symptoms and signs of DVT include calf pain, swelling, warmth, redness and engorged veins. However, most will show no physical signs. On palpation the muscle may be tender and there may be a positive Homans' sign (calf pain on dorsiflexion of the foot), but this test is neither sensitive nor specific. Duplex Doppler ultrasound and venography can be used to assess flow and the presence of a thrombosis. Other investigations include D-dimer. If a significant DVT is found (one that extends above the knee), treatment with parenteralanticoagulation initially, followed by longer-term warfarin or new oral anticoagulant. In some patients with a large DVT, a caval filter may be required to decrease the possibility of pulmonary embolism. Ref: Bailey and love 27th edition Pg no : 296 -### End" -6121,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which arm of tRNA binds it to vibosomal surface, with the following options: A: DHU arm, B: Pseudouridine arm, C: Acceptor arm, D: Anticodon arm - -### Response: -Pseudoridine arm of tRNA is involved in binding of aminoacyl tRNA to ribosomal surface. -### End" -6122,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major dopaminergic pathway is, with the following options: A: Nigrostriate pathway, B: Mamillothalamic tract, C: Thalamo cortical relays, D: Cerebral association fibres - -### Response: -(A) Nigrostriate pathviay> The long dopamine systems are the nigrostriatal system, which projects from the substantia nigra to the striatum and is involved in Motor control. -### End" -6123,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Constriction of the afferent aeriole to the kidney glomerulus results in:, with the following options: A: Reduction of glomerular filtration rate and decreased urinary output, B: Increased urine output, C: Increased glomerular filtration rate and no change in urine output., D: Decreased urine output - -### Response: -The kidney is innervated primarily by the sympathetic nervous system, and as such, regulates the contraction of the smooth muscle surrounding the afferent and efferent aerioles of the glomerulus. Sympathetic stimulation to the efferent glomerular aerioles causes their constriction and increases the filtration rate, leading to an increase in urinary output. Similarly, with the loss of sympathetic innervation, such as due to sympathectomy of the kidney, relaxation of tone of the afferent aeriole occurs and the filtration rate increases, which results in an increased urine output. Decreased urine output may result from the constriction of the afferent aerioles, leading to a decrease in glomerular filtration rate. Also Know: Factors affecting the GFR: Changes in renal blood flow Changes in glomerular capillary hydrostatic pressure Changes in systemic blood pressure Afferent or efferent aeriolar constriction Changes in hydrostatic pressure in Bowman's capsule Ureteral obstruction Edema of kidney inside tight renal capsule Changes in concentration of plasma proteins: dehydration, hypoproteinemia, etc (minor factors) Changes in Kf Changes in glomerular capillary permeability Changes in effective filtration surface area Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 37. Renal Function & Micturition. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e. -### End" -6124,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Milwalkee brace is used in treatment of -, with the following options: A: Scoliosis, B: Kyphosis, C: Cubitus varus, D: Genu varum - -### Response: -Ans. is 'a' i.e., Scoliosis o The Milwaukee brace is principally a thoracic support consisting of a pelvic corset connected by adjustable steel supports to a cervical ring earning occipital and chin pads,o Its purpose is to reduce the lumbar lordosis and encourage active stretching and straightening of the thoracic spine.o It is used in the consenative management of idiopathic scoliosis. -### End" -6125,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of seizure in newborn is, with the following options: A: Hypoxia induced ischemic encephalopathy, B: Hypocalcemia, C: Metabolic abnormality, D: Sepsis - -### Response: -Most common cause of seizure in first day of new born baby is anoxia ,hypoxia induced ischemic Symptomatic neonatal seizures may be caused by: lack of oxygen before or during bih because of problems such as placental abruption (premature detachment of the placenta from the uterus), a difficult or prolonged labour, or compression of the umbilical cord infection acquired before or after bih, such as bacterial (a blood clot in the brain) bleeding in the brain congenital brain abnormalities, either genetic or acquired during fetal development, such as tuberous sclerosis blood sugar or electrolyte imbalances, including hypoglycemia (low blood sugar), hypocalcemia (low calcium), hyponatremia (low sodium), or hypernatremia (high sodium) metabolic problems, such as maple syrup urine disease, pyridoxine dependency, or drug withdrawal, which may be seen in infants born to mothers addicted to barbiturates, alcohol, heroin, cocaine or methadone Reference: GHAI Essential pediatrics, 8th edition -### End" -6126,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which antihypeensive is a prodrug and is conveed to its active form in brain?, with the following options: A: Clonidine, B: Methyl dopa, C: Minoxidil, D: Nitroprusside - -### Response: -Both methyldopa and minoxidil are prodrugs. Conversion of methyl dopa to a-methylnorepinephrine takes palce in the brain. Minoxidil is activated to minoxidil sulphate (by phase II reaction) in the periphery. -### End" -6127,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pain sensations from the ethmoidal sinus are carried by:, with the following options: A: Supraorbital nerve, B: Lacrimal Nerve, C: Nasociliary Nerve, D: Infraorbital Nerve - -### Response: -(c) Nasociliary Nerve(Ref. Cummings, 6th ed., 476)SinusMaxillaryFrontalEthmoidsSphenoidOpeningInfundibulum of middle meatusBy Fronto-nasal recess into middle meatusAnterior ethmoids - middle meatusPosterior ethmoids - superior meatusSpheno-ethmoidal recess above the superior turbinateAt birthPresentSize increases with age becoming almost maximum by the time of completion of secondary dentition (of 2nd premolar and 1st molar), i.e. 12 years, further enlargement coincides with the development of 2nd and 3rd molars till 18 yearsAbsentAttains full size by 19 yearsPresentSize increases with age reaching a maximum by 15 yearsPresent (but small)Attains full size by 15 yearsX-ray identification at 4-5 months6 years1 year4 yearsCapacity15ml7ml2-3ml0.5-5mlNerve supplyMaxillary V2 (infraorbital and alveolar nerves)Ophthalmic (V1 )(supra orbital branch)Ophthalmic V1 (nasociliary branch) and Maxillary V2 (from sphenopalatine fossa)Ophthalmic V1 (nasociliary branch) and Maxillary V2 (from sphenopalatine fossa)RemarksEarliest sinus to developMost common sinusitis in adultsLargest paranasal sinusAlso known as the antrum of ""Highmore""Last sinus to developMost pneumatised at birth so Most common sinusitis in infants and young childrenHigh opening so least commonly infectedPain sensations from the frontal sinus are carried by supraorbital nerve, a branch of ophthalmic division (VI) of trigeminal.Infra-orbital nerve along with alveolar nerves (branches of the maxillary division of trigeminal) carries pain sensations from the maxillary sinus.Lacrimal nerve (a branch of ophthalmic division of trigeminal) do not supply the paranasal sinuses. -### End" -6128,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of cardiac muscle?, with the following options: A: Tetany, B: All or none phenomenon, C: Pacemaker potential, D: Length-tension relationship - -### Response: -Tetany is not possible in cardiac muscle due to long refractory period -### End" -6129,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For a mobile tumour on vocal cord, treatment is:, with the following options: A: Surgery, B: Chemotherapy, C: Radiotherapy, D: None of the above - -### Response: -According to Dhingra Radiotherpy is the treatment of choice for vocal cord cancer with normal mobility. Normal mobility of cord suggests that growth is only limited to the surface and belongs to either stage T1 or T2. TOC for stage T1 of glottic carcinoma - radiotherapy. TOC for stage T2 of glottic carcinoma - depends on mobility of the cord -### End" -6130,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pathogenic cryptococci differ from non pathogenic strains by all of the following criteria except, with the following options: A: Grow at 37 o C, B: Produces urease, C: Pathogenic for mice, D: Ferments carbohydrates - -### Response: -Differentiation of pathogenic Cryptococcus from other non-pathogenic cryptococci is they grow at 37C, hydrolyse urea, produced brown colonies on niger seed agar and produce disease in mice. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition -### End" -6131,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most likely inheritance pattern in the pedigree given below-, with the following options: A: Autosomal dominant, B: Mitochondrial, C: Autosomal recessive, D: X-linked dominant - -### Response: -It is an X-linked dominant pattern of inheritance. -The features which suggest the X-linked dominant pattern of inheritance are- -A single abnormal X chromosome is sufficient to express the disease. -All of the female offspring’s of a diseased male XY will receive the abnormal X chromosome and express the disease, whereas none of the male offspring to the diseased father will have the disease (as sons don't receive X chromosome from their father). -A diseased mother can transmit the abnormal X chromosome to both daughter and sons equally. - -Important facts - -If a female is transmitting the disease to all offspring’s (both males and females) and a male is not transmitting the disease to any child, it is mitochondrial inheritance. -If a male is transmitting the disease only to daughters (all daughters) and not to the sons whereas female transmit the disease to half daughters and half of the sons, it is X-linked dominant. -If only males are affected in a pedigree, it is likely to be an X-linked recessive disease (females act as carriers; only transmit the disease and themselves remain unaffected). -If there is no sex-predilection and affected individuals transmit the disease to half of the offspring’s, it is an autosomal dominant disorder. -If there is no sex-predilection and affected individuals transmit the disease to one-fourth of the offspring’s, it is likely to be an autosomal recessive disorder. -### End" -6132,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypeension is seen with all except, with the following options: A: Erythropoietin, B: Cyclosporine, C: NSAID, D: Levodopa - -### Response: -levodopa Drug causing hypeension * Cocaine * MAO Inhibitors * Cyclosporine * Glucocoicoids * Oral contraceptives * Tricyclic antidepressants * NSAID, Rofecoxib * Sympathomimetics Ibuprofen, Naproxen * Clonidine withdrawl * Decongestants (pseuodephedrine) * Erytlu-opoietin Drugs causing hypotension * Theophylline * Adenosine * Morphine * Quinidine * Fosphenytoin * Amiodarone * 1L-2 * Guanethidine * Alphablockers * Beta blockers (i.v.) * Bretylium * Chlorpromazine * Glyceryltrinitrate * Clonidine * Diuretics * Calcium channel blockers -### End" -6133,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about screw feed technology, with the following options: A: Waste is reduced by 80% in volume and by 20-35% in weight, B: Waste is reduced by 85% in volume and by 10-20% in weight, C: Wet thermal disinfection process, D: Used to process pathological waste - -### Response: -Screw-feed technology is the basis of a non-burn, dry thermal disinfection process in which waste is shredded and heated in a rotating auger.The waste is reduced by 80 percent in volume and by 25-35 percent in weight.This process is suitable for treating infectious waste and sharps. Should not be used to process pathological, cytotoxic or radioactive waste.Park 23e pg: 792 -### End" -6134,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of Tuberculosis of the spine:, with the following options: A: Back pain earliest symptom, B: Stiffness of back, C: Exaggerated lumbar lordosis, D: Cold abscess - -### Response: -Ans. C. Exaggerated lumbar lordosisTuberculosis of the spine usually involves vertebral bodies and is of paradiscal type. It results in kyphosis and not lordosis due to collapse of vertebrae. -### End" -6135,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common organism causing UI in adult?, with the following options: A: H influenza, B: Stap aureus, C: Strepto pneumonia, D: Streptococcus pyogenes - -### Response: -Ans. is 'd' i.e., Streptococcus pyogenes Most common cause of upper respiratory tract infection is viral infection. Rhinovirus is the most common cause. Among the bacteria, group A beta-hemolytic streptococci (streptococcus pyogenes) is the most common cause. And most common type of infection is pharyngitis. -### End" -6136,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Amount of coronary flow per minute is:, with the following options: A: 225 mL, B: 250 mL, C: 50 mL, D: 300 mL - -### Response: -Coronary flow at rest in humans is about 250 mL/min (5% of the cardiac output). -### End" -6137,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Peyronie's disease EXCEPT:, with the following options: A: Self limiting, B: Medial treatment is effective, C: Association with Dupvytren's contracture, D: Calcified plaques - -### Response: -(Medical treatment is effective) (1399-1400-Baily & 24th) (1373-B &L 25th)PEYRONIE'S DISEASE - Common cause of erect penis.* Hard plaques of fibrosis can usually be palpated in the tunica of one or both corpora covemosa. The plaque may be calcified.* May result of past trauma, there is association with dupuytren *s contracture.Treatment - continue to progress or remit after 3-5 years* When the deformity of the penis is causing distress, it may be possible to straighten it by placing non absorbable sutures in corpus cavernous opposite the plaque. This reduces the elasticity in the region to balance that caused by the plaque (NES BITT'S OPERATION)Peyronie's disease* Medical treatment are often ineffective* The disease is typically self-limiting* Surgery may be indicated to correct deformity with sexual function. -### End" -6138,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epigenetics is ?, with the following options: A: Alteration in nucleotide sequence, B: Alteration in chromosome number, C: Alteration in gene expression, D: Alteration in chromosome size - -### Response: -Ans. is 'c' i.e., Alteration in gene expression Epigenetics is a heritable change in the level of gene expression, not caused by changes in DNA sequence. It includes changes like Histone modification or DNA methylation -### End" -6139,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Looser's zones is seen in – a) Osteoporosis b) Hyperparathyrodismc) Osteomalacia d) Renal osteodystrophye) Paget's disease, with the following options: A: bcde, B: abd, C: abcd, D: acde - -### Response: -Looser's zone or pseudofracture is pathognomonic for osteomalacia, However, it may occur rarely also in Paget's disease, Fibrous dysplasia, Hyperparathyroidism, Renal osteodystrophy, Hyperphosphatasia, and osteogenesis imperfecta. -### End" -6140,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement regarding aneurysms is -, with the following options: A: True aneurysm contains all the 3 layers, B: In dissecting aneurysms media is defective, C: Charcot bouchard aneurysms are seen in brain, D: Saccular aneurysms involves the entire circumference - -### Response: -An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. leading to uncontrolled bleeding. Although they may occur in any blood vessel, paicularly lethal examples include aneurysms of the Circle of Willis in the brain, aoic aneurysms affecting the thoracic aoa, and abdominal aoic aneurysms. Aneurysms can arise in the hea itself following a hea attack, including both ventricular and atrial septal aneurysms. There are three types of aneurysms: abdominal aoic, thoracic aoic, and cerebral. Abdominal aoic aneurysms, sometimes known as ""Triple A,"" are the most common aneurysms of the aoa - the large blood vessel that carries blood away from your hea and through your body. The three major types of true intracranial aneurysms are as follows: Saccular aneurysms - Degenerative or developmental; traumatic; mycotic; oncotic; flow-related; vasculopathy-related; and drug-related. Fusiform aneurysms. Dissecting aneurysms Saccular aneurysms, also called ""berry"" aneurysms because they look like berries, are the most common type of brain aneurysm. Saccular aneurysms have a ""neck"" that connects the aneurysm to its main (""parent"") aery and a larger, rounded area called the dome. These aneurysms bulge on only one side of the aery wall. Ref Davidson 23rd edition pg 445 -### End" -6141,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Assessment of patient with prostatism include all except, with the following options: A: Rectal examination, B: Serum prostate specific antigen, C: Pressure flow urodynamic studies, D: Transrectal ultrasound scanning - -### Response: -Evaluation of patient with lower urinary tract infection (LUTI) Urine analysis and culture Hemoglobin, total count, ESR, blood urea and serum creatinine Digital examination of rectum (P/R) CNS examination PSA, acid phosphatase Uroflowmetry, flow rate assessment, residual urine analysis US abdomen, IVU to see upper urinary tract, CT abdomen in selected patients only Cystoscopy, transrectal US (TRUS) Prostatic abscess aspiration/drainage through perineal approach under guidance. Ref: SRB's Manual of Surgery 5th edition Pgno : 1048 -### End" -6142,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presenting with cutaneous vasculitis, glomerulonephritis, and peripheral neuropathy. Which investigation is to be performed next that will help you diagnose the condition?, with the following options: A: ANCA, B: RA factor, C: HbsAg, D: MIF - -### Response: -(A) ANCA [?]ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES (ANCA):oANCA are antibodies directed against certain proteins in the cytoplasmic granules of neutrophils & monocytes.oAs in the given question case history:-ANCA are present in a High percentage of patients with active granulomatosis with Polyangiitis (Wegener's) & Microscopic Polyangiitis.-ANCA present with a Lower percentage of patients with Eosinophilic Granulomatosis with Polyangiitis (Churg- Strauss).oThese diseases share the presence of ANCA & small-vessel vasculitis, some investigators have come to refer to them collectively as ""ANCA-associated vasculitis.""APPLICATIONS OF ANCAPrevalence of ANCA in renal vasculitisType of renal vasculitisANCA test positivity (%) P-ANCAC-ANCA*. Polyarteritis nodosa10-20%10-20%*. Microscopic polyangitis50-80%10-20%*. Wegener's granulomatosis10-20%80-90%*. Necrotizing & crescentic GN50-80%10-20% pANCA disease associationcANCA disease: associationAtypical*. Primary vasculitis. Microscopic polyangiitis. Churg-Strauss syndrome. Polyarteritis nodosa*. Collagenosis. Felty's syndrome. SLE. Rheumatoid arthritis. Sjogren's syndrome*. Chronic inflammatory bowel disease*. Chronic liver disease. Primary sclerosing cholangitis*. Primary vasculitis. Wegener's granulomatosis. Microscopic polyangiitis. Churg-Strauss syndrome*. Primary sclerosing cholangitis*. Primary biliary cirrhosis*. Autoimmune hepatitis*. SLE*. RA ANCA ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS (AAV)Defining featuresClinical RelevanceCHCC 2012 definitions of AAVEvidence that ANCAs are pathogenicGPA:*. Granulomatous inflammation usually involving the respiratory tract*. Small-vessel necrotizing vasculitis*. Necrotizing glomerulonephritis is commonMPA:*. Small-vessel necrotizing vasculitis*. Necrotizing glomerulonephritis is very common*. Pulmonary capillaries often occursEGPA:*. Eosinophil-rich granulomatous inflammation of the respiratory tract*. Small-vessel necrotizing vasculitis*. Blood eosinophlia*. AsthmaClinical evidence:*. Strong association with ANCA (MPA >90%, GPA >90%, EGPA >40%**. Partial correlation of ANCA titre with disease activity*. Correlation of ANCA epitope specificity with disease activity (MPO-ANCA only)*. Disease indication by trans-placental transfer of ANCA (one MPO-ANCA case report)*. Similar disease associated drug-induced ANCA*. HLA genetic associations with MPO-ANCA and PR3-ANCA-assocated disease*. Response to immunosuppressive therapy that targets B cellsIn vitro evidence:*. Activation of cytokine-primed neutrophils by ANCA IgG*. Endothelial injury by ANCA-activated neutrophils*. Alternative complement pathway activation by ANCA-activated neutrophilsEvidence from animal models:*. Induction of pauci-immune vasculitis, glomerulonephritis and graunolomatosis in mice and rats by anti-MPO IgG*. Prevention of murine anti-MPO IgG induced disease by blockade of alternative complement pathway activation or blockade of C8a receptor -### End" -6143,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common strain of E.coli giving rise to traveller's diarrhea is, with the following options: A: Entero-invasive E.coli (EICE), B: Entero-pathogenic E.coli (EPEC), C: Entero-toxigenic E.coli (ETEC), D: Entero-aggregative E.coli (EAEC) - -### Response: -Ans. is 'c' i.e., Entero-toxigenic E.coli -### End" -6144,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the action of anterior fibres of deltoid?, with the following options: A: Flexion, B: Lateral Rotation, C: Flexion and medial dotation, D: Extension and lateral rotation - -### Response: -Multipennate acromial fibres are powerful abductors of arm at the shoulder joint from beginning to 90deg.Extension and lateral rotation of arm is mediated by the posterior fibres.Flexion and medial rotation is mediated by the anterior fibres.B D Chaurasia 7th edition Page no: 70,71 -### End" -6145,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best for management of hypoglycemia in a girl child with Congenital adrenal hyperplasia?, with the following options: A: Betamethasone, B: Beclomethasone, C: Budesonide, D: Hydrocoisone - -### Response: -* Most common type of CAH (21 hydroxylase deficiency) presents with hypoglycemia with hypotension and virilization. Hydrocoisone injection after bih will help in stabiizing the child by increasing blood sugar and increasing salt absorbtion from the kidney. * Methylprednisolone and dexamethasone have negligible mineralocoicoid effects. Therefore, if the patient is hypovolemic, hyponatremic, or hyperkalemic, large dosages of hydrocoisone are preferred because of its mineralocoicoid effect. -### End" -6146,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of Basal cell carcinoma on face is, with the following options: A: Forehead, B: Ears, C: Nose, D: Cheeks - -### Response: -Face is the most common site for BCC -And nose is the most common site on face. -### End" -6147,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wrong about time since death is, with the following options: A: Less than 1 hour : body is warm, B: 6 - 8 hours : Lividity paially developed and not fixed, C: 12 hours : rigor present all over, D: 1 - 3 months : Body skeletonized - -### Response: -Reddish- to bluish-purple discoloration of the skin due to the settling and pooling of blood following death If her body was contoed for four to five hours after death . In 6 - 8 hours , Lividity fully developed and fixed . Ref synopsis of forensic laxminarayana 4e ; Krishnan vij Textbook of Forensic medicine and Toxicology 5th edtion -### End" -6148,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A right-sided disc herniation at the L5-S1 level typically may cause:, with the following options: A: Low back pain and right sciatica, B: Weakness of dorsiflexion of the right foot, C: A preserved right ankle jerk, D: Diminution of sensation over the medial aspect of the right foot, including the great toe - -### Response: -A lumbar disc herniation at the L5-S1 or L4-L5 level typically causes low back pain and ipsilateral sciatica. If a ruptured L5-S1 disc causes weakness, it ordinarily involves plantar flexion of the ipsilateral foot. Although a diminished or absent ankle jerk can be caused by either an L5-S1 or an L4-L5 disc herniation, it is more common with the former. The L5-S1 disc herniation ordinarily affects the S1 nerve root, which supplies the lateral aspect of the foot, including the small toe. -### End" -6149,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for Polycystic ovarian disease is, with the following options: A: Metformin, B: Estrogen, C: Estrogen and progesterone combination pill, D: Dopamine antagonist - -### Response: -Refer CMDT 2014/744 Oral contraceptives are used for the treatment of mennstrul irregularity These are the drug of choice for PCOD PCOD is also known as Stein-Levanthal syndrome. Weight loss by regular exercise low glycemic index diet combined with insulin lowering drugs like metformin can restore feility in 85 percnt of females For females who don't respond to weight loss, metformin therapy may be helpful -### End" -6150,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Marked decreased FEV1 and FEV1/ FVC ratio are seen in, with the following options: A: Asthma, B: Kyphosis, C: Scoliosis, D: Fibrosis of lung - -### Response: -In obstructive diseases like asthma,marked fall in FEV1 and FEV1/FVC ratio is present.In restrictive diseases like kyphoscoliosis and fibrosis,lung volumes like TLC,FRC,RV as well as FVC are lowered.Maximal expiratory flows like FEV1 are also reduced compared with normal values,but are relatively elevated when considered in relation to lung volumes.So FEV1/FVC ratio will be normal or slightly increased Ref:Harrison's medicine-18th edition,page no:2093. -### End" -6151,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient present with pedal oedema with Water- hammer pulse. What is the diagnosis?, with the following options: A: B1 deficiency, B: B3 deficiency, C: B6 deficiency, D: B12 deficiency - -### Response: -Ans. A. B1 deficiencyWater hammer pulse is seen in high output cardiac failure caused by wet beri-beri. The development of CHF can explain the pedal/periorbital edema of the patient. -### End" -6152,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following manifestations suggest the development of lymphoma is sjogren syndrome except:, with the following options: A: High C4 Complement Levels, B: Leucopenia, C: Purpura, D: Cryoglobulinemia - -### Response: -Low C4 Complement levels suggest the development of lymphoma. -### End" -6153,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a feature of Grave's disease?, with the following options: A: Hyperreflexia, B: Chorea, C: Lid lag sign, D: Late diastolic murmur - -### Response: -There is aoic systolic murmur is due to hyper-dynamic circulation. No diastolic murmur heard The increased thyroid hormones lead to increase in intrinsic sympathomimetic activity. The positive reinforcement of this stimulation leads to brisk reflexes. Concomitant myopathy occurs but minus fasciculations. Chorea is rare but seen. The sympathomimetic action explains lid lag sign due over-activity of Muller's muscle. -### End" -6154,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An antrochoanal polyp is associated most commonly with, with the following options: A: Middle meatus, B: Sphenoethmoidal recess, C: Inferior meatus, D: Superior meatus - -### Response: -Antrochoanal polyp arises from the mucosa of the maxillary antrum near its accessory ostium, comes out of it and grows in the choana and nasal cavity. -Hypertrophied middle turbinate, one of the important differential diagnosis, which is differentiated by its pink appearance and hard feel of the bone on probe testing.  -Antrochoanal polyps are most commonly associated with middle meatus. -### End" -6155,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The characteristic features of poisonous snakes are all except -, with the following options: A: Long fangs, B: Compressed tail, C: Nocturnal habit, D: Belly scales are incomplete - -### Response: -Belly scales are complete in poisonous snakes, i.e. belly scales cover entire breadth of belly. -Other three options are true regarding poisonous snakes. -### End" -6156,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A boy died in an emergency room with white froth in the mouth. The poisoning is due to -, with the following options: A: Organophosphorus, B: Opium, C: HCN, D: None - -### Response: -Froth near the mouth or nasal aperture may be due to death by drowning or some poisons like opium or organophosphorus. -Blood mixed frothing from nose and mouth may be due to organophosphorus poisoning. -Death due to drowning or opium poisoning causes fine white copious leathery frothing. -### End" -6157,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 45yr old female with sudden onset headache and neck rigidity There is no history of trauma .., with the following options: A: SAH, B: Meningitis, C: SDH, D: Hemorrhagic stroke - -### Response: -ref : david sutton 9th ed -### End" -6158,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Virus that affect lymphoid tissue -, with the following options: A: Adenovirus, B: Herpes virus, C: CMV, D: HIV - -### Response: -HIV virus also called lymphadenopathy associated virus REF:ANANTHANARAYANAN TEXT BOOK OF MICROBIOLOGY 9EDITION PGNO. 570 -### End" -6159,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sullivan's index indicates, with the following options: A: Life free of disability, B: Pregnancy rate per HW, C: Hook worm eggs/gm of stool, D: Standard of living - -### Response: -Ans. is 'a' i.e., Life free of disability Sullivan's index Sullivan's index is the expectation of life free of disability. It is computed by subtracting from the life expectancy the probable duration of bed disability and inability to perform major activities. Sullivan's index = life expectancy-- Duration ofbed disability & Inability to perform minor work It is a direct indicator of health and well being in a community. t is one of the most advanced health indicators currently available. -### End" -6160,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about corneum lucidum:, with the following options: A: Sadwitched b/w s.spinosum & s. granulosum, B: Sandwitched b/w s. comeum & s. granulosum, C: Contain hair follicle, D: Also k/a prickle cell layer - -### Response: -B i.e. Sandwitched b/w s. corneum & s. granulosum -### End" -6161,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reye's syndrome-histological finding-, with the following options: A: Budding and branching of mitochondria, B: Swelling of endoplasmic reticulum, C: Paranuclear microdense deposits, D: Glycogen depletion - -### Response: -Reye's syndrome is defined as an acute postviral syndrome of encephalopathy and fatty change in the viscera. The syndrome may follow almost any known viral disease but is most common after influenza A or B and varicella. Viral infection may act singly, but more often its effect is modified by ceain exogenous factors such as by administration of salicylates, aflatoxins, and insecticides. These effects causemitochondrial injury and decreased activity of mitochondrial enzymes in the liver. This eventually leads to rising in blood ammonia and accumulation of triglycerides within hepatocytes.The patients are generally children between 6 months and 15 years of age. Within a week after a viral illness, the childdevelops intractable vomiting and progressive neurological deterioration due to encephalopathy, eventually leading tostupor, coma, and death. Characteristic laboratory findings are elevated blood ammonia, serum transaminases, bilirubinand prolonged prothrombin time.Microscopically, hepatocytes show small droplets ofneutral fat in their cytoplasm (microvesicular fat). Similarfatty change is seen in the renal tubular epithelium andin the cells of skeletal muscles and hea. The brain showsedema and sometimes focal necrosis of neurons. HARSH MOHAN Textbook of pathology 6th edition pg no 602 -### End" -6162,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Definition of suspended animation is :, with the following options: A: It is a condition of apparent death when no signs of life are discovered as the functions are interrupted for sometimes or are reduced to minimum, B: Sign of death are irreversible, C: Only signs of brain death are present, D: None - -### Response: -A i.e. It is a condition of apparent death when no signs of life are discovered as the functions are interrupted for sometimes or are reduced to minimum -### End" -6163,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best way to know the position and integrity of ICD (implantable Cardioverter defibrillator) is, with the following options: A: Plain radiograph, B: CT, C: MRI, D: PET - -### Response: -Best way to know the position and integrity of ICD is to do a plain radiograph. -### End" -6164,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzyme replacement therapy is not available for which disease?, with the following options: A: Gaucher disease, B: Hunter disease, C: Hurler disease, D: Pompe disease - -### Response: -Disease for which emzyme replacement therapy available are - -Gaucher disease -Hurler disease  -Pompe disease -Fabry disease -Marteaux Lamy disease -### End" -6165,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A per NFHS III data, the wealthiest state is:, with the following options: A: Delhi, B: Haryana, C: Punjab, D: Goa - -### Response: -Delhi has the highest percentage of population (70%) in the highest quintile of wealth index, followed by Goa (55%). States with low wealth index include Chhattisgarh and Orissa. Ref: Park 21st edition page: 639. -### End" -6166,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mesothelioma is seen in which type of pneumoconiosis:, with the following options: A: Anthracosis, B: Byssinosis, C: Asbestosis, D: Silicosis - -### Response: -Ans. (c) AsbestosisRef.: K. Park 23rd ed. / 807* Pneumoconiosis occurs due to occupational exposure to dust.* Dust particle of size 0.5 to 3 microns are most dangerous, as they can reach the interior of lungs easily.* Most common pneumoconiosis associated with Mesothelioma and lung cancer: Asbestosis.* Most common pneumoconiosis: SilicosisOther important pneumoconiosis to remember:DiseaseExposure source* SilicosisSilica dust* AnthracosisCoal dust* AsbestosisAsbestos dust* BagassosisSugarcane dust (thermoactinomyces sacchari)* ByssinossisCotton fibre* SiderosisIron dust -### End" -6167,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following signs is classic for CT scanning in Graves ophthalmopathy:, with the following options: A: Nodular muscle enlargement, B: Solitary muscle enlargement, C: Fusiform muscle enlargement with sparing of tendoms, D: Kinking of extraocular muscles. - -### Response: -Ans. Fusiform muscle enlargement with sparing of tendoms -### End" -6168,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Vision 2020. Ophthalmic personnel per population ratio is -, with the following options: A: 5000, B: 10000, C: 50000, D: 1 lac - -### Response: -Ans is 'c' i.e. 50000 -### End" -6169,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pasteurized milk is most commonly tested by?, with the following options: A: Phosphatase test, B: Coliform test, C: Catalase test, D: Oxidase Test - -### Response: -Phosphatase test is conducted on pasteurized milk to detect the presence of heat-labile phosphatase enzyme in pasteurized milk. -### End" -6170,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anaphylaxis is caused by-, with the following options: A: N2O, B: Althesin, C: Halothane, D: Propofol - -### Response: -(Refer: Morgan and Mikhail’s Clinical Anaesthesiology, 5th edition) -Althesin - -Althesis is a neurosteroid -It was used as a parenteral anaesthetic -It was withdrawn from the market because of several severe anaphylactic reactions -### End" -6171,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Traveller's diarrhoea is caused by ?, with the following options: A: Enteropathogenic E. coli, B: Enterohaemorrhagic E. coli, C: Enterotoxigenic E. coli, D: Enteroinvasive E. coli - -### Response: -Ans. is `c i.e., Enterotoxigenic E. coli -### End" -6172,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Definitive treatment of all types of phobias, with the following options: A: Behaviour therapy, B: Social therapy, C: Avoidance, D: Drug therapy - -### Response: -A i.e. Behaviour therapy -### End" -6173,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gastrointestinal stromal malignancy arises from which of the following, with the following options: A: Smooth muscle, B: Nerve cells, C: Vascular endothelium, D: Interstial cells of cajal - -### Response: -Refer Robbins page no Pg P775 Gastrointestinal stromal tumors (GISTs) may be malignant (cancer) or benign (not cancer). They are most common in the stomach and small intestine but may be found anywhere in or near the GI tract. Some scientists believe that GISTs begin in cells called interstitial cells of Cajal (ICC), in the wall of the GI tract. -### End" -6174,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following imaging modality is most sensitive to detect early renal tuberculosis, with the following options: A: Intravenous urography, B: Ultrasound, C: Computed tomography, D: Magnetic resonance imaging - -### Response: -Ans. is 'a' i.e., Intravenous Urography Intravenous urography or pyelography (I VU or I VP) is the most sensitive modality to detect early renal tuberculosis. In the early stages it shows irregularity or destruction of one or more renal papillae.For ultrasound, Campbell writes- ""Ultrasonography is of limited value in the initial investigation of the genitourinary TB.""For CT, Campbell writes - ""CT is of limited value in the early investigation of genitourinary TB because intravenous urography gives such accurate pictures"".For MRI, Campbell writes - ""MRI has very little application in the management of genitourinary TB"" -### End" -6175,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyperophy is a type of, with the following options: A: Cell injury, B: Cellular adaptation, C: Carcinoma, D: Cell aging - -### Response: -Physiological adaptive responses include: * Hyperophy - increase in cell size * Hyperplasia - increase in number of cells * Atrophy - decrease in cell size and number * Metaplasia - reversible replacement of one cell type by another differentiated cell type Refer robbins 9/e p3 -### End" -6176,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In anencephaly, Polyhydramnios is seen due to all of the following. EXCEPT?, with the following options: A: Transudation of CSF, B: Absence of swallowing, C: Absent fetal pituitary, D: Uteroplacental Insufficiency - -### Response: -Anencephaly is a lethal NTD characterized by the absence of the brain and cranium above the base of the skull and orbits. It can be diagnosed as early as the first trimester on USG. Polyhydramnios is commonly seen due to the following reasons: a. Transudation of fluid across the membranes b. The absence of swallowing c. Absent fetal pituitary (absence of ADH hormone implies that the baby passes more urine). -### End" -6177,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypersegmented neutrophils are seen in, with the following options: A: Thalassemia, B: Iron deficiency, C: Megaloblastic anemia, D: All - -### Response: -Ans. (c) Megaloblastic anemia -### End" -6178,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pyogenic infection and brain infarction are associated with:, with the following options: A: Coagulative necrosis, B: Liquefactive necrosis, C: Caseous necrosis, D: Fat necrosis - -### Response: -Liquefactive necrosis, is characterized by digestion of the dead cells, resulting in transformation of the tissue into a liquid viscous mass. It is seen in focal bacterial or occasionally, fungal infections because microbes stimulate the accumulation of leukocytes and the liberation of enzymes from these cells. The necrotic material is frequently creamy yellow because of the presence of dead leukocytes and is called pus. For unknown reasons, hypoxic death of cells within the central nervous system often manifests as liquefactive necrosis. -### End" -6179,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sensitivity is a measure of, with the following options: A: True positive, B: False positive, C: True negative, D: False negative - -### Response: -(A) True positive # Term Sensitivity was introduced by Yarushalmy in 1940s as a statistical index of diagnostic accuracy.> It has been defined as the ability of a test to identify correctly all those who have the disease, that is ""True positive"".> A 90% sensitivity means that 90% of the diseased people screened by the test will give a ""true positive"" result and remaining 10% a ""false negative"" result.> Sensitivity has been defined as the ability of a test to identify correctly all those who have the disease, that is ""true positive"".> Sensitivity: the ability of a test to identify correctly all those who have the disease, i.e. true positive ... a/a + c x 100> Specificity: The ability of a test to identify correctly those who do not have the disease i.e. true negative ...d/(b+d) x 100 -### End" -6180,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Esophagus starts at which level -, with the following options: A: Upper border of cricoid cartilage, B: Lower border of cricoid cartilage, C: Thyroid cartilage, D: Hyoid cartilage - -### Response: -At the lower end of pharynx, at the level of lower border of cricoid cartilage, esophagus begins. -### End" -6181,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best fetal monitoring/screening is by :, with the following options: A: Bishop score, B: Manning score, C: Non-stress test, D: Cardif's count 10 formula - -### Response: -Manning score -### End" -6182,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following clearly states the role of cerebellum in motor performance:, with the following options: A: Planning and programming of movement, B: Conve abstract thought into voluntary action, C: Initiation of skilled voluntary action, D: Smoothens and coordinates ongoing movements - -### Response: -D i.e. Smoothens and coordinates ongoing movement Cerebellum smoothens & coordinates ongoing movement in motor performance this is the reason why lesion of cerebellum causes: - Ataxia (lack of coordination of movement) - Asynergia (lack of coordination b/w different group of muscles) - Astasia (Unsteady voluntary movement). -### End" -6183,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: By what age, does the child develops the following developmental milestone?, with the following options: A: 8 months, B: 9 months, C: 10 months, D: 12 months - -### Response: -This is Object Permanence - Develops by 9 months of age. -When the baby loses object while playing. Knows that it is somehwere around. -### End" -6184,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: TRUE/FALSE about post traumatic fat embolism syndrome: 1. Fracture mobility is a risk factor 2. Associated diabetes pose a risk factor 3. Bradycardia occurs 4. Thrombocytopenia 5. On ABG PaO2, with the following options: A: 1,2,3 true & 4,5 false, B: 1,4,5 true & 2,3 false, C: All are false, D: All are true - -### Response: -Pulmonic type of fat embolism syndrome presents with tachypnoea and tachycardia. Diabetes is not mentioned as a risk factor for fat embolism syndrome. Risk factors for fat embolism syndrome include: Long bone fracture especially femur and tibia Multiple trauma with major visceral injuries and blood loss (incidence may be as high as 5-10%) Delay in fixation of bone and extensive reaming of medullary canal contribute to severity of fat embolism syndrome Patients with coexisting lung injury are at additional risk of fat embolism Hypoxemia (ABG PaO2 Ref: Barash Anesthesia 6/e, page 1388 ; Miller Anesthesia 6/e, page 2425 ; Maheswari 3/e, page 34 ; Apley's 8/e, page 535 -### End" -6185,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thymus gland abscess seen in congenital syphilis is called -, with the following options: A: Fouchier's abscess, B: Politzeri abscess, C: Douglas abscess, D: Dubois abscess - -### Response: -• An abscess of the thymus associated with congenital syphilis -• It can present with chest pain behind the sternum. -### End" -6186,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following methods for induction of labor should not be used in a patient with previous lower segment cesarean section?, with the following options: A: PGE2 gel, B: PGE1 tablet, C: Stripping of the membrane, D: Oxytocin drip - -### Response: -PGE1 is contraindicated in previous cesarean scar pregnancy in view of scar ruptureRef: William&;s obstetrics; 25th edition -### End" -6187,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To which of the following, milliamperes-second is not related to?, with the following options: A: Quantity, B: Blackening of film, C: Contrast, D: Quality - -### Response: -mAs is directly propoional to quantity(number) of X-rays , blackening of film and contrast. Milliampere-seconds more commonly known as mAs is a measure of radiation produced (milliamperage) over a set amount of time (seconds) an x-ray tube. It directly influences the radiographic density, when all other factors are constant. -### End" -6188,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a good source of vitamin D?, with the following options: A: Fatty fish, B: Milk, C: Fish liver oils, D: Egg yolk - -### Response: -Good sources of vitamin D include fatty fish,fish liver oils, egg yolk etc. Milk is not a good source of  vitamin D. -Reference: Satyanarayana- Biochemistry, 3rd edition, pg-128 -### End" -6189,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dorello's canal transmits in tip of temporal bone-, with the following options: A: Middle meningeal artery, B: Mandibular nerve, C: Superior alveolar branch of maxillary, D: Abducent nerve - -### Response: -Dorello canal is an opening to cavernous sinus that transmit aducent nerve underneath the superior petrosal sinus. -### End" -6190,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of hematocolpos, with the following options: A: Cervical atresia, B: Vaginal atresia, C: Transverse vaginal septum, D: Imperforate hymen - -### Response: -Hematocolpos is collection of blood in the vagina. Which means the level of obstruction should be at or below the hymen. Cervical atresia will result In hematometra. The commonest cause is imperforate hymen followed by low transverse vaginal septum. The complications include hematometra, hematosalpinx, endometriosis and infeility. -### End" -6191,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following GLP - 1 analogue is cardioprotective?, with the following options: A: Exenatide, B: Lixisenatide, C: Liraglutide, D: Teduglutide - -### Response: -Liraglutide is cardioprotective and it is also used to treat obesity. -### End" -6192,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fungus not cultivable usually -, with the following options: A: Rhinosporidium, B: Cryptococcus, C: Dermatophytes, D: Histoplasma - -### Response: -Rhinosporidium seeberi has not been cultivated in media. -### End" -6193,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Double-bubble sign in X-ray is seen in, with the following options: A: Colon carcinoma, B: Duodenal atresia, C: Acute pancreatitis, D: Perforation - -### Response: -Duodenal atresia -### End" -6194,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Human developmental index includes all except:, with the following options: A: Adult literacy rate, B: Per capita income, C: Life expectancy, D: Infant moality rate - -### Response: -PQL I ( physical quality of life index) HDI ( human development index) 1) Literacy rate 1) Literacy rate 2) Infant moality rate 2) Income 3) Life expectancy at 1 year of age 3) life expectancy at bih. 4) 0 Neuroleptics produce hypotension (primarily postural) by a central as well as peripheral action on sympathetic tone.> Chlorpromazine lowers seizure threshold and can precipitate fits in untreated epileptics.> The piperazine side chain compounds have a lower propensity for this action.# Endocrine:> They reduce gonadotropin secretion but amenorrhoea and infertility occur only occasionally.> ACTH release in response to stress is diminished -- corticosteroid levels fail to increase under such circumstances.> Release of GH is also reduced but this is not sufficient to cause growth retardation in children or to be beneficial in acromegaly. -### End" -6199,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sipuleucel - T is a vaccine for:, with the following options: A: RCC, B: Testicular tumor, C: Carcinoma prostate, D: Carcinoma bladder - -### Response: -In prostate cancer, several immunologic strategies have been under clinical development. The most impoant of these include the sipuleucel-T(Provenge) autologous prostatic acid phosphates (PAP) - loaded dendritic cell vaccine, the GVAX allogeneic recombinant whole cell vaccine, and CTLA-4 inhibitory approaches. -### End" -6200,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Soap bubble appearance is seen in which meningo-encephalitis -, with the following options: A: Cryptococcus, B: Mucormycosis, C: Tubercular, D: HSV - -### Response: -Ans. is 'a' i.e., CryptococcusSoap bubble appearance occurs in CNS cnptococosisCryptococcal meningitis in common in immunocompromised patientsIt typically results from hemotogenous spread from the lungs (which is usually the primary site).The disease can have either meningeal or parenchymal involvement with the former being the primary manifestation,o There are three dominant CNS forms of the disease which are :MeningitsCryptococcosisGelatinous pseudocy>stGelatinous pseudocvst tends to she ""soap bubble annerance"" on CT. scan -### End" -6201,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following inhibits appetite by counteracting the effects of neuropeptide Y?, with the following options: A: Orexins, B: Neuropeptide Y, C: Ghrelin, D: Leptin - -### Response: -Leptin acts on receptors in the hypothalamus of the brain where it inhibits appetite by (1) counteracting the effects of neuropeptide Y (a potent feeding stimulant secreted by cells in the gut and in the hypothalamus); (2) counteracting the effects of anandamide (another potent feeding stimulant that binds to the same receptors as THC), and (3) promoting the synthesis of a-MSH, an appetite suppressant. Ghrelin is a hormone produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates hunger. Neuropeptide Y is a natural substance that acts on the brain to stimulate eating.Leptin reduces the output of NPY from the hypothalamus, a major production center. Orexins (hypocretins) are neuropeptides primarily localized in the hypothalamus and are implicated in the regulation of a variety of activities, including feeding behavior and energy balance. -### End" -6202,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PET stands for -, with the following options: A: Positive electron tomography, B: Proton-electron therapy, C: Positron emission tomography, D: Photon emitting tomography - -### Response: -PET stands for positron emission tomography -### End" -6203,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'Fracture-ala signature' or signature fracture is:, with the following options: A: Gutter fracture & Contre coup injury, B: Depressed fracture of skull, C: Ring fracture at foramen magnum, D: Sutural separation - -### Response: -Signature fracture or Fracture-ala signature is a type of skull fracture. It's a fracture wherein the fractured bone is driven inwards and it correspond in terms of size, shape to the causative weapon. It is called signature fracture as it gives clue regarding the causative weapon. This is also known as depressed fracture. Ref: Textbook of Forensic Medicine and Toxicology, by Nagesh Kumar Rao ,Page 194; The essentials of forensic medicine and toxicology,By K.S Narayan reddy,27th Edition Page 214-217 -### End" -6204,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oligohydramnios is associated with, with the following options: A: Renal agenesis, B: Neural tube defects, C: Postmature birth, D: Premature birth - -### Response: -Etiology of oligohydramnios:  - -Intrauterine growth restriction -Post-term pregnancy  -Premature rupture of membrane  -Drugs like ACE inhibitors and prostaglandin inhibitors  -Renal anomalies  -Renal Agenesis  -Infantile polycystic disease  -Upper urinary tract obstructions  -Lower urinary tract obstructions -### End" -6205,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: neologism is a charecterstic of, with the following options: A: schizophrenia, B: mania, C: depression, D: phobia - -### Response: -Type of thought disorder clinical condition clang assosiation mania flight of ideas mania prolixity hypomania loosening of assosiation schizophrenia neologism schizophrenia circumstantiality organicity Ref. Kaplon and Sadock, synopsis of psychiatry, 11 th edition, Pg.No.194 -### End" -6206,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Histamine causes all EXCEPT:, with the following options: A: Aeriolar dilatation, B: Increased permeability of venules, C: Constriction of large aeries, D: Platelet aggregation - -### Response: -Platelet aggregation REF: Robbin's pathology 7th edition page 63 Preformed histamine is present in mast cell granules and is released by mast cell degranulation in response to variety of stimuli. In humans histamine causes: Aeriolar dilatation Increased permeability of venules (however constricts large aeries) Via binding to H1 receptor on endothelial cells -### End" -6207,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antiprogesterone compound RU-486 is effective for inducing aboion if the duration of pregnancy is:, with the following options: A: 63 days, B: 72 days, C: 88 days, D: 120 days - -### Response: -Mifepristone (RU 486) an Antiprogestin, degenerates the pregnancy in doses ranging from 200-600mg. This is followed by Misoprostol (prostagladin) in 400ug orally or 800ug vaginally which causes uterine contractions to expel the dead fetus. This regime is -99% successful - If done within 1st 7 weeks -95% successful - If done within 1st 9 weeks -### End" -6208,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mature ovum contains: March 2013, with the following options: A: 23X, B: 46X, C: 45XO, D: 47XXY - -### Response: -Ans. A i.e. 23X -### End" -6209,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following diuretic is used in the given condition?, with the following options: A: Furosemide, B: Thiazide, C: Acetazolamide, D: Neomycin - -### Response: -Loop diuretics are 1st choice in hepatic cirrhosis associated edema along with aldosterone antagonist.Ref: Katzung 13thed.Pg 265 -### End" -6210,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Uveitis associated with vitiligo & auditory defects occurs in –, with the following options: A: Behcet's syndrome, B: Steven Johnson syndrome, C: Vogt–Koyanagi syndrome, D: Ankylosing–spondylitis - -### Response: -Vogt Koyanagi - Harada (VKH) syndrome - -It is an idiopathic multisystem disorder which includes cutaneous, neurological and ocular lesions. -The disease is comparatively more common in Japanese who are usually positive for HLA-DR4 and DW15. - -Clinical features - - -Cutaneous lesions include: alopecia, poliosis and vitiligo. - - -Neurological lesions are in the form of meningism, encephalopathy, tinnitus, vertigo and deafness. - - -Ocular features are bilateral chronic granulomatous anterior uveitis, posterior uveitis and exudative retinal detachment. -### End" -6211,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Collagen synthesis requires which vitamin -, with the following options: A: Vitamin B1, B: Vitamin D, C: Vitamin C, D: Vitamin E - -### Response: -Ans. is 'c' i.e., Vitamin C o Hydroxylation of proline and lysine during collagen synthesis requires vitamin C (ascorbic acid), molecular oxygen (O2), (X-ketoglutarate and enzymes dioxygenases (prolyl hydroxylase, lysyl hydroxylase). -### End" -6212,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug used in Narcoanalysis is:, with the following options: A: Cocaine, B: Pethidine, C: Atropine, D: Scopalamine - -### Response: -Ref: Essentials of Medical Pharmacology by K.D. Tripat hi p. 109, 113.Explanation:Hyoscine (Scopalamine)Atropine substitute and quartemary ammonium compoundLess potent and longer acting than atropineUsed for esophageal and gastrointestinal spastic conditions.- Hyoscine has been used to produce sedation and amnesia during labour (twilight sleep) and to control maniacal states.- It had earned a reputation as a lie detector' during world war SI: its amnesic and depressant action was believed to put the subject 'off guard' in the face of sustained interrogation and sleep deprivation, so that he came out with the truth. -### End" -6213,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The first to appear in a cause of acute intestinal obstruction is, with the following options: A: Colicky pain, B: Constipation, C: Vomiting, D: Distension - -### Response: -Symptoms of intestinal obstruction Symptoms of intestinal obstruction : Pain, vomiting, distension and constipation Pain is the first symptom encountered ; it occurs suddenly and is usually severe Pain in intestinal obstruction It is colicky in nature and is usually centered on the umbilicus(small bowel) or lower abdomen (large bowel) The pain coincides with increased peristaltic activity With increasing distension, the colicky pain is replaced by a mild constant diffuse pain The development of severe pain is indicative of the presence of strangulation Pain may not be a significant feature in post operative simple mechanical obstruction and does not usually occur in paralytic ileus Ref: Bailey and love 27th edition Pgno : 1285 -### End" -6214,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ketone body is not utilised by -, with the following options: A: Neurons, B: Kidney, C: Muscle, D: Liver - -### Response: -Ans. is 'd' i.e., Liver* Ketone bodies are synthesised in conditions of starvation and diabetes mellitus* They are synthesised by incomplete oxidation of fatty acids as oxaloacetate is unavailable* They get synthesised in liver* Rate limiting enzyme of ketone body synthesis is HMG CoA lyase* Ketone bodies get utilised in extrahepatic tissues including neurons (Ketone bodies can cross Blood brain barrier as they are polar), muscle cells and kidney* Ketone bodies can not be utilised in liver. Because liver lacks the enzyme Thiophorase or Succinyl CoA Acetoacetate CoA transferase. -### End" -6215,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of following is not seen in nephritic syndrome, with the following options: A: Edema, B: Hematuria, C: HTN, D: Hypocholesterolemia - -### Response: -Hypercholesterolemia is not seen with nephritic syndrome. It is rather a feature of nephrotic syndrome All others hematuria , edema , hypeension are seen . Reference: GHAI Essential pediatrics, 8th edition -### End" -6216,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following oncogenes is a growth factor?, with the following options: A: fos, B: myc, C: jun, D: sis - -### Response: -The 'sis' oncogene is a growth factor. The protooncogene 'sis' encodes the ( b chain of) Platelet Derived Growth Factor (PDGF). Ref: Robbin's Illustrated Pathology, 7th Edition, Pages 293, 295; Cancer: Principles and Practice of Oncology, 6th Edition, Page 13 -### End" -6217,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The specialized mammalian tissue/organ in which fuel oxidation serves not to produce ATP but to generate heat is, with the following options: A: Adrenal gland, B: Skeletal muscle, C: Brown adipose tissue, D: Hea - -### Response: -Uncouplers will allow oxidation to proceed, but the energy instead of being trapped by phosphorylation is dissipated as heat. Impoant mitochondrial membrane transpoers. 1 = PYT (pyruvate transpoer); 2 = TCT (tricarboxylate transpoer); 3 = ANT (adenine nucleotide transpoer) . This is achieved by removal of the proton gradient. The uncoupling of oxidative phosphorylation is useful biologically.In hibernating animals and in newborn human infants, the liberation of heat energy is required to maintain body temperature. In Brown adipose tissue, thermogenesis is achieved by this process. Thermogenin, a protein present in the inner mitochondrial membrane of adipocytes, provides an alternate pathway for protons. It is one of the uncoupling proteins (UCP). Thyroxine is also known to act as a physiological uncoupler.Ref: Chatterjee Textbook of Medical Biochemistry; 8th edition; Page no: 234 -### End" -6218,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45 year old woman with Intracranial extradural hemorrhage is presented with all except, with the following options: A: Absence of Lucid interval, B: Not commonly seen in old age, C: Middle meningeal artery involvement, D: Temporoparietal region fracture - -### Response: -(A) Absence of Lucid interval SYMPTOMS OF CEREBRAL HEMORRHAGESubduralSubarachnoidEpiduralIntracerebralCerebellar HerniatiorLethargyAbrupt onset of headacheInitial loss of consciousnessAltered level of consclo susnessExtensor postruingSeizuresMeningeal irritation (e.g. neck stiffness, low back pain, bilateral leg pain)Lucid IntervalNausea/ vomitingAsymmetric dilated or unreactive pupilsNausea, HeadacheNausea, vomitingSecond loss of consciousnessHeadacheDecreased brain stem bbodflow, cardiovascular collapseSlurred speechPhotophobia & visual changesHemiparesisSeizures WeaknessGlobal or focal neurological changesNausea/vomitingFocal neurological deficits Loss of consciousness after injurySeizures, motor deficitsTranstenortal herniation, coma, fixed/ dilated pupils, decerebrate posturingNuchal rigidity # Extradural haemorrhage (EDH) is a collection of blood in the potential space between the Extradural haemorrhage (EDH) is most often due to a fractured temporal or parietal bone damaging the middle meningeal artery or vein, with blood collecting between the dura and the skull, dura and the bone.> There is usually a history of trauma and head injury that causes loss of consciousness.> However, this 'classical' presentation occurs in less than a third of cases. -### End" -6219,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about nodular sclerosis of Hodgkin&;s disease except -, with the following options: A: Well formed fibrous stands, B: CD 15 +, C: CD 20 +, D: Infiltration by plasma cells - -### Response: -There will be no well-formed fibrous stands but variable amount of fibrous tissue is characteristically present in the involved lymph nodes. occasionally the entire lymph node may be replaced by dense hyalinised collagen Reference textbook of Pathology 7th edition author Harsha Mohan page number 350 -### End" -6220,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following are the examples of intracytoplasmic inclusion bodies except:, with the following options: A: Molluscum bodies, B: Guarneri bodies, C: Bollinger bodies, D: Owl's eye bodies - -### Response: -Owl's eye bodies are intranuclear inclusion bodies. Characteristic features of the cell infected by CMV (Cytomegalovirus). These cells are found in most tissues of the body and in the urine. INCLUSION BODIES- Intracytoplasmic: * Negri body - Rabies * Guarneri body - Vaccinia * Paschen body - Variola * Bollinger body - Fowl pox * Molluscum body - Molluscum contagiosum Intranuclear: * Cowdry A - Herpes (Lipschultz body), Yellow fever (Torres body) * Cowdry B - Adenovirus, Poliovirus Intracytoplasmic and Intranuclear: * Measles * CMV - intranuclear bodies called as Owl's eye appearance. -### End" -6221,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common extra-cranial complication of ASOM is:, with the following options: A: Facial nerve paralysis, B: Lateral sinus thrombosis, C: Subperiosteal abscess, D: Brain abscess - -### Response: -Ans. C Subperiosteal abscessAs discussed earlier therelative incidence of various extracranial complications in a case of chronic, otitis media are:Extracranial complicationPercentagePost auricular abscess:Fpcial palsyBezold abscessPetrous apicitis (Petrositis)Meningitis 75620.212 So M/C complication is post auricular abscessNow what is post auricular abscessThere are many abscesses in relation to mastoid -Post aural subperiosteal abscessZygomatic abscessBezold abscessIt is the commonest abscess thatforms over the mastoidPinna is displaced forward, out wardand downward In infants and chiidrenabscess forms overMcEwan's trianglePosterior root of zygoma is invovedSwelling lies in front of and above thepinnaAssociated oedema of upper eye lidPus lies superficial or deep totemporalis muscle. Passes throughthe tip of mastoid intosterno cleido mastoid muscle in theupper pa of neck.? Citelli abscessLucs abscess (Meatal abscess) Pus passes through inner-table ofmastoid process into the dfgastrictriangle? ln-thiscase, pus breaks throughthebony wall between the antrum andexternal osseus meatus. Swelling is.seen in deep pa of rneatus.? lateral sinus thrombosis So As is clear from above explanation - M/C. Extra cranial complication is - Post Aural sub periosteal abscess: If this optionis not given then the next best option would be Mastoiditis. -### End" -6222,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triad of alopecia, neuropathy and diarrhea results from which poisoning, with the following options: A: Thallium, B: Dhatura, C: Opium, D: Mercury - -### Response: -Ans. is 'a' i.e. thallium The classic symptoms of acute thallium toxicity are:Severe stomach pain, nausea, vomiting, and diarrhea within 3-4 hours of exposurePainful and rapidly progressing peripheral neuropathies (numbness, tingling and pain, especially on the soles and palms) about 2-5 days after exposure.Sudden hair loss that progresses to widespread alopecia about 2-3 weeks after exposure.Signs and symptoms of chronic poisoning include tiredness, headaches, depression, hallucinations, psychosis, dementia, poor appetite, leg pains, hair loss and disturbances of vision. -### End" -6223,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an example for mature defense mechanism?, with the following options: A: Intellectualization, B: Dissociation, C: Displacement, D: Suppression - -### Response: -Suppression is a mature defense mechanism where a person voluntarily makes decision to not to think about an distressful event and accompanying emotions. -### End" -6224,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tall T waves on ECG are seen in:, with the following options: A: Hyperkalemia, B: Hypokalemia, C: Hypercalcemia, D: Hypocalcemia - -### Response: -Answer is A (Hyperkalemia) Hyperkalemia is typically associated with Tall peaked narrow based frnted T wave. -### End" -6225,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Megaloblastic anemia is due to?, with the following options: A: Folic acid deficiency, B: Vitamin B6 deficiency, C: Defect in RNA synthesis, D: Defect in protein synthesis - -### Response: -Ans. is 'a' i.e., Folic acid deficiency * Megaloblastic anemia is an anemia which results from inhibition of DNA synthesis during red blood cell production.* It is characterized by many large immature and dysfunctional red blood cells (megaloblasts) in the bone marrow, and also by hypersegmented neutrophills.* Vit B12 and folic acid are required for DNA synthesis. Any factor that results in deficiency of vit B12 or folic acid will lead to defective DNA synthesis. Inadequate DNA synthesis results in defective nuclear maturation. However, the synthesis of RNA and proteins is not altered, so cytoplasmic maturation proceeds in advance of nuclear maturation - Nuclear/Cytoplasmic asynchrony that results in formation of megaloblasts.Important causes of megaloblastic anemiaVitamin BJ2 deficiency* Decrease intake: Inadequate diet, vegetarianism.* Impaired absorption : Intrinsic factor deficiency (pernicious anemia, gastrectomy), intestinal diseases (crohn's disease, ileitis, ileal resection, lymphoma, systemic sclerosis), fish tapeworm infestation (D. latum), blind loop syndrome (bacterial overgrowth), diverticuli of bowel, chronic pancreatitis.* Increased requirment: Pregnancy, hyperthyroidism, disseminated cancer.Folate deficiency* Decrease intake: Inadequate diet, alcoholism, infancy.* Impaired absorption : Malabsorption state, intestinal diseases.* Increased requirment: Pregnancy, infancy, disseminated cancer.* Others : Hemodialysis, antifolate drugs (methotrexate, phenobarbitone, phenytoin, trimethoprim, primidone, triametrene, azathioprine.Rare causes* These are : Hereditary orotic aciduria, hypothyroidism, Di-Gueglielmo syndrome, congenital dyserythropoietic anemia, thiamine and pyridoxine deficiency. -### End" -6226,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common mechanism of drug resistance in staphylococci is, with the following options: A: Conjugation, B: Plasmids, C: Transduction, D: Translation - -### Response: -The most common mechanism of drug resistance in staphylococci is through production of beta lactamase or penicillinase, which inactivates penicillin by splitting the beta lactum ring. These are inducible enzymes which are plamid mediated. They can be transmitted by transduction or conjugation. Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; 10th Edition; Page No: 202 -### End" -6227,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thick pasty increased salivation seen in new complete denture wearer is mainly due to:, with the following options: A: Reflex parasympathetic stimulation of the salivary gland., B: Hypersensitivity to the denture base., C: Reflex sympathetic stimulation of the salivary gland., D: All of the above. - -### Response: -Thick pasty saliva us due to sympathetic stimulation of the salivary gland while watery saliva us due to parasympathetic stimulation -### End" -6228,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an indication for use of Hormone Replacement Therapy in menopausal women:-, with the following options: A: Hot flushes, B: Cardiovascular protection, C: Pyelonephritis, D: Post menopausal bleeding - -### Response: -H indicated in menopausal women to overcome the sho term and long term consequences of estrogen deficiency. Indications of hormone replacement therapy in a menopausal woman Relief of vasomotor symptoms: hot flushes Prevention and treatment of osteoporosis Urogenital atrophy Premature Menopause Hormone Replacement Therapy is NOT indicated for prevention or treatment of cardiovascular disease. Natural estrogens produced in the body till menopause are cardioprotective, however Hormone Replacement Therapy (containing exogenous estrogens and progesterones)is not cardioprotective. There is no role of Hormone Therapy in pyelonephriis Post menopausal bleeding needs evaluation of cause, especially to rule out malignancies and treated accordingly. Hormone Replacement Therapy is contraindicated in any undiagnosed vaginal bleeding. -### End" -6229,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Auxiliary ohotopic liver transplant is indicated for:, with the following options: A: etabolic liver disease, B: As a standby procedure until finding a suitable donor, C: Drug induced hepatic failure, D: Acute fulminant liver failure for any cause - -### Response: -Acute fulminant liver failure for any cause Following arc the types of liver transplantation: Cadaver donor transplantation: The donor liver is obtained from a person who is diagnosed as brain dead whose family volunteers to donate the organ for transplantation. Living donor transplant: A healthy family member or a volunteer donates pa of his liver for transplantation. Ohotropic liver transplant: it involves the replacement of the patient's diseased liver with the donor's liver. Auxiliary liver transplant Auxiliary transplantation (A-OLTX): Here the patient's liver is not removed. Pa of the liver of a healthy adult donor (living or cadaver) is transplanted into the recipient, alongside pa of the patient's own liver. Auxiliary heterotopic liver transplantation is theoretically attractive because it leaves the recipient's liver in place. The surgical trauma of hepatectomy is avoided, and failure of the graft does not necessarily lead to the death of the patient or a second, emergency transplantation. Another advantage is that matching the body sizes of the donor and the recipient is not mandatory, which increases the number of possible donors The following aicle-""Auxiliary Paial Ohotopic Living Donor Liver Transplantation: Kyoto University Experience"" (at the .following website latp://www.inedscape.combiewaicle/500102) mentions four indications for auxiliary paial ohotopic liver transplantation: reversible fulminant hepatic failure non-cirrhotic metabolic liver disease snzall-for-size grafts for ABO-incompatibility Fultninant hepatic failure: Total ohotopic liver transplantation (OLTX) is a lifesaving therapeutic option for patients with FI-1F, but requires lifelong immunosuppression to maintain the graft. Auxiliary paial ohotopic liver transplantation whereby only a poion of the native liver is removed, and the remainder of the native liver is left in situ, provides temporary suppo until the native liver recovers and then immunosuppression can be withdrawn. The advantage claimed for APOLT in non-cirrhotic metabolic liver disease (most commonly Crigler-Najjar syndrome) is that it can compensate for enzyme deficiencies without complete removal of the native liver, which may have to aid the recipient in case of potential graft failure. The remaining native liver could benefit in the future from potential success in gene treatment Transplants of ABO-incompatible grafts are often unavoidable due to the limited number of potential donor candidates. A high incidence of early graft failure with a high rate of binary and vascular complications in ABOincompatible liver transplantation was repoed. The remnant native liver could sustain a patient's life if the anticipated graft failure occurred in an ABO-incompatible case. The rationale of APOLT for a small-for-size graft is that the remnant native liver is expected to suppo the function of the implanted graft during the early post-operative period. The graft liver expands its function in propoion to volume growth. After the graft liver has grown sufficiently, it can be expected to meet the hepatic functional demands of the recipient. The following aicle ""Auxiliary paial liver transplantation for end-stage chronic liver disease"" in The New England Journal of Medicine Volume 319:1507-1511December 8, 1988Nutnber 23 (at the following website gi/content/abstract/319/23/1507) mentions another indication for A-OLTX - End-stage chronic liver disease who are high-risk patients. These patients are not accepted for ohotopic liver transplantation because of massive ascites, deficient clotting function, cachexia, or poor pulmonary reserve. So we see that all the options except 'b' are indications for A-OLTX We have chosen acute liver ds. as the answer as it's the probably the most common indication as evident by maximum number of aicles on the net describing A-OLTX for acute liver failure. This book -""Atlas of Upper Gastrointestinal and Hepato-Pancrato-Biliary surgery- publisher: Springer Berlin Heidelberg "" mentions only acute liver failure as an indication for A-OLTX. -### End" -6230,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glucokinase is inhibited by:, with the following options: A: ATP, B: ADP, C: Glucose 6 phosphate, D: All of the above - -### Response: -Hexokinase is inhibited allosterically by its product, glucose 6-phosphate. Ref: Harper 28th edition, chapter 17. -### End" -6231,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sunflower cataract is Seen in, with the following options: A: Haemochromatosis, B: Wilson's disease, C: Galactosemia, D: Diabetes milletus - -### Response: -A typical 'sunflower cataract' is seen in disorder of copper metabolism (Wilson's disease). It is produced by deposition of copper under the posterior capsule of the lens. It is brilliant golden green in colour and arranged like the petals of a sun flower. Ref:- A K Khurana; pg num:-410,476, -### End" -6232,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: GLP - 1 is broken down by, with the following options: A: α - glucosidase, B: Rasburicase, C: Dipeptidyl peptidase, D: Glucose 1 phosphatase - -### Response: -GLP - 1 is a peptide hormone released from intestinal cells that act on β -  cells to release insulin. It is rapidly broken down by Dipeptidyl peptidase 4 (DPP - 4). -### End" -6233,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Membrana tectoria is continuation of:, with the following options: A: Anterior longitudinal ligament, B: Posterior longitudinal ligament, C: Anterior atlanto-occipital membrane, D: Posterior atlanto-occipital membrane - -### Response: -Ans. b. Posterior longitudinal ligament -### End" -6234,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After I.V drug administration , elimination of a drug depends on, with the following options: A: Volume of distribution, B: Clearance, C: Lipids solubility, D: All - -### Response: -elimination of drug depends on -volume of distribution -clearance Volume of distribution is more for high lipids solubility Ref-KDT 7/e p30-31 -### End" -6235,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of following are associated with external oblique muscle -a) Pouparts ligamentb) Lacunar ligamentc) Superficial inguinal ringd) Conjoint tendone) Cremaster muscle, with the following options: A: ab, B: abc, C: acd, D: bcd - -### Response: -Internal oblique forms cremasteric muscle. Internal oblique and transversus abdominis form the conjoint tendon. Poupart's ligament, lacunar ligament, pectineal ligament, superficial inguinal ring, and external spermatic fascia are all formed by external oblique muscle. -### End" -6236,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Structures not removed in radical neck dissection, with the following options: A: X nerve, B: XI nerve, C: Tail of parotid, D: Parotid and post-auricular nerve - -### Response: -The classic operation involves resection of the cervical lymphatics and lymph nodes and those structures closely associated: the internal jugular vein, the accessory nerve, the submandibular gland and the sternocleidomastoid muscle. These structures are all removed en blocand in continuity with the primary disease if possible. The main disability that follows the operation is weakness and drooping of the shoulder due to paralysis of the trapezius muscle as a consequence of excision of the accessory nerve Bailey & Love ,25th,733. -### End" -6237,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most halophilic vibrio -, with the following options: A: Vcholerae, B: Vvulnificus, C: Valginolvticus, D: Vparahemolyticus - -### Response: -Ans. is 'c' i.e., V alginolyticus o V alginolyticus is most salt tolerant (most halophilic) species of vibrio.Halophilic vibrios# Vibrios that have a high requirment of sodium chloride are known as halophilic vibrios. They are abundant in coastal water throughout the world. Examples are -V. ParahaemolyticusV. alginolyticusV. VulnificusV. damselaV. fluvialisV. HallisaeV. furnissii# Remember simple funda.""Except for V.cholerae and V.mimicus, alt vibrios are halophilic"" - Harrison 16th/e p. 909Note : Vibio alginolyticus is the most salt tolerant species of vibrio. -### End" -6238,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Number of ovum at bih is, with the following options: A: 2-3 million, B: 2-5 million, C: 7-10 million, D: 10-15 million - -### Response: -In humans no ova formed after bih. at time of bih there are 2 million ova.Ref: Ganong&;s review of medical physiology; 24th edition; page no: 401 -### End" -6239,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Deficiency of which one of the following dietary components is most likely to have caused this rash?, with the following options: A: Biotin, B: Folate, C: Niacin, D: Riboflavin - -### Response: -Answer C. NiacinThe symmetric, scaly, sunburn-like, hyperpigmented rash extending from the hands to a clearly demarcated border midway up the arm suggests a photosensitive distribution, most consistent with pellagra (niacin deficiency). Deficiency of the other listed dietary components is not typically associated with a photosensitive dermatitis in this area. -### End" -6240,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient while lifting a heavy weight presents with sudden onset pain in the lower back radiating along the postero-lateral thigh and lateral leg to the big toe with numbness. The most likely diagnosis is:, with the following options: A: L5 fracture, B: L3 - IA Disc prolapsed, C: L4 - L5 Disc prolapsed, D: L5 - SI Disc prolapse - -### Response: -C i.e. L4 -- L5 Disc prolapsed Sudden onset lower back pain with radioculopathy while lifting something heavy from ground (i.e. in spinal flexion) indicates acute PIVD (prolapsed of interveebral disc). Pain or paresthesia along posterolateral aspect of lower thigh, anterolateral aspect of knee and leg and dorsal surface of foot covering great toe, 1st web space upto 3rd MTP joint (but never little toe) indicates compression of L5 nerve root (i.e. prolapsed of L4 --L5 disc). Level of Disc Prolapse Compressed Nerve Root Pain and Sensory Loss Motor Weakness Reflex Affected L3-L4 L4 - Over medial malleous - Ankle dorsiflexion (TA) a/t Knee (quadriceps/patella) (ASIA) - Medial aspect (both anterior ASIA - Knee extension (Quadriceps; jerk | & posterior) of lower thigh, knee, leg (calf) and ankle L4 is main root) - Hip/thigh adduction L4-L5 L5 - Dorsal of foot at 3rd MTP - Great toe extensor (EHL; a/t Knee & Ankle jerks are joint (ASIA) ASIA)Q normal; or knee - Posterolateral buttock (+-) & - Foot eversion (peroneii; paradoxically increased due thigh (esp lower), lateral aspect (anterior > posterior) of knee and leg (calf) and dorsum of foot covering great toe, 1st web space & 3rd main root) - Ankle/foot dorsiflexion (TA) - Toe dorsiflexors - Hip abduction (gluteus medius) to weak knee flexion MTP joint but never little toe. - Knee flexion L5-S1 S1 - Lateral aspect of calcaneus (ASIA) - Lateral aspect of ankle & foot (both on dorsal & plantar aspect) involving lateral malleolus, lateral border of foot & little toe - Ankle & foot plantar flexion (gastrocnemius & soleus; main root; ASIA) - Abductor hallucis (great toe flexion; main root) - Hip extension (gluteus maximus) Ankle jerk | -### End" -6241,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bullae of bullous pemphigoid are ?, with the following options: A: Intraepiderma, B: Subepidermal, C: Subepidermal, D: None - -### Response: -Ans. is 'b' i.e., Subepidermal Intra-epidermal immunobullous disorder Sub-epidermal immunobullous disorder Pemphigus vulgaris Bullous pemphigoid Pemphigus vegetan Mucous memb. Pemphigoid Pemphigus foliaceu Pemphigoid gestationalis Pemphigus foliaceu Linear IgA disease Intercellular IgA dermatosis Epidermolysis bullosa aquisita Paraneoplastic Pemphigus Dermatitis herpetiformis -### End" -6242,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best method to diagnose hydrocephalus in 6 month old FETUS is:, with the following options: A: X-ray, B: Ultrasound, C: CT scan, D: MRI - -### Response: -Ans. B. UltrasoundHydrocephalusObstetric ultrasound study is one of the best methods for antenatal diagnosis of hydrocephalus as it is non-invasive and hazard-free not only to fetus but also to mother.However, assessment prior to GA of 20 weeks may be difficult, as ventricles constitute a large portion of cranial vault.Signs suggestive of fetal hydrocephalus on obstetric USG study are:a. Atrial size >10mmb. Dangling ""choroid plexus"" signc. Banana signd. Lemon signe. BPD > 95th percentilef. +- Polyhydramnios -### End" -6243,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest functional tumor of pituitary gland is?, with the following options: A: Gonodotroponoma, B: ACTH secreting tumour, C: TSH secreting tumour, D: Prolactinoma - -### Response: -ANSWER: (D) ProlactinomaREF: Sabiston textbook of surgery, 18th ed, chapter 72Pituitary adenomas arise primarily from the anterior pituitary gland and are classified as either functional (secreting) or nonfunctional (non-secreting) tumors, with the former presentingearlier with symptoms caused by physiologic effects and the latter presenting when of sufficient size to cause neurologic deficits by mass effect on the chiasm with consequent bitemporal hemianopsia.Tumors smaller than 1 cm in diameter are called microadenomas, and the rest are considered macroadenomas; 50% of pituitary tumors are smaller than 5 mm at the time of diagnosis. Their incidence is increased in multiple endocrine neoplasias. They occur commonly in the third and fourth decades of life and affect both sexes equally""The most common functional tumor is the prolactinoma, which causes amenorrhea and galactorrhoea in women"" -### End" -6244,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the marker enzyme for Endoplasmic reticulum?, with the following options: A: ATP synthase, B: 5' nucleotidase, C: Catalase, D: Glucose-6-phosphatase - -### Response: -ATP synthase is marker enzyme for mitochondria. -5' nucleotidase is marker enzyme for plasma membrane. -Catalase and urate oxidase is marker enzyme for peroxidase. -Glucose-6-phosphatase is marker enzyme for Endoplasmic reticulum. -### End" -6245,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common organ affected in underwater blast ?, with the following options: A: Intestine, B: Liver, C: Spleen, D: Hea - -### Response: -Ans. is 'a' i.e., Intestine The most common organ affected in underwater blast injury is intestine. Explosion injury An explosion is a phenomenon resulting from sudden release of energy which is then dissipated by a blast wave, by translocation of objects, or by the generation of heat. Injuries in explosion occur due to four factors :? 1) Blast or shock wave When an explosion occurs, the explosive material produces a large volume of gas and releases a large amount of energy. It produces a 'shock wave' which spread concentrically from the site of explosion. The injuries depend on the enviornment in which blast occurs :- Air blast (most common) : Explosion occurs in air. There is barotrauma to air filled hollow organs. Tympanic membrane (ear drum) is most sensitive and most commonly injured. Lung is the second organ to be injured and is the most commonly injured hollow organ and most common cause of life threatening injury. Other pas injured are middle ear, cochlea, eyes, bowels, mesentery, omentum and brain. Homogenous solid organs like liver and muscles are usually not affected. Under water blast (explosion under water): Gastrointestinal tract is injured most commonly. Lungs are also injured. Solid blast : Explosive is detonated near a rigid/solid structure and wave of energy spreads through it. If people are in contact with that rigid structure, injuries take place. The injuries are mostly skeletal; fracture of legs and veebral column are more common. GIT damage is more common than lung. 2) Flame or hot gases Burns or burning of body may occur. 3) Flying missiles (debris) Flying pieces of explosive debris may be driven through air against the skin causing bruises, abrasions, lacerations, and ragged perforations. 4) Anoxia Various gases liberated during explosion may cause anoxia, e.g. carbon monoxide, nitrous oxide, nitric oxide, HCN and SO,. -### End" -6246,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following skeletal muscle relaxants causes pain on injection?, with the following options: A: Succinyl choline, B: Vecuronium, C: Rocuronium, D: Pancuronium - -### Response: -Rocuronium causes pain on injection. It can be minimized by alkalinizing the solution. Remember, post-operative muscular pain is caused by succinylcholine -### End" -6247,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Woods lamp has a frequency of -, with the following options: A: 250 nm, B: 300 nm, C: 320 nm, D: 360 nm - -### Response: -

WOOD'S LAMP Hand held device used to diagnose various dermatological conditions.It is a mercury vapour long wave,ultraviolet lamp with an inbuilt wood's filter made of barium silicate with 9% nickel oxide. Opaque to all wavelengths except those between 320 nm and 400 nm with a peak at 365 nm. Flourescence occurs when wood's light is absorbed and radiation of longer wavelengths is emitted.Examination done in dark room. Iadvl textbook of dermatology page 109 -### End" -6248,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What are the features of colonic obstruction ?, with the following options: A: No passage of gas absolutely (Obstipation), B: No passage of stools absolutely, C: Distention of abdomen, D: All - -### Response: -Answer is 'a' i.e. No passage of gas absolutely (obstipation); 'b' i.e. No passage of stools absolutely; 'c' i.e. Distention of abdomen Colonic obstruction may occur in any poion of the colon, but most commonly is seen in the sigmoid colon. Obstruction at the ileocecal valve produces symptoms and signs of small bowel obstruction. So do obstruction in proximal asc. colon if the ileo-cecal valve becomes incompetent. The pathophysiology of more distal colonic obstruction depends on the competence of the ileocecal valve. If the ileocecal valve is incompetent the colonic pressure is relieved by reflux into the ileum. If the colon is not decompressed through the ileocecal valve, a 'closed loop' is formed between the valve and the obstructing point. The colon distends progressively because the ileum continues to empty gas and liquids into the obstructed segment. Increasing colonic pressure may lead to impaired circulation with gangren and perforation. The risk of perforation is highest in the cecum. Symptoms & signs - depend on the degree and acuity of obstruction, as well as on the cause. Abdominal distention is the most prominent initial finding. Pain is cramping in nature but of less severity than seen in small bowel obstruction. Vomiting is late and occurs only if the ileocecal valve is incompetent. Feculant vomiting is very rare (cf. feculant vomiting is seen in distal small bowel obstruction). Constipation or obstipation is a universal feature of complete obstruction, though the colon distal to the obstruction may empty after the initial symptom begins. So its a late feature even in complete obstruction. If ileocecal valve incompetence decompresses the colonic contents into the small intestine, features of both small & large intestine obstruction appears. Fever is commonly seen in acute diveiculitis, ischemic injury or perforation. (But I don't think its an early finding) Plain x-ray films will show peripheral gas filled dilated colon segments. Air fluids level will not be noted unless the ileocecal valve incompetence has decompressed the colonic contents into small intestine. Also know MC cause of colonic obstruction Ca colon -### End" -6249,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which are seen in endodermal sinus tumor?, with the following options: A: Schiller-duval bodies, B: Reed-Sternberg cells, C: Reinke's crystals, D: Russell bodies - -### Response: -Ans. is a, i.e. Schiller-Duval bodiesRef: CGDT 9th/ed, p938; Shaw 13rd/ed, p362Call exner bodies are small cyst like spaces found in cases of granulosa cell tumor.FeatureAssociated tumorCall exner bodies & coffee bean nucleiGranulosa cell tumorSchiller duval bodiesEndodermal sinus tumorReinke's crystalHilus cell tumorPsammoma bodiesSerous epithelial tumorsWalthard cell nestBrenner tumorSignet ring cellKrukenberg tumorHobnail cellClear cell tumorLarge polygonal cell with lymphocyticInfiltration and fibrous septaDysgerminomaSkin, teeth, cartilageTeratoma -### End" -6250,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which intravenous anaesthetic can be used for upper airway manipulation in absence of neuromuscular blockers-, with the following options: A: Thiopentone, B: Propofol, C: Etomidate, D: Ketamine - -### Response: -Propofol - induced depression of upper airway reflexes exceeds that of any other agent thus allowing intubation, endoscopy or laryngeal mark placement in absence of neuromuscular blockers. ketamine preserve upper airway reflexes. -### End" -6251,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Xylose absorption test is used to assess:, with the following options: A: Insulinoma, B: Atypical carcinoid, C: ZES, D: Monosaccharide absorption - -### Response: -Condition Investigation of choice Insulinoma 72 hour prolonged fasting Atypical carcinoid 5 HTP ( hydroxyl tryptophan) ZES Secretin study Monosaccharide malabsorbtion D xylose absorption test -### End" -6252,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coarctation of the aoa is common in which syndrome:, with the following options: A: Down's, B: Turner's, C: Klinefelter's, D: Noonan's - -### Response: -Answer is B (Turner's syndrome) Turner's syndrome is commonly associated with coarctation of aoa. Congenital Syndromes Cardiac anomaly Turner's syndrome Coarctation of Aoa Q Pulmonic stenosisQ Aoic stenosis Q Down's syndrome ASD Q -endocardial cushion type Noonan's syndrome (Nelson 6'"" / 1747) Pulmonary stenosis Q ASD Hyperophic cardiomyopathy -### End" -6253,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Flipped LDH indicating Myocardial Infarction is represented by:, with the following options: A: LDH-1> LDH-2, B: LDH-2 > LDH-1, C: LDH-4 > LDH-5, D: LDH-5 > LDH-4 - -### Response: -When LDH-1 is greater than LDH-2, it is referred to as flipped LDH and is indicative of MI. LDH-1 isoenzyme is found primarily in hea muscle and is lesser in concentration than the LDH-2 Isoenzyme which is primarily found in RBC. When the concentration of LDH-1 is observed to be greater than LDH2. It is referred to as flipped LDH and is indicative of Myocardial infarction. LDH has five isoenzymes: LDH-1 LDH-1 is found primarily in hea muscle 17% to 27% LDH-2 LDH-2 is primarily found in Red blood cells 27% to 37% LDH-3 LDH-3 is highest in the lung 18% to 25% LDH-4 LDH-4 is highest in the kidney, placenta, and pancreas 3% to 8% LDH-5 LDH-5 is highest in the liver and skeletal muscle 0% to 5% The LDH test helps determine the location of tissue damage. Thus in Normal ratios LDH-1 is less than LDH-2 and LDH-5 is less than LDH-4. When LDH-1 is greater than LDH-2: It is referred to as flipped LDH. It is indicative of MI. When your LDH-5 is greater than your LDH-4: It could mean damage to the liver or liver disease. This includes cirrhosis and hepatitis. Ref: Harrisons 19th edition -### End" -6254,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudoarthrosis of Tibia is classical feature of?, with the following options: A: Sturge Weber syndrome, B: Neurofibromatosis type 1, C: Neurofibromatosis type 2, D: Tuberous sclerosis - -### Response: -Pseudoarthrosis of Tibia and scoliosis are classicle feature of NF 1. -### End" -6255,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in drowning except -, with the following options: A: Miosis, B: Wet heavy lungs, C: Water and weeds in stomach and lung, D: Froth from mouth - -### Response: -There is dilatation of pupil/mydriasis (not miosis). -### End" -6256,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Post-Menopausal woman complains of itching over labia majora for 4 years with minimal relief in itching with topical medication. On examination there is an indurated lesion over right labia with positive inguinal nodes. Most appropriate management is?, with the following options: A: Topical beclomethasone, B: Topical estrogen with antibiotic, C: Amoxicillin + clavulanic acid and follow up for lymph node status, D: Biopsy - -### Response: -Intractable itching in Post-Menopausal age group with indurated lesion with inguinal lymph nodes appears to be a case of vulval carcinoma warranting a biopsy of the lesion. -### End" -6257,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Body mass index of Pre-obese is:-, with the following options: A: <18.5, B: 18.5-25, C: 25-30, D: >30 - -### Response: -Classification of adults according to BMI: Classification BMI Underweight < 18.50 Normal BMI 18.50-24.99 Overweight > 25 Pre-Obese 25-29.99 Obese Class 1 30.00 -34.99 Obese Class 2 35.00-39.99 Obese Class 3 > 40.00 -### End" -6258,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Membranous GN with reduced complement level is seen in?, with the following options: A: Hepatitis B, B: SLE, C: Malaria, D: Syphilis - -### Response: -MGN is subtype of nephrotic associated with solid organ tumours MGN is related to the infections mentioned in answer All of these lead to subepithelial deposits with uniform thickening of basement membrane but does not have low complement level. Lupus nephritis / SLE however is the only one that leads to low complement and similar Histopath changes of MGN. -### End" -6259,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Wilson's disease is:, with the following options: A: Increased serum ceruloplasmin, B: Decreased liver copper, C: Increased urinary copper excretion, D: Decreased urine copper excretion - -### Response: -C. Increased urinary copper excretion(Ref: Nelson's 20/e p 1939-1940)In Wilson disease serum ceruloplasmin is decreased (<20mg/dL), ""free"" copper level may be elevated in early ds (>1.6mmol/L)Urinary copper excretion is increased to >100-1000mg/day & hepatic copper content is >250mg/g dry weight in Wilson disease -### End" -6260,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Laser iridotomy is useful in, with the following options: A: Angle closure glaucoma, B: Neovascular glaucoma, C: Open angle glaucoma, D: Secondary glaucoma - -### Response: -Ans. (a) Angle closure glaucomaRef.: A.K. Khurana 6th ed. 1247 -### End" -6261,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary amenorrhoea is seen in all except: (Repeat), with the following options: A: Kali man syndrome, B: Rokitansky syndrome, C: Ashermann syndrome, D: Turner's syndrome - -### Response: -Ans: C (Ashermann syndrome) Ref: Dutta's Gynecology pg 433Explanation:(See Table 17 and Figure Below)Asherman's syndrome or Fritsch syndromeIt is characterized by adhesions and fibrosis of the endometrium.Most often associated with dilation and curettage of the intrauterine cavity.Patients present with secondary amenorrhea. Table 17 : Causes of Primary AmenorrheaOutflow tractAnomalies/obstructionGonadal/end-organ disordersPituitary and hypothalamicUterine* Mullerian agenesis (2nd MC cause)* Gonadal dysgenesis, including Turner syndrome, is the most common cause* Androgen insensitivity syndrome {Testicular feminization syndrome)* Receptor abnormalities for hormones FSH and LH* Specific forms of congenital adrenal hyperplasiaHypothalamic: Kallmann syndromeVaginal:* Vaginal atresia,* Cryptomenontioea* Imperforate hymen.* Swyer syndrome* Galactosaemia* Aromatase deficiency* Prader-Willi syndrome* Male pseudo-hermaphroditism Approach to Primary Amenorrhea History and Physical Exam | Uterus Present Uterus absent or uncertain || |FSH -20 IU/L and' LH >40 IU/LFSH -20 IU/L and' LH >40 IU/L || KaryotypePatient Hypogonadotropic HypogonadismEating disordersBrain injury or irradiationKallman SyndromePituitary defectHyperprolactinemiaHemochromatosisHypergonadotropicHypogonadism | |KaryotypePatient 46. XX46. XY||||45. XO46. XXMullenanAgenesis/MayerRokitansktKusterHauserSyndromeAndrogenInsensitivitySyndrome.Vanishing TestesSyndrome.5 alpha reductase deficiency|| TurnerSyndromePremature OvarianFailureConsider MRI -### End" -6262,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about iodinated intravascular contrast media except –, with the following options: A: They are used in digital subtraction angiography, B: They are radio opaque, C: They can cause anaphylactic reactions, D: They are used in magnetic resonance imaging - -### Response: -MRI functions through different principles and thus utilizes different contrast agents. Gadolinium is the most commonly used contrast in MRI. -Both gadolinium-based and iodinated contrast media are used for digital subtraction angiography. -Radiocontrast agents are radiopaque. -Radiocontrast agents are excreted by the kidney. -Radiocontrast agents can cause anaphylactoid reaction and nephropathy. -### End" -6263,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19-year-old college student develops a rash. She works pa-time in a pediatric AIDS clinic. Her blood is drawn and tested for specific antibody to the chickenpox virus (varicella-zoster). Which of the following antibody classes would you expect to find if she is immune to chickenpox?, with the following options: A: IgA, B: IgG, C: IgM, D: IgD - -### Response: -The initial response to a new infection is with an IgM class antibody. IgM develops quickly and usually disappears within a few months. The secondary response is IgG and reflects the patient's immune status or, in the case of chickenpox, a vaccination given. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition -### End" -6264,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following type of virus is known as Lymphoproliferative virus?, with the following options: A: Adenovirus, B: Hepatitis A, C: Mumps, D: EB virus - -### Response: -EBV is known to cause lymphoproliferative disease especially in patients with primary or secondary immunodeficiency. The incidence of these lymphomas is 1% to 2% after renal transplantations and 5% to 9% after hea-lung transplantations. Most of the patients presents with persistent fever, lymphadenopathy, and hepatosplenomegaly. EBV is known to cause infectious mononucleosis, burkitt's lymphoma, nasopharyngeal carcinoma, and in AIDS patients its known to cause hairy leukoplakia of tongue, interstitial lymphocytic pneumonia and lymphoma. In Sub saharan africa Burkitt lymphoma is the most common malignancy in young children. It is thought to result from an early EBV infection that produces a large pool of infected B lymphocytes. It can be diagnosed by presence of increased IgA antibody levels to both VCA and early EBV antigens. Nasopharyngeal carcinoma is endemic in Southern China, where it is responsible for 25% of moality from cancer. Ref: Ray C.G., Ryan K.J. (2010). Chapter 14. Herpesviruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. Ray C.G., Ryan K.J. (2010). Chapter 14. Herpesviruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. -### End" -6265,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most characteric features of acture inflammation is -, with the following options: A: Vasoconstriction, B: Vascular stasis, C: Vasodilati on and increased vascular permeability, D: Margination of leukocytes - -### Response: -Ans. is 'c' i.e., Vasodilatation and increased vascular permeability o The hallmark of acute inflammation is increased vascular permeability leading to escape of protein rich fluid (exudate) into the extravascular tissue -### End" -6266,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Main feature of chemotaxis is -, with the following options: A: Increased random movement of neutrophils, B: Increased adhesiveness to intima, C: Increased phagocytosis, D: Unidirectional locomotion of neutrophils - -### Response: -Ans. is 'd' i.e., Unidirectional locomotion of neutrophils When a host encounters an injurious agent, such as an infectious microbe or dead cells, phagocytes that reside in all tissues try to get rid of these agents.At the same time phagocytes and other host cells react to the presence of the foreign or abnormal substance by liberating cytokines/ chemokines and various other mediators of inflammation.Some of these mediators act on the endothelial cells in the vicinity and promote the efflux of plasma and the recruitment of circulating leucocytes to the site where the offending agent is located.Chemotaxis is recruitment of leucocytes at the site of injury. Leucocytes moves towards the site of injury because of the chemokines/cytokines present at the site of injury. Chemotaxis is defined as movement of leucocytes oriented along a chemical gradient -### End" -6267,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a labile cell –, with the following options: A: Hepatocytes, B: Bone marrow, C: Epidermal cells, D: Small intesting mucosa - -### Response: -o When a cell proliferates, it passes through a cell cycle. -o Cell cycle has a series of phases : - -□ G1 phase → Rest phase (Presynthetic phase) -□ S phase → Synthetic phase in which the synthesis of DNA takes place. -□ G2 phase → Resting phase (Postsynthetic or postmitotic phase). -□ M phase → Mitotic phase in which mitosis takes place. -### End" -6268,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: GVHD -, with the following options: A: Associated with solid organ transplantation, B: Graft must contains immunocompitant T-cell, C: It is seen in immunosupressed persons, D: All - -### Response: -Ans. is 'a' i.e., Associated with solid organ transplantation; 'b' i.e., Graft must contains immunocompetant T-cell; 'c' i.e., It is seen in immunosupressed persons -### End" -6269,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Myasthenia gravis is associated with, with the following options: A: Thymoma, B: Thymic carcinoma, C: Thymic hyperplasia, D: Lymphoma - -### Response: -Some 60%of Myasthenia gravis are associated with a peculiar reactive hyperplasia of intrathymic B cells and another 20%are associated with thymoma, a tumor of thymic epithelial cells. Robbins basic pathology 9th edition page no 800,heading =Myasthenia gravis Option 4 is correct -### End" -6270,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Plasma sterilization accuracy is assessed using -, with the following options: A: Bacillus subtilis, B: Geobacillus stereothermophilus, C: Staphylococcus aureus, D: Clostridium tetani - -### Response: -Sterilization control Hot air oven Clostridium tetani non toxigenic strain, B. subtilis subsp niger Autoclave B. Stearothermophillus, Filtration Brivundimonas dimunata, Ionizing radiation B. Pumilus Ethylene oxide B. Globigi Plasma Sterilization B. Stearothermophillus -### End" -6271,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4 year child with bronchial asthma presents history of with and 3 and more episodes during daytime in a week and 2 wheezing episodes during night in a month. How will you grade this asthma?, with the following options: A: Mild Persistent, B: Moderate Persistent, C: Severe Persistent, D: Mild intermittent - -### Response: -Ref: Nelson's Textbook of Pediatrics. 19th Edition, Page: 790.Explanation:This is a straightforward question to assess whether you know the recent NAEPP classification of chronic asthma (2007).Be aware that there are some changes to the previous classification (2002). Latest edition of Nelson gives the most recent classification (2007) and the same is given below. (See table on below) National Asthma Education and Prevention Program (NAEPP) Classification of asthmaCOMPONENTS OFCLASSIFICATION OF ASTHMA SEVERITYSEVERITYMild IntermittentMild PersistentModerate PersistentSeverePersistentImpairment Daytime symptoms< 2 days/wk>2 days/wk but not dailyDailyThroughout the dayNighttime awakenings* Age 0-4 yr * Age >5 yr 0<2 x/month1-2x/mo3-4x/mo3-4x/mo>1x/wk but not nightly>1x/wkOften 7x/wkShort-acting b2-agonist use forsymptoms<2 days/wk>2 days/wk but not daily, and not more than 1 x on any dayDailySeveral times per dayInterference with normal activityNoneMinor limitationSome limitationExtremelimitationLung function: FEV1 % predictedage >5 yrNormal FEV1betweenexacerbations >80%predicted 60- 80% predicted <60%predicted >80%predictedFEV1/FVC ratio* Age 5- 11 yr* Age 2 yrRisk >85%Normal>80%Normal75-80% Reduced 5%<75%Reduced >5%Exacerbations requiring systemic corticosteroids:* Age 0-4 yr0-1/yr> 2 exacerbations in 6 mo requiring systemic corticosteroids or> 4 wheezing episodes/yr lasting >1 day and risk factors for persistent asthma* Age > 5 yr0-1/yr> 2;yr -### End" -6272,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Co-60 units:, with the following options: A: g radiation, B: b radiation, C: a, and b radiation, D: a, b and g radiation - -### Response: -Ans. g radiation -### End" -6273,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Motor supply of the diaphragm is -, with the following options: A: Thoracodorsal nerve, B: Intercostal nerves, C: Phrenic nerve, D: Sympathetic nerves - -### Response: -Nerve supply of diaphragm --        Sensory- -o   Peripheral part- lower 6 intercostal nerves -o   Central part- phrenic nerve --        Motor- Phrenic nerve -### End" -6274,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which splint is used in management of fracture shaft femur in age group of 2 - 10 years?, with the following options: A: Split russel traction, B: Gallows traction, C: Bucks traction, D: Brandth traction - -### Response: -Ans. is 'a' i.e., Split russel traction * In children, conservative treatment is given by:-i) 0-2 yeas : - Plaster spica or modified Bryant or Gallow's traction or pavllic harness (< 6 month of age).ii) 2-10 years: - Split Russel tractioniii) 10-15 years : - 90-90deg femoral skeletal traction. -### End" -6275,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for colon cancer is -, with the following options: A: Caecum, B: Transversecolon, C: Rectosiigmoid, D: Ascendingcolon - -### Response: -Ans. is 'None > c' i.e., i.e., None > RectosigmoidColon cancero Virtually 98% of all concers in the large intesting are adenoearcinoms.o Peak age of presentation is 60-80 years.Overall, adenocarcinoma are distributed approximately equally over the entire length of colon Robbins 8th/e p 824Note: according to 7th/e of Robbins answer was recotosigmoid. Information given in 7th/e of Robbins were:o The most common site is rectosigmoido The distribution is as follows:-Rectosigmoid colonCecum .''ascending colonother sites---55%22%6%Transverse colonDiscending colon--11%6% -### End" -6276,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Quickening appears at about: PGI 09, with the following options: A: 6 weeks, B: 8-10 weeks, C: 16-20 weeks, D: 20-24 weeks - -### Response: -Ans. 16-20 weeks -### End" -6277,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old hypeensive man develops very severe, ""tearing"" chest pain, which migrates from his upper back to mid-back over the period of an hour. Pathologic examination of a specimen removed from the patient during emergency surgery would MOST likely demonstrate which of the following?, with the following options: A: Cystic medial degeneration, B: Infarction, C: Plasma cells around the vasa vasorum, D: Wrinkling of intima - -### Response: -This is a classic description of a dissecting aoic aneurysm, a very impoant condition that may cause death if missed or misdiagnosed. Dissecting aneurysms are actually dissecting hematomas, with the blood located between the middle and outer thirds of the media of the aoa. Dissecting aneurysms are associated with hypeension in many cases; they are also associated with cystic medial degeneration of the wall of the aoa (seen in Marfan's syndrome). Often, an intimal tear is present; these are thought to represent the staing point for the dissection. Unlike abdominal aoic aneurysm and syphilitic aneurysm, aoic dissection is not usually associated with aoic dilatation.The pain of myocardial infarction does not usually move.Plasma cells around the vasa vasorum and ""tree-barking"" (wrinkling of the aoic intima; ) are features of syphilitic aneurysms. Ref: Rapp J.H., MacTagga J. (2010). Chapter 34. Aeries. In G.M. Dohey (Ed),CURRENT Diagnosis & Treatment: Surgery, 13e. -### End" -6278,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To achieve a net reproduction rate (NRR) of 1, the couple protection rate (CPR) should be:, with the following options: A: 20%, B: 30%, C: 40%, D: 60% - -### Response: -Ref. Foundations of Community medicine. Page. 113 -  -Couple Protection Rate (CPR) -• It is an indicator of the prevalence of contraceptive practice in the community -• Definition: the percentage of eligible couples effectively protected against childbirth by one or the other approved methods of family planning -– Sterilization -– IUD -– Condom -– OCP’s -• NRR = 1 can be achieved only if the CPR > 60% -### End" -6279,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest cause of death in peptic ulcer patients is, with the following options: A: Perforation, B: Malignancy, C: Hemorrhage, D: Pyloric stenosis - -### Response: -Peptic ulcers may be in thestomach, the small intestine just below the stomach, or the food pipe above the stomach. Sometimes,peptic ulcers can bleed (known asbleeding ulcers). More severebleeding, known as hemorrhaging, can be life-threatening. Ref surgery Srb 5e p432 -### End" -6280,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: At pH 7 the binding of 2,3-BPG to hemoglobin occurs at which site?, with the following options: A: Sulphydryl group, B: Carboxy terminal, C: Amino terminal, D: Histidine - -### Response: -2,3-BPG Stabilizes the T Structure of HemoglobinA low Po2 in peripheral tissues promotes the synthesis of 2,3-bisphosphoglycerate (BPG) in erythrocytes. The hemoglobin tetramer binds one molecule of BPG in the central cavity formed by its four subunits (Figure 6-6). However, the space between the H helices of the b chains lining the cavity is sufficiently wide to accommodate BPG only when hemoglobin is in the T state. BPG forms salt bridges with the terminal amino groups of both b chains Val NA1 and with Lys EF6 and His H21.Ref: Harper&;s Biochemistry; 30th edition; Chapter 6 Proteins: Myoglobin & Hemoglobin -### End" -6281,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pulsed gel electrophoresis is used for-, with the following options: A: DNA, B: RNA, C: Ribosome, D: Protein - -### Response: -Ans. is 'a' i.e., DNA* Large DNA of size larger than 15 to 20 KB can be separated with higher resolution by periodically changing the voltage direction. This is called as pulsed gel Electrophoresis.* The rationale behind this technique is that generally for separating DNA of smaller size, the electrode close to the point of application is connected to negatively charged electrode and the other side is connected to positively charged electrode. When the electric current is switched on, the DNA fragments move from negatively charged electrode to positively charged electrode and the separation is based on length. But when the size of the DNA fragments to be separated is more than 15 to 20 KB, they all move together and create a broader band. Hence to improve the resolution, the voltage direction is changed frequently. This is called as pulsed gel electrophoresis. In this case, the larger fragments take longer time to realign and hence they get separated from relatively smaller fragments. Hence resolution for separating larger fragments is increased. -### End" -6282,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a 2 months old infant undergoing surgery for biliary atresia, you would avoid one of the following anaesthetic -, with the following options: A: Thiopentone, B: Halothane, C: Propofol., D: Sevoflurane. - -### Response: -Ans. is 'b' i.e. Halothane Among the anesthetics given in the option, only halothane is known to cause liver toxicity. So Halothane should be avoided in a patient undergoing surgery for Biliary atresia (as the liver is already damaged). -### End" -6283,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: WHAT IS THE TYPE OF CAILAGES?, with the following options: A: Hyaline cailage, B: FIBRO cailage, C: elastic cailage, D: aicular cailage - -### Response: -ref : BD CHAURASIA -### End" -6284,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triangle of Koch is not formed by, with the following options: A: Limbus of Fossa ovalis, B: Tendon of Todaro, C: Coronary sinus, D: Septal Cusp of Tricuspid valve - -### Response: -Triangle of Koch is formed by - -Tendon of Todaro -Coronary sinus -Septal Cusp of Tricuspid valve -### End" -6285,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of cushings syndrome is, with the following options: A: Pituitary adenoma, B: Adrenal adenoma, C: Ectopic ACTH, D: Iatrogenic steroids - -### Response: -Most common cause of Cushing's syndrome is prolonged administration of glucocorticoid harmones. -### End" -6286,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to WHO, blindness is defined as a visual acuity of the better eye, less than, with the following options: A: 6/60., B: 5/60., C: 4/60., D: 3/60. - -### Response: -Blindness - -WHO has proposed a uniform criterion and defined blindness as ""Visual acuity of less than 3/60 or its equivalent"". -In the absence of appropriate vision charts, the WHO has now added the ""inability to count fingers in daylight at a distance of 3 meters"" to indicates less than 3/60 or its equivalent. -### End" -6287,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cofactor for glutathione peroxidase, with the following options: A: Mg +2, B: Se, C: Mn +2, D: Ca +2 - -### Response: -Selenocysteine is abbreted as SeCys. It is seen at the active site of the following enzymes: a) Thioredoxin reductase; b) Glutathione peroxidase, which scavenges peroxides; c) 5&;- De-iodinase that removes iodine from thyroxine to make triiodothyronine and d) Selenoprotein P, a glycoprotein seen in mammalian blood. Replacement of SeCys by Cys will lead to decreased activity of these enzymes. Deficiency of some of these enzymes with the anti-oxidant function may be related to atherosclerosis. Concentration falls in selenium deficiency. Its structure is COOH-CHNH2-CH2-SeH. It is directly incorporated into proteins during the translation process. Biosynthesis of selenocysteine is by replacing the oxygen of serine by selenium; this is done by two steps: Se + ATP - Se-P + AMP + Pi Serine + Se-P - SeCys + Pi Its genetic code is UGA. The tRNA-Sec is the specific tRNA, inseing SeCys. However, normally UGA codon is a stop signal. UGA code for SeCys is identified by a SeCys inseion element in the mRNA, with the help of a specific elongation factor. The tRNA-Sec is first charged with serine, then it is conveed into SeCys. This is then inseed into the correct position when protein is synthesized.Ref: DM Vasudevan, page no: 187 -### End" -6288,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin K is given to every child at the age of :-, with the following options: A: At bih, B: At 9 months age, C: At 5-6 years age, D: Not required in Indian babies - -### Response: -Vitamin K: The role of Vitamin K is to stimulate the production and/or the release of ceain coagulation factors. In Vitamin K deficiency, prothrombin content of blood is markedly decreased & blood clotting time is considerably prolonged. Newborn infants tend to be deficient in vitamin K due to minimal stores of prothrombin at bih & lack of an established intestinal flora. Thus, soon after bih, all infants or those at increased risk should receive a single intramuscular dose of a Vitamin K preparation (0.1- 0.2 mg of menadione sodium bisulphite or 0.5 mg of vitamin K1) by way of prophylaxis. -### End" -6289,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First change observed in distal part, of a cut nerve is, with the following options: A: Axonal degeneration, B: Sprouting, C: Myelin degeneration, D: Schwann cells proliferation - -### Response: -Ans. (a) Axonal degeneration(Ref: Ganong, 25th ed/p.89)Axonal degeneration is the earliest to occur followed by degeneration of myelin sheathMacrophages and Schwann cell clear the debris following degenerationThe neurolemma of the nerve fiber doesn't degenerate and remains as a hollow tube -### End" -6290,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Age and sex of the individual is known by the age of _________, with the following options: A: 24 months, B: 36 months, C: 48 months, D: 60 months - -### Response: -Emerging patterns for language behaviour from 1-5years of age 15months Jargon Follows simple commands May name a familiar object (e.g., ball) Responds to his/her name 18months 10 words (average) Names pictures Identifies 1 or more pas of the body 24months Puts 3 words together (subject, verb, object) 30months Refers to self by the pronoun ""I"" Knows full name 36months Knows age and sex Counts 3 objects correctly Repeats 3 numbers or a sentence of 6 syllables Most of the speech intelligible to strangers 48months Counts 4 pennies accurately Tells story 60months Names 4 colours Repeats sentence of 10 syllables Counts 10 pennies correctly Ref: Nelson paediatrics; Table 11-1 -### End" -6291,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a calcium sensiting agent?, with the following options: A: Levosimendan, B: Cinacalcet, C: Alendronate, D: Teriparatide - -### Response: -Ref: Katzung 11th p.210,221Explanation:Levosimendan, a drug that sensitizes the troponin system to calcium, also appears to inhibit phosphodiesterase and to cause some vasodilation in addition to its inotropic effects.Levosimendan also inhibits phosphodiesterase, and is used in acute heart failure.Cinacalcet (calcimimetics) is the first representative of a new-' class of drugs that activates the calcium sensing receptor (CaR).CaR has greatest concentration in the parathyroid gland.Cinacalcet blocks PTH secretion by activating CaR and is approved for the treatment of secondary hyperparathyroidism in chronic kidney disease and for the treatment of parathyroid carcinoma.Teriparatide, the recombinant form of PTH 1- 34, is approved for treatment of osteoporosis. Like fluoride, teriparatide stimulates new bone formation, but unlike fluoride, this new; bone appears structurally normal and is associated with a substantial reduction in the incidence of fractures.Alendronate is a bisphosphonate. -### End" -6292,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sullivan index denotes: September 2006, with the following options: A: Life expectancy at bih, B: Life expectancy excluding disability free period, C: Contraceptive failure rate, D: Hookworm density in stool - -### Response: -Ans. B: Life expectancy excluding disability free period This index (expectation of life free of disability) is computed by subtracting from the the life expectancy the probable duration of bed disability and inability to perform major activities, according to cross-sectional data from the population surveys. It is one of the most advanced indicators of disability rates currently available. -### End" -6293,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glycogenolysis is mediated by:, with the following options: A: Alpha 1 receptor, B: Alpha l+beta2 receptor, C: Beta 2 receptor, D: Alpha 2 + beta 1 receptor - -### Response: -Ans: b (Alpha 1 + beta 2 receptors) Ref: Katzung, 10th ed, p. 130Glycogenolysis is mainly mediated by beta 2 receptors in the liver, but role of alpha 1 receptors have been mentioned in Katzung.Relative selectivity of adrenoceptor agonists. Relative Receptor AffinitiesAlpha agonists Phenylephrine, methoxaminea, > a 2 >>>>> bClonidine, methylnorepinephrinea 2> a1 >>>>> bMixed alpha and beta agonists Norepinephrinea1= a 2; b,>> b 2Epinephrinea1= a 2; b,= b 2Beta agonists Dobutamine b1 > b 2>>>> aIsoproterenol b1 = b 2>>>> aTerbutaline MetaproterenolAlbuterolRitodrine}b 2 >> b1>>>> aDopamine agonists Dopamine D1 =D2 >> b >> aFenoldopam D1 >> D2 -### End" -6294,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a risk for cholangio carcinoma -, with the following options: A: Hepatolithiasis, B: Hepatitis C, C: Clonorchi sinensis, D: Choledocholithiasis - -### Response: -

Davidson&;s principles and practice of medicine 22nd edition. *The tumour is associated with gallsgallstones,primary and secondary cholangitis,caroli&;s disease and choledochalcyst,chronic liver fluke infection (clonorchis sinensis) is the major risk factor for development for CCA.

-### End" -6295,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication of acute otitis media in children -, with the following options: A: Deafness, B: Mastoiditis, C: Cholesteatoma, D: Facial nerve palsy - -### Response: -Most common complication following ASOM is mastoiditis. -Facial nerve palsy is an uncommon complication of ASOM. -### End" -6296,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is of the following drug is known as Angel dust?, with the following options: A: Cannabis, B: Cocaine, C: Ecstasy, D: Phencyclidine (PCP) - -### Response: -Ans. D. Phencyclidine (PCP)Abused drug - Synonym/manifestation* Methylenedioxymethamphetamine. MDMA: Rave drug/Ecstasy.* LYSERGIC ACID DIETHYLAMIDE (LSD): ""bad trip""* Methamphetamine: Also called ""meth,"" ""speed,"" ""crank,"" ""chalk,"" ""ice,"" ""glass,"" or ""crystal.""* Phencyclidine (PCP): ""Angel dust""* MARIJUANA (CANNABIS): Delta-9-tetrahydrocannabinol (THC); ""Hash oil"" -### End" -6297,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old man is admitted to the hospital with pain on swallowing. Imaging reveals a dilated left atrium. Which structure is most likely being compressed by the expansion of the left atrium to result in the patient's symptoms?, with the following options: A: Esophagus, B: Root of the lung, C: Trachea, D: Superior vena cava - -### Response: -The patient's chief complaint is pain upon swallowing. With a dilated left atrium, the most probable structure being compressed is the esophagus. The esophagus descends into the abdomen immediately posterior to the left atrium below the level of the tracheal carina. The root of the lung is the site of junction at the hilum where the pulmonary arteries, veins, and bronchi enter or leave. The lung root is not so intimately associated with the esophagus and would not be associated with pain during swallowing. The trachea ends and bifurcates above the level of the left atrium and therefore would be unaffected by a dilated left atrium. The inferior vena cava ascends from the abdomen to the right atrium and the superior vena cava is quite anterior in position. Neither of these veins is closely related to the esophagus or the left atrium. -### End" -6298,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of secondary hypeension includes -, with the following options: A: Old age, B: Renal parenchymal disease, C: Pregnancy-indued HTN, D: Hypothyroidism - -### Response: -causes of secondary hypeension includes, Alcohol,Obesity,Pregnancy (pre-eclampsia) *Renal disease * Renal vascular disease * Parenchymal renal disease, paicularly glomerulonephritis * Polycystic kidney disease *Endocrine disease * Phaeochromocytoma * Cushing's syndrome * Primary hyperaldosteronism (Conn's syndrome) * Glucocoicoid-suppressible hyperaldosteronism * Hyperparathyroidism * Acromegaly * Primary hypothyroidism * Thyrotoxicosis * Congenital adrenal hyperplasia due to 11-b-hydroxylase or 17a-hydroxylase deficiency * Liddle's syndrome * 11-b-hydroxysteroid dehydrogenase deficiency Drugs * e.g. Oral contraceptives containing oestrogens, anabolic steroids, coicosteroids, NSAIDs, carbenoxolone, sympathomimetic agents Coarctation of the aoa ref:davidsson&;s principles and practices medicine,21 st ed,pg no 624 -### End" -6299,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Poor prognostic factor in schizophrenia is:, with the following options: A: Acute onset, B: Family history of affective disorder, C: Middle age, D: Past history of schizophrenia - -### Response: -Past history of schizophrenia -### End" -6300,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following enzymes activity is increased in fasting state except, with the following options: A: Acetyl CoA carboxylase, B: Carnitine acyl transferase, C: Phospho enol pyruvate carboxykinase, D: Pyruvate carboxylase - -### Response: -MetabolismRegulatory enzymesLipid metabolism Fatty acid oxidation Carnitine acyltransferase 1KetogenesisHMG CoA synthaseLipolysis Hormone-sensitive lipaseCarbohydrate metabolism Glycogenolysis Glycogen phosphorylase Gluconeogenesis Pyruvate carboxylase Phosphoenol pyruvate carboxykinase (PEPCK)Fructose1,6 bisphosphataseGlucose-6-phosphatase(Refer: DM Vasudevan, Textbook of Biochemistry, 7th edition, pg no: 102-103) -### End" -6301,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Periapical granuloma is mainly composed of:, with the following options: A: Macrophages, B: Lymphocytes, C: Plasma cells, D: All of the above - -### Response: -The apical periodontal cyst is histologically identical with the periapical granuloma, from which it is actually derived, except for the presence of the epithelium-lined lumen.  -The lesion is predominantly composed of plasma cells that are mixed with macrophages and lymphocytes with endothelial cells and fibroblasts. -Periapical granuloma is not a true granuloma due to the fact that it does not contain granulomatous inflammation; however, periapical granuloma is a common term used. -Reference: Shafer’s Textbook of ORAL PATHOLOGY Eighth Edition page no 78 -### End" -6302,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Therapeutic uses of prostaglandin E1 include all of the following except, with the following options: A: Medical termination of pregnancy, B: Impotance, C: Primary pulmonary hypeension, D: Maintenance of patent ductus aeriosus - -### Response: -Prostaglandin I2 analogue (like epoprostenol and treprostinil) are used for the treatment of Pulmonary hypeension. prostaglandin E1 analogue are used for first trimester aboion (Misoprostol), impotence (alprostadil) and maintenance of patency of ductus aeriosus patency of ductus aeriosus (alprostadil). Refer kDT 6/e p181 -### End" -6303,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are arboviral diseases -, with the following options: A: Japanese encephalitis, B: Dengue, C: KFD, D: Hand-foot-mouth disease - -### Response: -Arboviral diseases are Japanese encephalitis, Dengue, KFD REF:ANANTHANARYANAN TEXTBOOK OF MICROBIOLOGY 9EDITION PGNO.516 -### End" -6304,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following transpo processes is passive?, with the following options: A: Co-transpo of Na+ ion and a molecule into cell, B: Exchange of K+ ion outside the cell for Na+ ion inside the cell, C: Flow of H2O through cell membrane by osmosis, D: Uptake of molecules into cell by endocytosis - -### Response: -Osmosis is the movement of water molecules across a semi-permeable membrane from a region of Lower solute concentration to an area of higher solute concentration. It is passive in nature. (REF: TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, PAGE NO - 3) -### End" -6305,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A woman presents at term pregnancy for first antenatal visit and tests positive for HIV in screening and confirmatory tests. Next step in management is?, with the following options: A: Sta A after clinical staging, B: Plan an early delivery and sta A after it, C: Sta A immediately, D: Sta A after CD4 counts - -### Response: -Lifelong A is to be initiated in all pregnant women with confirmed HIV infection regardless of WHO clinical stage or CD4 counts. Samples for CD4 counts must be taken before staing A, but there is no need to wait for repos. TDF+3TC+EFV is recommended as first line A in pregnant and breast feeding women, including women in their first trimester and women of childbearing age. (NOTE: EIRENZ IS NOT CONTRAINDICATED IN PREGNANCY) -### End" -6306,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rosenthal fibers are -, with the following options: A: Intranclear inclusions, B: intracytoplasmic inclusions, C: Present extracellularly, D: Pa of cell membrane - -### Response: -A Rosenthal fiber is a thick, elongated, worm-like or ""corkscrew"" eosinophilic (pink) bundle that is found on H&E staining of the brain in the presence of long-standing gliosis, occasional tumors, and some metabolic disorders. ASSOCIATED CONDITIONS Its presence is associated with either pilocytic astrocytoma(more common) or Alexander's disease (a rare leukodystrophy). They are also seen in the context of fucosidosis. COMPOSITION The fibers are found in astrocytic processes and are thought to be clumped intermediate filament proteins. Their components include glial fibrillary acidic protein. Ref: Wikipedia -### End" -6307,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following condition is associated with a Carha's notch in an audiogram?, with the following options: A: Otospongiosis, B: CSOM, C: Meniere's disease, D: Acoustic neuroma - -### Response: -Carha's notch is seen in otosclerosis. The otosclerotic focus is defined by an area of increased bone turnover and metabolic activity and the term ""otospongiosis"" is most descriptive of the histologic appearance at this stage of the disease. Bone conduction curve shows maximum loss at 2000 Hz. -### End" -6308,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which fungus is not dimorphic, with the following options: A: Blastomycosis, B: Histoplasmosis, C: Candida, D: Sporotrix schenkii - -### Response: -Candida is a yeast like fungi Reference: Textbook of Microbiology; Baveja; 4th edition -### End" -6309,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congenital rubella causes: March 2013, with the following options: A: Cardiac malformation, B: Cochlear/ sensorineural deafness, C: Thrombocytosis, D: Cataract - -### Response: -Ans. C i.e. Thrombocytosis Rubella Risk to fetus is maximum if mother gets infected during: 6-12 weeks of pregnancy Congenital rubella syndrome: Deafness, Cardiac malformations (PDA), Cataracts Rubella vaccine is given: To girls, between 11-14 years of age Recommended vaccination strategy for rubella vaccine: 15-49 years women -### End" -6310,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for trauma of spine is -, with the following options: A: Cervical, B: Thoracic, C: Lumbar, D: Sacrum - -### Response: -Ans. is 'a' i.e., Cervical [Ref: Clinical orthopaedics p. 786}o Spinal injury occurs in about 6% of all trauma cases.o More than 50% of patients with spinal column injury have neurological deficito Motor vehicular accidents and fall from height are the two most common modes of spine injuriesi) Fall from heightMost common cause in developing countries.ii) Road traffic accidentMost common cause in developed countries,o Traumatic spine injuries most commonly affect cervical spine (50-60%) followed by dorsolumbar junction.o The direction and size of the articular facets forming the facet joints is different in different parts of the spine,o In cervical spine, they are short and more horizontally placed; therefore, cervical spine is more prone for dislocation without associated fracture.o In lower spine they becomes more stouter and more vertical, maximum in lumbar spine. Therefore, pure dislocation without fracture does not occur in lumbar region. -### End" -6311,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wavelength of Nd:Yag laser, with the following options: A: 1040 nm, B: 1040 mm, C: 1040 cm, D: 1040 pm - -### Response: -A i.e. 1040 nm -### End" -6312,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shape of birbicks granules is -, with the following options: A: Hockeystick, B: Bat, C: Ball, D: Tennis racket - -### Response: -Ans. is 'd' i.e., Tennis racket o Under the electron microscope, Birbeck granules have a pentalaminar, rod!ike, tubular appearance and sometimes a dilated terminal end resembling tennis-racket appearance. -### End" -6313,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Kartagener's syndrome is all except-, with the following options: A: Dextrocardia, B: Infertility', C: Brochieactasis, D: Mental retardation - -### Response: -Ans. is 'd' i.e., Mental retardation o Kartagener's syndrome is a subgroup of primary ciliary dyskinesia. Primary ciliary dyskinesia - o It is an antosomal recessive syndrome. o It is characterized by poorly functioning cilia. There is absence or shortening of Dynein arms that are responsible for the coordinated bending of cilia. o Approximately half of the patients with primary' ciliary' dyskinesia have kartagener's syndrome. Kartagener's syndrome Bronchiectasis - Poor functioning of cilia contribute to retention of secretions and recurrent infections Sinusitis - Lack of ciliary activity interferes with bacterial clearance, predisposing sinuses to infection Situs in versus - Due to ineffective cell motility during embryogenesis Infertility - Due to ineffective mobility of sperm -### End" -6314,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pressure created in vacuum is -, with the following options: A: 12 kgs, B: 0.2 kg/cm2, C: 0.8 kg/cm2, D: 18 kgs - -### Response: -Ans. is 'c' i.e., 0.8 kg/cm2 * When using rigid cups, it is recommended that the vacuum be created gradually by increasing the suction by 0.2 kg/cm2 every 2 min until a negative pressure of 0.8 kg/cm2 (600 mm Hg) is reached. With soft cups, negative pressure can be increased to 0.8 kg/cm2 within 1 min.Differences between forceps and vacuumForcepsVacuumTraction force = +18 kg for primi, +13 kg for multiNegative pressure = 0.8 kg/cm2 (600 mm Hg)Cervix should be fully dilatedMinimum 7 cm dilationLess fetal but more maternal complicationsMore fetal but less maternal complicationsPreferred in fetal distressLess preferred (as vacuum takes time to build up)Rotation forceps not applied nowadaysVacuum causes rotation and extractionCan be applied on face presentation and after-coming head of breechCannot be applied on face presentation and after coming head of breechCan be applied on preterm fetusContraindicated on preterm fetus (increased risk of intraventricular hemorrhage)Can be applied in cases of fetal coagulopathy and if recent scalp blood sampling has been doneContraindicated in cases of fetal coagulopathy and if recent scalp blood sampling has been doneCan be applied in cases of IUFDShould not be applied as chignon formation will not occur in IUFD -### End" -6315,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: You are being asked to give your expe opinion as a toxicologist regarding and effective antidot for belladonna poisoning .which of the following agents would you suggest, with the following options: A: Neostigmine, B: Physostigmine, C: Pilcocarpine, D: Methacholine - -### Response: -Ref-KDT 6/e p113,114 Being Teritiary amine,physostigmine can reverse.CNS manifestation of belladonna(source of atropine) poisoning. It is therefore, Prefered as an antidot for this type of poisoning -### End" -6316,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hung-up reflexes are seen in, with the following options: A: Chorea, B: Atheotosis, C: Cerebral palsy, D: Cerebellar palsy - -### Response: -Ans. is 'a' i.e., Chorea Hung up knee jerk When patellor tendon is tapped while the foot is hanging free, the leg may be held in extension for few seconds before relaxing owing to prolonged contraction of quadriceps. This is seen in ""chorea"". Other neurological signs associated with chorea Milkmaids grip Piano sign Handwriting Milkmaid's grip Inability to maintain sustained voluntary contraction of muscle group at a constant level. Inability to apply steady pressure during handshake leading to a characteristic squeeze and release of grip. Patient's have difficulty maintaining sustained eyelid closure and sustained tongue protrusion -### End" -6317,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The differential diagnosis of lesion, histologically resembling giant cell tumour in the small bones of the hands or feet, includes all of the following except:, with the following options: A: Aneursymal bone cyst, B: Fibrosarcoma, C: Osteosarcoma, D: Hyperparathyroidism - -### Response: -Ans. is 'b' i.e. Fibrosarcoma Histological differential diagnosis of Giant cell tumorGiant cell reparative granuloma (a benign reactive condition)Brown tumor of hyperparathyroidism Non-ossifying fibroma Benign fibrous histiocytoma Aneurysmal bone cyst Osteosarcoma with prominent giant cells.Metastatic ca with giant cells. -### End" -6318,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Biopsy findings of celiac disease all of the following, except, with the following options: A: Crypt hyperplasia, B: Villous atrophy, C: Mucosal atrophy, D: Intraepithelial lymphocytes - -### Response: -Answer is C (Mucosal atrophy) Mucosa! atrophy and presence of Giardia lambia are not seen in biopsy front celiac disease. Small Intestinal Biopsy (duodenal /jejunal) in Celiac disease (Characteristic but not diagnostic()) Absence or reduced height of villi (Flat appearance)() Crypt hyperplasia, villous atrophy (but not mucosal atrophy)() Cuboidal appearance of epithelial cells and increased intraepithelial lymphocytes Increased lymphocytes and plasma cells in lamina propriaQ -### End" -6319,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Obesity in a child of age 2 years is defined as:, with the following options: A: Weight for height more than double of expected, B: Weight for age more than double of expected, C: BMI >30, D: BMI >95th percentile - -### Response: -d. BMI >95th percentile(Ref: Nelson's 20/e p 307-315, Ghai 8/e p 528-529)Obesity in children is defined as BMI >95th percentile; Body mass index (BMI) is equal to weight/height2 (in kg/m2). -### End" -6320,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Passavant ridges is due to contraction of?, with the following options: A: Palatoglossus, B: Superior constrictor, C: Middle constrictor, D: Inferior constrictor - -### Response: -Some of the upper fibers of the palatopharyngeus pass circularly deep to mucous membrane of the pharynx and form a sphicter internal to the superior constrictor.these fibres constitute passvant's muscle which on contraction raises a ridge called the passavant's ridge on the posterior wall of the nasopharynx.when the soft palate is elevated it comes in contact with this ridge the two together closing the pharyngeal isthmus between the nasopharynx and the oropharynx. Ref BDC volume 3;6 th edition pg 225 -### End" -6321,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Vitamin B|2, except -, with the following options: A: Active form is methylcobalamine, B: Requires for conversion of homocysteine to methionine, C: Requires in metabolism of methylmalonyl Co A, D: Requires for conversion of pyruvate to lactate - -### Response: -Ans. is 'd' i.e., Requires for conversion of pyruvate to lactate o Active form of vitamin B12 are methylcobalamine and deoxyadenosylcobalamine. Following reactions require vitamin B12 coenzyme:i) Isomerization of methylmalonyl CoA to succinyl CoA : In this reaction, active form of vitamin B12 is deoxyadenosyl cobalamine. Propionyl-CoA is produced as catabolic end product of some alipathic amino acids and b-oxidation of odd chain fatty acids. Propionyl CoA is then converted to succinyl CoA through methyimalonyi-CoA. Thus methylmalonyl-CoA is accumulated and excreted in urine as methylmalonic acid (methylmalonate) in vitamin B12 deficiencyQ, i.e. methylmalonic aciduriaQ.ii) Conversion of homocystein to methionine : - In this reaction, active form is methylcobalamine. This is the only reaction which requires both vitamin B12, (as methylcobalamine) and folic acid (as N2-methyl- H4-folate). The reaction is catalyzed by the enzyme cobalamin-dependent methionine synthase also called 5-methyltetrahydrofolate-homocysteine methyltransferaseQ.iii) Methylation of pyrimidine ring to form thymine.iv) Conversion of ribonucleotides to deoxyribonucleotides in DNA synthesis.v) Required for metabolism of diols :vi) In bacteria for interconversion of glutamate and b methyl asparate -### End" -6322,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Length of small intestine is:, with the following options: A: 4 metres, B: 6 metres, C: 9 metres, D: 10 metres - -### Response: -Ans. B i.e. 6 metresSmall intestine dimensionsThe average length of the small intestine in an adult human male is 6.9 m (22 feet 6 inches), and in the adult female 71 m (23 feet 4 inches).It can vary greatly, from as sho as 4.6 m (15 feet) to as long as 9.8 m (32 feet).It is approximately 2.5-3 cm in diameter. -### End" -6323,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Death due to police firing, inquest is done by?, with the following options: A: Assistant commissioner of police, B: District magistrate, C: Doctor, D: All of the above - -### Response: -Ans. B. District magistrate.(Ref FMT by Dr KS Narayan Reddy 29th/pg. 5; FMT by Apurva Nandy lst/pg. 4)Reddv 29th/pg. 5...........""In case of Death in Police firing, the inquest is conducted by the Magistrate"".INQUEST:# Inquest means legal or judicial inquiry to ascertain matter of fact.# Types of inquest in India:- * Coroner's inquest (in Bombay & Calcutta)- * Police inquest- * Magistrate's inquestNormally Inquest in India is conducted by a police officer as per the provisions of Criminal Procedure Code.Magistrate's inquest is commonly held in following cases:But in certain conditions as outlined in Criminal Procedure Code 176 the inquest is conducted by a Magistrate. Such conditions are (Magistrate inquest, which is conducted by a District Magistrate (Collector/Deputy Commissioner),Subdivisional Magistarte (S.20 to 23 Cr. PC), especially empowered by State government (executive magistrate) is done in following cases):1. Death in Police Custody or while under Police Interrogation2. Death due to Police Firing3. Death in Prison, reformatories, Borstal school4. Death in psychiatric hospital.5. Dowry Deaths - Death of a female within 7 yrs of marriage or death in suspicious conditions6. Exhumation (S.174 (4) and S.176, Cr.P.C.)Thus, The following persons can conduct the magistrate inquest in conditions mentioned above:# Judicial Magistrate- Distric Magistrate- Sub Divisional Magistrate# Executive Magistrate - as nominated by the State Government- Collector- Deputy Collector- TahsildharAdditional Educational points:# Inquest means legal or judicial inquiry to ascertain matter of fact.# In forensic work an inquest generally means an inquiry into the cause of death, which is apparently not due to natural cause.# When a person dies it is necessary to determine the cause of death either natural or unnatural to meet with the requirement of law.# Types of inquest in India:- Coroner's inquest (Mumbai and Calcutta)- Police inquest- Magistrate inquest# In any case of death, a Magistrate may conduct an inquest, instead of or in addition to the police inquest.# The most common type of inquest in India is: Police inquest.# Coroner's inquest was abolished in India in the year 1999.# Medical examiner's inquest is supposed to be the best inquest internationally.# In India inquest is not carried by doctor. -### End" -6324,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest infection causing blindnesss in adult man :, with the following options: A: Toxocara, B: Plasmodium, C: Toxoplasma gondii, D: Tenia solium - -### Response: -C i.e. Toxoplasma gondii -### End" -6325,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug given to reduce the uterine contraction during preterm labour with least side effect, with the following options: A: Ritodrine, B: Nifidipine, C: Magnesium sulphate, D: Progesterone - -### Response: -Progesterone Among the given options progesterone is the drug with the least side effect. - Natural progesterone is completely innocuous for the mother and fetus. - The problem is that, the use of progesterone as tocolytics is controversial. Some studies have proved that progesterone can be used as tocolytics. Progesterone does have a role in prefer'', labour According to American college of obs and Gynae (ACOG) progesterone is given in patients with history of previous preterm labour and in women who are at risk for preterm labour (i.e., women with sho cervix). - In these patients progesterone administration stas from 16th month and is continued up to 36 months progesterone acts by reducing uterine contractions. An impoant point Progesterone reduces or prevents uterine contractions when the uterine contractions are not fully established but once the labour sets in i.e., regular uterine contractions sta progesterone has no role. - Progesterone cannot prevent regular uterine contractions of labour. We are not sure from the question, what they want to ask. The question does not clearly differentiate if they are asking about uterine contractions of pregnancy or labour. Once again remember If labour has begun, progesterone has no use. Among other tocolytics, calcium channel blockers have the least side effects. It is an effective tocolytic that is well tolerated by the majority of the pregnant patient. No significant fetal problems have been repoed after treatment with Nifedipine. The most common side effect seen with Nifedipine is lowering of B.P, facial flushing can be seen in ceain cases. Unlike the [3 adrenergic tocolytics they have no effect on carbohydrate metabolism and can be given to diabetic patient. Beta adrenergic agonists These are usually the tocolytics of choice for the treatment of preterm labour. They also have serious side effects which are Pulmonary edema - It is a serious and common side effect of 13 agonists. - It occurs in patients receiving oral or intravenous treatment. - It is common in patients having chorioamnionitis and in twins. Hyperglycemia - When 13 adrenergic drugs are given to patients with insulin dependent diabetes it causes significant hyperglycemia, glycosuria and ketonuria. - This occurs due to increased glycogenolysis and increased lipolysis. fi adrenergic agents are contraindicated in chorioamnionitis Side effects of magnesium Pulmonary edema Hypothermia Neuromuscular toxicity -### End" -6326,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Barr body is not seen in:, with the following options: A: Klinefelter syndrome, B: Turner syndrome, C: Normal female, D: XXX syndrome - -### Response: -Barr body, or X chromatin Inactive X can be seen in the interphase nucleus as a darkly staining small mass in contact with the nuclear membrane known as the. Number of Barr bodies = number of X chromosome -1 , Turner syndrome patients, number of Barr body = 1-1=0. -### End" -6327,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Iron in heme is linked to globin through, with the following options: A: Histidine, B: Alanine, C: Glycine, D: Cysteine - -### Response: -Ans. a (Histidine) (Ref. Harper's biochemistry 27th ed., Chapter 6,12; Harrison's 17th/ pg. 635)Heme, an essentially planar, slightly puckered, cyclic tetrapyrrole, has a central Fe2+ linked to all four nitrogen atoms of the heme, to histidine F8, and, in oxyMb and oxyHb, also to O2.The Hemoglobin:# Heme synthesis:- Occurs in the liver and bone marrow.- Committed step is glycine + succinyl CoA -delta aminolevulinate (ALA Synthase required).- Lead inhibits ALA dehydratase and ferrochelatase, preventing incorporation of iron and causing anemia and porphyria.# Glutathione reductase requires NADPH for its action. In G6PD deficiency NADPH cannot be generated at the normal rate and hence oxidants cannot be destroyed, which in turn cause damage, both to hemoglobin and cell membrane cause hemolysis.# Solubility and reversible oxygen binding, both depend most on the hydrophilic surface amino acids, the hydrophobic amino acids lining the heme pocket, a key histidine in the F helix, and the amino acids forming the a1 b1, and a1 b2 contact points.# Hemoglobin is a tetramer composed of 4 globin molecules; 2 alpha globins and 2 beta globins. The alpha globin chain is composed of 141 amino acids and the beta globin chain is composed of 146 amino acids. Both alpha and beta globin proteins share similar secondary and tertiary structures, each with 8 helical segments (labeled helix A-G).# Each globin chain also contains one heme molecule. Heme, an essentially planar, slightly puckered, cyclic tetrapyrrole, has a central Fe2+ linked to all four nitrogen atoms of the heme, to histidine F8, and, in oxyMb and oxyHb, also to O2 The heme molecule is located between helix E and helix F of the globin protein. The alpha and beta subunits of the globin chains exist in two dimers, which are bonded together strongly. The four Pyrole rings are joined by Methylene or Methylidene bridge (-C = bridge).# In Heme synthesis, the two starting materials are succinyl-CoA and glycine. Pyridoxal phosphate is also necessary in this reaction to ""activate"" glycine. -### End" -6328,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Specific reason to disallow the sample for culture -, with the following options: A: Sample brought within 2 hr of collection, B: Sample brought in sterile plastic container, C: Sample brought in formalin, D: Sample obtained after cleaning the collection site - -### Response: -Sample brought in formalin are not allowed for culture,as it may loose it's characteristic propeies specific to that organism. Ref ananthnarayana and panikers microbiology textbook -### End" -6329,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alcohol withdrawal is not associated with?, with the following options: A: Seizure, B: Amnesia, C: Tremers, D: Delirium - -### Response: -Ans. is 'b' i.e., Amnesia * Amnesia occurs during acute intoxication (not during withdrawal).Alcohol withdrawal symptoms* The most common symptom is hangover on the next morning.* Other common symptoms are fine tremer, nausea, vomiting, weakness, insomnia, anxiety, restlessness, irritability.* Three severe withdrawal syndrome are delerium tremens, Alcoholic hallucinosis, and alcoholic seizure (rum fits). They require special mention.1. Delirium tremens# Delirium tremens is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant alcohol abstinence. This is an acute organic brain syndrome (delirium) with characteristic features of delirium. It is characterized by:-a) Clouding of consciousness with disorientation in time and place.b) Poor attention span and distractability.c) Visual (and also auditory) hallucination, and illusion. Tactile hallucination of insect crawling under the skin (formication) may also occur.d) Marked autonomic disturbances with tachycardia, sweating, hypertension, mydriasis, coarse tremers.e) Insomnia, psychomotor agitation, ataxia, anxiety.# Benzodiazepines are the drugs of choice for delirium tremens. Chlordiazepoxide is the agent of choice with diazepam as an alternative.2. Alcoholic seizures (rum fits)# Generalized tonic clonic seizures occur, usually 12-48 hours after a heavy bouts of drinking. Benzodiazepines are the drugs of choice for alcoholic seizures.3. Alcoholic hallucinosis# Alcoholic hallucinosis is characterized by the presence of hallucinations (usually auditory) classically in the presence of clear consciousness alcoholic hallucinosis develops within 12-24 hours after drinking stops -### End" -6330,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bitemporal hemianopia is characteristic of -, with the following options: A: Glaucoma, B: Optic neuritis, C: Pituitary tumor, D: Retinal detachment - -### Response: -Ans. is 'c' i.e., Pituitary tumor o Characteristic visual field defect of central chiasmatic lesion is bitemporal hemianopia. Pituitary tumor causes central chiasmatic lesion.o Bitemporal hemianopia results due to central (sagittal) lesion of the optic chiasma. common causes of which are tumors of the pituitary gland (most common), craniopharyngioma, suprasellar meningioma, glioma of third ventricle, chiasmal arachnoiditis, and third ventricular dilatation.Site of lesionVisual field defectOptic nerveOptic chiasmaOptic tractLateral geniculate bodyOptic radiation (Total)Optic radiation lower fibres (temporal lobe)Optic radiation upper fibres (parietal lobe)Visual cortex (anterior occipital cortex)Occipital cortex tipBlindnessBitemporal hemianopiaIncongruent homonymous hemianopiaHomonymous hemianopiaHomonymous hemianopia, sometimes with macular sparingHomonymous upper quadrantanopiaHomonymous lower quadrantanopiaHomonymous hemianopia with macular sparingHomonymous macular defect -### End" -6331,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about the condition shown except:, with the following options: A: Cysts increase in size with age, B: Spider leg deformity, C: Anemia, D: Low Renin due to pressure atrophy of JG apparatus - -### Response: -Ans. (d) Low Renin due to pressure atrophy of JG apparatus* The picture shows autosomal dominant polycystic kidneys in which there is progressive enlargement of cysts with new ones developing with age. The IVU shows a spider leg deformity of the calyces.* The damage to the kidney results in decrease in amount of erythropoietin leading to normocytic normochromic anemia.* The damage to the kidney results in development of reduction in GFR and positive feedback to R.A.A.S system results in increase in renin levels as well as high Blood pressure. -### End" -6332,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common organ involved in retroperitoneal fibrosis is?, with the following options: A: Aorta, B: Ureter, C: Inferior vena cava, D: Sympathetic nerve plexus - -### Response: -Ans. (b) UreterRef.: Campbell 10th ed./ 1108-1112* Ureters are involved most commonly.* MC site is lower third.* Obstructive uropathy is the earliest and most common specific symptom.* 70% cases are primary or idiopathic (Ormond's disease)* Investigation of choice is CT scan.* In patients with renal compromise, MRI is the investigation of choice. -### End" -6333,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Depolarization in myelinated axons jumps from one node of Ranvier to the next is known as:, with the following options: A: Retrograde conduction, B: Antidromic conduction, C: Saltatory conduction, D: None of the above - -### Response: -Conduction in myelinated axons depends on a similar pattern of circular current flow. However, myelin is an effective insulator, and current flow through it is negligible. Instead, depolarization in myelinated axons jumps from one node of Ranvier to the next, with the current sink at the active node serving to electrotonically depolarize the node ahead of the action potential to the firing leve. This jumping of depolarization from node to node is called saltatory conduction. It is a rapid process that allows myelinated axons to conduct up to 50 times faster than the fastest unmyelinated fibers. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 4. -### End" -6334,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following congenital heart diseases has cyanosis without cardiomegaly and/or congestive heart failure –, with the following options: A: Transposition of great arteries, B: Fallot's tetralogy, C: Congenital mitral regurgitaion, D: Congenital pulmonary stenosis - -### Response: -Cardiomegaly and CHF do not occur in Fallot's tetrology. -No Cardiomegaly - - -First you should know the following facts : - - - -Pressure overload to ventricles causes concentric hypertrophy without dilatation. -Volume overload to ventricles causes hypertrophy with dilatation → Eccentric hypertrophy. - - -Due to pulmonary stenosis, there is pressure overload to right ventricle → Concentric hypertrophy of right ventricle without dilatation → No Cardiomegaly. - -No CHF - -The VSD of TOF is always large enough to allow free exit to the right to left shunt. -Since the right ventricle is effectively decompressed by the VSD, CHF never occurs in TOF. -### End" -6335,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Okazaki fragments are, with the following options: A: Short pieces of DNA on leading strand, B: Long pieces of DNA on Lagging strand, C: Short pieces of DNA on Lagging Strand, D: Long pieces of DNA on Leading strang - -### Response: -Okazaki fragments are short pieces of DNA that are synthesized on lagging strand and later these small pieces are joined together by DNA ligase. -### End" -6336,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Toxic effects of high oxygen tension include all of the following except, with the following options: A: Pulmomnary edema, B: Decreased cerebral blood flow, C: Retinal damage, D: CNS excitation and convulsion - -### Response: -Prolonged exposure to above-normal oxygen paial pressures, or shoer exposures to very high paial pressures, can cause oxidative damage to cell membranes, collapse of the alveoli in the lungs, retinal detachment, and seizures. Oxygen toxicity is managed by reducing the exposure to increased oxygen levels. Ref: guyton and hall textbook of medical physiology 12 edition page number:355,356,357 -### End" -6337,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glomerulonephritis associated with sensory neural deafness are features of, with the following options: A: Alport's syndrome, B: Nail patella syndrome, C: Down's syndrome, D: Fabry's syndrome - -### Response: -Ans. is 'a' Alport's syndrome Alport's syndrome is characterized byGlomerulonephritis*Deafness*Lenticonus*Some other frequently asked syndromes associated with deafness:1. Waardenburg syndrome*Pigmentary abnormalityHearing loss2. Pendred syndrome*Defect in thyroid hormone synthesis &Hearing loss -### End" -6338,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is the inheritance pattern of Caroli's syndrome?, with the following options: A: Autosomal dominant, B: Autosomal recessive, C: X linked dominant, D: X linked recessive - -### Response: -Caroli's syndrome is a congenital syndrome and often follows an autosomal recessive pattern of inheritance. It is associated with peripoal hepatic fibrosis and cystic kidney disease. Caroli's disease is characterised by saccular dilatation of segmental intrahepatic bile ducts, without other hepatic abnormalities. Both patients presents with right upper quadrant pain, recurrent bouts of cholangitis, and formation of calculi in the dilated ducts. Diagnosis i smade by MRCP or contrast cholangiography. Ref: Teaching Atlas of Interventional Radiology: Non-Vascular Interventional Procedures edited by Saadoon Kadir, page 178. -### End" -6339,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The functional surface molecule on T-lymphocytes that facilitates antigen recognition major histocompatibility complex (MHC) molecules is which one of the following subset of T-cells?, with the following options: A: T4, B: T11, C: T3, D: T8 - -### Response: -Surface molecule receptors located on T-lymphocytes allow them individual cellular functions mediated by activation of the presence of specific surface molecules. The subset T-cells, refer to as T8, are T-cells which possess a molecule that facilitates recognition of antigens the MHC molecules. Ref: Levinson W. (2012). Chapter 58. Cellular Basis of the Immune Response. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e. -### End" -6340,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following disease, the overall survival is increased by screening procedure?, with the following options: A: Prostate cancer, B: Lung cancer, C: Colon cancer, D: Ovarian cancer - -### Response: -Randomized controlled trials of faecal occult blood screening for carcinoma colon have shown a reduced number of deaths by 15-33% in the screened group i.e. increased survival by 15-33%. Ref: Kirk's Manual of Clinical Surgery, Pages 424-426; Harrison's Internal Medicine, 16th Edition, Page 26 -### End" -6341,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thinnest part of lens is?, with the following options: A: Anterior pole, B: Posterior pole, C: Posterior capsule, D: Apex - -### Response: -ANSWER: (B) Posterior poleREF: Cataract and refractive surgery: Volume 1; Volume 1 by Thomas Kohnen (Dr. med.), Thomas Kohnen, Douglas D. Koch page 134, Age-Related Changes Of The Human Eye by Carlo Cavallotti, Luciano Cerulli page 68In all age groups, the thinnest part of the lens capsule was found at the posterior pole.The back or posterior capsule is thinner, and thinnest at the pole.The anterior capsule is the thicker and stronger of the two, its center being its thickest part, while the center of the posterior capsule is its thinnest part.Cataract formation at the posterior pole of the lens can be explained by a missing epithelial barrier and by the thinnest part of the lens capsule. -### End" -6342,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most Basic amino acid is, with the following options: A: Lecuine, B: Istidine, C: Arginine, D: Glutamic acid - -### Response: -(C) Arginine # Aminoacid can be acidic, basic or neutral depending up on their side chain.> The lower the Pka of the R gp, the more acidic will be the amino acids, so aminoacid with the highest Pka of the RGP will be most basic.Basic Amino AcidPka of 'R' group* Arginine12.5* Lysine10.8* Histidine6.0 -### End" -6343,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Seal like limbs i.e. phocomelia is a specific side effect of -, with the following options: A: Thalidomide, B: Cyclophosphamide, C: Doxorubicin, D: Terazocin - -### Response: -Ans. is 'a' i.e., Thalidomide * Repeat from NEET Dec -16 -### End" -6344,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carcinoid tumours commonly arise from:, with the following options: A: G. cells in pancreas, B: Argentaffin cells of small intestine, C: Pancreatic endocrine tumour, D: Colon polyps - -### Response: -Ans. (b) Argentaffin cells of small intestineCarcinoid tumors arise from argentaffin cells of the crypts of Lieberkuhn and are found from the distal duodenum to the ascending colon, areas embryologically derived from the midgut. -### End" -6345,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DNA amplification is done in by all, except: PGI 06, with the following options: A: Polymerase chain reaction, B: Nucleic Acid Sequence Based Amplification, C: Ligase chain reaction, D: DNA sequencing - -### Response: -Ans. DNA sequencing -### End" -6346,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: With regard to hepatic anatomy, the falciform ligament divides the___from the ___., with the following options: A: Right unit, left unit, B: Left medial section, left lateral section, C: Caudate lobe, quadrate lobe, D: Left medial section, right lobe - -### Response: -The overall anatomy of the liver is divided into a functional right and left 'unit' along the line between the gallbladder fossa and the middle hepatic vein ( Cantlie's line ). The falciform ligament divides the left lateral section from the left medial section. Clinical significance : The falciform ligament, along with the round, triangular, and coronary ligaments may be divided in a bloodless plane during liver resection. Couinaud liver segments RESECTIONS can be performed of individual segments or of the whole of the left or right hemiliver. -### End" -6347,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug which arrests mitosis in metaphase ?, with the following options: A: Busulfan, B: 5-fu, C: Vinca Alkaloids, D: Methotrexate - -### Response: -Ans. is 'c' i.e., Vinca alkaloids M-phase inhibitors (Mitosis inhibitors) are vincristine, vinblastine, paclitaxel, docetaxel ixabepilone and extramustine. -### End" -6348,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sound intensity required to elicit stapedial reflexis more than:, with the following options: A: 45 - 65 db, B: 70 - 90 db, C: 90 - 100 db, D: 30 - 45 db - -### Response: -- The pure tone intensity range to elicit an acoustic reflex is 70 to 100dBHL -### End" -6349,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is false about Hurler syndrome:, with the following options: A: X linked, B: Mental retardation, C: Joint stiffness, D: Coarse facial features - -### Response: -Ans. (a) X linkedRef: Robbiris pathology 9th ed. /155* HURLER syndrome is autosomal recessive while HUNTER SYNDROME is X linked recessive* HURLER syndrome is marked by progressive deterioration, hepatosplenomegaly, dwarfism and unique facial features. There is a progressive mental retardation, with death frequently occurring by the age of 10 years* Hurler is due to defective IDUA gene, which has been mapped to the 4pl6.3 site on chromosome 4. The gene is named IDUA because of its iduronidase enzyme protein product. -### End" -6350,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antisnake venom may cause: CMC (Vellore) 13, with the following options: A: Type II hypersensitivity reactions, B: Type III hypersensitivity reactions, C: Type IV hypersensitivity reactions, D: Type V hypersensitivity reactions - -### Response: -Ans. Type III hypersensitivity reactions -### End" -6351,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a patient with acute leukemia, immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, CD 13+ve. He may probably have -, with the following options: A: Biphenotypic leukemia, B: ALL, C: AML- M2, D: AML-M0 - -### Response: -Ans. is 'a' i.e., Biphenotypic leukemia o The information provided in the question is -- Patient is having acute leukemia Immunophenotypic pattern of the cells. CD 19 +ve CD 10 +ve CD 33 +ve CD 13 +ve o You know CD l0+ve and CD 19+ve is immunophenotypic pattern for B cell lineage. CD 33 & CD 13 is associated with monocyte & Macrophages o So it is clear that the patient is having acute leukemia with immunophenotypic pattern of more than one cell lineage. o So, ALL(option b) and AML (option c & d).are ruled outas these will have blast cells of one lineage only. o Now we are left with biphenotypic leukemia. o According to recent WHO classification (2008) of biphenotypic leukemia, we cannot make the diagnosis of biphenotypic leukemia in this question ( see previous explanation). Recent WHO (2008) classification of biphenotypic leukemia. Myeloid lineage B lymphoid lineage B lymphoid Lineage (multiple antigens required MPO or moncytic differentiation (at least 2 of the following : NSE CD11c CD 14, CD64, lysozyme) Cytoplasmic CD3 or Surcace CD3 Strong CD19 with at least 1 of the following weekly expressed : CD79a cytoplasmic CD22, CD 10 or weak CD 19 with at least 2 of the following strongly expressed : CD79a, cytoplasmic CD22, CD10 o This recent classification was made in 2008 ( while this question came in 2004). Before 2008, the criteria for diagnosis of biphenotypic leukemia was EGIL criteria modified by WHO. EGIL criteria for biphenotypic leukemia modified by WHO Score B lineage T lineage Myeloid 2 cCD 79a cIgM cCD22 CD3 (c or Sm) Anti-TCR (oc(l or 13) MPO 1 CD1 CD2 CD117 CD10 CD5 CD13 CD20 CD8 CD33 CD10 CD65 0.5 TdT TdT CD14 CD24 CD7 CD15 CD1a CD64 By WHO modified EGIL criteria the total score required for myeloid or lymphoid lineage is 2 for each -### End" -6352,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypoxic pulmonary vasoconstriction:, with the following options: A: Depends more on the PO2 of mixed venous blood than alveolar gas, B: Is released in the transition from placental to air respiration, C: Involves CO2 uptake in vascular smooth muscle, D: Paly dives blood flow from well-ventilated regions of diseased lungs - -### Response: -The great reduction in pulmonary vascular resistance during the transition from placental to normal respiration is largely brought about by the process of hypoxic pulmonary vasoconstriction. The other choices are incorrect because the PO2 of alveolar gas is much more impoant than the PO2 of mixed venous blood, CO2 uptake is irrelevant, the constriction paly dives blood flow from poorly ventilated, not well-ventilated regions of diseased lungs, and the inhalation of nitric oxide paly reverses hypoxic pulmonary vasoconstriction. -### End" -6353,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: International Olympic committee has prohibited the use of all of the following except, with the following options: A: Salbutamol, B: Furosemide, C: Estrogen, D: Nandrolone - -### Response: -(A) Salbutamol # All BETA-2 AGONISTS (including both optical isomers where relevant, are prohibited except salbutamol (maximum 16 micrograms over 24 hours), formoterol (maximum 36 micrograms over 24 hours, and salmeterol when taken by inhalation in accordance with the manufacturers' recommended therapeutic regime."" -### End" -6354,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statement regarding non-coagulase staphylococci is -, with the following options: A: They are non-pathogenic, B: They commonly infect indwelling prosthesis, C: They may cause scarlet fever, D: They are seperated by gram staining - -### Response: -Staph epidermidis - -Most common coagulase negative staph. causing human infections. -It is present on the normal human skin (where it is the most abundant bacterial species) as well as in the oropharynx and vagina. -It is a common cause of stitch abscesses. -It has a predilection for growth on the implanted foreign bodies such as artificial heart valves, shunts, intravascular catheters and prosthetic appliances leading to bacteremia. -S. epidermidis is uniquely adopted to colonize these devices by its capacity to elaborate the extracellular poly­saccharide (slime) that facilitates the formation of a protective biofilm (slime layer) on the device surface. This biofilm acts as a barrier protecting bacteria from host defense mechanisms as well as from antibiotics. -The surface - associated staphylococcal enzyme autolysin (Atle) may play a role in attachment to prosthetic surfaces, which are often coated with host serum or tissue constituents such as fibrinogen or fibronectin. -It can cause cystitis and endocarditis. -### End" -6355,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the risk of recurrence of anencephaly in subsequent pregnancy?, with the following options: A: 1%, B: 2%, C: 3%, D: 4% - -### Response: -ns. is 'b' i.e., 2% Anencephalyo The incidence of anencephalv is 1 in 1000 pregnancies.o About 70% of anencephalic fetuses are females.o The risk of recurrence of anencephalv in subsequent pres nancy is 2%.o Folic acid supplementation has reduced the incidence of neural tube defects by 85%.o Folic acid supplementation is given beginning 1 month before conception to about to about 12 weeks of pregnancy. A dose of 4mg daily is recommended. -### End" -6356,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25 years old female complains of recurrent rhinitis, nasal discharge and bilateral nasal blockage since one year. She has a history of asthma and allergy. On examination, multiple ethmoidal polyps are noted with mucosal thickening and impacted secretions in both the nasal cavities. A biopsy is taken and the material is cultured which show the growth of many hyphae and pseudohyphae with dichotomous branching typically at 45°. Which of the following is the most likely responsible organism?, with the following options: A: Aspergillus fumigatus, B: Rhizopus, C: Mucor, D: Candida - -### Response: -Information provided in this question are : - - - -Recurrent rhinitis, nasal discharge, bilateral nasal blockage. -H/O asthma and allergy -Hyphae with dichotomous branching at 45°C. - - -All suggest the diagnosis of Aspergillus fumigatus. - - -Most common type of fungal infection of the nose and paranasal sinuses are due to Aspergillus. -The most common fungus causing an allergy is aspergillus. -Aspergillus has septate hyphae that branch typically at 45°C (V-shaped). -### End" -6357,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IgA deposition in mesangial cells arr seen in, with the following options: A: Good Pasteur syndrome, B: Berger syndrome, C: Cresentic glomerulonephritis, D: Alpo syndrome - -### Response: -Refer Robbins page no 923 IgA Nephropathy (Berger Disease) IgA nephropathy, characterized by the presence of prom- inent IgA deposits in the mesangial regions and recurrent hematuria, is the most common type of glomerulonephri- tis worldwide. The disease can be suspected by light microscopic examination, but the diagnosis is made only by the detection of glomerular IgA deposition (Fig. 20-19). Mild proteinuria is usually present, and the nephrotic syndrome may occasionally develop. -### End" -6358,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hereditary retinoblastoma develop as a result of which of the following chromosomal deletion?, with the following options: A: 13q 14, B: 13p 14, C: 14p 13, D: 14q 13 - -### Response: -Hereditary retinoblastomas develop from the deletion of Rb gene, located on chromosome 13q14. Retinoblastoma gene is a tumor suppressor gene, which serves as a break on the advancement of cells from the G1 to S phase of cell cycle.Ref: Robbins Pathologic Basis of Disease, 7th Edition, Pages 287, 289, 1372. -### End" -6359,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following are predispositions of Alzheimer's disease except:, with the following options: A: Down's syndrome, B: Head trauma, C: Smoking, D: Low education group - -### Response: -Smoking is considered to be one of the protective factors in Alzheimer's disease; however this finding has been inconsistent across the studies. Risk factor for Alzheimer disease Age Head injury HTN Insulin resistance Depression Down syndrome -### End" -6360,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How many permanent teeth will be present in a 8 year old child?, with the following options: A: 20, B: 24, C: 12, D: 16 - -### Response: -Permanent teeth erupt in the following order: First molar 6-7 years Central and lateral incisors 6-8 years Canine and premolars 9-12 years Second molar 12-13 years Third molar 18 years or later So at the age of 8 years first molar, central and lateral incisors would have erupted in each quadrant Hence, totally 12 permanent teeth will be present at the age of 8 years -### End" -6361,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is Dohlman's Procedure in Zenker's Diveiculum, with the following options: A: Endoscopic Suturing of Pouch, B: Endoscopic Stapling of Septum, C: Resection of Pouch, D: Laser excision - -### Response: -* Endoscopic Stapling Technique for Pharyngeal Pouch (Zenker's Diveiculum)is known as Dohlman's Procedure. Ref:- Surgery Sixer 3rd Edition; Pg num:- 322 -### End" -6362,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Infliximab ?, with the following options: A: CD 20 antagonist, B: IL6 antagonist, C: Chimeric antibody against TNF alpha, D: Chimeric antibody against Her2-neu - -### Response: -Ans. is 'c' i.e., Chimeric antibody against TNF alpha -### End" -6363,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Population growth is rated explosive if annual growth rate exceeds, with the following options: A: 2%, B: 1.50%, C: 1%, D: 0.50% - -### Response: -Relation between Annual growth rate(AGR) and population Rating Annual GR Population doubling Time Stationary population None - Slow growth <0.5 >139 years Moderate growth 0.5-1.0 139-70 Rapid growth 1.0-1.5 70-47 Very rapid growth 1.5-2.0 47-35 Explosive growth 2.0-2.5 35-28 Explosive growth 2.5-3.0 28-23 Explosive growth 3.0-3.5 23-20 Explosive growth 3.5-4.0 20-18 Ref: Park 25th edition Pgno : 532 -### End" -6364,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following develops from 2nd brachial arch EXCEPT:, with the following options: A: Buccinator, B: 7th cranial nerve, C: Anterior belly of digastric, D: Stapes - -### Response: -ANSWER: (C) Anterior belly of digastricREF: Langman's Medical Embryology 9th edition Page 366, Table 15.1See APPENDIX-6 for ""Brachial arches""'Anterior belly of digastric develops from 1st brachial arch and posterior belly from 2nd brachial arch"" APPENDIX - 6Brachial ArchesThere are six pharyngeal arches, but in humans the fifth arch only exists transiently during embryologic growth and development. Since no human structures result from the fifth arch, the arches in humans are I, II, III, IV, and VI. The first three contribute to structures above the larynx, while the last two contribute to the larynx and tracheaPharyngealArchMuscularContributionsSkeletal ContributionsNerveArteryCorresponding Pouch Structures1st(mandibulararch)Muscles of mastication, Anterior belly of the digastric, Mylohyoid, Tensor tympani, Tensor veli palatiniMaxilla, mandible (only as a model for mandible not actual formation of mandible), Incus and Malleus, Meckel's cartilage, Ant. ligament of malleus, Sphenomandibular ligamentTrigeminal nerve (V2 and V3)Maxillary artery, external carotid arteryEustachian tube, middle ear, mastoid antrum, and inner layer of the tympanic membrane.2nd (hyoid arch)Muscles of facial expression. Buccinator, Platysma, Stapedius, Stylohyoid, Posterior belly of the digastricStapes, Styloid process, hyoid (lesser horn and upper part of body), Reichert's cartilage, Stylohyoid ligamentFacial nerve (VII)StapedialArterymiddle ear, palatine tonsils3rdStylopharyngeusHyoid (greater horn and lower part of body), thymusGlossopharyngeal nerve (IX)Commoncarotid/InternalcarotidInferiorparathyroid,Thymus4thCricothyroid muscle, all intrinsic muscles of soft palate including levator veli palatiniThyroid cartilage, epiglottic cartilageVagus nerve (X) Superior laryngeal nerveRight 4th aortic arch: subclavian artery Left 4th aortic arch: aortic archSuperior parathyroid, ultimobranchial body (which forms the Para follicular C-Cells of thyroid gland)6thAll intrinsic muscles of larynx except the cricothyroid muscleCricoid cartilage, arytenoid cartilages, corniculate cartilageVagus nerve (X) Recurrent laryngeal nerveRight 6th aortic arch: pulmonary artery Left 6th aortic arch: Pulmonary artery and ductus arteriosusRudimentary structure, becomes part of the fourth pouch contributing to thyroid C-celts. -### End" -6365,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pinna calcification is seen in all except, with the following options: A: Gout, B: Ochronosis, C: Frost bite, D: Addison's disease - -### Response: -Ans. a. Gout Pinna Calcification is seen in Addison's diseaseQ Diabetes mellitus OchronosisQ HypehyroidismQ AcromegalyQ von Meyenburg's disease (systemicchondromalacia) Hypeension Late calcification of the auricular cailage following frostbite. ( of Chapter/1550092413 .pdf) Delayed dystrophic calcification of the underlying auricular cailage may develop years after the initial frostbite. When this occurs, the pinna is bony and hard to palpation. A radiograph of the pinna will reveal radiodense areas of calcification in the auricular cailage. -### End" -6366,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The malunion of Supracondylar fracture of the humerus most commonly involved in ?, with the following options: A: Flexion defornity, B: Cubitus varus, C: Cubitus valgus, D: Extension deformity - -### Response: -Cubitus varus also known as gun stock deformity It is the most common complication of Supracondylar fracture of humerus Refer Maheshwari 9th /e p 102 -### End" -6367,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Movements taking place during abduction of shoulder joint are all except:, with the following options: A: Medial rotation of scapula, B: Axial rotation of humerus at acromioclavicular joint, C: Elevation of humerus, D: Movements at clavicular end of sternoclavicular joint - -### Response: -Medial rotation of scapula Abduction of the ann involves rotation of the scapula as well as movement at the shoulder joint.For every 3deg abduction, a 2 deg abduction occurs in the shoulder joint & 1 deg abduction occurs by rotation of the scapula (forward rotation round the chest wall i.e. lateral rotation). Rotation of the scapula is facilitated by movements at the sternoclavicular and acromioclavicular joints.Also know: Abduction is initiated by the supraspinatus but the deltoid muscle is the main abductor. -### End" -6368,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following increases turbulence in blood flow:, with the following options: A: When the diameter of the blood vessel increases., B: When density decreases., C: When resistance increases., D: All of the above. - -### Response: -Turbulence ∞ Re (Reynolds no) =ρDV/И -So increase in density → increases Re → increases turbulence. -### End" -6369,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the only prokaryotic DNA polymerase with 5'-3' exonuclease activity?, with the following options: A: DNA Polymerase I, B: DNA Polymerase II, C: DNA Polymerase III, D: DNA Polymerase IV - -### Response: -DNA polymerase I 1st DNA polymerase discovered Only polymerase with 5'-3' exonuclease activity. DNA polymerase I 5' - 3' polymerase Polymerisation 3' - 5' exonuclease Proofreading 5' - 3' exonuclease Removal of RNA primer, DNA repair, nick-translation -### End" -6370,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bernad-Soulier syndrome is a defect in platelet, with the following options: A: Aggregation, B: Adhesion, C: Morphology, D: Release reaction - -### Response: -Bernad-Soulier syndrome is a defect in platelet adhesion defect with gp Ib / IX defect. -### End" -6371,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not seen in tuberous sclerosis?, with the following options: A: Astrocytoma, B: Ependymoma, C: White matter lesions, D: Subpendymal nodules - -### Response: -Tuberous sclerosis characterized by angiofibroma,astrocytoma,subependymal lesion and white matter lesion. Ref : Ghai essential of pediatrics, eighth edition, p.no:586 -### End" -6372,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mastoid is which type of epiphysis-, with the following options: A: Traction epiphysis, B: Atavistic epiphysis, C: Aberrant epiphysis, D: Pressure epiphysis - -### Response: -Ans. is 'a' i.e., Traction epiphysis Types of epiphysisExamplesPressureHead of femur, head of humerus, condyles of tibia, lower end of radiusTractionGreater and lesser trochanters of femur, tubercles of humerus, mastoid processAtavisticCoracoid process of scapula, posterior tubercle of talus (as trigonum)AberrantHead of 1st metacarpal and base of other metacarpals. -### End" -6373,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the management of toxicity caused by ingestion of methanol in wood spirits, which one of the following statements is most accurate?, with the following options: A: Treatment should involve the administration of disulfiram in the ER., B: Naltrexone is a suitable antidote in poisoning due to alcohols., C: Ethanol will prevent formation of formaldehyde in methanol poisoning., D: Hemodialysis will not remove methanol from the blood. - -### Response: -Ethanol saturates alcohol dehydrogenase (ADH) at very low blood levels (zero- order elimination), preventing the conversion of methanol to formaldehyde, a toxic compound that can result in blindness. Ethanol (IV) continues to be used as an antidote in poisoning due to the ingestion of liquids containing methanol or ethylene glycol (antifreeze). Hemodialysis is also employed in management of methanol intoxication. Disulfiram (Antabuse) is an inhibitor of aldehyde dehydrogenase used in some alcohol rehabilitation programs, and naltrexone (an opioid antagonist) is approved for use in alcoholism because it decreases ""craving."" Delirium tremens is a characteristic of the withdrawal or abstinence syndrome in patients who have become physically dependent on ethanol. -### End" -6374,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the commonest true benign bone tumor?, with the following options: A: Osteoid osteoma, B: Hemangioma, C: Osteochondroma, D: Enchondroma - -### Response: -Ans. is 'a' i.e.. Osteoid osteoma Important factso Commonest bone malignancieso Commonest primary' malignant tumoro Commonest primary malignant tumor of long bones---SecondariesMultiple myelomaOsteosarcomao Commonest benign tumor of bone-Osteochondroma(Osteochondroma is not true neoplasm since its growth stops with cessation of growth at the epiphyseal plate)o Commonest true benign tumor of bone-Osteoid osteomao Commonest benign tumor of hand-EnchondromaCommonest siteo Ivory osteoma-Frontal sinuso Osteoid osteoma-Tibiaa Admantinoma (Ameloblastoma)-Mandibleo Chordoma-Sacrum and cervical spineo Osteoclastoma-Lowrer end of femuro Ewing's sarcoma-Femur diaphysis > tibia diaphysiso Osteosarcoma-Distal femur (45%), Proximal tibia (25%)o Simple bone cyst-Proximal humeruso Aneurysmal bone cyst-Bones around knee (Femur, tibia)o Osteochondroma-Bones around knee (distal femur > proximal tibia)o Fibrous dysplasiao Enchondroma--Proximal femur > Tibia\Phalanges of hando Multiple myeloma-Vertebraeo Metastasis-Vertebrae -### End" -6375,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not true of hypersensitivity vasculitis: March 2011, with the following options: A: May be due to deposition of immune complexes or delayed hypersensitivity, B: Affects small, medium sized and larger aeries commonly, C: Immunologic response to an antigen, D: None of the above - -### Response: -Ans. B: Affects small, medium-sized and larger aeries commonlyMicroscopic polyangitis is a necrotizing vasculitis that generally affects capillaries, as well as aerioles and venules of a size smaller than those involved in polyaeritis nodosa (medium vessel vasculitis); rarely larger aeries may be involvedIt is also called hypersensitivity vasculitis/ leukoclastic vasculitisCutaneous small-vessel vasculitis/Cutaneous leukocytoclastic angiitis/Cutaneous leukocytoclastic vasculitis/ Cutaneous necrotizing venulitis/ Hypersensitivity angiitis.It is inflammation of small blood vessels (usually post-capillary venules in the dermis), characterized by palpable purpura.It is the most common vasculitis seen in clinical practice.Leukocytoclasis refers to the damage caused by nuclear debris from infiltrating neutrophils in and around the vessels.Subtypes of small-vessel vasculitis include:- Henoch-Schonlein purpura- Acute hemorrhagic edema of infancy- Uicarial vasculitis- Cryoglobulinemic vasculitis- Erythema elevatum diutinum- Granuloma faciale -### End" -6376,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which out of the following bones ossify first?, with the following options: A: Mandible, B: Nasal bone, C: Vomer, D: Occipital - -### Response: -Mandible is the second bone, next to clavicle, to ossify in the body.  -It ossifies in membrane in its greater part. Each half of the body of mandible is ossified in membrane from 1 centre, which appears during 6th week I.U. near future mental foramen. -The parts ossifying in cartilage includes, - -Incisive part, below the incisor teeth. -Upper half of ramus, above the level of mandibular foramen. -Condylar process. -Coronoid process. -### End" -6377,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady came with complaints of a bluish lesion over left side of forehead and left eye. Shows Irregular bluish lesion in Left superior conjunctive and forehead. Diagnosis is, with the following options: A: Nevus of Ota, B: Nevus of Ito, C: Becker's nevus, D: Mongolian spot - -### Response: -. -### End" -6378,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are examples of primary colours, EXCEPT:, with the following options: A: Red, B: Green, C: Blue, D: None of the above - -### Response: -The sensation of white, any spectral color, and even the extraspectral color, purple, can be produced by mixing various propoions of red light (wavelength 723-647 nm), green light (575-492 nm), and blue light (492-450 nm). which are therefore called the primary colors. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 12. -### End" -6379,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Incidence of scar rupture in a pregnant lady with previous LSCS is:, with the following options: A: 0.2, B: 0.5, C: 0.7, D: 0.9 - -### Response: -Ans: B (0.5) Ref: Williams obstetrics, 23rd edition & www. caesarean, org. uk/a rticles/VBA CMM. htmlExplanation:Incidence of Scar RuptureThe most commonly quoted scar rupture for LSCS. especially by those opposed to and afraid of VB AC is 0.5%, or 1 in 200 chance. (Ref: Murray. Enkin and Chalmers, 1994)Estimated risk of scar rupture:Type of incisionIncidence of scar ruptureLow transverse0.2- 1.5%Low vertical1 - 7%T shaped4-7%Classical4-7% -### End" -6380,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A middle aged women presented with right sided hearing loss , Rinne's test shows positive result on left side & negative result on right side. Weber's test showed lateralisation to left side. Diagnosis is :, with the following options: A: Right sided conductive deafness, B: Right sided sensorineural deafness, C: Left sided sensorineural deafness, D: Left sided conductive deafness - -### Response: -The Rinne tuning fork test is sensitive in detecting conductive hearing losses. A Rinne test compares the ability to hear by air conduction with the ability to hear by bone conduction.Normally and in the presence of sensorineural hearing loss, a tone is heard louder by air conduction than by bone conduction.With a unilateral conductive hearing loss, the tone is perceived in the affected ear. With a unilateral sensorineural hearing loss, the tone is perceived in the unaffected ear. So in this case it is right sided sensorineural deafness. -### End" -6381,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Loop of Henle handles the following ions except:, with the following options: A: Na+, B: K+, C: CI?, D: Urea - -### Response: -D i.e. UreaIn the thick ascending limb, a carrier co-transpos one Na+, one K.' and 2C1-Q from the tubular lumen into the tubular cells. -### End" -6382,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Slot size commonly used in orthodontics is:, with the following options: A: 0.017 x 0.021, B: 0.014 x 0.024, C: 0.018 x 0.025, D: 0.010 x 0.020 - -### Response: -The most commonly used slot size is 0.022*0.028 inch followed by 0.018*0.025 inch slot. -### End" -6383,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The main enzyme responsible for activation of xenobiotics is -, with the following options: A: Cytochrome P-450, B: Glutathione S-transferase, C: NADPH cytochrome P-450-reductase, D: Glucuronyl transferase - -### Response: -Most important reaction in biotransformation of xenobiotics is oxidation reaction. The most important enzyme for oxidation reactions is cytochrome P450. -### End" -6384,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False regarding ulnar nerve is, with the following options: A: C7 fibers come from lateral cord, B: C7 8 T1, C: No branch in arm, D: Pass between supinator heads - -### Response: -D i.e. Pass between supinator headsDeep branch of ulnar nerve supplies all interossei (palmar & dorsal), all hypothenar (flexor/ abductor/ opponens digiti ininimi), two (3rd & 4th) luinbricles, adductor pollicis and deep head of flexor pollicis brevis muscleQ. -### End" -6385,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Highest concentration of potassium is in?, with the following options: A: Bile, B: Pancreatic juice, C: Terminal ileal secretions, D: Rectal fluid - -### Response: -Colon and rectal secretion contain highest concentration of K+. -### End" -6386,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Flocculo nodular lobe has direct connection with :, with the following options: A: Red nucleus, B: Inferior olivary nucleus, C: Vestibular nucleus, D: Dentate nucleus - -### Response: -C i.e. Vestibular nucleusFlocculonodular lobe constitutes the vestibulo- cerebellum. Output from flocculonodular lobe goes directly to the brainstemQ, bypassing the deep cerebellar nuclei and is concerned with maintenance of equlibriumQ. -### End" -6387,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Potts shunt is:, with the following options: A: Rt subclan aery to it pulmonary aery, B: Descending aoa to left pulmonary aery, C: Left subclan to left pulmonary aery, D: Ascending aoa to right pulmonary aery - -### Response: -In POTT'S shunt: The descending aoa is anastomosed to pulmonary aery. Operative treatment of TOF consist of two types: Palliative and Definitive. Palliative treatment consist of anastomosing systemic aery and pulmonary aery to increase the pulmonary blood flow and thus increase amount of oxygenated blood reaching systemic circulation. Ref: Kliegman, Behrman, Jenson, Stanton (2008), Chapter 430.1, ""Tetralogy of Fallot"", In the book, ""NELSON TEXTBOOK OF PEDIATRICS"", Volume 2, 18th Edition, New Delhi, Pages 1908-10 ; O P Ghai Essential Pediatrics, 6th Edition, Page 409 -### End" -6388,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An obese woman of 49 years of age, affluent woman with diabetes and hypeension, complains of heavy menstrual bleeding with delayed and irregular cycles. Which of these is the most impoant cause that should be ruled out in this patient?, with the following options: A: Cancer cervix, B: Ca endometrium, C: Fibroid uterus, D: Polycystic ovaries - -### Response: -Risk factors for ca endometrium are Nulliparity Late menopause Obesity Diabetes mellitus Unopposed estrogen therapy Tamoxifen therapy Atypical endometrial hyperplasia Lynch II syndrome 20 Since the patient here is 49 yrs, obese, and diabetic, endometrial cancer must be ruled out here. -### End" -6389,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 years multiparous lady with 30 weeks Pregnancy presents with sudden onset painless vaginal bleeding. USG done shows presence of:, with the following options: A: Abruption placenta, B: Placenta previa, C: Vasa previa, D: Sub-amniotic cyst - -### Response: -Ans. (b) Placenta previa.* The image shows internal cervical os cannot be visualized. The second black shadow appears to be the urinary bladder.* In mid-gestation the placenta occupies 50% of the uterine surface. By 40 weeks' gestation, the placenta occupies 17 - 25% of the uterine volume.* Since about one-third cases of antepartum haemorrhage belong to placenta previa and are more common in multiparous women. In clinical setting of painless bleeding in multiparous woman in 30 weeks of pregnancy diagnosis goes in favour of placenta previa.* The high risk factors for placenta previa are (a) Multi-parity (b) Increased maternal age (> 35 years) (c)History of previous caesarean section or any other scar in the uterus (myomectomy or hysterotomy) (d) Succenturiate lobes. -### End" -6390,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 64-year-old woman with type 2 diabetes for 10 years now develops increasing fatigue, dyspnea, and pedal edema. On examination, her blood pressure is 165/90 mmHg, pulse 90/min, JVP is 4 cm, heart sounds are normal, lungs are clear, and there is 3+ pedal edema.Her urinalysis is positive for 3 gm/L of protein and no casts or red blood cells. An abdominal ultrasound reveals normal size kidneys and no hydronephrosis. Which of the following renal diseases is the most likely diagnosis in this patient?, with the following options: A: acute glomerulonephritis (GN), B: obstructive uropathy, C: glomerulosclerosis with mesangial thickening, D: renal infarction - -### Response: -The patient is most likely to develop glomerulosclerosis. This can be diffuse or nodular (Kimmelstiel-Wilson nodules). Poor metabolic control is probably a major factor in the progression of diabetic nephropathy. Acute GN is unlikely given the lack of casts or red cells in the urine, and patients with renal infarction usually provide a history of flank pain and/or hematuria. The ultrasound results argue against obstructive uropathy and PCKD. -### End" -6391,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following conditions the lead pipe appearance of the colon on a barium enema is seen?, with the following options: A: Amoebiasis, B: Ulcerative colitis, C: Tuberculosis of the colon, D: Crohn's involvement of the colon - -### Response: -Ans. Ulcerative colitis -### End" -6392,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type of deafness seen in early stages of Meniere's disease:, with the following options: A: Low frequency conductive hearing loss, B: Low frequency sensorineural hearing loss, C: High frequency conductive hearing loss, D: High frequency sensorineural hearing loss - -### Response: -Ans: B (Low frequency sensorineural hearing loss) Ref: Diseases of the Ear Nose and Throat by PL Dhingra 5th edn .2010.Page 113Explanation:Hearing loss in Meniere's disease is sensorineural type and is tluctuating.It is associated with episodic vertigo, tinnitus and sensation of fullness of ear.Early Meniere's has low frequency loss and the PTA curve is rising type.Later on the higher frequencies are affected and the PTA curve becomes flat and finally it becomes sloping type. -### End" -6393,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 65 year old Ramdeen presents with Abdominal pain and distension of abdomen. His stools were maroon coloured and he gives a past history of cerebrovascular accident and myocardial infarction. What will be the probable diagnosis ?, with the following options: A: Ulcerative colitis, B: Acute mesentric ischemia, C: Irritable bowel syndrome, D: Chron's disease - -### Response: -Ans. is 'b' ie. Acute Mesenteric ischemia -### End" -6394,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: VDRL test is used for -, with the following options: A: Chanchroid, B: LGV, C: Granuloma inguinale, D: Syphilis - -### Response: -Ans. is 'd' i.e., Syphilis Laboratory diagnosis of syphiliso Lab. diagnosis of syphilis consists of: -A) Demonstration of spirochetes under microscopy# Microscopy is applicable only in primary & secondary stage as spirochetes are abundant during primary, and secondary stage (maximum number of spirochetes and infectivity). Microscopy used are Dark field microscopy, and immunofluorescence microscopy (Direct fluerecent antibody test - DFA-TP).B) Serological tests# These tests form the mainstay of laboratory diagnosis. Serological tests are: -1) Non-specific tests (reagin antibody or standard tests):- Kahn test, VDRL, Rapid plasma reagin (RPR), automated VDRL-ELISA, Washermann test. These test measure IgG & IgM against cardiolipin.2) Group specific test: - CFT3) Species specific tests: - Treponema pallidum particle agglutination (TPPA) test, Treponema pallidum immobilization (TP1), Triponema pallidum hemagglutination assay (TPHA), ELISA.o Specific treponemal tests (FTA-ABS, TPHA, TPI) are of little value as indicators of clinical cure, as they tend to remain positive inspite of Treatment. Non treponemal tests (eg VDRL) will become nonreactive or will be reactive at lower titers after therapy, so can be used for monitoring patient's response to treatment These tests usually become negative 6-18 months after effective treatment of syphiliso A four fold or greater decrease in antibody titre indicates response to therapy -### End" -6395,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Who is referred as the Father of Psychoanalysis?, with the following options: A: Benjamin Rush, B: Emil Kraepelin, C: Sigmund Freud, D: Eugen Bleuler - -### Response: -Ans. C. Sigmund FreudFather of PsychoanalysisSigmund FreudFather of Modern PsychiatryJohann WeyersFather of American PsychiatryBenjamin Rush -### End" -6396,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following conditions are associated with venous and aerial thrombotic events, except:, with the following options: A: Paroxysmal Nocturnal Haemoglobinuria (PNH), B: Disseminated Intravascular Coagulation, C: Idiopathic Thrombocytopenic Purpura (ITP), D: Heparin Induced Thrombocytopenia (HIT) - -### Response: -Answer is C (Idiopathic Thrombocytopenic Purpura (ITP)) Idiopathic Thrombocytopenic Purpura (ITP) is an immune complex mediated thrombocytopenia characterized by varying degrees of bleeding manifestations due to destruction of platelets. 1TP is not associated with an increased incidence of venous and/or aerial thrombosis. Paroxysmal Nocturnal Haemoglobinuria (PNH), Diseminated Intravascular Coagulation (DIC) and Heparin Induced Thrombocytopenia (HIT) are all associated with increased risk of venous and/or aerial thrombotic events. Risk factors for Thrombosis: Venous -- Venous and Aerial Inherited Inherited Factor V Leiden Homocystinuria Prothrombin G20210A Dysfibrinogenemia Antithrombin deficiency Protein S deficiency' Elevated F VIII Acquired Acquired Age Malignancy Previous thrombosis Antiphospholipid antibody syndrome (APLA) Immobilization Hormonal therapy Major surgery Polycythemia vera Pregnancy &puerperium Essential thrombocythemia Hospitalization Paroxysmal nocturnal hemoglobinuria (PNH) Obesity Thrombotic thrombocytopenic Purpura (TTP) Infection Heparin-induced thrombocytopenia (HIT) APC resistance, nogenetic Disseminated intravascular cogulation (DIC) Unknowndeg Mixed (Inherited and acquired) Elevated factor II, IX, XI Hyperhomocysteinemia Elevated TAFI levels Low levels of TFPI ""Unknown whether risk is inherited or acquired. Note APC, activated protein C; TAFI. thrombin-activatable fibrinolysis inhibitor: TFPI, tissue factor pathway inhibitor. Note : Heparin induced Thrombocytopenia is more commonly associated with Thrombosis than Bleeding Heparin induced Thrombocytopenia is more commonly associated with Thrombosis than Bleeding Heparin induced thrombocytopenia should be included in the differential diagnosis of conditions that produce thrombosis despite thrombocytopenia. Despite thrombocytopenia bleeding is rare in HIT. On the contrary HIT is more related to thrombosis, which often leads to initial recognition of this condition (HIT). `Thrombosis often leads to initial recognition of HIT. Bleeding is rare despite thrombocytopenia' - Essentials of Emergency Medicine (2006)/286 Thrombocytopenia with Thrombosis DIC TTP HUS HIT Thrombosis in Heparin Induced Thrombocytopenia is caused by the generation of prothrombotic platelet micropaicles that promote thrombin generation. HIT is an antibody - mediated process that is triggered by antibodies directed against neoantigens on PF4 that are exposed when heparin binds to this protein. These antibodies (usually IgG type) bind simultaneously to heparin PF4 complex and to platelet Fc receptors. Such binding activates the platelets and generates platelet micropaicles. Circulating micropaicles are prothrombotic because they express anionic phospholipids on their surface and can bind clotting factors and promote thrombin generation. Features of Heparin-Induced Thrombocytopenia Features Details Thrombocytopenia Platelet count of <100,000/,uL or a decrease in platelet count > 50% Timing Platelet count falls 5-10 days after staing heparin Type of heparin More common with unfractionated heparin than with low-molecular-weight heparin Type of patient More common in surgical patients than medical patients; more common in women than in men. Thrombosis Venous thrombosis more common than aerial thrombosis -### End" -6397,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a fundamental symptom of schizophrenia:-, with the following options: A: Autism, B: Automatism, C: Association defect, D: Ambivalence - -### Response: -Eugen Bleuler's well-known four A's of schizophrenia - These 4 A also known as fundamentals/ primary symptoms of schizophrenia 1. AUTISM - autistic thinking and behavior . it must not be confuse with childhood autism. 2. AMBIVALENCE - Coexistence of two opposing impulses toward the same thing in the same person at the same time. Seen in schizophrenia, borderline states, and obsessive- compulsive disorders (OCDs). 3. AFFECT DISTURBANCES - disturbance of emotions 4.ASSOCIATION DISTURBANCE - is a lack of logical connection between a sequence of thoughts. This lack of logical association is sometimes called knight's-move thinking (referring to the sudden change of direction of the knight in chess) -### End" -6398,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Who looks after the work of Anganwadi worker, with the following options: A: ANM, B: ASHA, C: Mukhya Sevika, D: Village health guide - -### Response: -Ref:Park's Textbook of Preventive and Social Medicine 25th Ed -### End" -6399,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inveogram is taken after -, with the following options: A: 2 hrs after bih, B: 4 hrs after bih, C: 6 hrs after bih, D: 8 hrs after bih - -### Response: -Ans. is 'c' i.e., 6 hrs 24 hrs is a better option. Both 6 hrs and 24 hrs were mentioned in Bailey's 24th edition, whereas 25th edition mentions only 24 hrs. Read the lines from 24th below. 24th edition- ""Six hours after bih, sufficient air may have collected in the large intestine to cast a radiographic shadow. With a metal button or a coin strapped to the site of the anus, the infant is held upside down and radiographed in the inveed position. .......................................................................... It may be necessary to wait until the baby is 24 hours old before rectal gas appears."" 25th edition- ""By 24 hours, the distal limit of air within the rectum, seen on a lateral prone radiograph, indicates the distance between the rectal stump and perineum"" -### End" -6400,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Warfarin induced skin necrosis is seen in ?, with the following options: A: Protein C deficiency, B: Protein S deficiency, C: Hemophillia, D: Antithrombin III deficiency - -### Response: -Ans. is 'a' i.e., Protein C deficiency o Warfarin - induced skin necrosis occurs in patients with undiagnosed protein C deficiency. -### End" -6401,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 54-year-old woman has a long history of chronic hepatitis B infection and has had increasing malaise for the past year. She was hospitalized 1 year ago because of upper gastrointestinal hemorrhage. Physical examination now shows a firm nodular liver. Laboratory findings show a serum albumin level of 2.5 g/dL and a prothrombin time of 28 seconds. Which of the following additional physical examination findings is most likely to be present in this woman?, with the following options: A: Caput medusae, B: Diminished deep tendon reflexes, C: Distended jugular veins, D: Papilledema - -### Response: -Cirrhosis with portal hypertension increases venous collateral flow in esophageal submucosal veins, producing varices, and in the abdominal wall, producing caput-medusae. Hyperreflexia, but not a diminution of deep tendon reflexes, can occur when hepatic encephalopathy develops from decompensated cirrhosis. Right-sided heart failure, in which the liver may be enlarged because of passive congestion, is associated with distended jugular veins. Liver failure with cirrhosis may lead to hepatic coma, but brain swelling with papilledema is not a major feature. The coagulopathy from decreased liver function may lead to purpuric hemorrhages, but splinter hemorrhages of the nails are the most characteristic of embolization from infective endocarditis. -### End" -6402,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false regarding dimorphic fungi?, with the following options: A: Occurs in two growth forms, B: Can cause systemic infection, C: Cryptococcus is an example, D: Coccidioides is an example - -### Response: -Ans. is 'c' i.e., Cryptococcus is an example(Ref: Ananthanarayan, 9th/e, p. 601, 609; Jawetz, 23rd/e, p. 645)Dimorphic Fungi* Fungi that have two growth forms, such as mold (filaments) and a yeast, which develop under different growth conditions.* In host tissues or cultures at 37degC they occur as yeasts, while in the soil and in cultures at 22degC they appear as moulds.* Most fungi causing systemic infections are dimorphic fungi.Examples:* Coccidioides.* Histoplasma.* Blastomyces.* Paracoccidioides.* Sporothrix (Sporotrichum).* Penicillium marneffi. -### End" -6403,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: P. Carni causes infection of primarily ?, with the following options: A: Rats, B: Mice, C: Humans, D: Rabbits - -### Response: -Ans. is 'a' i.e., Rats . Although the organisms within the pneumocystis genus are morphologically very similar, they are genetically diverse and host specific --> P jirovecii infects humans, where as Pcarinii infects rats. -### End" -6404,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: O2 carrying capacity of crystalloids & colloids is?, with the following options: A: More than whole blood, B: Equivalent to whole blood, C: More than packed RBCs, D: None - -### Response: -Ans is 'd' i.e. None* Colloids 8c crystalloids have no oxygen carrying capacity.Oxygen carrying resuscitation fluids* Only class of fluids that are able to carry oxygen are Blood Products. These are Cryoprecipitate and plasma protein factors (PPF), Fresh frozen plasma (FFP), and Packed red blood cells (PRBCs) and whole blood.* They pull fluid from extravascular space into intravascular space to increase plasma volume (plasma expanders). RBC products also carry oxygen to increase tissue oxygenation 8c they also increase body's supply of various products (such as clotting factors, hemoglobin).* Indications include -i) Cryoprecipitate and plasma protein factors (PPF) - Management of acute bleeding (greater than 50% slow blood loss or 20% acutely)ii) Fresh frozen plasma (FFP) - Increase clotting factor levels in patients with demonstrated deficiencyiii) Packed red blood cells (PRBCs) and whole blood - To increase oxygen-carrying capacity in patients with anemia and substantial hemoglobin deficits PRBCs are used for blood loss up to 25% of total blood volume & whole blood is used for blood loss over 25% of total blood volume. -### End" -6405,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Two siblings with ostegenesis imperfect, but their parents are normal. Mechanism of inheritance Is, with the following options: A: Anticipation, B: Genomic impriting, C: Germ line mosaicism, D: New mutation - -### Response: -Germline mosaicism, also called gonadal mosaicism, is a type of genetic mosaicism where more than one set of genetic information is found specifically within the gamete cells. Somatic mosaicism, a type of genetic mosaicism found in somatic cells, and germline mosaicism can be present at the same time or individually depending on when the conditions occur. When the mosaicism is only found in the gametes and not in any somatic cells, it is referred to as pure germline mosaicism. Germline mosaicism can be caused either by a mutation that occurs after conception, or by epigenetic regulation, alterations to DNA such as methylation that do not involve changes in the DNA coding sequence. A mutation in an allele acquired by a somatic cell early in its development can be passed on to its daughter cells, including those that later specialize to gametes. It can also be caused by a sporadic mutation in a gamete cell. If the germline mosaicism causing mutation occurs in the somatic cell, it never results in pure germline mosaicism because it will be present in somatic cells as well. -### End" -6406,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Psychiatric complications of alcohol dependence -a) Anxietyb) Suicidec) Depressiond) Schizophrenia e) Mania, with the following options: A: ab, B: bc, C: acd, D: abc - -### Response: -Psychiatric disorder associated with alcohol :- Anxiety disorders, depression, suicide, antisocial personality disorder, hallucination and paranoid delusions, amnestic syndrome, alcoholic dementia, psychosis, morbid (pathological) jealousy. -### End" -6407,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A neonate is found to have an imperforate anus. You recommend studies to search for other anomalies because infants with anorectal anomalies tend to have other congenital anomalies. Associated abnormalities include which of the following?, with the following options: A: Abnormalities of the cervical spine, B: Hydrocephalus, C: Duodenal atresia, D: Hea disease - -### Response: -Congenital anorectal anomalies are frequently associated with other congenital anomalies including hea disease; esophageal atresia; abnormalities of the lumbosacral spine; double urinary collecting systems; hydronephrosis; and communication between the rectum and the urinary tract, vagina, or perineum. They occur in approximately 1 in 2000 live bihs. Depending on the type of anomaly (whether the rectum ends above or below the level of the levator ash complex), a variety of surgical procedures has bean devised to treat the problem. However, even when anatomic integrity is established, the prognosis for effective toilet training is poor. In 50% of cases continence is never achieved, Cervical spine thnormalities, hydrocephalus, duodenal atresia, and corneal opacities have no significant association with congenital anorectal anomalies. -### End" -6408,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Auerbachs plexus is present in the -, with the following options: A: Colon, B: Esophagus, C: Stomach, D: All of the above - -### Response: -All of the above -### End" -6409,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following causes both cutaneous and respiratory diphtheria, with the following options: A: Corynebacterium diphtheria, B: Corynebacterium ulcerans, C: Corynebacterium xerosis, D: Corynebacterium hoffmanii - -### Response: -C.diptheria causes both cutaneous and respiratory diphtheria. In the tropics, diphtheria bacilli infect the skin more than the respiratory tract. toxigenic diphtheria persists in the skin over three years. Cutaneous infections are secondary to pre-existing skin lesions. Ref: Textbook of microbiology; Ananthanarayan and paniker's; Pg 241; 10th Edition -### End" -6410,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least common site of volvulus in children, with the following options: A: Midgut, B: Small bowel, C: Ileocolic, D: Large bowel - -### Response: -VolvulusIt's twisting of a segment of the intestine on the axis formed by its mesentery, results in paial or complete bowel obstruction.It's the second most common cause for complete colonic obstruction after Ca colon and most commonly involved site is sigmoid colon> cecal volvulus> transverse colon> splenic flexureOn a plain film, volvulus is seen asInveed U shaped loop / bent inner tube/coffee bean appearanceHaustra is absent. The apex of the loop lies near the left diaphragmGastrograffin enema shows bird of prey sign or bird's beak appearanceManagement includes endoscopic decompression and detorsion, effective sigmoid colectomy is done to prevent recurrence(Refer: Sabiston's Textbook of Surgery, 19th edition, pg no: 1314-1315) -### End" -6411,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hydatidiform -- mole is characterized histologically by :, with the following options: A: Hyaline membrane degeneration, B: Hydropic degeneration of the villous stroma, C: Non proliferation of cytotrophoblast, D: Non proliferation of syncytiotrophoblast - -### Response: -Hydropic degeneration of the villous stroma -### End" -6412,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pacemaker regulating the rate of respiration:, with the following options: A: Pneumotaxic center, B: Dorsal group of nucleus, C: Apneustic center, D: Pre Botzinger complex - -### Response: -Pacemaker of respiration is Pre-Botzinger complex of neurons, which is a part of Ventral Respiratory Group(VRG) in medulla. -### End" -6413,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with hepatomegaly and bilateral lenticular opacities. Which of the following enzyme deficiency will NOT cause such features?, with the following options: A: Galactose-1 -phosphate uridyl transferase, B: UDP-galactose-4-epimerase, C: Galactokinase, D: Lactase - -### Response: -Inability to metabolize galactose occurs in the galactosemias, which may be caused by inherited defects of galactokinase, uridyl transferase, or 4-epimerase, though deficiency of uridyl transferase is best known. Galactose is a substrate for aldose reductase, forming galactitol, which accumulates in the lens of the eye, causing cataract. Ultimately, liver failure and mental deterioration result. Ref: Bender D.A., Mayes P.A. (2011). Chapter 21. The Pentose Phosphate Pathway & Other Pathways of Hexose Metabolism. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. -### End" -6414,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Epidemic typhus except, with the following options: A: Also known as Flea born typhus, B: Causative agent is Rickettsial prowazekki, C: Vector - Louse, D: Tetracycline is drug of choice - -### Response: -Rickettsial diseases Diseases Rickettsial agent Insect vectors Mammalian reservoirs 1. Typhus group a. Epidemic typhus b. Murine typhus c. Scrub typhus R. prowazekii R. typhi R. tsutsugamushi Louse Flea Mite Humans Rodents Rodents 2. Spotted fever group a. Indian tick typhus b. Rocky mountain spotted fever c. Rickettsial pox R. conorii R. rickettsii R. akari Tick Tick Mite Rodents, dogs Rodents, dogs Mice 3. Others a. Q fever b. Trench fever C. burnetii Rochalimaea quintana Nil Louse Cattle, sheep, goats Humans Also serve as ahropod reservoir, by maintaining the rickettsiae through ovarian transmission Murine typhus is also known as Endemic typhus or Flea typhus -### End" -6415,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a feature of pilonidal sinus?, with the following options: A: Common is young males, B: Abscess formation, C: Jack knife position is used for surgery, D: Recurrance is not common - -### Response: -Recurrance is common in pilonodal sinus. -### End" -6416,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypogammaglobenemia causes?, with the following options: A: Chronic recurrent sinusitis, B: Epistaxis, C: Contractures, D: Eczemia - -### Response: -Repeated question -### End" -6417,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type II A is associated with all of the following, EXCEPT, with the following options: A: Normal Anion Gap Acidosis, B: Hyper calciuria, C: Decreased urinary citrate, D: Minimum urinary pH < 5.5 - -### Response: -Answer is C (Decreased Urinary citrate) Type II A is associated with normal or increased urinary citrate `Urine citrate levels are normal or high because of reduced proximal tubular reabsorption of citrate' -- Harrisons -### End" -6418,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Objectives of cleaning and shaping are all except:, with the following options: A: Sufficient space should be created for intracanal medicaments and irrigants., B: To aid in condensation of inert filling material., C: Should keep the apical foramen as small as possible., D: None of the above - -### Response: -Schilder objectives of cleaning and shaping of root canals: -a) Mechanical objectives: -• Continuous tapering canal shape, with the narrowest cross-sectional diameter apically and the widest diameter coronally. -• Walls should taper evenly towards apex -• To give the prepared root canal the quality of flow. -• Should keep the apical foramen as small as practical. -  -b) Biologic objectives: -• To debride and disinfect root canal system -• Necrotic debris should not be forced periapically -• Sufficient space for intracanal medicaments and irrigants should be created. -### End" -6419,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Flumazenil false is ?, with the following options: A: It is a specific antagonist of BZD, B: It may be used in barbiturate poisoning as it acts on the same receptor GABAA, C: Given intravenously, D: Acts on GABAA receptor - -### Response: -Ans. is 'b' i.e., It may be used in barbiturate poisoning as it acts on the same receptor GABAA Flumazenil is specfic antagonist of BZDs. i.e., it acts on BZDs binding site of GABAA receptors, which is different from Baributurate binding site. Therefore, flumazenil does not antagonize barbiturates not effective in barbiturates poisoning. -### End" -6420,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AFP is raised in-, with the following options: A: Yolk sac tumor, B: Seminoma, C: Teratoma, D: Choriocarcinoma - -### Response: -Harshmohan textbook of pathology 7th edition. *seminoma malignant tumor of testes-it is associated with elevated hCG level in blood. *choriocarcinoma- hCG level increases in blood. *yolk sac tumor/endodermal sinus tumor -alphafetoprotien increases. -### End" -6421,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Man is the primary host for which poxvirus?, with the following options: A: Monkey pox, B: Orf, C: Tanapox, D: Molluscum contagiosum - -### Response: -Ans. is 'd' i.e., Molluscum contagiosum (Ref: Ananthanarayan, 8th/e, 461)* Pox viruses affecting primarily human are Variola, Vaccinia and Molluscum contagiosum.* Monkey pox - Its primary host are rodents.* Orf - Its primary host is Sheep - Human infections are rare.* Tanapox - Its primary host are Monkeys - Human infections are rare. -### End" -6422,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following aery is most common to undergo atherosclerotic changes leading to coronary aery disease ?, with the following options: A: Right coronary aery, B: Left anterior descending coronary aery, C: Left circumflex coronary aery, D: Left main coronary aery - -### Response: -Left anterior descending coronary aery(40-50%) is most commonly involved in CAD, followed by Right coronary aery (30-40%)then Left Circumflex coronary aery (15-20%). -### End" -6423,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The highest degree of pain localization comes from which of the following?, with the following options: A: Simultaneous stimulation of free nerve endings and tactile fibers, B: Stimulation of free nerve endings by bradykinin, C: Nerve fibers traveling to the thalamus by way of the paleospinothalamic tract, D: Stimulation of d-type A fibers - -### Response: -In general, the sensation of pain is poorly localized. However, when a tactile receptor and a pain receptor are stimulated simultaneously, the pain sensation is localized with greater accuracy. -### End" -6424,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common mode of lead poisoning, with the following options: A: Ingestion, B: Dermally, C: Inhalation, D: Through conjuctiva - -### Response: -Ans. is 'c' i.e., Inhalation Lead poisoning (plumbism) may occur in 3 ways : ? 1) Inhalation - Most cases of industrial lead poisoning is due to inhalation of fumes and dust of lead or its compounds. 2) Ingestion - Small quantities of lead trapped in the upper respiratory tract may be ingested. Contaminated hands may also lead to ingestion. 3) Skin - Only organic lead (e.g., tetraethyl lead) is absorbed dermally. -### End" -6425,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rademaker complex in EEG is seen in:, with the following options: A: SSPE, B: vCJD, C: CJD, D: Kuru - -### Response: -Characteristic periodic activity (Rademaker complex) is seen on EEG showing widespread coical dysfunction in SSPE. It is characterised by high voltage spike occurring at high frequency of 0.5 -1.5 seconds. Pathologically, the white matter of both the hemispheres and brainstem are affected, as well as the cerebral coex, and eosinophilic inclusion bodies are present in the nuclei of neurons and oligodendrocytes. Extra edge Diagnosis of SSPE is made by clinical course and at least 1 of the following findings: A. Measlesantibody detected in CSF B. CharacteristicEEGfindings called Rademaker complex. C. Typical histologic findings or isolation of virus or viral antigen inbrain tissueobtained bybiopsyor postmoem examination. D.CSF analysisreveals elevated IgG and IgMantibodytiters in dilutions of > 1:8. -### End" -6426,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chromosome make up of tall individual with criminal behavior:, with the following options: A: XXY, B: XYY, C: XXXY, D: XXYY - -### Response: -B i.e. XYYRef: Kaplan and Saddock's Comprehensive Textbook of Psychiatry and Ahuja-Textbook of PsychiatryExplanation:XYY is a condition characterized by 47, XYY karyotype affecting males.Around 1 in 1,000 boys are born with a 47, XYY karyotype.These boys have increased growth velocity. They have above average height.Some of them might have learning disabilities.Some of them might have aggressive behavior.Criminal behavior is noted in few studies, though recent evidence disputes the claim. -### End" -6427,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by, with the following options: A: ECHO, B: ECG, C: Radionucletide Scan, D: Endomyocardial Biopsy - -### Response: -D i.e. Endomyocardial Biopsy and CT cause fibrosis; which can be best diagnosed by seeing the tissue under microscope Endomyocardial Biopsy.Q IInd best answer is Radionucleotide scanQ. -### End" -6428,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 24-year-old woman's urinalysis is positive for blood on dipstick measurement. This is repeated twice between menstrual periods and it remains positive. Microscopic evaluation reveals RBCs, some of which are deformed and some in the form of casts. Which of the following is the most likely cause of the hematuria?, with the following options: A: urinary tract stones, B: GN, C: trauma, D: benign renal tumor - -### Response: -The finding of red cell casts or dysmorphic red cells (best appreciated by phase microscopy) suggests the source of bleeding is glomerular in origin. Isolated hematuria is usually of urologic cause (eg, tumor, trauma, stone) but can also be of glomerular in origin. -### End" -6429,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a characteristic feature of chronic myeloid leukemia (CML)?, with the following options: A: Auer rods, B: Basophilia, C: Increased LAP score, D: Bone marrow fibrosis - -### Response: -Characteristic features of CML are massive splenomegaly, hyperleucocytosis, peripheral blood Basophilia & Philadelphia Chromosome/ t(9;22). -### End" -6430,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 44 year old man complaints of abdominal distention and nausea since few months. USG of abdomen shows a growth on right lobe of the liver. Tumor marker study shows the evidence of primary hepatocellular carcinoma. All of the following tumor markers will be raised in this patient, EXCEPT:, with the following options: A: Alpha fetoprotein, B: Alpha 2 macroglobulin, C: PIVKA-2, D: DCP - -### Response: -AFP is a serum tumor marker for HCC; however, it is only increased in approximately one-half of patients. The lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) assay is thought to be more specific. The other widely used assay is that for des-gamma-carboxy prothrombin (DCP), a protein induced by vitamin K absence (PIVKA-2). Many other assays have been developed, such as glypican-3, but none have greater aggregate sensitivity and specificity. Ref: Carr B.I. (2012). Chapter 92. Tumors of the Liver and Biliary Tree. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e. -### End" -6431,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of endonucleases:, with the following options: A: Cut DNA at specific DNA sequences, B: To point out the coding regions, C: Enhancers, D: To find out antibiotic resistance - -### Response: -Ans. A. Cut DNA at specific DNA sequences(Ref: Harper 31/e page433)Restriction endonuclease cut DNA at specific palindromic sites.These enzymes are isolated from bacteria.They restrict the entry of phages into the bacteria. -### End" -6432,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DENOSUMAB a monoclonal antibody against RANKL receptor is used in the treatment of, with the following options: A: Rheumatoid arthritis, B: Osteoporosis, C: Osteoarthritis, D: SLE - -### Response: -Ans. is 'b' i.e. Osteoporosis Osteoclast is a cell responsible for bone resorption.Osteoclasts express RANK receptors on its surface (RANK receptor activator for nuclear factor)When RANK receptor combine with their ligands (RANKL), osteoclastogenesis is a initiated and bone resorption occurs.Denosumab is a fully humanized monoclonal antibody against RANK ligand.It prevents the activation of the osteoclasts by these ligand.Note:Osteoporosis is a disease characterized by decrease in the bone massIn osteoporosis there is increase in the osteoclast activity and there is increased expression of RANK and RANKL. -### End" -6433,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: magnocellularr and parvocellular neurons project to ?, with the following options: A: layer 2 of visual coex, B: layer 4 and 4c of visual coex, C: layer 6 and 1 of visual coex, D: layer 2 and 3 of visual coretx - -### Response: -ref : guyton and hall -### End" -6434,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Barrett oesophagus can result from, with the following options: A: H. Pylori infection, B: H. Simplex infection, C: Gastroesophagal reflux, D: Varices - -### Response: -Refer Robbins page no p 957 Barrett esophagus is a complication of chronic GERD that is characterized by intestinal metaplasia within the esophageal squamous mucosa. The incidence of Barrett esophagus is rising, and it is estimated to occur in as many as 10% of individuals with symptomatic GERD. Barrett esophagus is most common in white males and typically presents between 40 and 60 years of age. The greatest concern in Barrett esophagus is that it confers an increased risk of esoph- ageal adenocarcinoma. Genomic sequencing of biopsies involved by Barrett esophagus has revealed the presence of mutations that are shared with esophageal adenocarci- noma, in keeping with the idea that Barrett esophagus is a precursor lesion to cancer. Potentially oncogenic mutations are more numerous when biopsies demonstrate dysplasia, which is detected in 0.2% to 2% of persons with Barrett esophagus each year. The presence of dysplasia, a prein- vasive change, is associated with prolonged symptoms, longer segment length, increased patient age, and Caucasian race. Although the vast majority of esophageal adenocar- cinomas are associated with Barrett esophagus, it is impor- tant to remember that most individuals with Barrett esophagus do not develop esophageal tumors. -### End" -6435,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Home bleach is also called as:, with the following options: A: Walking bleach, B: Thermocatalytic bleach, C: Power bleach, D: All of the above - -### Response: -Commonly used solutions for nightguard bleaching/home bleaching/walking bleach: - -10% carbamide peroxide with or without carbopol -15% carbamide peroxide -Hydrogen peroxide (1–10%) - -Indications for home bleaching/night guard bleaching  - -Mild generalized staining -Age-related discolorations -Mild tetracycline staining -Mild fluorosis -Acquired superficial staining -Stains from smoking tobacco -Color changes related to pulpal trauma or necrosis -### End" -6436,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not a radiological feature of rickets, with the following options: A: Splaying of metaphysis, B: Cupping of metaphysis, C: Subluxation of epiphysis, D: Widening of metaphysis - -### Response: -Ans. c (Subluxation of epiphysis) (Ref. RRM 6th ed., 156)RICKETS# Faulty mineralization of the bone before the fusion of growth plate, i.e., during enchondral bone growth, is known as RICKETS.# Histo: zone of maturation has an increase in number of maturing cartilage cells with loss of normal columnar arrangement; zone of preparatory calcification does not form; failure of osteoid mineralization also in shafts so that osteoid production elevates periosteum.# Location: Metaphyses of long bones subjected to stress are particularly involved (wrist, ankles, knees)# X-rav features:- Widening and lengthening of growth plate (zone of provisional calcification affected) is earliest radiographic feature of rickets.- Reaction of periosteum may occur - - Indistinct cortex - Coarse trabeculation - Knees + wrists + ankles mainly affected - Rickets- Epiphyseal plates widened + irregular - Tremendous metaphysis (fraying, splaying, cupping) - Spur (metaphyseal) - Additional features: --- * Bowing of long bones* Genu recurvatum* At costochondral junction, epiphyseal widening results in typical 'rachitic rosary'* Frontal bossing* Scoliosis* Slipped capital femoral epiphysis* Triradiate pelvis* Basilar invaginationEducational point:D/d of Frayed Metaphyses# Congenital infections (rubella, syphilis)# Hypophosphatasia # Achondroplasia # RicketsMnemonic: CHARMS# Metaphyseal dysostosis # Scurvy The radiological features of scurvy1)Spurs (Pelkan Spur)Metaphyseal spurs projecting at right angles to axis of shaft2)Subperiosteal hemorrhagesDiaphyseal subperiosteal hematoma with calcification of elevated periosteum is the sure sign of healing (woody-leg)3)Cortical thinning""Pencil-thin"" cortex4)Corner sign of ParkeSubepiphyseal infarction or comminution causing mushrooming or cupping of epiphysis5)5)OsteoporosisCharacteristically ""ground-glass"" osteoporosis6)Rarefaction zone of TrummerfeldMetaphyseal radiolucent zone on shaft side7)White line of FrankelMetaphyseal zone of provisional/preparatory calcification also seen in lead or phosphorus or bismuth poisoning and in healing rickets8)Wimberger's signSclerotic ring seen around the low-density osteopenic epiphysis -### End" -6437,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about AJCC staging of oral cavity carcinoma -a) Involvement of pterygoid plate in stage T3 b) Involvement of pterygoid plate in stage T4 c) Involvement of lateral pterygoid muscle in stage T4 d) Involvement of medial pterygoid muscle in stage T3, with the following options: A: a, B: c, C: ac, D: bc - -### Response: -The 'T' classification is specific to different sites of origin. -I am going to mention 'T' classification of the oral cavity and oropharynx, as anterior two third of the tongue lies in oral cavity and the base of the tongue in the oropharynx. -Oral cavity consists of the lip, floor of the mouth, oral tongue (anterior 2/3 of tongue), buccal mucosa, upper and lower gingiva, hard palate and retromolar trigone. -Oropharynx includes the base of the tongue, the tonsillar region (tonsillar fossa and tonsillar pillars), the so palate, and the pharyngeal wall between the pharyngoepiglottic fold and the nasopharynx. -### End" -6438,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hormonal levels in PCOD :, with the following options: A: LH decreases, B: LH increases, FSH increases, C: Insulin decreases, D: Testosterone increases - -### Response: -Hormones increased in PCOS : 1.Androgens(testosterone,Androstenodione,DHEAS) 2.Luteinizing hormone(LH>10IUml) 3.Estrogen(Estrone>Oestradiol,increased E2/E1 ratio) 4. Insulin (10m IU/L due to insulin resistance) 5.Prolactin (in some patients) 6.increased LDL/cholesterol and triglycerides. Hormones which decreases in PCOS : 1.Follicle stimulating hormone(FSH) 2.Progesterone 3.Sex hormone binding Globulin. 4.HDL and Apoprotein A-I. Shaw's Textbook of Gynaecology, 16th edition page 432 -### End" -6439,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are unique features of WHO growth chas 2006 except, with the following options: A: Breast fed infants as normative growth model, B: Sample collection from 6 states in the US, C: Includes new indicators such as skinfold thickness, D: Reiterates children grow similarly all over the world. - -### Response: -WHO growth chas are based on multicentre growth reference study( MGRS) conducted in 6 countries all over the world. Brazil Norway Ghana Oman US India Ref: Nelson's ,20th edition, Page 84-89 -### End" -6440,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malarial pigment is formed by:, with the following options: A: Parasite, B: Bilirubin, C: Hemoglobin, D: Any of the above - -### Response: -Ans. is 'c' i.e., Hemoglobin(Ref: Parasitology, Panicker, 6th/e, p. 71)* The malarial parasite (plasmodium) feeds on the haemoglobin of the erythrocyte. Haematin globin pigment - Haemoglobin left behind as a residue after metabolism of parasite.* These iron containing pigments formed from haemoglobin accumulate in the body of the parasite as dark granules, which becomes more prominent, as the parasite grows.* The appearance of malaria pigments varies in the different species.# P. vivax - Yellowish brown# P. falciparum - Dark brown# P. malariae - Dark brown# P. ovale - Yellowish brownNote: The malaria pigment released when the parasitized cells rupture is taken up by reticuloendothelial cells. Such pigment laden cells in the internal organs provide histological evidence of previous malarial infection. -### End" -6441,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following forms of thyroid hormone is most readily found in the circulation?, with the following options: A: Tri-iodothyronine (T3)., B: Thyroxine (T4)., C: Thyroglobulin., D: TSH. - -### Response: -Thyroxine and triiodothyronine are formed by the cleavage of thyroglobulin following stimulation by TSH. Most thyroxine is converted to triiodothyronine in liver and kidney. Thyroglobulin is the storage form of thyroid hormone. TSH (thyroid-stimulating hormone) is produced in the anterior pituitary. It is not a hormone secreted from the thyroid but acts to stimulate the synthesis and secretion of thyroid hormones. -### End" -6442,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common organism, responsible for pseudomembranous colitis is:, with the following options: A: Clostridium difficile, B: Clostridium botulism, C: Clostridium bifermentans, D: Clostridium histolyticum - -### Response: -Pseudomembranous colitis refers to swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridium difficile (C. difficile) bacteria.  -This infection is a common cause of diarrhea after antibiotic use. -### End" -6443,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Familial amyloidotic polyneuropathy is due to amyloidosis of nerves caused by deposition of :, with the following options: A: Amyloid associated protein, B: Mutant Calcitonin., C: Mutant transthyretin, D: Normal transthyretin - -### Response: -. Mutant transthyretin -### End" -6444,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Signet ring sign is seen in: March 2013 (b, d), with the following options: A: Blastomycosis, B: Bronchogenic carcinoma, C: Invasive aspergillosis, D: Bronchiectasis - -### Response: -Ans. D i.e. Bronchiectasis Signet ring sign The signet ring sign is a CT finding seen in patients with Bronchiectasis The ring of soft-tissue attenuation represents the wall of the dilated bronchus seen on a cross-sectional CT scan, whereas the low-attenuating circle of air represents air within the dilated bronchus. The circle of soft-tissue attenuation abutting the ring represents a cross-sectional image of the pulmonary aery that lies adjacent to the dilated bronchus. -### End" -6445,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Case finding in RNTCP is based on-, with the following options: A: Sputum culture, B: Sputum microscopy, C: X-ray chest, D: PCR antibody detection - -### Response: -Ans. is 'b' i.e. Sputum microscopy o Sputum smear examination by direct microscopy is the method of choice for case detection.o Two sputum samples are collected.Day 1sample 1Patient provides an ""on-the-spot"" sample under supervision when presenting to the health facility. Give the pateient a sputum container to take home for an early moring sample the following morning.Day 2sample 2Patient brings an early morning sampleo It any of the two samples or both samples are positive, case is diagnosed as smear-positive TB and anti-TB treatment is started. -### End" -6446,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All IgG are responsible are coagglutination by bind to S.Aureus protein-A except, with the following options: A: IgG1, B: IgG2, C: IgG3, D: IgG4 - -### Response: -IgG3 not responsible for Coagglutination. -### End" -6447,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glycogen storage disorder is-, with the following options: A: Niemann - Pick disease, B: Gaucher disease, C: Tay- Sacks disease, D: Pompe's disease - -### Response: -Glycogen storage disease type II, also called Pompe disease, is an autosomal recessive metabolic disorder which damages muscle and nerve cells throughout the body. It is caused by an accumulation of glycogen in the lysosome due to deficiency of the lysosomal acid alpha-glucosidase enzyme. It is the only glycogen storage disease with a defect in lysosomal metabolism, and the first glycogen storage disease to be identified,The disease is caused by a mutation in a gene (acid alpha-glucosidase: also known as acid maltase) on long arm of chromosome 17.Most cases appear to be due to three mutations. A transversion (T - G) mutation is the most common among adults with this disorder. This mutation interrupts a site of RNA splicing.The gene encodes a protein--acid alpha-glucosidase (EC 3.2.1.20)--which is a lysosomal hydrolase. The protein is an enzyme that normally degrades the alpha -1,4 and alpha -1,6 linkages in glycogen, maltose and isomaltose and is required for the degradation of 1-3% of cellular glycogen. The deficiency of this enzyme results in the accumulation of structurally normal glycogen in lysosomes and cytoplasm in affected individuals.clinical features: Accumulation of glycogen in lysosomes: Juvenile onset variant, muscle hypotonia, death from hea failure by age 2; adult onset variant, muscle dystrophy -### End" -6448,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following marker is used to assess the monoclonality in T-cells -, with the following options: A: Kappa and Lambda chain, B: TCR gene rearrangement, C: CD, D: CD34 - -### Response: -Molecular analysis of the rearrangement in T cell population can distinguish polyclonal lymphocyte proliferations from monoclonal expansions. Reference :Robbins basic pathology 9th edition pg no 100: -### End" -6449,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In an 8 yr old girl with symptoms of rickets, lab investigations show Serum Calcium 7.2 mg/dl, Serum Phosphates 2.3 mg/dl Alkaline Phosphatase 2420 IU/L. The most probable diagnosis is?, with the following options: A: Vitamin D dependant type II, B: Hypophosphatemic Rickets, C: Nutritional Rickets, D: Secondary Hyperparathyroidism - -### Response: -ANSWER: (C) Nutritional RicketsREF: Nelson 17th edition page 2342 Table 691-2Table 691-2 Clinical variants of Rickets and Related ConditionsTypeSerum calcium LevelSerumPhosphorusLevelAlkaline Phosphatase ActivityUrine Concentration of Amino AcidsGeneticsI. Calcium deficiency with secondary hyperparathyroidism (deficiency of vitamin D; low 25(OH) D and no stimulation of higher 1,25 (OH)2 D values)1. Lack of vitamin D a. Lack of exposure to sunlighN orLLE E b. Dietary deficiency of vitamin in DN orLLEE c. CongentialN or LLEE 2. Malabsorption of Vitamin DN or LLEE 3. Hepatic diseaseNorLLEE 4. Anticonvulsive drugsN or LLEE 5. Renal osteodystrophyN or LEEV 6. Vitamin D-dependent type ILN or LE EARII. Primary phosphate deficiency (no secondary hyperparathyroidism)1. Genetic primary hypophosphatemiaNLENXD2. Fanconi syndrome a. CystinosisNLEEARb. TyrosinosisNLEEARc. Lowe syndromeNLEEXRd. AcquiredNLEE 3. Renal tubular acidosis, type II proximalNLEN 4. Oneogenic hypophosphatemiaNLEN 5. Phosphate deficiency or malabsorption a. Parenteral hyperalimentationNLEN b. Low phosphate intakeNLEN III. End-organ resistance to 1.25(OH)2 D31. Vitamin D-dependent type II (Several variants)LL or NEEARIV. Related conditions resembling rickets1. HypophosphatasisNNLPhosphoet- hanolamine AR elevated 2. Metaphyseal dysostosis a. Jansen typeENENADb. Schmid typeNNNNADN = normal; L = low; E = elevated; V = variable; X = X-linked; A = Autosomal; D = dominant; R = recessive; Yes = Y.Rickets may be classified as calcium-deficient or phosphate-deficient rickets. The two types of rickets are distinguishable by their clinical manifestations (Table 691-2)In this case Serum Ca levels are low; Phosphate levels are low, while ALP levels are high. -### End" -6450,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fouth stage of labour i.e. observation of patient after delivery of placenta is defined as period of___________after delivery:, with the following options: A: 1 hour, B: 2 hour, C: 3 hour, D: 4 hour - -### Response: -1 hour -### End" -6451,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are TRUE about the middle ear, EXCEPT:, with the following options: A: The joints between ossicles are synol, B: The chorda tympani nerve is related to the lateral wall, C: The facial nerve passes in a canal situated in the medial and anterior walls, D: The auditory tube connects the nasopharynx with the anterior wall - -### Response: -The facial nerve passes in a canal situated in the posterior and medial walls of the middle ear. It is not associated with the anterior wall. -### End" -6452,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One gram of smokeless gunpowder produces: Karnataka 11, with the following options: A: 3000-4000 cc of gas, B: 9000-10,000 cc of gas, C: 12,000-13,000 cc of gas, D: 15,000-16,000 cc of gas - -### Response: -Ans. 12,000-13,000 cc of gas -### End" -6453,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following enzyme is responsible for respiratory burst in neutrophils?, with the following options: A: NADPH oxidase, B: Dehydrogenase, C: Peroxidase, D: Catalase - -### Response: -When stimulated by contact with bacteria, neutrophils exhibit a respiratory burst and produce superoxide in a reaction catalyzed by NADPH oxidase. Also know: Superoxide (, hydrogen peroxide (H2O2), peroxyl radicals (ROO*), and hydroxyl radicals (OH*) and are referred to as reactive oxygen species (ROS). Superoxide is formed in the red blood cell by the autoxidation of hemoglobin to methemoglobin; in other tissues, it is formed by the action of enzymes such as cytochrome P450 reductase and xanthine oxidase. Superoxide can release iron ions from ferritin. Ref: Murray R.K. (2011). Chapter 52. Red & White Blood Cells. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. -### End" -6454,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Autoantibody specific for SLE -, with the following options: A: ds DNA, B: Anti RO, C: Anticentromere, D: Anti topoisomerse - -### Response: -Ans. is 'a' i.e., ds DNA Antinuclear antibodies in SLEo Systemic lupus erythematosus is characterized by bewildering array of autoantibodies, particularly antinuclear antibodies.o The antibodies are directed against an array of nuclear and cytoplasmic components of the cell, in addition a third group of antibodies is directed against cell surface antigen of group cells,o The existence of seemingly limitless number of antibodies in patients against self-constituents indicate that the fundamental defect in SLE is a failure of the mechanism that maintain self-tolerance.o ANA is positive in virtually every patient of SLE, hence this test is sensitive but is not specific because patients with other autoimmune diseases are also positive.o Of the numerous antinuclear antibodies, antibodies to double stranded DNA and the antibodies, to (Smith) antigen are virtually diagnosis of SLEQ.o Presence of abtibodies to antismith and anti double stran ded DNA is virtually diagnostic of SLE.o The best serening test for SLE is demonstration of antinuclear antibodies.o Most sensitive antibody test for SLE - Antinuclear antibody test for SLE.o Afost specific antibody test for SLE - Anti ds DNA and Anti Sm antibodyo Antibody associated with drug induced SLE - Antihistone antibodyAutoantibodies in Systemic Lupus Ery thematosus (SLE! Prevalence Antibody%Antigen RecognizedClinical Utilityo Antinuclear antibodies98Multiple nuclearBest screening test; repeated negative tests make SLE unlikelyo Anti-ds DNA70DNA (double-stranded)High titers are SLE-specific and in some patients correlate with disease activity, nephritis, vasculitiso Anti-Sm25Protein complexed to 6 species of nuclear U1 RNASpecific for SLE; no definite clinical correlations; most patients also have anti-RNP; more common in blacks and Asians than whiteso Anti-RNP40Protein complexed to U1 RNAyNot specific for SLE; high titers associated with syndromes that have overlap features of several rheumatic syndromes including SLE; more common in blacks than whiteso Anti-Ro (SS-A)30Protein complexed to hY RNA, primarily 60 kDa and 52 kDaNot specific for SLE; associated with sicca syndrome, predisposes to subacute cutaneous lupus, and to neonatal lupus with congenital heart block; associated with decreased risk for nephritis -o Anti-La (S3-B)1047-kDa protein com- plexed to hY RNAUsually associated with anti-Ro; associated with decreased risk for nephritiso Antihistone70Histones associated with DNA (in nucleo-some, chromatin)More frequent in durg-induced lupus than in SLEo Antiphospholipid50Phospholipids, b2 glycoprotein 1 cofac- tor prothrombinThree tests available - ELISAs for cardiolipin and b2G1, sensitive prothrombin time (DRVVT); predisposes to clotting, fetal loss, thrombocytopeniao Antierythrocyte60Erythrocyte membraneMeasured as direct Coombs' test; a small proportion develops overt hemolysiso Antiplatelet30Surface and altered cytoplasmic antigens on plateletsAssociated with thrombocytopenia but sensitivity and specificity are not good; this is not a useful clinical testo Anti neuronal (includes anti-glutamate receptor!60Neuronal and IvmphoIn some series a positive test in CSF correlates with cyte surface antigens active CNS lupuso Antiribosomal P20Protein in ribosomesIn some series a positive test in serum correlates with depression or psychosis due to CNS lupus -### End" -6455,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50 year old handicraft lady presented with numbness and weakness of the right hand. On examination, there was atrophy of the thenar eminence and and hypoaesthesia in the area. Compression of which of the following nerve could explain the presentation?, with the following options: A: Ulnar Nerve, B: Radial Nerve, C: Axillary Nerve, D: Median Nerve - -### Response: -Median nerve innervates the thenar muscles and the skin over it. The likely condition is Carpal Tunnel Syndrome. -### End" -6456,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are true of haemorrhoids except ?, with the following options: A: They are aeriolar dilatations, B: They are common causes of painless bleeding, C: They cannot be per rectally palpated, D: They can be banded - -### Response: -Ans. is 'a' i.e., They are aeriolar dilatations -### End" -6457,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A head injured patient, who Opens eyes to painful is confused and localizes to pain. What is his Glassgow coma Score, with the following options: A: 7, B: 9, C: 11, D: 13 - -### Response: -Harrison's principles of internal medicine 17th edition *Glasgow coma score eye opening 4-spontaneous,3- verbal stimuli, 2- painful stimuli,1-no response ( nonintubated). 5- oriented and talks, 4- disoriented and talks,3-inappropriate words,2- incomprehensible sounds,1-no response verbal(intubated). 5- seems able to talk,3- questionable ability to talk,1-generally unresponsive activity. 6- verbal command,5- localises to pain,4-withdraws to pain,3- decoicate,2- decerebrate,1-no response -### End" -6458,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Alzheimer's disease, the characteristic lesion is seen in, with the following options: A: Amygdaloid complex, B: Nucleus of Meynert, C: Basal ganglia, D: Periventricle - -### Response: -(B) Nucleus of Meynert # Pathology in Alzeihmer's disease:> The most severe pathology is usually found in the hippocampus, temporal cortex, and nucleus basalis of Meynert (lateral septum).> The most important microscopic findings are neuritic ""senile"" plaques and NFTs.> These lesions accumulate in small numbers during normal aging of the brain but occur in excess in AD.> Neuritic plaques contain a central core that includes A p amyloid, proteoglycans, Apo E4, a1 antichymotrypsin, and other proteins.> A amyloid is a protein of 39 to 42 amino acids that is derived proteolytically from a larger transmembrane protein, amyloid precursor protein (APP), which has neurotrophic and neuroprotective activity.> The normal function of A p amyloid is unknown.> Soluble amyloid fibrils may represent the initial pathologic event in AD leading to formation of neuritic plaques.> The plaque core is surrounded by the debris of degenerating neurons, microglia, and macrophages.> The accumulation of amyloid in cerebral arterioles, termed amyloid angiopathy, may lead to cerebral lobar hemorrhages. -### End" -6459,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is not true regarding fibrolamellar carcinoma?, with the following options: A: Seen in young adults, B: Better prognosis than HCC, C: Associated with HBV infection, D: Elevated AFP is not seen - -### Response: -Unlike HCC, fibrolamellar Ca is not associated with HBV infection. Fibrolamellar carcinoma characteristically manifests as a large hepatic mass in adolescents or young adults. Most patients present in the 2nd or 3rd decade of life. Cirrhosis; elevated a-fetoprotein levels; and typical risk factors for hepatocellular carcinoma such as viral hepatitis, alcohol abuse, and metabolic disease are typically absent. -### End" -6460,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following immunohistochemical markers are positive in the neoplotic cells of granulocytic sarcoma, EXCEPT:, with the following options: A: CD 45 RO, B: CD 43, C: Myeloperoxidase, D: Lysozome - -### Response: -A variety of markers for myeloid precursors in granulocytic sarcoma are identified. CD43, lysozyme, myeloperoxidase and CD 15 are the most sensitive markers staining a large propoion of the cells of the majority of well-differentiated tumors. CD 45 RO is not mentioned as a immunohistochemical marker of granulocytic sarcoma. Ref: Manual of Diagnostic Antibodies For Immunohistology By Anthony Siew-Yin Leong, Kumarasen Cooper, F. Joel W.-M. Leong, 2002, Page 339. -### End" -6461,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurofibrillary tangles are associated with: March 2007, with the following options: A: Bipolar disorder, B: Alzheimer's disease, C: Schizophrenia, D: Multiple infarctions - -### Response: -Ans. B: Alzheimer's Disease Neurofibrillary tangles were first described by Alois Alzheimer in one of his patients suffering from the disorder now referred to as Alzheimer's disease. Neurofibrillary tangles are pathological protein aggregates found within neurons in cases of Alzheimer's disease. Tangles are formed by hyperphosphorylation of a microtubule-associated protein known as tau, causing it to aggregate in an insoluble form. (These aggregations of hyperphosphorylated tau protein are also referred to as PHF, or ""Paired Helical Filaments""). It is also believed that neurofibrillary tangles are seen in Creutzfeldt-Jakob disease. Neurofibrillary tangles are also found in Supranuclear palsy. It's also related to frontotemporal dementia however without detectable (beta}-amyloid plaques. -### End" -6462,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How many parathyroid glands do humans have?, with the following options: A: 4, B: 3, C: 2, D: 1 - -### Response: -Parathyroid glands: The parathyroid glands are small, yellowish-brown, ovoid or lentiform structures, usually lies between the posterior lobar borders of the thyroid gland and its capsule. -They are commonly 6 mm long, 3-4 mm across, and 1-2 mm from back to front, each weighing about 50 mg. -Usually, there are two on each side, superior and inferior. Variations: There may be only three or many minute parathyroid islands scattered in connective tissue near the usual sites. -Normally the inferior parathyroids migrate only to the inferior thyroid poles, but they may descend with the thymus into the thorax or not descend at all, remaining above their normal level near the carotid bifurcation. -To help identification, the anastomotic connection between the superior and inferior thyroid arteries along the posterior border of the thyroid gland usually passes very close to the parathyroids. The inferior pair are more variably situated, and may be within the fascial thyroid sheath, below the inferior thyroid arteries and near the inferior lobar poles; or outside the sheath, immediately above an inferior thyroid artery; or in the thyroid gland near its inferior pole. The superior parathyroids are usually dorsal, the inferior parathyroids ventral, to the recurrent laryngeal nerves. Vasculature: -The parathyroid glands have a rich blood supply from the inferior thyroid arteries or from anastomoses between the superior and inferior vessels. -Approximately one-third of human parathyroid glands have two or more parathyroid arteries. -Lymph vessels are numerous and associated with those of the thyroid and thymus glands. -Nerve supply:The nerve supply is sympathetic, either direct from the superior or middle cervical ganglia or via a plexus in the fascia on the posterior lobar aspects. -Parathyroid activity is controlled by variations in blood calcium level: it is inhibited by a rise and stimulated by a fall. -The nerves are believed to be vasomotor but not secretomotor Histology : Contains two types of cells Active cells or chief cells which produce parathormone. -Chief cells differ ultrastructurally according to their level of activity: active chief cells have large Golgi complexes with numerous vesicles and small membrane-bound granules. -Glycogen granules are most abundant in inactive cells, which appear histologically as ‘clear' cells. -In normal human parathyroid glands, inactive chief cells outnumber active cells in a ratio of 3-5:1 Second cell type, the oxyphil (eosinophil) cell, appears just before puberty and increases in number with age. -Oxyphil cells are larger than chief cells and contain more cytoplasm, which stains deeply with eosin. -Their nuclei are smaller and more darkly staining than those of chief cells, and their cytoplasm is unusually rich in mitochondria. -The functional significance of oxyphil cells and their relationship to chief cells are uncertain -### End" -6463,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following investigations are needed for the diagnosis of osteosarcoma, except -, with the following options: A: MRI of femur, B: Bone marrow biopsy, C: Bone scan, D: CT chest - -### Response: -A biopsy of the lesion (not bone marrow biopsy) should always be carried out before commencing treatment. -Bone scan, MRI and CT chest are used. -### End" -6464,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Knee joint in a patient with Hemophilic ahritis shows all of the following except, with the following options: A: Juxtraicular osteosclerosis, B: Squaring of patella, C: Narrowing of Intercondylar notch, D: Subchondral cysts - -### Response: -Following are the characteristic finding in knee Hemophilic ahritis SUBACUTE OR CHRONIC AHRITIS * Recurrent hemahroses, may lead to a self-perpetuating condition * Joint abnormalities persist in intervals between bleeding episodes * Involved joint is chronically swollen although painless and only slightly warm * Chronic synovitis, including prominent synol proliferation with or without effusion, may be present * Mild limitation of motion often with a flexion deformity * Factor replacement does not modify these findings END-STAGE HEMOPHILIC AHROPATHY * Features in common with DJD and advanced RA * Joint appears enlarged and ""knobby"" - osteophytic bone overgrowth * Synol thickening and effusion - not prominent * Range of motion is severely restricted * Fibrous ankylosis is common * Subluxation, joint laxity, and malalignment - frequently present * Hemahroses decreases in frequency Refer Caffeys pediatric diganitsic imaging by Brian D, Cooley p 1458 -### End" -6465,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diagnosis:, with the following options: A: CBD dilatation on ERCP, B: CBD dilatation on PTC, C: Cystic duct dilation on ERCP, D: Cystic duct ectasia on ERCP - -### Response: -Ans. (a) CBD dilation on ERCPRef: Cleveland Internal Medicine Case Reviews, 5e/93You can see the endoscope in left top half and right 5 o clock position which is radiopaque. It is advanced into D2 from where the ampulla of vater is located. The probe is advanced and dye injected which shows dilatation of whole biliary tree. A stricture is also noted proximal to which the biliary pathway is advanced. -### End" -6466,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient at 22 weeks pregnancy is on warfarin for oral anticoagulation for a known cardiac condition. Heparin is re-introduced at what gestation?, with the following options: A: 32 weeks, B: 36 weeks, C: 40 weeks, D: At the time of labor - -### Response: -Heparin is given in first trimester to ease the mother from deep vein thrombosis but it cannot be continued as an injection after 12 weeks. After 12 weeks of gestation, oral warfarin tablets are given; if the warfarin is given before 12 weeks then warfarin related anomalies can happen to the fetus. Around 36 weeks, warfarin is stopped and we should resta heparin because continuing warfarin leads to increased bleeding during delivery. -### End" -6467,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: It is probable that physician have a higher index of suspicion for tuberculosis in children without BCG scar that those with BCG scar. If this is so and an association is found between Tuberculosis and not having BCG scar, the association may be due to-, with the following options: A: Selection bias, B: Interviewer bias, C: Surveillance bias, D: Non-response bias - -### Response: -Ans. is 'b' i.e., Interviewer bias Information (Observer or misclassification bias) o Information bias is a type of connitive bias o Are when propoion of subjects misclassified on exposure or disease. o Information bias occurs due to people's curiosity and confusion of goals when trying to choose a course of action. o It may be of following types i) Repoing bias Individual with severe disease tends to have complete records therefore more complete information about exposures and greater association found. ii) Recall bias (memory bias) Those who have disease (cases) have a greater sensitivity for recalling exposure than those who dont have disease (controls). iii) Interviewer bias Caused by the action of the interviewer, e.g., Interviewer generally devote more time to cases as compared to controls. iv) Hawthorne bias (Attention bias) It is caused by change in behavior of human subjects of an experiment, simply becasue they know that they are being observed. For example, if we want to study the smoking as a risk factor for lung carcinoma and we take 2 groups (50 smokers and 50 nonsmoker) and follow them for 10 years. It may be possible that over the time study subjects may change their behavior, e.g. 5 out of 50 smokers quit smoking behavior. This will cause Hawthorne bias. It is quite obvious that Hawthorne effect will occur in prospective studies (where the study subject are being observed), e.g. in Coho Study. This bias will not occur in retrospective study as the study subjects are not observed rather their history is taken. Coming back to question o Interviewer bias occurs because the investigator knows beforehand, the paicular procedure or therapy to which the patient has been subjected. o This prior information may lead him to focus more on the group which he knows, is more susceptible. o In the question the physician already knows that children without BCG scar (nonimmunized) children are more prone to develop Tuberculosis than patients with BCG scar (immunized) children. o This prior information will lead him to investigate children without BCG scar more thoroughly as he knows, that being unimmunized these children are more prone to develop T.B. o On the other hand while investigating children with BCG scar, the interviewer will be bit careless as he knows that these children are already immunized. o This will automatically lead to detection of more cases of T.B. in children without B.C.G. scar. -### End" -6468,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements regarding transfer of drugs across placenta is FALSE?, with the following options: A: Transfer across placenta is lesser in early pregnancy, B: most of the drugs to some extent can cross the placenta except heparin and insulin, C: drugs most commonly transfers through active transpo, D: P-glycoprotein is present in placenta - -### Response: -80% develop long term complications Hearing loss, vision impairment, developmental delay H=herpes simplex (HSV) Most are asymptomatic at bih - 3 patterns of equal frequency with symptoms between bih and 4 weeks: Skin, eyes, mouth (SEM) CNS disease Disseminated disease (present earliest) Initial manifestations very nonspecific with skin lesions NOT necessarily present -### End" -6566,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an example of disorders of sex chromosomes, with the following options: A: Marfan's syndrome, B: Testicular feminization syndrome, C: Klinefelter's syndrome, D: Down's syndrome - -### Response: -Klinefelter syndrome is an impoant genetic cause of reduced spermatogenesis and male infeility. In some patients the testicular tubules are totally atrophied and replaced by pink, hyaline, collagenous ghosts. In others, apparently normal tubules are interspersed with atrophic tubules. In some patients all tubules are primitive and appear embryonic, consisting of cords of cells that never developed a lumen or progressed to mature spermatogenesis. Leydig cells appear prominent, as a result of the atrophy and crowding of the tubules and elevation of gonadotropin concentrations. Patients with Klinefelter syndrome have a higher risk for breast cancer (20 times more common than in normal males), extragonadal germ cell tumors, and autoimmune diseases such as systemic lupus erythematosus. The classic pattern of Klinefelter syndrome is associated with a 47,XXY karyotype (90% of cases). This complement of chromosomes results from nondisjunction during the meiotic divisions in the germ cells of one of the parents. Maternal and paternal nondisjunction at the first meiotic division are roughly equally involved. There is no phenotypic difference between those who receive the extra X chromosome from their father and those who receive it from their mother. Maternal age is increased in the cases associated with errors in oogenesis. In addition to this classic karyotype, approximately 15% of patients with Klinefelter syndrome have been found to have a variety of mosaic patterns, most of them being 46,XY/47,XXY.Other patterns are 47,XXY/48,XXXY and variations on this theme. As is the case with normal females, all but one X chromosome undergoes inactivation in patients with Klinefelter syndrome. Why then, do the patients with this disorder have hypogonadism and associated features? The explanation for this lies in genes on the X chromosome that escape lyonization and in the pattern of X inactivation. Ref Robbins 9/e pg 165 -### End" -6567,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sex reassignment surgery is done in -, with the following options: A: Gender identity disorder, B: Premature ejaculation, C: Erectile dysfunction, D: Orgasmic dysfunction - -### Response: -Ans is 'a' i.e. Gender identity disorder ""Many persons with gender identity disorder have sought sex-reassignment surgery, that is, physical change that is constant with their cross sexual identity."" - encyclopedia of relationships across the life span p.191 -### End" -6568,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about subcutaneous nodules in rheumatic fever, with the following options: A: Non tender, B: Most common manifestation, C: Present in flexor surfaces, D: Associated with ahritis - -### Response: -Ref Harrison 19 th ed pg 2152 Subcutaneous nodules occur as painless, small (0.5-2 cm), mobile lumps beneath the skin overlying bony prominences, paicularly of the hands, feet, elbows, occiput, and occasionally the veebrae. They are a delayed manifestation, appearing 2-3 weeks after the onset of disease, last for just a few days up to 3 weeks, and are commonly asso- ciated with carditis. -### End" -6569,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following infections due to nematodes result from ingestion of infective eggs except-, with the following options: A: Ascaris lumbricoides, B: Enterobius vermicularis, C: Strongyliodes stercoralis, D: Trichuris trichura - -### Response: -filariform larvae- infective form Man acquires infection by walking on barefoot on the contaminated soil. The filariform larvae penetrates the skin coming in contact with soil. (refer pgno:149 baveja 3 rd edition) -### End" -6570,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thiamine deficiency is known to occur in all of the following except :, with the following options: A: Food Faddist, B: Homocysteinemia, C: Chronic alcoholic, D: Chronic hea failure patient on diuretics - -### Response: -Homocysteinemia (Option B ) occurs due to deficiency of vitamins - B6, B9 & B12 (NOT Vitamin B1 i.e. Thiamine). Option C - Alcohol interferes with the absorption of Thiamine. Option A - Food faddism is a term generally used to describe a paicular food or food group that is exaggerated in the routine diet or is eliminated in order to cure one specific disease. A person believing in this may exclude thiamin containing food in its diet and consequently may get thiamine deficiency. Option D - Loop diuretics cause thiamine deficiency by increasing its urinary loss. ADDITIONAL EDGE ON THIAMINE DEFICIENCY B1 deficiency leads to Beri Beri. As vitamin B1 is mainly involved in oxidative decarboxylation reactions, so in B1 deficiency, highly aerobic tissues e.g. Hea and Brain fail first. -### End" -6571,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Therapeutic drug monitoring of plasma concentrations of antihypeensive drugs is not practiced because:, with the following options: A: Determination of plasma level of these drugs is quite tedious and long process, B: It is easier to measure the effect of these drugs, C: Antihypeensive effect do not increase linearly with the dose, D: All antihypeensive drugs are prodrugs - -### Response: -* TDM is done for drugs (with narrow therapeutic index) whose response cannot be monitored by simple laboratory parameters. * Antihypeensive effect can be easily measured, therefore TDM is not required. -### End" -6572,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the contribution of this scientist to molecular genetics?, with the following options: A: Chemical synthesis of ribonucleotide, B: Sequencing of amino acid, C: Base pairing rule, D: Structure of DNA - -### Response: -Ans. A. Chemical synthesis of ribonucleotide* The scientist given in picture is Har Gobind Khorana* Developed chemical method to synthesize polyribonucleotide.* This lead to the cracking of genetic code. -### End" -6573,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is most common fixative used in electron microscope, with the following options: A: Glutaraldehyde, B: Formalin, C: Picric acid, D: Absolute alcohol - -### Response: -Ref,Ackerman 9/e p27 Commenest fixative used for light microscope examination 10%buffered neutral formalin Commenest fixative used for electron microscope examination.Glutaraldehyde -### End" -6574,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is not a measure of dispersion -, with the following options: A: Mean, B: Range, C: Mean detion, D: Standard detion - -### Response: -The measures of dispersion are; - the range - the mean detion - the standard detion Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:848 -### End" -6575,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In culex mosquito the type of biological transmission for filarial parasite is ?, with the following options: A: Cyclo-developmental, B: Cyclo-propagative, C: Propagative, D: Cyclical - -### Response: -Ans. is 'a' i.e., Cyclo-developmental -### End" -6576,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Risk of the damage to fetus by maternal rubella is maximum if mother gets infected in -, with the following options: A: 6-12 weeks of pregnancy, B: 20-24 weeks of pregnancy, C: 24-28 weeks of pregnancy, D: 32-36 weeks of pregnancy - -### Response: -Ans. is 'a' i.e., 6-12 weeks of pregnancy -### End" -6577,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about Odontogenic keratocyst?, with the following options: A: Most common in females, B: Not pre malignant, C: Seen in posterior mandible, D: Treatment is observation - -### Response: -Odontogenic keratocyst has risk for SCC transformation. Treatment is removal. -### End" -6578,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common location of solitary rectal ulcer is:, with the following options: A: Anterior wall, B: Right lateral wall, C: Posterior wall, D: Left lateral wall - -### Response: -Most common location of solitary rectal ulcer is: Anterior wall Solitary rectal ulcer syndrome (SRUS)- benign disease C/F- Rectal bleeding Copious mucus discharge Prolonged excessive straining, feeling of incomplete defecation, constipation Perineal and abdominal pain Histopathological features- obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. COLONOSCOPY WITH BIOPSY is the investigation of choice -### End" -6579,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following anti diabetic drugs can cause vitamin B12 deficiency, with the following options: A: Glipizide, B: Acarbose, C: Metformin, D: Pioglitazone - -### Response: -Refer Goodman Gilman 12/e p 1259 Lactic acidosis and Megaloblastic anemia due to vitamin B12 deficiency are the major adverse effects of these drugs Lactic acidosis is more likely to occur in the presence of hepatic and renal impairment or alcohol ingestion -### End" -6580,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which anti - TB drug causes ocular problem?, with the following options: A: Rifampin, B: Ethambutol, C: Streptomycin, D: Pyrazinamide - -### Response: -Ans. is 'b' i.e., Ethambutol Important educational points* First line antitubercular drugs causing hyperuricemia - Ethambutol, pyrazinamide.* Drugs causing peripheral neuropathy - streptomycin, INH, Ethambutol, ethionamide.* Drugs causing hepatitis - INH, rifampicin, pyrazinamide, ethionamide.* Optic neuritis - INH, ethambutol, ethionamide.* First line antitubercular drugs which are not hepatotoxic (does not require dose adjustment in liver diseases) - streptomycin, ethambutol.* Drugs not requries dose adjustment in renal failure - rifampicin, rifabutin rifapentine.* Hypothyroidism can be caused by - PAS, ethionamide.* Ethambutol and streptomycin do not cross BBB.* Active against extracellular mycobacteria: Rifampicin (Tuberculocidal), INH (tuberculocidal), streptomycin (tuberculocidal)* Active against intercellular mycobacteria: Rifampicin (Tuberculocidal), INH (tuberculocidal), Pyrazinamide (tuberculocidal) -### End" -6581,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Example of artificial passive immunity?, with the following options: A: Infection, B: Mother to child, C: Vaccine, D: Readymade immunoglobulin - -### Response: -Infection - Natural active -Mother to child - Natural passive -Vaccine - Artificial active -Immunoglobulins - Artificial passive -### End" -6582,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anti-D prophylaxis should be given in all of the following conditions except:, with the following options: A: Medical abortion for 63 days pregnancy, B: Amniocentesis at 16 weeks, C: Intrauterine transfusion at 28 weeks, D: Manual removal of Placenta - -### Response: -Ans. is c, i.e. Intrauterine transfusion at 28 weeksRef. Dutta Obs. 7/e, p 344; Sheila Balakrishnan, p 369Rh anti D immunoglobulin (IgG) is given to unimmunized Rh negative mothers with Rh positive fetus to prevent active immunization and formation of antibodies against fetal RBC's. The Anti D binds to antigen sites on the fetal red cells so that these cells do not mount an immune response, provided the baby is Rh negative and direct coombs test done on baby is negative. If mother's IUT is positive or fetus has positive direct coombs test, it means mother is already immunized. In such cases there is no point in giving anti D.Indications for Anti D immunoprophylaxis:First trimesterLater pregnancyMiscarriageEctopic (medically or surgically managed)Hydatidiform moleThreatened abortionMedical or surgical MTPChorionic villus samplingMiscarriageAmniocentesisFetal blood samplingAntepartum hemorrhageExternal cephalic versionRoutine antepartum prophylaxisDeliveryIntrauterine fetal deathManual removal of placentaNote: As far as intrauterine fetal transfusion is concerned. It is done as a therapy in case Rh isoimmunization has occurred prior to 34 weeks so, administration of anti-D at this stage will not help.Dose:Ideally amount of Anti D should be calculated according to the volume of fetomaternal bleed by doing a Kleihauer test.Generally:-Gestational age <12 weeks - dose is 50 mg-Beyond 12 weeks - dose is 300 mcgAntepartum prophylaxis: At 28 weeks gestation in a Rh negative patient: Indirect coombs test is done and if antibodies are not detected i.e. patient is unimmunised, Anti D 300 mg is given as antepartum prophylaxis.300 mg of Anti D will neutralize about 15 mL of fetal RBC. -### End" -6583,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Interface dermatitis"" is a histological feature of, with the following options: A: Psoriasis, B: Lichen planus, C: Pityriasis rosea, D: Dermatophytosis - -### Response: -Interface dermatitis includes diseases in which the primary pathology involves the dermo-epidermal junction. (hence called interface). The salient histological findings include basal cell vacuolization, apoptotic keratinocytes (colloid or Civatte bodies), and obscuring of the dermo-epidermal junction by inflammatory cells. Lupus erythematosus, dermatomyositis, lichen planus, graft versus host disease, erythema multiforme, fixed drug eruptions are some examples. Ref Harrison 20th edition pg 1234 -### End" -6584,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding follicular carcinoma of the thyroid, with the following options: A: Hematogemous spread, B: Commonly multifocal, C: Best prognosis among thyroid malignancies, D: Most common carcinoma of thyroid - -### Response: -Multiple foci and lymph node involvement are much less common than in papillary carcinoma. Papillary carcinoma is the most common thyroid malignancy.Blood-borne metastases are more common Moality rate, although low, is twice that of papillary cancerRef: Bailey and love, page no: 818 -### End" -6585,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Careful testing of the visual fields in a patient complaining of difficulty reading demonstrates a central scotoma involving one visual field. This defect is MOST likely due to a lesion involving which of the following structures?, with the following options: A: Macula, B: Optic chiasm, C: Optic radiations in the parietal lobe, D: Optic radiations in the temporal lobe - -### Response: -Here is a list that may help you so through these problems: Central scotoma ~ macula Ipsilateral blindness ~ optic nerve Bitemporal hemianopia ~ optic chiasm Homonymous hemianopia ~ optic tract Upper homonymous quadrantanopia ~ temporal optic radiations Lower homonymous quadrantanopia ~ parietal optic radiations Also, coical lesions produce defects similar to those of the optic radiations, but may spare the macula. Ref: Sterns G.K., Faye E.E. (2011). Chapter 24. Low Vision. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. -### End" -6586,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pinna is supplied by:, with the following options: A: Vagus nerve, B: Auriculotemporal nerve, C: Grater auricular nerve, D: All - -### Response: -A i.e. Vagus nerve; B i.e. Auriculotemporal nerve; C i.e. Great auricular nerve -### End" -6587,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female presented with thick white discharge and pruritus. aetiological agent is: September 2009, March 2013, with the following options: A: Gardnerella, B: Trichomonas vaginalis, C: Candida, D: Gonococci - -### Response: -Ans. C: Candida The most common etiologies in adults resulting in symptoms of vaginitis include Candida albicans, Trichomonas vaginalis, and bacterial vaginosis. Candidiasis is a fungal infection common in women of childbearing age that results in pruritus, with a thick, white vaginal discharge. Patients often have a history of recurrent yeast infections or recent antibiotic treatment. Symptoms of candidiasis often begin just before menses. Precipitating factors include immunosuppression, diabetes mellitus, pregnancy, and hormone replacement therapy. Candidiasis is usually not contracted from a sexual paner. Seventy-five percent of all women have one episode of candidiasis in their lifetime. Recurrent episodes may indicate underlying immunodeficiency or diabetes. Trichomoniasis is associated with risk factors for other sexually transmitted diseases (STDs); elicit a history of multiple sexual paners. The discharge is usually copious, slightly green and frothy, resulting in local pain and irritation. Pruritus might be present. Symptoms often peak just after menses. Trichomonas vaginalis is the most common nonviral STD in the world. Infection during pregnancy has been associated with preterm deliveries and low bih weight infants. Bacterial/ gardnerella vaginosis is asymptomatic in up to 50% of women. If a discharge is present, it is typically a homogeneous grayish white or yellowish white. Bacterial vaginosis is common in pregnant women and is associated with preterm bih. Treating pregnant women that have a history of preterm bih with symptomatic bacterial vaginosis early in pregnancy has been shown to decrease the incidence of preterm bih. -### End" -6588,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metabolic abnormality is seen in large colorectal villous adenoma, with the following options: A: Hypokalemic metabolic alkalosis, B: Hypokalemic metabolic acidosis, C: Chlorine sensitive metabolic acidosis, D: Chlorine resistant metabolic alkalosis - -### Response: -Villous adenomas causing profuse watery diarrhoea and hypokalemia is known as the McKittrick Wheelock syndrome after it was first described in 1954. -Metabolic abnormalities seen are hyponatraemia, hypokalaemic, and hypochloraemic metabolic acidosis. -Severe volume loss may cause acute renal failure and cardiovascular collapse. -The mechanism of fluid and electrolyte loss is unclear. Locally released prostaglandin E2 has been suggested as the secretagogue responsible for salt wasting, as has a cyclic AMP. - -Treatment: - -Reversal of the biochemical derangement is the cornerstone of successful management. Once resuscitated, immediate surgical resection of the tumor, is the treatment of choice. -### End" -6589,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Positive moality indicator is ?, with the following options: A: IMR, B: Child moality rate, C: MMR, D: Life expectancy - -### Response: -Ans. is 'd' i.e., Life expectancy Moality indicators These are :? Crude death rate Maternal moality rate Expectation of life (life expectancy) Disease specific moality rate Infant moality rate Age specific death rate Child moality rate Adult moality rate Under-5 propoional moality rate Years of potential life lost Among these only life expectancy is a positive moality indicator, i.e. increase life expectancy means improvement in health. All other are 'negative' health indicators, i.e. increase value of these indicators implies poor health of community. -### End" -6590,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First heart sound is loud in, with the following options: A: Mitral stenosis with calcified valves, B: Aortic stenosis with calcified valves, C: Mitral stenosis with friable valves, D: Aortic stenosis - -### Response: -(C) Mitral stenosis with friable valves # Loud S1 (Cannon sound)> Intensity of the First heart sound (S1) is influenced by: Position of the mitral leaflets at the onset of ventricular systole Rate of rise of the left ventricular pressure pulse Presence or absence of structural disease of the mitral valve Amount of tissue, air, or fluid between the heart and the stethoscope.> S1 is louder if diastole is shortened because of tachycardia, if AV flow is increased because of high cardiac output or prolonged because of mitral stenosis, or if atrial contraction precedes ventricular contraction by an unusually short interval, reflected in a short PR interval> Loud S1 in mitral stenosis usually signifies that the valve is pliable and that it remains open at the onset of isovolumetric contraction because of the elevated left atrial pressure.> A soft S1 may be due to poor conduction of sound through the chest wall, a slow rise of the left ventricular pressure pulse, a long PR interval, or imperfect closure due to reduced valve substance, as in mitral regurgitation.> Reversed splitting of the S1, in which the mitral component follows Tricuspid component, may be present in patients with severe mitral stenosis, left atrial myxoma, and left bundle branch block. -### End" -6591,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The genotype of blood group A would be, with the following options: A: AB, B: AO, C: OO, D: BO - -### Response: -The genotype for a blood group can be AA OR AO blood groups are three genes Ia,Ib,Io Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:155,156,157 -### End" -6592,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following organisms is the most frequent cause of acute pyogenic meningitis in adults:, with the following options: A: Streptococcus pneumoniae, B: Neisseria meningitis, C: Haemophilus influenza, D: Listeria monocytogenes - -### Response: -Ans. (a) Streptococcus pneumoniaeRef: Dhingra 5th ed. /61y 81 -### End" -6593,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A hemodynamically stable patient with blunt abdominal trauma, the best investigation is?, with the following options: A: CECT abdomen, B: MRI abdomen, C: Diagnostic Peritoneal lavage, D: F.A.S.T - -### Response: -Ans. (a) CECTRef: Bailey & Love 26th ed./208Since the patient is in shock with history of blunt abdomen trauma, the first investigation to be done should be FAST. The main role of ultrasound includes the assessment of intraperitoneal fluid and haemopericardium In the presence of free intraperitoneal fluid and an unstable patient, the ultrasound allows the trauma surgeon to explore the abdomen as a cause of blood loss.In the presence of fluid and a haemodynamically stable individual further assessment by way of CT shall be performed. Occasionally, a second ultrasound scan may show free fluid in the presence of an initially negative FAST scan. -### End" -6594,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Structures passing through superior orbital fissure, with the following options: A: Cranial nerve VI, B: Cranial nerve I, C: Cranial nerve II, D: Ophthalmic nerve - -### Response: -superior orbital fissure * lateral pa lacrimal and frontal nerves, trochlear nerve, superior ophthalmic vein, meningeal branch of lacrimal aery, anastomotic branch of middle meningeal aery, which anastomoses with recurrent branch of lacriamal aery. * middle pa Upper and lower divisions of oculomotor nerve, nasociliary nerve, abducent nerve *medial pa Inferior ophthalmic vein .sympathetic nerve from plexus around internal carotid aery Ref BDC volume 3; 6th edition pg 56 -### End" -6595,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Moist heat burn which is present ?, with the following options: A: Charring, B: Blister, C: Ulcer, D: Slough - -### Response: -.blisters are characteristic of moist burn -### End" -6596,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rx of choice in postoperative lung collapse is ?, with the following options: A: Needle drainage, B: Coicosteroids, C: Pulmonary resection, D: Endoscopic suction - -### Response: -Ans is 'd' ie Endoscopic suction The text given on post-op lung collapse in sabiston as well as schwaz mention no where that `endoscopic suction' is a treatment modality But still reading the text it appears that Endoscopic suction is the best answer among the given options. Below, I have quoted the text. Read it to make your own inference. ""The most common postoperative respiratory complication is atelectasis. As a result of the anesthetic, abdominal incision, and postoperative narcotics, the alveoli in the periphery collapse and a pulmonary shunt may occur. If appropriate attention is not directed to aggressive pulmonary toilet with the initial symptoms, the alveoli remain collapsed and a buildup of secretions occurs and becomes secondarily infected with bacteria. The risk appears to be paicularly high in patients who are heavy smokers, are obese, and have copious pulmonary secretions. Pneumonia may develop early (i.e., 2-5 days after admission to the hospital) or late (i.e., >5 days) and is referred to as health care-related pneumonia. Aspiration of oropharyngeal and gastric contents is the leading cause of health care-related pneumonia. Presentation and Management The most common cause of a postoperative fever in the first 48 hours after the procedure is atelectasis. The patients has a low-grade fever, malaise, and diminished breath sounds in the lower lung fields. Very often the patient is uncomfoable from the fever but has no other ove pulmonary symptoms. Atelectasis is so common postoperatively that a formal workup is not usually required. However, if not aggressively managed, frank development of pneumonia is likely. A patient with pneumonia, on the other hand, will have a high fever, occasionally mental confusion, and the production of a thick secretion with coughing, leukocytosis, and a chest radiograph that reveals infiltrates. If the condition is not expeditiously diagnosed and treated, the patient may rapidly progress to respiratory failure and require intubation. Prevention of atelectasis and pneumonia is associated with pain control, which allows the patient to take deep breaths and cough. A patient-controlled analgesia device seems to be associated with better pulmonary toilet, as does the use of an epidural infusion catheter, paicularly in patients with epigastric incisions. Respiratory care, otherwise, begins preoperatively. The patient must be instructed in use of the incentive spirometer and be held accountable by nurses and physicians during rounds. Encouraging the patient to cough while applying counterpressure with a pillow on the abdominal incision site is most helpful. Rarely, other modalities such as intermittent positive pressure breathing and chest physiotherapy may be required. Encouraging the patient to breathe deeply and cough is the single most valuable management approach in preventing and resolving atelectasis and pneumonia. Patients in whom pneumonia develops in the postoperative period are managed with aggressive pulmonary toilet, induced sputum for culture and sensitivity testing, and empirical broad-spectrum IV antibiotic therapy while awaiting culture results. Once the organisms are cultured from sputum, a specific antibiotic must be used as indicated."" -### End" -6597,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient complains of knee pain Routine investigations are unremarkable and still the patient is unsatisfied Urine turns black on standing what is the enzyme involved, with the following options: A: Homogentisate Oxidase, B: Xanthine oxidase, C: Phenylalanine hydroxylase, D: Dihydroorlate Dehydrogenase - -### Response: -REF : LIPPINCOTT 6TH ED -### End" -6598,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Toll like receptors are present in, with the following options: A: PMNs, B: Reticuocytes, C: Reticuocytes, D: Leukocytes - -### Response: -Toll-like receptors (TLRs) -Microbial sensors that recognize products of bacteria (such as endotoxin and bacterial DNA), viruses (like DS-RNA), and other pathogens. -TLRs are located in plasma membranes and endosomes of leukocytes, so they are able to detect extracellular and ingested microbes. -### End" -6599,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pyruvate kinase is inhibited by -, with the following options: A: Insulin, B: Fructose -1,6 bisphosphate, C: ATP, D: All of the above - -### Response: -Ans. is 'c' i.e., ATPPyruvate Kinaseo This enzyme catalyzes conversion of PEP to pyruvate.o Pyruvate kinase is an inducible enzyme that increases in concentration with high insulin level and decreases with glucagon.o It is activated by fructose-1,6 bisphosphate and inactivated by ATP and alanine. -### End" -6600,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: River blindness is caused by?, with the following options: A: Onchocerca volvulus, B: Loa loa, C: Wurcheria bancrofti, D: All of the above - -### Response: -Ans. A. Onchocerca volvulus. (Ref. Harrison 18th/Table. E16-2).Tissue nematodes:Onchocerca volvulusFemale blackfly bileHyper pigmented skin and river blindness (black flies, black skin nodules, ""black sight""); allergic reaction to microfilaria possibleIvermectin (ivermectin for river blindness)LoahaDeer fly, horse fly, mango flySwelling in skin, worm in conjunctivaDiethylcarbamazinewucnerena ooncrowFemale mosquitoBlocks lymphatic vessels: elephantiasis; takes 9 mo-1 yr after bite to become symptomaticDiethylcarbamazineTaxocara cantsFecal-oralVisceral larva migransAlbendazole or mebendazole ROUNDWORM INFECTIOUS Life-Cyde Hosts Diagnosis Geographic DistributionIntermediate (Transmission) Parasite StageBody Fluid or TissueSerologic Tests ParasiteDefinitiveOtterIntestinal RoundwormsEnterobius vermicularis (pinworm)Temperate and tropical zonesFecal-oralHumansOvaPerianal skin ""Cellophane tape""Trichuris trichiura(whipworm)Temperate and tropical zonesSoil, fecal-oralHumansOvaFeces--Rectal prolapseAscoris lumbricoids (roundworm of humans)Temperate and tropical zonesSolfocaForaiHumansOvaFeces--Sx of pulmonary migrationAncylostoma duodenale (Old World hookworm)Eurasia, Africa, PacificSoil-SkinHumansOva/larvaeFeces--Sx of pulmonary migration, anemiaNecator americanus (New World hookworm)US, Africa. worldwideSoil-SkinHumansOva/larvaeFeces--Sx of pulmonary migration, anemiagration. anemiaStrangyloids stercoralis (strongyloidiasis)Moist tropics and subtropicsSoil-SkinHumansLarvaeFeces, sputum duodenal FluidEIADissemination in immunodeficiencyCapillaria philippinensisSoutheast Asia Taiwan. EgyptRaw fishBirds Ova, larvae, adultsFeces--Malabsorption/ autoinfection, biopsyTissue Roundworms Trichinella spiralis (trichinellosis)WorldwideSwine/ humansSwine/ humansLarvaeMuscleEIAMuscle biopsyWuchereris bancrafti (Filariasis)Coastal areas in tropics and subtropics MosquitoesHumansMicrofilariaeBlood lymph nodesEIA RAPIDNocturnal periodicityBrugia malayl (filariasis)Asia, Indian SubcontinentMosquitoesHumansMicrofilariaeBloodEIA RAPIDNocturnalLoa loa (African eye worm)West and Central AfricaMango flies (Chrysops)HumansMicrofilariaeBlood--May be visible in eye diurnalOnchocerca volvulus (river blindness)Africa, Mexico, Central and South AmericaBlackfliesHumansAdults/ larvaeSkin/eye--Examine nodules or skin snipsDracunculus medinensis (gulnea wormAfricaCyciopsHumansAdultys/ larvaeSkin--May be visible in lesionAnglostrongylus contonensisSoutheast asia, Pacific CaribbeanSnils/ slugs, shrimp/ fishRatsLarvaeCSF rarely found)--Eosinophilic meningitisLarva Migrans Syndromes Ancylostoma braziliense (creeping eruption}Tropical and temperate zonesSoil-SkinDcgs/ cats. humansLarvaeSkin--Dog and cat hookwormToxocara canis and cot) (Visceral larva migrans)Tropical and temperate zonesSoil, fecal-oralDogs/ cats, humanslarvaeViscera, CNS, eyeEIAAlso caused by roundworms of other speciesAlso know: ManifestationsCausative parasite1""Visceral larva migrans""Toxocara canis2""Larva currens"" Strongyloides stercoralis3""Cutaneous larva migrans""- Strongyloides larva- Hookworm larvae (E.g. A. braziliense and A. caninum),- Spiruroid larva (Gnathostoma spinigerum), and- Migrating flying maggot, Gasterophilus.4Pruritus aniEnterobius vermicularis5Rectal prolaspseTrichuris trichura6MyocarditisTrichinella spiralis7Tropical Pulmonary eosinophiliaWuchereria bancrofti8Calabar swellingLoa-loa9River blindnessOnchocercus volvulus10Black water feverPlasmodium falciparum11Painless hematuriaSchistosoma japonicum12""Ground itch"" (Ancylostome dermatitis)Ancylostoma duodenale -### End" -6601,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most unlikely cause of acute tubular necrosis amongst the following is -, with the following options: A: Severe bacterial infection, B: Massive burn, C: Severe cursh injury in the foot, D: Rupture of aoic aneurysm - -### Response: -ISCHEMIA alone in a normal kidney is usually not sufficient to cause severe AKI, as evidenced by the relatively low risk of severe AkI even after suprarenal aoic clamping or cardiac arrest. (so rupture of aoic aneurysm is the most unlikely cause of ATI. ) AKI is an ominous complication of burns affecting 25%of individuals with >10%total body surface area involvement . In addition to hypovolemia, burns and acute pancreatitis both lead to dysregulated inflammation and increased risk of sepsis and acute lung injury which facilitate the development of AKI. Ref: Harrison20th edition pg 297 -### End" -6602,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The antimalignancy drug which is potentially cardiotoxic is:, with the following options: A: Doxorubicin, B: Bleomycin, C: Fluororacil, D: Dacarbazine - -### Response: -Daunorubicin (Rubidomycin), Doxorubicin): These are antitumour antibiotics with quite similar chemical structures. However, utility of daunorubicin is limited to acute leukaemia (in which it is highly active) while doxorubicin, in addition, is effective in many solid tumours. They are capable of causing breaks in DNA strands by activating topoisomerase II and generating quinone type free radicals. They have mutagenic and carcinogenic potential. Maximum action is exeed at S phase, but toxicity is usually exhibited in G2 phase. Both these antibiotics produce cardiotoxicity as a unique adverse effect. This can manifest either acutely with ECG changes, arrhythmias and hypotension which are reversible, or be delayed-congestive hea failure (related to the totaldose administered). CHF is due to cardiomyopathy and may be fatal. Marrow depression, alopecia, stomatitis, vomiting and local tissue damage (on extravasation) are other adverse effects. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:826 -### End" -6603,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heat labile liquids are sterilized by ?, with the following options: A: Hot air oven, B: Autoclaving, C: Membrane filter, D: Moist heat - -### Response: -Ans. is 'c' i.e., Membrane filter Filters are used to sterilize heat-labile solutions. Membrane filters are used to sterilize pharmaceutical substances, ophthalmic solutions, liquid culture media, oils, antibiotics and other heat sensitive solutions. -### End" -6604,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cataract is a cause of:, with the following options: A: Painful sudden vision loss, B: Painless sudden vision loss, C: Painful gradual vision loss, D: Painless gradual vision loss - -### Response: -Painless gradual vision loss -### End" -6605,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The umbilical cord stump of a newborn most frequently sloughs off about the :, with the following options: A: Second day after delivery, B: Fifth day after delivery, C: 10th day after delivery, D: 15th day after delivery - -### Response: -10th day after delivery -### End" -6606,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following drugs cause aeriolar dilatation except, with the following options: A: Hydralazine, B: Diazoxide, C: Nifedipine, D: Glyceryl trinitrate - -### Response: -Nitrates are primary venodilators. Nefidipine is a calcium channel blocker and aeriolar dilator.Fenoldopam , minoxidil also cause vasodilationRef: KD Tripathi; 6th ed, pg 540 -### End" -6607,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Male child with hyper intensities on T2 weighted MRI in bilateral frontal lobe. Most probable diagnosis is:, with the following options: A: Canavan disease, B: Krabbe disease, C: X-linked adrenoleukodystrophy, D: Alexander disease - -### Response: -d. Alexander disease(Ref: Nelson's 20/e p 713-714;Radiopaedia.org; Caffey's 12e/p337)Name of diseaseMRI Brain findingAlexander diseaseT2 hyperintensities in frontal white matter; shows contrast enhancement;Canavan diseaseMacrocephaly; bilateral symmetric T2 white matter hyperintensity diffusely throughout cerebral white matter; does not enhance at CT & MRI; Large N acetyl aspartate (NAA) peak on MRSAdrenoleukodystrophySymmetrical cerebral white matter signal change involving posterior (occipitoparietal) periventricular white matterKrabbe's diseaseCT: Hyperdense areas symmetrically involving thalami, caudate nuclei (basal ganglia), cerebellum, posterior limbs of internal capsule and brainstem.MRI: 2 patterns; (i) A patchy hyperintense periventricular signal with thalamic involvement onT2-weighted images, consistent with hypomyelination, (ii) patchy low signal on T2-weighted images in a similar distribution to the hyperdense regions seen on CT, which is suspected to represent a paramagnetic effect from calcium deposition in the region. -### End" -6608,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The drug of choice for treating cholera in pregnant woman is -, with the following options: A: Tetracycline, B: Doxycycline, C: Furazolidone, D: Cotrimoxazole - -### Response: -Ans. is 'c' i.e., Furazolidone Antibiotics used in the treatment of choleraAntibiotics aChildrenAdultsDoxycycline once 300 mgbTetracycline 4 times a day for 3 days12.5 mg/kg500 mgTrimethoprim (TMP) Sulfamethoxazole (SMX) twice a day for 3 daysTMP 5mg/kg, 5mg 25mg/kgcTMP 160Mg SMX 800 MgFurazolidone 4 times a day for 3 days1.25 mg/kg100mgdE a) Erythromycin and chloramphenicol may also be used when none of the other recommended antibiotics are available or when vibrio cholera 01 is resistant to the latter.b) Doxycycline is the antibiotic of choice for adults (excepting pregnant women), since a single dose suffices.T c) TMP-SMX is the antibiotic of choice for children tetracycline is equally effective, but is not available everywhere in pediatric form.F d) Furazolidone is the antibiotic of choice for pregnant woman. -### End" -6609,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Forced dieresis with acidification or alkalinization of urine is a common method for elimination of ceain poisons/drugs from the body. The elimination of which of the following drugs is commonly enhanced by alkaline dieresis -, with the following options: A: Amphetamines, B: Phenobarbitone, C: Phencyclidine, D: Theophylline - -### Response: -Most drugs taken in overdose are extensively detoxified by the liver to produce inactive metabolites which are voided in the urine. Sometimes hepatic degradation produces active metabolites, but the secondary compounds are then conveed to non-toxic derivatives. Under these circumstances, forced diuresis is inappropriate. The procedure should be undeaken only if the following conditions are satisfied: # A substantial propoion of the drug is excreted unchanged. # The drug is distributed mainly in the extracellular fluid. # The drug is minimally protein-bound. # Principle-- Most drugs are weak electrolytes and exist paly as undissociated molecules at physiological pH. The extent of ionisation is a function of the ionisation constant of the drug (Ka for both acids and bases), and the pH of the medium in which it is dissolved. Ionisation constants are usually expressed in the form of their negative logarithm, pKa. Hence the pKa scale is analogous to the pH notation : the stronger an acid the lower its pKa, and the stronger a base the higher its pKa. Thus when pKa = pH, the concentrations of ionised and non-ionised drugs are equal. Cell membranes are most permeable to substances that are lipid soluble and in the non-ionised, rather than the ionised form. Thus the rate of diffusion from the renal tubular lumen back into the circulation is decreased when a drug is maximally ionised. Because ionisation of acidic drugs is increased in an alkaline environment, and that of basic drugs is increased in an acid solution, manipulation of the urinary pH enhances renal excretion. # Forced alkaline diuresis : This is most useful in the case of phenobarbitone, lithium, and salicylates. Administer 1500 ml of fluid IV, in the first hour as follows : - 500 ml of 5% dextrose - 500 ml of 1.2 or 1.4% sodium bicarbonate - 500 ml of 5% dextrose. # Forced acid diuresis : Forced acid diuresis is no longer recommended for any drug or poison, including amphetamines, strychnine, quinine or phencyclidine. REF:THE SYNOPSIS OF FORENSIC MEDICINE AND TOXICOLOGY:K S NARAYANA REDDY;PAGE NO 289 -### End" -6610,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child with frog like position and resistance to move the limbs -, with the following options: A: Scurvy, B: Rickets, C: Trauma, D: Congenital dislocations - -### Response: -Congenital dislocations -### End" -6611,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Suppos of uterus are all except:, with the following options: A: Uterosacral ligaments, B: Mackenrodt's ligament, C: Broad ligament, D: Levator ani - -### Response: -DeLancey level of suppo. Level I --Uterosacral and cardinal ligaments/Mackenrodt suppo the uterus and vaginal vault Level II -- Formed by Paravaginal tissue and their attachment to levator ani muscles and white line. Level III-- Made by Perineal body and muscles attached to it. Includes Levator ani muscle. -### End" -6612,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a randomized controlled trial, the essential purpose of randomization is-, with the following options: A: To produce double blinding, B: To decrease the follow - up period, C: To eliminate the selection bias, D: To decrease the sample size - -### Response: -Randomization ensures that the investigator has no control over the allocation of paicipants to either study or control groups, thus eliminating what is known as selection bias. In other words by random allocation, every individual gets an equal chance of being allocated into either group or any of the trial groups ( refer pgno:82 park 23rd edition) -### End" -6613,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following type of glucose transpoer is present in the skeletal muscle and adipose tissue?, with the following options: A: GLUT 1, B: GLUT 2, C: GLUT 3, D: GLUT 4 - -### Response: -GLUT 4 receptors are present in hea, skeletal muscle and adipose tissue. It's function is to mediated insulin stimulated glucose uptake. Types of major glucose transpoers: Tissue Location Functions GLUT 1 Brain, kidney, colon, placenta, erythrocytes Glucose uptake GLUT 2 Liver, pancreatic beta cell, small intestine, kidney Rapid uptake or release of glucose GLUT 3 Brain, kidney, placenta Glucose uptake GLUT 4 Hea and skeletal muscle, adipose tissue Insulin-stimulated glucose uptake GLUT 5 Small intestine Absorption of glucose Ref: Bender D.A., Mayes P.A. (2011). Chapter 20. Gluconeogenesis & the Control of Blood Glucose. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e. -### End" -6614,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most Probable cause of food poisoning in a child who has eaten Ice Cream 16-18 hrs earlier is ?, with the following options: A: Staph aureus, B: Clostridium perfringens, C: Clostridium botulinum, D: Salmonella typhimurium - -### Response: -Ans. is 'd' i.e., Salmonella typhimurium . Food poisoning 16-18 hrs after eating ice cream suggests S.typhimurium food poisoning. . Lets see each option - Staph aureus food poisoning has incubation period less than 6 hours. - Clostridium perfringens food poisoning has incubation period less than 16 hours. - Now two options are left - Cl. botulinum and salmonella typhimurium both can have incubation period > 16 hours. - Food sources responsible for botulism are home preserved foods such as home-canned vegetables, smoked or pickled fish, home-made cheese and similar home made food. - Salmonella typhimurium food poisoning occurs after eating contaminated meat, milk and milk products (ice cream), sausages, custards, eggs and egg products. -### End" -6615,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are pathologic features of primary tuberculosis, EXCEPT:, with the following options: A: Cavitation, B: Caseation, C: Calcification, D: Langerhans giant cell - -### Response: -Primary TB is a form of disease that develops in a previously unexposed, and therefore unsensitized person. Secondary TB is the pattern of disease that arises in a previously sensitized host. Cavitation occurs in secondary TB. The caseous necrosis occurring in primary TB is conveed into a cavity in secondary TB. Ref: Robbins Pathologic Basis of Disease, 6th Edition, Pages 723-4 -### End" -6616,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is most common symptom of tetanus, with the following options: A: Risus sardonicus, B: Trismus, C: Hyperreflexia, D: Tonic clonic convulsion - -### Response: -Trismus, due to spasm of masseter and pterygoids is the most common symptom of tetanus. -### End" -6617,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MC cause of morbidity and moality late in the course of mitral stenosis: March 2013, with the following options: A: Infective endocarditis, B: Pulmonary edema, C: Recurrent pulmonary emboli, D: Pulmonary infections - -### Response: -Ans. C i.e. Recurrent pulmonary infections Mitral stenosis/ MS Features: - Atrial fibrillation - Hemoptysis - Pulmonary hypeension, - Hoarseness of voice Most impoant differential diagnosis: Left atrial myxoma Investigation of choice for MS: Echocardiography Mitral valve area less than 0.6 cm2 is incompatible with life -### End" -6618,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the most common cause of preload disorders in children?, with the following options: A: Distributive shock, B: Hypovolemic shock from vomiting and diarrhea, C: Congestive hea failure, D: Severe anemia - -### Response: -Preload is the amount of blood that the hea receives to distribute to the body. In addition to hea rate, afterload, and cardiac contractility, preload determines cardiac output. In children, the most common cause of decreased preload is hypovolemia, usually from vomiting and diarrhea. Distributive shock secondary to sepsis, neurogenic spinal shock, or anaphylaxis is a less common cause of preload reduction. Acute anemia may also be associated with decreased preload. Congestive hea failure is a frequent complication in children with congenital hea disease. Increased preload results in elevation of left atrial pressure leading to pulmonary edema and decreased oxygenation. Reference: GHAI Essential pediatrics, 8th edition -### End" -6619,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cryptomenorrhea occurs due to :, with the following options: A: Imperforate hymen, B: Asherman's syndrome, C: Mullerian agenesis, D: All - -### Response: -Imperforate hymen -### End" -6620,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Collection of sero-sanguineous fluid in the scalp AFMC 12, with the following options: A: It is present at bih, B: It does not cause jaundice in newborn, C: It is limited to individual bone, D: It disappears within a few hours of bih - -### Response: -Ans. It is limited to individual bone -### End" -6621,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hormones stimulates gastric emptying _________, with the following options: A: Gastrin, B: Secretion, C: CCK, D: Gastric inhibitory peptide - -### Response: -Gastrin stimulates gastric emplying. -CCK, secretin, gastric inhibitory peptide (GIP) inhibits gastric emptying. -### End" -6622,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A component of conversion disorder is?, with the following options: A: Hysteric fits, B: Derealisation, C: Depersonalisation, D: Amnesia - -### Response: -Hysteric fits REF: Kaplan 9th ed p. 676ICD 10 includes conversion disorders under dissociative disorders, however, traditionally conversion disorders are known as hysteriaConversion disorder may present withHysterical fitsMotor symptoms like abnormal movements and gait disturbance or inability to moveSensory symptoms likeBlindness but walks and doesnt injure himselfTubular visionGlove stocking anesthesiaLoss of sensation (not dermatomal) -### End" -6623,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: On exposure to cold, all are seen EXCEPT:March 2013, with the following options: A: Increased adrenaline, B: Shivering, C: Increased thyroxine, D: Cutaneous vasodilation - -### Response: -Ans. D i.e. Cutaneous vasodilationHypothermiaIt is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as 35.0 degC (95.0 degF).Symptoms may be sympathetic nervous system excitation:- Shivering,Hypeension,- Tachycardia,- Tachypnea, and- VasoconstrictionThese are all physiological responses to preserve heat. Cold diuresis, mental confusion, as well as hepatic dysfunction may also be present. -### End" -6624,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which nerve is damaged in ant dislocation of shoulder:, with the following options: A: Axillary, B: Median, C: Radial, D: Musculocutaneous - -### Response: -A i.e. Axillary nerve -### End" -6625,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A lady dimple has a lytic lesion in X-ray of the upper end of the humerus. The diagnosis is -, with the following options: A: Osteosarcoma, B: Osteochondroma, C: Unicameral bone cyst, D: Osteoclastoma - -### Response: -Amongst the given options, unicameral bone cyst arises commonly in proximal humerus. -### End" -6626,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Albumin is impoant factor in maintaining osmotic pressure, has:, with the following options: A: Low molecular weight and high blood concentration, B: Low molecular weight and low blood concentration, C: High molecular weight and low blood concentration, D: High molecular weight and high blood concentration. - -### Response: -A i.e. Low molecular weight and high blood concentration Osmotic pressure is determined by the number of paicles in solution and not by the mass of the paicle, that means 1 gm of a heavy molecular weight protein will contain a lesser no. of paicles than 1 gm of a light molecular weight protein, & conse uentiv will have a lesser osmotic pressure Plasma protein MW Concentration Contribution to plasma osmolality Albumin 69,000 3.5-5 gm% 80% Globulin 1,40,000 2.0 gm% 20% Fibrinogen 4,00,000 0.3 gm% 0% Of the there major types of plasma protein, albumin with minimum molecular weight contributes. max to plasma oncotic pressure. -### End" -6627,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for NSAID resistant Rheumatoid Arthritis, with the following options: A: Methotrrexate, B: Sulphasalezine, C: Corticosteroid, D: Salicylic acid - -### Response: -(A) Methotrrexate # Usual approach to Rheumatoid Arthritis: is to attempt to alleviate the patient's symptoms with NSAIDs or Coxibs. Some patients may have mild disease that requires no additional therapy. However, if the patient has any evidence of aggressive disease, initiation of DMARD therapy should be considered as early as feasible. This group of agents includes methotrexate, gold compounds.D-penicillamine, the antimalarials, and sulfasalazine. Despite having no chemical or pharmacologic similarities, in practice these agents share a number of characteristics Methotrexate has emerged as the DMARD of choice because of its relatively rapid onset of action, its capacity to elfect sustained improvement with ongoing therapy, and the higher level of patient retention on therapy. -### End" -6628,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Medical management of hyperparathyroidism includes which of the following?, with the following options: A: Bisphosphonates, B: Calcitonin, C: Plicamycin, D: All the above - -### Response: -Ans. is 'd' i.e., All the above Medical management for hyperparathyroidism* Medical management rather than corrective surgery is still acceptable, but it is clear that surgical intervention is the more frequently recommended option.* When surgery is not selected, or not medically feasible, there is interest in the potential value of specific medical therapies.* There is no long-term experience regarding specific clinical outcomes such as fracture prevention, but it has been established that bisphosphonates increase bone mineral density significantly without changing serum calcium (as does estrogen, but the latter is not favored because of reported adverse effects in other organ systems).* Expansion of intravascular volume, administration of loop diuretics, pharmacotherapy which reduces osteoclastic bone resorption (like Bisphosphonates, Calcitonin, and Plicamycin) are useful in the medical management of hyperparathyroidism. -### End" -6629,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old man arrives in the emergency department in respiratory distress following a motor vehicle collision. A chest x-ray shows abdominal viscera in the left thorax. What is the most likely diagnosis?, with the following options: A: Traumatic rupture of the diaphragm, B: Sliding esophageal hernia, C: Short esophagus with intrathoracic stomach, D: Rupture of the esophagus - -### Response: -Blunt trauma is the most common cause of diaphragmatic rupture. Associated injuries are common. In blunt trauma, the left diaphragm is ruptured more frequently than the right. The stomach, spleen, colon, and omentum may enter the left pleural cavity. Diaphragmatic injury without herniation of abdominal contents is difficult to diagnose. Patients may present with symptoms many years after the initial trauma. Early surgery is indicted. -### End" -6630,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum congestion is seen in -, with the following options: A: Choking, B: Hanging, C: Strangulation, D: Drowning - -### Response: -In strangulation, all internal viscera are deeply congested and there is marked congestion of face. -### End" -6631,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 4 day old newborn baby having icterus involving sole, bilirubin level (mg/dl) -, with the following options: A: 12, B: 15, C: 8, D: 6 - -### Response: -Ans. is 'b' i.e., 15 mg/dl Dermal staining of biiirubin-o Described by kramero Jaundice progress in cephalocaudal directiono Divided in 5 zoneZone Bilirubin1) 4-6 mg/dl-Face2) 6-8 mg/dl-Trun k & upper abdomen3) 8-12 mg/dl-Lower abdomen & thign4) 12-14 mg/dl-Arm & leg5) > 15 mg/dl-Palm & sole -### End" -6632,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Delirium and schizophreinia differ from each other by:, with the following options: A: Change in mood, B: Complete consciounsness, C: Tangenital thinking, D: All - -### Response: -B. i.e. Complete consciousness -### End" -6633,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fallopian tube patency is checked by, with the following options: A: Hysterosalpingography, B: Laparoscopy, C: Hysteroscopy, D: All of the above - -### Response: -All of the above Tests Performed for Tubal patency are : 1. CO, insufflation test/ Rubins test (out dated)deg Hysterosalpingography (HSG)deg: Screening test. Laparoscopic chromotubationdeg: Best test Sonosalpingography (Sion Test)deg Hysteroscopydeg Transcervical Falloscopydeg Ampullary and Fimbrial Salpingoscopy.deg Extra Edge : Time of performing Tubal Patency test 61' - 111h day of cycle (-= 10'h day). Result : If tubes are patent, the medium will be seen to spill out of the abdominal ostia on to the adjacent viscera.deg If either of the tubes is blocked - site will be shown.deg A hydrosalpinx will show as a large confined mass of dye without peritoneal spill.deg Bilateral cornual block with extravasation of the dye is suggestive of tubercular salpingitis.deg * Laparoscopic chromotubation -Once HSG shows blocked tubes, it can be confirmed by laparoscopic visualization of the pelvis, fallopian tubes and ovary and injection of methylene blue through the cervix to visualize free spill or absence of spill. In addition to tuba! patency it can diagnose any peritubal adhesions or endometriosis. Sonosalpingography -(SION TEST) : In this test, 200 ml of physiological saline is slowly injected into the uterine cavity with the help of foleys catheter (its inflated bulb lies at the level of internal os) and flow of the saline along the tube is then visualized by USG. -### End" -6634,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Onion peeling of renal vessels is seen in-, with the following options: A: Benign hypeension, B: Malignant hypeension, C: Diabetic nephropathy, D: SLE - -### Response: -Malignant nephrosclerosis Histology: Fibrinoid necrosis and onion-skinning of aerioles. Flea-bitten kidney: It is characterized by the presence of small, pinpoints petechial hemorrhages on the coical surface due to rupture of aerioles or glomerular capillaries. Causes of the flea-bitten kidney: Malignant hypeension Subacute bacterial endocarditis Rapidly progressive GN Henoch-Schonlein purpura. Ref: RAM DAS NAYAK EXAM PREPARATORY MANUAL FOR UNDERGRADUATES 2nd ed. pg no: 621 -### End" -6635,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dryness of mouth caused by antipsychotics due to their -, with the following options: A: Anticholineic action, B: Antiodrenergic action, C: Antidopaminergic action, D: Antihistaminic action - -### Response: -Ans. is 'a' i.e., Anticholineic action o Antipsychotics has anticholinergic propey which can cause anticholinergic side effects, e.g., Dry mouth, bad taste, urinary retention, blurred vision, palpitation and constipation. o It is interesting to know that clozapine causes hypersalivation despite anticholinergic propey. -### End" -6636,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is involved in cleavage of recombinant DNA, with the following options: A: Helicases, B: Restriction enzyme, C: Ligases, D: All of the above - -### Response: -(Restriction enzyme) (398-Harper 26,h) (187-NMS 4,h) (579- U.S.3rd)Restriction enzymes - are named after the bacterium from which they are isolated* **Each enzymes recognizes and cleaves a specific double stranded DNA sequence that is 4-7 bp long. These DNA cuts result in blunt ends or overlapping (sticky) ends* **Sticky ends are particularly useful in preparation of chimeric or hybrid DNA molecules* Restriction enzymes requires no additional energy from adenosine triphosphate or other energy source for cleavage (186-NMS 4,h)DNA iigases - It is essential tool in the formation of recombinant DNA clonesHelicases - Processive unwinding of DNA (328-HP)Some of the enzymes used in recombinant DNA research (400 HP)* Alk. phosphatase* Exonuclease III* Reverse transcriptase* BAL-31 nuclease* X exonuclease* SI nuclease* DNA polymerase I* DNase I* Polynucleotide kinase* Terminal transferase -### End" -6637,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a mineralocoicoid antagonist -, with the following options: A: Spironolactone, B: Inamrinone, C: Nicorandil, D: Ketorolac - -### Response: -Ans. is 'a' i.e., Spironolactone -### End" -6638,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs are used for prophylaxis of migraine except;, with the following options: A: Propranolol, B: Imipramine, C: Flutamide, D: Flunarizine - -### Response: -Flutamide is androgen receptor antagonist. Used in Ca prostate and hirsutism. -### End" -6639,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Follman's balanitis is seen in, with the following options: A: Candida, B: Trichomonas, C: HIV, D: Syphilis - -### Response: -Syphilitic balanitis of Follmann (SBF) is a rare condition that is considered as manifestation of primary syphilis. Syphilitic balanitis of Follmann presents with variable clinical appearances, and primary chancre may be absent, associated with, or occur after the balanitis. Usually the inguinal lymphadenopathy is present, and syphilitic serology is positive or is going to become positive. Treatment is identical to that of primary syphilis. -### End" -6640,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a multipennate muscle:March 2012, with the following options: A: Rectus femoris, B: Deltoid, C: Flexor pollicis longus, D: Temporalis - -### Response: -Ans: B i.e. DeltoidMusclesRectus femoris is a bipennate muscleMultipennate muscle examples include subcapsularis, deltoid (acromial fibres)Flexor pollicis longus is an unipennate muscleTemporalis is a triangular muscle -### End" -6641,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The commonest congenital anomaly seen in pregnancy with diabetes mellitus is:, with the following options: A: Multicystic kidneys, B: Oesophageal atresia, C: Neural tube defect, D: Duodenal atresia - -### Response: -Ans. is c, i.e. Neural tube defectRef Fernando Arias 3/e, p 454; COGDT 10/e, p 312; Sheila Balakrishnan, p 288; Wiilliams Obs. 21/e, p 1369Friends, this is one of the most frequently asked and most controversial topic of PGMEE Exams.I am giving you all the information I could lay my hands and the rest is up to you.Congenital malformation in Diabetes: --Fernando Arias 3/e, p 454""The most frequent abnormalities involve the heart and the central nervous system. Most common are anencephaly, spina bifida, transposition of the great vessels, and ventricular septal defects"".""The lesion classically associated with diabetic embryopathy, the 'caudal regression syndrome', is rare, with an incidence of 1.3 per 1000 diabetic pregnancies"". --Fernando Arias 3/e, p 454Most common Anomalies in Infants of Diabetic mothers:Central nervous systemHeart and great vesselsSkeletal and spinal systemGenitourinary systemGastrointestinal systemAnencephalyHoloprosencephalyEncephaloceleTransposition of the great vesselsVentricular septal defectAortic coarctationAtrial septal defectCaudalregressionsyndromeRenal agenesisUreteral duplicationAnal atresiaSheila Balakrishnan p 288 says --Cardiac defects are the commonest (transposition of great vessels and VSD).Neural tube defects like anencephaly and spina bifida.Caudal regression syndrome or sacral agenesis, which is very rare, is the congenital defect which is specific to diabetes.""The most common single-organ system anomalies were cardiac (38%), musculoskeletal (15%) and central nervous system (10%)"" --Williams Obs. 21/e, p 1369Remember:Most common system involved = Cardiovascular system.IInd most common system involved = Nervous systemMost common anomalies = VSD, ASD, TGA, Anencephaly, spina bifidaIn cardiac anomalies M/C is VSD but most specific is TGA.Anomaly most specific for gestational diabetes - Caudal regression syndrome/sacral agenesis.Congenital anomalies are seen in overt diabetes and not gestational diabetesInvestigation of choice to predict the risk of congenital anomalies in diabetic patients-HbA1CInvestigation of choice to detect the risk of congenital anomalies in diabetic patients-USG -### End" -6642,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Function of LCAT is:, with the following options: A: Helps in cholesterol synthesis, B: Conves cholesterol to cholesterol ester, C: Helps in formation of chylomicrons, D: All of the above - -### Response: -The cholesterol (cholesteryl) ester forms an integral pa of HDLThe cholesterol from the peripheral tissues is trapped in HDL by a reaction catalyzed by LCATLecithin-cholesterol acyltransferase/ LCAT/ Phosphatidylcholine-sterol 0-acyltransferaseIt conves free cholesterol into cholesteryl ester (a more hydrophobic form of cholesterol)Which is then sequestered into the core of a lipoprotein paicle, eventually making the newly synthesized HDL spherical and forcing the reaction to become unidirectional since the paicles are removed from the surface.The enzyme is bound to high-density lipoproteins (HDLs) and low-density lipoproteins in the blood plasma -### End" -6643,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following constitute primary diagnostic criteria for ABPA, except:, with the following options: A: Elevated serum IgE levels > 417 IU/ml, B: Peripheral eosinophilia >500 cells/ml, C: Central/Proximal bronchiectasis, D: Identification of A. fumigatus from sputum - -### Response: -Identification of A.fumigatus from sputum is a secondary Diagnostic criteria for ABPA: Major/Primary diagnostic criteria Secondary Diagnostic criteria Clinical history of Asthma Pulmonary infiltrates transient/fleeting or fixed) Peripheral eosinophilia Immediate skin reactivity to Aspergillus antigen Elevated serum IgE levels or Central/Proximal Bronchiectasis Precipitating antibodies to A.fumigatus Elevated specific serum IgE or IgG antibodies to A.Fumigatus History of brownish plugs in sputum Identification of A.fumigatus from sputum Late skin reactivity to aspergillus antigen Ref: CMDT 2017; Harrisons 19 edition/1686 -### End" -6644,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atropine is useful in organophosphate poisoning because it:, with the following options: A: Reactivates acetylcholinesterase, B: Competes with acetylcholine release, C: Binds with both nicotinic and muscarinic acetylcholine receptors, D: Is a competitive antagonist of acetylcholine - -### Response: -Atropine acts as an antagonist at muscarinic receptors. It has no activity on nicotinic receptors and does not interfere with the release of ACh. -### End" -6645,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Protein filtration across cerebral capillaries is limited by:, with the following options: A: Fibrous tissue, B: Foot process of astrocytes, C: Low BP, D: High CSF pressure - -### Response: -B i.e. Foot process of astrocytes Blood Brain Barrier (BBB) -### End" -6646,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 18 yrs. old hears voices discussing him in third person has:, with the following options: A: Schizophrenia, B: Depression, C: Mania, D: Phobia - -### Response: -Ans. is 'a' Schizophrenia 3rd Person hallucination is Characteristics of Schizophrenia. -### End" -6647,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Catalase test is used to differentiate ?, with the following options: A: Staphylococcus aureus from staphylococcus epidermidis, B: Staphylococci from streptococci, C: Streptococcus pyogenes from other streptococci, D: None of the above - -### Response: -Ans. is 'b' i.e., Staphylococci from streptococci The catalase test is used to differentiate staphylococci (catalase-positive) from streptococci (catalase-negative). The enzyme, catalase, is produced by bacteria that respire using oxygen, and protects them from the toxic by-products of oxygen metabolism -### End" -6648,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: “Aschoff bodies” are seen in:, with the following options: A: Rheumatoid arthritis, B: Rheumatic fever, C: Bacterial endocarditis, D: Marantic endocarditis - -### Response: -Rheumatic fever (RF) -Morphology - -During acute RF, focal inflammatory lesions are found in various tissues. -Distinctive lesions occur in the heart, called Aschoff bodies, which consist of foci of lymphocytes (primarily T cells), occasional plasma cells, and plump activated macrophages called Anitschkow cells (Pathognomonic for RF). -These macrophages have abundant cytoplasm and central round-to ovoid nuclei in which the chromatin is disposed in a central, slender, wavy ribbon (hence the designation ""caterpillar cells""), and may become multinucleated. -During acute RF, diffuse inflammation and Aschoff bodies may be found in any of the three layers of the heart, causing pericarditis, myocarditis, or endocarditis (pancarditis). -Inflammation of the endocardium and the left sided valves typically results in fibrinoid necrosis within the cusps or along the tendinous cords. -Overlying these necrotic foci are small (1 - to 2- mm) vegetations, called verrucae, along the lines of closure. -Subendocardial lesions, perhaps exacerbated by regurgitant jets, may induce irregular thickenings called MacCallum plaques, usually in the left atrium. - -Chronic Rheumatic Heart Disease - -The changes of the mitral valve in are: - - -Leaflet thickening -Commissural fusion -Shortening, thickening and fusion of the tendinous cords - - -In chronic disease, the mitral valve is virtually always involved -The mitral valve is affected alone in 65% to 70% of cases, and along with the aortic valve in another 25% of cases. -Fibrous bridging across the valvular commissures and calcification create ""fish mouth"" or “buttonhole” stenoses. -### End" -6649,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adrenal insufficiency in not associated with ?, with the following options: A: Hyponatremia, B: Hyperkalemia, C: Hypoglycemia, D: Metabolic alkalosis - -### Response: -Ans. is 'd' i.e., Metabolic alkalosis Features of adrenal insufficiency (Addison's disease) are :-i) Hypoglycemiaiv) Hyponatremiaii) Hyperpigmentationv) Hypotensioniii) Hyperkalemiavi) Metabolic acidosisAssociated features are nausea, vomiting, diarrhea and abdominal cramps. -### End" -6650,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 26 year old male complains of urethral discharge for past 5 days. Which colour kit has to be administered?, with the following options: A: Yellow, B: Gray, C: Red, D: Blue - -### Response: -Kit 1 (Gray colour) is given for symptoms of urethral /cervical discharge. It includes T.cefixime single dose and T.Azithromycin single dose to cover gonorrhoea and chlamydia. -### End" -6651,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is true about H. pylori-, with the following options: A: Gram -ye Cocci curved, B: Gram +ve Cocci straight, C: Gram +ve bacilli curved, D: Gram -ye spiral bacteria - -### Response: -Ans. is 'd' i.e., Gram -ye spiral bacteria -### End" -6652,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inclusion body of CMV is -, with the following options: A: Cowdry type A, B: Cowdry type B, C: Intranuclear, D: Cytoplasmic - -### Response: -Ans. is 'c' i.e., Intranuclear Cytomegalovirus (CMV)* Also known as salivary gland virus* CMV is the largest virus amongst herpes viruses* They are characterized by enlargment of infected cells (cytomegalic cells) and intranuclear inclusions.* Intranuclear inclusion is eccentrically placed and is surrounded by a halo - owl's eye appearance.* Once infected an individual carries CMV for life* CMV is the most common organism causing intrauterine infection.* CMV is the most common pathogen complicating organ transplantation.Clinical manifestations* Most of the infections in immunocompetent persons are asymptomatic.* Clinical features are divided intoA) Congenital infection# Infection is acquired in pregnancy.# It causes cytomegalic inclusion disease. Most common presentation is petechiae, hepatosplenomegaly and jaundice. Other features are microcephaly, cerebral calcification, chorioretinitis, IUGR, prematurity and thrombocytopenia.B) Perinatal infection# Infection is acquired during delivery or postnatally by breast feeding. Most patients are asymptomatic.C) Beyond neonatal period# Most common presentation is heterophile antibody-negative mononucleosis (CMV mononucleosis).D) Immunocompromized host# It causes retinitis, colitis, gastritis, esophagitis, pneumonitis, fever, leukopenia and hepatitis.# Maximum risk of infection after kidney transplant is between 1-4 months after transplantation. Most common presentation is fever, leukopenia and hepatosplenomegaly.# Most common presentation after bone marrow transplantation is interstitial pneumonia.Laboratory diagnosis* Definitive diagnostic test (most specific test) is isolation of virus from urine, saliva, blood or bronchoalveolar washing.* Most sensitive test is PCRfor viral genome (DNA) detection in blood or intraocular fluid (in CMV retinitis).* Serology (IgM or IgG) is not very useful.Treatment* Ganciclovir or valganciclovir are drugs of choice. Foscarnet is used for CMV retinitis. -### End" -6653,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug useful in breast cancer is, with the following options: A: Tamoxifen, B: Cyprotenene, C: Testosterone, D: Chlorambucil - -### Response: -Medications Estrogen modulator, Chemotherapy, Hormone based chemotherapy, and Bone health -### End" -6654,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Copper sulfate poisoning manifests with, with the following options: A: High anion gap acidosis, B: Rhabdomyolysis, C: Acute hemolysis, D: Peripheral neuropathy - -### Response: -COPPER Poisonous Compounds: (1) Copper sulphate (blue vitriol) occurs in large, blue crystals. (2) Copper subacetate (verdigris), occurs in bluish-green masses or powder. Signs and Symptoms: Increased salivation, burning pain in the stomach with colicky abdominal pain, thirst, nausea, eructations and repeated vomiting. The vomited matter is blue or green. There is diarrhoea with much straining; motions are liquid and brown but not bloody. Oliguria, haematuria, albuminuria, acidosis and uraemia may occur. In severe cases haemolysis,haemoglobinuria, methaemoglobinaemia, jaundice, pancreatitis and cramps of legs or spasms and convulsions occur. The breathing is difficult, cold perspiration and severe headache occur. In some cases, paralysis of limbs is followed by drowsiness, insensibility, coma and death due to shock. Later deaths occur due to hepatic or renal failure or both. Ref:- k s narayan reddy; pg num:-547 -### End" -6655,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 year old female presents with cervical and axillary lymphadenopathy. There is history of fever and drenching night sweats. She is diagnosed to have hodgkin's lymphoma. What is the stage of the disease?, with the following options: A: II-A, B: II-B, C: IIE-A, D: IIE-B - -### Response: -Ans. (b) II-B(Ref: Robbins 9th/pg 606-611/ 8th pg 616-621)Involvement of two or more lymph node regions on the same side of diaphragm alone (II) or localized involvement of an extra-lymphatic organ or site (IIE).Presence of (B) symptoms: QUnexplained fever,Drenching night sweats, and/orUnexplained weight loss >10% -### End" -6656,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ectopic pregnancy is most commonly associated with:, with the following options: A: Endometriosis, B: Congenital tubal anomalies, C: Tuberculosis, D: Tubal inflammatory diseases - -### Response: -Read the question carefully, it says ectopic pregnancy is most commonly associated with: -“Pelvic inflammatory disease (PID) increases the risk of ectopic pregnancy by 6-10 fold.” -Dutta Obs. 7/e, p 178 -“The most common cause (of ectopic pregnancy) is previous salpingitis due to sexually transmitted disease such as gonococcal and chlamydial infection or salpingitis that follows septic abortion and puerperal sepsis.” -Shaw 14/e, p 239 - -After one episode of PID – 13% -After two episode of PID – 35% -After three episode of PID – 75% - -Note: M/C cause of ectopic pregnancy is PID but Maximum risk of ectopic pregnany is after tubal damage, either due to previous ectopic pregnancy or tubal surgery amongst which previous ectopic is more common. -“Prior tubal damage either; from a previous ectopic pregnancy or from tubal surgery to relieve infertility or for sterilization confers the highest risk for ectopic pregnancy.” -Williams Obs 23/e, p 238 -### End" -6657,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hardening of sodalime done by?, with the following options: A: CaCO, B: CaSO4, C: BaSO4, D: Sodium silicate - -### Response: -Ans. is 'd' i.e.,Sodium silicateSoda lime is a mixture of chemicals, used in granular form in closed breathing environments, such as general anaesthesia to remove carbon dioxide from breathing gases to avoid hypercarbia -### End" -6658,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding Dandy-Walker syndrome, all are seen except-, with the following options: A: Hydrocephalus, B: Arachnoid cyst, C: Posterior fossa cyst, D: Cerebellar vermis deficiency - -### Response: -Dandy-walker malformation - -The Dandy-Walker malformation consists of a cystic expansion of the 4th ventricle in the posterior fossa and midline cerebellar hypoplasia. -There is : - -Hydrocephalus (90% of cases) -Agenesis of the cerebellar vermis and corpus callosum. -The rapid increase in head size with prominent occiput. -### End" -6659,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of hemolytic uremic syndrome, EXCEPT:, with the following options: A: Thrombocytopenia, B: Anemia, C: Renal dysfunction, D: Neuro-psychiatric disturbances - -### Response: -Neuro-psychiatric disturbances are not a feature of hemolytic uremic syndrome, but may be seen in TTP. HUS: Hemolytic-uremic syndrome (HUS) is a common cause of community acquired acute kidney injury in young children characterised by a triad of Microangiopathic Hemolytic anemia Thrombocytopenia Renal dysfunction In HUS, capillary and aerial endothelial injury in kidney leads to localized thrombosis. The entrapment of platelets in micro-thrombi formed in small blood vessels leads to thrombocytopenia. The consumption of clotting factors due to initiation of coagulation cascade leads to hypofibrinogenemia. Microangiopathic hemolytic anemia results from mechanical damage to red blood cells as they through the damaged and thrombotic microvasculature. -### End" -6660,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about shunt vessels?, with the following options: A: Evenly distributed throughout the skin, B: Role in nutrition, C: Play a role in thermoregulation, D: No autonomic nervous regulation - -### Response: -Ans. c. Plav a role in thermoregulation Cutaneous (anterior-venous anastomosis) shunt vessels play an important role in temperature thermoregulation.Functional Classification of Vessel WaltVesselIncludeFeatureElastic ArteriesAorta, pulmonary artery and major branches* Elastic recoil maintains continuous blood flow and diastolic arterial pressure0Conduct (muscular) ArteriesMain arteries e.g. cerebral, coronary, popliteal, radial* Thicker muscle in tunica mediaResistance vesselsSmallest terminal arteries and arterioles* Single layer of muscle in tunica media* Regulate local blood flow to match local demandsArteriovenous anastomosisShunt vessels* Connect arteriole to venule by passing capillaries* Present in skin and nasal mucosa* Regulate temperatureExchange vesselsCapillaries* Largest cross section area* Provide O2 and nutrition to tissues0Capacitance vesselsVeins* Store large volumes of bloodArteriovenous Anastomosis {Shunt Vessels)* Shunt vessels are short muscular vessels that connect arterioles and venules, by passing the capillaries,* Like other vascular smooth muscles the shunt vessels are under the control of sympathetic nervous system (and receive sympathetic innervation)* Uneven distribution: shunt vessels are mainly concentrated in tissue with a small surface area / volume ratio e.g. fingers, toes, ears, and nose.Shunt vessels are found in skin and nasal mucosa especially inHandsPalm and fingersFeetSole and toesFaceEar, nose and lips* No nutritive only thermoregulatory function: Nutrition is provided by capillaries since capillaries deliver O2 to tissues. Because shunt vessels bypass capillaries, these have no nutritive function.* Shunt vessel have important role in thermoregulation. These provide an important site of hodV heat transfer between skin and blood stream. By dilating in cold conditions and directing large volumes of blood through these vessels, it provides a valuable mechanism to prevent tissue freezing and cold damage to the extremitiesQ -### End" -6661,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are not the cause of hypopigmentation:, with the following options: A: Leprosy, B: Pinta, C: Syphilis, D: None - -### Response: -D i.e. None -### End" -6662,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chlamydia psittacosis all are true except -, with the following options: A: Acquired from bird's droppings, B: Causes urethritis, C: Causes pneumonia, D: Treatment is tetracycline - -### Response: -Urethritis does not occur in psittacosis -### End" -6663,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most important intracellular cation -, with the following options: A: Na+, B: K+, C: Ca2+, D: Mg2+ - -### Response: -Ans. is 'b' i.e., K+ o In ECF, most abundant cation is Na+ and most abundant, anion is Cl-.o On the other hand, in ICF most abundant cation is K+ and most abundant anion is PO4-2 followed by protein. -### End" -6664,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diethylstilbesterol should never be used in pregnant women because it is associated with:, with the following options: A: Development of deep vein thrombosis in the pregnant woman, B: Feminization of the external genitalia of male offspring, C: Infeility and development of vaginal cancer in female offspring, D: Virilization of the external genitalia of female offspring - -### Response: -Diethylstilbesterol is associated with development of vaginal adenocarcinoma in female offsprings. Therefore, it is contra-indicated in pregnancy. -### End" -6665,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: T cells are derived from:, with the following options: A: Tonsils, B: Thymus, C: Thalamus, D: Thyroid - -### Response: -Ans. B ThymusRef: BDC, 6th ed. vol. II pg. 147T cells originate in the bone marrow but mature in the thymus. So, T stands for 'Thymus'.* Thymus and bone marrow are primary lymphoid organs.* Lymph node and spleen are secondary lymphoid organs. -### End" -6666,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First quaile of the following data is - 1, 3, 4, 2, with the following options: A: 1, B: 3, C: 1.5, D: 4 - -### Response: -Ref: Parks 23rd edition Arrange the values in ascending order 1,2,3,4 Median= 2.5, that is Q2 Q1= middle of 1 and 2 , that is 1.5 -### End" -6667,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Content of superficial perineal pouch -, with the following options: A: Sphincter urethrae, B: Deep transverse perinei\, C: Bulbospongiosus, D: Artery of penis - -### Response: -Ans. is 'c' i.e., Bulbospongiosus FeaturesSuperficial perineal spaceDeep perineal spaceSituationSuperficial to perineal membraneDeep to perineal membraneBoundaries a) Superficialb) Deepc) Laterald) Posteriorlye) AnteriorlyColles' fasciaPerineal membraneIschiopubicramiClosed by union of the perineal membrane with Colles fasciaOpen and continuous with the spaces of scortum, penis and anterior abdominal wallPerineal membraneSuperior fascia of urogenital diaphragmIschiopubic ramiClosed by the union of perineal membrane with superior fascia of the urogenital diaphragmClosed by the union of perineal membrane with superior fascia of the urogenital diaphragm at transverse perineal ligament.Contents1. Root of penis, made up of tw o crura and one bulb1. Membranous urethra 2. Muscles :a) Ischiocavernosusb) Bulbospongiosusc) Superficial transverse perinei2. Muscles :a) Sphincter urethraeb) Deep transverse perinei 3. Nerves :a) Three sets of branches from the perineal nerve--posterior scrotal, nerve to the bulb and muscular branches.b) Long perineal nerve from the posterior cutaneous nerve of thigh.3. Nerves:a) Dorsal nerve of the penisb) Muscular branches from the perineal nerve. 4. Vessels :a) Branches of perineal arteryy Posterior scrotaly transverse perinealb) Branches from the artery of penis :y Artery to the bulby The urethral arteryy The deep artery of the penisy dorsal artery of the penis4. Vessels :a) Artery of the penisb) Stems of origin of four arteries from the artery of penis passing to the superficial perineal space. 5. Glands and ducts :y Greater vestibular glands in femalesy Ducts of bulbo-urethral glands in males5. Glands:# Bulbourethral glands in males -### End" -6668,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most Common site of tubal sterilization is -, with the following options: A: Fimbria, B: Isthmus, C: Ampulla, D: Interstitial part - -### Response: -Ans-B i.e., Isthmus o Most commonly performed method of female sterilization is Pomeroy's method.o The part of the fallopian tube is ligated and excised in Pomeroy's method is isthmus.a) Pomeroy's Method - Through an avascular area in the mesosalpinx, a needle threaded with No. ""0"" chromic catgut is passed and both the limbs of the loop are firmly tied together. About 1-1.5 cm of the segment of the loop distal to the ligature is excised. The tube is so excited as to leave behind about 1.5 cm of the intact tube adjacent to the uterus.# The segment of the loop removed is to be inspected to be sure that the wall has not been partially resected and to send it for histology.b) Uchida technique - A saline solution is injected subserosally in the mid-portion of the tube to create a bleb. The serous coat is incised along the antimesenteric border to expose the muscular tube. The tube is ligated with No. 0 chromic catgut on either side and about 3-5 cm of the tube is resected off. The ligated proximal stump is allowed to retract beneath the serious coat. The serous coat is closed with a fine suture in such a way that the proximal stump is buried but the distal stump is open to the peritoneal cavity. No failure in this method has been observed so far.c) Irving method - The tube is ligated on either side and mid portion of the tube (between the ties) is excised. The free medial end of the tube is then turned back and buried into the posterior uterine wall creating a myometrial tunneld) Madlener technique - It is the easiest method. The loop of the tube is crushed with an artery forceps. The crushed area is tied with black silk. The loop is not excised. The failure rate is very high to the extent of 7% and hence, it is abandoned in preference to the Pomeroy's technique.e) Kroener method of fimbriectomy is not a common procedure. -### End" -6669,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following reactions are catalyzed by microsomal enzymes EXCEPT:, with the following options: A: Glucuronidation, B: Acetylation, C: Oxidation, D: Reduction - -### Response: -- Acetylation is done by N-acetyl transferase which is a non-microsomal enzyme. -- Most of the Phase 1 reactions and Glucuronidation is done by microsomal enzymes. -### End" -6670,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about epidural opioids are all except:, with the following options: A: Act on dorsal horn substantia gelatinosa, B: Can cause Itching, C: Function of the intestine is not affected, D: Can cause respiratory depression - -### Response: -Ans. (C) Function of the intestine is not affected(Ref: Katzung 11/e p542)Because of their direct action on the superficial neurons of the spinal cord dorsal horn, opioids can also be used as regional analgesics by administration into the epidural or subarachnoid spaces of the spinal column.It was initially assumed that the epidural application of opioids might selectively produce analgesia without impairment of motor, autonomic, or sensory functions other than pain. However, respiratory depression can occur after the drug is injected into the epidural space and may require reversal with naloxone.Effects such as pruritus and nausea and vomiting are common after epidural and subarachnoid administration of opioids and may also be reversed with naloxone if necessary.Currently, the epidural route is favored because systemic adverse effects are less common -### End" -6671,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which off the following is an oncogenic retrovirus?, with the following options: A: HTLV-1, B: HPV, C: EBV, D: HBV - -### Response: -Ans: A (HTLV-1) Ref: Jawetz, Mel nick & Adel bergs Textbook of Medical Microbiology, 25th Edition. 2010Explanation:* Viruses which produce tumors in either their natural host or experimental animals or induce malignant transformation in cell cultures are called oncogenic viruses.RNA virusesCANCERHCVHTLV1HIVHepatocellular cancerAdult T cell leukemiaAIDS related malignanciesDNA virusesCANCERHPVGenital tumoursOropharyngeal cancerBurkitt's lymphomaNasopharyngeal carcinomaB cell lymphomaKaposi's sarcomaHepatocellular cancerEBVHHV 8HBV -### End" -6672,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rectified spirit not used as preservation in case of-, with the following options: A: Phenol, B: Cyanide, C: Insecticides, D: Aluminium phosphide - -### Response: -Rectified spirit is used in all poisonings except phenol, phosphorus, paraldehyde, kerosene, formaldehyde, formic acid, alcohol, acetic acid, chloroform, chloral hydrate and ether. -### End" -6673,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about early stages of GERD, with the following options: A: Increased number of TLOSRs, B: Increased LOS pressure, C: Shoening of LOS, D: Loss of intra abdominal oesophagus - -### Response: -In normal circumstances, the LOS transiently relaxes as a coordinated pa of swallowing, as a means of allowing vomiting to occur and in response to stretching of the gastric fundus, paicularly after a meal to allow swallowed air to be vented. Most episodes of physiological reflux occur during postprandial transient LOS relaxations (TLOSRs). In the early stages of GORD, most pathological reflux occurs as a result of an increased number of TLOSRs rather than a persistent fall in overall sphincter pressure. In more severe GORD, LOS pressure tends to be generally low, and this loss of sphincter function seems to be made worse if there is loss of an adequate length of intraabdominal oesophagus.Ref: Bailey and Love 27e pg: 1076 -### End" -6674,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A positive ""Staliwohy's sign"" is suggestive of which of the following conditions :, with the following options: A: Twin pregnancy, B: Breech presentation, C: Vesicular mole, D: Low lying placenta - -### Response: -Low lying placenta -### End" -6675,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In humans, cryptosporidiosis presents as ?, with the following options: A: Meningitis, B: Diarrhea, C: Pneumonia, D: Hepatitis - -### Response: -Ans. is 'b' i.e., Diarrhea -### End" -6676,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organism commonly causing sterility in pelvic Inflammatory disease is :, with the following options: A: Gonococcus, B: Streptococcus, C: Staphylococcus, D: Hemophilus - -### Response: -Gonococcus -### End" -6677,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The mesocortical system of dopaminergic neurons is hyperactive and this can be proved by the occurrence of which of the following disease?, with the following options: A: Huntington's chorea, B: Schizophrenia, C: Parkinson's disease, D: Depression - -### Response: -Ans. b (Schizophrenia). (Ref. Harrison's medicine 16th ed. 2559)Mesocortical system of dopaminergic neurons is hyperactive in schizophrenia. The dopamine hypothesis of schizophrenia is based on the discovery that agents that diminish dopaminergic activity also reduce the acute symp-toms and signs of psychosis, specifically agitation, anxiety, and hallucination. An increase in the activity of nigrostriatal and mesolimbic systems and decrease in the mesocortical tracts activity innervating the prefrontal cortex is hypothesized, although it is likely that the other neurotransmitters, including serotonin, acetylcholine, glutamine, and GABA, also contribute to the pathophysiology of the illness. -### End" -6678,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patients present with dogs bite in the palm, fingers and oozing of blood on the neck regions, belongs to which class of the exposures, with the following options: A: Class I, B: Class II, C: Class III, D: None - -### Response: -(Class III) (231- Park 19th) (243-Park 20th)CLASSIFICATION OF EXPOSURESClass I (Slight risk)Class II (Moderate risk)* Licks on healthy unbroken skin* Consumption of unboiled milk of the suspected animals* Scratches without oozing of bloodLikes on fresh cutsScratches with oozing of bloodAll bites except those on head neck,face, palms and fingersMinor wounds less than 5 in numberClass III (Severe risk)* All bites or scratches with oozing of blood on the neck, head, face, palms and fingers* Lacerated wounds on any part of the body* Multible wounds 5 or more in numbers* Bites from wild animals -### End" -6679,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 year old male is not able to adduct his left eye while looking to the right. It indicates a lesion of which of the following cranial nerves?, with the following options: A: Abducens nerve, B: Oculomotor nerve, C: Trochlear nerve, D: Trigeminal Nerve - -### Response: -Ans. (b) Oculomotor nerveRef: Kanski 7/e, p, 781All adductors are paralyzed, SO4 , and LR6 which are not paralyzed both abduct the eye. -### End" -6680,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Remnant of notochord is-, with the following options: A: Annulus fibrosus, B: Nucleus pulposus, C: Ligament flavum, D: Intertransverse ligament - -### Response: -Ans. is 'b' i.e., Nucleus pulposuso After development of verteral bodies, the notochord degenerates and disappears but persists as the nucleus pulposus of intervertebral disc.o Notochord is a bud like structure formed by epiblast cells extending from cranial end of primitive streak to caudal end of prochordal plate, in between the ectoderm and endoderm. Significances of notochord includes followingIt defines the axis of embryo.It functions as the primary inductor, inducing the overlying ectoderm to develop into neural plate (the primordiwn of CNS).iii) It serves as the basis for development of axial skeleton. The notochord is an intricate structure around which vertebral column is formed and indicates future site of vertebral bodies. However, the notochord does not give rise to vertebral column, after development of vertebral bodies, the notochord degenerates and disappears, but parts of it persist as the nucleus pulposus of intervertebral disc. -### End" -6681,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following drug acts by blocking reverse transcriptase, with the following options: A: Zidovudine, B: Acyclovir, C: Amantadine, D: Ribavirin - -### Response: -Zidovudine acts by inhibiting the conversion of RNA to DNA by blocking the enzyme reverse transcriptase. It is a prodrug which has to be conveed to triphosphate form to be active Baveja 5th ed Pg.: 519 -### End" -6682,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 12 year old girl with the mood and emotional liability has a golden brown discoloration in descement membrane. Most likely diagnosis is ?, with the following options: A: Fabry's disease, B: Wilson's disease, C: Glycogen storage disease, D: Acute rheumatic fever - -### Response: -Ans. is 'b' i.e., Wilson's disease Emotional liability, tremors (Neurological symptoms) with brown discoloration of descemet's membrane of coenea suggest the diagnosis of Wilson's disease. Wilson's disease ? o It occurs due to reduced mobilization of copper from lysosomes in liver cells for excretion into the bile. o Abnormal gene for Wilson's disease is on long arm of chromosome 13 (AR). Clinical features ? o Younger patient likely to develop hepatic involvement. o Later on Neurologic manifestation like tremor, dystonia, behavioral changes also develops. o K-F rings may be absent in young patients with liver diseases but are always present in patient with neurologic symptoms. o Hemolysis may be an initial manifestation. Sensory changes never occur. Diagnosis ? o Decrease ceruloplasmin level o Liver biopsy -### End" -6683,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The vasodilatation produced by carbon dioxide is maximum in:, with the following options: A: Kidney, B: Brain, C: Liver, D: Hea - -### Response: -Inhalation of 7% CO2 increases cerebral blood twofold. Cerebral blood vessels are very sensitive to CO2 tension. Hepatic aerial system is sensitive to adenosine; it brings about vasodilatation. Adenosine is the most impoant vasodilator of coronary vessels. CO2, H+, K+, hypoxia also cause reactive hyperemia. NO, an endothelium-derived relaxing factor is an impoant vasodilator of renal aerioles. -### End" -6684,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Uteroplacental blood flow at term is:, with the following options: A: 300-500 mL/min, B: 500-700 mL/min, C: 700-900 mL/min, D: 900-1100 mL/min - -### Response: -Ans. is b, i.e. 500-700 mL/minRef. Williams Obs. 25/e, p 132""Using ultrasound to study the uterine arteries, utero placental blood flow has been measured to increase progressively during pregnancy from approximately 450 mL/min in mid trimester to nearly 500-750 mL/min at 36 weeks"" -### End" -6685,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cadmium can cause all cancer except-, with the following options: A: Lung, B: Pancreas, C: Prostate, D: Skin - -### Response: -Cadmium can cause lung cancer and possibly has also been related to prostate cancer. -Cadmium has also been linked to cancer of breast, kidney, pancreas and urinary bladder. -Lung cancer is caused by inhaled cadmium while other are due to ingestion. -### End" -6686,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of infantile colic syndrome, with the following options: A: Vomiting, B: Paroxysmal symptoms, C: Abdominal pain, D: Continous severe cry - -### Response: -Other Colic Symptoms Clench her fists. Bend her arms and legs toward her belly. Have a bloated tummy. Have a red, flushed face when she cries. Pass gas while she sheds tears, often because she&;s swallowed air. Tighten her stomach muscles. Reference: GHAI Essential pediatrics, 8th edition -### End" -6687,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gallows traction is used for ?, with the following options: A: Fracture shaft femur, B: Fracture shaft tibia, C: Fracture shaft humerus, D: Fracture neck femur - -### Response: -Ans. is 'a' i.e., Fracture shaft femur Fracture of shaft femur in infant and young children It is published that upto one half of infants and young children who sustain femur fractures are victims of childabuse and child abuse occurs in 50 - 80% of children (< 2 years of age) with femoral fracture. Other causes of fracture are osteogenesis imperfecta (blue sclera, hearing loss, multiple fracture), bone tumors(eosinophilic granuloma, aneurysmal bone cyst). Fracture heals within 2 weeks in infant and children upto 2 years of age. Treatment depends upon the age of the patient : ? 1. Conservative : - It is the treatment of choice in children. 0-2 yeas : - Plaster spica or modified Bryant or tallow's traction or pavllic harness (< 6 month of age). 2-10 years : - Split Russel traction 10-15 years : - 90-90deg femoral skeletal traction. 2. Surgical Surgery is done less commonly in children. It is indicated in older children when closed reduction by conservative treatment is not possible. Intramedullar titanium elastic nailing is the surgery of choice. -### End" -6688,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person has different multiple personalities is suffering from -, with the following options: A: Mania, B: Personality disorder, C: Paranoid schizophrenia, D: Dissociative disorder - -### Response: -More than one personality appears to possess the individuals, showing their characteristic behavior is seen in dissociative identity (multiple personality) disorder. -### End" -6689,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following statement stands Trite for Mantoux test, with the following options: A: Test is read before 48 hrs, B: 6-9 mm induration shows maximum chances of developing TB, C: A positive test does not indicate that the person is suffering from disease., D: New cases are more likely to occur in tuberculin negative person than those who already are tuberculin reactors - -### Response: -Answer is C (A positive test does not ...... ) A positive test indicates that patient is infected with M. tuberculosis. It does not however prove that the person is `suffering' from the disease - Park Montoux test Montoux test is carried out by injecting one tuberculin unit (1TU) of PPD in 0.1 ml on the flexor surface of forearm (PPD 23 with Tween 80) A positive test indicates that patient is infected with M. tuberculosis. It does not however prove that the person is `suffering' from the disease - Park Studies indicate that 92% of new cases occur in persons who already are tuberculin reactors.- Park 6-9 mm induration does not indicate high chances of developing tuberculosis. Infact patients with 25 mm induration have more chances of developing tuberculosis than those with 6-9 mm induration - -### End" -6690,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are known to cause biliary obstruction, except:, with the following options: A: Clonorchis, B: Ascaris, C: Ankylostoma, D: Fasciola - -### Response: -Biliary obstruction has been noticed in infection with Clonorchis, Fasciola and Ascaris but not with Ankylostoma duodenale infection. Ref: Harrison's Principles of Internal Medicine, 16th Edition, Pages 1257, 1271 -### End" -6691,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An elderly female presents to the emergency depament and was found to have a transmural myocardial infarction. Based on her ECG, she was staed on thrombolytie therapy with streptokinase. On fuher examination, which of the following findings would indicate that the thrombolytic therapy is risky and should be stopped, with the following options: A: Pericardial friction rub, B: Mobitz Type II block, C: Significant pericardial effusion on echocardiography, D: Lower limb vein thrombosis - -### Response: -Ans. c. Significant pericardial effusion on echocardiography Fibrinolytics and anticoagulants can be continued in case of pericarditis, however, once significant pericardial effusion develops after MI, fibrinolytics should be discontinued ""The risk of post MI pericardial effusion is not increased with the use of fibrinolytic agents, heparin, aspirin and other antiplatelet agents. In contrast, a pericardial effusion occurring I the setting of MI is an indication to discontinue anticoagulation and fibrinolytics. Fibrinolytic Therapy Absolute Contraindications History of cerebrovascular hemorrhage at any timeQ A non-hemorrhagic stroke or other cerebrovascular event within the past yearQ Marked hypeension (areliabl determined systolic aerial pressure >a180 mm Hg and/or a diastolic pressure>110 mm Hg) at any time during theacute presentation, suspicion of aoicdissection, and active internalbleeding (excluding menses).Q Relative Contraindications Current use of anticoagulantsQ(INR 2) A recent (<2 weeks) invasive or surgical procedure or prolonged (> cardiopulmonary resuscitation)Q Known bleeding diathesisQ PregnancyQ A hemorrhagic ophthalmic condition (e.g., hemorrhagic diabetic retinopathy) ctive peptic ulcer diseaseQ A history of severe hypeension that is currently adequatelyQ Allergic reactions to streptokinaseQ -### End" -6692,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: As a general anaesthetic, halothane has the following advantages EXCEPT:, with the following options: A: Very good analgesic action, B: Non-inflammable and non-explosive, C: Reasonably rapid induction of anaesthesia, D: Pleasant and non-irritating - -### Response: -(Ref: KDT 6/e p372) Newer inhalationai anaesthetic agents like halothane, isoflurane etc. lack analgesic activity. All other advantages listed in the question are present in halothane. -### End" -6693,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest complication of mature treatoma is:, with the following options: A: Torsion, B: Rupture, C: Haemorrhage, D: Malignancy - -### Response: -Torsion -### End" -6694,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DNA estimation can be done by:, with the following options: A: Spirometer, B: Spectrophotometer, C: pH meter, D: Sphygmomanometer - -### Response: -Ans. b. Spectrophotometer (Ref: Laboratory Protocols. ClMMYT Applied Biotechnology Center, 2nd Edition; http: //en. wikipedia. org/wiki/ Spectrophotometer_ for_Nucleic_ Acid_ Measurements)DNA estimation can be done by spectrophotometer.DNA Quantification and Quality AnalysisAfter isolation of DNA. quantification and analysis of quality are necessary to ascertain the approximate quantity of DNA obtained and the suitability of DNA sample for further analysis.This is important for many applications including digestion of DNA by restriction enzymes or PCR amplification of target DNA.The most commonly used methodologies for quantifying the amount of nucleic acid in a preparation are:Gel electrophoresisSpectrophotometric analysisSpectrophotometric DeterminationAnalysis of UV absorption by the nucleotides provides a simple and accurate estimation of the concentration of nucleic acids in a sampleQ.Components of SpectrophotometerSpectrophotometerBiomolecules absorb light at characteristic wavelengths, just as tryptophan, tyrosine and to a much lesser extent phenylalanine absorb ultraviolet light near a wavelength of 280 nmQ.The fraction of incident light absorbed by solution at given wavelength depends on thickness of absorbing layer (path length ) and concentration of the absorbing species.Lambart Beer LawAbsorbance = log Ideg/I = eClWhere e is molar extinction coefficient and it has been assumed that incident light is parallel, mono chromatic (of single wave length) and solvent and solute are randomly oriented.So each successive millimeter path of absorbing solution absorbs not a constant amount but a constant fraction of light.However, with fixed path length absorbing layer, absorbance is directly proportional to the concentration of absorbing soluteQ.So it can be used in quantitative estimation of DNA, RNA or aminoacidsQ. -### End" -6695,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tinea Versicolour is caused by:, with the following options: A: E. Flaccosum, B: Malassezia Furfur, C: T. rubrum, D: T. Schonleini - -### Response: -B i.e. Malazzezia furfur -### End" -6696,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A new inhaled anesthetic has been developed and tested in a series of experiments. Anesthetic tension in the arterial blood is shown on the graph below as a function of time after inhalation (Drug A) similar curve for nitrous oxide is also shown:Which of the following best describes the properties of the new anesthetic compared to nitrous oxide'?, with the following options: A: High blood: gas partition coefficient, B: Low solubility in the blood, C: Rapid onset of action, D: Low potency - -### Response: -Ans. (A) High blood: gas partition coefficient(Ref: Katzung 11th/e p427)The depth of anesthesia depends on the partial pressure of anesthetic in CNS. The transfer of anesthetic into the brain starts only after the blood is fully saturated (or, in other words partial pressure of the anesthetic in blood equals the partial pressure in the inspired air). The speed of transfer of anesthetic to the brain determines its onset of action (rapid vs slow induction of anesthesia) and is dependent on the solubility of anesthetic in the blood. Solubility of an anesthetic is directly related to its blood/gas partition coefficient: highly soluble anesthetics have high blood/gas partition coefficient.If the agent is poorly soluble the amount of gas needed to saturate the blood is small and saturation occurs fairly quickly. Nitrous oxide is an example of poorly soluble gas with a blood/gas partition coefficient of 47. On the graph above the curve of partial pressure of NO in blood rises rapidly. In the highest point on the curve the partial pressure on NO in blood equals that in the inspired air, and the transfer to brain occurs.The second curve (drug A) portrays the process of blood saturation for a highly soluble gas. The higher the solubility the more gas can be taken up by blood before it is saturated. Note that the curve of the partial pressure of drug A in blood rises slower than that for NO. When the blood is fully saturated with NO the partial pressure of drug A in blood is approximately 25% of that in inspired air. For drug A, it takes a longer time to fully saturate the blood and to start transfer in tissues. Drug A, therefore is characterized with high blood/gas partition coefficient and slower onset of action.EffectPoorly soluble gas NOHighly soluble gas (Halothane)Amount needed to saturate the bloodSmallLargeRise in tension of gas in bloodRapidSlowEquilibrium with the brainRapidSlowOnset of actionRapidSlow -### End" -6697,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anti-HIV drug combination that should not be used, with the following options: A: Zidovudine + Stavudine, B: Atazanavir + Indinavir., C: Didanosine/stavudine + Zalcitabine, D: All of the above. - -### Response: -Anti-HIV drug combinations that should NOT be used are: - -Zidovudine + Stavudine: Pharmacological antagonism (compete for intracellular phosphorylation) -Atazanavir + Indinavir: Additive unconjugated hyperbilirubinemia. -Didanosine/stavudine + Zalcitabine: Additive peripheral neuropathy. -Lamivudine + Zalcitabine: In vitro antagonism. -### End" -6698,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Volkmann&;s ischemic contracture is seen in, with the following options: A: Supracondylar fracture of humerus, B: Dislocation of knee, C: Colle's fracture, D: Bennett's fracture - -### Response: -Compament syndrome can also be recognized by so-called 7 P'sPain out of propoion to physical examination findingsPain on passive stretching ( 1st sign )Pressure increasedPallor/may be pink alsoPulselessness/pulse may be presentParesthesiaParalysis(Refer: Rockwood and Green's Fractures in Adults, 7th edition, pg no: 543-86) -### End" -6699,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Immunoglobulin found in bronchial secretion:, with the following options: A: IgA, B: IgG, C: IgM, D: IgE - -### Response: -Ref: Microbiology by Ananthanarayan and Paniker, 8th ed. pg. 100Immunoglobulins and their salient featuresImmuno-globulinsSalient featuresIgGMost abundant Ig, consists of about 80%Marker of chronic infectionOnly Ig that Can cross placenta (lgG1 subtype)IgA2nd most abundant, 10-13%Found in glandular secretion like saliva, tear, ileum, and mucosal secretion like bronchial secretionIgM5-8% of total Ig; aka pentameric Ig.First Ig to be synthesized by fetus (20 weeks AOG) Marker of acute infectionIgDPresent mostly intravascularServe as recognition receptor for antigensIgEMostly extravascular in distribution Highly elevated levels in case of type-1 HPS reaction Produced chiefly in the linings of respiratory and intestinal tracts -### End" -6700,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5-year-old boy is brought to the pediatrician for a physical examination prior to beginning elementary school. On examination, the boy has only one palpable testis in the scrotum. Fuher examination reveals a palpable mass in the left inguinal region. This condition is referred to as, with the following options: A: Cryptorchidism., B: Hydrocele., C: Orchitis., D: Varicocele. - -### Response: -Only One palpable testes in scrotal sac and palpable mass in inguinal region is suggestive of Cryptorchidism. Cryptorchidism - It is a complete/paial failure of the intra-abdominal testes to descend into the scrotal sac and is associated with testicular dysfunction. - It is associted with increased incidence of germ cell tumors of testes, even if the testis is surgically moved from its ectopic location back to the scrotum. - Physical examination reveals only one palpable testes in Scrotum and there may be palpable mass in inguinal region. - Descent of testes occurs in two phases : 1. Transabdominal phase - During this phase ,the testes comes to lie within the lower abdomen or brim of the pelvis. This phase is regulated by mullerian inhibiting substance. 2. Inguinoscrotal Phase - In this phase the testes descend through the inguinal canal into the scrotum This phase is regulated by androgen-induced calcitonin gene-related peptide from the genitofemoral nerve. - The descent of testes may arrest anywhere in between the pathway but the most common site is in the inguinal canal - Histological changes : arrested germ cell development associated with marked hyalinization and thickening of the basement membrane of spermatic tubules = A hydrocele is a serous fluid collection in the scrotum. = Orchitis (inflammation of the testis) can result from bacterial or viral infection. = A varicocele results from dilation of the veins of the spermatic cord, and the term ""bag of worms"" aptly describes the abnormality. -### End" -6701,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common malignancy in childhood is, with the following options: A: Acute Lymphoblastic Leukemia (ALL), B: Bone tumor, C: Wilm's tumor, D: Retinoblastoma - -### Response: -(A) Acute Lymphoblastic Leukomia (ALL) # LEUKEMIA is a cancer of the blood cells. It is the most common childhood cancer, accounting for almost one-third of all childhood cancers.# Types of leukemia include:> Acute Lymphoblastic Leukemia (ALL): Commonly referred to as ""childhood leukemia"", because it is the most common child- hood cancer. Almost 75% of children with leukemia have ALL, a cancer of the lymphoid cells in the bone marrow and the lymphoid organs of the body. They are involved in the body's immune system. Usually occurs between 2 and 8 years old.> Acute Myelogenous Leukemia (AML): AML (acute myeloid leukemia, acute nonlymphatic leukemia or ANLL) is cancer of the myeloid blood cells which are produced in the bone marrow and which help fight bacterial infections. Usually occurs in people over age 25, but sometimes affects teenagers and children. Wilm's tumour: also called Nephroblastoma, is a type of cancer that originates in the kidney. Wilm's tumour is the second most common type of all childhood solid tumours. Average age of diagnosis is between 2 and 3 years when the disease affects only one kidney, but often diagnosed at a younger age when both kidneys are involved.> Non-Hodgkin's Lymphoma: affects the lymph nodes that are found deep within the body and is the third most common childhood cancer. There are many types of lymphoma, including Burkitt's, non-Burkitt's, and lymphoblastic lymphoma. Most often in children between 2 and 10. More common in boys than girls.# Osteosarcoma is the most common type of bone sarcomas in children and the sixth most common malignancy in children. These tumours often start at the end of the bone. (This was the type of cancer that Terry Fox had). Occurs between the ages of 10 and 25.# Retinoblastoma is a malignant tumour of the retina (a thin membrane in the back of the eye). It is the most common type of eye cancer found in children. The tumour may be in one eye only or both. Most common in children younger than 5.# Neuroblastoma is a cancer of the sympathetic nervous system and the most common tumour outside of the brain. Generally occurs in children under the age of 5. -### End" -6702,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hydroxyethyl starch is a ?, with the following options: A: Vasodilator, B: Inotrope, C: Plasma expander, D: Diuretic - -### Response: -Ans. is 'c' i.e., Plasma expander Plasma expanders These are high molecular weight substances which exes colloidal osmotic (oncotic) pressure, and when infused i.v. retain fluid in the vascular compament. Human plasma or reconstituted huma albumin are the best, However, the former carries the risk of transmitting serum hepatitis, AIDS, and latter is expensive. Therefore synthetic colloids are more often used. Desirable propeies of plasma expander are : Should exe oncotic pressure comparable to plasma. Should remain in circulation and not leak out in tissues, or be too rapidly disposed. Should be pharmacodynamically ine. -### End" -6703,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Interferon gamma release assay measures IFN release against which M.TB antigen:, with the following options: A: ESAT 6, B: ESAT 7, C: CF 11, D: CF 12 - -### Response: -Interferon gamma release assay (IGRA) measure T cell release of gamma interferon against TB antigen ESAT 6 and CF 10. This test also called as Quantiferon- more specific than Tuberculin skin testing as a result of less cross reactivity due to BCG vaccination and sensitization by nontuberculosis mycobacteria. - It reduces patient visits and gives an ability to perform serial testing without the hassle of boosting phenomenon caused by Tuberculin skin testing. -### End" -6704,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the EEG wave recorded in a subject who is awake but eyes closed?, with the following options: A: Alpha waves, B: Beta waves, C: Theta waves, D: Delta waves - -### Response: -Alpha waves are recorded best in the parieto-occipital region in adults at rest, i.e., awake but relaxed with eyes closed. EEG Waves Frequency (in HZ) Amplitude (in mV) Location where it is best-recorded Alpha Rhythm 8-13 50-100 Parieto-occipital regions Beta Rhythm 13-30 5-10 Frontal region Theta Waves 4-8 <200 Parietal and temporal regions in children Delta Waves 0.5-4 20-200 (large amplitude) Occipito-temporal Ref: Ganong's Review of Medical Physiology 25th edition Pgno: 272-273 -### End" -6705,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following has rough appearance:, with the following options: A: Rough endoplasmic reticulum, B: Agranular endoplasmic reticulum, C: Golgi apparatus, D: All - -### Response: -Rough endoplasmic reticulum has granules on the surface hence appear rough The granules mainly contain ribosomes and involved in protein synthesis -### End" -6706,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about nephrotic syndrome in children except?, with the following options: A: It is not associated with hypeension, B: Minimal change disease in children <10 year, C: Massive proteinuria > 3.5gm%/ 24 hours, D: Low complement levels - -### Response: -Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia, and edema. Massive proteinuria > 3.5gm%/ 24 hours Persistently low C3 levels are indicative of Acute Glomerulonephritis Minimal change disease- most common cause of nephrotic syndrome in children (2-8 yrs) -### End" -6707,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cajal cells are involved in-, with the following options: A: Mesangial cell contraction in Kidney, B: Pacemaker activity in Heart, C: Pacemaker activity in GIT, D: Respiratory rhythm generation - -### Response: -Ans. is 'c' i.e., Pacemaker activity in GIT * Pacemaker cells are called interstitial cells ofCajal.* Pacemaker cells (interstitial cells of Cajal) are stellate mesenchymal cells with smooth muscle like features. Pacemaker cells are absent in the esophagus and proximal stomach. In the distal stomach and small intestine they are located in outer circular muscle layer near myentric plexus. In the colon they are at the submucosal border of circular muscle layer. In stomach and small intestine, pacemaker frequency is in descending gradient and the pacemaker with highest frequency usually dominates (like heart). -### End" -6708,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient of rectal carcinoma found to have tumor invading through the muscularis propria into the perirectal tissues, and two enlarged lymph nodes. How will you manage the patient?, with the following options: A: Surgery only, B: Surgery + Adjuvant chemotherapy, C: Preoperative chemoradiation followed by surgical resection, D: Palliative chemoradiation - -### Response: -Stage of rectal cancer in the given scenario- Tumor invading through the muscularis propria into the perirectal tissues- T3 Two enlarged lymph nodes- N1b Thus, making it stage 3 Management of rectal cancer according to its stage- Stage Management Tis Polypectomy I Segmental resection II Neoadjuvant chemotherapy followed by surgical resection III Preoperative chemoradiation followed by surgical resection IV Palliation, metastatectomy -### End" -6709,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The percentage of Schizophrenia in First degree relatives is, with the following options: A: 1.25%, B: 2.40%, C: 6.40%, D: 4.35% - -### Response: -(C) 6.4% # Genetic factors are involved in at least a subset of individuals who develop schizophrenia. Schizophrenia is observe d in 6.6% of all first-degree relatives of an affected proband. If both parents are affected, the risk for offspring is 40%. The concordance rate for monozygotic twins is 50%, compared to 10% for dizygotic twins. -### End" -6710,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Culture media are sterilized by -, with the following options: A: Autoclaving, B: Beta- radiation, C: Hot air oven, D: All - -### Response: -Ans. is 'a' i.e., Autoclaving -### End" -6711,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diagnosis, with the following options: A: Congenital melanocytic nevus, B: Junctional, C: Nevus of Ito, D: Nevus of Ota - -### Response: -The image is suggestive of ""Nevus of Ota"" which is a dermal melanocytic nevus seen in maxillary and ophthalmic nerve distribution. -It is usually unilateral and often associated with blue sclera and conjuctiva. -### End" -6712,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year-old man is injured in a car accident and fractures his left elbow. He now complains of numbness of his fourth and fifth fingers, and weakness in his hand grip. Neurologic findings confirm weakness of handgrip with weakness of finger abduction and adduction, and decreased sensation over the fifth finger and lateral aspect of fourth finger. Which of the following is the most likely diagnosis?, with the following options: A: ulnar nerve injury, B: radial nerve injury, C: median nerve injury, D: carpal tunnel syndrome - -### Response: -Injury to the ulnar nerve results in impaired adduction and abduction of the fingers. The nerve is commonly injured in elbow dislocations and fractures. The fibers arise from the eighth cervical and the first thoracic segments. The ulnar is a mixed nerve with sensory supply to the medial hand. -### End" -6713,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following type of cells are NOT found in stomach?, with the following options: A: Chief cells, B: Parietal cells, C: Argentaffin cells, D: Goblet cells - -### Response: -Cardia and pyloric region of the stomach consist of glands which secretes mucus and body of the stomach including the fundus consist of parietal cells and chief cells. Goblet cells are found in the epithelium lining the small intestine.The parietal cell secretes hydrochloric acid and are located the middle and basilar poion of the gastric glands.Chief cells or zymogen cells are found near the base of the gastric glands. They synthesize and secrete pepsinogen.Enteroendocrine (argentaffin) cells secrete different neuropeptides and regulatory molecules. Gastrin producing G cells are found in the antrum, enterochromaffin cells secreting serotonin, substance P or motilin are found throughout the gastric mucosa, glucagon secreting A cells are found in the proximal third of the stomach and somatostatin secreting D cells are found in the upper third of stomach and antrum. -### End" -6714,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carbohydrate-related to blood grouping?, with the following options: A: Arabinose, B: Xylulose, C: Xylose, D: Fucose - -### Response: -The major blood groups of this system are A, B, AB, and O.O type RBCs lack A or B antigens. These antigens are carbohydrates attached to a precursor backbone, may be found on the cellular membrane either as glycosphingolipids or glycoproteins, and are secreted into plasma and body fluids as glycoproteins. H substance is the immediate precursor on which the A and B antigens are added. This H substance is formed by the addition of fucose to the glycolipid or glycoprotein backbone. The subsequentaddition of N-acetylgalactosamine creates the A antigen, whereas the addition of galactose produces the B antigen.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 138e; Transfusion Biology and Therapy -### End" -6715,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rheumatoid factor in Rheumatoid ahritis is:, with the following options: A: IgG, B: IgM, C: IgA, D: IgD - -### Response: -Answer is B (IgM): Rheumatoid ahritis is an IgM antibody directed against the Fe fragment of IgG. -### End" -6716,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs is used in Ml?, with the following options: A: Cocaine, B: Pethidine, C: Morphine, D: Butorphanol - -### Response: -Ans. is 'c' i.e., Morphine -### End" -6717,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum benefit from ECT is seen in, with the following options: A: Hysteria, B: Depression with suicidal tendency, C: Chronic schizophrenia, D: Mania - -### Response: -Lucio Bini and Ugo Cerletti *introduced ECT in 1938 for the treatment of psychiatric illness Indications for the Use of Electroconvulsive Therapy (ECT) Diagnostic Indications Clinical indications Major a)Major depression, both unipolar and bipolarb)Psychotic depression in paicularMania, including mixed episodesc)Schizophrenia with acute exacerbation d)Catatonic subtype paicularly Schizoaffective disorder Primary use Rapid definitive response required Risks of alternative treatments outweigh benefitsPast h/o poor response to drugs/good response to ECTPatient preference Other Secondary use a)Parkinson's disease b)Neuroleptic malignant disorder Failure to respond to pharmacotherapy in the current episodeIntolerance of pharmacotherapy in the current episodeRapid definitive response necessitated by deterioration of the patient's condition this is one of the repeated questions in psychiatry you always have to carefully read all the choices if the choice has depression with suicidal ideas , that is the answer if depression with suicidalideas is not given in the choice , then search for catatonia if catatonia is also not in the choice then go for treatment resistant schizophrenia and mania in PGI queestion paper where there are multiple answers for a single question, you can select all these choices namely depression with suicidal ideas catatonia treatment resistant mania and schizophrenia Ref: P.3290 chap. 31.34a Electroconvulsive Therapy -### End" -6718,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A baby has recently developed mouthing but has not developed stranger anxiety. Likes and dislikes for food. What is the most appropriate age of this baby ?, with the following options: A: 3 months, B: 5 months, C: 7 months, D: 9 months - -### Response: -Here the child has developed mouthing and likes and dislikes for food (4 months) but no stranger anxiety(6 months). So developmental age is 5 months. Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 15months : vocabulary of 6 words 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. Reference: GHAI Essential pediatrics, 8th edition -### End" -6719,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Half-Life of Cobalt-60, with the following options: A: 30 years, B: 5.2 years, C: 74.5 days, D: 6 hours - -### Response: -Cobalt-60 – 5.2 years -Cesium-137 – 30 years -Iridum-192 – 74.5days -### End" -6720,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with LVH. and pulmonary complications. ECG, shows left axis deviation. Most likely diagnosis is –, with the following options: A: TOF, B: Tricuspid atresia, C: TAPVC, D: VSD - -### Response: -Congenital absence of tricuspid valve is called tricuspid atresia. -Haemodynamics : - -The inflow portion of R.V. is hypoplastic -The systemic venous blood coming to R.A. exits by way of a patent foramen ovale or an ASD. -A VSD provides communication between L.V. and outflow portion of R.V. -The L.V. thus maintains both the systemic and pulmonary circulation. -The saturation of blood in the pulmonary artery and aorta is identical —> Because unoxygenated blood from right atrium mixes with oxygenated blood into left atrium. -The pulmonary blood flow is dependent on size of VSD —› Smaller the VSD, less the pulmoanry blood flow. Clinical features : - - -Child is cyanotic from birth -Anoxic spells and squatting may be present. - Features suggestive of tricuspid atresia : - - -L.V. type of apical impulse -Prominent large 'a' waves -Enlarged liver with presystolic pulsations (a waves) -ECG characterised by Left axis deviation and Left ventricular hypertrophy. -### End" -6721,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Communicating opening between greater sac and lesser sac?, with the following options: A: Foramen of winslow, B: Foramen of Monro, C: Hepatorenal pouch, D: Pouch of Douglas - -### Response: -Epiploic foramen (foramen of winslow or aditus to lesser sac) is a slit-like opening through which lesser sac communicates with greater sac. It is situated at the level of T12 veebra. Its boundries are :- Anterior :- Right free margin of lesser omentum (contains poal vein, hepatic aery proper and bile duct). Posterior :- IVC, right suprarenal gland and T12 veebra. Superior :- Caudate lobe of liver. Inferior :- 1 pa of duodenum and horizontal pa of hepatic aery. -### End" -6722,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Distribution of weakness in Pyrimidal tract lesions?, with the following options: A: Extensors more than flexors in lower limb, B: Flexors more than extensors in upper limb, C: Antigravity muscles are affected, D: Antigravity muscles are spared - -### Response: -Ans. is 'd' i.e., Antigravity muscles are spared The following clinical features characterize a UMN lesion: Increased tone (spasticitv) Initially, UMN weakness may be flaccid, with absent or diminished deep tendon reflexes. There is little understanding of the reasons behind this initial flaccidity and it is often referred to as 'shock'. Increased tone of a UMN type is called spasticity. It may develop several hours, days or even weeks after the initial lesion has occurred. Spasticity is manifested by : Spastic catch' : Mild spasticity may be detected as a resistance to passive movement or 'catch' in the pronators on passive supination of the forearm and in the flexors of the hand/forearm on extension of the wrist/elbow. The 'clasp-knife' phenomenon: In more severe lesions, following strong resistance to passive flexion of the knee or extension of the elbow, there is a sudden relaxation of the extensor muscles of the leg and flexor muscles in the arm. Clonus: Rhythmic involuntary muscular contractions follow an abruptly applied and sustained stretch stimulus, e.g. at the ankle following sudden passive dorsiflexion of the foot. `Pyramidal-pattern' weakness The antigravity muscles are preferentially spared and stronger The flexors of the upper limbs and the extensors of the lower limbs. The patient can develop a characteristic posture of flexed and pronated arms with clenched fingers, and extended and adducted legs with plantar flexion of the feet. In upper extremiteis Relative sparing of the flexors More involvement of the extensor In lower extremities Predominant invovlement of the flexors with Relative sparing of the extensor or Absence of muscle wasting and fasciculations Focal muscle wasting andjasciculations are features of an LMN lesion. With chronic disuse, some loss of muscle bulk can occur after a UMN lesion, but this is rarely severe or focal. Brisk tendon reflexes and extensor plantar responses The tendon reflexes are brisk. The cremasteric and abdominal or 'cutaneous' reflexes are depressed or absent. The plantar responses are extensor (upgoing toes' or 'positive' babinski sign). Anti-gravity muscles are typically spared in pyramidal tract lesions. Weakness, in pyramidal tract lesions is often termed as 'pyramidal' in distribution affecting extensors more than flexors in the upper limb, and flexors more than extensors in the lower limb (Anti-gravity muscles are spared). Pyramidal weakness - Loss of power most marked in the extensors muscles in the arms and flexors in the legs Proximal weakness - Shoulders, hips, trunks, neck and sometimes face. Associated with myopathy. Distal weakness - Affects hands and feets. Associated with peripheral motor neuropathy. Global weakness - Generalized weakness in limbs which may result from severe pathologies. -### End" -6723,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Staph. aureus causes vomiting in 16-18 hours. The mechanism of action is -, with the following options: A: Stimulation of cy AMP, B: Vagal stimulation, C: Stimulation of CyGMP, D: Acts through ganglioside GM receptor - -### Response: -Ans. is 'b' i.e., Vagal stimulation -### End" -6724,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Betamethasone in pregnancy is given to prevent, with the following options: A: Prematurity, B: Neonatal convulsions, C: Cerebral palsy, D: Respiratory distress syndrome - -### Response: -Respiratory distress syndrome can be prevented by administration of Betamethasone to the mother two doses IM 24hrs apa given before 34 weeks Ref: Dutta Obs 9e pg 444. -### End" -6725,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true about osteosarcoma?, with the following options: A: Sunburst appearance due to bony involvement, B: Lung metastasis is common, C: Seen in the metaphyseal region of the long bones, D: Secondary osteosarcoma is seen in older age groups - -### Response: -Sunburst appearance is due to inability of periosteum to lay down new layer and instead the Sharpy's fibres (a matrix of connective tissue consisting of bundles of strong predominantly type I collagenfibres connecting periosteum to bone) stretch perpendicular to the periosteum. Lung metastasis is most common(15%) cases. CT chest is mandatory to rule out lung metastasis before sta of the treatment. It occurs in metaphyseal region with most common site being where the growth of long bones occur i.e. around knee(distal femur and proximal tbia) proximal femur and humerous. Secondary osteosarcoma occurs in previous bone lesions like Paget's disease, previous irradiation, bone infarcts,chronic osteomyelitis. This explaining its bimodal distribution with second peak in older age groups. -### End" -6726,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Respiratory rate in a 2 month old, to label it tachypnea is -, with the following options: A: 40, B: 50, C: 60, D: 70 - -### Response: -Ans. is 'c' i.e., 60 Tachypnea o < 2 months --> 60 or more RR/min o 2-12 months ---> 50 or more RR/min o 12-60 months ----> 40 or more RR/min -### End" -6727,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neurotrophic keratopathy is caused by –, with the following options: A: Bell's palsy, B: Facial and trigeminal nerve palsy both, C: Trigeminal nerve palsy, D: All of the above - -### Response: -Neuroparalytic keratitis occurs due to interruption of sensory impulses over trigeminal nerve. -### End" -6728,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Imatinib mesylate used in the treatment of GIST is a inhibitor of, with the following options: A: IL-12, B: TNF-x, C: Tyrosine kinase, D: VEGE - -### Response: -Imatinib mesylate used in the treatment of GIST ( GastroIntestinal Stromal Tumours) is a c-kit(transmembrane receptor tyrosine kinase) tyrosine kinase inhibitor. GIST is rare but most common nonepithelial small bowel tumours. More than 95% show c-kit mutation. Reference : page 877 SRB's manual of surgery 5th edition -### End" -6729,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prion includes, with the following options: A: DNA and RNA, B: Only RNA, C: Proteins, D: Only DNA - -### Response: -Ans. is 'c' i.e. Proteins Prions are infectious proteins that cause degeneration of the central nervous system.They are infectious particles that lack nucleic acid.Prions are composed largely, if not entirely of PrP molecules.Four important points about prions are: -Prions are the only known infectious pathogens that are devoid of nucleic acid, all other infectious assents possess genomes composed of either RNA or DNA that direct the synthesis of their progeny.Prions disease may manifest as infectious, genetic and sporadic disorders; no other group of illness with a single etiology presents with such a wide spectrum of clinical manifestations. Prions disease results from the accumulation of PrPSc the conformation of which differs substantially from that of its precursor PrPc.PrPSc can exist in a variety of different conformations each of which seems to specify a particular disease phenotype.Prions reproduce by binding to the normal cellular isoform of prion protein and stimulating conversion of PrP into the disease causing isoform. -### End" -6730,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which type of thyroid carcinoma is classically with calcitonin induced amyloid deposition?, with the following options: A: Papillary, B: Follicular, C: Anaplastic, D: Medullary - -### Response: -Calcitonin derived amyloid deposition is seen associated with medullary carcinoma of thyroid. It is a neuroendocrine tumour of thyroid derived from parafollicular cells It is characterised by secretion of calcitonin.Calcitonin is readily demonstrable within the cytoplasm of tumour cells as well as in stromal amyloid by immunohistochemical methods. Ref: Robbins and cotrans 9e Pg 1099 -### End" -6731,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A contraceptive ""X"" is used by 100 couples for continuous period of 2 years. During this period 20 women become pregnant despite using contraceptive ""X"". What is the pearl index of contraceptive ""X""?, with the following options: A: 0.1 per HWY, B: 1 per HWY, C: 10 per HWY, D: 1000 per HWY - -### Response: -- The Pearl index is defined as the number of ""failures per 100 woman-years of exposure (HWY)."" - This rate is given by the formula : - PI = Total accidental pregnancies x 1200/ Total months of exposure In given question: Total accidental pregnancies=20 Total months of exposure=100 couples x 24 months each=2400 months PI = 20 x1200/ 2400 =10 per HWY -### End" -6732,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Child begins to sit with suppo, able to transfer objects from one hand to another hand and speak monosyllabic babbles at the age of -, with the following options: A: 3 months, B: 6 months, C: 9 months, D: 12 months - -### Response: -Ans. is 'b' i.e., 6 months -### End" -6733,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The reproductive method by which fungi asexually produce rectangular spores by fragmentation of hyphae is known as, with the following options: A: Chlamydospore, B: Blastospore, C: Conidiophore, D: Ahrospore - -### Response: -Ahrospores are produced by fragmentation of hypha of some fungi like Trichosporon, Coccidioides immitis and Paracoccidioides brasiliensis. -### End" -6734,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Association can be measured by all of the following except-, with the following options: A: Correlation coefficient, B: cronbach's alpha, C: P value, D: Odds ratio - -### Response: -. -### End" -6735,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phrynoderma is deficiency of:-, with the following options: A: Zinc, B: EFA, C: Selenium, D: Iodine - -### Response: -NUTRITIONAL DEFICIENCIES:- Vitamin B2 Zinc Vitamin B6 Vitamin E Chromium Zinc EFA Selenium Increase circumcorneal congestion Acrodermatitis enteropathica Seizures (infant) Progressive external Opthalmoplegia Glucose Intolerance Liver disease, Growth failure Phyrnoderma (toad like skin) - Treated by supplementing B-complex vitamin & safflower oil. Endemic cardiomyopathy (Keshan's disease) -### End" -6736,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The regression between height and age follows y=a+bx. The curve is, with the following options: A: Hyperbola, B: Sigmoid, C: Straight line, D: parabola - -### Response: -Ans. is 'c' straight line Regression:If two variables are highly correlated, it then becomes possible to predict the value of the dependent variable from the value of the independent variable by using regression technique .Regression analysis is the mathematical modelling to describe the effect that one or more independent variables have on a dependent variable.Types:Linear regression: The value of one variable (X) is used to predict the value of the other variable (Y) by means of a simple mathematical formula. In linear regression the dependent variable (Y) depends upon a single independent variable (X).The linear regression equation takes the form as the equation for any straight line. y = a + bx where - a = is a constant k/a intercept constant b = is the regression coefficient x = is the independent variable.y = is the dependent variable whose value is to be found out.Multiple regression: More than one variable is used to predict the expected value of Y.Y = a + b1X1 + b2x2 +b1x1 where a = intercept constantb = regession coefficient for independent variable X1 eg. Rubin found that the birth weight of a baby (Y in grams) can be partially predicted from the no. of cigarettes smoked on the daily basis by both the baby's mother and the baby's father (X2). According to multiple regression equation Y = 3385 - 9x1 - 6x2Nonlinear regression: Involves more complicated mathematical forms, including logarithmic functions. -### End" -6737,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best view for visualizing sella turcica on X-Ray:, with the following options: A: A P View, B: Town's view, C: Lateral view, D: Open mouth view - -### Response: -C i.e. Lateral view -### End" -6738,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are seen in adrenal insufficiency except, with the following options: A: Hyperkalemia, B: Fever, C: Weight gain, D: Postural hypotension - -### Response: -Refer Harrison 19th/ p 2325 Adrenal insufficiency results in weight loss -### End" -6739,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In primary T.B. seen -, with the following options: A: Ghon's focus, B: Pleural effusion, C: Miliary mottling, D: Fibrosis - -### Response: -Primary T.B. includes. - - -An area of grey-white (size of approx. 1 - 1.50 cm) inflammatory consolidation - called ghon's focus. -Lymph node. -Lymphatics and lymphatic channel. - - -Cavity and fibrosis is seen in secondary T.B. -### End" -6740,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cervical cytology smear revealed CIN2- next step -, with the following options: A: Colposcopy, B: Cryocautery, C: Hysterectomy, D: Laser ablation - -### Response: -Ans- A Colposcopy guided biopsy -### End" -6741,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A microbiologist is working with PCR and wishes to quantify the PCR by monitoring the amplification process while the PCR is ongoing. Which of the following types of PCR should he do?, with the following options: A: image_question, B: image_question, C: image_question, D: image_question - -### Response: -Real time polymerase chain reaction (PCR) can be used to quantify the PCR by monitoring the amplification process while the PCR is ongoing. Types of PCR: Reverse transcriptase PCR: The enzyme reverse transcriptase () is used to synthesise a complementary copy of DNA (cDNA) from RNA and this cDNA is then used a template for PCR. Real-time PCR: This helps quantify the PCR and gives an estimate of the pathogen DNA load in the specimen. It uses fluoroscent dyes or specific DNA probes. Multiplex PCR: Primers to more than one pathogen are used simultaneously and hence multiple products are obtained. Nested PCR: It involves the sequential use of two primer sets. First primer set is used for amplification and the amplicon obtained is then used as a target sequence for second amplification. This ensures specificity. Reference Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition -### End" -6742,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 76 year old man presents with a lytic lesion in the vertebrae. X-ray skull showed multiple punched out lesions. The diagnosis is –, with the following options: A: Metastasis, B: Multiple myeloma, C: Osteomalacia, D: Hyperparathyroidism - -### Response: -Punched out lesions of skull are seen both in Eosinophilic granuloma and multiple myeloma. However, beveled edges (double contour) is characteristic of eosinophilic granuloma due to uneven destruction of the inner and outer table of the skull. - -          Punched out lesions of skull                    →  Multiple myeloma -          Punched out lesions with beveled edges   →  Eosinophilic granuloma -### End" -6743,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Varicose veins of size less than __can be best treated by sclerotherapy:, with the following options: A: 2 mm, B: 3 mm, C: 4 mm, D: 6 mm - -### Response: -Sclerotherapy is useful for dealing with minor varicosities (<3 mm) and recurrences in the calf and lower leg. Amount of sclerosants used in treatment of varicose veins is 0.5 ml. -### End" -6744,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young female presents with history of dyspnoea on exeion. On examination, she has wide, fixed split S. with ejection systolic murmur (TJIAT) in left second Intercostal space. Her EKGshows left axil detion. The most probable diagnosis Is -, with the following options: A: Total anomalous pulmonary venous drainge, B: Tricuspid atresia, C: Ostium primum atrial septal defect., D: Ventricular septal defect with pulmonary aerial hypeension - -### Response: -Examination Usually reveals a prominent RV impulse and palpable pulmonary aery pulsation. Midsystolic pulmonary outflow murmur. The second hea sound is widely split and is relatively fixed in relation to respiration. A mid-diastolic rumbling murmur, loudest at the fouh intercostal space and along the left sternal border Electrocardiogram In ostium primum ASD, the RV conduction defect is accompanied by left superior axis detion and counterclockwise rotation of the frontal plane QRS loop. Varying degrees of RV and right atrial (RA) enlargement or hyperophy may occur (Harrison's Principles of internal medicine, 18 th edition, page 1922 ) -### End" -6745,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In camera trial of a rape case hearing is done under ?, with the following options: A: 376 IPC, B: 327 CrPC, C: 53 CrPC, D: 375 IPC - -### Response: -Ans. is 'b' i.e. 327 CrPC S. 327 CrPC (2) -The inquiry into and trial of rape or an offence under sec.376 IPC shall be conducted in camera and it is not lawful for any person to print or publish any matter in relation to such proceedings except with the permission of cou. -### End" -6746,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an agent used for deep chemical peels?, with the following options: A: Carbolic acid, B: Glycolic acid, C: Mandelic acid, D: Salicylic acid - -### Response: -Carbolic acid / phenol is used for deep peels & is a component of Baker - Gordon formula. All others are hydroxy acids used for superficial & medium depth peels. Ref: Textbook of dermatosurgery & cosmetology, Satish S savant, E-2, P-177. -### End" -6747,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is false, with the following options: A: A, B: B, C: C, D: D - -### Response: -In polycythemia vera RBC mass is high as a result of negative feedback erythropoeitin levels should be less. -### End" -6748,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest histological change in MI -, with the following options: A: Macrophage infiltration, B: Neutrophilic infiltration, C: Waviness of fibers, D: Coagulative necrosis - -### Response: -Ans. is 'c' i.e., Waviness of fibersVariable waviness of fibres at border is the earliest histological finding (see tables of previous explanation). -### End" -6749,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 19 year old patient came with C/o primary amenorrhea. She had well developed breasts and pubic hair. However there was absence of vagina and uterus. Likely diagnosis is, with the following options: A: Turners syndrome, B: Mullerian agensis, C: Kinefelter's syndrome-XXY, D: Gonadal agenesis - -### Response: -Mullerian agenesis : Physical appearance Normal breast development Normal sexual hair Average stature External genitalia Normal Internal genitalia Absence of vagina Absence of uterus D.C.DUTTA'S TEXTBOOK OF GYNAECOLOGY, Pg no:453, 6th edition -### End" -6750,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The defect Marfan syndrome is?, with the following options: A: Fibrillin 1, B: Fibrillin 2, C: Fibrillin 3, D: Fibrillin 4 - -### Response: -* Fibrillin is the major component of extracellular microfibrils and is widely distributed in connective tissue throughout the body.# Mutations in the fibrillin-1 (FBN1) gene, on chromosome 15q21.1, have been found to cause Marfan syndrome, a dominantly inherited disorder characterised by clinically variable skeletal, ocular; and cardiovascular abnormalities.# Fibrillin-1 mutations have also been found in several other related connective tissue disorders, such as severe neonatal Marfan syndrome, dominant ectopia lentis, familial ascending aortic aneurysm, isolated skeletal features of Marfan syndrome, and Shprintzen-Goldberg syndrome. -### End" -6751,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following does not require any specific treatment?, with the following options: A: Epstein pearls, B: Bohn’s nodule, C: Gingival cyst of newborn, D: All of the above - -### Response: -1. Epstein pearls, Bohn’s nodule, and Gingival cyst of new born → Contains keratinized tissue. -→ No specific treatment is required. -→ Small keratinized cystic lesions rupture spontaneously. -2. Eruption cyst with its soft tissue eruption haematoma. -→ No treatment is required as the perforated Cyst shows spontaneous marsupialization. -### End" -6752,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bitot spots are seen in?, with the following options: A: Bulbar conjunctiva, B: Palpebral conjunctiva, C: Cornea, D: Eyelid - -### Response: -Ans. (a) Bulbar conjunctivaRef Kanski 7/e, p. 210Bitot spots are triangular patches of foamy keratinized epithelium in the interpalpebral zone (elliptic space between the medial and lateral canthi of the two open lids) thought to be caused by Corynebacterium xerosis.Interpalpebral zone-sclera and thus bulbar conjunctiva is seen as involved. -### End" -6753,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following rabies vaccines are commercially available except -, with the following options: A: Killed sheep brain vaccine, B: Human diploid cell vaccine, C: Vero continous cell vaccine, D: Recombinant glycoprotein - -### Response: -Subunit vaccine -The glycoprotein subunit in the virus surface which is the protective antigen, has been cloned and recombinant vaccines produced. They are still in the experimental stage. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:536 -### End" -6754,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Side effect of minoxidil which is used as therapeutic use?, with the following options: A: Bradycardia, B: Hair growth, C: Gynecomastia, D: Vasodilation - -### Response: -Ans. B. Hair growthMinoxidil is arteriolar dilator. Its peculiar side effect is hair growth which is used in patients suffering from alopecia. -### End" -6755,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Alexithymia is, with the following options: A: A feeling of intense rapture, B: Pathological sadness, C: Affective flattening, D: Inability to recognize and describe feelings - -### Response: -Alexithymia is inability or difficulty in describing or being aware of one's emotions or moods; elaboration of fantasies associated with depression, substance abuse, and posttraumatic stress disorder (PTSD). Reference:Kaplan & Sadock's Comprehensive textbook of Psychiatry Tenth edition, Volume 3 Pg.4559 -### End" -6756,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true in motor aphasia, EXCEPT, with the following options: A: Impaired naming, B: Impaired repetition, C: Impaired fluency, D: Preserved comprehension - -### Response: -(B) Impaired repetition # APHASIA is an acquired disorder of language due to brain damage. It does not include developmental disorders of language or speech disorders that are limited to the motor apparatus of speech (dysarthria). Related disorders include alexia (disorder of reading), agraphia (disorder of writing), and apraxia (disorder of skilled movements).> Transcortical Motor Aphasia (TMA) results from an injury to the anterior superior frontal lobe. The injury is typically caused by a cerebrovascular accident (CVA), commonly referred to as a stroke. The area of insult is sometimes referred to as a watershed region, a region surrounding Broca's area. The insult typically involves the left hemisphere as most people (regardless of handed-ness) are left hemisphere dominant for language (nearly 100% of right-handers, about 85% of left-handers).> Characteristics: TMA is a less common impairment than Broca's aphasia. People with TMA generally have good comprehension since Wernicke's area is usually not affected. People with TMA experience non-fluent (halting and effortful) speech due to frontal lobe damage and their utterances are typically only one or two words long. People with TMA retain the ability to repeat words, phrases or sentences.> Repetition is preserved since the arcuate fasciculus (the neural pathway that connects Wernicke's and Broca's areas via the parietal lobe) is intact. Preserved repetition is a defining quality of all transcortical aphasias. People who suffer from transcortical motor aphasia, however, may experience delays in initiation when they try to repeat words due to damage in the frontal lobe. -### End" -6757,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clinical Features of deciduous dentition are all, except:, with the following options: A: Baume spaces, B: Developmental spaces, C: Deep overbite, D: Proclined incisors - -### Response: -Normal Signs of Primary Dentition -a. Spaced anteriors :Spacing is usually seen in the deciduous dentition to accommodate larger permanent teeth in the jaws. -b. Primate/ simian/ anthropoid space: This space is present mesial to the maxillary canine and distal to the mandibular canine.Most subhuman primates have it throughout life and use it for interdigitation of opposing canines. This space is used for early mesial shift. -c. Shallow overjet and overbite. -d. Almost vertical inclination of the anteriors. -e. Ovoid arch form. -f. Straight/flush terminal plane relation. -### End" -6758,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Migratory thrombophelibitis is seen in -, with the following options: A: Dissaminated cancer, B: Rheumatic hea disease, C: Libman - sacks endocarditis, D: All of the above - -### Response: -Robbins and Cotran pathologic basis of disease South Asia edition. migratory thrombophlebitis ( Rousseau syndrom) encountered in association with deep seated cancers most often carcinoma of the pancrpancreas or lung.. -### End" -6759,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 72-year-old man is brought to the clinic by his daughter because she is concerned about his memory. A careful history, mini mental status, and physical examination confirm your suspicions of the patient having Alzheimer's disease. Which of the following investigations is included in the initial work up for reversible causes of dementia?, with the following options: A: electroencephalogram (EEG), B: urine tests for heavy metals, C: thyroid function tests, D: red blood cell (RBC) folate - -### Response: -Other tests to rule out reversible disease might include serum electrolytes, B12 levels, CBC, Venereal Disease Research Laboratory (VDRL), and CT or MRI. Diagnosis of Alzheimer's disease remains a diagnosis of exclusion. However, the insidious and subtle onset, with few focal signs (except for higher mental functioning) and a slowly progressive course are characteristic. Careful attention to the pattern of cognitive defects also improves diagnostic accuracy. The intensity of investigation will depend on numerous factors, including age, presence of atypical findings, and the timing of presentation. There is as yet no definite consensus on the most appropriate plan of investigation. -### End" -6760,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triangular space between clitoris and hymen -, with the following options: A: Fourchette, B: Fossa navicularis, C: Vestibule, D: Labia minora - -### Response: -Ref: synopsis of Forensic Medicine & Toxicology (K.S.Narayan Reddy)28th edition ,page 203 In a virgin female, the labia minora are two thin folds of skin just within the labia majora. The lower poions of labia mainora fuse in midline and form a fold fourchette. The depression between fourchette and vaginal orifice is called fosa navicularis. The clitoris is small and the triangular narrow space clitoris and hymen is called vestibule. -### End" -6761,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for chronic gout is, with the following options: A: Allopurinol, B: Febuxostat, C: Probenecid, D: Sulfinpyrazone - -### Response: -(Ref: Katzung 14th ed. P 661)DOC for chronic gout/period between acute gout attacks: AllopurinolMOA: Xanthine oxidase inhibitorWhen initiating allopurinol therapy, colchicine or NSAID should be used until steady-state serum uric acid is normalized or decreased to less than 6mg/dL and they should be continued for 6 months or longer.Initial dose: 50-100mg/daySide effect:#Precipitation of gout (that's why initially given with NSAIDS or colchicine)#GI intolerance (N/V/D)#Peripheral neuritis and necrotizing vasculitis#Bone marrow suppression - Aplastic anemia#Hepatotoxicity and interstitial nephritis#Maculopapular rash and exfoliative dermatitis#CataractDOC for acute gout attack: Probenecid (NSAID except Aspirin)Febuxostat: Also, a xanthine oxidase inhibitor. Used in patients with intolerance to allopurinol or not responding to it.Uricosuric agents like Probenecid, Sulfinpyrazone, Lesinurad can also be used in treatment of gout especially when allopurinol or febuxostat is contraindicated. -### End" -6762,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Barr body is absent in ?, with the following options: A: Kleinfelter, B: Turner, C: Super female, D: None of the above - -### Response: -Ans. is 'b' i.e., Turner Barr body (Sex - chromatin) It is a densely staining inactivated condensed 'X' chromosome that is present in each somatic cells of female. o It is found in the nucleus. It is used as a test of genetic femaleness -4 it is possible to determine the genetic sex of an individual according as to whether there is a chromatin mass present on the inner surface of the nuclear membrane of cells with resting or intermitent nuclei. Remember following fact and the question will seem very easy. Chromatid body (Barr body or sex chromatin) is derived from one of the two X-chromosomes which becomes inactivated. The numer of Barr bodies is thus one less than the number of X-chromosomes. -### End" -6763,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement is NOT true about prostatic urethra?, with the following options: A: Trapezoidal in cross-section, B: Opening of prostatic ducts, C: Presence of verumontanum, D: Contains urethral crest - -### Response: -The lumen of the prostatic urethra, where the colliculus seminalis is located, has cresent appearance in cross section. The main prostatic gland drain into prostatic urethra through 15-30 prostatic ducts. The posterior wall of the urethra forms a longitudinal fold, the urethral crest (UC), which is the reason why the prostatic urethra has a crescent-shaped profile.Verumontanum is an elevation, or crest, in the wall of the urethra where the seminal ducts enter it.Ref: Human Microscopic Anatomy: An Atlas for Students of Medicine and Biology By Radivoj V. Krstic 3rd Ed Page 370 -### End" -6764,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4 yr old paially immunized boy came to OPD with history of bouts of coughing. On staining the sputum sample an organism with bipolar staining was seen. Which among the following organism it would be ?, with the following options: A: Y. Pestis, B: B. peussis, C: S. Agalactae, D: K. Pneumonae - -### Response: -Ans. is 'b' i.e., B. peussis Bouts of Coughing and bipolar staining suggest the diagnosis of whooping cough (peussis). -### End" -6765,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of acute bacterial endocarditis is:September 2009, with the following options: A: Staphylococcus aureus, B: Streptococcus viridans, C: Streptococcus intermedius, D: Candida albicans - -### Response: -Ans. A: Staphylococcus aureusOverall, S aureus infection is the most common cause of Infective Endocarditis (IE), including acute IE, and Intravenous drug abusers IE.More than half the cases are not associated with underlying valvular disease.Streptococcus viridans accounts for approximately 50-60% of cases of subacute disease.Most clinical signs and symptoms are mediated immunologically.Streptococcus intermedius group infections may be acute or subacute.S intermedius infection accounts for 15% of streptococcal IE cases.S intermedius is unique among the streptococci; it can actively invade tissue and can cause abscesses. -### End" -6766,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are used for the transpoation of vaccines except :, with the following options: A: Vaccine van, B: Cold box, C: Vaccine carriers, D: ILR - -### Response: -ILR is pa of electrical storage equipment Transpoation : Refrigerator vaccine van Insulated vaccine van Cold box Vaccine carrier -### End" -6767,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transfusion of stored blood causes: (Repeat), with the following options: A: Hyperkalemia, B: Hyponatremia, C: Hypercalcemia, D: Hypokalemia - -### Response: -Ref: Harrison's 18th editionExplanation:The two important electrolyte disturbances caused by transfusion of stored blood areHyperkalemiaHypocalcemia.RBC leakage during storage increases the concentration of potassium in the unit.Neonates and patients in renal failure are at risk for hyperkalemia.Preventive measures, such as using fresh or washed RBCs. are warranted for neonatal transfusions because this complication can be fatal.Citrate, commonly used to anticoagulate blood components, chelates calcium and thereby inhibits the coagulation cascade.Hypocalcemia, manifested by circumoral numbness and tingling sensation of the fingers and toes, may result from multiple rapid transfusions.Because citrate is quickly metabolized to bicarbonate, calcium infusion is seldom required in this setting.If calcium or any other intravenous infusion is necessary, it must be given through a separate tine. -### End" -6768,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Out of the following which is not a radiotherapy equipment?, with the following options: A: Betatron, B: Telecurie-cobalt unit, C: Linear accelerator, D: Thimble chamber - -### Response: -Ans. Thimble chamber -### End" -6769,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Baon's fracture of the wrist, with the following options: A: Involves radio carpal subluxation, B: Is a severe form of a colles' fracture, C: Is often treated by open reduction and internal fixation, D: All of the above - -### Response: -A i.e. Involves radio carpal subluxation -### End" -6770,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common nerve damaged in CSOM is, with the following options: A: II, B: III, C: VI, D: VII - -### Response: -The facial nerve is most commonly damaged in CSOM because it traverses through the middle ear.Ref: Hazarika; 3rd ed; Pg 164 -### End" -6771,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CHF in an infant is characterized by all Except, with the following options: A: Pedal edema, B: Tachypnea, C: Sweating, D: Poor weight gain - -### Response: -Congestive Cardiac Failure in InfantsSymptomsSignsFeeding difficulty.Takes less volume per feed.Diaphoretic while sucking.Forehead sweating.Suck-rest-suck cycle.Poor weight gain. Periorbital edema Clothes no longer fit.Increasing cloth sizeRapid breathing/nasal flaring/cyanosis/chest retractions.Tachycardia.Hepatomegaly. Occasionally Splenomegaly.Periorbital edemaEdema in flanks. Dependent edema (Refer: Nelson's Textbook of Paediatrics, 19thedition,pg no:1530) -### End" -6772,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Before surgerywhat is not done, with the following options: A: Shaving, B: Draping, C: Control of blood glucose, D: Anticoagulation - -### Response: -.before surgery ,cleaning of the area is a must.he area of interest is cleaned and draped well and also to promote fastr healing of the incisions put,control of blood sugar is also advised. ref:SRB&;s manual of surgery,ed 3,pg no 1113 -### End" -6773,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Head quaers of FAO is at -, with the following options: A: New york, B: Geneva, C: Rome, D: San francisco - -### Response: -The Food and Agriculture Organization was formed in 1945 with headquaers in Rome .It was the first United Nations Organization specialized agency created to look after several areas of world cooperation (refer pgno:923 park 23rd edition) -### End" -6774,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 5 year old child presents with a red colored localized rash on his back. The dermatologist gave a diagnosis of Pityriasis rosea, and assured the mother that it is a self limiting disease and would resolve on its own. The mother is concerned, as it has already been 10 days, and the rash hasn't subsided. How long does the rash usually last for from the time of onset?, with the following options: A: 15 days, B: 6 weeks, C: 5 months, D: 5 days - -### Response: -Pityriasis rosea (PR) : The eruption tends to be moderately pruritic and lasts 6-12 weeks The herald patch is followed in a few days to a few weeks by the appearance of many smaller annular or papular lesions with a predilection to occur on the trunk. -### End" -6775,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Delirium is caused by which poison?, with the following options: A: Aconite, B: Dhatura, C: Morphine, D: Kerosene - -### Response: -Ans. (b) DhaturaRef.: Parikh 6th ed. 11.30 -### End" -6776,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A codon codes for a single amino acid. This characteristic is called ?, with the following options: A: Non-overlapping, B: Unambiguous, C: Non-punctate, D: Degeneracy - -### Response: -Ans. is 'b' i.e., Unambiguous Characteristics of genetic codes Genetic codes have following characteristics ? 1) Universal :- Each codon specifically codes for same amino acid in all species, e.g. UCA codes for serine and CCA codes for proline in all organisms. That means specificity of codon has been conserved from very early stages of evolution. Exception to the universality of genetic coder are found in human mitochondria, where the code :- a UGA codes for tryptophan instead of serving as a stop codon. AUA codes for methionine instead of isoleucine. CUA codes for threonine instead of leucine. LI AGA and AGG serve as stop codon instead of coding for arginine. 2) Unambiguous/Specific :- A paicular codon always codes for the same amino acid. For example CCU always codes for proline and UGG always codes for tryptophan. 3) Degeneracy/Redundancy :- A given amino acid may have more than one codon. For example, CCU, CCC, CCA and CCG all four codons code for proline. Therefore, there are 61 codons for 20 amino acids. 4) Stop or termination or nonsense codons:- Three of the 64 possible nucleotide triplets UAA (amber), UAG (Ochre) and UGA (opal) do not code for any amino acid. They are called nonsense codons that normally signal termination of polypeptide chains. Thus, though there are 64 possible triplet codons, only 61 codes for 20 amino acids (as remaining three are non-sense codons). 5) Non overlapping and nonpuntate (Comma less) :- During translation, the code is read sequentially, without spacer bases, from a fixed staing point, as a continuous sequence of bases, taken 3 at a time, e.g. AUGCUA GACUUU is read as AUG/CUA/GAC/UUU without ""ponctation"" (coma) between codons. -### End" -6777,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The greatest buffering capacity at physiologic pH would be provided by a protein rich in which of the following amino acids?, with the following options: A: Lysine, B: Histidine, C: Aspartic acid, D: Valine - -### Response: -Ans. B. HistidineProteins can be effective buffers of body and intracellular fluids. Buffering capacity is dependent on the presence of amino acids having ionizable side chains with pKs near physiologic pH. In the example given, only histidine has an ionizable imidazolium group that has a pK close to neutrality (pK=6.0). Valine and leucine are amino acids with uncharged, branched side chains. Lysine has a very basic amino group (pK=10.5) on its aliphatic side chain that is positively charged at physiologic pH, and aspartic acid has a side chain carboxyl (pK=3.8) that is negative at pH7.Amino acidpK of the side chain groupAspartic acid3.9Glutamic acid4.2Lysine10.5Arginine12.5Histidine6.0 -### End" -6778,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Allergic rhinitis nasal mucosa is:, with the following options: A: Pale and swollen, B: Pink and swollen, C: Atrophied, D: Bluish and atrophied - -### Response: -Ans. is a i.e Pale and swollen Nasal mucosa pale, boggy, swollen and bluish Nasal mucosa congested and swollen (Hyperophic) Mulberry appearance Pale and atrophied nasal mucosa Allergic rhinitis Vasomotor rhinitis Chronic hyperophic rhinitis Atrophic rhinitis -### End" -6779,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phases of ARDS are all except, with the following options: A: Exudative, B: Transudative, C: Proliferative, D: Fibrotic - -### Response: -The natural history of ARDS is marked by three phases--exudative, proliferative, and fibrotic. The exudative phase is notable for early alveolar edema and neutrophil-rich leukocytic infiltration of the lungs, with subsequent formation of hyaline membranes from diffuse alveolar damage. Within 7 days, a proliferative phase ensues with prominent interstitial inflammation and early fibrotic changes.Approximately 3 weeks after the initial pulmonary injury, most patients recover. However, some patients enter the fibrotic phase, with substantial fibrosis and bullae formation.Ref: Harrison 19e pg: 1736 -### End" -6780,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Toxic shock syndrome is Staphylococcus infection is due to, with the following options: A: Superantigen, B: Alpha-hemolysis, C: Coagulase, D: Penton Valentine factor - -### Response: -Toxic shock syndrome is a potentially fatal multisystem disease caused by TTST type 1(formerly known as enterotoxin type F or pyrogenic exotoxin C) is most often responsible, though enterotoxins B or C may also cause the syndrome. Staphylococcal enterotoxins and TSST-1 are superantigens which are potent activators of T lymphocytes. Being V beta-restricted T cell mitogens, such superantigens stimulate very large numbers of T cells, without relation to their epitope specificity. This leads to an excessive and dysregulated immune response, with the release of cytokines interleukins 1 and 2, tumor necrosis factor and interferon gamma. This explains the multisystem involvement and florid manifestations in staphylococcal food poisoning and TSS. Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; 10th Edition; Page No: 204 -### End" -6781,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mites are known to transmit-, with the following options: A: Scabies, B: Relapsing fever, C: KFD, D: Human babesiosis - -### Response: -Scabies is transmitted by itch mite or Sarcoptes scabiei. They are small globular ahropods. Scabies is spread by close contact and contaminated clothes. Other diseases transmitted by mites include Shrub typhus and rickettsialpox Relapsing fever and KFD transmitted by ticks. Park's Textbook of Preventive and Social Medicine, 25th edition, Page No. 841 -### End" -6782,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Candidiasis is associated with all except, with the following options: A: OCP user, B: IUCD user, C: Diabetes, D: Pregnancy - -### Response: -The predisposing factors for candidiasis are diabetes, immunodeficiency, malignancy, prolonged administration of antibiotics and patients on immunosuppressive drugs and intravenous catheters. OCP causes elevation of blood glucose levels by causing carbohydrate intolerance which in turn causes diabetes. IUCD causes PID mainly bacterial. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition -### End" -6783,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Crescents are derived from, with the following options: A: Mesangium + fibrin + macrophage, B: Visceral epithelial cells + fibrin + macrophage, C: Parietal epithelial cells + fibrin + macrophages, D: Tubular epithelium + fibrin + macrophages - -### Response: -Crescents are feature of RPGN. -They are made up of parietal epithelial cells, -fibrin and monocytcs / Macrophages. -### End" -6784,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50-year-old lady presented with a 3-month history of pain in the lower third of the right thigh. There was no local swelling; tenderness was present on deep pressure. Plain X-rays showed an ill-defined intra medullary lesion with blotchy calcification at the lower end of the right femoral diaphysis, possibly enchondroma or chondrosarcoma. Sections showed a cailaginous tumor. Which of the following histological features (if seen) would be most helpful to differentiate the two tumours?, with the following options: A: Focal necrosis and lobulation, B: Tumor permeation between bone trabecuae at periphery, C: Extensive myxoid change, D: High cellularity - -### Response: -Ans. is 'b' i.e., Tumour permeation between bony trabeculae at periphery Chondroma (enchondroma) Vs Chondrosarcoma o The term chondroma is used for benign neoplasm composed of cailage. It is of two types : - i) Enchondroma : - Cailage tumors occuring within the bone. ii) Periosteal chondroma : - Cailage tumors occuring on the surface of the bone. o Chondrosarcoma is the malignant tumor of cailage. Growth potential of chondroma is limited and mostly remain stable, but they have a potential to undergo malignant (sarcomatous) change to become chondrosarcoma. lnfact, enchondromas are considered to be a low grade chondrosarcoma. o A painful chondroid neoplasm in a large bone in an adult patient can be either enchondroma or chondrosarcoma o The differentiation between a low grade chondrosarcoma and an enchondroma can be difficult. o To make distinction between these two neoplasms, one has to make use of Cytological changes Myxoid quality of stroma Permeative characteristics Among these permeation, maifested as marrow spaces filled with the neoplasm and entrapment of preexisting bony trabeuculae is the most impoant sign of malignancy. -### End" -6785,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Atropine is used for following except:, with the following options: A: Organophosphorus posioning, B: Mushroom poisoning, C: Physostigmine overdose, D: Glaucoma - -### Response: -D i.e. Glucoma Atropine is contraindicated in narrow angle glucomaQ. Atropine is used as antidote for various poisons with cholinergic symptoms as - Anticholine Esterase (Organophosphorus) poisoning, Neostigmine / Pyridostigmine / Plzysostigmine overdose, Mushroom poisoningQ -### End" -6786,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An isograft is one that is transferred, with the following options: A: In the same individual, B: Between monozygotic twins, C: From I belonging to blood group A and other to blood group B, D: From animal to human when the organ involved is identical - -### Response: -Graft: It is transfer of tissue from one area to other without its blood supply or nerve supply. Autograft: It is tissue transferred from one location to another on the same patient. Isograft: It is tissue transfer between two genetically identical individuals, i.e. between two identical twins. Allograft: It is tissue transfer between two genetically different members, e.g. kidney transplantation (Human to human) (Homograft). Xenograft: It is tissue transfer from a donor of one species to a recipient of another species (Heterograft).Reference : page 321 SRB's manual of surgery 5th edition -### End" -6787,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 8-year-old girl is brought into the physician's office in mild respiratory distress. She has a history of allergies to cats and wool, and her parents state that she has recurrent episodes of upper respiratory tract infections. Physical examination shows expiratory wheezes, use of accessory respiratory muscles and a hyperresonant chest to percussion. Analysis of aerial blood gases discloses respiratory alkalosis and theperipheral eosinophil count is increased. What is the appropriate diagnosis?, with the following options: A: Acute bronchiolitis, B: Asthma, C: Cystic fibrosis, D: Usual interstitial pneumonia - -### Response: -Asthma is a chronic lung disease caused by increased responsiveness ( inflammatory reaction) of the airways to a variety of stimuli either extrinsic (e.g., pollen) or intrinsic (e.g., exercise). Extrinsic asthma is typically a childhood disease, whereas intrinsic asthma usually begins in adults. Patients typically have paroxysms of wheezing, dyspnea and cough. Bronchial biopsy of asthmatic patient showing sub-basement membrane fibrosis, eosinophilic inflammation, and smoothmuscle hyperplasia -### End" -6788,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Basement membrane collagen is, with the following options: A: IV, B: II, C: V, D: VI - -### Response: -(IV): (170 Harsh mohan 6th edition)Basement membrane are PAS positive amorphous structures that lies underneath epithelia of different organs and endothelial cells, they consist of collagen type IVand laminin** -### End" -6789,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Breast conservative surgery is done in all except:-, with the following options: A: Young patients, B: Ductal carcinoma in situ, C: Lobular carcinoma, D: Tumor of 5 cm size - -### Response: -Breast Conservation Surgery (BCS)- Performed for early invasive breast cancer (Stage I, IIA, IIB)Treatment options- Excision of lump - Lumpectomy- Wide local excision with 1 cm margin- Whole quadrant excision (Quadrantectomy) Lobular carcinoma is frequently multifocal, multicentric and bilateral and is contraindication for breast conservative surgery. Contraindications of Breast conservation surgery Absolute contraindications Relative contraindications Pregnancy H/ O Collagen vascular disease (Scleroderma, Active lupus erythematosus) 2 or >2 tumors in different quadrants or diffuse malignant appearing diffuse micro-calcification. Multiple tumors in same quadrant Persistently +ve margins Large tumor in small breast History of exposure of therapeutic radiation Large pendulous breast (difficult to give uniform dose of radiotherapy) Centrally located tumor (excision of nipple and areola should also be done for centrally located tumor but reconstruction of nipple of areola is difficult -### End" -6790,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hallmark cells are seen in, with the following options: A: Diffuse large B cell lymphoma, B: Hodgkin lymphoma, C: Anaplastic large cell lymphoma, D: Hairy cell leukemia - -### Response: -Anaplastic large cell lymphoma is characterized by the presence of large bizarre cells, called Hallmark cells, with the embryo or horseshoe-shaped nuclei. -### End" -6791,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In an adult man,there is about how much grams of hemoglobin in the circulating blood, with the following options: A: 350, B: 500, C: 900, D: 1000 - -### Response: -PURPOSE: A standardized carbon monoxide (CO) rebreathing procedure with measurements of CO-hemoglobin, hemoglobin concentration (), and hematocrit (Hct) enables to determine total Hb mass (Hb(tot)), blood, erythrocyte, and plasma volume (BV, EV, and PV). These calculations are normally based on venous blood samples. However, micromethods also allow determinations from capillary blood. METHODS: The accuracy of using capillary blood for Hb(tot), BV, EV, and PV determination was evaluated in 42 men (age: 25.1 +/- 4.0 yr, body mass: 80.3 +/- 9.6 kg) by comparison of capillary and venous data. RESULTS: Capillary Hb(tot) (962 +/- 110 g) Ref Robbins 9/e pg 420 and internet -### End" -6792,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about the below eyelid condition except, with the following options: A: It is a painless nodule, B: Involves the meibomian gland, C: Located within the tarsal plate, D: More common in children - -### Response: -Ans. (d) More common in childrenOption a - patient presents with a painless, hard swelling on either lid, increasing gradually in size, without inflammatory symptoms.Option b - It is a chronic, sterile granuloma of the meibomian gland caused due to retained secretions.Option c - FactOption d - More common in adults than in children. -### End" -6793,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An intestitinal biopsy is most diagnostic in which of the following conditions?, with the following options: A: Celiac disease, B: Tropical sprue, C: Whipple disease, D: Lactose intolerance - -### Response: -Whipple disease A gram-positive actinomycete, named Trophyrema whippleii, is responsible for Whipple disease. Clinical symptoms occur because organism-laden macrophages accumulate within the small intestinal lamina propria and mesenteric lymph nodes, causing lymphatic obstruction- resulting in malabsorptive diarrhoea due to impaired lymphatic transpo. Morphological hallmark- dense accumulation of distended, foamy macrophages in the small intestinal lamina propria. The macrophages contain periodic acid-Schiff (PAS)-positive, diastase-resistant granules that represent lysosomes stuffed with paially digested bacteria. Intact rod-shaped bacilli can also be identified by electron microscopy. Distension of villi due to dense macrophage infiltrates, impas a shaggy gross appearance to the mucosal surface. In Whipple disease, bacteria-laden macrophages can accumulate within mesenteric lymph nodes, synol membranes of affected joints, cardiac valves, the brain, and other sites. Findings typically seen in celiac disease such as intraepithelial lymphocytosis and villous atrophy are not specific for celiac disease and can be present in other diseases, including viral enteritis. Therefore, a combination of histology and serology is most specific for diagnosis of celiac disease. -### End" -6794,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Differential expression of same gene depending on parent of origin is referred to as -, with the following options: A: Genomic imprinting, B: Mosaicism, C: Anticipation, D: Nonpenetrance - -### Response: -Ans. is 'a' i.e., Genomic imprinting The phenomenon referred to as genomic imprinting leads to pereferential expression of an allele depending on its parental origin - Harrisons Genomic imprinting Human inherits two copies of each gene, i.e. two alleles, from homologous maternal and paternal chromosomes. o There is no functional difference between the genes derived from mother or the father. But, with respect to some genes, there are functional differences between the paternal gene and maternal gene. o These differences result from an epigenetic process, called genomic imprinting. o In most cases, genomic imprinting selectively inactivates either the maternal or paternal allele. Maternal genomic imprinting o Selective inactivation of maternal allele. o Example is Angelman syndrome. Paternal genomic imprinting o Selective inactivation of Paternal allele. o Example is Prader - Willi syndrome. -### End" -6795,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Geniculate ganglion is associated with:, with the following options: A: Lacrimation, B: Taste sensation, C: Salivation, D: Sweating - -### Response: -The facial nerve is a mixed cranial nerve. Its sensory axons extend from the taste buds of the anterior 2/3 of tongue through the geniculate ganglion. -### End" -6796,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mutation in which of the following gene is found in Marfan's syndrome?, with the following options: A: Collagen I, B: Collagen IV, C: Fibrillin I, D: Fibrillin II - -### Response: -Marfan's syndrome is caused by recurrent de novo missense mutation in the fibrillin-1 gene. Fibrillin1 is a large glycoprotein that is a structural component of microfibrils. Fibrillin 1 is found in the zonular fibers of the lens, in the periosteum and elastin fibers of aoa. Defect in fibrillin gene accounts for the manifestations of marfans syndrome such as ectopia lentis, arachnodactyly and cardiovascular problems. Mutation of fibrillin 2 gene on chromosome 5 lead to causation of congenital contractural arachnodactyly. -### End" -6797,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anti-inflammatory action of glucocoicoids is mainly due to, with the following options: A: Increase IL-2, B: Decrease arachidonic acid, C: Increase annexins, D: Decrease CRP - -### Response: -Increase in annexins or lipocoins causes inhibition of PLP A2 thus fuher inhibiting arachidonic acid.Ref: KDT 6/E p279 -### End" -6798,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hanup disease, limiting amino acid, with the following options: A: Tyrosine, B: Tryptophan, C: Rhenylalanine, D: None - -### Response: -It&;s an autosomal recessive disease. Absorption of aromatic amino acids from intestine as well as reabsorption from renal tubules are defective Patient improve when put on high protein diet with supplementation of niacin Hence the limiting amino acid is tryptophanRef: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 242 -### End" -6799,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: WPW syndrome is caused by -, with the following options: A: Bundle Branch Block, B: Right sided accessory pathway, C: Ectopic pacemaker in atrium, D: Left budle Branch block - -### Response: -Ans. is 'b' i.e., Right sided accessory pathwayAnatomy (Location of Accessory pathway) in W.P.W. syndromeo Electrophysiological studies and mapping have shown that accessory. Atrioventricular pathways may be located anywhere along the A-V rign or groove in the septum.o The most frequent locations are:-# Left lateral (50%), posteroseptal (30%) right anteroseptal (10%).# Right lateral (10%).o Preexcitation resulting from left sided accessory is called type A preexcitation.o Preexcitation resulting from right sided accessory pathway is called type B preexcitation. -### End" -6800,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which teratogen causes deafness ?, with the following options: A: Isotretnoin, B: Chloroquine, C: Alcohol, D: Warfarin - -### Response: -Ans. is 'a' i.e., Isotretnoid o Isotretinoin can cause microtia or anotia. o These defects are frequently associated with agenesis or stenosis of external ear canal and may lead to deafness. -### End" -6801,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Colonic divericulosis and diverticulitis maximally seen in:, with the following options: A: Sigmoid colon, B: Rectum, C: Transverse colon, D: Ascending colon - -### Response: -Ans. (a) Sigmoid colonRef: Sabiston 20th edition, Page 1333Acquired diverticulum:* Most common site in colon -- sigmoid* Most common site in small intestine -- duodenum -### End" -6802,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about Swine flu -(A)Older bird influenza vaccine is equally effective in swine flu -(B)Ostelmavir is effective in prevention -(C)Zanamavnr can be used for treatment -(D)Influenza vaccine provides immunity just after vaccination, with the following options: A: BC, B: AB, C: AD, D: BA - -### Response: -It emerged in march 2009 as new H1N1 virus disease -Also called as swine origin influenza -ft spread from person to person & caused a pandemic -PANDEMIC INFLUENZA A (H1N1)  -Currently susceptible to ose!tavir&zanamivir but resistant to amantadine or rimantadine -Treatment: oseltavir adult oral dose is 75 mg twice daily for 5 days. Zanamivir dose is two inhalation {2 x5 mg] twice daily for 5 days -Chemoprophylaxis:Oseltavir is drug of choice for chro mo prophylaxis. It should be given till 10 days after last exposure -1 nfluenza vaccine only become effective about 14 days after vaccination. Those infected shortly before(l-3 days) or shortly after immunization can still get the disease. -Vaccinated individuals can also get influenza caused by a different strain of influenza virus, for which the vaccine does not provide protection -### End" -6803,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement about post-dural puncture headache (PDPH):, with the following options: A: Breach of dura, B: Onset of headache is usually 12-72 hours following procedure, C: Commonly occipito - frontal in location, D: Headache is relieved in sitting standing position - -### Response: -Post Dural puncture Headache Pathophysiology - CSF leak - ICP |es - Traction on nerve fibres originating from piamater Site - Occipital > Frontal > Retrorbital Duration - 7-10 days Pathognomic sign - Change in posture aggravates headache Predisposing conditions - Dura cutting needle (spinal needle)* Most commonly seen with 22G Quincke needle Wide bore needle * Multiple attempts * Pregnancy (In pregnancy dura mater is very fragile- venous engorgement fragility increases chances of PDPH is more) Note- Early ambulation never predispose to PDPH -### End" -6804,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Second gas effect is ?, with the following options: A: Displacement of N20 by Oxygen, B: Displacement of oxygen by N20, C: Facilitation of inhalation of Halothane by N20, D: Removal of oxygen by N20 from alveoli during recovery from general anaesthesia - -### Response: -Ans. is 'c' i.e., Facilitation of inhalation of halothane by N20 -### End" -6805,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Correlation coefficient of 0.5 indicates, with the following options: A: Confidence interval of 95 %, B: Weak association, C: Not statistically significant, D: Good association - -### Response: -Ref:Park's Textbook of Preventive and Social Medicine 25th Ed -### End" -6806,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are live attenuated vaccines, except:, with the following options: A: Oral polio, B: Yellow fever, C: Measles, D: Influenza - -### Response: -Influenza -### End" -6807,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Weil's disease is caused by?, with the following options: A: Leptospira, B: Plague, C: Yersinia, D: Rickettsial fever - -### Response: -ANSWER: (A) LeptospiraREF: Jawetz's 24th ed chapter 25Leptospira icterohaemorrhagiaeSource of Infection - Rat urine, waterDisease in Humans - Weil's diseaseClinical Findings - Jaundice, hemorrhages, aseptic meningitisLeptospirosis is also known as Weil's disease, Weil's syndrome, canicola fever, canefield fever, nanukayami fever, 7-day fever, Rat Catcher's Yellows, Fort Bragg fever, and Pretibial feverClassicactivationpathwayAntigerif'antftxxfy immune complexClq-C1r-C1sMannose-bindinglectinactivation pathwayMicrobes with terminal manose groupsMBL-MASP1 -MASP2AlternativeactivationpathwayBacteria, fungi, vims, or tumor celtsC3 (H2O) -### End" -6808,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest aery for cannulation is -, with the following options: A: Radial, B: Ulnar, C: Brachial, D: Cubital - -### Response: -Answer is 'a' i.e. Radial ""Aerial puncture and cannulation is performed to measure the Pa02, PaCO2, Sa02 and pH to clarify the acid-base and electrolyte status. Any aery that can be compressed after puncture may be used (but not end-aeries); usually the radial (preferred), brachial, or femoral"" - Lee 12/e -### End" -6809,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old patient presents with numbness over the neck. On examination decreased pain and temperature sensation is found in the distribution of C4, C5. Scalp sensation, cranial nerve function and limb examination are normal. Bladder and bowel sphincter control are normal. What is the diagnosis?, with the following options: A: Amyotrophic lateral sclerosis, B: An intramedullary tumor, C: Neuro-syphilis, D: A.I.D.P - -### Response: -The patient is having features suggestive of central cord syndrome with involvement of lateral spinothalamic tract leading to decreased pain and temperature sensation. Amyotrophic lateral sclerosis - Asymmetric motor weakness with findings of LMNL and UMNL. Hence choice A is ruled out. Neurosyphilis can involve the spine - Tabes dorsalis. Presents as Lhermitte sign, sensory ataxia, and urinary incontinence. Hence choice C is ruled out. AIDP (Subtype of GBS) presents as fast onset paraplegia/ quadriplegia with/ without diaphragmatic paralysis. Hence choice D is ruled out. -### End" -6810,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Initial maneuver done in congenital dacryocystitis:, with the following options: A: Probing, B: Massaging, C: Ointments, D: Observation - -### Response: -Congenital Acute Chronic Cause Non -Canalization Of NLD S.Aureus S.Aureus C/F Epiphora and Discharge Epiphora and Discharge Epiphora and Discharge Treatment <9 months=CRIGLER massage + antibiotic drops when needed (acute infections) 9 mon.- 4 years=probing >4 years= DCR Antibiotics + NSAIDS | DCR DCR Sequelae None Lacrimal fistula Rx:-DCR Mucocele-> pyocele-> fibrosis Rx:- DCT -### End" -6811,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: VIII nerve receives afferents of, with the following options: A: Balance, B: Equilibrium, C: Hearing, D: All of above - -### Response: -AUDITORY NEURAL PATHWAYS AND THEIR NUCLEI Hair cells are innervated by dendrites of bipolar cells of spiral ganglion which is situated in Rosenthal's canal (canal running along the osseous spiral lamina). The nerve receives afferents from vestibule and cochlea. Axons of these bipolar cells form the cochlear division of CN VIII and end in the cochlear nuclei, the dorsal and ventral, on each side of the medulla. Fuher course of auditory pathways is complex. From cochlear nuclei, the main nuclei inthe ascending auditory pathways, sequentially, from below upwards are: 1. Superior olivary complex 2. Nucleus of lateral lemniscus 3. Inferior colliculus 4. Medial geniculate body 5. Auditory coex The auditory fibres travel the ipsilateral and contralateral routes and have multiple decussation points. Thus each ear is represented in both cerebral hemispheres. The area of coex, concerned with hearing is situated in the superior temporal gyrus (Brodmann's area 41). For auditory pathways, remember the mnemonic E.COLI-MA: Eighth nerve, Cochlear nuclei, Olivary complex, Lateral lemniscus, Inferior colliculus, Medial geniculate body and Auditory coex. Ref : ENT textbook by Dhingra 6th edition Pgno : 13,14 -### End" -6812,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Female patient with loss of interest in sex is known as: September 2006, with the following options: A: Vaginismus, B: Impotency, C: Sterility, D: Frigidity - -### Response: -Ans. D: Frigidity Vaginismus is spasmodic contraction of the vagina due to hyperaestheisa Frigidity is the inability to initiate or maintain the sexual arousal pattern in the female. Impotency is the inability of a person to perform sexual intercourse Sterility is the inability to produce children -### End" -6813,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with ARF with a normal ultrasound repo. The next most useful investigation is:, with the following options: A: Renal angiography, B: Retrograde pyelography, C: Intravenous pyelography, D: DTPA scan - -### Response: -Ans. DTPA scan -### End" -6814,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If alternate of medicine were accepted as a modality of therapy, then 'Yoga' would be best described as a form of-, with the following options: A: Physiotherapy, B: Preventive Medicine, C: Emergency Medicine, D: Caloric usurper - -### Response: -Ans. is 'b' i.e., Preventive Medicine 'Yoga' is a practice that involves training of the mind, body and breathing to deliver various health benefits. Regular practice of Yoga can be best defined as a form of 'Preventive Medicine' that has shown beneficial effect on several aliments including Backache, Anxiety, Headache, Hypeension etc. -### End" -6815,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True pseudomyxoma peritonei is caused by:, with the following options: A: Cystadenoma of the appendix, B: Mucinous adenocarcinoma, C: Colorectal mucinous cancer, D: Ovarian malignancy - -### Response: -In reality the pseudomyxoma peritonei or ""jelly belly"" probably represents mucinous ascites, in association with a cystadenoma of the appendix (resulting in true PMP); to frank mucinous adenocarcinoma. Additionally intestinal mucinous tumours, paicularly colorectal cancers, or any mucinous neoplasm may present with clinical, radiological and pathological features resembling pseudomyxoma peritonei. Ref: World J Gastrointest Oncol 2010 January 15; 2(1): 44-50. -### End" -6816,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle attached to the rough anterior impression of greater trochanter of femur?, with the following options: A: Gluteus minimus, B: Gluteus medius, C: Gluteus maximus, D: Pyriformis - -### Response: -Ans. A. Gluteus minimus. (Ref BDC 4th/Vol 2./pg. 17-20). BDC 4th/Vol 2./pg. 19...................... ""The gluteus minimus arises from the outer surface of the ilium, between the anterior and inferior gluteal lines, and behind, from the margin of the greater sciatic notch and is inserted into the rough lateral part of the anterior surface of the greater trochanter."" Muscle Origin Insertion Gluteus maximus # Outer slope of dorsal segment of iliac crest # Posterior gluteal line # Posterior part of gluteal surface of ilium behind the posterior gluteal line # Aponeurosis of erector spinae # Dorsal surface of lower part of sacrum # Side of coccyx # Sacrotuberous ligament # Fascia covering gluteus maximus - Deep fibres of the lower part - gluteal tuberosity - Greater part of the muscle - iliotibial tract Gluteus minimus Gluteal surface of ilium between the anterior and inferior gluteal lines Greater trochanter of femur, on a ridge on the lateral part of anterior surface Gluteus medius Gluteal surface of ilium between the anterior and posterior gluteal lines Greater trochanter of femur, on oblique ridge on lateral surface Piriformis # Pelvic surfaces of middle 3 pieces of sacrum (by 3 digitations). # Upper margin of greater sciatic notch and the adjoining areas of the sacroiliac joint and sacrotuberous ligament. - Apex of greater trochanter of femur Muscle attachments to femur Parts of femur Attachments 1 Fovea on the head - Ligament of head of femur (round ligament/ligamentum teres) 2 Greater trochanter - Pyriformis into - apex. - Gluteus minimus - rough lateral part of anterior surface. - Obturator internus and two gemelli into - upper rough impression on medial surface. - Obturator externus into - trochanteric fossa. - Gluteus medius - ridge on the lateral surface. 3 Lesser trochanter - Psoas major on the apex and the rough anterior surface. - Iliacus on anterior surface of the base of the trochanter and on the area below it. - Smooth posterior surface covered by bursa that lies deep to upper fibers of adductor magnus. 4 Intertrochanteric line - Capsular ligament of hip joint. - Upper and lower bands of iliofemoral ligament. - Origin to highest fibers of vastus medialis from lower end of the line. 5 Quadrate tubercle Insertion of quadratus femoris 6 Shaft - Medial and popliteal surface bare except for origin of medial head of the gastrocnemius. - Vastus intermedius from upper 3/4th of anterior and lateral surfaces. - Articular genu just below vastus intermedius. - Lower 5 cm of anterior surface related to suprapatellar bursa. - Vastus lateralis from upper part of the intertrochanteric line, anterior and inferior borders of greater trochanter, upper lip of gluteal tuberosity, upper half of lateral lip of linea aspera. - Vastus medialis from lower intertrocahnteric line, spiral line, medial lip of linea aspera, and upper l/4th of the medial supracondylar line. - Deeper fibers of gluteus maximus inserted into gluteal tuberosity. - Adductor magnus inserted along medial lip of the linea aspera between vastus medialis and adductor brevis and magnus. - Adductor brevis inserted into line from lesser trocahnter to upper linea aspera. - Adductor magnus inserted into medial margin of gluteal tuberosity, linea aspera, medial supracondylar line, and adductor tubercle. - Pectinus inserted on line extending from lesser trochanter to the linea aspera. - Short head biceps from lateral lip of linea aspera. - Lower end of lateral supracondylar line gives origin to plantaris and lateral end of gastrocnemius. - Popliteal surface covered with fat and forms floor of poiiteal fossa. - Origin of medial end of gastrocnemius extends to poiiteal surface. 7 Lateral condyle - Fibular collateral ligament of knee to lateral epicondyle. - Popliteus from deep anterior part of poiiteal groove. - Origin to lateral head of gastrocnemius. 8 Medial condyle - Tibial collateral ligament attached. - Adductor tubercle receives insertion of hamstring part of adductor magnus. 9 Intercondylar notch - Anterior cruciate ligament to posterior part of medial surface of lateral condyle. - Posterior cruciate ligament to anterior part of lateral surface of medial condyle. - Inetrcondylar line provides attachment to capsular ligament and laterally to oblique popliteal ligament. - Infrapatellar synovial fold is attached to anterior border of intercondylar fossa. -### End" -6817,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following antituberculosis drug is not given in pregnancy, with the following options: A: Streptomycin, B: INH, C: Ethambutol, D: Rifampicin - -### Response: -Ans. is 'a' i.e. Streptomycin ""Streptomycin is contraindicated during pregnancy because it causes congenital deafness""Tuberculosis t/t in pregnancyIsoniazid, Rifampicin and pyrazinamide and ethambutol are safe to the fetus.Standslrd 6 month regimen of 2 HRZ+4HR should be given. Ethambutol should be added during late but not early pregnancy.The teratogenic effect of I.N.H. is not known therefore it is avoided in U.S.A.Treatment of the T.B. should not be withheld or delayed because of pregnancy.Of the many second-line antituberculous drug regimens, the aminoglycosides, streptomycin, kanamycin, amikacin and capreomycin are ototoxic to the fetus and are contraindicated during pregnancy.Tuberculosis t/t in breast feeding womenAll Anti T.B. drugs are compatible with breast feeding.Full course should be given to the mother, but the baby should be watched.The infant should receive BCG vaccination and isoniazid prophylaxis.The use and recommendations of antitubercular drugs are as follows :* AzithromycinNo evidence of risk* ClarithromycinRisk cannot be ruled out* EthambutolRisk cannot be ruled out* IsoniazidRisk cannot be ruled out* PyrazinamideRisk cannot be ruled out* RifabutinNo evidence of risk* RifampinRisk cannot be ruled out* RifapentineRisk cannot be ruled out* StreptomycinDefinitive evidence of risk -### End" -6818,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following stain is used for visualising degenerated fungi in tissue?, with the following options: A: PAS, B: Gomori methamine silver, C: H&E, D: Muciramine - -### Response: -The periodic acid Schiff (PAS) and Gomori methanamine silver stains are valuable methods for the demonstration of fungal elements in tissue sections. But since GMS is most sensitive it is the best possible answer. Ref: Textbook of Microbiology by Ananthanarayan, 6th edition, Page 565. -### End" -6819,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The antibody class specific for infectious mononucleosis is: March 2003, with the following options: A: IgA, B: IgD, C: IgM, D: IgG - -### Response: -Ans. C i.e. IgM -### End" -6820,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The tumor which is more commonly located in the tail of the pancreas is:, with the following options: A: Glucagonoma, B: Somatostatinoma, C: Gastrinoma, D: Insulinoma - -### Response: -Glucagonomas are usually large tumors at diagnosis. 50-80% occur in the pancreatic tail. Insulinoma distributed equally in the head, body and tail. Gastrinoma is usually located at the gastrinoma triangle in the duodenum. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Pages 3065-67 -### End" -6821,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 77-year-old man has had progressive dementia and gait ataxia for the past 9 years. He succumbs to bronchopneumonia. Autopsy shows that the thoracic aorta has a dilated root and arch, giving the intimal surface a ""tree-bark"" appearance. The microscopic examination of the aorta shows an obliterative endarteritis of the vasa vasorum. Which of the following laboratory findings is most likely to be recorded in this patient's medical history?, with the following options: A: Antibodies against Treponema pallidum, B: Double-stranded DNA titer positive at 1 :512, C: Ketonuria of 4+, D: P-ANCA positive at 1 :1024 - -### Response: -This description is most suggestive of syphilitic aortitis, a complication of tertiary syphilis, with characteristic involvement of the thoracic aorta. The history also suggests tabes dorsalis and neurosyphilis. Obliterative endarteritis is not a feature of other forms of vasculitis. High-titer double-stranded DNA antibodies are diagnostic of systemic lupus erythematosus, and the test result for P-ANCA (antibodies mainly directed at myeloperoxidase) is positive in various vasculitides, including microscopic polyangiitis. Ketonuria can occur in individuals with diabetic ketoacidosis. A high sedimentation rate is a nonspecific marker of inflammatory diseases. -### End" -6822,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 15-year-old girl has developed multiple nodules on her skin over the past 10 years. On physical examination, there are 20 scattered, 0.3-cm to 1-cm, firm nodules on the patient's trunk and extremities. There are 12 light brown macules averaging 2 to 5 cm in diameter on the skin of the trunk. Slit-lamp examination shows pigmented nodules in the iris. A sibling and a parent are similarly affected. Genetic analysis shows a loss-of-function mutation. Which of the following inheritance patterns is most likely to be present in this family?, with the following options: A: Autosomal dominant, B: Autosomal recessive, C: Mitochondrial, D: Multifactorial - -### Response: -Neurofibromatosis type 1 (NF-1) is characterized by the development of multiple neurofibromas and pigmented skin lesions. Neurofibromas are most numerous in the dermis but also may occur in visceral organs. Patients with NF-1 also may develop a type of sarcomatous neoplasm known as a malignant peripheral nerve sheath tumor (MPNST). NF-1 is a tumor suppressor that appears with an autosomal dominant pattern of inheritance, though some cases result from spontaneous new mutations (no prior family members with the mutation). NF-1 exhibits variable expressivity, because the manifestations (location and types of neoplasms) are not the same in all patients. The other forms of inheritance listed are not associated with tumor suppressor genes. -### End" -6823,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common intracranial neoplasm in adults is:, with the following options: A: Meningioma, B: Astrocytoma, C: Posterior fossa tumor, D: Ganglioneuroma - -### Response: -Harrison&;s says ""meningiomas are diagnosed with increasing frequently as more people undergo neruroimaging for various indications. They are now the most common primary brain tumor, accounting for approximately 35% of total MC primary tumor: Meningioma(35%)>glialtumors(30%) MC malignant tumor of childhood: Medulloblastoma MC brain tumor: Metastasis Ref: Harrison&;s 19th edition Pgno: 602 -### End" -6824,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spleniculi are seen most commonly in:, with the following options: A: Colon, B: Hilum, C: Liver, D: Lungs - -### Response: -Spleniculi or accessory spleens are most commonly ( about 80% ) seen at the hilum of the spleen. Also know: Location of accessory spleen in decreasing order are: Splenic hilum Gastrocolic ligament Tail of pancreas Greater omentum Greater curvature of stomach Splenocolic ligament Small and large bowel mesentery Left broad ligament of women Left spermatic cord in men Ref: Schwaz 9/e, Page 1246; Bailey & Love 25/e, Page 25/e, Page 1103 -### End" -6825,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following condition is not associated with an increased anion-gap type of metabolic acidosis?, with the following options: A: Lactic acidosis, B: Ingestion of antifreeze, C: Diabetic ketoacidosis, D: COPD - -### Response: -High-anion gap metabolic acidosis is caused by ? Lactic acidosis ? Ketoacidosis (Diabetic, Alcoholic, Starvation) ? Toxins - Ethylene glycol, Methanol, Salicylates, Propylene glycol and Pyroglutamic acid and ? Renal failure (acute and chronic). COPD is not associated with high anion gap metabolic acidosis. Metabolic acidosis results from an imbalance between the plasma concentration of H+ and HCO3- and is defined as a decrease in to below 22meq/l with a decrease in pH below 7.36. High anion gap metabolic acidosis result from excess accumulation of fixed acid. If its level is increased to 30mmol/L or more, a high anion gap metabolic acidosis is present regardless of pH and HCO3. Anion gap is calculated by the formula, anion gap= Na+ - (CL- + HCO-3). Normal value is 8- 12 mmol/l. Ref: Harrison's Principle of Internal Medicine, 18th Edition, Page 366, Table 47-4; CURRENT Diagnosis and Treatment Emergency Medicine, 7th Edition, Chapter 44 -### End" -6826,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Joint not involved in Rheumatoid arthritis according to 1987 modified ARA criteria?, with the following options: A: Knee, B: Ankle, C: Tarsometatarsal, D: Metatarsophalangeal - -### Response: -According to 1987 modified ARA criteria : - - -Arthritis of 3 or more joint areas: soft tissue swelling (arthritis) of 3 or more joint areas observed simultaneously by a physician. The 14 possible joint areas involved are, right or left: - - -Proximal interphalangeal    -Metacarpophalangeal      -Metatarsophalangeal -Wrist -Knee  -Elbow -Ankle -### End" -6827,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Loose body in joint most common site is -, with the following options: A: Knee, B: Hip, C: Elbow, D: Ankle - -### Response: -Ans. is 'a' i.e., Knee Loose body in jointo A loose body is a free-floating piece of bone, cartilage or foreign object in a joint,o The knee is the most common joint where one would find a loose body.o Causes of loose bodies include :-OsteoarthritisOsteochondritisdessicansOsteochondral fracture(injury)Charcot's diseaseSynovial chondromatosis -### End" -6828,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Common symptoms of panic attacks include the all of following except?, with the following options: A: Fear of dying, B: Fear of losing control, C: Fear of going crazy, D: Suicidal thoughts - -### Response: -Suicidal thought is not common symptom of panic attack. Patient has a feeling of impeding doom. There is feeling of going crazy , losing control and dying. -### End" -6829,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Hb level is healthy women has mean 13.5 g/dl and standard detion 1.5 g/dl, what is the Z score for a woman iwht Hb level 15.0 g/dl-, with the following options: A: 9, B: 10, C: 2, D: 1 - -### Response: -Ref:Parks 23rd edition pg 849 Z score = (individual value - mean) / SD =(15-13.5)/1.5= 1 -### End" -6830,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following use c-AMP as a second messenger except:, with the following options: A: Corticotropin, B: Dopamine, C: Glucagon, D: Vasopressin - -### Response: -Vasopressin receptor  V1 and V3 acts via IP3/calcium pathway. V2 acts via cAMP. -### End" -6831,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ponto Geniculo Occipital spike is characteristic of ------- sleep, with the following options: A: Stage 1 NREM, B: Stage 2 NREM, C: Stage 4 NREM, D: REM - -### Response: -PGO waves are prominent phasic bioelectrical , closely related to rapid eye , that occur in or during Ref: Principles and practice of sleep medicine, 6e, 2017. -### End" -6832,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Saddle nose is-, with the following options: A: Depressed nose, B: Crooked nose, C: Deviated nose, D: C-shaped - -### Response: -Ans. is 'a' i.e., Depressed nose Saddle nose (Depressed nose)o Nasal dorsum is depressed (sagging of the bridge of nose).o Depressed nasal dorsum may involve either bony, cartilaginous or both bony and cartilaginous components. Most common etiology: Nasal traumao Causes are hematoma, excessive surgical removal, trauma, syphilis, abscess, Leprosy, and tuberculosis. Crooked or deviated noseo Crooked nose is the external deviation of nose due to deviation of the dorsal border of septal cartilage, forming a 'C' or 'S' shaped curve.o In crooked nose, the midline dorsum is curved in 'C' or 'S' shaped manner from the frontonasal angle to the tip of nose.o In a deviated nose, the midline is straight but deviated to one side, midline is not curved as in crooked nose. -### End" -6833,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chediak Higashi syndrome is characterized by the following EXCEPT:, with the following options: A: Neutrophilia, B: Defective degranulation, C: Delayed microbial killing, D: Giant granules - -### Response: -Chediak-Higashi syndrome: Neutropenia (most common) Defective degranulation Delayed microbial killing Giant granules -### End" -6834,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: EEG waves seen in Hippocampus are, with the following options: A: alpha, B: beta, C: theta, D: delta - -### Response: -(C) theta > Large amplitude, pattern of regular 4-7/sec waves called theta rhythm occurs in children and is generated in the hippocampus in experimental animals.> a-rhythm occurs in adult humans who are awake but at rest within eyes closed, EEG shows a regular pattern of waves at a frequency of 8-12 Hz and amplitude of 50-100 mv, most marked in parieto-occipital area.> b-rhythm is harmonic of alpha, showing patterns of lower amplitude, 18-30 Hz, seen over frontal regions.> Delta waves are large slow waves of frequency less than 4 Hz, seen in deep sleep. -### End" -6835,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the best method for confirming amyloidosis-, with the following options: A: Colonoscopy, B: Sigmoidoscopy, C: Rectal biopsy, D: Tongue biopsy - -### Response: -“The most definitive investigation for Amyloidosis is biopsy”. - -For many years rectal biopsy was the first procedure of choice. -An important clinical advance was the recognition that the capillaries in the subcutaneous fat are often involved in patients with systemic amyloidosis and can often provide sufficient tissues for the diagnosis of amyloidosis.  -Thus, a biopsy of the organ with the most severe clinical involvement is often unnecessary. -For example in cardiac amyloidosis, the definitive diagnosis of the type of amyloid can be made using an endomyocardial biopsy specimen with Congo red and immunologic staining of the tissue sample. -Alternatively, when a noninvasive testing suggests cardiac amyloidosis - A specific diagnosis is often made by studying a subcutaneous fat aspiration instead of endomyocardial biopsy thereby avoiding an invasive procedure. -When the subcutaneous fat aspiration biopsy does not provide information to reach a firm diagnosis, biopsy samples can be collected from other organs. -In addition, an advantage to performing a biopsy of an involved organ (e.g., kidney heart) is that it definitively establishes a cause and effect relationship between the organ dysfunction and amyloid. -It is important to realize that not all biopsy sites offer the same sensitivity. - -The best sites of biopsy are: - - -Abdominal fat pad and (90% sensitivity) -Rectal mucosa (73% - 84% sensitivity) - -Other sites that are often sampled but have poor sensitivity for the diagnosis of amyloid include: - - -Salivary glands -Skin -Tongue -Gingiva -Stomach -Bone marrow -### End" -6836,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vestibular Evoked Myogenic Potential (VEMP) detects lesion of -, with the following options: A: Cochlear Nerve, B: Superior Vestibular Nerve, C: Inferior Vestibular Nerve, D: Inflammatory Myopathy - -### Response: -Vestibular Evoked Myogenic Potentials - -The vestibular evoked myogenic potential (VEMP) are short latency electro myograms that are evoked by acostic stimuli in high intensity and recorded from surface electrodes over the tonically contracted sternocleido mastoid muscle. -The origin of VEMP is the saccule. -The response pathway consists of: - -– Saccule; Inferior Vestibular Nerve, Lateral Vestibular Nucleus, Lateral Vestibulospinal Tract and Sternocleidomastoid muscle. - -The test provides diagnostic information about saccular and/or inferior vestibular nerve function. -An intact middle ear is required for the response quality. - -Waveform of the response -The VEMP waveform is characterised by a - -Wave I – positive peak at 13-15 (p13) -Wave II – negative peak at 21-24 ms (p23) - -Peak to peak amplitude of p13-23 is measured and asymmetries between the right and left side is noted (by calculating asymmetry ratio AR) -Abnormal AR is seen a case of: - -Saccular hydrops (AR > 36%) -Vestibular schwannoma orignating from inferior vestibular nerve. -Vestibular neuronitis -Superior canal dehiscence syndrome. -### End" -6837,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Filigree burns occur in ?, with the following options: A: Lightening, B: Electrocution, C: Vitrilage, D: Infanticide - -### Response: -Ans. is 'a' i.e., Lightening Lightening burns Lightening refers to discharge of current between a negatively charged cloud and positively charged aicle on eah. During lightening, injuries result due to following mechanisms :- Direct effect of high voltage current. Heat, i.e. super heated air causing burns. Expanded and displaced air, which acts as a blast wave. Sledge hammer blow by compressed air pushed before the current (sledge hammer effect and blow death). The characteristic finding in lightening burns is filigree burns/ arborescent burns/arborescent marking/ litchenberg flower. In this burns are seen as coloured branching patterns, especially on shoulder and flanks. This branching distribution like inveed tree, does not correspond to blood vessels. -### End" -6838,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Post coital test showing non motile sperms in the cervical smear and Motile sperms from the posterior fornix suggests:, with the following options: A: Faulty coital practice, B: Immunological defect, C: Hypospadias, D: Azoospermia - -### Response: -Post coital test showing non motile sperms in the cervical smear and motile sperms in the posterior forix suggest that the sperms are normal and motile when they reach forenix. After that in cervix they become inmotile, i.e antisperm artibodies are present in the cervix, i.e imunlogical defect seen. -### End" -6839,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fluctuating, recurring, variable sensorineural deafness is seen in, with the following options: A: Serous otitis media, B: Hemotympanum, C: Perilabyrinthine fistula, D: Labrinthine concussion - -### Response: -Sensorineural hearing loss is also seen in presbycusis, ototoxicity, Meniere&;s disease, acoustic neuroma, also been associated with diabetes, hypothyroidism, kidney disease, autoimmune disorders, multiple sclerosis and blood dyscrasias. Ref: PL DHINGRA diseases of ear nose and throat, 6th edition, page no 33 -### End" -6840,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation useful for detecting extra adrenal phecochromocytoma-, with the following options: A: USG, B: CCT, C: T2-weighted MRI with gadolinium contrast, D: MIBG - -### Response: -T2 weighted MRI with gadolinium contrast is optional for detecting pheochromocytoma and is somewhat better than CT for imaging extra adrenal pheochromocytoma and paragangliomas Ref ( Harrison 17 pg 2271) -### End" -6841,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In an ablated animal, If Myeloid Stem Cells are injected, which type of cells are induced after the incubation period?, with the following options: A: T-Lymphocyte, B: Erythroid, C: Fibroblast, D: Hematopoietic Stem Cells - -### Response: -Ans. (b) Erythroid(Ref: Robbins 9th/pg 27-28, 580-581)Neutrophils, Monocytes, Basophils, Erythroids and Megakaryocytes are myeloid in origin while lymphocytes are Lymphoid in origin. Hematopoietic Stem Cells give rise to myeloid stem cells and not the reverse. -### End" -6842,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pure red cell aplasia is associated with all except?, with the following options: A: ABO incompatibility after renal transplant, B: 5q- syndrome, C: Drugs, D: Large granular lymphocytic leukemia - -### Response: -Ans. (b) 5q- syndrome(Ref: 9th/pg 653-655)Pure red cell aplasia is not associated with 5q- syndrome Pure red cell aplasia is a primary marrow disorder in which only erythroid progenitors are suppressed. -### End" -6843,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: WHO criteria for High endemicity for meningococcal disease include -, with the following options: A: 0 .1%, B: 0 .01%, C: 0.00%, D: 1.00% - -### Response: -WHO Classification of Meningococcal areas: - -Low endemicity: < 2 cases per 100,000 population per year -Moderate endemicity: 2-10 cases per 100,000 population per year -High endemicity: > 10 cases per 100,000 population per year (0.01%) -Epidemic: > 100 cases per 100,000 population per year (0.1%) -### End" -6844,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Low calcium and high phosphate is seen in -, with the following options: A: Hyperparathyroidism, B: Hypoparathyroidism, C: Hypehyroidism, D: Hypothyroidism - -### Response: -Ans is option 2 Hypoparathyroidism In hypoparathyroidism there is decreased PTH which leads to decreased activation of osteoclasts in bone which leads to decreased Ca++ In kidney Decreased PTH leads to decreased Ca++ reabsorption and increased reabsorption of phosphate Which leads to low Ca level and high phosphate level Ref Harrison 17/e p2391 -### End" -6845,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are chlolinergic agents except, with the following options: A: Galantamine, B: Donepezil, C: Tacrine, D: Memantine - -### Response: -Donepezil,rivastigmine,gallantamine and tacrine are cholinergic (due to inhibition of cholinesterase enzyme) drugs useful for alzheimer's disease. Memantine is an NMDA blocker,used for Alzheimer's disease. Ref-KDT 6/3 p472,473 -### End" -6846,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an example of holocrine gland, with the following options: A: Mammary glands, B: Sweat glands, C: Sebaceous glands, D: Parotid glands - -### Response: -Inderbir Singh's Human Histology Seventh edition Pg 58 Holocrine glands seen typically in sebaceous glands -### End" -6847,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Smoking may be associated with all of the following cancers, except:, with the following options: A: Ca Larynx, B: Ca Nasopharynx, C: Ca Bladder, D: None - -### Response: -Ans is None > Ca Nasopharynx All the given options are mentioned by Harrison: Harrison 17/e p2737 writes- ""Tobacco smoking causes cancer of the lung, oral cavity, naso-, oro-, and hypopharynx, nasal cavity and paranasal sinuses, larynx, esophagus, stomach, pancreas, liver, kidney (body and pelvis), ureter, urinary bladder, and uterine cervix and also causes myeloid leukemia. There is evidence suggesting that cigarette smoking may play a role in increasing the risk of colorectal and possibly premenopausal breast cancer, but there is no association with postmenopausal breast cancer. There does not appear to be a causal link between cigarette smoking and cancer of the endometrium, and there is a lower risk of uterine cancer among postmenopausal women who smoke."" Thus the answer should be none, however Nasopharyngeal carcinoma is found to be least associated with smoking. Head & Neck Cancers by Enslow Jacobs 2003e p492 writes-""Association between smoking and nasopharyngeal carcinoma has been shown only by a few studies. If the association of tobacco and NPC is real, the possible mechanism of tumor induction would be the nitrosamines and its precursors in tobacco."" -### End" -6848,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following two muscles contract together while climbing a tree?, with the following options: A: Latissimus dorsi and trapezius, B: Teres major and minor, C: Teres major and pectoralis major, D: Latissimus dorsi and Pectorals major - -### Response: -Latissimus dorsi action: Adduction, extension, and medial rotation of the shoulder as in swimming rowing, climbing, pulling, folding Pectoralis Major: Helps in climbingRef: BD Chaurasia; Volume 1; 6th edition; Table: 3.2 and 5.2 -### End" -6849,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The organ that can be spared in Mitochondrial disorders is, with the following options: A: Brain, B: Eye, C: Liver, D: Small Intestine - -### Response: -Mitochondrial Inheritance An individual's mitochondrial genome is entirely derived from the mother because sperm contains few mitochondria, which are typically shed upon feilization. It follows that mitochondrial disorders exhibit maternal inheritance. A woman with a mitochondrial genetic disorder can have affected offspring of either sex, but an affected father cannot pass on the disease to his offspring.The mitochondria are the cell's suppliers of energy, and the organs that are most affected by the presence of abnormal mitochondria are those that have the greatest energy requirements, such as the brain, muscle, hea, and liver Common manifestations include developmental delay, seizures, cardiac dysfunction, decreased muscle strength and tone, and hearing and vision problems. Examples of mitochondrial disorders include MELAS (myopathy, encephalopathy, lactic acidosis, and stroke-like episodes), MERRF (myoclonic epilepsy associated with ragged red fibers), and Kearns-Sayre syndrome (ophthalmoplegia, pigmentary retinopathy, and cardiomyopathy)Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 80; Patterns of Genetic Transmission -### End" -6850,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most basic amino acid among the following is:, with the following options: A: Alanine, B: Arginine, C: Histidine, D: Lysine - -### Response: -Acidic Amino Acid - -Aspartic Acid (Aspartate) -Glutamic Acid (Glutamate) - -Basic Amino Acid - -Arginine (Most Basic Amino acid) -Lysine -### End" -6851,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 56 year old patient presents after 3 days of cataract surgery with a history of increasing pain and diminution of vision after an initial improvement. The most likely cause would be:, with the following options: A: Endophthalmitis, B: After cataract, C: Central retinal vein occlusion, D: Retinal detachment - -### Response: -Ans. is 'a' i.e. EndophthalmitisRef Khurana 2nd/e p 208Symptoms of the patient suggest - endophthalmitisClinical features of endophthalmitis -It is an early complication of cataract surgery, usually seen after 48-72 hours of surgeryIt is caused due to bacterial infectionThe sources of infection are usually contaminated solutions, instruments, surgeon's hands, patient's own flora from conjunctiva, eye lids and air borne bacteria.Signs and symptomsOcular pain Diminished vision Lid edemaConjunctival chemosisMarked Circumciliary congestion Corneal edema Exudates in pupillary area HypopyonAbsent red pupillary glow.About other options -After cataract and Retinal detachment usually occur after weeks, months or years of cataract surgery. Central retinal vein obstruction - it has nothing to do with cataract surgery -### End" -6852,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Direct fibrinolytics are/is:, with the following options: A: R4prourokinase, B: Alfimiprase, C: rtpA, D: All - -### Response: -Ans. b (Alfimeprase). (Ref. Harrison's medicine 16th ed. 690)Alfimeprase is a metalloproteinase that degrades fibrin in a plasmin-independent fashion. It is a novel thrombolytic based on snake venom derived protein. It is a direct fibrinolytic. It is not a plasminogen activator. It is neutralized by alpha-macroglobulin.PHARMACOLOGICAL REPERFUSION# Therapeutic plasminogen activators include streptokinase, urokinase, tPA and non-tPA fibrinolytics like Recombinant prourokinase, staphylokinase, and alfimeprase.- They are fashioned after endogenous tPA or urokinase that convert plasminogen into active plasmin. Plasmin degrades fibrinogen and fibrin in to FDPs.- tPA is released from endothelial cells, enters the fibrin clot, and activates plasminogen to plasmin.- Any free plasmin is complexed with a,plasmin inhibitor (a2PI).- Fibrin is degraded to low-molecular-weight fragments, fibrin degradation products (FDPs).# Innovative intravenous pharmacological reperfusion strategies include:- Novel fibrinolytic agents (tenecteplase, reteplase, desmetolplase, plasmin, and microplasmin),- GP Ilb/IIIa antagonists = platelet disaggregating effects (abciximab and tirofiban),- Combination therapies to improve efficacy of clot lysis (fibrinolytics and GP IIb/IIIa agents, and fibrinolytics and direct thrombin inhibitors), increase the time window for clot lysis (fibrinolytics and neuroprotectants), and reduce the frequency of hemorrhagic complications. -### End" -6853,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Graft from identical twin is defined as:, with the following options: A: Allograft, B: Isograft, C: Xenograft, D: Autograft - -### Response: -Ans. (b) Isograft(Ref: Robbins 9th/pg 231-234)Types of grafts QAutografts Q: transplant of individual own organIsograft: Graft from identical twinAllografts Q: between individuals of the same speciesXenografts Q: grafts from one species to another species -### End" -6854,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is not a part of ortolani test -, with the following options: A: Examiners thumb rests on the medial thigh, B: Examiners fingers li on the greater trochanter, C: Hips are flexed to 90 degrees and gently abducted, D: Jerk is given to the knee to dislocate the femur head - jerk of exit - -### Response: -Ans. is 'd' i.e., Jerk is given to the knee to dislocate the femur head - jerk of exit * In Ortolani's test, the baby's thighs are held with the thumbs medially on thigh and the fingers resting on the greater trochanters; the hips are flexed to 90 degrees and gently abducted. Normally there is smooth abduction to almost 90 degrees.# In congenital dislocation the movement is usually impeded, but if pressure is applied to the greater trochanter there is a soft 'clunk' as the dislocation reduces, and then the hip abducts fully (the 'jerk of entry').# If abduction stops halfway and there is no jerk of entry, there may be an irreducible dislocation. -### End" -6855,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Test based on the principle of suspect's reaction, if he witnesses an event then he behaves in a ceain way is?, with the following options: A: Narcoanalysis, B: Brain mapping, C: Truth serum testing, D: Polygraph - -### Response: -Ans:D. PolygraphA polygraph, popularly referred to as a lie detector test, is a device or procedure that measures and records several physiological indicators such as blood pressure, pulse, respiration, and skin conductivity while a person is asked and answers a series of questions.The belief underpinning the use of the polygraph is that deceptive answers will produce physiological responses that can be differentiated from those associated with non-deceptive answersUS law enforcement and federal government agencies such as the FBI, NSA and the CIA and many police depaments such as the LAPD and the Virginia State Police use polygraph examinations to interrogate suspects and screen new employee -### End" -6856,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are major complications of massive transfusion except, with the following options: A: Hypothermia, B: Hypocalcaemia, C: Hypokalemia, D: Hypomagnesemia - -### Response: -Hyperkalemia not hypokalemia is a major complication of a massive blood transfusion Metabolic complications of Massive transfusion General Fluid overload Hypothermia Impaired oxygen delivery capacity of Hb (decreased 2,3-DPG) Electrolyte Hyperkalemia Hypocalcemia Hypomagnesemia Metabolic alkalosis Metabolic acidosis (rare) Ref: Harrison's 19th edition Pgno :138e-3 -### End" -6857,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 64-year-old man presents to the clinic because he is experiencing generalized weakness. He notes difficulty getting out of a chair, and lifting objects above his head as examples of the muscle weakness. He has lost 15 lb and feels unwell. On physical examination, there is a blue purple rash on his eyelids and knuckles, and muscle strength in his proximal muscles is rated 4 out of 5. His laboratory investigations are abnormal for an elevated creatinine kinase (CK) level. He is started on prednisone therapy. Which of the following is the most important in monitoring response to therapy?, with the following options: A: testing of muscle strength, B: sedimentation rates, C: urine transaminase enzymes, D: EMG - -### Response: -The goal of therapy is to increase muscle strength and function, so following muscle strength is the key clinical assessment of response to therapy. The course of muscle necrosis in dermatomyositis can also be followed by repeated CK determinations. Repeated muscle biopsies or EMGs are rarely required. -### End" -6858,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ATP yield in Beta oxidation of palmitic acid ?, with the following options: A: 106 ATP, B: 102 ATP, C: 120 ATP, D: 110 ATP - -### Response: -Energetics of Beta Oxidation (ATP Yield) - Palmitic acid (16 C) needs 7 cycles of beta oxidation. So, it gives rise to 8 molecules of acetyl CoA. Every molecule of acetyl CoA when oxidised in the TCA cycle gives 10 molecules of ATP. Each molecule of FADH2 produces 1.5 molecules of ATP and each NADH generates 2.5 molecules of ATP, when oxidised in the electron transpo chain. Hence, the energy yield from one molecule of palmitate may be calculated as: 8 acetyl CoA x 10 = 80 ATP 7 FADH2 x 1.5 = 10.5 ATP 7 NADH x 2.5 = 17.5 ATP Gross total = 108 ATP Net yield = 108-2 = 106 ATP. Ref: DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY, EIGHTH EDITION,PG.NO.,196. -### End" -6859,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The replicative E. coli can multiply and produce daughter cells in?, with the following options: A: 20 minutes, B: 24 hours, C: 20 days, D: 4 weeks - -### Response: -Ans. a (20 minutes). (Ref. Textbook of Microbiology by Ananthnarayan, 7th/275)BacteriaGeneration time1Lepra bacillus12-13 days (8-42 days)2Tubercle bacillus14 hours3Coliform bacillus20 minutes -### End" -6860,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4 year old child had cyanosis only involving the lower limbs, but not involving the upper limbs. Which of the following could be a possible underlying cause for differential cyanosis?, with the following options: A: PDA with reversal of shunt, B: VSD with Eissenmenger syndrome, C: Tetralogy of Fallot, D: ASD with reversal of shunt - -### Response: ---> Differential cyanosis is seen in PDA with reversal of shunt --> Differential cyanosis: No cyanosis in upper limbs --> as oxygenated blood goes there. Cyanosis in lower limbs --> d/t mixing of oxygenated blood with deoxygenated blood. PATENT DUCTUS AERIOSUS : --> Failure of closure of Ductus aeriosus after bih , resulting in persistent connection b/w aoa & pulmonary aery. --> Hypoxia & prematurity predispose to PDA --> AUSCULTATION --> Continuous machinery murmur is seen --> DOC for medical closure of PDA in preterm neonate --> PG Inhibitor --> Normally PDA is acyanotic hea disease but with reversal of shunt, differential cyanosis is seen. -### End" -6861,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The outcome following resuscitation of cardiac arrest is worsened if during resuscitation patient is given –, with the following options: A: Ringer's lactate, B: Colloids, C: 5% Dextrose, D: Whole blood transfusion - -### Response: -Glucose containing solutions should not be used in I.V. lines during treatment of shock or cardiac arrest because the amount needed to maintain B.P. would cause pulmonary edema and congestive heart failure d/t volume overload. -### End" -6862,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30 years old known alcoholic patient presented to EMOPD with a complaint of severe pain in the abdomen. On examination, rigid abdomen is seen. Patient also had multiple episodes of pain in the abdomen for the last 4-5 years and lost 5 kg of weight in the past 6 months. Serum lipase and amylase level is normal. CECT abdomen was perfomed . What is the most likely diagnosis?, with the following options: A: Acute pancreatitis, B: Chronic pancreatitis, C: Adenocarcinoma of pancreas, D: Periampullary carcinoma - -### Response: -- CT shows atrophy of the pancreas with multiple calcific foci within it. Chronic pancreatitis: Has calcifications On MRCP / ERCP - Beaded / toures appearance of the pancreatic duct - String of Pearls/string of beads appearance - Chain of lake appearance On Barium - Reverse 3 sign of Frostburg (also seen in Ca Head of Pancreas) Figure: Chain of lakes appearance on MRCP image -### End" -6863,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about intra ocular pressure, with the following options: A: More common in males, B: Diurnal variation not present in glaucomatous patients, C: No change in postural variations, D: Increasing advancing age - -### Response: -(Increased in advancing age) (208-210-Khurana 4th)Intraocular pressure Normal IOP varies between 10 and 21 mm of Hg (mean 16 +- 2.5 mmHg)Various factors influencine TOP(a) Local factors(I) Rate of aqueous formation(II) Resistance of aqueous outflow (drainage) - Most important(III) Increased episcleral venous pressure - rise in IOP, the valsalva maneuver causes temporary increases(IV) Dilatation of pupil in narrow anterior chamber may cause rise of IOP.(b) General factors1. Heredity - It influences IOP by multifactorial modes2 **Age - The mean IOP increases after the age of 40 years, possibly due to reduced facility of aqueous outflow.3. **Sex - IOP is equal between the sexes in age 20-40 years. In older age groups increases in mean IOP with age is greater in female.4. **Diurnal variations of IOP - Usually there is tendancy of higher IOP in the morning and lower in the evening. This has been related to diurnal variation in the level of plasma cortisol5. **Postural variations - IOP increases when changing from the sitting to the supine positions6. Blood pressure -As such it does not have longterm effect on IOP. However, prevalence of glaucoma is marginally more in hypertensive than the normotensive.7. osmotic pressure of blood- An increase in plasma osmolarity as occurs after IV - mannitol, oral glycerol or in patients with uraemia) is associated with a fall in IOP, while a reduction in plasma osmolarity (as occurs with water drinking provocative test) is associated with rise in IOP.8. General anaesthetics and many other drugs also influence IOP e.g. alcohol lowers IOP, tobacco, smoking, caffeine and steroids may cause rise in IOP. In addition there are many antiglaucoma drugs which lower IOP. -### End" -6864,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypoxic hypoxia with increased (A - a) gradient is seen in, with the following options: A: Diaphragmatic paralysis, B: Pulmonary fibrosis, C: Respiratory centre depression, D: Severe asthma - -### Response: -Hypoxic hypoxia with increased (A-a) gradiant is seen in Type I Respiratory failure ⇒ Pulmonary fibrosis. -### End" -6865,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Conservative surgical treatment of PPH includes, with the following options: A: Internal iliac artery ligation, B: Intravenous methergin, C: Packing of uterus, D: Vaginal hysterectomy - -### Response: -Ans. a (Internal iliac artery ligation). (Ref. Dutta, Obstetrics 4th/ 447, Williams, Obstertrics, 21st/620, 635)Traditionally, postpartum hemorrhage (PPH) has been defined as the loss of 500 mL of blood or more after completion of the third stage of labor. This is unreasonable, because nearly half of all women who are delivered vaginally shed that amount of blood or more when measured quantitatively. After the first 24 hours it is designated late postpartum hemorrhage.Scheme for the management of true PPH:# If uterus is flabby:- Massage uterus- IV methergin (Drug of choice) - MH 2006- Oxytocin- Bladder catheterization- Examine expelled placenta# Bleeding Unresponsive to Oxytocics: Following management should be initiated immediately:- Use bimanual uterine compression- Begin blood transfusions- Explore the uterine cavity manually for retained placental fragments or lacerations.- If still flabby, hot uterine douche and intrauterine packing and- If this fails, either hysterectomy or bilateral ligation of anterior division of internal iliac arteries (in exceptional cases as an alternative to hysterectomy). -### End" -6866,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MEN1 tumour suppressor gene is associated with all of the following, except:, with the following options: A: Menin, B: JunD, C: KMT2A (MLL), D: GDNF (glial-derived neurotrophic factor) - -### Response: -MEN-1 syndrome Caused by germline mutations in the MEN1 tumor suppressor gene, which encodes a protein called menin. The dichotomy in menin function is best exemplified in the interactions of menin with two oncogenic transcription factors: JunD Mixed lineage leukemia (MLL)/KMT2A protein. RET proto-oncogene in MEN-2 syndrome encodes a receptor tyrosine kinase that binds glial-derived neurotrophic factor (GDNF). -### End" -6867,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Number of ATP formed by oxidation of one molecule of palmitic acid (16c):, with the following options: A: 146, B: 106, C: 135, D: 34 - -### Response: -Ans. B. 106(Ref: Harper 31/e page 209, 210)Energetics of Beta OxidationThe number of ATPs obtained depends on the number of carbon atoms in the fatty acid.From Beta oxidation of palmitic acid (C-16)First calculate how many cycles of beta oxidation where n = number of carbon atomsIn case of palmitic acid, 7 cycles of beta oxidationFrom one cycle of beta oxidation1FADH2 =1.5ATPs1NADH=2.5ATPsTotal=4ATPsFrom 7 cycles of beta oxidation7x number of ATPs from 1 cycle7x4=28ATPsIn case of palmitic acid (16/2)=8Acetyl-CoAFrom one Acetyl-CoA by TCA cycle 10 ATPsFrom 8 Acetyl-CoA8x10=80ATPsTotal ATPs from palmitic acid =28+80=1082 ATPs utilised for initial activation of fatty acidSo net ATPs from palmitic acid =108-2=106ATPs -### End" -6868,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Catecholamines are synthesized from, with the following options: A: Tryptophan, B: Tyrosine, C: Methionine, D: Histidine - -### Response: -Tyrosine -------------------->DOPA ---------------->dopamine ----------------->norepinephrine ----------------->epinephrine (catecholamines)Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 235 -### End" -6869,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Covalent bond is seen in ?, with the following options: A: Hydrogen bond, B: Disulphide bond, C: Electrostatic bond, D: Ionic bond - -### Response: -Ans. is 'b' i.e., Disulphide bond There are two types of interactions between molecules that stabilize molecular structure ?1) Covalent bonds: These are the strongest bonds.Examples are :?Peptide bondsDisulphide bonds2) Non-Covalent bonds: These are relatively weak bonds.Examples are :?Electrostatic interactions (ionic bonds or salt bridges)Hydrogen bondsHydrophoic interactionsVan Der Waal's forces (weakest bonds) -### End" -6870,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 59-year-old man experiences acute chest pain and is rushed to the emergency room. Laboratory studies and ECG demonstrate an acute myocardial infarction; however, coronary artery angiography performed 2 hours later does not show evidence of thrombosis. Intravascular thrombolysis that occurred in this patient was mediated by plasminogen activators that were released by which of the following cells?, with the following options: A: Cardiac myocytes, B: Endothelial cells, C: Macrophages, D: Segmented neutrophils - -### Response: -Endothelial cells. The vascular endothelium has the ability to promote or inhibit tissue perfusion and inflammatory cell influx through multiple mechanisms. For example, endothelial cells in the vicinity of the thrombus produce tissue-type plasminogen activators, which activate plasmin and initiate thrombolysis (fibrinolysis). None of the other cells produce significant quantities of plasminogen activators.Diagnosis: Myocardial infarction, hemostasis -### End" -6871,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28-year-old woman with cystic fibrosis presents with increasing shortness of breath and production of abundant foul-smelling sputum. The sputum in this patient is most likely associated with which of the following pulmonary conditions?, with the following options: A: Atelectasis, B: Bronchiectasis, C: Empyema, D: Pneumothorax - -### Response: -Bronchiectasis. Bronchiectasis refers to the irreversible dilation of bronchi, which is caused by the destruction of the muscular and elastic elements of bronchial walls. Bronchiectasis is often localized to a segment of the lung distal to mechanical obstruction of a bronchus by a variety of lesions, including tumors, inhaled foreign bodies, mucous plugs (e.g., cystic fibrosis and asthma), and compressive lymphadenopathy. Nonobstructive bronchiectasis is usually a complication of chronic pulmonary infections. Patients with bronchiectasis present with chronic productive cough, often with copious mucopurulent sputum. Pyothorax (choice E) is infection of pleural effusion.Diagnosis: Bronchiectasis, cystic fibrosis -### End" -6872,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The right costo-phrenic line extends up to the level of which rib in the mid-axillary line -, with the following options: A: 6th, B: 10th, C: 8th, D: 12th - -### Response: -The inferior margin of pleura extends onto diaphragm at the level of (Costodiaphragmatic line) --        8th rib in the midclavicular line --        10th rib in mid-axillary line --        12th rib at the lateral border of erector spinae. -The lower border of lungs extends till the level of --        6th rib in the midclavicular line --        8th rib in mid-axillary line --        10th rib at the lateral border of erector spinae. -### End" -6873,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of action of disgitalis is, with the following options: A: Inhibits Na +K+ ATPase pump, B: Inhibits Na+ H+ ATPase pump, C: Active metabolite are produced in liver, D: Inhibit calcium concentrations in blood - -### Response: -Digoxin's primary mechanism of action involves inhibition of the sodium potassium adenosine triphosphatase (Na+/K+ ATPase), mainly in the myocardium. This inhibition causes an increase in intracellular sodium levels, resulting in decreased activity of the sodium-calcium exchanger, which normally impos three extracellular sodium ions into the cell and transpos one intracellular calcium ion out of the cell. The reversal of this exchanger causes an increase in the intracellular calcium concentration that is available to the contractile proteins. Increased intracellular calcium lengthens phase 4 and phase 0 of the cardiac action potential, which leads to a decrease in hea rate. Increased amounts of Ca2+ also leads to increased storage of calcium in the sarcoplasmic reticulum, causing a corresponding increase in the release of calcium during each action potential. This leads to increased contractility (the force of contraction) of the hea without increasing hea energy expenditure Refer kDT 7/e p 212 -### End" -6874,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Accidental injury of the ureter during abdominal operation should be managed by all except:, with the following options: A: Deligation, B: End-to-end anastomosis through an ureteric catheter, C: Implantation into the bladder, D: Colonic implantation - -### Response: -Surgeries for ureteric fistula: -• Bladder flap procedure (modified Boari–Ocker–Blad) -• Ureteroneocystostomy -• Implantation into the bladder -Note: End to end anastomosis may lead to stricture formation. -Colonic transplantation results in recurrent pyelonephritis and hyperchloremic acidosis. -### End" -6875,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MEN 1 syndrome is associated with all EXCEPT:, with the following options: A: Pancreatic tumors, B: Anterior pituitary adenomas, C: Parathyroid adenoma, D: Medullary carcinoma of thyroid - -### Response: -ANSWER: (D) Medullary carcinoma of thyroidREF: Harrisons Internal Medicine 17th ed Chapter 345 Table 345-1, http://en.wikipedia.org/wiki/Multiple_endocrine_neoplasiaSome people think that option (D) was Pheochromocytoma not Medullary carcinoma of thyroid. However Table 345-1 of Harrison enumerates Pheochromocytoma as a rare possibility of MEN 1 but its text does not describes it like most other references.FeatureMEN 1MEN 2AMEN 2BEponymWermer syndromeSipplesyndromeWilliams-Pollock syndrome, Gorlin-Vickers syndrome, and Wagenmann-Froboese syndromeEntero-Pancreatic tumorsgastrinoma (50%',insulinoma (20%), vipoma, glucagonoma, PPoma--Pituitary adenoma66%--Parathyroid hyperplasia90%50%-Medullary thyroid carcinoma-100%85%Pheochromocytoma->33%50%Marfanoid body habitus--80%Mucosal neuroma--100%Gene(s)MEN1RETRETApprox. prevalence1 in 35.000 (1 in 20,000 to1 in 40,000)1 in 40,0001 in 40,000Primary hyperparathyroidism is the most common manifestation of MEN1Hyperparathyroidism is the earliest manifestation of the syndrome in most MEN1 patients.Enteropancreatic tumors are the second most common manifestation of MEN1Gastrinomas are the most common enteropancreatic tumors observed in MEN1 patientsInsulinomas are the second most common enteropancreatic tumors in patients who suffer from MENl. Unlike gastrinomas, most insulinomas originate in the pancreas bed, becoming the most common pancreatic tumor in MEN1. -### End" -6876,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following tests can help in the diagnosis of Galactosemia EXCEPT?, with the following options: A: GALT assay, B: Mutation analysis, C: Benedicts test, D: Guthrie's test - -### Response: -Guthrie's bacterial inhibition test:- Screening test for phenylketonuria (PKU) Used to detect the abnormal presence of phenylalanine metabolites in blood i.e. Phenyl pyruvate Phenyl alanine Phenyl lactate. Procedure: A small amount of blood sample is taken from heel of the infant and placed in a medium with a strain of Bacillus subtilis, a bacteria that cannot grow without phenylalanine. If phenylalanine metabolites are present, then these bacteria reproduce, and the test result is positive,indicating that patient has PKU. Benedict's test Benedict's reagent(blue in color) is taken in a test tube and the urine sample is added to it | Then the test tube is heated. | If color changes to green, orange or brick red then it shows a positive test for reducing sugar. GALT assay- used for galactosemia. Mutation analysis- can be used for mutation detection, or as a confirmation of next generation sequencing and microarray results. -### End" -6877,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drug have been used for medical aboion except:, with the following options: A: Mifepristone, B: Misoprostal, C: Methotrexate, D: Atosiban - -### Response: -Atosiban is an Oxytocin antagonist It has Tocolytic action so used for inhibition of preterm labor. Other options Mifepristone (RU 486) an Antiprogestin, degenerates the pregnancy in doses ranging from 100-600mg. This is followed by Misoprostal (prostagladin) in 400ug orally or 800ug vaginally which causes uterine contractions to expel the dead fetus. Methotrexate can be substituted for Mifepristone as the agent which degenerates the pregnancy. -### End" -6878,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Runt disease is -, with the following options: A: Graft rejection, B: Graft versus host reaction, C: Deficient T cell function, D: Complement deficiency - -### Response: -The graft mounts an immune response against the antigens of the host is called graft-versus-host reaction. The main clinical features of the GVH reaction in animals are retardation of growth, emaciation, diarrhea, hepatosplenomegaly, lymphoid atrophy, and anemia. - terminates fatally. This syndrome is called runt disease. Reference:athanarayan & paniker's 9th edition, pg no: 186 <\p> -### End" -6879,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Enteral nutrition except:, with the following options: A: Common techniques used for gastrostomy are Stamm, Witzel & Janeway, B: Jejunostomy is usually preferred over gastrostomy, C: Jejunostomy is especially useful in severe pancreatitis, D: Enteral nutrition is used in proximal small intestinal fistula - -### Response: -Enteral Nutrition: Common techniques used for gastrostomy are Stamm,Witzel& Janeway Jejunostomy is usually preferred over gastrostomy Jejunostomy is especially useful in severe pancreatitis Enteral nutrition is used in distal small intestinal fistula. ROUTES OF ENTERAL NUTRITION - Oral supplements by mouth - Nasogastric tube / Nasojejunal tube: Nasojejunal tube is better due to low risk of aspirations. - Feeding gastrostomy - Feeding jejunostomy -### End" -6880,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Basal Electrical Rhythm occurs in all pas of GIT, EXCEPT:, with the following options: A: Esophagus, B: Stomach, C: Duodenum, D: Colon - -### Response: -Except in the esophagus and the proximal poion of the stomach, the smooth muscle of GIT has spontaneous rhythmic fluctuations in membrane potential between about -65 and -45 mV. Basic electrical rhythm (BER) is initiated by the interstitial cells of Cajal, stellate mesenchymal pacemaker cells with smooth muscle-like features that send long multiply branched processes into the intestinal smooth muscle. In the stomach and the small intestine, these cells are located in the outer circular muscle layer near the myenteric plexus; in the colon, they are at the submucosal border of the circular muscle layer. In the stomach and small intestine, there is a descending gradient in pacemaker frequency, and as in the hea, the pacemaker with the highest frequency usually dominates. -### End" -6881,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Method of identification using lips:, with the following options: A: Dactylography, B: Poroscopy, C: Cheiloscopy, D: Tricology - -### Response: -Ans. Cheiloscopy -### End" -6882,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prophylaxis for health personnel working in plague ward is -, with the following options: A: Vaccine, B: Tetracycline throughout the duty, C: A course of tetracycline, D: Vaccine and Erythromycin - -### Response: -- immunisation with plaque vaccine is a valuable preventive measure. The WHO recommends that under all circumstances, vaccination should be used only for the prevention not the control of human plaque - the plaque vaccine is killed vaccine. - two doses of 0.5 &1 ml given subcutaneously at interval of 7-14 days. Booster doses are recommended after 6 months for persons at continuing risks of infection. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:296 <\p> -### End" -6883,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common false neurological sign is:, with the following options: A: Wasting of hands, B: Abnormal unilateral pupil, C: Diplopia, D: Unilateral papilledema - -### Response: -Diplopia REF: Journal of Neurology, Neurosurgery Psychiatry 2003; 74:415-418 Doi:10.1136/ jnnp.74.4.415, Neurological signs have been described as ""false localizing"" if they reflect dysfunction distant or remote from the expected anatomical locus of pathology. False localizing signs occur in two major contexts: as a consequence of raised intracranial pressure, and with spinal cord lesions. Cranial nerve palsies (especially sixth nerve palsy), hemiparesis, sensory features (such as truncal sensory levels), and muscle atrophy, May all occur as false localizing signs. Sixth nerve palsies are the most common false-localizing sign of raised intracranial pressure. In one series of 101 cases of IIH, 14 cases were noted, 11 unilateral and 3 bilateral. Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI (the abducens nerve), which is responsible for contracting the lateral rectus muscle to abduct (i.e., turn out) the eye. The inability of an eye to turn outward results in a convergent strabismus or esotropia of which the primary symptom is double vision or diplopia in which the two images appear side-by-side. The condition is commonly unilateral but can also occur bilaterally. -### End" -6884,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gunn sign is?, with the following options: A: Silver wiring of aerioles, B: Deflection of veins at aeriovenous crossing, C: Copper wiring of aerioles, D: Tapering of veins on the either side of the crossings - -### Response: -Tapering of veins on either side of the crossings Gunn sign is seen in grade III hypeensive retinopathy. Grade 1 Generalized aeriolar attenuation Broadening of aeriolar light reflex Concealment of vein at A-V Crossings Grade 2 Severe generalized and focal aeriolar constriction A-V crossing change (Salus sign) Grade 3 Copper wiring of aerioles Venous banking distal to a-v crossing (bonnet's sign) Venous tapering on either side of the crossing (Gunn's sign) Right angle deflection of veins Flame shaped haemorrhages, cotton wool spots, hard exudates Grade 4 All changes of grade 3 Silver wiring of aerioles Disc oedema -### End" -6885,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enucleation of the eyeball is contraindicated in, with the following options: A: Endophthalmities, B: Panophthalmities, C: Intraoccular tumours, D: Painful blind eye - -### Response: -Endophthalmities is treated by intravitreal injection of antibiotics. If not managed and removal of eye of eye is indicated.we should go for evisceration. This is because the outer coats of the eyeball are not involved and hence we should not remove it. Also it is more convenient to put aificial eye then orbital implant Refer khurana 6/e 307 -### End" -6886,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 47-year-old female tennis professional is informed by her physician that she has a rotator cuff injury that will require surgery. Her physician explains that over the years of play a shoulder ligament has gradually caused severe damage to the underlying muscle. To which of the following ligaments is the physician most likely referring?, with the following options: A: Acromioclavicular ligament, B: Coracohumeral ligament, C: Glenohumeral ligament, D: Coracoacromial ligament - -### Response: -Coracoacromial ligament prevents superior displacement of the head of the humerus. the ligament can cause inflammation or erosion of the tendon of the supraspinatus muscle as the tendon passes back and foh under the ligament. Acromioclavicular ligament, connecting the acromion with the lateral end of the clavicle, is not in contact with the supraspinatus tendon. Coracohumeral ligament is located too far anteriorly to impinge upon the supraspinatus tendon. Glenohumeral ligament is located deep to the rotator cuff muscles and would not contribute to injury of the supraspinatus muscle. -### End" -6887,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The virus causes aplastic anemia in chronic hemolytic diseases is -, with the following options: A: Adenovirus, B: Hepatitis virus, C: EB virus, D: Parvo virus - -### Response: -parvovirus B19 induxes aplastic crisis in children with chronic hemolyyic anemia REF:ANATHANARAYANAN MICROBIOLOGY NINTH EDITION PAGE.554 -### End" -6888,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug is deposited in the retina?, with the following options: A: Isoninazid, B: Chloroquine, C: Rifampicin, D: Pyrizinamide - -### Response: -Prolonged use of high doses (as needed for rheumatoid ahritis, DLE, etc.) may cause loss of vision due to retinal damage. Corneal deposits may also occur and affect vision, but are reversible on discontinuation. ESSENTIALS OF PHARMACOLOGY page no. 823 -### End" -6889,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Middle finger extension test (Maudsley test) is done for, with the following options: A: Medial epicondylitis, B: Carpal tunnel syndrome, C: Lateral Epicondylitis, D: Dequervain's disease - -### Response: -Middle finger extension test will cause the stretch of entire extensor tendon and so it is used for tennis elbow (Lateral epicondylitis) -### End" -6890,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: RK - 39 antigen testing is done in, with the following options: A: Kala azar, B: Chagas disease, C: African sleeping sickness, D: American sleeping sickness - -### Response: -RK - 39 test is a Immunochromatographic test done in Kala azar. -### End" -6891,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: For the development of sickle cell disease, codon of aminoacid glutamate is replaced with codon of amino acid_____ at the 6th position of beta globin gene -, with the following options: A: Valine, B: Phenylalanine, C: Aspargine, D: Serine - -### Response: -Ans. is 'a' i.e., Valine * Sickle cell disease is a common hereditary hemoglobinoopathy caused by a point mutation in b-globin that promotes the polymerization of deoxygenated hemoglobin, leading to red cell distortion, hemolytic anemia, micro- vascular obstruction, and ischemic tissue damage.* Several hundred different hemoglobinopathies caused by mutations in globin genes are known, but only those associated with sickle cell disease are prevalent enough in the United States to merit discussion.* Hemoglobin is a tetrameric protein composed of two pairs of globin chains, each with its own heme group.* Normal adult red cells contain mainly HbA (a2b2), along with small amounts of HbA2 (a2d2) and fetal hemoglobin (HbF; a2g2).* Sickle cell disease is caused by a point mutation in the sixth codon of b-globin that leads to the replacement of a glutamate residue with a valine residue.* The abnormal physiochemical properties of the resulting sickle hemoglobin (HbS) are responsible for the disease. -### End" -6892,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Test for the tight iliotibial band is -, with the following options: A: Ober's test, B: Osber's test, C: Sirru-nand's test, D: Charnley's test - -### Response: -Signs and Tests - -Adson's test : for thoracic outlet syndrome -Allen's test : for testing patency of radial and ulnar arteries -Alli's test : for CDH -Anvil test : for testing tenderness of the spine -Ape thumb : for median nerve injury -Apley's grinding test :for a meniscus injury -Apprehension test : for recurrent dislocation of the shoulder -Barlow's test : for CDH -Blue sclera : Osteogenesis imperfecta -Bryant's test : for anterior dislocation of the shoulder -Callways' test : for anterior dislocation of the shoulder -Chovstek's sign : for tetany -Claw hand : for ulnar nerve injury -Coin test : for dorso lumbar tuberculosis of spine -Cozen's test : for tennis elbow -Drawer test : for ACL and PCL injuries -Anterior : for ACL injury -Posterior : for ACL injury -Finkelstein's test : for de Quervain's tenovaginitis -Foot drop : for common peroneal nerve injury -Froment's sign : for ulnar nerve injury -Gaenslen's test: for SI joint involvement -Galleazzi sign : for CDH -Gower's sign : for muscular dystrophy -Hamilton ruler test : for anterior dislocation of the shoulder -Kanavel's sign : for infection in ulnar bursa -Lasegue's test: for disc prolapse -Lachmann test : for ACL injury -Ludloffs sign: for avulsion of lesser trochanter -McMurray's test : for meniscus injury -Nagffziger test : for disc prolapse -Ober's test : for tight ilio- tibial band (e.g., in polio) -O' Donoghue triad: traid of MCL, ACL & medial meniscus injuries occurring together -Ortolani's test : for CDH -Pivot shift test : for ACL injury -Policeman tip : for Erb's palsy -Runner's knee : Patellar tendinitis -Sulcus sign: for inferior dislocation of the shoulder -Thomas' test : for hip flexion deformity -Trendelenburg's test: for unstable hip due to any reason (e.g., CDH) -Tinel's sign: for detecting improving nerve injury -Volkmann's sign : for ischemic contracture of forearm muscles -Wrist drop : for radial nerve injury -### End" -6893,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Flail chest, except:, with the following options: A: Fracture of atleast 3 ribs, B: If overlapping of fractured ribs with severe displacement is seen then patients are treated surgically with open reduction and fixation, C: Pa0260 treated with intubation and PEEP, D: Paradoxical movement may not be seen in conscious patients - -### Response: -Ans is 'd' i.e. Paradoxical movement may not be seen in conscious patients Flail chest is simply when a poion of the bony chest wall loses its continuity from the remainder of the thorax due to multiple fractures. By definition, a flail chest occurs in the presence of two or more fractures in three or more consecutive ribs (either on one side of the chest or either side of the sternum) and causes instability of the chest wall: however, it can also occur after costochondral separation. Flail chest is characterized by paradoxical motion of the chest wall (inward with inspiration and outward with expiration). The chance of having an intrathoracic injury in this situation increases severalfold. The paradoxical motion increases the work of breathing, and the most impoant consequence of flail chest is respiratory failure. Until recently it was believed that ineffective air movement between both lungs caused by paradoxical motion of the chest wall was the main cause of the respiratory distress in patients with flail chest. It is now understood that underlying pulmonary contusion and pain during inspiration are the most impoant components in the pathophysiology of the respiratory failure. Management: Patients without evidence of respiratory distress can be managed with only analgesia. Pain control can be provided by an intercostal nerve block or more adequately by epidural anesthesia. If respiratory distress develops, endotracheal intubation and mechanical ventilation with peak end-expiratory pressure are usually indicated, provided that pain control is adequate. - Sequential aerial blood gas determination may gauge the severity of an injury and is useful to predict which patients will require ventilatory suppo.The ratio of aerial oxygen tension to the fraction of inspired oxygen (Pa02:Fi02 ratio) yields an estimate of the extent of intrapulmonary shunt and may be used as a parameter to determine the need for mechanical ventilation. - Schwaz 7/e p689 writes-""1ntubation is delayed until clear evidence of a need of ventilator suppo develops: a respiratory rate of 40/min, a falling PaCO2 (evidence of excessive work of breathing) or a Pa02 below 60 Corr on inspired 02 fraction of over 0.5"" - General Thoracic Surgery By Thomas W. Shields 7/e p894 writes-""Suggested parameters for instituting ventilator suppo are respiratory rate >30 breaths per minute, Pa02 45mm Hg."" Open reduction plus internal fixation of sternal or rib fractures is rarely needed. -### End" -6894,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common psychiatry disorder is, with the following options: A: Dementia, B: Schizophrenia, C: Depression, D: Paronia - -### Response: -C i.e. Depression -### End" -6895,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 year old child has violaceous papule and pterygium of Nails, the diagnosis is :, with the following options: A: Psoriasis, B: Lichen Planus, C: Pemphigus, D: Pemphigoid - -### Response: -Ans. is 'b' Lichen Planus Violaceous papules and pterygium clinches the diagnosis of lichen planusImp, point about lichen planusPruritic Papular disorder involvingFlexural surface*Mucous membraneGenitaliaClinical FeaturesAge group 30-60 yrsLesions arePolygonal*Plain topped*Papules*Purple*The lesions are Symmetrical and usually effectForearm and wristsLower legs & thighGenitaliaPalms and solesMucosal involvement (especially the buccal mucosa) occurs in 2/3 cases.Other characteristic features :Wickham's Striae* - Delicate white lines on surface of lesionKoehler phenomenon * Nail Involvement - Occurs in 10% cases {pterygium*, Anychia) Scalp lesions - Scarring Alopecia* occurs. -### End" -6896,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which of the following phases of clinical trial of drug ethical clearance is not required -, with the following options: A: Phase I, B: Phase II, C: Phase III, D: Phase IV - -### Response: -Ans. is `d i.e., Phase IV o 'Phase 4' of clinical testing is a phase of post marketing surveillance and is undeaken on the basis of result of phase 1, 2 and 3. This phase occurs only after 'FDA Safety Review', 'ADA submission' and finally WDA approval' and hence does not require ethical clearance. -### End" -6897,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Severe disability in primary osteoarthritis of hip is best managed by -, with the following options: A: Arthrodesis, B: Arthroplasty, C: Mc Murray's osteotomy, D: Intra-articular hydrocortisone and physiotherapy - -### Response: -The primary aim of surgery is relief of pain, while secondary aim is to restore movements, increase stability deformity correction. -In early stage when a fair amount of hip movements is still present, osteotomy may be used. -However, in severe arthritis with functional disability, arthroplasty provides best results and significantly improves daily functioning. Total hip replacement (THR) is most commonly used arthroplasty of hip. -### End" -6898,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about Lesch-Nyhan syndrome, EXCEPT:, with the following options: A: Affects almost solely males, B: Excessive synthesis of purines is a feature, C: Characterized by gouty ahritis, D: Febuxostat is routinely used for treatment - -### Response: -Lesch-Nyhan syndrome is a genetic disease, affecting almost solely males, of excessive synthesis of purines because of defective recycling and, therefore, uric acid production from their breakdown. Lesch-Nyhan syndrome is characterized by gouty ahritis but, in addition, affects the brain, resulting in mental retardation, loss of control of arm/leg/face movements, aggressive behavior, and self-mutilation by biting and scratching. Successful treatment of this disorder is still being sought. Febuxostat has been approved for use in the treatment of chronic hyperuricemia. This drug appears to be more effective than allopurinol in preventing acute attacks of gout and reducing the size of the crystal deposits. Ref: Janson L.W., Tischler M.E. (2012). Chapter 4. Nucleosides, Nucleotides, DNA, and RNA. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry. -### End" -6899,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following nerve arise from the lateral cord of the brachial plexus?, with the following options: A: Ulnar nerve, B: Musculocutaneous nerve, C: Medial root of median nerve, D: Medial cutaneous nerve of arm - -### Response: -Musculocutaneous nerve arise from the lateral cord of the brachial plexus. Other nerves arising from the lateral cord are lateral root of median nerve and lateral pectoral nerve. Branches of the medial cord of the brachial plexus are:Medial root of median nerveMedial pectoralMedial cutaneous nerve of forearmMedial cutaneous nerve of armUlnar nerveBranches of the posterior cord are:Upper subscapularLower subscapularThoracodorsalAxillary nerveRadial nerveRef: Clinical Anatomy: (a Problem Solving Approach) By Kulkarni page 99 -### End" -6900,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are indications for early clamping of cord except, with the following options: A: Preterm delivery, B: Postdated pregnancy, C: Bih asphyxia, D: Maternal diabetes - -### Response: -Early cord clamping is done in: Preterm Low bih weight Rh Incompatibility Bih asphyxia Diabetic mother Ref: Dutta Obs 9e pg 132. -### End" -6901,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Choice of contraception in recently delivered lactating mother: (Repeat), with the following options: A: Safe period, B: Combined OCPs, C: Post Partum IUCD, D: Depot provera - -### Response: -Ans: C. Post Partum IUCD CONTRACEPTIVE PRESCRIPTION Conventional contraceptives can be safely prescribed during the entire reproductive period. Advice on the usage of pill or IUCD during different phases of reproductive life 1. Post partum Contraception for lactating women Progestin only pill to be started at 2-3 weeks postpartum (best choice) Depot medroxyprogesterone acetate initiated at 6 weeks postpartum Hormonal implants inserted at 6 weeks postpartum Levonorgestrel IUCD inserted at 6 weeks postpartum POP contains LNG 75 microgm taken from day of cycle at same time every day-failure rate 0.5-2 per HMY Depot provera dose 150mg every 3 months within 5th day of cycle, administered i.m - failure rate 0-0.3per HWY NORPLANT contains 75 microgm LNG, releases 50microgm/day for 3 yrs- failure rate 0.1 per HWY LNG-IUD contains 58 mg LNG releases 20 microgm/day Non lactating Contraception started as early as 3 weeks following delivery OCPs /IUCD/ DMPA inj./ Implanon Adolescent girls LD OCPs - most effective Alternatives - DMPA, Norplant Newly married OCPs - most effective Post abortnl Started immediately following abortion OCPs / IUCD Women at risk of STDs Need dual protection against pregnancy and STDs Condom w ith spermicides/ condom w ith any other contraceptive method Women using enzyme inducers High dose OCPs, if prescribed/ IUCD/ DMPA inj. -### End" -6902,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When a person changes position from standing to lying down, following change is seen:, with the following options: A: Hea rate increases, B: Venous return to hea increases immediately, C: Cerebral blood flow increases, D: Blood flow at apices of lung decreases - -### Response: -B i.e. Venous return to hea increases immediately In standing posture, 300- 500m1 of blood pools in venous capacitance vessels of lower extremities, which is immediately returned towards heaQ on assuming lying down posture. Cardiovascular system Onlying On standing - Stroke volume - Cardiac output - Venous return - Central blood pool Increase Decrease - Central venous pressure - Aerial BP - Abdominal & limb flow - Hea rate - Peripheral venous pooling - Total peripheral resistance Decrease Increase - Abdominal & limb resistance - Small vein pressure -### End" -6903,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In congenital adrenal hyperplasia, deficient enzyme is - most womon, with the following options: A: 11(3 hydroxylase deficiency, B: 21 a hydroxylase deficiency, C: 3a hydroxylase deficiency, D: 17a hydroxylase deficiency - -### Response: -Ans. is 'b' i.e., 21-a Hydroxylase Congenital adrenal hyperplasia (CAH) Group of AR disorder MC adrenal disorder in childhood Most common 21-hydroxylase deficiency In 21a-hyroxylese deficiency There is deficiency of mineralocoicoids & glucocoicoid. This leads to hypoglycemia, hyponatremia -### End" -6904,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Action of 20mcg/kg/min dopamine is, with the following options: A: Renal vasodilatation, B: Vasoconstriction, C: Increased blood pressure, D: Increased myocardiac contractility - -### Response: -Less than 2mcg/kg/min: Renal VD 2-10mcg/kg/min: B1 stimulation More than 10: alpha stimulation -VC -### End" -6905,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30 year old male patient presents with bleeding per rectum. -He complains of Hemorrhoids which are reduced spontaneously. -Treatment of choice Is, with the following options: A: Open hemorroidectomy, B: Sitz bath, C: Sclerotherapy, D: Stapled hemorroidopexy - -### Response: -2nd degree hemorrhoids are treated by sclerotherapy which is done without anesthesia. -### End" -6906,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Endoscope tube is sterilized by -, with the following options: A: Glutaraldehyde, B: Formalin, C: Autoclaving, D: Boiling - -### Response: -Glutaraldehyde is especially effective against the tubercle bacilli, fungi, and viruses. It is less toxic and irritant to eyes and skin than formaldehyde. it has no deleterious effects on the cement or lenses of instruments such as cystoscope and bronchoscpe. It can be safely used to treat corrugated rubber, anesthetic tubes, face masks, plastic endotracheal tubes, metal instruments, and polythene tubings REF:Ananthanarayan and Panicker's Textbook ofMicrobiology 8thEdition pg no:36 -### End" -6907,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The blood cell most likely to be involved in phagocytosing bacteria at sites of infection is the leukocyte which in blood smears:, with the following options: A: Is the smallest, B: Is the least frequently observed, C: Has the greatest number of nuclear lobes, D: Has a bilobed nucleus and eosinophilic granules - -### Response: -The white blood cell(leukocyte)with the largest number of lobes in its nucleus is the neutrophil (also called the polymorphonuclear leukocyte). Mature neutrophils have a minimum of 3 lobes to their nucleus. These cells are specialized for phagocytosis and killing of bacteria and hence this is the correct answer for this question. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 31. Blood as a Circulatory Fluid & the Dynamics of Blood & Lymph Flow. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e. -### End" -6908,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Peripheral smear of malaria shows:, with the following options: A: Single ring form-Vivax, B: Multiple ring-Falciparum, C: Bar and band forms-Malariae, D: Oval form-Ovale - -### Response: -Ans. b. Multiple ring-FalciparumPLASMODIUM SPECIESSpeciesImportant featuresBlood smearsLiver stagesTreatmentVivax48-hour fever, spikesEnlarged host cells; ameboid trophozoitesPersistent hypnozoites RelapseChloroquine, then PrimaquineOvale (2 substrains)48-hour fever, spikesOval, jagged, infected RBCsPersistent hypnozoites RelapseChloroquine, then PrimaquinePlasmodium malariae72-hour fever spikes; recrudescenceBar and band forms; rosette schizontsNo persistent stage; recrudescenceChloroquine (no radical cure necessary)Plasmodium falciparumIrregular fever spikes; causes cerebral malariaMultiple ring forms crescent-shaped gametesNo persistent stage; recrudescenceChloroquine for susceptible, non-severe cases Atovaquone proguanil, artemetherlumefantrine, mefloquine for resistant, non-severe cases Quinine/quinidine for severe casesPlasmodium knowlesi24-hour fever spikesSimilar to P. malariaeNo persistent stageChloroquine -### End" -6909,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest site for ectopic salivary gland tumour is ?, with the following options: A: Tongue, B: Cheek, C: Palate, D: Neck - -### Response: -Ans. is 'c' i.e., Palate -### End" -6910,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female with recurrent aboion and isolated prolonged APTT is most likely associated with:, with the following options: A: Lupus anticoagulant, B: DIC, C: Von willebrand disease, D: Hemophilia - -### Response: -Miscarriages are more common in women with systemic lupus erythematosus. Many of these women have antiphospholipid antibodies, which are a family of autoantibodies that bind to negatively charged phospholipids, phospholipids-binding proteins, or a combination of the two. A prolongation in the aPTT is observed that does not correct completely on mixing. Specialized testing such as the hexagonal phase phospholipid neutralization assay, the dilute Russell viper venom time, and platelet neutralization assays can confirm the presence of a lupus anticoagulant. Ref: (2010). Chapter 9. Aboion. In Cunningham F, Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (Eds), Williams Obstetrics, 23e. -### End" -6911,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a patient presenting with a swelling of the thyroid, the radionuclide scan showed a cold nodule and the ultrasound showed a non cystic solid mass. The management of this patient would be:-, with the following options: A: Lobectomy, B: Hemithyroidectomy, C: Eltroxin, D: Radio Iodine therapy - -### Response: -Ans. is 'b' i.e. Hemithyroidectomy .A discrete solid swelling of the thyroid is mostly treated surgically by hemithyroidectomy. Biopsy of the resected segment is performed and if carcinoma found a total or near total thyroidectomy is done.A cystic swelling is treated by aspiration and surgery is performed only if it recurs or cytology is suspicious of malignancy.A discrete thyroid swelling is:malignant in 15% of cases.a follicular adenoma in 30-40% of cases.remainder are non-neoplastic i.e. colloidal degeneration, cysts or thyroiditis.Thus most of the discrete thyroid swelling are non-neoplastic and benign, still surgery Is the mainstay of treatment because of the risk of leaving a malignant nodule.Role of Isotope scanAn isotope scan divides thyroid swellings into - 'Hot', 'Warm' and 'Cold' nodule.Hot rules out malignancy.Cold favours malignancy andWarm in equivocal.Even though cold nodule favours malignancy only a very small percentage of them (~ 15%) turn out to be malignant, so isotope scanning is of very little use in distinguishing between malignant and non-malignant swellings and is rather obsolete now.Eltroxin for TSH suppression is used only for a small number of cases. It is tried for 6-12 months. If the swelling regresses, well and good. If it does not surgery is performed. -### End" -6912,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year-old patient has a small but painful tumor under the nail of the little finger. Which of the following nerves would have to be anesthetized for a painless removal of the tumor?, with the following options: A: Superficial radial, B: Common palmar digital of median, C: Common palmar digital of ulnar, D: Deep radial - -### Response: -The common palmar digital branch comes off the superficial branch of the ulnar nerve and supplies the skin of the little finger and the medial side of the ring finger. The superficial branch of the radial nerve provides cutaneous innervation to the radial (lateral) dorsum of the hand and the radial two and a half digits over the proximal phalanx. The common palmar digital branch of the median nerve innervates most of the lateral aspect of the palmar hand and the dorsal aspect of the second and third finger as well as the lateral part of the fourth digit. The deep radial nerve supplies the extensor carpi radialis brevis and supinator muscles and continues as the posterior interosseous nerve. The recurrent branch of the median nerve supplies the abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis muscles. -### End" -6913,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trendlenburg's test done for varicose veins is for detection of:, with the following options: A: Perforator in competency, B: Deep veins patency, C: Saphenofemoral incompetency, D: Site of perforators - -### Response: -Ans: C (Saphenofemoral incompetency) Ref : 74 A Manual on Clinical Surgery S. DasExplanation:Clinical Examination of Varicose VeinsBrodie-Trendelenherg TestDone to determine the incompetency of Saphenofemoral valve.Patient is placed in recumbent position.Limbs are raised to empty the veins. Veins are milked proximally for further emptying.Saphenofemoral junction is compressed either with the thumb of the examiner/toumiquet and the patient is asked to stand up quickly.There are two variants of this test.The first method is to assess saphenofemoral incompetency. The pressure is released and if the column of blood fills up quickly from above downwards it indicates saphenofemoral incompetency.The second method is to assess the perforators. Here, the pressure is maintained for one minute. Gradual filling of the veins during this period indicates incompetent perforators allowing reflux of blood from deep veins to superficial veins.Positive Brodie--Trendelenberg test i~ an indication for surgery.Tests to Assess Saphenofemoral IncompetencyBrodie -Trendelenberg testMorrisey's cough impulse testTests to Assess Deep VeinsPerthe's testModified Perthe's testTests to Assess PerforatorsMultiple tourniquet testPratt's testFegan's testBrodie-Trendelenberg testTest to Assess V alves in Superficial VeinSchwartz testNote:Even though Brodie-Trendelenberg test is used to assess both saphenofemoral incompetency and incompetent perforators its primary purpose is to assess saphenofemoral incompetency. -### End" -6914,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following is used for sex chromatin testing, with the following options: A: Barr body, B: Testosterone receptors, C: Hormone levels, D: Phenotypic features - -### Response: -Chromosomal sex can be determined by the study of the leucocytes or by simply taking a smear from the buccal mucosa -The nuclei of the female chromosome contain a stainable body called the sex chromatin, hence female cells are termed as chromatin positive. -In epithelial cell nuclei, this small peripherally situated darkly staining nodule is called Barr body - -Male cell nuclei lack this body and termed chromatin negative. -### End" -6915,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Niemann-Pick disease is due to deficiency of, with the following options: A: Hexosaminidase, B: Sphingomyelinase, C: Galactokinase, D: Glucosidase - -### Response: -It is a lipid storage disease, due to deficiency of sphingomyelinase. Leads to the accumulation of sphingomyelin.Ref: DM Vasudevan, 7th edition, page no: 193 -### End" -6916,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kernahan Striped Y Classification - The major reference point is., with the following options: A: Soft palate, B: Hard palate, C: Incisive foramen, D: Third molar - -### Response: -Ans. (c) Incisive foramenRef: Internet Sources, Syed Nasir Shah, Mariya Khalid, Muhammad Sartaj KhanKernahan proposed this classification in 1971.This system provides graphic classification scheme using Y-configuration as shown in image.* Areas 1 and 4 - Lip (It represents the fusion line between the maxillary prominence and medial nasal prominence at lip level).* Areas 2 and 5 - Alveolus (It represents the fusion line between the maxillary prominence and intermaxillary segment).* Areas 3 and 6 - Primary Palate (It represents the fusion line between the primary and secondary palate and lies anterior to the incisive foramen).* Areas 7 and 8 - Hard palate (It represents the fusion line between palatine shelves of the hard palate posterior to the incisive foramen).* Area 9 - Soft palateThe small circle represents incisive papilla. In order to show the cleft, stippling of the appropriate areas is done on the above diagram.For Examples:* Clefts of the soft palate will be represented by the following diagram* Left Cleft lip will be represented by the following diagram. -### End" -6917,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest sensation lost in leprosy is, with the following options: A: Thermal, B: Tactile, C: Pain, D: Vibration - -### Response: -The earliest manifestation of leprosy is the involvement of the cutaneous nerve, resulting in a loss of thermal sensation as the initial deficit and then evolving to involve other modalities like pain and touch. Sensory modalities subserved by larger fibers are lost in more advanced stages of the disease. Ref Harrison20th edition pg 1335 -### End" -6918,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common receptor for typical antipsychotics is -, with the following options: A: D1, B: D2, C: D3, D: D4 - -### Response: -Ans. is 'b' i.e.. D2 ANTIPSYCHOT1CSo Antipsychotic (neuroleptic) drugs can be divided into typical and atypical.Typicalo Block D, receptorso Have significant extrapyramidal symptoms (except for thioridazine) - Parkinsonism, Acute muscular dystonia, Akathisia, Malignant neuroleptic syndrome. Tardive dyskinesia,o Drugs are1 .Phenothiazines - Chlorpromazine, Thioridazine, Trifluperazine, Fluphenazine.2. Thioxanthenes - Thiothixene, Flupenthixol.3 .Butyrophenones - Haloperidoi, Trifluperidol, Penfluridol.4. Other heterocyclics - Pimozide, Loxapine, sulpirideAtypicalo These are newer generation (second generation) antipsychotics that have weak D_, blocking but potent 5-HT2 antagonistic activity.o Called atypical because they have no D2 blocking property (except resperidone).o Extrapyramidal side effects are minimal (Resperidone can cause some extrapyramidal effects),o Have no antiemetic effect.o Examples are - Clozapine, Risperidone, Olanzapine, Quetiapine, Aripiprazole, Ziprasidone. -### End" -6919,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30-year-old primigravida with BP of 160/96 mm Hg,BUN 14 mg/dL and creatinine is 1.0 mg/dL. Urinalysis shows no proteinuria. Complete blood count and liver function tests show no abnormalities. What is the first best drug to be given to this patient?, with the following options: A: Furosemide, B: Labetalol, C: Lisinopril, D: Losaan - -### Response: -The first-line agents for management of essential hypeension during pregnancy are labetalol and methyldopa. If asked to choose between these two, then Labetelol is now considered to best first line drug for the management of hypeension in pregnancy Labetelol- 100-200 mg TID MOA- a + b blocker CCBs and hydralazine are acceptable alternate therapies. ACE inhibitors and ARBs are contraindicated in pregnancy. -### End" -6920,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 32 week preterm infant, weighing 1400 gm, vitals stable, admitted in NICU, What is the best feeding procedure ?, with the following options: A: Total enteral nutrition, B: Sta IV fluids; introduce feeding from second day, C: Total parenteral nutrition, D: IV fluid only - -### Response: -32 - 34 weeks : sta feed by spoon or paladai ( Total enteral nutrition ) Ref : Ghai pediatrics eighth edition pg no 159 -### End" -6921,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Clevidipine is?, with the following options: A: ACEI, B: Calcium Channel blocker, C: Alpha Blockers, D: ARB - -### Response: -Ans. B. Calcium Channel blockerIt is dihydropyridine Ca2+ channel blocker indicated for the reduction of blood pressure when oral therapy is not feasible or not desinable. -### End" -6922,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most prevalent esophageal cancer world wide is:, with the following options: A: Squamous cell ca, B: Adenocarcinoma, C: Sarcoma, D: Adenoid cystic carcinoma - -### Response: -Answer is A (Squamous cell Ca): `By far the most common esophageal cancer world wide is squamous cell carcinoma' - Current Gastroenterology 'Over the past few decades there has been a progressive increase in the incidence of adenocarcinoma of the distal esophagus so that it accounts for more than 50% of all new cases of esophageal cancer. Squamous cell carcinoma is still the most common type world wide' - CSDT/469 Confusing inference Most prevalent esophageal cancer world wide (old + new cases) is Squamous cell ca Most common esophageal cancer world wide (new cases) is Adenocarcinoma -### End" -6923,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oncogenic RNA virus is -, with the following options: A: An leukosis virus, B: Herpes virus, C: Adenovirus, D: Togavirus - -### Response: -only an leukosis viruse are RNA viruses(retro virus)others are DNA virus REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.565 -### End" -6924,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which off the following represents the most charachteristic function of Type II Restriction Enzymes, with the following options: A: Prevent folding of proteins, B: Remove fromed DNA, C: Prevent supercoiling, D: Cut DNA at palindromic sites - -### Response: -Type H Restriction Enzymes cleave DNA at specific palindromic nucleotide sequences. -### End" -6925,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which body fluid has maximum HIV load?, with the following options: A: Urine, B: blood, C: Breast milk, D: Saliva - -### Response: -virus has been found in greatest concentration in blood,semen,CSF lower concentration have been detected in tears,saliva,breast milk,urine,cervical and vaginal secretions also isolated in brain tissue,lymph node,bone marrow cells,skin (park edition 23 page 345) -### End" -6926,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: OTC deficiency causes, with the following options: A: Citrullinemia, B: Argininemia, C: Hyperammonemia type-1, D: Hyperammonemia type-2 - -### Response: -Ans. is 'd' i.e., Hyperammonemia type-2Orinithine transcarbomylase (OTC) deficiency causes hyperammonemia type-2. -### End" -6927,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Important components of collagen synthesis, wound strength and contraction include all of the following EXCEPT, with the following options: A: Fibroblasts, B: Myofibroblasts, C: Vitamin C, D: Vitamin D - -### Response: -Nutritional  status  has  profound  effects  on  repair; protein  malnutrition  and  vitamin  C  deficiency,  for example, inhibit collagen synthesis and retard healing. -Robins 10 th ed page no 93 -### End" -6928,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of Acyclovir resistance -, with the following options: A: Thymidine kinase, B: DNA-dependent RNA polymerase, C: | spectrum, D: | Side effects - -### Response: -Ans. is 'a' i.e., Thymidine kinase Both HSV and VZV have been found to develop resistance to acyclovir during therapy the former primarily due to mutants deficient in thymidine kinase activity and the latter primarily by change in specificity of virus directed enzyme so that its affinity for acyclovir is decreased. -### End" -6929,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Newborn is presented with microcephaly, Chorioretinitis, Limb hypoplasia & Cicatrising lesion of hands. Most probable diagnosis is, with the following options: A: Herpes simplex, B: Congenital varicella syndrome, C: CMV, D: Rubella - -### Response: -Congenital varicella syndrome - -Microcephaly -Chorioretinitis -Limb hypoplasia -Cicatrizing lesion -### End" -6930,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mr. Ramu, a 49 yr old gentleman, undergoes a root canal procedure. Few days later he develops fever, weight loss, and anorexia. He is diagnosed with mitral valve prolapsed with mitral regurgitation. The most common organism implicated in causation of this condition is:, with the following options: A: Streptococcus pneumonia, B: Staphylococcus aureus, C: Viridans streptococci, D: Providencia stuaii - -### Response: -Viridans streptococci. (Braunwald, 15/e, pp 809-814, 882-885, 959, 1009, 1620.) The 30-year-old-female with mitral valve prolapse has developed subacute bacterial endocarditis. The likely etiologic agent is a viridans streptococci. Viridans streptococci cause most cases of subacute bacterial endocarditis. No other agent listed is likely to cause this infection. -### End" -6931,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The superior vesical arteries are direct branches of the, with the following options: A: Internal iliac artery, B: Umbilical artery, C: Internal pudendal artery, D: External pudendal artery - -### Response: -The umbilical artery is a branch of the internal iliac artery. In the fetus, the umbilical artery passes over the bladder and continues up the anterior body wall to the umbilical cord and out to the placenta. As it passes the bladder, it gives rise to the superior vesical arteries. After birth, the part of the artery distal to the bladder becomes fibrous, but the proximal part remains patent and continues to supply the bladder. -### End" -6932,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Auricle of the ear is made of:, with the following options: A: Hyaline cailage, B: Fibrocailage, C: Elastic cailage, D: None of the above - -### Response: -There are three types of cailage: Hyaline cailage has a high propoion of amorphous matrix. Throughout childhood and adolescence, it plays an impoant pa in the growth in length of long bones (epiphyseal plates are composed of hyaline cailage). It has a great resistance to wear and covers the aicular surfaces of nearly all synol joints. Fibrocailage has many collagen fibers embedded in a small amount of matrix and is found in the discs within joints (e.g., the temporomandibular joint, sternoclavicular joint, and knee joint) and on the aicular surfaces of the clavicle and mandible. Fibrocailage, if damaged, repairs itself slowly in a manner similar to fibrous tissue elsewhere. Elastic cailage possesses large numbers of elastic fibers embedded in matrix. It is flexible and is found in the auricle of the ear, the external auditory meatus, the auditory tube, and the epiglottis. Elastic cailage, if damaged, repairs itself with fibrous tissue. -### End" -6933,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Steroid synthesis occurs in which organelle?, with the following options: A: Lysosome, B: Smooth endoplasmic reticulum, C: Rough endoplasmic reticulum, D: Lysozyme - -### Response: -Ans. B Smooth endoplasmic reticulum* The smooth endoplasmic reticulum is continuous with the rough endoplasmic reticulum and does not contain any ribosomes. Although it has several functions, the sER is specialized for the production of steroid hormones in cells of the adrenal cortex.* Remember that cholesterol is the main precursor for steroid hormones produced in the adrenal cortex and the gonads. -### End" -6934,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute GVHD is caused by-, with the following options: A: B lymphocyte, B: T lymphocyte, C: Macrophage, D: NKcell - -### Response: -Graft versus host (gvh) diseases - -Graft versus host disease occurs in any situation in which immunologically competent cells or their precursors are transplanted into immunologically crippled patients and the transferred cells recognize alloantigens in the host. -Graft versus host disease occurs most commonly in the setting of allogeneic bone marrow transplantation but may also follow transplantation of solid organs rich in lymphoid cells (e.g. the liver) or transfusion of unirradiated blood. -Recipients of bone marrow transplants are immunodeficient because of either their primary disease or prior treatment of the disease with drugs or irradiation. -When such recipients receive normal bone marrow cells from allogeneic donors, the immunocompetent, T cells present in the donor marrow recognize the recipient’s HLA antigen as a foreign antigen and react against them. Both CD4+ and CD8+ T cells recognize and attack host tissues. -In clinical practice, GVH can be so severe that bone marrow transplants are done only between HLA matched donor and recipient. - -Pathological changes in GVH diseases - -There are three principal target tissues affected in GVHD: Skin, liver, and gut. GVHD may be acute or chronic:- - -A) Acute GVHD - -Acute GVHD occurs within 100 days (usually 10-50 days) of bone marrow transplantation. The manifestations of acute GVHD are - -1. Skin - -It is the most commonly affected tissue in acute GVHD. There is generalized rash (maculopapular). - -Histological findings are -i. Perivascular mononuclear infiltrates. -ii. Vacuolar degradation of dermo-epidermal junction -iii. Dyskeratotic or eosinophilic bodies in the epidermis. -iv. Epidermolysis & bullae. -v. Denudation of epidermis (separation of epidermis from dermis), -2. Gut - -The primary clinical manifestation of gut GVHD is diarrhoea and abdominal pain. There is lymphocytic infiltrate at the crypts with accompanied necrosis and drop out of crypt cells. - -3. Liver - -Lymphocytic infiltrates in the interlobular and marginal bile ducts are characteristic histopathologic findings. This results in hepatitis with necrosis of hepatocytes and bites duct epithelial cells. There is inflammation of the parenchyma and portal tracts. These findings lead to a clinically identifiable cholestatic picture. - -B) Chronic GVHD - -It occurs after 100 days of bone marrow transplantation. Manifestations are:- - -1. Skin - -Extensive cutaneous injury, with the destruction of skin appendages and fibrosis of the dermis. - -2. Gut - -Damage to GIT may result in necrosis, ulceration fibrosis and strictures. - -3. Liver - -The findings of liver damage are i) Portal tract inflammation ii) Selective bile duct destruction - -iii. Endothelitis of the portal vein and hepatitis vein radicles, in which a subendothelial lymphocytic infiltrate lifts the endothelium from its basement membrane. -iv. Intrahepatic cholestasis -### End" -6935,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding crude bih rate all are true except, with the following options: A: Unaffected by age distribution, B: Indicator of feility, C: Excludes the still bihs, D: Better measure of feility than general feility rate - -### Response: -Bih rate = Number of live bihs during the year X 1000/ estimated mid year population Unsatisfactory measure of feility because the total population is not exposed to child bearing Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 488 -### End" -6936,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patient of juvenile myoclonic epilepsy on valproate comes to you at 5 months of pregnancy with level H scan normal what will you advise?, with the following options: A: Change the drug, B: Continue the drug in same dose, C: Decrease the dose of drug, D: Increase the dose of drug - -### Response: -Ans. is 'b' i.e., Continue the drug in same dose Valproic acid has the risk of fetal malformations during the first trimester of pregnancy. This patient has normal level II scan at 5 months of pregnancy so the risk period of valproate is already over and valproate is the drug of choice in juvenile myoclonic epilepsy. Thus the drug shoud be continued in the same doses. -### End" -6937,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gold standard flap for breast reconstruction -, with the following options: A: TRAM flap, B: LD flap, C: DIEP flap, D: Silicone gel implant - -### Response: -Ans. is 'C' i.e., DIEP flap -### End" -6938,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true about cleft lip and palate except:, with the following options: A: Associated with Treacher-Collins' syndromes, B: Cleft lip with cleft palate is most common type, C: Pierre Robin sequence is the most common syndrome, D: Isolated cleft palate can be diagnosed by ultrasound after 28 weeks gestation - -### Response: -- Incidence of cleft lip & palate is 1:600 live bihs - Incidence of isolated clef palate is 1:1000 live bihs Distribution - In unilateral cleft lip the deformity affects the left side in 60% of cases Typical distribution of Cleft types - Cleft lip alone 15% -Cleft lip & palate: 45% (MC) -Isolated cleft palate: 40% Note: - Isolated cleft palate can be diagnosed by ultrasound after 18 weeks gestation Associated Syndromes: - Although most clefts of the lip and palate occur as an isolated deformity, Pierre Robin Sequence remains the most common syndrome. - Other associated syndromes Stickler's (ophthalmic and musculoskeletal abnormalities) Sphrintzen's (cardiac anomalies), Down's, Ape's and Treacher-Collins' syndromes -### End" -6939,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Least blood gas paition coeficient anesthetic agent:, with the following options: A: Desflurane, B: Nitrous oxide, C: Halothane, D: Ether - -### Response: -A i.e. Desflurane -### End" -6940,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is reabsorbed along with sodium in early poion of proximal tubules?, with the following options: A: Glucose, B: Amino acids, C: Bicarbonate, D: All of the above - -### Response: -Glucose, amino acids, and bicarbonate are reabsorbed along with Na+ in the early poion of the proximal tubule. Glucose is typical of substances removed from the urine by secondary active transpo. Also know: Normally about 60% of the filtered Na+ is reabsorbed in the proximal tubule, primarily by Na-H exchange. Another 30% is absorbed the Na-2Cl-K cotranspoer in the thick ascending limb of the loop of Henle. Ref: (2012). Chapter 37. Renal Function & Micturition. In Barrett K.E., Boitano S, Barman S.M., Brooks H.L. (Eds), Ganong's Review of Medical Physiology, 24e. -### End" -6941,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most potent bronchodilator among inhalational anethestic agents is-, with the following options: A: Isoflurane, B: Sevoflurane, C: Halothane, D: Desflurane - -### Response: -(Refer: Morgan and Mikhail’s Clinical Anaesthesiology, 5th edition, pg no. 167 – 169) -Effect of inhalational agents on respiratory system - -All inhalational agents are bronchodilators →Halothane cause maximum bronchodilatation.  Inhalational agent of choice in asthmatics (intravenous anaesthtic of choice is ketamine). -All inhalational agents cause respiratory depression to some extent → Maximum depression of respiration is seen with enflurane, on the other hand maximum inhibition of ventilator response to increased CO2 and hypoxia is caused by halothane -All inhalational agents vasodilate pulmonary vascular bed by blunting the hypoxic pulmonary vasoconstriction (HPV) response.  Halothane has maximum effect: Isoflurane, Enflurane, desflurane, sevoflurane have similar effect. -### End" -6942,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following causes lupus like features-, with the following options: A: Hydralazine, B: Amphetamines, C: Clozapine, D: Esmolol - -### Response: -Ans. is 'a' i.e., Hydralazine Drugs inducing ANA and SLE :o Antiarrhythmics : Procainamide, disopyramide, propafenomeo Anti-hypertensives : hydralazine, methyldopao ACE inhibitorso Beta-blockerso Antithyroid-propylthiouracilo Antipsycbotics - chlorpromazine. lithiumo Anti-convulsauts : carbamazepine, phenytoino Antibiotic :Isoniazid, minocycline, macrodantino Antirheumatic : sulfasalazineo Diuretics : Hydroclorothiazideo Statins : Lovastatin, simvastatino Biologies : IFN, TNF-a inhibitors -### End" -6943,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following malignancy is seen in male child with sho stature, low IQ, murmur in pulmonary area and lymphedema?, with the following options: A: Retinobalstoma, B: Hepatocellular carcinoma, C: Juvenile myelomonocytic leukemia, D: Germ cell tumour - -### Response: -Male child with sho stature, low IQ, murmur in pulmonary area and lymphedema suggests Noonan syndrome with pulmonary valve stenosis. Hematological abnormality seen in Noonan syndrome is Juvenile Myelomonocytic Leukemia -### End" -6944,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: To prevent exercise-induced bronchial asthma drug used is :, with the following options: A: Sodium cromoglycate, B: Ipratropium bromide, C: Terbutaline, D: Epinephrine - -### Response: -Mast cell stabilizers like cromoglycate and nedocromil are used to prevent exercise-induced asthma. However, corticosteroids are preferred for this indication. -### End" -6945,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Frontal resorption is caused due to:, with the following options: A: Light continuous force, B: Heavy continuous force, C: Heavy interrupted force, D: Light interrupted force - -### Response: -Frontal resorption (direct/periosteal/forward resorption) - -With light continuous forces, the bone is resorbed directly by a frontal osteoclastic attack.  -The first step in orthodontic tooth movement is the activation of osteoclasts. -In frontal resorption, resorption is initiated from the PDL side of the alveolar bone. It usually takes place after 2 days. -### End" -6946,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A congenital hydrocele is treated by?, with the following options: A: No treatment before 5 years, B: Herniorraphy, C: Herniotomy, D: Eversion of sac - -### Response: -""Congenital hydrocele will resolve spontaneously within 1 year. The operation is required only when it persists for longer than 1 year” In congenital hydrocele, the processes vaginalis is patent and connects with the peritoneal cavity. The communication is usually too small to allow herniation of intra-abdominal contents. Pressure on the hydrocele does not always empty it but the hydrocele fluid may drain into the peritoneal cavity when the child is lying down; thus, the hydrocele is often intermittent. Ascites should be considered if the swellings are bilateral. -""Congenital hydroceles are treated by herniotomy if they do not resolve spontaneously” Treatment usually, no treatment of congenital hydrocele is indicated because this condition typically resolves spontaneously by age 1. Most surgeons advocate observation in the majority of infants less than 12 months. Others may continue to be observed for longer, as the majority of patent processes vaginalis will close within the first 12-24 months of life -### End" -6947,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In addison's disease, most diagnostic test is:, with the following options: A: Serum Na+, K+, rennin, B: Serum Na+, K+, saline suppression, C: Serum creatinine/urea ratio, D: ACTH stimulation test - -### Response: -Answer is D (ACTH stimulation test): The diagnosis of Adrenal insufficiency should be made only Hith A C'TH stimulation testing - Harrison's ACTH stimulation test / Cosvntropin stimulation test Synthetic ACTH (Cosyntropin) is given parentrally in a dose of 250 tg (or 0.25 mg) Serum is obtained for coisol between 30 to 60 minutes after Cosyntropin is administered Coisol levels should be greater than 495 mmol/L (> 18pg/dL) Coisol levels >495 exclude the diagnosis of Addison's disease while coisol levels < 495 suggest a possible diagnosis of Adrenal insufficiency (primary or secondary). -### End" -6948,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Feature of slow filter (w.r.t. fast filter) is/are:, with the following options: A: Occupies less space, B: Highly skilled operation, C: Poor bacterial quality, D: Takes more time for purification - -### Response: -Ans. is 'd' i.e. Takes more time for purification o Slow sand filter occupies large area (more space). o Slow and filter requires less skilled operation. o Slow sand filter removes more bacteria and has better bacterial control (99.9-99.99%) o Slow sand filter requires longer duration for purification. o Size of sand is smaller (0.2-0.3 mm). -### End" -6949,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Resection of 90% of ileum and jejunum causes all of the following Except, with the following options: A: Hypogastrinemia, B: Steatorrhoea, C: Anemia, D: Extra cellular volume depletion - -### Response: -Harrison's says ""Gastric hypersecretion of acid occurs in many patients following large resection of the small intestine. The etiology is unclear but may be related to reduced hormonal inhibition of acid secretion or increased gastrin levels due to reduced small intestinal catabolism of circulating gastrin "" Ref: Harrison's 19th edition Pgno : 1443 -### End" -6950,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old Lady goes to her physician because she is concerned that she may have systemic lupus erythematosus after hearing a public health announcement on TV while working at grocery store. She has no significant past medical history, and her only medication is occasional ibuprofen. She repos that she has had intermittent oral ulcers and right knee pain. Physical examination shows no evidence of alopecia, skin rash, or joint swellimg. Her blood repos shows that she has a positive ANA at a titer of 1:40, but no other abnormalities. Which of the following statements is true?, with the following options: A: Four diagnostic criteria are required to be diagnosed with systemic lupus erythematosus; this patient has three, B: Four diagnostic criteria are required to be diagnosed with systemic lupus erythematosus; this patient has two, C: If a urinalysis shows proteinuria, she will meet criteria for systemic lupus erythematosus, D: The demonstration of a positive ANA alone is adequate to diagnose systemic lupus erythematosus - -### Response: -Diagnostic criteria for SLE: Include four or more of the following criteria - CRITERIA FEATURE 1.Malar Rash Fixed Erythema,Flat or Raised,Over the malar eminences 2.Discoid Rash Erythematous circular raised patches and adherent keratotic scaling 3.Photosensitivity Exposure to ultraviolet light causes rash 4.Oral ulcers Oral and Nasopharyngeal ulcers 5.Ahritis Non Erosive Ahritis of 2/more peripheral joints with Tenderness, swelling or effusion 6.Renal disorder Protienuria > 0.5g/d or 3+ or cellular casts 7. Neurologic disorder Siezuers, Psychosis 8.Hematologic disorders Hremolytic anemia or leucopenia, Lymphopenia, Thrombocytopenia 9. Immunologic disorder Anti DsDNA, Anti Sm, and/or Antiphospholipid, Low serum complement, +ve Direct Coombs 10. Antinuclear antibody(ANA) Abnormal titer of ANA Total 4 features should be positive At least 1 clinical feature and At least 1 lab features If renal features positive alone is enough to diagnosis SLE. Diagnosis of SLE The patient does not meet the ahritis criteria; her only criteria are oral ulcers and weakly positive ANA.So, she will not have SLE. -### End" -6951,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug which can cause Hyperophic Pyloric stenosis is:, with the following options: A: Rifampicin, B: Erythromycin, C: Azithromycin, D: Ampicillin - -### Response: -Erythromycin -### End" -6952,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 20-year-old male presented with high-grade fever, groin pain and a swollen scrotum for 1 week and are worsening progressively. On examination, Tender inguinal lymphadenopathy Scrotal swelling with hydrocoele Lymphatic streaking Blood samples are taken and a parasite infection is suspected. Which of the following is the most likely organism: -, with the following options: A: , B: , C: , D: - -### Response: -This is a case of filariasis (acute lymphadenitis) due to Wuchereria bancrofti. Microfilariae are found in blood, hydrocoele and other body fluids. 1 Wuchereria bancrofti Sheath, no nuclei in the tip of the tail 2 Brugia malayi Sheath, 2 distinct nuclei in the tip of the tail 3 Loa loa Sheath, nuclei extending to the tip of the tail 4 Onchocerca volvulus (skin) No sheath, no nuclei in the tip of the tail 5 Mansonella perstans No sheath, nuclei extending to the tip of the tail 6 Mansonella ozzardi No sheath, no nuclei in the tip of the tail 7 Mansonella streptocerca (skin) No sheath, nuclei extending to the tip of the hooked tail -### End" -6953,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which test is used to measure nasal mucociliary clearance?, with the following options: A: Saccharin test, B: SISI test, C: handkerchief test, D: Endoscopy - -### Response: -Ans. is 'a' i.e., Saccharin test Nasal mucociliary clearance testso Nasal nitric oxide measuremento Saccharin testo Tests using radioisotope labeled particlesNasal myiasis (Maggots in nose)o It results from the presence of ova of flies particularly chrysomia species in the nose which produce ulceration and destruction of nasal structure. Mostly seen in atrophic rhinitis when the mucosa becomes insensitive to flies laying eggs inside.Clinical featureso Initial symptoms (3-4 days maggots):- Intense irritation, sneezing, headache, blood stained disharge, lacrimation.o Later:- Maggots may crawl out of nose and there is foul smell.Complicationso Destruction of nose, sinuses, soft tissues of face, palate and eyeballo Fistulae in nose and palateo Death occurs due to meningitis.Treatmento Chloroform water or vapor must be instilled in order to anaesthetize or kill the maggots and so release their grip from the skin. -### End" -6954,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Operation theatre sterilisation is done by, with the following options: A: savlon cleansing, B: Carbolic acid spray, C: Ultra violet radition, D: Autoclave - -### Response: -UV rays are used to disinfect OT for 30-45 min exposure Formaldehyde gas also can be used for fumigation of operation theatres. Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 33 -### End" -6955,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CSF Rhinorrhea occurs d/t, with the following options: A: Roof of orbit, B: Frontal sinus, C: Cribriform plate of ethmoid bone, D: Sphenoid bone - -### Response: -Commonest area of # causing CSF Rhinorrhea → cribriform plate of ethmoid bone as it is extremely thin. -Other possible areas of # causing CSF Rhinorrhea Frontal sinus (Posterior wall) or of the anterior cranial fossa. -Difference between CSF Rhinorrhea & allergic or vasomotor rhinitis CSF contains glucose which can be demonstrated by chemical tests. -CSF when collected into a test tube and allowed to stand, it remains clear in contradistinction to nasal discharge that leaves a sediment because of mucus and other proteins. -Nasal discharge stiffens the handkerchief and CSF dries soft in it. -Treatment: Prophylactic antibiotics & X-ray * If more than 2 wks then correct it surgically. -### End" -6956,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common complication of an ovarian tumor is:, with the following options: A: Torsion, B: Hemorrhage, C: Infection, D: Hyaline change - -### Response: -Ans. is a, i.e. TorsionRef: Shaw 15th/ed, p382Complications of Ovarian tumor (TRIP):T Torsion* Most common complication* Seen in 12% cases* Most common in benign tumors* Most common tumor to undergo torsion is dermoid cyst. - Ref: Jeffcoate 7th/ed, p548R Rupture* Which can be traumatic or spontaneous.I Infection* Rare complication* Seen following acute salpingitis or during puerperium as a part of an ascending genital tract infection.P Pseudomyxoma peritonei* Peritoneal cavity is filled with coagulated mucinous material.In ovarian Tumors* Most common in mucinous cystadenoma and mucinous carcinoma.Also seen in: Mucocele of appendix.* Carcinoma of large intestine.* Appendix cancer overall is the M/C cause of pseudomyxoma peritonei. -### End" -6957,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patients suffering from multidrug-resistant tuberculosis can be treated with all the following drugs EXCEPT :, with the following options: A: Tobramycin, B: Amikacin, C: Ciprofloxacin, D: Clarithromycin - -### Response: -Aminoglycosides effective in MDR tuberculosis are amikacin, kanamycin and capreomycin, Tobramycin is not effective against mycobacterium. -Ciprofloxacin and clarithromycin are also useful for tuberculosis. -### End" -6958,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common complication of varicose vein stripping is:, with the following options: A: Infection, B: Hemorrhage, C: Ecchymosis, D: Thromboembolism - -### Response: -Complications of varicose vein surgery Recurrence (MC): Incidence of recurrence after surgery in upto 10%. Hematoma or Ecchymosis: MC cause of discomfo after varicose vein surgery Sensory nerve injury Greater saphenous vein should only be stripped to just below the knee to avoid damage to the accompanying saphenous nerve Sural nerve must be carefully dissected off the lesser saphenous vein at the ankle. -### End" -6959,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sensory supply of first web space of foot is by:, with the following options: A: Superficial peroneal nerve, B: Deep peroneal nerve, C: Sural nerve, D: Saphenous nerve - -### Response: -Ans. B. Deep peroneal nerveSensory supply of first web space of foot is by Deep peroneal nerve.Sensory supply of dorsum and sole of foot -### End" -6960,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest cause of fungal uveitis is:, with the following options: A: Candida, B: Aspergillus, C: Fusarium, D: Mucor mycosis - -### Response: -Ans. Candida -### End" -6961,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 52-year-old man, after suffering a heart attack, was put on 81 mg of aspirin daily by his cardiologist. The purpose of this treatment is to reduce the levels of which one of the following?, with the following options: A: Cytokines, B: Leukotrienes, C: Thromboxanes, D: Cholesterol - -### Response: -Platelet aggregation is often a determining factor in heart attacks. Thromboxane A2 , produced by platelets, promotes platelet aggregation when clotting is required, and inhibition of thromboxane A2 synthesis by aspirin reduces the potential for inappropriate clot formation, and further heart attacks. Thromboxane A2 is produced from arachidonic acid by the action of COX, the enzyme covalently modified and irreversibly inhibited by aspirin. Leukotrienes are also synthesized from arachidonic acid, but utilize lipoxygenase in their synthesis, which is not inhibited by aspirin. Cholesterol, triglyceride, and cytokine synthesis do not require COX activity. -### End" -6962,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pulmonary mycetomas on radiographs most commonly show as, with the following options: A: Air fluid level, B: Lucent crescent, C: Eccentric nodule, D: Rim calcification - -### Response: -The fungal ball produces a tumor-like opacity on X ray,but can be distinguished from a carcinoma by the presence of a crescent of air between the fungal ball and the upper wall of the cavity(Air crescent sign).HRCT is more sensitive. Reference:Davidson's Medicine-22nd edition,page no:698. -### End" -6963,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Triad of vomiting, abdominal distension and ''String of beads"" sign on abdominal X-ray is typically suggestive of?, with the following options: A: Duodenal atresia, B: Small bowel obstruction, C: Large bowel obstruction, D: Gastric volvulus - -### Response: -Ans. b (Small bowel obstruction). (Ref. Grainger & Allison's Diagnostic Radiology, 5th ed., 981, 1089)Erect abdomen X-ray features of small bowel obstruction:# Multiple fluid levels (3 or more than 3, size more than 3 cm and in mid-abdomen - 'candy-cone appearance).# ""Step-ladder"" appearance in low obstruction (the greater the number of dilated bowel loops, more distal is the site obstruction) and the ""concertina effect"" in Jejunal obstruction are known features.# Visualization of 'valvulae conniventes' is diagnostic feature.# Pathognomonic feature is ""String of beads sign"" (gas trapped between valvulae conniventes only when very dilated small bowel is almost completely fluid filled and it is virtually diagnostic of small bowel obstruction).Educational points:# Standing (erect) X-ray abdomen is 'gold standard' investigation of diagnosis of bowel obstruction.# The mucosal folds of small bowel - 'valvulae conniventes', are numerous in jejunum and sparse in ileum.# On barium study, jejunum gives typical feathery appearance \ while ileum is almost featureless.# The most common cause of small bowel obstruction is post-operative adhesions.Q""STRING OF BEADS"" APPEARANCE('Pile of plates' appearance)Is classically seen on angiography in FibroMuscular Dysplasia.""STRING SIGN""Persistent narrow stream of barium indicating stenosis.'STRING SIGN'CHPS (a string of barium seen through pyloric canal seen in CHPS .STRING SIGN OF KANTOR'Crohn's diseaseAlso know following x-ray signs in abdomen:X-ray AppearanceDiagnosis1Double bubble sign# Duodenal atresia.# Ladd's band.# Annular pancreas2Triple bubble sign# Jejunal atresia3Multiple bubble sign# Ileal atresia4'String of beads' sign# Small bowel obstruction5Cupola sign# Pneumoperitoneum6Rigler's double wall signFoot-ball signDog's cape sign# Pneumoperitoneum7Sentinel Loop SignGas less abdomenRenal halo signColon cut-off sign# Acute pancreatitis8Coffee bean signInverted 'U' or 'V' signOmega signBent inner tube signLiver overlap signDIO overlap signApex under diaphragm# Sigmoid volvulus9Medusa Lock sign# Roundworms -### End" -6964,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The lamina propria, a layer of dense connective tissue is:, with the following options: A: Thicker in anterior than posterior part of the palate., B: Thicker in posterior than anterior part of the palate., C: Not found in the posterior part of the palate., D: Not found in the anterior part of the palate. - -### Response: -The lamina propria may attach to the periosteum of the alveolar bone , or it may overlay the submucosa. -### End" -6965,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aldehyde test is used for:, with the following options: A: Fasciola hepatica, B: Leishmania, C: Leishmania, D: Toxocara cams - -### Response: -Leishmania -### End" -6966,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35 year old patient complains of abdominal cramps along with profuse diarrhea. The treating physician wants to process the stool specimen for isolation of Campylobacter jejuni. Which of the following is the method of choice for the culture of stool ?, with the following options: A: Culture on TCBS medium incubated at 37degC under aerobic conditions, B: Culture on Skirrow's medium incubated at 42degC under micro-aerophilic conditions., C: Culture on MacConkey's medium incubated at 42degC under anaerobic contions, D: Culture on Wilson and Blair's medium incubated at 37deg under microaerophilic conditions - -### Response: -Ans. is 'b' i.e., Culture on skirrow's medium incubated at 42degC under micro-aerophilic conditions . Compylobacter jejuni is thermophilic, growing well at 42degC. Inoculated plates are incubated under microaerophilic conditions with an atmosphere of 5% 02, 10% CO2 and 85% N2 at 42degC. . Plating media commonly used are 1) Skirrow's medium 2) Butzler's medium 3) Campy BAP medium . Transpo medium - Cary-Blair medium . The jejunum and the ileum are the primary sites of colonization. . C. jejuni is invasive pathogen, may involve mesentric lymph node and cause bacteremia. Treatment . Most cases resolve without antimicrobial therapy with fluid and electrolyte replacement. . When needed, erythromycin is the drug of choice. -### End" -6967,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ketamine is useful as an anesthetic agent in -, with the following options: A: Ischemic heart disease, B: Intracranial hemorrhage, C: Hyperactive airways, D: Glaucoma - -### Response: -Ans. is 'c' i.e., Hyperactive airways o Ketamine is a potent bronchodilator and relieves bronchospasm - Intravenous anaesthetic agent of choice in asthmatico Ketamine increases ICT, IOP and cardiac oxygen demand, therefore contraindicated in other three conditions.o Note - Inhalation anaesthetic agent of choice in asthmatics is halothane. -### End" -6968,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In comparison to breast milk, colostrum has a higher content of, with the following options: A: Carbohydrates, B: Fat soluble vitamins, C: Water, D: Potassium - -### Response: -Colostrum is the milk secreted during the first three days. It is yellow, thick and contains more of antibodies and fat-soluble vitamins.Transitional milk is that secreted during the following 2 weeks and contains plenty of immunoglobulins.This is followed by mature milk which is thin and watery.(refer to pgno: 430 Sheila 2nd edition) -### End" -6969,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common cause of renal scarring in a 3 year old child is –, with the following options: A: Trauma, B: Tuberculosis, C: Vesicoureteral reflux induced pyelonephritis, D: Interstitial nephritis - -### Response: -The small scarred kidney in childhood:. Risdon RA] 'Reflux nephropathy is now a generally accepted term to describe small scarred kidneys discovered during childhood; it recognizes the close association between this renal lesion and vesicoureteric reflux (VUR)'. -Renal scarring is most commonly a result of chronic pyogenic infection of the kidney or chronic pyelonephritis. Chronic pyelonephritis occurs only in patients with major anatomic abnormalities, such as obstructive uropathy struvite calculi or, most commonly, VUR (in 30 to 45% of young children with symptomatic UTI). -### End" -6970,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 20 years old nulliparous women is on oral contraceptives pills. She is currently diagnosed as having pulmonary tuberculosis. Which anti-tubercular drug decreases the effect of OCP, with the following options: A: INH, B: Pyrazinamide, C: Ethambutol, D: Rifampicin - -### Response: -Ans. is d i.e. Rifampicin Interacuons of OCP's with other Drugs -### End" -6971,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: LGV (lymphogranuloma venerum) is caused by ?, with the following options: A: Treponema pallidum, B: Chlamydia trachomatis, C: Calymmatobacter granulomatosis, D: H Ducreyi - -### Response: -Ans. is 'b' i.e., Chlamydia trachomatis -### End" -6972,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about decoicate rigidity ?, with the following options: A: Removal of cerebral coex and basal ganglia, B: Flexion of lower limbs & extension of upper limbs, C: Rigidity is less pronounced than decerebrate rigidity, D: None of the above - -### Response: -Ans. is 'c' i.e., Rigidity is less pronounced than decerebrate rigidityA decoicate rigidity is made by removing the whole cerebral coex but leaving the basal ganglia intact.Decoicate rigidity is characterized by flexion of upper extrimities at elbow and extension of lower extrimities.The flexion is due to rubrospinal tract excitation of flexors in the upper extrimities and hyperextension of the lower extermity has same mechanism as in decerebrate rigidity.The decoicate animal does not have such intense hypeonia as decerebrate animal.This is because the basal ganglia, which are intact in the decoicate animal, activate the descending inhibitory reticular formation, and thereby prevent excessive hypeonia. -### End" -6973,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with microcytic hypochromic anaemia shows reduced total serum iron, percentage saturation of serum transferrin, TIBC and increased levels of serum ferritin. What is the diagnosis?, with the following options: A: Iron deficiency anaemia, B: Anaemia of chronic disease, C: Sideroblastic anaemia, D: Pernicious anaemia - -### Response: -Microcytic Hypochromic Anemia Caused by:- - -Sideroblastic anemia -Iron deficiency anemia -Thalassemia -Anemia of chronic disease - -Macrocytic Anemia Caused by: - -Alcoholic Liver disease -Hypothyroidism -Megaloblastic anemia (Folic acid and vitamin B12 deficiency) • Anemia by Cytotoxic drugs like methotrexate or other drugs phenytoin. - -Different Microcytic Hypochromic anemia features:- -### End" -6974,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal Glucose level in CerebroSpinal Fluid (CSF) is, with the following options: A: Glucose is not present in CSF, B: 40 -- 70 mg/dL, C: 80-- 120 mg/dL, D: 120-- 180 mg/dL - -### Response: -(B) 40-70 mg/dL REFERENCE VALUES FOR SPECIFIC ANALYTESCerebrospinal FluidReference RangeConstituentSI UnitsConventional UnitsOsmolarity292-297 mmol/kg water292-297 mOsm/LElectrolytesSodium137-145 mmol/L137-145 meq/LPotassium2.7-3.9 mmol/L2.7-3.9 meq/LCalcium1.0-1.5 mmol/L2.1-3.0 meq/LMagnesium1.0-1.2 mmol/L2.0-2.5 meq/LChloride116-122 mmol/L116-122 meq/LC02 content20-24 mmol/L20-24 meq/LPC026-7 kPa45--49 mmHgpH7.31-7.34 Glucose2.22-3.89 mmol/L40-70 mg/dLLactate1-2 mmol/L10-20 mg/dLTotal protein:Lumbar0.15-0.5 g/L15-50 mg/dLCisternal0.15-0.25 g/L15-25 mg/dLVentricular0.06-0.15 g/L6-15 mg/dLAlbumin0.066-0.442 g/L6.6-44.2 mg/dLIgG0.009-0.057 g/L0.9--5.7 mg/dLIgG index0.29-0.59 Oligoclonal bands (OGB)<2 bands not present in matched serum sample Ammonia15-47 pmol/L25-80 pg/dLCreatinine44-168 pmol/L0.5-1.9 mg/dLMyelin basic protein<4 mg/L CSF pressure 50-180 mmH2OCSF volume (adult)~150 mL Red blood cells00LeukocytesTotal0-5 mononuclear cells per L DifferentialLymphocytes60-70% Monocytes30-50% NeutrophilsNone > Normal CSF glucose range is 40-70 mg/dl (2.2-3.9 mmol/1).> Normal CSF glucose concentration is 2/3 of blood glucose concentration. If mean plasma glucose of 100 mg/dI is taken, then CSF glucose is 64 mg/dI, i.e. ratio of CSF glucose: plasma glucose = 0.64 (i.e., 2/3).> Cerebrospinal Fluid Chloride 120-130 mEq/l Glucose 50-75 mg/dl Proteins, total 15-40 mg/dl Albumin 8-30 mg/dl -### End" -6975,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rise in end tidal CO2 during thyroid surgery can be due to all except:, with the following options: A: Anaphylaxis, B: Malignant hypehermia, C: Thyroid storm, D: Neuroleptic malignant syndrome - -### Response: -A i.e. Anaphylaxis Thyroid storm, malignant hypehermia, neuroleptic malignant syndrome and pheochromocytoma are hypermetabolic states with a massive increase in CO2 production, characterized by hyperpyrexia, tachycardia striking alteration in consciousness and rise in ET CO2 (end tidal CO2 on capnometery)Q. Anaphylaxis l/t hypotension and shock results in hypoperfusion of lungs and deceased ET CO2Q. -### End" -6976,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are causes of ""lupus"", except;, with the following options: A: Hydralazine, B: Clofibrate, C: Penicillamine, D: INH - -### Response: -drug induced lupus- sulphonamides, procainamide, INH, hydralazine- SHIP-code SLE is an autoimmune disease which can affect the whole body system. The main medication used is 1.anti inflammatories like aspirin to reduce lupus, acetaminophen, NSAIDS, coicosteroids 2.anti materials 3.immune modulators i. e cyclophosphamide, methotrexate, azathioprine, 4.anticoagulants 5.monoclonal antibodies, etc REF KD Tripathi 8th ed -### End" -6977,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disulfiram-like reaction is caused by: Kerala 11, with the following options: A: Acamprostate, B: Metronidazole, C: Tetracycline, D: Digitalis - -### Response: -Ans. Metronidazole -### End" -6978,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the acronym ""SWELLING"" used for thehistory and examination of a lump or swelling,the letter 'N' stands for -, with the following options: A: Nodes, B: Noise (Thrill/bruit), C: Numbness, D: Neurological effects - -### Response: -Ans. is 'b' i.e., Noise (Thrill/bruit) -### End" -6979,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mucosal transfer of iron in GIT is by:, with the following options: A: Transferrin, B: Apoferritin, C: Apotransferrin, D: Ferritin - -### Response: -Ans: bRef: Harrison, 16thed, p. 587, Fig. 90.1 -### End" -6980,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Disability adjusted life year (DALY) is a measure of ?, with the following options: A: Life expectancy, B: Effectiveness of treatment, C: Quality of life, D: Human development - -### Response: -Ans. is 'b' i.e., Effectiveness of treatment Disability - adjusted life year (DALY) DALY is a measure of :- The burden of disease in a defined population The effectiveness of interventions It expresses years lost to premature death and years lived with disability adjusted for the severity of the disability. That means, DALY measures both moality and disability together (in contrast to sullivan's index which is related to disability only). One DALY is one lost year of healthy life. DALY combines following : - Years of lost life (YLL). Years lost to disability (YLD) DALY = YLL + YLD Japanese life expectancy statistics are used as a standard for measuring premature death, as Japanese have the longest life expectancy. Health - adjusted life expectancy (HALE) HALE is the indicator used to measure healthy life expectancy. HALE is based on the life expectancy at bih but includes an adjustment for time spent in poor health. It is the equivalent number of years in full health that a newborn can expect to live based on current rates of ill health and moality. -### End" -6981,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is known as labourer's nerve?, with the following options: A: Ulnar nerve, B: Axillary nerve, C: Radial nerve, D: Median nerve - -### Response: -Ans. D. Median nerveThe median nerve is the main nerve of the front of the forearm. It supplies the muscles of the front of the forearm and muscles of the thenar eminence, thus controlling the coarse movements of the hand. Therefore, it is also called ""labourer's nerve"".The median nerve originates from the lateral and medial cords of the brachial plexus, and has contributions from ventral roots of C5 -C7 (lateral cord) and C8 and T1 (medial cord). -### End" -6982,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are TRUE regarding health planning, except -, with the following options: A: Resiource planning and implementation, B: Eliminating wasteful expenditure, C: Creating demands for needs, D: To develop best course of action for best results - -### Response: -Steps of health planning analysis of health situation Establishment of objectives and goal Assessment of resources Fixing priorities Write up formulated plan Programming and implementation Monitoring Evaluation (refer pgno: 870 park 23 rd edition) -### End" -6983,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: \r\nAll of the following are true about Aedes mosquito, except:, with the following options: A: It transmits dengue fever, B: It breed in stagnant water, C: They are recurrent day time biters, D: Its eggs cannot survive more than one week without water - -### Response: -Aedes Aegypti are recurrent day time biters and breed in stagnant water. It transmits dengue fever. Aedes Aegypti eggs can remain ble for long periods under without water. Hence it is carried to many pas of the world as dry eggs in suitable containers. Ref: Physician's Guide to Ahropods of Medical Impoance, 4th Edition, Pages 265-66; Park's Textbook of Preventive and Social Medicine By K. Park, 19th Edition, Pages 625-26 -### End" -6984,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dye used in chromoendoscopy for detection of cancer:, with the following options: A: Gentian violet, B: Toluidine blue, C: Hemotoxiline and eosine, D: Methylene blue - -### Response: -Ans is d i.e. Methylene blue > Toluidine blue ""Chromoendoscopy, the intravital staining of gastrointestinal epithelia, provides additional diagnostic information with respect to the epithelial morphology and pathophysiology. Based on experience gathered mainly in Japan, chromoendoscopy is now in more widespread use, in paicular to identify preneoplastic and neoplastic lesions. The most promising techniques are the depiction of squamous epithelium neoplasia of the esophagus with Lugol's solution, staining of Barrett's mucosa by methylene blue, including the potential to identify neoplasia, and the demarcation of neoplasia with indigo carmine in stomach and colon for local endoscopic resection.""- aicle: Chromoendoscopy: From a Research Tool to Clinical Progress U. Peitz, P. Malfeheiner at website: ikelNr=67480 ""Chromoendoscopy involves the use of agents that enhance the distinction between diseased and normal mucosa, either by filling surface cervices or by differential uptake by diseased epithelium. Many chromoendoscopy agents have been studied in the detection of esophageal carcinoma, of which Lugol's iodine and methylene blue have been most widely studied.""- Carcinoma of the Esophagus By Sheila C. Rankin p.31 Chromoendoscopy involves the use of stains or dyes during endoscopy to improve the visualization and characterization of the gastrointestinal mucosa. The stains are mainly Vital dyes- Lugol's solution, methylene blue, and toluidine blue or Contrast agents- indigo carmine and dilute acetic acid solution Lugol's solution Is absorbed by glycogen containing, nonketatinized squamous epithelium. Lugol's stained tissue will characteristically turn green-brown. Any condition that depletes glycogen, including inflammation, dysplasia, and early-stage cancer, will result in an absence of uptake of the dye. Lugol's iodine is used to determine the extent of BE, and to screen for squamous esophageal cancer in high-risk populations. Methylene blue dye is taken up by the cytoplasm or absorptive cells such as the normal epithelial cells of the colon and small intestine, and goblet cells, which are present in Barrett's epithelium. It will not stain nonabsorptive normal epithelium of the stomach as is found in the cardia and fundus, or normal squamous mucosa of the esophagus. Chromoendoscopy with methylene blue has been used to screen for colonic neoplasia , to diagnose BE and to screen for areas of precursor lesions and carcinoma in the stomach. Methylene blue stains barrett's epithelium as it is taken up by the cytoplasm of goblet cells. Dysplastic change is associated with a reduction in goblet cell numbers and an increasing nuclear to cytoplasmic ratio propoional to the degree of dysplasia, and such tissues absorb methylene blue to a lesser extent than surrounding cells. Increasing grades of dysplasia may appear as heterogeneous or unstained areas, allowing targeted rather than random biopsies to be taken and have been repoed to improve the detection of high-grade intraepithelial neoplasia in Barrett's esophagus. Indigo carmine Unlike Lugol's iodine or methylene blue, indigo carmine is not taken up by tissues but instead pools in crevices between epithelial cells, thereby highlighting small lesions or irregularities in the mucosal architecture. Chromodendoscopy with indigo carmine has been used to diagnose BE, and to investigate polypoid and nonpolypoid lesion in the colon.Toluidine Blue Toluidine blue stains cellular nuclei. When applied topically it preferentially identifies malignant and inflammatory tissues, in pa because of their greater nuclear/cytoplasmic ratio. It has most commonly been used for the identification of early squamous esophageal cancer. -### End" -6985,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The neonatal feature of cystic fibrosis is, with the following options: A: Bronchitis, B: Bronchiolitis, C: Meconeum ileus, D: Bronchiectasis - -### Response: -Meconium is the first stool (bowel movement) that a newborn has. This stool is very thick and sticky. Meconium ileus is a bowel obstruction that occurs when the meconium in your child&;s intestine is even thicker and stickier than normal meconium, creating a blockage in a pa of the small intestine called the ileum. Most infants with meconium ileus have a disease called cystic fibrosis. Reference: GHAI Essential pediatrics, 8th edition -### End" -6986,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inguinal ligament forms the boundaries of -, with the following options: A: Femoral triangle, B: Hesselbach's triangle, C: Both, D: None - -### Response: -Inguinal ligament forms the base of femoral triangle and also forms the inferior border of Hesselbach’s triangle. -### End" -6987,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Poiseuille’s hagen lawis, with the following options: A: F = (PA–PB) × 3.14 × r4/8nl, B: F = (PA+PB) × 3.14 × r4/8nl, C: F = (PA/PB) × 3.14 × r4/8nl, D: F = (PA × PB) × 3.14 × r4/8nl - -### Response: -Poiseuille-Hagen Formula -The relation between the flow in a long narrow tube, the viscosity of the fluid, and the radius of the tube is expressed mathematically in the Poiseuille-Hagen formula: -### End" -6988,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of upper GI bleed, with the following options: A: Gastric cancer, B: Oesophageal varices, C: Duodenal ulcers, D: Gastric ulcers - -### Response: -Answer- C. Duodenal ulcersCauses ofupper GI bleeding (in descending order)Peptic ulcer - Duodenal ulcer - gastric ulcerOesophageal varicesGastritis erosionsMallory-Weiss tearsUncommon causes - Gastric carcinoma, esophagitis, pancreatits. -### End" -6989,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epiphyseal enlargement occurs in -, with the following options: A: Paget's disease, B: Sheurmann's disease, C: Epiphyseal dysplasia, D: Hemophilia - -### Response: -Epiphyseal enlargement - -Most common causes of epiphyseal enlargement are chronic inflammation (e.g. JRA) or chronic increase in blood flow. Causes of Epiphyseal enlargement are:- - -a) Solitary (Enlargement of particular epiphysis) - -Post-inflammatory (JRA, Septic arthritis) -Perthe's disease (in repair stage) -Status post hip dislocation -Hemophilia (Hemophilic arthropathy) -Turner syndrome -Klippel-trenaunay syndrome (angiohypertrophy syndrome) -Kascibach - Merritt syndrome -Beckwith - Wiedemann syndrome (Hemihypertrophy) -Trevor disease (Dysplasia epiphysealis hemimelica) - -b) Generalized - -Hyperthyroidism    -Acromegaly or cerebral gigantism          -Adrenogenital syndrome   iv) Rickets -Spondyloepiphyseal dysplasia -McCune-Albright syndrome -Kniest syndrome -### End" -6990,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thumb print sign in plain x-ray is seen in:, with the following options: A: Ischeamic colitis, B: Ulcerative colitis, C: Pseudomembranous colitis, D: Appendicitis - -### Response: -Ans: a (Ischeamic colitis)Ref: Harrison, 17 ed. pg. 1091, 213; Grainger and Allison 5 ed. pg. 889.Thumb printing sign, i.e., bowel wall oedema seen as an early sign in ischaemic colitis. Also seen in: amoebic colitis and ulcerative colitisIschaemic colitis: Most common sites - Watershed areas of colon Splenic flexure (Griffith's point )Descending/sigmoid colon (Sudeck's point)Radiological signs in ischemic colitis:Early: Late :Thumb printing sign Pneumoperitoneum (due to (bowel wall oedema) -perforation) HallmarkPneumatosisintestinalis (air in Luminal narrowing bowel wall) Funneling of bowelOther specific radiological signs related to GIT:String sign : congenital hypertrophic pyloric stenosis String of kantor : Crohn's disease Sawtooth appear- ance : DiverticulosisWhirlpool sign : Midgut volvulus Coffee bean sign : Sigmoid volvulus Claw sign/target sign/meniscus sign:IntussusceptionBridgeThumb print sign in neck x-ray is seen in acute epiglotitis -### End" -6991,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 29 yrs aged presents with active tuberculosis, delivers baby. All of the following are indicated, EXCEPT:, with the following options: A: Administer INH to the baby, B: Withhold breast feeding, C: Give ATT to mother for 2 years, D: Ask mother to ensure proper disposal of sputum - -### Response: -Treatment of tuberculosis is not a contraindication for breast feeding. Breastfeeding should not be discouraged for women being treated with first-line anti-tuberculosis drugs because the concentrations of these drugs in breast milk are too small to produce toxicity in the nursing newborn. The child cannot be infected by the mother breast milk, unless she has tuberculous mastitis. Ref: Manual of Neonatal Care By John P. Clohey, Eric C. Eichenwald, Ann R. Stark, Page 303. -### End" -6992,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intermediate host of Toxoplasma gondi is?, with the following options: A: Cat, B: Human, C: Sheep, D: Fish - -### Response: -Cat and felines-definite host Only the asexual forms,trophozoites and tissue cysts are found in other animals including humans and birds which act as intermediate host(refer pgno:64 baveja 3 rd edition) -### End" -6993,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 32-year-old man is feeling unwell and brought to the hospital. His serum sodium is 125 mEq/L. On examination, his blood pressure is 110/70 mmHg, pulse 110/min supine, and sitting up causes him to feel lightheaded with a drop in his blood pressure. His urine sodium is 5 mEq/L and urine osmolality is 800 mOsm/kg.For the above patient with hyponatremia, select the most likely diagnosis., with the following options: A: congestive heart failure (CHF), B: extrarenal sodium and fluid losses, C: SIADH, D: polydipsia - -### Response: -The combination of ECF volume contraction and low urinary sodium (<10 mmol/L) suggests extrarenal sodium loss. Common causes are vomiting, diarrhea, or excessive sweating. -### End" -6994,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs used in prophylaxis of migraine are all except?, with the following options: A: Propanolol, B: Flunarizine, C: Topiramate, D: Levetiracetam - -### Response: -Drugs used in prophylaxis of migraine are 1.b blockers 2.Tricyclic antidepressants 3.Ca channel blockers 4.anticonvulsants Levetiracetam is used for treating epilepsy- especially paial seizures ESSENTIALS OF MEDICAL PHARMACOLOGY:KD TRIPATHI;8TH EDITION -### End" -6995,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blast crises CML are characterized by:, with the following options: A: Blast cells in blood/bone marrow > 10%, B: Blast cells in blood >/= 20%, C: Blast cells absent, D: All - -### Response: -Ans. b (Blast cells in blood >/= 20%). (Ref. Harrison, 17th, Chapter 104; 18th/Chapter 109. ; Robbins, Pathology, 7th, 314, 697)CML# Disease acceleration is defined by:- Development of increasing degrees of anemia unaccounted for by bleeding or therapy;- Cytogenetic clonal evolution; or- Blood or marrow blasts between 10 and 20%,- Blood or marrow basophils 20%, or- Platelet count <100,000/L.# Blast crisis is defined as:- Acute leukemia, with blood or marrow blasts 20%.- Hyposegmented neutrophils may appear (Pelger-Huet anomaly).# Very low leukocyte alkaline phosphatase i.e. LAP score is feature of CML (vs. leukemoid reaction).# Imatinib is DOC for CML.Blast cells can be classified as myeloid, lymphoid, erythroid, or undifferentiated, based on morphologic, cytochemical, and immunologic features. Occurrence of de novo blast crisis or following imatinib is rare. -### End" -6996,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Axial proptosis is produced by tumors lying in -, with the following options: A: Retrobulbar space, B: Subperiosteal space, C: Tenon space, D: Peripheral space - -### Response: -The central space. It is also called muscular cone or retrobulbar space. It is bounded anteriorly by the Tenon's capsule lining back of the eyeball and peripherally by the four recti muscles and their intermuscular septa in the anterior pa. In the posterior pa, it becomes continuous with the peripheral space. Tumours lying here usually produce axial proptosis. Retrobulbar injections are made in this space. Other surgical spaces of orbit include: 1. The subperiosteal space. This is a potential space between the bone and the periorbita (periosteum). 2. The peripheral space. It is bounded peripherally by the periorbita and internally by the four recti with thin intermuscular septa. Tumours present here produce eccentric proptosis and can usually be palpated. For peribulbar anaesthesia, injection is made in this space. 3. Tenon's space. It is a potential space around the eyeball between the sclera and Tenon's capsule. Ref: Comprehensive Ophthalmoogy, A.K. Khurana - 4th edition. -### End" -6997,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is the COMMONEST complication of CSOM?, with the following options: A: Subperiosteal abscess, B: Mastoiditis, C: Brain abscess, D: Meningitis - -### Response: -Mastoiditis is the most common complication of otitis media. Mastoiditis refers to inflammation of the air cells in the mastoid process. Patients usually presents with fever and local pain. The classic triad consists of: Prominent auricle with retro orbital swelling Tenderness over the mastoid Otorrhea It is best diagnosed using CT scan. It shows clouding of the mastoid air cells and middle ear spaces. It can also demonstrate erosion of the mastoid bone structure. -### End" -6998,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Displacement reaction is characteristically seen in :, with the following options: A: Mania, B: Phobia, C: Conversion disorder, D: Depression - -### Response: -B i.e. Phobia -### End" -6999,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common benign tumour of middle ear is:, with the following options: A: Adeno carcinoma, B: Squamous cell carcinoma, C: Glomus tumour, D: Acoustic neuroma - -### Response: -(c) Glomus tumour(Ref. Cummings, 6th ed., 2738)Most common benign tumour of middle ear is glomus tumour.Acoustic neuroma is the most common benign tumour of the CP angle.Squamous cell carcinoma is the most common carcinoma of the middle ear.Adenocarcinoma is an occasional glandular tumour of the middle ear. -### End" -7000,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cu 380A should be replaced once in, with the following options: A: 4years, B: 6years, C: 8years, D: 10years - -### Response: -Change of IUDs Ine IUDs such as Lippes Loop may be left in place as long as required, if there are no side-effects. Copper devices cannot be used indefinitely because copper corrodes and mineral deposits build up on the copper affecting the release of copper ions. They have to be replaced periodically. The same applies to the hormone-releasing devices. This is an inherent disadvantage of medicated devices when they are used in large national family planning programmes. The Cu-T -380A is approved for use for 10 years. However, the Cu-T -380A has been demonstrated to maintain its efficacy over at least 12 years of use. The Cu-T -200 is approved for 4 years and the Nova T for 5 years. The progesterone-releasing IUD must be replaced every year because the reservoir of progesterone is depleted in 12-18 months. The levonorgestrel IUD can be used for at least 7 years, and probably 10 years. The progesterone IUD has a slightly higher failure rate, but the levonorgestrel device that releases 15-20 ug levonorgestrel per day is as effective as the new copper IUDs Ref : Park 25th edition Pgno : 531-548 -### End" -7001,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All help in protein folding except, with the following options: A: Chaperons, B: Zinc finger motiff, C: Protein disulfide isomerase, D: Proline-cis, trans- isomerase - -### Response: -Zinc finger motiff The specificity involved in the control of transcription requires that regulatory proteins bind with high affinity to the Correct region of DNA. Three unique motifs - The helix-turn-helix - Zinc finger - The leucine zipper accounts for many of this specific protein DNA interactions. So zinc finger motiff helps in binding of regulatory proteins to DNA and not in protein folding. -### End" -7002,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for a pregnant lady with upper abdominal mass, with the following options: A: Barium meal, B: MRI, C: CT scan, D: DSA - -### Response: -Ans. MRI -### End" -7003,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the term given to the relationship of the fetus to the long axis of the uterus?, with the following options: A: The Presentation, B: The Lie, C: The Engagement, D: The Version - -### Response: -Ans. B. The Lie'Fetal lie' is referred as the relation between fetal long axis and the mother. This can either be transverse or longitudinal.In some cases, the maternal and fetal axes may cross at a 45-degree angle, resulting in the formation of an oblique lie This is not stable and always becomes either transverse or longitudinal at the time of labor.Longitudinal lie is present in more than 99 percent of labor.Following list are the predisposing factors for transverse lies:* Hydramnios* Uterine Anomalies* Multiparity* Placenta PreviaThe part of the fetal body that is either foremost within the birth canal or in closest proximity to it is mainly the presenting portion.The mechanism by which the biparietal diameter passes through the pelvic inlet is designated engagement.Know more: Biparietal diameter is the greatest transverse diameter in an occiput presentation. -### End" -7004,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 year old boy presents with acute onset gross hematuria, loin pain, and diarrhea. Peripheral smear examination is normal. There is no history of decreased urine output. Serum C3 levels are normal. Probable diagnosis is?, with the following options: A: Berger's disease, B: PSGN, C: Microangiopathic hemolytic anemia, D: None of the above - -### Response: -In Berger's disease (IgA Nephropathy) gross Hematuria occurs within 1-2 days of onset of an upper respiratory or GI infection (Note:skin infection leads to poststreptococcal glomerulonephritis (PSGN) and not IgA nephropathy). Mild to moderate hypeension can be seen May be associated with loin pain Normal serum levels of C3 in IgA nephropathy help to distinguish this disorder from poststreptococcal glomerulonephritis (PSGN) where serum C3 levels are low. Serum IgA levels have no diagnostic value in IgA nephropathy because they are elevated in only 15% of pediatric patients. -### End" -7005,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 12 years old Shyam presented with gross hematuria with elevated serum immunoglobulin A. 2 days before he had mild upper respiratory tract infection. Diagnosis is:, with the following options: A: Microangiopathic thrombotic anaemia, B: IgA Nephropathy, C: PSGN, D: H.S. purpura - -### Response: -When asymptomatic gross hematuria appears to accompany a minor acute febrile illness or other stressful occurrence, the diagnosis of IgA nephropathy may be enteained. In contrast to postinfection GN, IgA nephropathy is not associated with prior streptococcal infection, complement is not depressed, and in 50% of cases, serum immunoglobin A is elevated. Often there are no associated symptoms or signs. Gross hematuria resolves within days, and there are no serious sequelae in 85% of cases. Treatment is not indicated, and the prognosis is good in most cases. Ref: Lum G.M. (2012). Chapter 24. Kidney & Urinary Tract. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e. -### End" -7006,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False statement about common bile duct -, with the following options: A: Lies in free margin of lesser omentum, B: Anterior to first part of duodenum, C: Right to hepatic artery, D: Anterior to portal vein - -### Response: -Bile duct (upper third or supraduodenal part) passes downwards in the free margin of lesser omentum (hepatoduodenal ligament), behind the liver, anterior to the portal vein and to the right of hepatic arteryQ. Middle third (retro duodenal) part and lower third (infraduodenal - pancreatic) portion curves behind the first (1st) part of duodenum and head of pancreas respectively; whereas both parts run in front of (anterior to) IVC. -### End" -7007,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Demyelination is the major feature of Multiple Sclerosis. Which of the following cells forms myelin in the central nervous system?, with the following options: A: Astrocytes, B: Ependymal cells, C: Microglia, D: OIigodendrocytes - -### Response: -The myelin sheath is formed by oligodendrocytes in CNS and by Schwann cells in the peripheral nervous system (PNS). The gaps formed between myelin sheath cells along the axons are called nodes of Ranvier. Since the lipid structure of myelin serves as a good insulator, the myelin sheaths increase the rate of propagation and efficacy of transmission of the impulse along the axon. The electrical impulse jumps from one node to the next at the rate as fast as 120 m/s. This rapid type of conduction is called saltatory conduction. Demyelination can occur early in life as consequence of congenital metabolic disorders. Demyelination later in life can be repaired with glia, which explains the frequent exacerbations and remissions in MS. It is believed that in MS, multiple mechanisms of immune injury of myelin coexist: cytokine-mediated injury of oligodendrocytes and myelin, digestion of surface myelin antigens by macrophages, complement-mediated injury, and direct injury by CD4+ and CD8+ T cells. This type of injury causes the loss of saltatory conduction in nerve fibers. The exposed axon is susceptible to fuher injury, resulting in irreversible axonal damage. Glial cells do not carry action potentials, but they have many impoant functions. There are several types of glial cells: astrocytes, which transpo nutrients to neurons, hold neurons in place, digest pas of dead neurons, and regulate the composition of extracellular space, and microglia, which possess phagocytic function, clean up debris, and protect the brain from microorganisms.Ependymal cells form the epithelial lining of the ventricle. Ref: Lomen-Hoeh C., Messing R.O. (2010). Chapter 7. Nervous System Disorders. In S.J. McPhee, G.D. Hammer (Eds), Pathophysiology of Disease, 6e. -### End" -7008,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If one wants to compare variation in two variables,which unit of measurement should be used, with the following options: A: Standard detion, B: Percentile, C: Variance, D: Coefficient of variance - -### Response: -Ref:Park's Textbook of Preventive and Social Medicine 25th Ed -### End" -7009,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Morbid jealousy is?, with the following options: A: Delusion of love, B: Delusion of infidelity, C: Delusion of persecution, D: Delusion of grandiose - -### Response: -Ans. is 'b' i.e., Delusion of infidelity Morbid jealousy (Pathological jealousy)* Also referred to as delusional jealously, obsessive jealousy and Othello syndrome. This condition occurs when a person feels an unreasonable fear that a partner has been unfaithful, is presently unfaithful, or plans to be unfaithful.* Morbid jealousy can occur in alcoholism, Schizophrenia, manic phase of bipolar illness, OCD, depression, or anxiety disorder.Also knowAlcoholic paranoia falcohal induced psychotic disorder with delusions)* Alcoholic parania refers to alcohol induced psychotic disorder with delusions. Delusions in alcoholic paranoia are fixed, ie. Alcoholic paranoia is associated with fixed delusions. Patients develop delusion of either persecution or jealousy, accompanied by delusion of reference. Auditary hallucinations may occur but play a minor role. -### End" -7010,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Hashimotos thyroiditis there is infiltration of, with the following options: A: Macrophages, B: Neutrophiks, C: Leukocytes, D: Eosinophils - -### Response: -Robbins page no 1087MORPHOLOGY The thyroid is often diffusely enlarged, although more localized enlargement may be seen in some cases. The capsule is intact, and the gland is well demarcated from adjacent structures. The cut surface is pale, yellow-tan, firm, and somewhat nodular. There is extensive infiltration of the parenchyma by a mono- nuclear inflammatory infiltrate containing small lympho- cytes, plasma cells, and well-developed germinal centers (Fig. 24-11). The thyroid follicles are atrophic and are lined in many areas by epithelial cells distinguished by the presence of abun- dant eosinophilic, granular cytoplasm, termed Huhle cells. This is a metaplastic response of the normally low cuboidal follicular epithelium to ongoing injury. In fine-needle aspiration biopsy samples, the presence of Huhle cells in conjunction with a heterogeneous population of lymphocytes is character- istic of Hashimoto thyroiditis. In ""classic"" Hashimoto thyroiditis, interstitial connective tissue is increased and may be abundant. Unlike Reidel thyroiditis (see later), the fibrosis does not extend beyond the capsule of the glands -### End" -7011,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Indication of internal podalic version is?, with the following options: A: Transverse lie, B: Transverse lie of second twin, C: Breech, D: Polyhydramnios - -### Response: -ANSWER: (B) Transverse lie of second twin REF: Dutta 6ch ed p. 388The only indication of internal cephalic version is transverse lie in the second twin -### End" -7012,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about pheochromocytoma except:, with the following options: A: 90% are malignant, B: 95% occur in the abdomen, C: They secrete catecholamines, D: They arise from sympathetic ganglions - -### Response: -Only 10% are malignant. They are also called 10 % tumors because 10% are bilateral, 10% are extra adrenal, 10% occur in pediatric patients, 10% are familial. One ""traditional"" 10% rule that has now been modified peains to familial cases. It is now recognized that as many as 25% of individuals with pheochromocytomas and paragangliomas harbor a germline mutation in one of at least six known genes -### End" -7013,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Boundaries of Koch's triangle is not formed by:, with the following options: A: Tricuspid Valve Ring, B: Coronary Sinus, C: Limbus fossa ovalis, D: Tendon of Todaro - -### Response: -Ans. C. Limbus fossa ovalisKoch's triangle, named after the German pathologist and cardiologist Walter Karl Koch, is an anatomical area located in the superficial paraseptal endocardium of the right atrium, which its boundaries are the coronary sinus orifice, tendon of Todaro, and septal leaflet of the right atrioventricular valve. It is anatomically significant because the atrioventricular node is located at the apex of the triangle. -### End" -7014,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about H I NI influenza except:, with the following options: A: Zanamivir commonly given through IV route, B: Fatality more in some high risk group, C: -PCR is used for investigation, D: WHO latest trivalent influenza vaccine contains two influenza A subtypes (H3N2 and H1N1) and one influenza B component - -### Response: -Answer (a) Zanamivir commonly given through IV route WHO: It is recommended that trivalent vaccines for use in the 2017 southern hemisphere influenza season contain the followingAn A/Michigan/45/2015 (H1N1)pdm09-like virus;An A/Hong Kong/4801/2014 (H3N2)-like virus; andA B/Brisbane/60/2008-like virus.-PCR provides the most timely and sensitive detection of the infectionPandemic influenza A (Hl nl) Treatment: oseltamivir adult oral dose is 75 mg twice daily for 5 days. Zanamivir dose is two inhalation (2 x 5 mg) twice daily for 5 days -### End" -7015,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prolonged pregnancy is the one that exceeds, with the following options: A: 390/7, B: 400/7, C: 410/7, D: 420/7 - -### Response: -The international definition of prolonged pregnancy, endorsed by the American College of Obstetricians and Gynecologists (2016b,d) is one that exceeds 420/7 weeks, namely, 294 days or more from the first day of the last menstrual period.Reference: William's Obstetrics; 25th edition; Chapter 43; Postterm pregnancy -### End" -7016,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statements regarding DMPA includes all the following except, with the following options: A: 3% failure rate, B: Useful in treatment of menorrhagia, C: Can be given in women with seizures, D: Protects against ovarian cancer - -### Response: -Risk of endometrial cancer is substantially reduced by past use of DMPA. -Noncontraceptive benefits of DMPA: - -Anemia, PID, Ectopic pregnancy, and Endometrial cancer are reported. -DMPA benefits women with sickle cell disease. -### End" -7017,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An infant presents with the condition as shown below after a pharyngeal infection. The shown condition is:, with the following options: A: Staphylococcal scalded skin syndrome, B: Epidermolysis bullosa simplex, C: Impetigo contagiosa, D: Pemphigus foliaceus - -### Response: -SSSS/ Pemphigus Neonatorum / Ritter's disease: - Caused by: Staph. aureus - Seen in neonates and infants - Usually follows pharyngeal infection. - Staph. aureus releases Exfoliative toxins A & B that destroys Desmoglein 1 - Mucosal involvement absent - Epidermal separation occurs superficially. - Nikolsky sign positive - when pressure applied tangentially to skin, overlying epidermis will separate. Treatment of SSSS - Usually requires hospitalisation i/v antibiotics are given. A penicillinase-resistant, anti-staphylococcal antibiotic such as flucloxacillin is used. Other antibiotics include nafcillin, oxacillin, cephalosporin and clindamycin. -### End" -7018,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Skin grafting is absolutely C/I in which skin infection-, with the following options: A: Staphylococus, B: Pseudomonas, C: Streptococus, D: Proteus - -### Response: -""The skin graft generally survives when placed over the wounds containing less than 105 organisms per gram of tissue unless the organisms are streptococci, which can rapidly dissolve transplanted skin."" - S. Das 3/e, p 142 -### End" -7019,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is DASH?, with the following options: A: Dietary approaches to stop hypeension, B: Domestic approach to safeguard hepatitis, C: Dietary approaches to stop hyperlipidemia, D: Domestic approaches to stop hemorrhage - -### Response: -DASH DIET (DIETRARY APPROACHES TO STOP HYPEENSION) : Description: dietary pattern promoted to prevent and control hypeension. DASH diet is rich in fruits, vegetables and has low-fat poultry products , nuts & beans; and limited sugar-sweetened foods and beverages, red meat . DASH reduces SBP by 6 mm Hg, DBP by 3 mm Hg in high BP. DASH leads to no changes on daily intake of 1,600-3,100 calories. -### End" -7020,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Waldenstrom's macroglobulinemia is characterized by all except, with the following options: A: IgE sereting clone of plasma cells, B: Hyperviseosity symptoms, C: Hepatosplenomegaly, D: Lymphadenopathy - -### Response: -Waldenstrom macroglobulinaemia is a low grade lymphoplasmacytoid lymphoma associated with an Ig M paraprotein, causing clinical featurws of hyperviscosity syndrome.Other features include anemia,splenomegaly & lymphadenopathy. Reference:Davidson's principles &practice of medicine 22nd edition pg no 1045. -### End" -7021,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The amino acid producing (a major source of) ammonia in the kidney is, with the following options: A: Glutamine, B: Alanine, Aspartate, C: Methionine, D: Glycine - -### Response: -Formation and secretion ammonia by renal tubular cells maintain acid-base balance. Ammonia is formed from glutamine by glutaminase. -### End" -7022,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Low bih weight baby is defined as baby weighing: September 2006, with the following options: A: 1000 gm, B: 1500 gm, C: 2000 gm, D: 2500 gm - -### Response: -Ans. D: 2500 gm Low bih weight (LBW) is defined as a fetus that weighs less than 2500 g (5 lb 8 oz) regardless of gestational age. Other definitions include Very Low Bih Weight (VLBW) which is less than 1500 g, and Extremely Low Bih Weight (ELBW) which is less than 1000 g. Normal Weight at term delivery is 2500 g - 4200 g. SGA is not a synonym of LBW, VLBW or ELBW. Small for gestational age (SGA) babies are those whose bih weight, length, or head circumference lies below the 10th percentile for that gestational age -### End" -7023,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prognosis of carcinoma breast depends on-, with the following options: A: Lymph node status, B: Size of tumor, C: Skin involvement, D: Peude orange - -### Response: -Ans. is 'a' i.e.. Lymph node status o ""Metastasis to ipsilateral axillary nodes predicts outcome after surgery more powerfully than tumor size does ""o ""The single most important predictor of 10 and 20 year survival rates in breast cancer is the number of axillary lymphnodes involved with metastatic disease"". -### End" -7024,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preload leads to, with the following options: A: Isovolumetric relaxation, B: Isovolumetric contraction, C: Peripheral resistance, D: Parasympathetic nervous system activation - -### Response: -The force of contraction of cardiac muscle depends on its preloading and its after loading. The initial phase of contraction is isometric; the elastic component in series with the contractile element is stretched and the tension increases until it is sufficient to lift the load. The tension at which load is lifted is the afterload. The muscle then contracts isotonically. In vivo preload is the degree to which myocardium is stretched before it contracts.Ref: Ganong&;s Review of medical physiology, 24th edition.Pg no. 547 -### End" -7025,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A truck driver has chronic cough with fever since one month. Chest x-ray show bilateral reticulonodular infiltrates in mid and lower zones. Which of the following is possible diagnosis?, with the following options: A: Tuberculosis, B: ILD, C: Pneumococcal pneumonia, D: Pneumocystis carini pneumonia - -### Response: -Patients with Pneumocystis pneumonia develop dyspnoea,fever,and non productive cough.The classic findings on chest radiography consist of bilateral diffuse infiltrates beginning in the perihilar regions,but various atypical manifestations(nodular densities,cavitary lesions) have also been repoed.HRCT shows groundglass opacities in earlier stage. Reference:Harrison's medicine-18th edition,page no:1671. -### End" -7026,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: RDA of calcium for a normal adult male is:, with the following options: A: 100 mg, B: 400 mg, C: 800 mg, D: 1200 mg - -### Response: -400 mg -### End" -7027,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A one year old child presented with multiple fractures seen in various stages of healing. The most probable diagnosis in this case is, with the following options: A: Scurvy, B: Rickets, C: Battered baby syndrome, D: Sickle cell disease - -### Response: -.Battered child syndrome: A disease in which children are physically abused. The battered child syndromeis a form of child abuse. Not until the 19th century were children granted the same legal status as domesticated animals in regard to protection against cruelty and/or neglect. -### End" -7028,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 2-year-old child presents with sho stature and cafe-au lait spots. Bone marrow aspiration yields a little material and mostly containing fat. What is your diagnosis:, with the following options: A: Fanconi anemia, B: Dyskeratosis congenita, C: Tuberous sclerosis, D: Osteogenesis imperfecta - -### Response: -- All features given in the question suggests the diagnosis of Fanconi anemia Common physical findings in Fanconi Anemia (FA): - Skin pigment changes including Cafe-au-lait spots (55% cases) - Sho stature (in 50% cases) - Microcephaly - Thumb and radial malformations - Renal and cardiac malformations - Hypogonadism - Associated with Aplastic anemia. -### End" -7029,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vi antigen found in -, with the following options: A: Salmonella paratyphi 'C', B: Salmonella Typhi, C: Salmonella dublin, D: All - -### Response: -Ans :D.)All The Vi antigen, is a capsular polysaccharide found mainly in Salmonella typhi and S. paratyphi C, as well as in a few strains of S. dublin and Citrobacter freundii -### End" -7030,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Female is affected, male is not. Disease is autosomal dominant, what is the chance in children?, with the following options: A: 50% affected, B: 25% affected, C: 75% affected, D: All affected - -### Response: -Robbins basic pathology 9th edition page no 218,Heading =Transmission patterns of single-gene disorders Disorders of autosomal dominant inheritance are manifested in the heterozygous state, so atleast in an index case usually is affected, both males and females are affected, and both can transmit the same. When an affected person marries an unaffected person, every one chance in two of having the disease. Thus there is 50%of the chidren may be affected -### End" -7031,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 45 yrs old Ramlal has intraabdominal sepsis. The causative organism was found to be vancomycin, gentamycin and ampicillin resistant. It grows well in presence of 6.5% NaCl and arginine. Bile esculin hydrolysis is positive. Which of the following is this organism, with the following options: A: Streptococcus agalactiae, B: Enterococcus fecalis, C: Streptococcus bovis, D: Streptococcus pneumoniae - -### Response: -Enterococci are present in the intestine, genital tract and saliva. They are frequently isolated from cases of urinary tract infection and wound infection. Also causes endocarditis, infection of the biliary tract, septicemia and intra-abdominal abscess complicating diveiculitis and peritonitis. Strains resistant to Penicillin and other antibiotics occur frequently, so it is essential to perform antibiotic sensitivity for proper therapy. Enterococci are intrinsically resistant to cephalosporins and offer low-level resistance to aminoglycosides. In penicillin-sensitive strains, synergism occurs with combination treatment with Penicillin and aminoglycosides. If strains showed high-level resistance to aminoglycosides, this synergism does not occur. The drug of choice in such cases is vancomycin. Recently vancomycin-resistant Enterococci have begun to emerge. The phenotypes are Van A, B, C, D and E. The mechanism is an alteration of D-alanyl-D-alanine chain in the cell wall. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 219, 220 -### End" -7032,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A driver wearing seat belt applied brake suddenly to avoid accident. Most common organ injured in seat belt injury, with the following options: A: Liver, B: Spleen, C: Mesentery, D: Abdominal aorta - -### Response: -Most common seat belt injury is mesentery -### End" -7033,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug not used in prophylaxis of bipolar disorder ?, with the following options: A: Haloperidol, B: Lithium, C: Carbamazepine, D: Valproate - -### Response: -Ans. A. HaloperidolProphylactic treatment for bipolar disorder:Lithium (drug of choice)CarbamazepineValproateOther drugs which can be used are topiramate, Lamotrigine, atypical antipsychotics (apiprazale, olanzapine,quetiapine, risperidone, Clozapine) and Gabapentin. -### End" -7034,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following lymphoma is associated with translocation of c-myc gene on chromosome 8?, with the following options: A: Burkitt's lymphoma, B: Mantle cell lymphoma, C: Follicular lymphoma, D: Anaplastic large cell lymphoma - -### Response: -All forms of Burkitt lymphoma are highly associated with translocation of MYC gene on chromosome 8 that lead to increased MYC protein levels. Mantle cell lymphomas have an (11;14) translocation involing the IgH locus on chromosome 14 and the cyclin D1 locus on chromosome 11 that leads to overexpression of cyclin D1. In follicular lymphoma there (14;18)translocation that juxtaposes the IGH locus on chromosome 14 and BCL2 locus on chromosome 18. In Anaplastic large cell lymphoma there is rearrangement of ALK. REFERENCE; ROBBINS AND COTRAN PATHOLOGIC BASIS OF DISEASE.SOUTH ASIA EDITION VOLUME 1.PAGE NO. 591,594,597,602 -### End" -7035,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Giardiasis may result in the following except-, with the following options: A: III health, B: Diarrhea, C: Steatorrhea, D: Gastrointestinal bleeding - -### Response: -Giardiasis Infection with Giardia lamblia is found worldwide and is common in the tropics. It paicularly affects children, tourists and immunosuppressed individuals, and is the parasite most commonly impoed into the UK. In cystic form, it remains ble in water for up to 3 months and infection usually occurs by ingesting contaminated water. Its flagellar trophozoite form attaches to the duodenal and jejunal mucosa, causing inflammation. Clinical features and investigations After an incubation period of 1-3 weeks, there is diarrhoea, abdominal pain, weakness, anorexia, nausea and vomiting. Onexamination, there may be abdominal distension and tenderness.Chronic diarrhoea and malabsorption may occur, with bulky stools that float. Stools obtained at 2-3-day intervals should be examined for cysts. Duodenal or jejunal aspiration by endoscopy gives a higher diagnostic yield. The 'string test' may be used, in which one end of a piece of string is passed into the duodenum by swallowing and retrieved after an overnight fast; expressed fluid is then examined for the presence of G. lamblia trophozoites. A number of stool antigen detection tests are available. Jejunal biopsy specimens may show G. lamblia on the epithelial surface. Management Treatment is with a single dose of tinidazole 2 g, metronidazole 400 mg 3 times daily for 10 days, or nitazoxanide 500 mg orally twice daily for 3 days. Ref Harrison20th edition pg 1154 -### End" -7036,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anaesthetic having epileptogenic potential is, with the following options: A: Desflurane, B: Sevoflurane, C: Ether, D: Halothane - -### Response: -Sevoflurane Enflurane Isoflurane Have epileptic potentials Refer Katzung 11/e p 432L -### End" -7037,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Regarding oncogenesis, all are true except:, with the following options: A: Proto-oncogenes are activated by chromosomal translocation, B: Malignant transformations involves accumulation of mutations in proto-oncogenes and tumor suppressor genes, C: Point mutation of somatic cells, D: Increase in telomerase activity causes anti-tumor effects - -### Response: -Activation of proto-oncogene results in cancer causing oncogenes by following mechanisms: -### End" -7038,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Scalp and face are involved in ?, with the following options: A: Adult scabies, B: Nodular scabies, C: Infantile scabies, D: None - -### Response: -Ans. is 'c' i.e., Infantile scabies Type Feature o Infantile scabies Scalp, face, palms and soles are involved o Norwegian scabies Crusted hyperkeratotic lesions on face , palms, soles, nails. Itching is not prominent. Mites are found in thousand, most severe form of scabies Crusted scabies Extensive crusts Nodular scabies Extensive crusts Genital scabies Extensive crusts Animal scabies History of contact with cat or dog. Atypical presentation -### End" -7039,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Tissue cartilages tendons are best visualized by:, with the following options: A: CT, B: MRI, C: Radionucleid scan, D: Ultrasound - -### Response: -(MRI - 246-Sutton 7th)* There is little doubt however that MR is superior to other techniques in the detection and discrimination of most aspects of soft tissues except fine calcification, and is the method of choice in the investigation of musculoskeletal and joint lesions.* It can differentiates muscle, tendon, cartilage, discs, menisci, nerves, blood vessels, fat and bone and has multi planar and contrast enhanced ability. -### End" -7040,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Right anterior oblique view of chest X–ray true is/are – a) Cassette near right shoulderb) Cassette near left shoulderc) Arch of Aorta best seend) Left atrial enlargement can be diagnosede) Mitral & tricuspid valves better seen, with the following options: A: ad, B: c, C: ac, D: ab - -### Response: -In RAO view of chest, the patient is rotated 45° to the left (right side is more forward) and the cassette is close to the right front (right shoulder) of the patient. The RAO view is generally used for the assessment of the pulmonary artery, right ventricle, and size of the left atrium. -### End" -7041,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are DNA binding domains found in transcription factors, EXCEPT, with the following options: A: Zinc finger, B: Helix-turn-Helix, C: Helix-loop-helix, D: Basic domains - -### Response: -DNA binding domains found in transcription factors DNA binding domains in transcription factors Zinc finger Helix-turn-Helix Basic domains Helix-loop-helix (HLH) Dimerisation domain, Not DNA-binding domain. Proteins with HLH also contains a separate DNA binding domain made up of basic amino acids. E.g. Hypoxia-inducible factor (HIF) MyoD MITF (Microphthalmia-associated transcription factor) -### End" -7042,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Screening under RNTCP emphasizes on, with the following options: A: Sputum microscopy, B: Chest X-ray, C: PCR, D: Sputum culture - -### Response: -Over-reliance on chesl X-ray was a draw back of National Tuberculosis Programme (NTP) which was over come by Revised National Tuberculosis Control Programme(RNTCP) which staed diagnosing patient by sputum microscopy &;A nation-wide network of RNTCP qaality assured designated sputum smear microscopy laboratories has been set up, providing appropriate, available, affordable and accessible diagnostic services for TB suspects and cases. Ref: Park 24th edition -### End" -7043,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum energy is liberated by hydrolysis of ?, with the following options: A: Creatine phosphate, B: ATP, C: Phosphoenol pyruvate, D: Glucose-6-phosphate - -### Response: -A compound that liberates 7 Kcal/n:ol or more on hydrolysis is called high energy compound, or a compound that on hydrolysis undergoes a large (. 7 kcal/mol) decrease in free energy (AG) under standard condition is called high energy compound, i.e., AG - 7 Kcal/mol. -### End" -7044,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a component of medial column of reticular formation?, with the following options: A: Raphe nuclei, B: Magnocellular, C: Subcuneiform nucleus, D: Cuneiform nucleus - -### Response: -Medial column of nuclei are made up of large size neurons hence this column is called magnocellular column.The medial group of nuclei consists of ventral reticular nucleus(medulla), gigantocellular nucleus(medulla and pons) and oral and caudal pontine nuclei(pons).Raphe nuclei forms the median column of reticular formation. It consists of dorsal raphe nucleus(midbrain), nucleus raphe pontis( pons), nucleus raphe magnus( medulla).The midbrain reticular formation consists of the dorsal tegmental nucleus, ventral tegmental nucleus, and cuneiform nucleus. Along with the oral pontine reticular nucleus, the midbrain reticular formation projects to the nucleus gigantocellularis.(Ref: vishram Singh textbook of clinical neuroanatomy second edition pg 226) -### End" -7045,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vincent's angina is caused by Borrelia vincenti along with-, with the following options: A: Lactobacillus, B: Peptostreptococcus, C: Fusobacterium, D: Bacteroides - -### Response: -Ans. is 'c' i.e., Fusobacterium o Vincent angina, also called trench mouth, is acute necrotizing ulcerative gingivitis.o It is an acute infection of gums characterized by pain, bleeding and ulcerationo It is caused by coinfection of Borrelia vincenti with fusobacterium. -### End" -7046,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Enzymes found in CSF:, with the following options: A: GGT + ALP, B: ALP + CK-MB, C: CK + LDH, D: Deaminase and Peroxidase - -### Response: -Ans. c. CK + LDH (Ref: Textbook of Medical Biochemistry by Dinesh Puri 2/e p154, 155)CK (Subunit composition BB) and LDH-3 (Subunit composition HHMM) are found in brain (CSF).Tissue Distribution of Lactate Dehydrogenase IsoenzymeIsoenzymeSubunit compositionTissuePercentage in serumLDH-1HHHHMyocardium, RBCQ30LDH-2HHHMMyocardium, RBCQ35LDH-3HHMMBrainQ, kidney20LDH-4HMMMSkeletal muscle, liverQ10LDH-5MMMMSkeletal muscle, liverQ5 Characteristics of CK IsoenzymesIsoenzymeSubunit compositionTissuePercentage in serumCKBBBrainQ30CKMBHeartQ35CKMMSkeletal muscleQ20 -### End" -7047,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prevalence of schizophrenia in dizygotic twins of schizophrenic patient is, with the following options: A: 40%, B: 1%, C: 12%, D: 0.10% - -### Response: -Usual prevalence in general population is 0.5 to 1% and 40% in child with both parents being schizophrenic. Among dizygotic twins, it is 12% if a parent is schizophrenic Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 386 -### End" -7048,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which disorder is associated with convulsions cataract and mental retardation?, with the following options: A: Galactosaemia, B: Phenylketonuria, C: Tyrosinemia, D: Maple syrup disease - -### Response: -Galactosemia is associated with convulsions, cataract and mental retardation. Uridyl transferase deficiency leads to galactosemia. Impoant features: Jaundice, hepatomegaly, vomiting, hypoglycemia, convulsions, lethargy, irritability, feeding difficulties, poor weight gain, aminoaciduria, cataract, vitreous hemorrhage, hepatic cirrhosis, ascites, splenomegaly, or mental retardation.Patients with galactosemia are at increased risk for Escherichia coli neonatal sepsis.Transferase deficiency galactosemia is an autosomal recessive trait. -### End" -7049,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During normal conversation, sound heard at 1meter distance is, with the following options: A: 60dB, B: 80dB, C: 90dB, D: 120dB - -### Response: -At a distance of 1 m, intensity of Whisper = 30 dB Normal conversation = 60 dB Shout = 90 dB Discomfo of the ear = 120 dB Pain in the ear = 130 dB Ref: Dhingra 7e pg 21. -### End" -7050,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Post translational modification in the form of sulfation of tyrosine residue happen in which GIT hormone:, with the following options: A: Gastrin, B: Somatostatin, C: CCK, D: VIP - -### Response: -Post translational modification is responsible for ceain changes in the peptide structure of GIT hormones, eg: 1. Peptide cleavage to smaller forms occurs in case of somatostatin 2. Amidation of the carboxyterminus occurs in the case of Gastrin 3. Sulfation of the tyrosine residue in the case of CCK (Cholecystokinin). Sulfated CCK is 100 times more potent than normal CCK. Ref: Sleisenger and Fordtrans, Edition-9, Page -6. -### End" -7051,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following drug is not used for the treatment of type II lepra reaction, with the following options: A: Chloroquin, B: Thalidomide, C: Cyclosporine, D: Coicosteroids - -### Response: -C i.e. Cyclosporine -### End" -7052,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mycosis cells are altered :, with the following options: A: T Lymphocytes, B: Monocytes, C: b lymphocytes, D: Eosinophils - -### Response: -A. i.e. T lymphacytis -### End" -7053,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an Omega-3 fatty acid?, with the following options: A: Linoleic acid, B: a-Linolenic acid, C: Oleic acid, D: Arachidonic acid - -### Response: -Box 7.3. Clinical Significance of PUFALinoleic and Linolenic acids are polyunsaturated fatty acids.They are called essential fatty acids because they cannot be synthesized by the body and have to be supplied in the diet.Unsaturated fatty acids are also designated o3 (omega 3) family--Linolenic acids o6 family--Linoleic and Arachidonic acids (Fig.7.2) o9 family--Oleic acidArachidonic acid is the precursor of prostaglandins. Arachidonic acid can be synthesized in the body, if the essential fatty acids are supplied in the diet.The pentatonic acid present in fish oils is of great nutritional impoance (o3 unsaturated fatty acid).Eicosanoids (eicosa = twenty) are derived from 20 C arachidonic acid. They are polyenoic fatty acids. They are prostanoids (prostaglandins, prostacyclins, thromboxanes) and leukotrienes.Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 76 -### End" -7054,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Radiation emitts by Ir-192:, with the following options: A: 0.5 Mev, B: 0.6 Mev, C: 0.66 Mev, D: 0.47 Mev - -### Response: -D i.e. 0.47 Mev -### End" -7055,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 20-year-old male presented with pain in the right shoulder region which aggravated with activity. On examination, a mass was felt in the right shoulder region which was warm and tender, had increased surface vascularity and a bruit was discernable over the mass. There was decreased range of motion of the right shoulder joint. X-ray of the concerned area was done. Radionuclide scan was also carried out. The tumour was resected and sent for HPE examination. Which is the most likely diagnosis in the above scenario: -, with the following options: A: Osteosarcoma, B: GCT, C: Osteoid osteoma, D: Osteoblastoma - -### Response: -This is a case of osteosarcoma. 1ST image shows impressive swelling throughout the deltoid region, as well as the disuse atrophy of the pectoral musculature. Radiographic appearance of a proximal humeral osteosarcoma with the radiodense matrix of the intramedullary poion of the lesion, as well as the soft-tissue extension and aggressive periosteal reaction. Intense radionuclide uptake of the proximal humerus is noted on a bone scan. The tumor cells vary in size and shape and frequently have large hyperchromatic nuclei. Bizarre tumor giant cells are common, as are mitoses, some of them abnormal (e.g. tripolar). Vascular invasion is usually conspicuous, and some tumors also exhibit extensive necrosis. The formation of bone by the tumor cells is diagnostic. X-RAY FEATURES: - Medullary and coical bone destruction Wide zone of transition, permeative or moth-eaten appearance Aggressive periosteal reaction Sunburst type Codman triangle Lamellated (onion skin) reaction: less frequently seen Soft-tissue mass -### End" -7056,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following dietary goals are reeommended for patients with high riskof coronary hea disease, Except, with the following options: A: LDL choIesterol <100mg\/dl, B: Saturated A < 7% of total calories, C: Salt restriction < 6 gm\/day, D: Avoid Alcohol - -### Response: -Ref: R.Alagappan Manual for Medicine 4th Edition pg no:182 Risk Factors Category I (For which interventions have been proved to lower CVD risks) 1. Raised LDL cholesterol 2. Reduced HDL cholesterol 3. Atherogenic diet 4. Cigarette smoking 5. Hypeension 6. LVH 7. Thrombogenic factors Category II (For which interventions are likely to lower CVD risks) 1. Diabetes mellitus 2. Physical inactivity 3. Increased triglycerides 4. Small dense LDL 5. Obesity Category III (Associated with increased CVD risk that, if modified, might lower risk) 1. Psychosocial factors 2. Increased Lipoprotein a (normal level--0-3 mg/dl) 3. Hyperhomocysteinemias 4. No alcohol consumption 5. Oxidative stress 6. Post-menopausal status Category IV (Associated with increased CVD risk which cannot be modified) 1. Age 2. Male gender 3. Low socio-economic status 4. Family history of early onset CVD -### End" -7057,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vasoconstriction in blood vessels is seen with:, with the following options: A: Cocaine, B: Lignocaine, C: Prilocaine, D: Bupivacaine - -### Response: -Cocaine -### End" -7058,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of death in breech delivery, with the following options: A: lntracranial hemorrhage, B: Aspiration, C: Atlanto axial dislocation, D: Asphyxia - -### Response: -Ans. is a i.e. Intracranial hemorrhage Intracraniai hemorrhage is the most common cause of fetal loss. occurs due to tear of tentorium cere.belli and falx cerebri. It is caused by traumatic delivery of the after coming head of breech or too rapid delivery of the soft head of a premature baby. -### End" -7059,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following are hepatotoxic anesthetic agents except-, with the following options: A: Halothane, B: Chloroform, C: Ether, D: Propofol - -### Response: -Ans. is 'd' i.e.. Propofol o Following are the groups of hepatotoxic anesthetic agents:i) Group I: Drugs with well known hepatotoxic potential and containing Chlorine or bromine. Eg: chloroform,ii) Group II: Drugs which contain fluorine Eg: halothane, methoxyflurane. o Desflurane, enflurane, sevoflurane, isoflurane, nitrous oxide and carbon tetrachloride are also linked with hepatotoxic ity. -### End" -7060,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: You are discussing surgical options with a patient with symptomatic pelvic relaxation. Partial colpocleisis (Le Fort procedure) may be more appropriate than vaginal hysterectomy and anterior and posterior (A&P) repair for patients who, with the following options: A: Do not desire retained sexual function, B: Need periodic endometrial sampling, C: Have had endometrial dysplasia, D: Have cervical dysplasia that requires colposcopic evaluation - -### Response: -Partial colpocleisis by the Le Fort procedure is reasonable for elderly patients who are not good candidates for vaginal hysterectomy and A&P (anterior and posterior) repair as treatment for vaginal and uterine prolapse. The technique involves partial denudation of opposing surfaces of the vaginal mucosa followed by surgical apposition, thereby resulting in partial obliteration of the vagina. Patients who are candidates for this procedure must have no evidence of cervical dysplasia or endometrial hyperplasia, have an atrophic endometrium, and no longer desire sexual function since the vagina is essentially obliterated and there is no longer access to the cervix or uterus via the vagina. Urinary incontinence can be a side effect of this procedure, so care must be exercised in the denudation of vaginal mucosa near the bladder. In a patient who already has urinary incontinence, the Le Fort operation would be relatively contraindicated. An A&P repair essentially involves excision of redundant mucosa along the anterior and posterior walls of the vagina, at the same time strengthening the vaginal walls by suturing the lateral paravaginal fascia together in the midline. -### End" -7061,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fixation at which psychosexual stage results in development of OCD-, with the following options: A: Oral, B: Anal, C: Phallic, D: Genital - -### Response: -Phase Age Organ of Gratification Psychiatric disorders linked to fixation 1 Oral Phase Bih to 1 1/2 years Oral region 2 Phases: Oral erotic phase (sucking) Oral sadistic phase (biting) Schizophrenia Dependent personality disorder Alcohol dependence syndrome 2 Anal Phase 1 1/2 to 3 years Anal and perianal area 2 Phases: Anal erotic phase (excretion) Anal sadistic phase ('holding' and 'letting go' at will) Obsessive compulsive personality traits and disorder OCD (Anal sadistic phase) 3 Phallic (Oedipal) Phase 3 to 5 years Genital areas Males: Sexual gratification towards mother Castration anxiety Oedipus complex Females: Penis envy Electra complex Sexual detions Sexual dysfunctions Neurotic disorders 4 Latency Phase 5 to 12 years - Special point: Super-ego is formed at this stage Neurotic disorders 5 Genital Phase > 12 years Genitals Neurotic disorders -### End" -7062,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type B Lactic acidosis is due to, with the following options: A: Congestive Hea Failure, B: Diabetes, C: Sho bowel syndrome, D: Cyanide poison - -### Response: -Lactic Acidosis:An increase in plasma l-lactate may be secondary to poor tissue perfusion (type A)--circulatory insufficiency (shock, cardiac failure), severe anemia, mitochondrial enzyme defects, and inhibitors (carbon monoxide, cyanide)--or to aerobic disorders (type B)-- malignancies, nucleoside analogue reverse transcriptase inhibitors in HIV, diabetes mellitus, renal or hepatic failure, thiamine deficiency, severe infections (cholera, malaria), seizures, or drugs/toxins (biguanides, ethanol, methanol, propylene glycol, isoniazid, and fructose).Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 66; Acidosis and Alkalosis -### End" -7063,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following technique is used to study current flow across a single ion channel?, with the following options: A: Patch clamp, B: Voltage clamp, C: Iontophoresis, D: Galvanometry - -### Response: -Ans. a. Patch clamp (Ref: Ganong 24/e p49; http://en.wikipedia.org/wiki/Patch_clamp)Patch clamp is used to study current flow across a single ion channel.'The patch clamp technique is a laboratory technique in electrophysiology that allows the study of single or multiple ion channels in cells. The technique can be applied to a wide variety of cells, but is especially useful in the study of excitable cells such as neurons, cardiomyocytes, muscle fibers and pancreatic beta cells. It can also be applied to the study of bacterial ion channels in specially prepared giant spheroplasts.'- http://en.wikipedia.org/wiki/ Patch clampPatch Clamp TechniqueThe patch clamp technique is a laboratory technique in electrophysiology that allows the study of single or multiple ion channels in cells.The technique can be applied to a wide variety of cells, but is especially useful in the study of excitable cells such as neurons, cardiomyocytes, muscle fibers and pancreatic beta cells.It can also be applied to the study of bacterial ion channels in specially prepared giant spheroplasts.The patch clamp technique is a refinement of the voltage clamp.Erwin Neher and Bert Sakmann developed the patch clamp in the late 1970s and early 1980s.This discovery made it possible to record the currents of single ion channels for the first time, proving their involvement in fundamental cell processes such as action potential conduction.In this technique a micropipette is placed on the membrane of a cell and form a tight seal to the membrane.The patch of membrane under the pipette tip usually contains only a few transport proteins, allowing for their detailed biophysical study.The cell can be left intact (cell-attached patch clamp). Alternatively, the patch can be pulled loose from the cell, forming an inside out patch.A third alternative is to suck out the patch with the micropipette still attached to the rest of the cell membrane, providing direct access to the interior of the cell (whole cell recording). -### End" -7064,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Plasma is a Newtonian fluid because:, with the following options: A: Viscosity is directly propoional to shear stress, B: Viscosity is equal to shear stress, C: Viscosity is inversely related to shear stress, D: Viscosity is independent of shear stress - -### Response: -For a Newtonian fluid, viscosity remains constant, independent of the shearing force. Whole blood is a non-Newtonian fluid; its viscosity goes changing with the changes in shearing force. -### End" -7065,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A farmer visiting a orchard gets unconscious, excessive salivation, constricted pupils and fasciculation of muscles, treatment started with-, with the following options: A: Atropine, B: Neostigmine, C: Physostigmine, D: Adrenaline - -### Response: -The farmer in question is having organophosphate poisoning, for which atropine is the drug of choice. -### End" -7066,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Light house sign in seen in ASOM in which stage?, with the following options: A: Stage of suppuration, B: Stage of hyperaemia, C: Stage of resolution, D: Stage of pre-suppuration - -### Response: -In the stage of supperation of ASOM, pus formation occurs, hence in this stage pulsatile otorrhea or light house sign in seen. Ref : Dhingra book of ENT 7th ed -### End" -7067,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Renin is synthesized as a large preprohormone: Renin is secreted by which among the following?, with the following options: A: PCT, B: DCT, C: Collecting duct, D: Juxtaglomerular apparatus - -### Response: -Ans. D. Juxtaglomerular apparatusActive renin:In the juxtaglomerular apparatus and is formed in the secretory granules of the granular cells. Only known function of its is to cleave the decapeptide angiotensin I from the amino terminal end of angiotensinogen i.e. renin substrate. -### End" -7068,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is a stomach poison for the larvae of insects of medical importance?, with the following options: A: DDT, B: Paris green, C: Pyrethrum, D: Antilarva oil - -### Response: -Insecticides are substances used to kill insects. -They are contact poisons,stomach poisons,fumigants. -Stomach poisons are those which when ingested cause death of the insects. -Examples are paris green and sodium flouride. DDT and pyrethrum are synthetic and natural contact poisons respectively. -Parks textbook of preventive and social medicine.K Park. -### End" -7069,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common ovarian tumor -, with the following options: A: Serous cystadenoma, B: Choriocarcinomac, C: Teratoma, D: Fibroma - -### Response: -Serous tumors are the most common of the ovarian epithelial tumors. About 60% are benign, 15% are of low malignant potential, and 25% are malignant. Benign lesions are usually encountered in patients between 30 and 40 years of age, and malignant serous tumors are more commonly seen between 45 and 65 years of age. Taken together, borderline and malignant serous tumors are the most common ovarian malignancies, accounting for about 60% of all ovarian cancers. ref : Robbins Basic Pathology, 9E,page-697 -### End" -7070,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best diagnostic test for cholestasis of pregnancy:, with the following options: A: Serum bilirubin, B: Bile acid, C: Serum alkaline phosphatase, D: Serum transaminase - -### Response: -Liver function tests, including serum bile acids are Evaluated. Bile acids are the specific measure of the diagnosis and monitoring. Liver USG is to be done to exclude cholelithiasis. Reference: Textbook of Duttas, 9th edition ,page 271 -### End" -7071,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: As per WHO, leprosy is a public health problem if prevalence is -, with the following options: A: 0.10%, B: 0.01%, C: 0.50%, D: 1% - -### Response: -

As per WHO , leprosy is a public health problem if prevalence is >0.01%. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:315. <\p> -### End" -7072,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Man is intermediate host of:, with the following options: A: Malaria, B: Filaria, C: Dengue, D: Plague - -### Response: -Malaria REF: Jawett's 24th edition Section VI. Parasitology > Chapter 46. Medical Parasitology Repeat in December 2011, June 2009 Man is the defenitive host in most parasitic infections except in: Echino co ccus granulosus Plasmodium Taenia Solium(man is both defenitive and intermediate host) Toxoplasma gondii Sarcocytis lindemanii -### End" -7073,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not included in Virchow's triad of thrombus formation?, with the following options: A: Endothelial injury, B: Stasis or turbulent blood flow, C: Hypercoagulability of the blood, D: Increased vascular permeability - -### Response: -The three primary abnormalities that lead to thrombus formation (called Virchow's triad) are (1) endothelial injury, (2) stasis or turbulent blood flow, and (3) hypercoagulability of the blood. Ref: Robbins 8th edition Chapter 4. -### End" -7074,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Juxtamedullary nephrons constitute what percentage of nephrons, with the following options: A: 10, B: 15, C: 30, D: 70 - -### Response: -Juxtamedullary nephrons constitute only 30 percent of total nephrons .....remaining being coical nephrons. Ref: guyton and hall textbook of medical physiology 12 edition page number:460,461,462 -### End" -7075,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Winging of scapula is seen in paralysis of which muscle?, with the following options: A: Serratus anterior, B: Supraspinatus, C: Pectoralis major, D: Infraspinatus - -### Response: -Ans. is 'a' i.e., Serratus anterior -### End" -7076,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the denominator in calculation of incidence -, with the following options: A: Number of fresh cases, B: Number of symptomatic cases, C: Total number of cases, D: Population at risk - -### Response: -Incidence is defined as new cases occurring in a defined population during a specified period of time. Incidence =(number of new cases of specific disease in a given time proof\population at risk during that period) 100 (refer pgno:60 park 23 rd edition) -### End" -7077,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an indication of cotrimoxazole?, with the following options: A: Lower UTI, B: Prostatitis, C: Chancroid, D: Typhoid - -### Response: -Ans. is 'c' i.e., None > Chancroid o Actually cotrimoxazole is used in all conditions provided in options. o Some guides have given chancroid as the answer. However, many text-books of (KDT, Satoskar, recent advances in pharmacotherapeutics, Evidence based medicine, and many others) have mentioned that cotrimoxazale is used in chancroid. o Amongst the given options,i will also go for chancroid as Harrison (18th/e-1109) has not mentioned cotrimoxazole for the treatment of chancroid. -### End" -7078,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hepatic lesions can be diagnosed with high accuracy by using nuclear imaging, with the following options: A: HCC, B: Hepatic adenoma, C: FNH, D: Hemangioma - -### Response: -Focal nodular hyperplasia FNH is second most common benign tumor of the liver Usually a small (<5cm) nodular mass arising in a normal liver, involves right and left liver equally Mainly seen in young women associated with OCP's use Pathology Central fibrous scar with radiating septa in the mass Typical hepatic vascularity is not seen with Atypical biliary epithelium Central scar contains a large aery that branches out into multiple smaller aeries in a spoke wheel pattern (on angiography) Clinical features Incudental finding at laparotomy or more commonly on imaging studies in most patients Vague abdominal pain in symptomatic cases AFP levsl are normal Diagnosis Most cases of FNH can be diagnosed radiologically on CECT or MRI Homogenous mass with a central scar that rapidly enhances during the aerial phase of contrast administration Histologic confirmation and resection for definitive diagnosis if radiologic diagnosis is difficult Treatment No treatment in asymptomatic patients with typical radiologic features Resection in cases of diagnostic unceainity for histological confirmation -### End" -7079,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Postmoem blood is collected from which vessel ?, with the following options: A: Femoral aery, B: Femoral vein, C: Cephalic vein, D: Brachial aery - -### Response: -Ans. is 'b' i.e., Femoral vein Before autopsy 10 - 20 ml of blood is collected from the femoral vein in groin. Jugular/ subclan vein can also be used. -### End" -7080,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The characteristic and common presentation of diabetic neuropathy is:, with the following options: A: Amyotrophy, B: Mononeuropathy, C: Symmetrical sensory neuropathy, D: Autonomic neuropathy - -### Response: -Answer is C (Symmetrical sensory neuropathy): The most common firm of diabetic neuropathy is distal symmetric sensory polyneuropathy 'The most common form of diabetic neuropathy is distal symmetric polyneuropathy. It most frequently presents with distal sensory loss. -### End" -7081,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stress hyperglycemia occurs due to all except -, with the following options: A: Increased level of ACTH, B: Increased level of coisol, C: Decreased level of norepinephrine, D: Insulin resistance - -### Response: -Ans. C. Decreased level of norepinephrineStress Hyperglycemia:Suppression of insulin secretion coupled with increased secretion of glucagon, growth hormone, glucocoicoids (coisol), and catecholamines (epinephrine ,norepinephrine) leads to hyperglycemia. -### End" -7082,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are the side effect/s of using argon laser -, with the following options: A: Hypopigmentation, B: Crusting, C: Keloid formation, D: All the above - -### Response: -argon gases causes all d side effects. REF:khurana,pg no 461 -### End" -7083,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Each lateral ventricle opens into the 3rd ventricle through, with the following options: A: Foramen of Monro, B: Lateral foramen, C: Foramen of luschka, D: Foramen of magendi - -### Response: -Cavities within brain and spinal cord: -a) The cerebrum contains a median cavity, the third ventricle and two lateral ventricles, one in each hemisphere. -b) Each lateral ventricle opens into the 3rd ventricle through interventricular foramen or foramen of  monro. -c) The third ventricle opens into the 4th ventricle  (i.e., cavity of hind brain) through the cerebral aqueduct. -d) The 4th ventricle communicates with subarachnoid space through two lateral foramen or foramen of luschka and a medial foramen or foramen of magendi. -### End" -7084,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Frameshift mutation occurs due to:, with the following options: A: Transition, B: Transversion, C: Inseion, D: Point mutation - -### Response: -A frameshift mutation is caused by a deletion or inseion in a DNA sequence that shifts the way the sequence is read. -### End" -7085,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bell's palsy is, with the following options: A: Hemiparesis with contralateral facial nerve palsy, B: Ipsilatera lower motor meuron lesion, C: Ipsilateral upper motor neuron lesion, D: Contralateral upper motor neuron lesions - -### Response: -B. i.e. (Ipsilateral LMN paralysis) (4- Dhingra 4th) (104 - Maqbool 11th)* BELL'S PALSY - Idiopathic infranuclear lesion of the facial nerve more common in diabetic (angiopathy) and pregnant women (retension of fluid)* BELL'S PHENOMENON - up and out rolling of the eyeball during forceful closure**Clinical presentation - LMN paralysis** patients is unable to close eye, saliva dribbles from the angle of mouth, face become asymmetrical, Tears flow down from the eye (epithora) stapedial reflex or loss of taste* Epiphora in bell's palsy is due to - lacrimal pump failure*** Melkersson's syndrome - Triad - Facial paralysis, swelling of lips, and fissured tongue* Recurrent facial palsy - causes - Melkersson's syndrome DM, sarcoidosis and tumoursPoor prognostic indicators - advanced age, hyperacusis, severe initial painBilateal facial paralysis - seen in GB syndrome sarcoidosis, sickle cell disease, acute leukemia, bulbar palsy, leprosy and sother systemic disorders.Supra nuclear (central) palsv primarily involves the lower part of face and emotional responses may be intact (eg- the patients not be able to show you his teeth but will smile to a Joke. Nuclear palsv affects all ipsilateral muscles of facial expression resulting in paralysis of the ipsilateral side (eg. mouth is pulled to the normal side and may droop on the affected side facial crease are effaced, eyelid may not close). -### End" -7086,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rheobase indicates:, with the following options: A: Magnitude of current, B: Rate of discharge, C: Velocity of nerve conduction, D: Specificity of impulse transmission - -### Response: -Rheobase: The minimum strength or magnitude of a stimulus, which is able to produce AP in an excitable tissue (e.g. Nerve,muscle) regardless of the duration it takes. -### End" -7087,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not antioxidant?, with the following options: A: Superoxide dismutase, B: Catalase, C: Coagulase, D: Glutathione peroxidase - -### Response: -Superoxide dismutase, Glutathione peroxidase, catalase are the key enzymatic antioxidants by which free radicals that are produced during metabolic reactions are removed. -### End" -7088,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Causes for reduced bioavailability include:, with the following options: A: High first pass metabolism, B: Increased absorption, C: IV drug administration, D: High lipid solubility - -### Response: -Ans. (A) High first pass metabolism(Ref: KDT 8th/e p22)The causes of low bioavailability are:1. Reduced absorption2. High first pass metabolism -### End" -7089,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient is admitted in a day care nursing home for a laparoscopic cholecystectomy. This patient is otherwise healthy. Anaesthetic of choice in this patient is:, with the following options: A: Halothane, B: Propofol, C: Ketamine, D: Ether - -### Response: -Propofol has a rapid onset of action. Awakening from a single bolus dose is also rapid due to a very sho initial distribution half-life (2-8 min). Most investigators believe that recovery from propofol is more rapid and is accompanied by less ""hangover"" than recovery from methohexital, thiopental, ketamine, or etomidate. This makes it a good agent for outpatient anesthesia. Propofol's shoer duration of action after infusion can be explained by its very high clearance, coupled with the slow diffusion of drug from the peripheral to the central compament. Ref: Butterwoh IV J.F., Mackey D.C., Wasnick J.D. (2013). Chapter 9. Intravenous Anesthetics. In J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e. -### End" -7090,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about blackball hyphema EXCEPT, with the following options: A: AC completely filled with bright red blood is total hyphema, blackball hyphema if dark red blood, B: Also called Eight ball hyphema, C: The black colour is suggestive of impaired aqueous circulation and decreased oxygen, D: Blackball hyphema causes less pupillary block and less angle closure - -### Response: -Post-traumatic hyphema is an ophthalmologic emergency that can result in permanent vision loss. Accumulation of blood in the anterior chamber causes trabecular meshwork obstruction, thereby elevating IOP. Hyphema with increased IOP can result in corneal blood staining, reduced corneal transparency, and vision loss. Hyphemas are graded by the percentage of the anterior chamber (AC) filled with blood, and range from Grade I (blood occupying <1/3 of the AC) to Grade IV (blood occupying 100 % of the AC, or ""eight-ball eye""). -### End" -7091,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rapid serological diagnostic tests include all except?, with the following options: A: Latex agglutination, B: Spectrophotometry, C: Gel electrophoresis, D: Radioimmunoassay - -### Response: -Ans. is 'b' i.e., Spectrophotometry -### End" -7092,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are clinical features of MEN-II EXCEPT: March 2004, with the following options: A: Pituitary tumour, B: Phaeochromocytoma, C: Medullary carcinoma of thyroid, D: Neuroma - -### Response: -Ans. A i.e. Pituitary tumour Pituitary tumours are a pa of MEN-I/ Wermer syndrome -### End" -7093,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cataract is caused by all except –, with the following options: A: Ultraviolet radiation, B: MRI, C: Infrared radiation, D: Microwave radiation - -### Response: -Radiation cataract is caused by ionizing & non-ionizing radiations e.g. UV rays, neutron, radium, ultrasonics; but MRI has no radiation exposure. -### End" -7094,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs cause hemolysis in G-6PD deficiency except:-, with the following options: A: Primaquine, B: Nitrofurantoin, C: Sulfonamides, D: Erythromycin - -### Response: -* G6PD protects RBC from free radical injury * Impoant drugs causing hemolysis in G6PD deficiency are - Primaquine - Nitrofurantoin - Sulfonamides - Furazolidone -### End" -7095,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Right hepatic duct drains all segments except, with the following options: A: 5, B: 6, C: 7, D: 3 - -### Response: -The right hepatic duct is located within the liver's biliary network. Together, the right and left hepatic ducts form the common hepatic duct.The right hepatic duct drains bile from the liver's internal right and caudate lobes. Pa of the right hepatic duct is extrahepatic, meaning it extends outside of the liver. The right hepatic duct leaves the liver, carrying bile that eventually ends up in the small intestine to aid in digestion. Bile contains bile salts and cholesterol, which help digest fats. Ref - BDC 6e vol2 287,307 -### End" -7096,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is a feature of Fuch&;s hetero chromic iridocyclitis -, with the following options: A: Heterochromia of iris, B: Keratin precipitates, C: Posterior subcapsular cataract, D: All the above - -### Response: -Ans. is 'd' i.e.. All the above Fuch's heterochromic iridocyclitis (Fush'S uveitis syndrome) o It is a form of anterior and intermediate uveitis. o The condition is usually unilateral and chronic in nature and is characterized by a chronic non-granulomatous uveitis and eventually results in iris heterochromia (a change in the color of the iris). o The disease has following characteristic features : Heterochromia of iris Diffuse stromal iris atrophy Fine KPs at the back of the cornea Faint aqueous flare The absence of posterior synechiae A fairly common rubeosis iridis, sometimes associated with neovascularization of the angle of the anterior chamber. Comparatively early development of complicated cataract and secondary glaucoma (usually open-angle type). Glaucoma has been reported in 10-59% of cases. Treatment o Fuch's heterochromic uveitis responds variably to steroids and cycloplegics. The complications of long-term use of these drugs may at times outweigh their potential benefits. Therefore, treatment with topical steroids is given to iritis which is sufficiently active to require the treatment, otherwise, the patient is routinely followed without giving any treatment. o Cataract responds well to most forms of intraocular surgeries, including the standard IOL implantation. Hyphemia may occur because of rubeosis iridis (neovascularization of iris}, o Glaucoma control may be somewhat more problematic, with surgical options indicated for later forms of the disease. -### End" -7097,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pauci immune glomerulonephritis is seen in aEUR', with the following options: A: After transplant in alpos, B: Microscopic polyangiitis, C: Henoch-Schonlein nephritis, D: Lupus - -### Response: -Microscopic polyangitis fRef Bobbin's Th/e p. 976] Rapidly progressive glomerulonephritis may be caused by number of different diseases, some restricted to the kidneys and others systemic. Although no single mechanism can explain all cases, there is little doubt that in most cases, the glomerular injury is immunologically mediated. Thus a practical classification divides rapidly progressive glomerulonephritis into three groups on the basis of immunological findings. RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS II Type RPGN Type I RPGN (anti GBM antibody) m (Immune (I complex) Type III RPGN (Pauci immune) * Idiopathic * Idiopathic * ANCA associated * Goodpasture * Post infectious * Idiopathic syndrome * Systemic lupus * Wegener erythematous granulomatosis * Henoch schnolein * Microscopic PAN purpura * Microscopic polyangitis -### End" -7098,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dye for myelography is injected in which space :, with the following options: A: Subdural, B: Epidural, C: Subarachnoid, D: Extradural - -### Response: -Myelography is the radiographic investigation of the spinal canal for the diagnosis of space occupying an obstructive lesion. It requires the contrast agent to be injected  into subarachnoid space. -MRI has replaced myelography, these days. -### End" -7099,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cushing disease cause is, with the following options: A: ACTH producing pituitary tumor, B: Adrenal Tumor, C: Ectopic production of ACTH, D: Adrenal Hyperplasia - -### Response: -Ans. (a) ACTH producing pituitary tumorRef: Endocrine Surgery by Schwartz Page 27* Pituitary adenoma arising from corticotroph cells causing secretion of ACTH resulting in Cushing's disease* Corticotroph cell adenomas may be clinically silent or may cause hypercortisolism, manifested clinically as Cushing syndrome, because of the stimulatory effect of ACTH on the adrenal cortex.* When the hypercortisolism is caused by Excessive production of ACTH by the pituitary, the process is designated Cushing disease, because it is the pattern of hypercortisolism originally described by Dr. Harvey Cushing. -### End" -7100,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Injury to cervical sympathetic trunk produces Horner's syndrome that includes all except:, with the following options: A: Enophthalmos, B: Ptosis, C: Mydriasis, D: Anhydrosis - -### Response: -Horner’s syndrome:  -The head and neck region is supplied by the sympathetic fibres, which arise in the upper thoracic spinal segments.  -These preganglionic fibres pass through stellate ganglion to relay in the superior cervical sympathetic -ganglion.  -The postganglionic fibres arise from cells of this ganglion and supply the structures in the head and neck. -An injury to cervical sympathetic trunk produces a clinical condition called Horner’s syndrome. -Characteristic features: - -Partial ptosis (partial drooping of upper eyelid), due to paralysis of smooth part of levator palpebrae superioris muscle (Muller’s muscle). -Miosis, i.e., constriction of the pupil, due to paralysis of dilator pupillae. -Anhydrosis, i.e., loss of sweating on that side of face, due to sudomotor and vasoconstrictor denervation. -Increased temperature and redness. -Enophthalmos, i.e., sunken eyeball, not confirmed by ophthalmometry. -Loss of ciliospinal reflex, i.e., pinching the skin of the back of neck does not produce dilation of the pupil, which in healthy person takes place. - - -Key Concept: -Injury to cervical sympathetic trunk produces Horner's syndrome that includes Enopthalmos, Ptosis and miosis. -Ref: Textbook of Anatomy, Vishram singh, pg no:175 -### End" -7101,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following structures is involved in the paramedian infarction of the base of the pons?, with the following options: A: Anterior spinocerebellar tract, B: Descending trigeminal tract, C: Pyramidal tract, D: Rubrospinal tract - -### Response: -Base of the pons includes coicospinal (pyramidal), coicobulbar, coicopontine tracts, pontine nuclei, and transverse pontine fibers. so in paramedian infarction of base of pons coicospinal (pyramidal ) tract is affected. -### End" -7102,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Features of obsessive-compulsive neurosis are, with the following options: A: Repetitiveness, B: Irresistibility, C: Unpleasantness, D: All - -### Response: -A i.e. Repetetiveness; B i.e. Irresistibility; C i.e. Unpleasantness -### End" -7103,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following condition(s) are associated with raised ANCA except, with the following options: A: Wegener's granulomatosis, B: Polyaeritis Nodosa, C: Microscopic Polyangitis, D: Churg-Strauss syndrome - -### Response: -Many patients with vasculitis have circulating antibodies that react with neutrophil cytoplasmic antigens, so-called anti-neutrophil cytoplasmic antibodies (ANCAs). ANCAs are a heterogeneous group of autoantibodies directed against constituents (mainly enzymes) of neutrophil primary granules, monocyte lysosomes, and endothelial cells. ANCAs are very useful diagnostic markers; their titers generally mirror clinical severity, and a rise in titers after periods of quiescence is predictive of disease recurrence. PR3-ANCAs are associated with Wegener granulomatosis. MPO-ANCAs are associated with microscopic polyangiitis and Churg-Strauss syndrome. (Robbins Basic Pathology,9th edition,pg no.350) -### End" -7104,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following anti-malarial drug is gameticidal for all species of Plasmodium?, with the following options: A: Quinine, B: Primaquine, C: Chloroquine, D: Aesunate - -### Response: -PRIMAQUINE - Kills Gametes of All 4 Species. So It is used for preventing the transmission of the malaria. Chloroquine and quinine can kill the gametes of mainly P vivax. Exo-erythrocytic stage: Radical cure of malaria PRIMAQUINE - given for 2 weeks TAFENOQUINE - Single Dose Erythrocytic stage:These drugs are used to treat malaria Fast Acting Drugs Slow Acting Drugs M - Mefloquine - Proguanil A - Aemisinin - Pyrimethamine C - Chloroquine - Sulfadoxine H - Halofantrine - Doxycycline A - Atovaquone R - Res-Q (Quinine) -### End" -7105,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Palmar interossei is supplied by, with the following options: A: Superficial branch of ulnar nerve, B: Deep branch of ulnar nerve, C: Superficial branch of medial nerve, D: Radial nerve - -### Response: -All palmar interossei are supplied by the deep branch of the ulnar nerve (C8, T1). Ref : B D Chaurasia's Human Anatomy, Seventh edition , volume 1 , pg. no, 124 -### End" -7106,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gasless abdomen on X-ray is seen with what type of trachea-esophageal fistula?, with the following options: A: Isolated TEF, B: Esophageal atresia with proximal TEF, C: Esophageal atresia with distal TEF, D: Esophageal atresia with double TEF - -### Response: -In esophageal atresia with proximal TEF, as there is no connection of distal esophagus with trachea or proximal esophagus, gasless abdomen will be seen on x-ray. -### End" -7107,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Excessive fibrosis in tumor in called -, with the following options: A: Anaplasia, B: Metaplasia, C: Desmoplasia, D: Dysplasia - -### Response: -Ans. is 'c' i.e., Desmoplasiao In some tumors, parenchymal cells stimulate the formation of an abundant collagenous stroma, referred to as desmoplasia, eg scirrhous carcinoma of breast. -### End" -7108,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following muscles are attached to Perineal body except, with the following options: A: Bulbospongiosus, B: Ischiocavernosus, C: Superficial Transverse Perinei, D: Levator ani - -### Response: -Ten muscles of the perineum converge and interlace in the perineal body.Two unpairedExternal anal sphincterFibers of longitudinal muscle coat of anal canalPairedBulbospongiosusSuperficial and deep transversus pereneiLevator aniReference: Chaurasia Volume II; 7th edition; Page no: 383 -### End" -7109,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A blood stained discharge from the nipple indicates one of the following:, with the following options: A: Breast abscess, B: Fibroadenoma, C: Duct Papilloma, D: Fat Necrosis of Breast - -### Response: -A common presenting symptom of duct papilloma is nipple discharge, which may be serous or bloody. Bloody discharge is more suggestive of cancer, but is usually caused by a benign papilloma in the duct. Ref: CSDT, 11th Edition, Page 342; Bailey and Love's Sho Practice of Surgery, 24th Edition, Page 828 -### End" -7110,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Reconstruction surgery in breast carcinoma, Best myocutaneous flap is, with the following options: A: Pectoralis minor, B: Pectoralis major, C: Latissimus dorsi, D: Transverse rectus abdominis - -### Response: -D. i.e. (Transverse rectus abdominis) (1241 - CSDT 12th) (845 -B&L 25th) (737 - S. Das 5th)* Majority surgeons now prefer to use transverse rectus abdominis (TRAM-flap) - TRAM- flap reconstruction results in a soft natural and ptotic breast and avoids the need for additional prosthetic volume replacement. Excellent cosmetic results are achieved at the expanse of 5 -7 days hospital stay, a 4 to 6 weeks convalescent period and an overall complication rate of 16% to 28%BREAST - RECONSTRUCTION is new regarded as an integral part of breast cancer management and is requested with increasing frequency by informed women at the time of mastectomy* The easiest type of reconstruction is using a silicone gel implant under the pectoralis major muscle* The latissimus dorsi myocutaneous flap is used most often for reconstruction of breast with an implant* Abbey - Estlander flap used for lip* ** that may be used to correct a tight upper lip due to severe tissue deficiency (1238 - CSDT 12th)* Abbey estlendes flap is based on Labial artery*** Lingual nerve block is given in neck of mandible** -### End" -7111,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 37 year old female presents to the clinic with a 3 month history of pain in her left index finger. X-ray of the hand shows a mass. Which is the most common bony tumor of hand?, with the following options: A: Enchondroma, B: Chondroblastoma, C: Giant cell tumour, D: Osteoid osteoma - -### Response: -Enchondroma is the most common tumor of the phalanges of the hand. In the hand it most commonly affects the proximal phalanges (40-50%) followed by metacarpal bones (15-30%), middle phalanges (20-30%) and terminal phalanges (5-15%). Plain Xray shows a purely radiolucent lesion. The bony coex is usually thinned and and is expanded in an uniform fashion. Pathologically it appear as lobules of blue white or blue grey hyaline cailage that are most commonly fragmented from the curettage procedure. Ref: Ohopaedic Oncology: Diagnosis and Treatment By Ernest U. Conrad, page 69 -### End" -7112,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following act as a vector for spreading Onchocerciasis?, with the following options: A: Tsetse fly, B: Culicoides midge, C: Simulium damnosum, D: Bugs of subfamily Triatominae - -### Response: -Onchocerciasis is caused by Onchocerca volvulus and is a major cause of blindness. It is transmitted by Simulium damnosum, a black fly that breeds in areas of rapidly flowing streams. The fly picks up microfilariae from the skin of the infected person, where it matures into larvae that become adult worms in 1 year. The adult parasite produces cutaneous nodules which are 5-25 mm in diameter on the trunk, thighs, arms, head, and shoulders. In the eye it causes nummular keratitis and sclerosing keratitis. Death of the microfilariae causes an intense inflammatory reaction and severe uveitis, vitritis, and retinitis. It is diagnosed by skin biopsy and microscopic examination looking for live microfilariae. The preferred treatment for onchocerciasis is with nodulectomy and ivermectin. Ref: Cunningham, Jr. E.T., Augsburger J.J., Correa Z.M., Pavesio C. (2011). Chapter 7. Uveal Tract & Sclera. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. -### End" -7113,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Moth eaten alopecia is seen in –, with the following options: A: Black dot tinea, B: Telogen effluvium, C: Alopecia areata, D: Secondary syphilis - -### Response: -Moth eaten alopecia is characteristic of secondary syphilis. This hair loss in its classical form resembles a somewhat diffuse and patchy alopecia areata (patches hair loss with ragged edges to alopecia spots). -### End" -7114,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Signs of increased intracranial tension are all except:, with the following options: A: Tachycardia, B: Papilledema, C: Headache, D: Seizures - -### Response: -Ans. A. TachycardiaIntracranial pressure may increase due to brain tumors, masses of congenital origin and inflammatory disorders such as brain abscess, neurocysticercosis, tuberculoma and subdural fluid collection. After closure of sutures and fontanel the adaptive mechanisms to raised pressure in the brain are through displacement of CSF from the intracranial cavity and compensatory hemodynamic changes. Heart rate slows, respiratory rate is altered and blood pressure rises to maintain the cerebral circulation. Persistent early morning headache, unexplained projectile vomiting, impaired vision, personality changes may also result. -### End" -7115,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Right coronary aery supplies all, except?, with the following options: A: Anterior 2/3 of ventricular septum, B: SA node, C: AV node, D: LBB - -### Response: -Right coronary aery supplies (i) SA node (in 65%), (ii) whole conducting system (AV bundle, bundle of his, pa of left bundle branch) except RBB and pa of left branch of AV bundle, (iii) posterior pa of ventricular septum, (iv) most of right ventricle except small pa adjoining anterior interventricular groove and small pa of left ventricle adjoining posterior interventricular groove. Left coronary aery supplies (i) most of the left atrium, (ii) most of the left ventricle including apex, (iii) small pa of right ventricle odjoining anterior interventricular septum, (iv) anterior 2/3 of ventricular septum, (v) RBB, LBB (vi) SA node in 35% of cases. -### End" -7116,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is most comonly implicated in genital (vul- val) was ?, with the following options: A: HPV -16, B: HPV 18, C: HPV 31, D: HPV 6 - -### Response: -Ans. is d i.e. HPV 6 ""Low Risk HPV types 6 and 11 cause nearly all genital was."" Details of Genital Was : Genital was are leisons created from productive infection with HPV (most common type 6 and 11). They display various morphologies and appearances ranging from flat papules to the classic verrucous, polyphytic lesions, termed condyloma acuminata"". Sites : External genital was may develop at sites in the lower reproductive tract, urethra, anus, or mouth. Diagnosis : They are typically diagnosed by clinical infection, and biopsy is nor required unless co-existing neoplasia is suspected. HPV serotyping is not required for routine diagnosis. Treatment : - Condyloma acuminata may remain unchanged or resolve spontaneously Effect of treatment on future viral transmission is unclear. However, many women prefer removal, and lesions can be destroyed with sharp or electrosurgical excision, cryotherapy, or laser ablation. In addition, very large. bulky lesions may be managed with cavitational ultrasonic surgical aspiration. Alternatively, 5-percent imiquimod cream is a immunomodulatory topical treatment for genital was. Other topical agents which may be applied for treatment of was are : Podophyllin which is a antimitoric agent available in a 10 to 25% tinctute of benzoin solution and disrupts viral activity by inducing local tissue necrosis. Alternatively, trichloroacetic acid and bichloroacetic acid are proteoplytic agents and are applied serially to was by clinicians. Intralesion injection of interferon is also an effective treatment for was. However as this method has high cost, is painful and is inconvenient to administer, So this therapy is not recommended as a primary modality and is best reserved for recalcirrant cases. Of therapy choice no data suggest the superiority of one treatment. Thus in general treatment should be selected based on clinical circumstances and patient and provider preferences. -### End" -7117,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mitsuda reaction is read after:, with the following options: A: 3 days, B: 3 hours, C: 3 weeks, D: 3 months - -### Response: -Lepromin Test is type IV HSR It is a PROGNOSTIC test not a diagnostic test 2 reactions are seen in Lepromin test- Early Reaction/ Fernandez- Erythema and induration develops in 24-48 hours and remain for 3-5 days and it is read after 3 days Late Reaction/Mitsuda Reaction- It stas in 1-2 weeks, reaching a peak in 4 weeks and this is read after 3 weeks -### End" -7118,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Gilbert's Syndrome Except -, with the following options: A: Mild conjugated hyper bilirubinemia, B: Autosomal dominant, C: Normal liver histology, D: Almost normal liver function - -### Response: -Ans-AGilbert syndrome causes unconjugated hyperbilirubinemia.Gilbert's syndrome is an autosomal dominant disorder*.Characteristic features are :*Mild unconjugated hyperbilirubinemia due to:Decreased hepatic uptake of bilirubinDecreased activity of uridyl glucuronyl transferase (causing defective conjugation).*Standard hepatic biochemical tests are normal.*Normal hepatic histology.Gilbert's syndrome is a type of congenital hyperbilirubinemia.Other types of congenital hyperbilirubinemia.*Crigler Najjar* Type I-The complete absence of the enzyme - UDP glucuronyl transferase.Causes severe jaundice, death in early life.Unconjugated hyperbilirubinemia* Type II-* Partial absence of enzyme.Dubin-Johnson-a defect in excretion of conjugated bilirubin, therefore, causes conjugated hyperbilirubinemia.*Rotor's syndrome Same as Dubin-Johnson. Note :The difference between Dubin-Johnson and Rotor's Syndrome.In Dubin-Johnson there is an accumulation of pigment in the hepatocytes, imparting a brown or black color to the liver.Mnemonic - (Michael) Johnson is black -### End" -7119,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are diagnostic features of illeocecal tuberculosis on barium follow through, except:, with the following options: A: Apple-core sign, B: Pulled up contracted angle, C: Widening of ileocecal angle, D: Strictures involving the terminal ileum - -### Response: -Apple core sign is a feature of carcinoma of colon, not ileocecal tuberculosis. Pulled up contracted angle, widening of ileocecal angle and strictures involving the terminal ileum are all signs of ileocecal tuberculosis. Ref: Clinical Medicine a Practical Manual for Students and Practice By Agarwal, Page 244; Journal of Indian Academy of Clinical Medicine, Volume 2 No 3, July-September, 2001, Page 171 -### End" -7120,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oligohydramnios is seen in:, with the following options: A: Renal agenesis, B: Cholangioma of placenta, C: Spina bifida, D: Esophageal atresia - -### Response: -Oligohydramnios can be caused by - Renal anomalies Uteroplacental insufficiency: IUGR ACE inhibitors Premature rupture of membranes Amniocentesis (leak) Pre-ecclampsia Amnion nodosum NSAIDs Post term pregnancy over estimated gestational age The sonographic diagnosis of oligohydramnios is usually based on an AFI < 5 cm or a single deepest pocket of amnionic fluid of < 2 cm -### End" -7121,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an amplifying host for Japanese encephalitis:, with the following options: A: Pig, B: Herons, C: Horse, D: Egrets - -### Response: -Japanese Encephalitis Virus- Amplifying host- Pig Reservoir- Egrets, Herons Vector- Culex tritaeniorhynchus (Most common in worldwide) C.vishnui (Most common in India) -### End" -7122,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epidemic typhus is caused by, with the following options: A: Rickettsia tsutsugamushi, B: Rickettsia Quintana, C: Rickettsia rickettsiae, D: Rickettsia prowazekii - -### Response: -(D) Rickettsia prowazekii # Epidemic typhus is caused by R. prowazekii.> R. prowazekii named after von Prowazek, who had contracted fatal typhus fever while investigating the disease. Amongst the options provided 'Louse' is the insect vector only for Rickettsia Prowazakii.# RICKETTSIAL INFECTION INSECT VECTORS:> Louse: Rickettsia Prowazekii (Epidemic typhus) Bartonella quintana (Trench fever)> Mites: Rickettsia tsutsugamushi (scrub typhus) Rickettsia akari (Rickettsial pox)> Ticks: Rickettsia rickettsii (Rocky Mountain Spotted Fever) Rickettsia conori (Ticky Typhus, Tick Fever) Rickettsia australis (Tick typhus) Rickettsia sibrica (Tick typhus)> Fleas: Rickettsia typhi (Endemic typhus)> Q Fever: Human infection occurs from inhalation of dust (No insect vectors) Etiological agent is Coxiella burneti Insect vector is None -### End" -7123,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient developed fasciculations when a muscle relaxant was administered for a surgery. Train of fasciculations is seen in:, with the following options: A: Mivacurium, B: Succinylcholine, C: Baclofen, D: Gallamine - -### Response: -The onset of paralysis by succinylcholine is usually signaled by visible motor unit contractions called fasciculations. These can be prevented by pretreatment with a small dose of nondepolarizing relaxant. Fasciculations are typically not observed in young children and elderly patients. Ref: Morgan, Jr. G.E., Mikhail M.S., Murray M.J. (2006). Chapter 9. Neuromuscular Blocking Agents. In G.E. Morgan, Jr., M.S. Mikhail, M.J. Murray (Eds), Clinical Anesthesiology, 4e. -### End" -7124,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HLA-A29 is associated with, with the following options: A: Serpiginous geographical choroidopathy, B: Bird shot retinochoroidopathy, C: Sympathetic ophthalmitis, D: Acute posterior multifocal placoid pigment epitheliopathy - -### Response: -BIRD-SHOT RETINOCHOROIDOPATHY It is a rare, idiopathic, bilaterally symmetrical chronic multifocal chorioretinitis characterised by numerous flat creamy-yellow spots due to focal chorioretinal hypopigmentation, resembling the pattern of 'bird- shot scatter from a shotgun'. The disease, more common in females than males, typically affects middle-aged healthy persons who are positive for HLA-A29. It runs a long chronic course of several years. Treatment with coicosteroids is usually not effective. Ref:- A K KHURANA; pg num:-161 -### End" -7125,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: High environmental temperature, best step for malaria control?, with the following options: A: Remove breeding place, B: Full sleeve cloth, C: Indoor insecticide, D: Early treatment - -### Response: -Ans. is 'a' i.e., Remove breeding place ""The most impoant step in reducing number of mosquitoes is to eliminate their breeding places"" Park -### End" -7126,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The cotton applied to the pulpal stumps in the formocresol pulpotomy technique should be:, with the following options: A: Left for 10 minutes in the cavity, B: Left for 5 minutes in the cavity, C: Left for an hour in the cavity, D: Time depends upon the severity of the infection - -### Response: -Steps in formocresol pulpotomy - -The pulp chamber is dried with sterile cotton pellets. Next, a pellet of cotton moistened with a 1:5 concentration of Buckley’s formocresol and blotted on sterile gauze to remove the excess is placed in contact with the pulp stumps and allowed to remain for 5 minutes.  -Because formocresol is caustic, care must be taken to avoid contact with the gingival tissues. The pellets are then removed, and the pulp chamber is dried with new pellets. -A thick paste of hard-setting zinc oxide–eugenol is prepared and placed over the pulp stumps.  -The tooth is then restored with a stainless steel crown. - -McDONALD AND AVERY’S DENTISTRY  CHILD   ADOLESCENT 10thEd P:229 -### End" -7127,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fastest acting agent –, with the following options: A: Sevoflurane, B: Desflurane, C: Isoflurane, D: None - -### Response: -Desflurane has least B : G partition coefficient → fastest induction. -### End" -7128,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug effects closely mimics ""Schizophrenia""., with the following options: A: Barbiturates, B: Cocaine, C: Phencyclidine, D: Levodopa - -### Response: -Though both levodopa and cocaine can cause psychotic symptoms, phencyclidine resembles schizophrenia most closely. -### End" -7129,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Botulism causes, with the following options: A: Descending flaccid paralysis, B: Descending spastic paralysis, C: Ascending paralysis, D: Ascending spastic paralysis - -### Response: -Clostridium botulinum produces Type A toxin. It acts by blocking the production or release of acetylcholine at the synapses and neuromuscular junction. Thus block neuromuscular transmission. Onset is marked by diplopia, dysphagia, and dysahria due to cranial nerve involvement. Symmetric descending flaccid paralysis is a characteristic pattern, ending in death by respiratory paralysis. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 269 -### End" -7130,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meckel's Diveicula in the inguinal hernia sac is called as, with the following options: A: Amyand's hernia, B: Cooper's hernia, C: Coquet hernia, D: Littre's hernia - -### Response: -Meckel's Diveicula can be found in inguinal or femoral sac is known as Littre's hernia and can cause intestinal obstruction Ref: schwaz's principle of surgery 10th edition Pgno : 1164 -### End" -7131,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is true about dislocation of hip joint?, with the following options: A: Posterior dislocation is commoner, B: In posterior dislocation whole lower limb is rotated medially, C: In anterior dislocation whole lower limb is rotated laterally, D: All of the above - -### Response: -D i.e. All of the above -### End" -7132,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dehiscence of anterior wall of the external auditory canal cause infection to the parotid gland known as:, with the following options: A: Fissure of santorini, B: Notch of rivinus, C: Petrous fissure, D: Retropharyngeal fissure - -### Response: -(Fissure of santorini): Ref: 220-LT (4-D 4th)* In the tympanic membrane, above the short process the pars flaccida, or shrapnell's membrane, filled the gap in the tympanic ring known as the notch of Rivinus (241- LT)* There is a deficiency superiorly of both the cartilaginous annulus and the bony annulus known as the notch of Rivirus (22-LT)* The Dehiscences in the anterior wall of external auditory canal (fissure of santorini) are important as infection can travel from external auditory canal to the parotid gland and vice versa (MaQbool) (220-LT) -### End" -7133,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following concentrations of epinephrine does not correspond to the respective route of administration ?, with the following options: A: 1 : 10000 for intravenous route, B: 1 : 1000 for inhalational route, C: 1 : 1000 for intramuscular route, D: 1 : 1000 for subcutaneous route - -### Response: -For inhalational route, adrenaline b used in a concentration of 1:100 for treatment of bronchial asthma by nebulizer. -Concentration of adrenaline for different routes and indications -### End" -7134,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A man hits his neighbour. Next day he feels that police is behind him and his brain is being controlled by radio waves by his neighbour. The probable diagnosis is:, with the following options: A: Thought inseion, B: Passivity feeling, C: Delusion of persecution, D: Obscessive Compulsive Disorder - -### Response: -C i.e. Delusion of persecution Delusions may occur in schizophrenia, depression, mania, bipolar disorder, organic disorders such as delirium, substance abuse and dementia but not in conversion disorderQ. Delusion of grandiosity (grandeur) or megalomania is characteristically seen in mania, organic delusional syndromes (such as neurosyphilis) , schizophrenia and paranoid disordersQ (i.e. schizoaffective mania and paranoid schizophreniaQ but not hypomania and cyclothymai = mild depression & hypomania). Nihilistic or depressive delusion (i.e. delusion of povey, guilt & nihlism) is seen in severe depression, and Cotards syndromeQ. -### End" -7135,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest among diseases with Mendelian inheritance is -, with the following options: A: Autosomal dominant, B: Autosnmal recessive, C: X-linked recessive, D: X-dominant - -### Response: -Ans. is 'a' i.e., Autosomal dominant It is estimated that the combined incidence of mendelian inheritance (autosomal dominant, autosomal recessive, x-linked) in man is about 1% of all live born individuals. a As many as 793 autosomal dominant phenotypes. 629 autosomal recessive traits and 123 sex linked diseases have been catalogued to date. -### End" -7136,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most sensitive test for carpal tunnel syndrome, with the following options: A: Phalen's test, B: Tinel's sign, C: Tourniquet test, D: None - -### Response: -Answer- A. Phalen's testThere are some provocative tests which act as impoant screening methods-Wrist flexion (Phalenb test) : - The patient is asked to actively place the wrist in compiete flexion. If tingling and numbness develop in the distribution of median nerve, the test is positive. This is the most sensitiye provocotive test.Tourniquet testMedial nerve percussion test (Tinel's sign)Median nerve compression test -### End" -7137,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Find out chronaxie and rheobase from the graph given below, with the following options: A: Chronaxie 0.2 msec; rheobas 0.3V, B: Chronaxie 0.3V; rheobase 0.2 msec, C: Chronaxie 0.3V; rheobase 0.6V, D: Chronaxie 0.2 msec; rheobase 0.6V - -### Response: -Rheobase is the minimum stimulus strength that will produce a response. It corresponds to 0.3V Chronaxie is the minimum time duration for which a stimulus doubles the rheobase. Double the rheobase is 0.6V which corresponds to 0.2 msec. -### End" -7138,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A A patient presents with multiple fractures. He develops respiratory distress and dies after few days. CT brain shows petechial hemorrhage. Most likely diagnosis is:, with the following options: A: Fat embolism, B: Stroke, C: Hemorrhage, D: Hypoxic ischemic encephalopathy - -### Response: -- A presenting long bone fractures + respiratory distress +petechiae / hemorrhage in brain suggests : fat embolism syndrome FAT EMBOLISM SYNDROME - Generally associated with displaced long bone fractures of lower extremities - Occurs in 0.5-3.05% of cases - Fat embolism will reach in the brain through a right to left cardiac shunt or through an intact pulmonary circulation in the patient without the shunt - Major clinical characteristics : respiratory insufficiency , neurologic symptoms , and petechial skin rash -### End" -7139,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which statement best describes a functional role for the lateral hemispheres of the cerebellum?, with the following options: A: Control and coordinate movements of the axial muscles, as well as the shoulder and hip, B: Control movements that involve distal limb musculature, C: Function with the cerebral coex to plan movements, D: Stimulate motor neurons through their connections to the spinal cord - -### Response: -From a functional point of view, the cerebellum is divided into three pas: 1. Vestibulocerebellum (or flocculonodular lobe) Consist of the nodulus in the vermis and the flanking flocculus in the hemisphere on each side. This lobe is phylogenetically the oldest pa of the cerebellum and has vestibular connections concerned with equilibrium and eye movements. 2. Spinocerebellum Formed by the rest of the vermis and the adjacent medial poions of the hemispheres. This region receives proprioceptive input from the body as well as a copy of the ""motor plan"" from the motor coex. By comparing plan with performance, it smooths and coordinates movements that are ongoing. 3. Cerebrocerebellum Includes the lateral poions of the cerebellar hemispheres. They interact with the motor coex in planning and programming movements. -### End" -7140,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudoproptosis caused by, with the following options: A: Buphthalmos, B: Meningioma of optic nerve, C: Orbital cellulitis, D: Dermoid cyst - -### Response: -Answer- A. Buphthalmoscauses are:Buphthalmos (congenital glaucoma),High myopia,Upper lid retraction,Paralysis of the extrinsic muscles,Stimulation of muller muscle by cocaine,Shallow orbit as in craniofacial dysostosis -### End" -7141,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the treatment of appendicular carcinoma 3cm x 2cm in size in 24 year old male?, with the following options: A: Right hemicolectomy, B: Appendicectomy, C: Caecal Resection, D: Radiotherapy - -### Response: -Ans. is 'a' i.e., Right hemicolectomy o Has been explained in previous sessions -### End" -7142,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In pyogenic liver abscess commonest route of spread is, with the following options: A: Hematogenous through poal vein, B: Ascending infection through biliary tract, C: Hepatic aery, D: Local spread - -### Response: -Routes of spread 1st most common - Biliary tract 2nd most common - poal vein -### End" -7143,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a normal adult sitting with eyes closed EEG will show, with the following options: A: Alpha, B: Beta, C: Theta, D: Delta - -### Response: -Ans. a (Alpha) (Ref. Ganong Physiology 22nd/pg. Chapter 11, Fig. 11-8).In a normal adult sitting with eyes closed EEG will show alpha waves. EEG with eyes open & mind wandering shows Beta waves.EEG wavesKey FactsAlpha# Happen between 8 and 13 times per second, or 8-13 Hertz (Hz).# Alpha represents a sort of ""idle"" state, or ""ready but not doing much"" state and is normally fairly large over the back third of the brain when the eyes are closed and when you are awake.# Alpha disappears when we either get mentally busy (e.g., open the eyes, start doing intense mental work even eyes closed) or when we become drowsy.# Thus the presence of alpha can show the presence of an awake, resting state,# If it is present at a fairly high voltage when the eyes are open, this would usually indicate an inattentive, daydreamy state.# In fact we often see this sign in adolescents and adults with attentional difficulties.Beta waves# The beta family of waves happen at frequencies from 16-40 Hz or higher.# When we get mentally busy and engaged, we should see alpha ""block,"" or reduce significantly in size.# In its place we see mostly smaller, quicker ""beta"" waves.Delta and theta waves# Are relatively slow.# Delta is usually defined as waves occurring from 1-4 times per second (1-4 Hz).# Theta occurs at 4-7 Hz.# During drowsiness, first alpha disappears, then the size of theta waves begins to increase.# As sleep begins, theta waves get quite large, then become mixed with and eventually give way to slower delta waves.# The presence of delta and theta waves in the waking, eyes open EEG is normal, but only if the waves are fairly small.# High-amplitude slow waves can be signs of various neurological and psychological problems, ranging from epilepsy to ADHD. Educational points:# In a typical night of sleep, a young adult first enters NREM sleep, passes through stages 1 and 2, and spends 70-100 minutes in stages 3 and 4.# Sleep then lightens, and an REM period follows. This cycle is repeated at intervals of about 90 minutes throughout the night. The cycles are similar, though there is less stage 3 and 4 sleep and more REM sleep towards morning.# Thus, four to six REM periods occur per night. REM sleep occupies 80% of total sleep time in premature infants and 50% in full-term neonates.# Thereafter, proportion of REM sleep falls rapidly and plateaus at about 25% until it falls further in old age.# In REM, there occurs | and variable pulse, | and variable blood pressure, penile/clitoral tumescence. ACh is the principal neurotransmitter involved in REM sleep.# Children have more total sleep time and stage 4 sleep than adults.# Serotonergic predominance of raphe nucleus key to initiating sleep.# NE reduces REM sleep.# Extraocular movements during REM due to activity of PPRF (paramedian pontine reticular formation/conjugate gaze center).# Benzodiazepines shorten stage 4 sleep; thus useful for night terrors and sleepwalking# Imipramine is used to treat enuresis because it | stage 4 sleep.# Characteristic feature of NREM stage IV sleep is DELTA waves.FeatureStage of SleepCardiovascular activity in Sleep:Beta wavesAwake with eyes openNREM:BP |with less variability, CO |, vasodilation increases (|flow resistance).Alpha wavesAwake with closed eyesIheta wavesStage 1Tonic REM :BP stays the same, CO stays the same, muscles vasoconstriction.Sleep-SpindlesStage 2Delta wavesStage 3 & 4Phasic REM:BP variable, CO stays the same, whole body vasoconstriction.Beta wavesREM (same as Awake)Mnemonic: (BATS Drink Blood) -### End" -7144,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements about LDL are true except, with the following options: A: It delivers cholesterol to cells, B: It contains only one Apoprotein, C: It is a marker for cardiovascular disease, D: It contains Apo-B4 - -### Response: -LOW DENSITY LIPOPROTEINS (LDL) transpos cholesterol from liver to peripheral tissues. The only apoprotein present in LDL is apo B100 (Fig. 12.12). Most of the LDL paicles are derived from VLDL, but a small pa is directly released from liver. The half-life of LDL in blood is about 2 days.Metabolism of LDL and LDL ReceptorsLDL is taken up by peripheral tissues by receptor mediated endocytosis (see Fig. 12.13). LDL receptors are present on all cells but most abundant in hepatic cells. LDL receptors are located in specialised regions called clathrin-coated pitsBinding of LDL to the receptor is by apo-B-100 and uptake of cholesterol from LDL is a highly regulated process. When the apo-B-100 binds to the apo-B-100 receptor, the receptor-LDL complex is internalised by endocytosis. The endosome vesicle thus formed fuses with lysosomes.The receptor is recycled and returns to the cell surface. The LDL paicle, along with apoproteins and cholesterol ester arehydrolysed by lysosomal hydrolases, forming amino acids and free cholesterol. The free receptors can now return to themembrane surface to bind fuher LDL molecules (Fig. 12.13).Approximately 70% of LDL is degraded in the liver, and the rest in extra-hepatic tissues. For their work on LDL receptors, Michael Brown and Joseph Goldstein were awarded Nobel prize in 1985.Function of LDLAbout 75% of the plasma cholesterol is incorporated into the LDL paicles. LDL transpos cholesterol from liver to the peripheral tissues. The cholesterol thus liberated in the cell has three majorFates:It is used for the synthesis of other steroids like steroid hormones.Cholesterol may be incorporated into the membranes.Cholesterol may be esterified to a MUFA by acyl cholesterol acyltransferase (ACAT) for storage. The cellular content of cholesterol regulates fuher endogenous synthesis of cholesterol by regulating HMG CoA reductase.LDL and Clinical ApplicationsLDL concentration in blood has positive correlation with incidence of cardiovascular diseases. A fraction of cholesterol is taken up by macrophages, this is not a regulated pathway. Increased levels of LDL or modification of LDL by glycation (as seen in diabetes mellitus) or oxidation increases the fraction of cholesterol taken up by macrophages. LDL infiltrates through aerial walls and is taken up by macrophages or scavenger cells. This is the staing event of atherosclerosis leading to myocardial infarction (see coronary aery diseases in Chapter 25). When these cells become engorged with cholesterol, foam cells are formed, that get deposited in the subendothelial space triggering formation of atheromatous plaque (see Fig. 25.3). Procoagulant changes are induced in the endothelium resulting in increased chances of thrombosis and coronary aery disease (Fig. 25.4). Since LDL-cholesterol is thus deposited in tissues, the LDL (low-density lipoprotein) variety is called ""bad cholesterol"" and LDL as ""Lethally Dangerous Lipoprotein"" in common parlanceRef: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 153-15 -### End" -7145,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: USG FAST does not involve scanning of which region from the following?, with the following options: A: Pericardial, B: Pleural, C: Pelvic, D: Hepatic - -### Response: -Ans is 'b' i.e., Pleural Focused abdominal sonar for trauma (FAST)* FAST is a technique whereby ultrasound imaging is used to assess the torso for the presence of blood, either in the abdominal cavity or in the pericardium. The purpose of the ultrasound evaluation of the injured casualty is to determine the presence of free intra-abdominal or pericardial fluid. The technique therefore focuses only on four areas : a) Pericardial, b) Splenic, c) Hepatic and d) Pelvic -### End" -7146,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with history of episodic painful edema of face and larynx. Which of the following is likely to be deficient –, with the following options: A: Complement C3, B: Complement C5, C: C1 Esterase Inhibitor, D: Properidin - -### Response: -Recurrent episodes of edema of face and larynx suggest the diagnosis of hereditory angioneurotic edema caused by deficiency of C1 esterase inhibitor. -### End" -7147,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following gene defect is associated with the development of medullary carcinoma of thyroid-, with the following options: A: RET Proto Oncogene, B: Fap gene., C: Rb gene, D: BRCA 1 gene - -### Response: -Thyroid carcinoma - -The major types of carcinoma and their relative frequency:- - -  Papillary carcinoma →  75% to 85% (most common)   -  Medullary carcinoma  → 5% -  Follicular carcinoma → 10% to 20%             -  Anaplastic carcinoma → < 5% - -Most thyroid carcinomas are derived from the follicular epithelium , except for medullary carcinoma which is derived from the parafallicular or 'C' cells . -Genetic factors in different thyroid carcinoma -Papillary  →  Tyrosine kinase receptors RET or NTR K1  - -          RAS mutation -          BRAF oncogene - -Follicular  → RAS oncogene (NRAS, HRAS and KRAS) - -                   PAX8- PPARr 1 translocation - -Medullary → RET proto oncogene. -Familial medullary cancers account for most inherited cases of thyroid cancer. -Familial nonmedullary thyroid cancers (papillary and follicular) are very rare. -### End" -7148,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 75-year-old male patient who has recent hemiparesis came to the hospital for followup. On physical examination, stroking the plantar surface of foot produced a reflex extension of large toe and fanning of lateral toes. This is due to damage to one of the following structures, with the following options: A: Cerebellum, B: Basal ganglia, C: Lower motor neuron, D: Upper motor neuron - -### Response: -Upper motor neurons typically refer to coicospinal tract neurons that innervate spinal motor neurons, but they can also include brainstem neurons that control spinal motor neurons. Damage to these neurons initially causes muscles to become weak and flaccid but eventually leads to spasticity, hypeonia (increased resistance to passive movement), hyperactive stretch reflexes, and abnormal plantar extensor reflex (positive Babinski sign). The Babinski sign is dorsiflexion of the great toe and fanning of the other toes when the lateral aspect of the sole of the foot is scratched. In adults, the normal response to this stimulation is plantar flexion in all the toes. -### End" -7149,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The earliest manifestation of increased intracranial pressure following head injury is -, with the following options: A: Ipsilateral pupillary' dilatation, B: Contralateral pupillary dilation, C: Altered mental status, D: Hemiparesis - -### Response: -Ans. is 'c' i.e., Altered mental status o Early signs of elevated ICP include drowsiness and a diminished level of consciousness.o Coma and unilateral pupillary changes are late signs and require immediate intervention. - Harrison -### End" -7150,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A G2P1 woman at 35 weeks pregnancy complains of decreased fetal movement. Next step in Mgt is:, with the following options: A: Observation, B: Do NST, C: Do CST, D: Do BPS - -### Response: -Ans. is b, i.e. Do NSTRemember: Whenever a pregnant female complains of decreased fetal movementDo NSTReactiveReassure the patient nothing needs to be done,Send the patient back homeNonreactiveNSTDo a biophysical score (BPS)A nonreactive NST earlier was being followed by a CST (contraction stress test) to confirm the diagnosis of hypoxia but CST is associated with risk of initiating labor and hence these days a nonreactive NST is being followed by a biophysical score (Manning score). -### End" -7151,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following develops from the Dorsal mesogastrium?, with the following options: A: Greater omentum, B: Lesser omentum, C: Coronary ligaments, D: Stomach - -### Response: -Ans. is 'a' i.e., Greater omentum -### End" -7152,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All lesions are seen in leprosy except, with the following options: A: Erythematous Macule, B: Hypo pigmented patch, C: Vesicles, D: Flat & raised patches - -### Response: -C i.e. Vesicles -### End" -7153,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for central diabetes insipidus -, with the following options: A: Vasopressin, B: Desmopressin, C: Lypressin, D: Presselin - -### Response: -Ans. is 'b' i.e., Desmopressin o Desmopressin (intranasal) is the DOC for central DI.Uses of vasopressine analogue|||Based on V2 action (Desmopressin is the DOC)Based on V1 actiono Central (neurogenic) diabetes insipiduso Nocturnal enuresiso Renal concentration testo Haemophilia, von willebrand's diseaseo Bleeding esophageas variceso Before abdominal radiography -### End" -7154,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of action of paclitaxei is -, with the following options: A: Topoisomerase inhibition, B: Increase the polymerization of tubulin, C: Inhibition of protein synthesis, D: Alkylation of DNA - -### Response: -Ans. is 'b' i.e., Increase the polymerization of tubulin Tasaneso Pacliiaxel and docetaxei function as a mitotic spindle poison through high affinity' binding to microtubules with enhancement of tubulin polymerization.o The microtubules are stabilized and their depolymerization is prevented - inhibition of mitosis and cell division.o Paclitaxel is metabolized in liver and undergoes enterohepatic circulation - dose should be reduced in liver dysfunction.o Paclitaxel can cause hypersensivitv reaction which does not occur with a novel albumin-bound paclitaxel preparation.o Paclitaxel and docetaxei both can cause bone marrow depression & peripheral neuropathy. -### End" -7155,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mayer-Rokitansky-Kuster-Hauser syndrome consists of -, with the following options: A: Ovaries, uterus fallopian tubes present, B: Uterus absent, fallopian tube ovaries present, C: All absent, D: Uterus present tubes and ovaries absent - -### Response: -Uterus absent, fallopian tube ovaries present Repeat from Nov 2009 Q no.160 -### End" -7156,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding corynebacterium diphtheriae except, with the following options: A: Club shaped, B: Non - sporing, C: Capsulated, D: Non - motile - -### Response: -It is non - capsulated. -### End" -7157,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The functional residual capacity is best defined as the sum of :, with the following options: A: Tidal volume and Inspiratory Reserve volume, B: Residual Volume and expiratory Reserve Volume, C: Residual Volume and Inspiratory reserve Volume, D: Tidal volume , Inspiratory Reserve volume and Expiratory Reserve Volume - -### Response: -The functional residual capacity represents the volume of the air remaining in the lungs after expiration of a normal breath. This is the volume remaining in the lungs after a tidal volume is expired and may be represented as the sum of Expiratory Reserve volume and residual volume (ERV+RV). Lung volumes and capacities (There are 4 primary Lung Volumes and Four Lung capacities: Primary Lung Volumes Lung or Respiratory Capacities The different amounts of air drawn into or out of the lungs by contracting different groups of muscles are called primary lung Volumes Respiratory capacities are when two or more repsiratory volumes are added together Tidal Volume(Vt): (Typically = 500-750 mL) Inspiratory Capacity (2.5 L) (TV+IRV) Tidal volume is the volume inspired or expired with each normal breath. The amount of air that moves into the lungs with each inspiration or the amount that moves out with each expiration during quiet breathing is called the tidal volume (TV) The inspiratory capacity ([?]2.5L) is the maximum amount of air inspired from the end-expiratory level Inspiratory Reserve volume (IRV) (Typically [?]2L) Vital lung capacity ([?]3.5L) (TV+IRV+ERV) Inspiratory Reserve volume is the volume that can be inspired over and above the tidal volume. The air inspired with a maximal inspiratory effo in excess of the TV is the inspiratory reserve volume The vital lung capacity ([?]3.5L) refers to the maximum amount of expired from the fully inflated lung, or maximum inspiratory level Expiratory reserve volume (ERV) (ERV;[?]1L) Functional Residual capacity ([?]2.5L) (RV+ERV) Expiratory reserve volume (ERV) is the volume that can be expired after the expiration of a tidal volume. The volume expelled by an active expiratory effo after passive expiration is the expiratory reserve volume The functional residual capacity represents the volume of the air remaining in the lungs after expiration of a normal breath. The functional residual capacity also includes the RV, so it cannot be measured by spirometry Residual Volume (RV) (RV; [?]1.3L) Total lung capacity ([?]5L) (TV+IRV+ERV+RV) Residual volume (RV) is the volume that remains in the lung after a maximal expiration Residual volume cannot be measured by spirometry Total lung capacity (TLC) is the volume in the lungs after a maximal inspiration and represents the sum of all four lung volumes. Total lung capacities (TLC) includes RV, so it cannot be measured by spirometry Ref: Ganong 24th edition Pgno: 629 -### End" -7158,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A married middle aged female gives history of repeated abortions for the past 5 years. Which of the following chromosomal anomaly is the most common cause for this?, with the following options: A: Klinefelter's syndrome, B: Turner's syndrome, C: Down's syndrome, D: Patau's syndrome - -### Response: -• The given karyogram shows three chromosomes at 21 instead of a pair. It is called Trisomy 21. -• Trisomy 21 is synonymous with Down’s syndrome and is the most common of the chromosomal disorders. It is a major cause of mental retardation. -• Other trisomies are Edward syndrome (Trisomy 18) and Patau syndrome (Trisomy 13) -### End" -7159,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lumbar plexus is situated in, with the following options: A: Anterior portion of psoas, B: Posterior portion of psoas, C: Anterior portion of quadratus lumborum, D: Posterior portion of quadratus lumborum - -### Response: -Ans. b (Posterior portion of psoas) (Ref. BDC anatomy Vol. II 3rd ed., 278)LUMBAR PLEXUS# The lumbar plexus lies in the posterior part of the substance of the PSOAS MAJOR muscle.# It is formed by the ventral rami of the upper 4 lumbar nerves.Its branches include:- Ilioinguinal nerve (L1)- Lateral cutaneous nerve of the thigh (L2, L3 dorsal divisions)- Lumbosacral trunk (L4, 5; ventral trunk)- Genitofemoral nerve (L1, L2, ventral divisions)- Obturator nerve (L2, 3, 4; dorsal divisions)- Femoral nerve (L2, 3, 4; dorsal divisions)- Iliohypogastric nerve (L1)Branches of the lumbar plexusNerveSegmentMuscleMotionSensationIliohypogastricT12 -L1# Inter oblique# External oblique# Transversus abdominusAnterior abdominal wall# Inferior abdominal wall# Upper lateral quadrant of buttockIlioinguinalL1Internal obliqueAnterior abdominal wall# Internal medial inguinal ligament# GenitaliaGenitofemoralL1-L2CremasterTesticular# Inferior medial inguinal ligament# Spermatic cordLateral femoral cutaneousL2-L3 # Anterior, lateral and posterior aspect of thighFemoral Nerve1. Anterior division L2-L4# Sartorius,# Pectineus# Medial aspect of lower thigh# Adduction of thigh# Anterior medial skin of thigh2. Posterior division Quadriceps# Knee extension# Patellar movement# Anterior thigh hip and kneeObturator nerve1. Anterior division L2-L4# Gracilis# Adductor longus# Adductor brevis# PectineusThigh adduction# Posterior medial thigh# Medial knee# Hip2. Posterior division # Adductor magnus# Obturator externusThigh adduction with lateral hip rotationKnee -### End" -7160,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gold standard test for for insulinoma, with the following options: A: >72 hr fasting test, B: Plasma insulin levels, C: C-paptide levels, D: Low glucose levels < 30 mg/di - -### Response: -72 hr fasting test [Ref: Harrison 17/e p23541 ""The most reliable test to diagnose insulinonza is a fast up to 72 h with serum glucose, C-peptide, and insulin measurements every 4-8 h."" -Harrison An insulinoma is an endocrine tumor of the pancreas derived from beta cells that ectopically secretes insulin, which results in hypoglycemia. The clinical symptoms are because of the effects of hypoglycaemia (sweating, tremor, palpitations, confusion, headache, disorientation, visual difficulties, irrational behavior, or even coma) The diagnosis of insulinoma requires the demonstration of an elevated plasma insulin level at the time of hypoglycemia. This is because insulinomas do not reduce the secretion of insulin in the presence of hypoglycaemia. Whereas in a normal person, insulin levels would decrease with decrease in blood glucose levels. The most reliable test to diagnose insulinoma is a fast up to 72 h with serum glucose, and insulin measurements every 4-8 h. The test is terminated if the the patient becomes symptomatic or glucose levels are <40 mg/dL (2.2 mmol/L). Diagnosis of insulinoma is made if: - A serum insulin level of 6 microunit/mL or more in the presence of blood glucose values below 40 mg/dL - ratio of plasma insulin to glucose is > 0.3 In addition to the above criteria, some other measurements are also required before making the diagnosis of insulinoma - C-peptide level - serum proinsulin level, - serum sulfonylurea levels These additional tests are used because any hidden use of insulin or oral hypoglycemics taken by the patient would resemble insulinoma causing high levels of insulin in presence of hypoglycaemia. The combination of elevated proinsulin levels (normal in exogenous insulin/hypoglycemic agent users), elevated C-peptide levels (low in exogenous insulin users), antibodies to insulin (positive in exogenous insulin users), and measurement of sulfonylurea levels in serum or plasma will allow the correct diagnosis to be made. -### End" -7161,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A woman presents to a dermatologist because she has lost almost all the hair on her body, including scalp hair, eyebrows, eyelashes, armpit and groin hair, and the fine hairs on her body and extremities. She most likely has a variant of which of the following?, with the following options: A: Alopecia areata, B: Androgenic alopecia, C: Chronic cutaneous lupus erythematosus, D: Lichen planopilaris - -### Response: -Alopecia areata is caused by an autoimmune attack on hair follicles. It has a wide range of clinical severity, with most cases involving a localized patch of hair (which regrows within 1 year in half of the patients). The hair that does regrow may be gray or depigmented. More severe cases can involve the entire scalp (alopecia totalis) or, as in this patient, the entire body surface (alopecia universalis). These more severe cases are less likely to resolve adequately. Treatment of alopecia areata is often unsuccessful, but topical steroids are typically tried. Androgenic alopecia is common male pattern baldness. Chronic cutaneous lupus erythematosus can produce localized baldness. Lichen planopilaris can produce localized baldness. Ref: Landthaler M., Baumler W., Hohenleutner U. (2012). Chapter 239. Lasers and Flashlamps in Dermatology. In K. Wolff (Ed), Fitzpatrick's Dermatology in General Medicine, 8e. -### End" -7162,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30 year old woman with sudden right-sided painful red eye associated with nausea, vomiting and headache. The diagnosis is:, with the following options: A: Acute congestive glaucoma, B: Endophthlmitis, C: Eale's disease, D: Trachoma - -### Response: -A i.e. Acute congestive glaucoma -### End" -7163,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not true about Ca hard palate?, with the following options: A: Painful, B: Maxillectomy may be needed, C: Lymphatic spread can occur, D: May be squamous or adenocarcinoma - -### Response: -In Ca Hard Palate the lesion is painless and usually presents as an irregularity on the hard palate. Half of all hard palate cancers are squamous cell carcinomas (SCCs). Palatal hypesthesia indicates trigeminal nerve involvement in the sphenopalatine foramen or pterygopalatine fossa extension. Lymph node involvement is of special concern in SCC and high-grade mucoepidermoid cancer. It is rare in other salivary gland carcinomas. -### End" -7164,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Loffler's medium is?, with the following options: A: Indicator medium, B: Selective medium, C: Enrichment medium, D: Enriched medium - -### Response: -Ans. D. Enriched medium.Enriched mediumThe media containing ingredients which enhance their growth-promoting qualities are enriched media e.g. blood agar, chocolate agar and Loeffler medium.The usual media employed for cultivation of the diphtheria bacillus are Loeffler's serum slope and tellurite blood agar.Diphtheria bacilli grow on Loeffler's serum slope very rapidly and colonies can be seen in 6-8 hours, long before the other bacteria grow.TYPES OF Bacteriological Media MediaCommente.g.1.Ordinary culture mediaThese are routinely employed in a laboratorye.g. nutrient broth, nutrient agar, infusion broth and lysate media.2.Enriched mediaCertain organisms do not grow on ordinary nutrient media. They require growth- promoting ingredients such as blood, glucose, serum, egg, etc. The media containing ingredients which enhance their growth- promoting qualities are enriched mediae.g. blood agar, chocolate agar and Loeffler medium.3.Enrichment mediaEnrichment media are liquid media containing chemical constituents which inhibit some normal flora and allow pathogens which may be present in very small number in the specimen, to grow unhampered and thus enriching them. Isolated colonies of these organisms may be obtained by subculturing onto solid media.An example of enrichment media is selenite F broth used for primary isolation of enteric bacteria.4.Differential/ Indicator mediaDifferential media have got some chemical constituents which characterize different bacteria by their special colonial appearances in the culture e.g. MacConkey agar contains lactose as a substrate and neutral red as an indicator. Bacteria fermenting lactose produce acid and this will change the colour of the indicator and thus the colonies will turn red. The red lactose fermenting colonies can be differentiated from the pale non-lactose fermenting colonies.1. Eosin methylene blue (EMB), which is differential for lactose and sucrose fermentation2. MacConkey (MCK), which is differential for lactose fermentation3. mannitol salt agar (MSA), which is differential for mannitol fermentation4. X-gal plates, which are differential for lac operon mutants5. Selective mediaSelective media will selectively permit the growth of pathogens and inhibit the commensals. In addition, it may differentiate the pathogen from commensals that grow by the colour and opacity of the coloniese.g. blood tellurite medium for C. diphtheriae.Buffered charcoal yeast extract agar, which is selective for certain gram-negative bacteria, especially Legionella pneumophila6. Transport mediaTransport media are also frequently used to sustain the viability of organisms when a clinical specimen is to be transported from the periphery to laboratory.The transport medium prevents the outgrowth of contaminants during transit and sustains the pathogen.Cary and Blair and Stuart media.Venkat-Ramakrishnan(VR) medium for v. cholerae.Thioglycolate broth for strict anaerobes.Loeffler MediaIt is primarily used for the isolation of Corynebacterium diphtheriae from clinical specimens. It is also used to determine the proteolytic activity and pigment production of various microorganisms.PRINCIPLE:Recovery is further enhanced when Loeffler Media is used in combination with Potassium Tellurite CystineAgar Media and blood agar. On Loeffler Media, C. diphtheriae produces characteristic metachromatic granules that can be detected by staining with methylene blue; it also demonstrates the characteristic Chinese-letter formation which is due to the cells snapping off when they divide. With the above information, a presumptive identification can result in 16-18 hours. Loeffler Media enhances the demonstration of the organism's natural morphological and physiological characteristics, i.e. pigmentation.FORMULA: Approximate, per 250 ml of deionized filtered water.Loeffler Media: Beef Extract..................................0.75 gDextrose.......................................1.25Sodium Chloride.............................1.25Proteose Micro Peptone....................2.50Horse Serum.................................750.00 mlInterpretation:Corynebacterium diphtheriae BiotypesMetachromatic GranulesMorphologyMitisIntensely stainedLong, pleomorphic but rigid rodsintermediusCells frequently swollen with terminal granules Irregularly barredHighly pleomorphic with very long and short rodsgravisNo granules but alternate bands of light and dark blueShort rods with many cocci of pear-shaped formsAdditional Educational points:Stains1Congo redAmyloid; apple-green birefringence in polarized light (because of a-pleated sheets).2Giemsa'sBorrelia, Plasmodium, trypanosomes, Chlamydia.3PAS (periodic acid-Schiff)Stains glycogen, mucopolysaccharides; used to diagnose Whipple's disease.4Ziehl-NeelsenAcid-fast bacteria.5India inkCryptococcus neoformans.6Silver stainFungi, PCP, Legionella. -### End" -7165,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not the complication of Rh incompatibility:, with the following options: A: APH, B: PPH, C: Oligohydramnios, D: Pregnancy induced hypeension - -### Response: -Ans. is c i.e. Oligohydramnios Rh incompatibility has adverse effect on the baby mainly, but mother may also be affected. In Rh negative mothers there is increased incidence of Preeclampsiadeg- due to hydropic placenta in case of hydrops. Polyhydramniosdeg Preterm labour Big size baby and its hazards Hypofibrinogenemia (due to prolonged retention of dead fetus in utero). Post paum hemorrhage due to big placenta and coagulopathy. Maternal mirror syndrome - Characterised by generalised oedema (similar to fetus), proteinuria and pruritis due to cholestasis. These features are omnious and indicate imminent fetal death in utero. Antepaum hemorrhage is not a direct complication of Rh incompatibility but may be the result of hypofibrinogenemia. -### End" -7166,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oil and grease are sterilised by-(, with the following options: A: Hot air oven, B: Autoclaving, C: Filtration, D: Irradiation - -### Response: -Ans. is 'a' i.e., Hot air oven -### End" -7167,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aminoglycoside side effects include : Cochlear toxicity Vestibular toxicity Neuromuscular Blockade, with the following options: A: Only 1, B: 1 and 2, C: 1,2 and 3, D: 2 and 3 - -### Response: -S/E of Aminoglycoside includes: 1. OTOTOXICITY: Due to accumulation of these in labyrinthine fluid.The Vestibular or Cochlear sensory cells and hairs undergo concentration dependent destructive changes. Aminoglycoside ear drops can cause ototoxicity when instilled in patients with perforated eardrum and so are contraindicated in them.No regeneration of the sensory cells occurs and the hearing loss is permanent. Cochlear damage - stas from Base and spreads to Apex; hearing loss affects high frequency sounds first then progressively involves the lower frequencies as well. Kanamycin and Amikacin produce greater cochlear damage than other aminoglycosides. Vestibular damage - Headache is usually first to appear other symptoms include Nystagmus, Veigo and Ataxia. Permanency of changes depends on the extent of initial damage and the age of the patient; Elderly have poor recovery. 2. NEPHROTOXICITY: Manifests as Tubular damage resulting in loss of urinary concentrating power, Nitrogen retention ,Low GFR, Albuminuria and casts.Concurrent use with Loop Diuretics (e.g Furosemide, Ethacrynic acid) or other Nephrotoxic antimicrobial agents (e.g Vancomycin or Amphotericin) can potentiate Nephrotoxicity and should be avoided if possible. 3. NEUROTOXICITY: Aminoglycosides reduce Ach release from the motor nerve endings byinterfering with mobilization of centrally located synaptic vesicles to fuse with the terminal membrane (probably by antagonizing Ca2+) and also decreases sensitivity of the muscle end plates to Ach. -### End" -7168,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Octreotide is not used in:, with the following options: A: Varices, B: Refractory diarrhoea in AIDS, C: Carcinoid, D: Glucagonoma - -### Response: -Glucagonoma -### End" -7169,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mutation in p53 gene is associated with which malignancy ?, with the following options: A: Endometrial carcinoma, B: Retinoblastoma, C: Colorectal carcinoma, D: Prostate cancer - -### Response: -Ans. is 'c' i.e., Colorectal carcinoma P53 mutations associated with breast, colorectal, liver, lung, and ovarian cancer. -### End" -7170,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The prognosis of rapidly prolifeating glomerulonephritis (Crescentric GN) depends upon, with the following options: A: Number of crescents, B: Size of crescents, C: Shape of crescents, D: Cellularity of crescents - -### Response: -Answer is A (Number of crescents) The prognosis of crescentric glonzerulonephritis relates to the number of crescents Prognosis can he roughly related to the number of crescents' - Robbins -### End" -7171,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heat Rupture is characterized by -, with the following options: A: Regular margins, B: Irregular margins, C: Ruptured blood vessels, D: Ruptured red blood cells/clotted blood - -### Response: -HEAT RUPTURE: If the heat applied is very great skin contracts and heat ruptures occur either before or after death. they are produced by splitting of the soft pas these splits may be anywhere but are usually seen over extensor surfaces joints and on the head These ruptures or splits of the skin may be several centimeters in length and are superficially they may resemble lacerations or even incised wounds They can be differentiated by : 1. absence of bleeding in the wound and surrounding tissues since heat coagulates the blood in the vessels 2. intact vessels and nerves are seen in the floor 3. irregular margins 4. bruising or other signs of vital reaction are not present in the margins. REF: The synopsis of forensic medicine and toxicology 29th edition page no: 161. -### End" -7172,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Corn picker's pupil seen in which plant poisoning, with the following options: A: Datura, B: Canabis, C: Odollum, D: Cocaine - -### Response: -signs and symptoms They are described as Moon and according to him, the person will be, Dry as a bone. Hot as a hare Blind as a bat Red as a beet on ingestion, will cause bitter taste in the mouth and dryness with difficulty in talking. The voice becomes hoarse. There may be dysphagia, burning pain in the stomach and vomiting. Pupils will be dilated with loss of accommodation for near vision (corn picker's pupil) . There may be photophobia, diplopia and temporary blindness. There may be numbness and paralysis of limbs and difficulty in micturition. Pulse will be rapid, full and bounding and later becomes weak and irregular. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 477 -### End" -7173,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is the best inotrope drug for use in right heart failure?, with the following options: A: Dobutamine, B: Digoxin, C: Dopamine, D: Milrinone - -### Response: -Ans. (D) Milrinone(Ref: Goodman and Gilman, 11th/e p575, Harmon 17th/e p1455)Inotropic drugs are not used for treatment of right sided heart failure where the major treatment is diuretics and vasodilators. Milrinone being a phosphodiesterase inhibitor act as an inodilator. Thus, this is the only inotropic drug that should be used in right sided failure due to its ability to produce vasodilation. It is indicated in right heart failure with pulmonary hypertension. -### End" -7174,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 9-year-old boy is brought with history of decreased urine output, cola colored urine and swelling of the face and hands, of 2 days duration. He is hypeensive, has a puffy face and pitting edema of the lower limbs. He has history of skin lesions 4 weeks earlier. A diagnosis of post streptococcal glomerulonephritis is made. ASO titers are likely to be?, with the following options: A: Elevated, B: Not elevated, C: Increased progressively over 2 weeks, D: Initially elevated, rapidly fall in 3-4 days - -### Response: -Lab Diagnosis of PSGN: Antistreptolysin O (ASO) titer is commonly elevated after a pharyngeal infection but rarely increases after streptococcal skin infections.(as in this case) Best single antibody to document cutaneous streptococcal infection is anti deoxyribonuclease (DNase) B level. Other Lab tests of PSGN: The serum C3 level is significantly reduced in >90% of patients, and returns to normal 6-8 wk after onset. C4 is most often normal. Serum CH50 is commonly depressed A biopsy is rarely indicated when: renal function is severely impaired beyond 7-10 days serum C3 remains depressed beyond 12 weeks Patient with features of a systemic illness -### End" -7175,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Apple-jelly nodules is/are seen in:, with the following options: A: Lupus vulgaris, B: DLE, C: Lichen planus, D: Psoriasis - -### Response: -Ans: A (Lupus vulgaris) Apple jelly nodules:characterized by yellow-brown nodules with tiny darker granules. On probing, the noduies are soft jelly-like""- Neena Khanna 3rd/217Lupus Vulgaris Neena Khanna 3rd/217MorphologySingle (or few) lesions.Well demarcated, annular or arcuate plaques which slowly extend centrifugally. Periphery' shows erythematous to brownish, deep seated nodules which on diascopy9 may stand out as apple jelly nodules..Over period of time, the center becomes atrophic (paper thin), depigmented and scarred. Characteristically, new nodules may appear within area of scarringFeatures of Psoriasis are: Isomorphic phenomenon for Koebner's phenomenon), ring of Woronoff, (a hypopigmented halo surrounding plaque), silvery scales, positive grattage test, Auspitz sign, Munro's micro-abscesses etc- Neena Khanna 3rd/40-41Psoriasis Neena Khanna 3rd/38It is a chronic dermatosis characterized by an unpredictable course of remissions and relapses and presence at typical sites of papules and plaques which are:Well definedErythematous.Surmounted with large, silvery, loose scales.DLE Neena Khanna 3rd/ 186Characteristic lesion is a well demarcated coin shaped (discoid), annular, erythematous plaque with adherent scalesWhen the scale is removed, its undersurface show's keratotic spikes which have occupied the dilated pilosebaceous canals (carpet tack sign)Features of Licken planus are: Isomorphic phenomenon (or Koebner's phenomenon), Wickham's striae (surface has white streaks when viewed under a magnifying lens)- Neena Khanna 3rd/ 52 -### End" -7176,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which type of FSGS has worst prognosis, with the following options: A: Perihilar variant, B: Collapsing variant, C: Glomerular tip variant, D: Cellular variant - -### Response: -Collapsing variant has the worst prognosis. -It is also associated with HIV. -### End" -7177,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lucid interval is seen in, with the following options: A: Syphilis, B: Malignant disease, C: Insanity, D: Electrical shock - -### Response: -(C) Insanity # Lucid Interval: This is a period occurring in insanity, during which all symptoms of insanity disappear completely.> The individual is able to judge his acts soundly, and he becomes legally liable for his acts.> The period of lucid interval varies from person to person & from time to time in the same person & as such one cannot be certain about the time when a person passes again in the state of insanity. -### End" -7178,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The hilum of the right lung is arched by:, with the following options: A: Recurrent laryngeal nerve, B: Azygos vein, C: Thoracic duct, D: Vagus nerve - -### Response: -B i.e. Azygous vein -### End" -7179,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urine cytology is used for the screening of:, with the following options: A: Wilms tumor, B: Renal cell carcinoma, C: Urothelial carcinoma, D: Carcinoma prostate - -### Response: -Ans. (c) Urothelial carcinomaRef: Campbell Urology 11th Edition, Page 2197* Urinary cytology is used for screening of urothelial cancer.* AUA guidelines for evaluation include cystoscopy, upper; tract imaging and urine cytology. -### End" -7180,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dorset egg medium is used for cultivation of, with the following options: A: Staphylococcus, B: Streptococcus, C: Gonococcus, D: M TB - -### Response: -Media which are used for the cultivation of Mycobacterium tuberculosis are LJ media which is most common media used in which growth is seen in 6 to 8 weeks and the colonies are Rough, Buff and tough. The other media used car door fitting media Petragnini media, Saula media, Dubois media or Middlebrook's media. Note-Extra edge M . tuberculosis M. bovis Rough , buff and tough colonies on LJ media Flat , moist and smooth colonies on LJ media Aerobic Microaerophile Shows glycerol and niacin enhancement No such enhancement -### End" -7181,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement are true regarding RDA ?, with the following options: A: RDA is statistically defined as two standard deviation above the estimated average requirement (EAR), B: RDA is statistically defined as equal to the EAR, C: RDA is statistically defined as equal to the adequate intake, D: RDA is defined as the recommended minimum requirement - -### Response: -RDA (Recommended dietary allowance) : -Amount of nutrient estimated to meet the nutrient requirement of 97% to 98% of healthy individual in an age and gender group. -RDA = EAR + 2SDEA -### End" -7182,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young man with leukemia is treated with methotrexate. Which of the following is the mechanism of action of this drug?, with the following options: A: preventing absorption of folic acid, B: inhibiting dihydrofolate reductase, C: preventing formation of messenger ribonucleic acid (mRNA), D: forming a cytotoxic metabolite - -### Response: -The most likely mode of action of methotrexate is by tightly binding dihydrofolate reductase (DHFR), which maintains the intracellular folate pool in its fully reduced form as tetrahydrofolates. These compounds are required in the de novo synthesis of pyrimidines and purines. -### End" -7183,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Test to detect spermine in semen is, with the following options: A: Barberio test, B: Ammonium molybdate test, C: Acid phosphatase test, D: Florence test - -### Response: -Ans. is 'a' i.e., Barberio test Tests to detect semen are:A. Chemical tests:1) Microchemical tests: Florence test (produces brown crystals of choline periodide), and barberio's test (produces yellow crystals of spermine picrate by picric acid).2) Enzyme tests : Acid phosphatase (concentration >10 K.A./ml), creatinine phosphokinase (>400 units) and specific glycoproteins (P30 orMHS-5).3) Ammonium molybdate test: It gives deep deep yellow colour, due to presence of phosphorus.B. Microscopic examination:# It is done to demonstrate the presence of spermatozoa in the vaginal fluid or in stain.C. Biological examination:1) Precipitin test: To know the species to which semen belongs.2) Blood group can be known from semen.D. UV light:# Invisible, softned and dry semen stains of the clothes can be rendered distinct by the filtered UV light, which produces bluish fluorescence.E. Testes for determination of specific protein component (e.g. LDH isoenzyme):# These are immunoelectrophoresis, gel diffusion precipitation, gel electrophoresis, immunodiffusion, isoelectric focussing and TLC (thin layer chromatography). -### End" -7184,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an X-linked dominant disorder?, with the following options: A: Vitamin D resistant rickets, B: Familial hypercholesterolemia, C: Red green color blindness, D: Achondroplasia - -### Response: -Ref: Robbins Pathology 9th ed. pg. 142Vitamin D resistant ricketsPHEX gene. X linked dominantFamilial hypercholesterolemiaAutosomal recessiveRed green colour blindnessX linked recessiveAchondroplasiaAutosomal dominant -### End" -7185,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the current trend in Health Care?, with the following options: A: Qualitative enquiry, B: Community Paicipation, C: Equitable distribution, D: Primary Health care - -### Response: -Among all the options listed above, community paicipation is the current trend followed as far as Health care is concerned. The whole concept to protect health is possible only with the paicipation of the community whose health is being protected. Primary health care is that health care being provided at the level individuals, family and community. Equitable distribution is one of the principles of primary health care as per Alma - Ata Declaration. Ref: Park's Textbook of Preventive and Social Medicine, 19th Edition, Pages 20, 21. -### End" -7186,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following diagnostic techniques is most specific for pulmonary embolism, with the following options: A: Pulmonary angiography, B: Ventilation lung scanning, C: Perfusion lung scanning, D: Aerial blood gas analysis - -### Response: -CT pulmonary angiography is the first-line diagnostic test for pulmonary thromboembolism.It has the advantages of visualising the distribution and extent of the emboli,or highlighting an alternative diagnosis,such as consolidation,pneumothorax or aoic dissection.A definitive diagnosis of Pulmonary embolism depends on visualisation of an intraluminal filling defect in more than one projection.Secondary signs of PE include abrupt occlusion(""cut off"")of vessels,segmental oligemia or avascularity, a prolonged aerial phase with slow filling,and touous,tapering peripheral vessels. Reference:Harrison's Medicine-18th edition,page no:2174;Davidson's Medicine-22nd edition,page no:722. -### End" -7187,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vaccine, contrainidicated in pregnancy is ?, with the following options: A: Tuberculin, B: Typhoid, C: Influenza, D: HBV - -### Response: -Ans. is 'a' i.e., Tuberculine or none o All live attenuated vaccines are contraindicated in pregnancy. o Pregnancy is not a contraindication for immunization by toxoid and killed (inactivated) vaccines. o Lets see each option Typhoid vaccine o There are two ypes of typhoid vaccines i.e., killed and live attenuated. o Killed vaccine is not contraindicated in pregnancy. Influenza vaccine Killed influenza vaccine is not contraindicated in pregnancy. HBV o Hepatitis B vaccine is killed vaccine and is not contraindicated in pregnancy. Now we are left with option 'a' o Tuberculin is a test not a vaccine. Vaccine used for TB is BCG. o BCG is a live attenuated vaccine and is contraindicated in pregnancy. o If examinar wanted to ask about vaccine used in TB (through option a), the answer is 'a' i.e., tuberculin, otherwise answer is none. -### End" -7188,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prevention of disease by immunization comes under which category, with the following options: A: Primordial prevention, B: Primary prevention, C: Secondary prevention, D: Teiary prevention - -### Response: -Primary prevention aims at preventing the progression of risk factors to disease. It includes health promotion and specific protection. Immunization comes under specific protection. Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition - Pgno. 42 -### End" -7189,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Veebral rotation in scoliosis is checked in, with the following options: A: Forward bending, B: Backward bending, C: Sideways, D: Without bending - -### Response: -(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 244, 245) -### End" -7190,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Presence of budding capsulated yeast in CSF is, with the following options: A: Histoplasma capsulatum, B: Coccidiomyces immitis, C: Cryptococcus neoformans, D: Blastomycetes - -### Response: -(C) Cryptococcus neoformans # Cryptococcus neoformans is round or ovoid budding cell, 4-30 mm in diameter with polysaccharide capsule,> Infection is acquired by inhalation causes pulmonary cryptococcosis, (cryptococcal meningitis is most serious type of infection seen in AIDS patients.)> Diagnosis is established by demonstration of capsulated budding yeast cells in the lesion or culture from CSR> Blastomyces is dimorphic fungus (lung and cutaneous lesion)> Histoplasma is a dimorphic fungus involving pulmonary and reticuloendothelial sys.> Coccidioides imitis is dimorphic fungus producing respiratory infection only.> Cryptococcus causes CNS infection, so can be isolated from CSR -### End" -7191,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acanthosis nigrans is most common due to carcinoma of:, with the following options: A: Bronchus, B: Breast, C: Colon, D: Testis - -### Response: -Bronchus -### End" -7192,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female presented with long standing nasal obstruction. She also complaints about comments from her friends telling about foul smell coming from her nose which she could not recognise. On evaluation, atrophic rhinitis is diagnosed. What can be the etiology in this patient to develop secondary atrophic rhinitis?, with the following options: A: Chronic sinusitis, B: Nasal trauma, C: Oropharyngeal cancer, D: Strong hereditary factors - -### Response: -Specific infections like syphilis, lupus, leprosy, and rhinoscleroma may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis, radiotherapy to nose or excessive surgical removal of turbinates. Extreme detion of nasal septum may be accompanied by atrophic rhinitis on the wider side. -### End" -7193,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dimensions of inner bow of facebow are?, with the following options: A: 0.045"" and 1.125 mm, B: 0.06"" and 0.09"", C: 0.045"" and 1.25%, D: 0.45 and 0.71"" - -### Response: -Components of a facebow -Kloehn facebow is made from rigid stainless steel wire framework. It has a horseshoe shape/dental arch form of inner bow of 0.045-in. diameter and an outer bow of 0.071-in diameter. The inner bow follows curves/arch form of the maxillary arch, while long arms of the outer bow lie on either side of face extending close to the tragus of the ear. Both bows are laser welded or soldered in incisor region, strong enough to withstand orthopaedic forces that are applied to the inner bow through extraoral traction system, either from a cervical neck strap or a high-pull headgear. Cervical facebows are commercially available in different sizes to suit variable arch lengths. -### End" -7194,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urine LAM is used for diagnosis of?, with the following options: A: Mycobacterium tuberculosis, B: Mycobacterium leprae, C: Mycoplasma Pneumoniae, D: Listeria monocytogenes - -### Response: -Urine LAM (Lipoarabinomannan) is used for diagnosis of Mycobacterium tuberculosis Mycobacterium leprae-split skin smear Mycoplasma pneumonia- can be detected by urine test but we use different antigen for it Listeria monocytogenes- causes meningitis in children, so we use CSF -### End" -7195,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young butcher cuts his forearm with a knife. Over the next week, he notices swelling, redness, and warmth at the site. Four days later, he presents to the emergency depament with fever, shaking chills and severe lower back pain. Physical examination reveals a temperature of 39.4 C (102.9 F), swelling in his forearm with an area of central softness, and tenderness to pressure over his lower spine. Laboratory data show a leukocyte count of 14,000/mm3 with 81% polymorphonuclear leukocytes. Blood cultures grew a gram positive cocci in clusters on blood agar; colonies show a yellow pigment, and the organism is positive on mannitol/salt agar. The organism is catalase and coagulase positive. Which of the following is the most likely pathogen?, with the following options: A: Bacteroides fragilis, B: Clostridium perfringens, C: Escherichia coli, D: Staphylococcus aureus - -### Response: -This organism is a gram positive coccus organized into grape-like clusters. It produces a yellow pigment and the positive mannitol salt agar test showed that it could ferment mannitol and had a high salt tolerance. This organism is catalase positive and coagulase positive, two critical tests for the correct identification of Staphylococcus aureus. Bacteroides fragilis is a gram-negative rod that grows anaerobically. It does cause abscesses, but does not have the characteristics described for the organism in this case. Clostridium perfringens is a gram-positive spore forming organism that causes gangrene. It would not grow aerobically on blood agar. The organism can ceainly spread in the skin when introduced by trauma, but would not demonstrate the biochemical profile described. Escherichia coli is a gram-negative rod that would grow on the blood agar but would not produce yellow pigment. Growth on MacConkey's agar after it was gram-stained would indicate lactose fermentation, and other biochemical tests would be used to specifically identify the organism. -### End" -7196,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Workshop is ?, with the following options: A: Discussion of 4-8 expes in front of audience, B: Discussion between 6-12 members, C: Series of four or more meetings, D: Series of speeches on given subject - -### Response: -Ans. is 'c' i.e., Series of four or more meetings WorkshopIt consists of a series of meeting usually four or more, with emphasis on individual work, within the group, with the help of consultants and resource personnel.The total workshop may be divided into small groups and each group will solve and discuss a problem with the help of consultants. -### End" -7197,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60 year old diabetic patient has an uneventful phacoemulsification with IOL implantation. He presented with pain, diminution of vision, redness, watering and a grayish yellow pupillary reflex on the third postoperative day. Examination revealed circumcorneal congestion, aqueous cells 4+, hypopyon in the anterior chamber with posterior synechiae and retrolental flare. The most likely diagnosis is:, with the following options: A: Post-op endophthalmitis, B: Post-op glaucoma, C: Post-op keratitis, D: Post-op cystitis - -### Response: -A i.e. Post-op endophthalmitis -### End" -7198,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vasoconstriction in burn wound is seen in, with the following options: A: Zone of coagulation, B: Zone of hyperemia, C: Zone of stasis, D: None of the above - -### Response: -Zone of stasis lies outer to zone of coagulation. It has  vasoconstriction and resultant ischaemia. -### End" -7199,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The term modified base refers to, with the following options: A: Purine or pyrimidine attached to deoxyribose, B: A purine or pyrimidine that has been altered, C: A nitrogen containing ring other than a purine or pyrimidine that is part of a nucleotide, D: A purine or pyrimidine attached to a sugar by O-glycoside linkage - -### Response: -A modified base is one that has been modified after nucleic acid chain has been formed. These bases are modified by methylation, reduction, acetylation or glycosylation. -In t-RNA there are many modified bases, e.g. dihydrouridine, ribothymidine, pseudouridine, and 7-methylguanosine. -In DNA, the most common modified base is 5-methylcytosine. -Other important modified bases are acetylcytosine and dimethyladenine. -### End" -7200,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Currarino triad includes:, with the following options: A: Pre-sacral meningocele + Sacral defect + Tethered cord, B: Ectopia vesicae + Anorectal malformation + Sacrococcygeal osseous defect, C: Anorectal malformations + Sacrococcygeal osseous defect + Presacral mass, D: Tethered cord + Anorectal malformations + Ectopia vesicae - -### Response: -Currarino triadorASP triad: - Anorectal malformation or congenital anorectal stenosis - Sacrococcygeal osseous defect (always present) - Classically, hemisacrum with intact first sacral veebra (""sickle-shaped sacrum"") - Mild (hypoplasia) to severe (agenesis) of sacrum and coccyx - Presacral mass (various types) - Anterior sacral meningocele - Tumor, e.g. mature teratoma - Dermoid/epidermoid cyst -### End" -7201,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presented with clinical features of demyelination. The chances of progression to MS is least with which of the following:, with the following options: A: Absent oligoclonal band, B: Bilateral visual loss, C: Poor recovery, D: Cord complete transaction - -### Response: -A i.e. Absent olgoclonal band Multiple sclerosis is a demyelination disorder characterized by selective destruction of CNS myelin predominantly of white matter long tractQ. Diagnosis suggestive MRI findings include >1 hyperintense T2 lesion in at least 2 out of & MS typical regions of CNS (i.e. periventricular, juxta coical, infratentorial or spinal cord) and Gd-enhancement. Lesions >6mm located in corpus callosum (juxtacoical), periventricular white matter, brainstem & cerebellum (infratentorial) and spinal cord are paicularly helpful diagnostically. (Harrison 18/e p 3399). However when the Q was asked Harrison 16/e p 2461 mentioned - confirmatory MRI must have either 4 lesions involving the white matter or 3 lesion if periventricular in locations. Acceptable lesion must be > 3 mm in diameter. CT findings of MS include focal decreased attenuation in periventricular white matter (most characteristic), contrast enhancing plaques (enhancement may be decreased or abolished by coicosteroid administration) and cerebral atrophy. MRI is imaging modality of choice and most characteristic diagnostic feature of MS plaque is not their high signal intensity (on T2WI) but their anatomical distribution. There is a predilection for periventricular distribution & ependymal surface (especially along occipital horns >frontal horns). If not pathognomic, corpus callosum lesions are so characteristic of MS to be almost specific. Other MS sites are corona radiata, internal capsule, centrum semiovale; and surface of pons esp near 5th CN entery zone, middle cerebral paduncle (brachium pontis), floor of 4th ventricle and colliculi in posterior cranial fossa. T1WI are less sensitive but chronic plaques of MS (esp in corpus callosum are often well shown as black holes (low signal lesions) surrounded by a very thin halo of mildly increased signal intensity. Progression to MS is more likely with presence of oligoclonal bandQ (not absent), bilateral optic neuritis, poor recovery & complete cord transection. -### End" -7202,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following structures passes behind the inguinal ligament? 1. Femoral branch of genitofemoral nerve 2. Superficial epigastric aery 3. Psoas major 4. Femoral vein 5. Saphenous vein, with the following options: A: 1,2 & 3, B: 3 & 4, C: 1,3,4 & 5, D: All - -### Response: -Three small cutaneous aeries (superficial external pudendal, superficial epigastric and superficial circumflex iliac aeries) arising from the femoral aery can be seen a little below the inguinal ligaments.Femoral branch of the genitofemoral nerve pierces the femoral sheath and overlying deep fascia 2 cm below the mid inguinal point.The great saphenous vein pierces the saphenous opening in the deep fascia (fascia lata) of the thigh and joins the femoral vein 4 cm below and lateral to the pubic tubercle.So from the above discussion it is clear that femoral branch of the genitofemoral nerve, superficial epigastric aery and saphenous vein passes below (not behind) the inguinal ligament. Psoas major inseion: The muscle passes behind the inguinal ligament and in front of the hip joint to enter the thigh. Femoral vein leaves the thigh by passing behind the inguinal ligament. Ref: Snell's 8/e, Page 650-52; BDC 4/e, Vol II, Page 47, 48, 318. -### End" -7203,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During cesarean section under general endotracheal anaesthesia, venous air embolism, with the following options: A: Is associated with high end-tidal CO2, B: Should be treated with nitrous oxide, C: Is associated with expired nitrogen, D: Induces severe hypertension - -### Response: -Expired Nitrogen is the most sensitive venous-air embolism detection method, as the largest component of air is nitrogen. -### End" -7204,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HLA B27 is commonly associated with which of the following: March 2010, with the following options: A: Rheumatic fever, B: Rheumatoid ahritis, C: Osteoahritis, D: Ankylosing spondylitis - -### Response: -Ans. D: Ankylosing Spondylitis HLA-B27 helps in diagnosis of ankylosing spondylitis, Reiter's syndrome and at times anterior uveitis. These diseases are chronic disorders that occur more commonly in men than in women. Basically this blood test is conducted to look for specific protein which is found on the white blood cell's surface. This protein is known as Human Leukocyte Antigen B27 (subtypes B*2701-2724). -### End" -7205,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 17 year old girl in the 4th month of pregnancy presents with vaginal bleeding, accompanied by passage of grapelike tissue fragments. Plasma human chorionic gonadotropin (hCG) is very high.Following ultrasound evaluation, dilatation and curettage is performed. Histologic examination shows diffuse trophoblastic proliferation and edema in all chorionic villi. Cytogenetic studies demonstrate 46, XY karyotype. Clinical studies show that this condition progresses to choriocarcinoma at a rate of?, with the following options: A: 0.20%, B: 2%, C: 20%, D: 50% - -### Response: -The condition described is a complete hydatidiform mole. Hydatidiform mole is a spectrum of conditions due to abnormal proliferation of trophoblast and ranging from entirely benign conditions (complete and paial mole) to very aggressive neoplasms (choriocarcinoma). Paial moles have a triploid karyotype (69,XXY) and derive from feilization of an ovum with one or two sperm; fetal pas are frequently seen. Complete moles have a diploid karyotype (46,XX or 46,XY) and derive from feilization of an empty ovum by a single sperm (androgenesis); no fetal pas are found. Ten percent of moles acquire a more aggressive behavior and invade deeper pas of the myometrium, degenerating into invasive moles. Two percent of complete moles may transform into choriocarcinoma, a very aggressive neoplasm that spreads rapidly through the bloodstream. Founately, choriocarcinomas of placental origin are highly responsive to chemotherapy, affording up to 100% cure or remission. Nongestational choriocarcinoma, in contrast, is poorly responsive to chemotherapy. Remember the following impoant points: Complete mole, usually diploid karyotype: results from androgenesis (sperm feilization of an empty egg), no fetal pas are identified, 2% progress to choriocarcinoma. Paial mole, usually triploid karyotype: results from feilization of normal egg by one or two sperm; fetal pas are often identified; rarely progresses to choriocarcinoma. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 11. Gestational Trophoblastic Disease. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. -### End" -7206,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Strategies in National Leprosy Control programme?, with the following options: A: Early detection of cases, B: Sho course multi drug therapy, C: Rehabilitation, D: All - -### Response: -Ans. is 'a' i.e., Early detection of cases; 'b' i.e., Sho course multi drug therapy; 'c' i.e., Rehabilitation Piational I.eprosv Eradication Programme (INTLEP) National leprosy Control Programme was launched in 1955 by Government of India. as a centrally aided programe to achieve control of leprosy through early detection of cases and dapsone monotherapy on an ambulatory basis. o In 1983 the control programme was redesignated National Leprosy Eradication Programme with the goal of eradicating the disease by the turn of the century. The aim was to reduce case load to I or less than 1 per 10000 population. Revised strategy (NLEP) was based on i) Early detection of case ii) Sho term multi-drug therapy iii) Health education iv) Ulcer and deformity care v) Rehabilitation activities o NLEP provided : ? i) Domiciliary treatment in endemic districts through specially trained staff. ii) In moderate to low endemic districts, services through mobile leprosy treatment units and primary health care persons. -### End" -7207,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Androgenic alopecia in female is caused by:, with the following options: A: Myxedema, B: Cushing disease, C: Stein-Leventhal syndrome, D: Addison's disease - -### Response: -Ans. C. Stein-Leventhal syndromeAndrogenetic Alopecia (Male pattern; Female pattern): AssociationsIn women, features of hyperandrogenism may be present inthe form of hirsutism, acne & clitoromegaly.Always rule out polycystic ovary disease (PCOD).Stein-Leventhal syndrome, also called polycystic ovary syndrome (PCOS)Myxedema:Hair texture may become fine, and a diffuse alopecia occurs in up to 40% of patients, persisting for months after restoration of euthyroidism. -### End" -7208,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Weight of 9 students of a class is as follows- 72, 74, 76, 72, 76, 78, 80, 73 and 72. What is the mode: March 2009, with the following options: A: 72, B: 74, C: 76, D: 78 - -### Response: -Ans. A: 72 Mode is the commonly occurring value in a distribution of data. It is the most frequent item or the most fashionable value in a series of observations. The mode or the most frequently occurring value is 72. The advantages of mode are that it is easy to understand, and is not affected by the extreme items. The disadvantages are that the exact location is often unceain and is often not clearly defined. Therefore, mode is not often used in biological or medical statistics. -### End" -7209,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the most appropriate management of diabetic ketoacidosis?, with the following options: A: 500ml of 0.9% Saline over 15 minutes and a fixed rate insulin infusion, B: 500ml of 0.9% Saline over 15 minutes with potassium chloride and a fixed rate insulin infusion, C: 500ml of 0.9% Saline over 30 minutes with potassium chloride and a rapid acting subcutaneous insulin injection, D: 500ml of 0.9% Saline over 30 minutes and a rapid acting subcutaneous insulin injection - -### Response: -In DKA we give Regular Insulin so Option C & Option D ruled out DKA : - Associated with insulinopenia (values of insulin in the blood reduced) - Patients suffering from DKA d/t deficiency of insulin, there will be K+ efflux from cells and | K+ in blood. -Regular Insulin drip IV given leads to K+ influx l/t | K+ in blood - Therefore, complication of DKA t/t is diaphragmatic paralysis so KCl is added to IV fluids with Insulin to avoid hypokalemia. -### End" -7210,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is associated with secondary hyperparathyroidism, with the following options: A: Parathyroid adenoma, B: Marked hypercalcemia, C: Chronic renal failure, D: Parathyroidectomy relieves the symptoms - -### Response: -Answer is C (Chronic renal failure): Conditions leading to decrease in serum calcium levels cause a compensatory increase in secretion of PTH resulting in secondary hyperparathyroidism. Amongst the options provided chronic renal failure is one such cause of secondary hyperparathyroidism. Primary hyperparathyroidism Elevated PTH due to increased PTH secretion from an intrinsic abnormality of one or more parathyroid glands This is most commonly due to solitary adenoma involving one gland Secondary hyperparathyroidism Excessive secretion of PTH by parathyroids secondary to a lowered serum ionized calcium This is a compensatory hyperplasia of all four glands aimed at correcting lowered serum calcium Ectopic parathyroid hormone syndrome Ectopic PTH syndrome results from the production by several malignant neoplasms of PTH related peptide -### End" -7211,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The feulgen reaction is used to test, with the following options: A: mRNA, B: tRNA, C: DNA, D: rRNA - -### Response: -*Feulgen stain is a staining technique to detect DNA *In this procedure, the specimen is exposed to warm HCL which causes hydrolysis of DNA to produce aldehyde. Then Schiff reagent is added which reacts with aldehyde to impa red colour. -### End" -7212,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Malignant neuroleptic syndrome is caused by: March 2009, with the following options: A: Antidepressants, B: Anxiolytics, C: Antipsychotics, D: Antiepileptics - -### Response: -Ans. C: Antipsychotics Neuroleptic malignant syndrome (NMS) refers to the combination of hypehermia, rigidity, and autonomic dysregulation that can occur as a serious complication of the use of antipsychotic drugs. The list of atypical antipsychotic drugs that may cause NMS include olanzapine, risperidone, paliperidone, aripiprazole, ziprasidone, amisulpride, and quetiapine. Clozapine may also be associated with the development of NMS, but it appears to be less likely to manifest with extrapyramidal features, including rigidity and tremor. The most widely accepted mechanism by which antipsychotics cause neuroleptic malignant syndrome is that of dopamine D2 receptor antagonism. Central D2 receptor blockade in the hypothalamus, nigrostriatal pathways, and spinal cord leads to increased muscle rigidity and tremor extrapyramidal pathways. Hypothalamic D2 receptor blockade results in an elevated temperature set point and impairment of heat-dissipating mechanisms. Peripherally, antipsychotics lead to increased calcium release from the sarcoplasmic reticulum, resulting in increased contractility, which can contribute to hypehermia, rigidity, and muscle cell breakdown. -### End" -7213,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25 year old lady presented with curdy white discharge from vagina is likely to be suffering from:-, with the following options: A: Gonococcal vulvovaginitis, B: Candida vaginitis, C: Trichomoniasis, D: Chlamydia trachomatis - -### Response: -Vaginitis Bacterial vaginosis Candidiasis Trichomonas vaginitis Organism Gardnerellavaginosis Candida Trichomonas vaginalis M/C PH >4.5 <4.5 >4.5 STD Not an STD Not an STD usually STD M/C Complaint Foul smelling Diy white discharge Intense purities curdy white cottage cheese like discharge Profuse frothy greenish yellow discharge IOC Saline microscopy clue cells are seen Saline microscopy pseudohyphae seen Saline microscopy typical motile flagellated trichomonas seen Gold standard investigation Amsler's criteria nugent scoring SDA medium Diamond media DOC Metronidazole Fluconazole Metronidazole Whift test (10%KOH to discharge) (+) (-) May be (+) or (-) due to its association with bacterial vaginosis -### End" -7214,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true regarding congenital syphilis except, with the following options: A: Rhinitis is an early sign, B: Notched incisors, C: Conductive hearing loss, D: Linear scars at the angle of mouth - -### Response: -Sensory neural hearing loss due to 8th nerve involvement is seen, not conductive hearing loss. Linear scars at angle of mouth is called Rhagades. -### End" -7215,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a patient with acute leukemia, immunophenotype pattern is CD 19+ve, CD 10+ve. CD33+ve and CD 13+ve. He may probably have which of the following type of leukemia?, with the following options: A: Biphenotypic leukemia, B: ALL, C: AML-M1, D: AML-M3 - -### Response: -Based on the immunophenotype pattern the leukemic cells are expressing both myeloid (CD13, 33) and B lineage antigens (CD10,19). As a result the most likely diagnosis is biphenotypic leukemia. Biphenotypic leukemia is the most common type of mixed phenotype acute leukemia, that contain a morphologically homogenous population of poorly differentiated blasts that uniformly express a mixture of lymphoid (B and/or T cell) associated and myeloid associated antigens. Immunophenotyping pattern found in various leukocytes: Antigen Cell lineage associated with CD1- CD8 T cell CD 10,19,20 to 23 B cell CD 13 to 15, 33 Monocyte, macrophage CD 16, 56 NK cell CD 34 Stem cell and progenitor cell CD 30 Activation markers CD 45 All leukocytes REf: Childhood Leukemias edited by Ching-Hon Pui page 36. -### End" -7216,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Radiation dose safe in pregnancy is, with the following options: A: 1 rad, B: 5 rads, C: 50 rads, D: 500 rads - -### Response: -(Ref: Farr&;s physics for medical imaging 2e,39) -### End" -7217,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Baholin gland correspond to :, with the following options: A: Bulbourethral gland, B: Urethral gland, C: Paraurethral gland, D: Cowper - -### Response: -Cowper -### End" -7218,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: SI unit of radiation absorption:, with the following options: A: Sievert, B: Gray, C: Becquerel, D: Rads - -### Response: -Ref: Internet SourcesExplanation:SI unit for Radiation absorption - Gray (Gy)The rad is a deprecated unit of absorbed radiation dose, defined as 1 rad = 0.01 GyThe sievert (Sv) is the International System of Units (SI) derived unit of equivalent radiation dose, effective dose, and committed dose.The gray is used with quantities of absorbed dose in any material, while the sievert is used with equivalent, effective, and committed dose in biological tissue.Becquerel (Bq) - S I Unit of radioactivityThe Curie (Ci) is a non-SI unit of radioactivityRoentgen equivalent man or 'rem' (Symbol rem) is a deprecated unit used to measure the biological effects of ionizing radiation.The rem is defined as equal to 0.01 sievert.The roentgen (R, also rontgen) is an obsolete unit of measurement for the kerma of X-rays and gamma rays up to 3 MeV.The rutherford (symbol rd) is an obsolete non SI unit of radioactivity. -### End" -7219,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Autoimmune destruction of platelet is seen in :, with the following options: A: SLE, B: Rheumatoid ahritis, C: Reiter disease, D: Polyaeritis nodosa - -### Response: -Answer is A (SLE) Previous table) SLE is characterized by antiplatelet antibody mediated autoimmune destruction of platelets. -### End" -7220,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A man with blunt injury abdomen after road side accident has a blood pressure of 100/80 mm Hg and a pulse rate of 120 bpm. Airway has been established and respiration has been stabilized. Next best step in management is?, with the following options: A: Immediate Blood Transfusion, B: Blood for cross matching & IV fluid adminisration, C: Ventilate the patient, D: Exoplratory laparotomy - -### Response: -Man in the question stem with abdominal trauma with airway and breathing stabilized, is showing features of hypovolemia. According to the ACLS protocol he should receive intravenous fluids and blood should be taken for cross matching to maintain the circulation intact. IV access for fluid resuscitation should be obtained with two 16G peripheral catheters. Blood should be drawn simultaneously and sent for measurement of hematocrit level, as well as for typing and cross-matching for possible blood transfusion in patients with evidence of hypovolemia. Ref: Schwaz's Principles of Surgery, 9th Edition, Chapter 7 -### End" -7221,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A newborn presented with bloated abdomen sholy after bih with passage of less meconium. A full thickness biopsy of the rectum was carried out. Which one of the following rectal biopsy findings is most likely to be present?, with the following options: A: Fibrosis of submucosa, B: Hyalinization of the muscular coat, C: Thickened muscularis propria, D: Lack of ganglion cells - -### Response: -Hirschsprung's disease:- Absence of ganglion cells- M/C pa - rectum > Sigmoid- Affected segment - Contracted / Narrowed - Longer & narrower the segment - More are S/S of Intestinal obstruction Dx -Full thickness Rectal biopsy -### End" -7222,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HMB 45 is tumor marker for ?, with the following options: A: Malignant melanoma, B: Mesothelioma, C: Bronchogenic carcinoma, D: Pancreatic carcinoma - -### Response: -Ans. is 'a' i.e., Malignant melanoma -### End" -7223,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The compound that regulates both glycolysis and gluconeogenesis is:, with the following options: A: Fructose-1,6-bisphosphate, B: Fructose-2,6-bisphosphate, C: Citrate, D: Glucose-6-phosphate - -### Response: -Fructose 2,6 bisphosphate Potent activator of PFK-1 inhibitor of gluconeogenic enzyme fructose 1,6 bisphosphatase. This helps in reciprocal regulation of glycolysis and gluconeogenesis. -### End" -7224,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Otosclerosis typically begins at:, with the following options: A: Scutum, B: Round window, C: Tympanic membrane, D: Fossa antefenestrum - -### Response: -Fossa antefenestrum -### End" -7225,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Menopausal hot flushes coincides with, with the following options: A: FSH secretion, B: Decrease in estrogen, C: LH surge, D: Increase in progesterone - -### Response: -Luteinizing hormone is a hormone produced by gonadotropic cells in the anterior pituitary gland. In females, an acute rise of LH triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone, it stimulates Leydig cell production of testosterone Ref: guyton and hall textbook of medical physiology 12 edition page number: 636,637,638 -### End" -7226,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Neuroblastoma Originates from the following. Choose the true/false statements. 1. Adrenals 2. Peripheral Nerve 3. Paraveebral retroperitoneum 4. Posterior Mediastinum 5. Lymph node, with the following options: A: 1, 2, 3 - True & 4, 5 - False, B: 1, 2, 3 - False & 4, 5 - True, C: 1, 3, 4 - True & 2, 5 - False, D: 1, 2, 4 - True & 3, 5 - False - -### Response: -Neuroblastoma originate from adrenals, peripheral nerves and posterior mediastinum. Ref: O.P.Ghai 7th Ed Page 590-591,6th Ed page 573,Robbins 8th Ed page 476. -### End" -7227,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The neurotransmitters; nor-adrenaline, adrenaline and dopamine act through which of the following receptors?, with the following options: A: Single pass transmembrane receptors, B: Four pass transmembrane receptors, C: Seven pass transmembrane receptors, D: Ligand gated receptors - -### Response: -Ans. (C) Seven pass transmembrane receptors(Ref: KDT 8th/e p54, 55)These neurotransmitters (A, NA, DA) act through G-protein coupled receptors which are also known as seven-transmembrane domain receptors, heptahelical receptors and serpentine receptors. -### End" -7228,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nail's involvement is NOT a feature of: March 2003, with the following options: A: Psoriasis, B: DLE, C: Dermatomyositis, D: Lichen planus - -### Response: -Ans. B i.e. DLE Discoid lupus is a benign variant of SLE in which only the skin is involved. -### End" -7229,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The recommended daily energy intake an adult woman with heavy work is which of the following?, with the following options: A: 1800, B: 2100, C: 2300, D: 2900 - -### Response: -Energy allowance per day for females involved in heavy work is 2925 kcal/day. Nature of work Males (kcal/day) Females (kcal/ day) Light work 2425 1875 Moderate work 2875 2225 Heavy work 3800 2925 -### End" -7230,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Implantation occurs at, with the following options: A: 2-3 days, B: 6-7 days, C: 15-20 days, D: 20-25 days - -### Response: -HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:72In humans implantation begins on the 6th day after feilization -### End" -7231,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Fleischer ring"" is a distinct feature of, with the following options: A: Keratoconus, B: Pterygium, C: Congenital ocular melanosis, D: Congenital epithelial Melanosis - -### Response: -A condition in which the clear tissue on the front of the eye (cornea) bulges outward. Visual: astigmatism, blurred vision, distoed vision, double vision, inability to see in dim light, nearsightedness, sensitivity to light, or vision loss Also common: a rim of discolouration around the front of the eye (fleischer ring) Picture show Keratoconus, a non circular, non-centered oval caused by a bulging cornea. Very common in Keratoconus, it is best viewed under cobalt blue light, that's why the sclera looks blue. Reference: Ganong&;s review of medical physiology 25edition page 132 -### End" -7232,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 27. Topical steriods are not recommended post surgery for:, with the following options: A: allergic fungal sinusitis, B: Chronic rhinosinusitis, C: Antrochoanal polyp, D: Ethmoidal polyp - -### Response: -For antrochoanal polyps cause is infection and not the allergy. antrochoanal polyps are single,unilateral and rarely recur. Topical steriods are rarely recommend ref Scott Brown 7/e,p 1553 -### End" -7233,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about 'Sham Range' is Not true:, with the following options: A: Caused by Hypothalamic stimulation, B: Abolished by Decoication, C: Pathological Rage Reaction, D: Association with sympathetic stimulation - -### Response: -B i.e. Abolished by DecoicationSham (false) rage is an outburst of pathological (inappropriate, uncontrolled & violent) anger & fear in decoicate animals on mild peripheral stimulation. It can be caused by stimulation of punishment center of hypothalamus and presents with features of sympathetic stimulationQ.Reward center (ie area of brain responsible for self stimulation reward on induction) includes medial forebrain bundleQ, especially in lateral and ventro medial nuclei of hypothalamusQ.Sham Rage (= False Anger) Reaction - Sham (false) rage is defined as an outburst of inappropriate, uncontrolled (pathological/ violent) rage (fear & anger) on mild peripheral provocation or stimulation. It is seen in decoicate animals (after removal of neocoex) and after destruction of venteromedial nuclei of hypothalamus & septa] nuclei, due to release of punishment centers of brain (esp in periventricular zone of hypothalamus & lateral hypothalamus) from coical and hypothalamic inhibitory control.It is misnomer, as originally it was thought that the rage attacks in decoicated animals (with fore brain, diencephalic lesions) represent only a physical - motor phenomenon of anger and lack emotional (mental) aspect. But now its proved wrong as animals develop unpleasant feelings directed with great accuracy at the source of irritation and develop extremely persistent conditioned avoidance response.Sham rage (like normal rage) can also be produced by strong (in normal) or mild (in decoicated animals) stimulation of punishment centers of hypothalamusQ and shows features of sympathetic stimulation like increased BP, increased hea rate, dilation of pupils and piloerection.Rage & Punishment Centers- Rage is an emotional behavior pattern that involves strong stimulation of the punishment centers of hypothalamus & other limbic structures (especially in periventricular zone of hypothalamus and in lateral hypothalamus) and cause animal to behave in a manner that one would expect from an animal being severely punished. It causes the animal to(1) Develop a defence posture(2) Lift its tail(3) Hiss, spit, growl or bite(4) Extend its claws(5) Develop sympathetic features like dilated pupils, wide open eyes & piloerection and(6) Cause an immediate savage (crudely violent) attack even on slightest provocation.- Normally, this rage phenomenon is held in check mainly by inhibitory signals from the ventero medial nuclei of hypothalamus. Poions of hippocampi & anterior limbic coex especially in anterior cingulate gyri and subcallosal gyri also help to suppress the rage reaction.Punishment or Escape Centers- Electrical stimulation of punishment center ie thin zone of periventricular nuclei (located adjacent to 3rd ventricle), adjoining central grey area of mesencephalon and lateral hypothalamus leads to unpleasant (aversive) fear, anger, defence, escape , terror, punishment (even sickness & pain) reactions.- Most potent areas for punishment & escape tendencies are found in central grey areasurrounding the aqueduct of Sylvius in mesencephalon, extending upwards into the periventricular zone of hypothalamus & thalamus; whereas less potent areas include amygdale and hippocampus.Stimulation of punishment center usually inhibit the reward & pleasure centers completely, showing that fear and punishment can take precedence over pleasure and reward.Reward or Pleasure CentersIf electrical stimulation of any area gives the animal a sense of reward, then it will stimulate the area by pressing lever again and again (sometimes even thousands of time per hour) - ie self stimulatory reward induction. When offered the choice between eating delectable (liked) food as apposed to stimulate the reward center, the animal often chooses electrical stimulation of reward induction.- Major reward centers are located along course of the media forebrain bundle especially in lateral and ventro medial nuclei of hypothalamus. Less potent reward centers which are secondary to major hypothalamic centers are found in the septum, amygdala, ceain areas of thalamus and basal ganglia and extending downward into the basal tegmentum of mesencephalon- Lateral nucleus, like many other areas, with weaker stimuli giving a sense of reward and with stronger stimuli a sense of punishment. -### End" -7234,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A Patient with history of shoness of breath has Decreased FEV1/FVC Ratio, Normal DLCO. A 200 ml increase in baseline FEVI is observed 15 minutes after administration of bronchodilators. The likely diagnosis is, with the following options: A: Asthma, B: Chronic Bronchitis, C: Emphysema, D: Interstitial Lung Disease - -### Response: -Ans. is 'a' i.e., Asthma -### End" -7235,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thyroid peroxidase is not involved in, with the following options: A: Oxidizes iodide to atomic iodine, B: Frequent epitope of autoantibodiesent epitope, C: Secretion of thyroglobulin into the colloid, D: Liberates iodine for addition on to thyrosine resideues on thyroglobulin - -### Response: -Inorganic iodine enters the body primarily as iodide, I-. After entering the thyroid follicle (or thyroid follicular cell) a Na+/I-sympoer (NIS) on the basolateral side, iodide is shuttled across the apical membrane into the colloid pendrin, after which thyroid peroxidase oxidizes iodide to atomic iodine (I) or iodinium (I+).The ""organification of iodine,"" the incorporation of iodine into thyroglobulin for the production of thyroid hormone, is nonspecific; that is, there is no TPO-bound intermediate, but iodination occurs reactive iodine species released from TPO.The chemical reactions catalyzed by thyroid peroxidase occur on the outer apical membrane surface and are mediated by hydrogen peroxide.Ref: DM Vasudevan, 7th edition, page no: 673 -### End" -7236,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is an effect of dinitrophenol on oxidative phosphorylation?, with the following options: A: Inhibition of cytochrome b, B: Blockade of both electron transpo transpo and ATP synthesis, C: Inhibition of ATP synthesis with normal electron transpo, D: Inhibition of electron transpo but not ATP synthesis - -### Response: -Mechanism of Action of DNP as uncoupler Dinitrophenol (DNP) a potent uncoupler is amphipathic and increase the permeability of the lipoid inner mitochondrial membrane to protons (H+), thus reducing the electrochemical potential and sho-circuiting the ATP synthase. In this way, oxidation can proceed without phosphorylation. Note: DNP was used for weight loss. But it was discontinued due to hypehermia and other side effects. Inhibitors of electron transpo chain and oxidative phosphorylationRef: MN Chatterjea Textbook of Medical Biochemistry, 8th Edition, Page no: 146 -### End" -7237,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MEN 2B includes all except, with the following options: A: MTC, B: Pheochromocytoma, C: Mucosal neuroma, D: Primary hyperparathyroidism - -### Response: -Ref - researchgate.net -### End" -7238,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following drugs action pseudomonas infection EXCEPT, with the following options: A: Carbenicilline, B: Azlocilline, C: Peperacilline, D: Azithromycin - -### Response: -(Azithromycin) (730-KDT 6th)Drugs which acts on Pseudomonas* Carbenicilline* Cefoperazone* Tobramycin* Acetic acid* Ticarcilline* Aztreonam* Sisomicin* Silver sulphadiazine* Azlacilline* Imipenem* Amikacin* Tetracyclines* Mezlocilline* Cefotaxime* Nitilmicin* Cefepime* Peperacilline* Ciprofloxacine* Gentamicin * Moxalactam* Norfloxacin* Polymyxin -B * Ceptazidime* Ofloxacin* Mafenide * Pefloxacin Azithromycin - It is more active than other macrolide against H. influenzae* Usefully active against a number of important gram negative organisms It is not active against erythromycin resistant bacteria -### End" -7239,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraindication for laparoscopic Cholecystectomy is?, with the following options: A: Coagulopathy, B: Obstructive pulmonary disease, C: End-stage liver disease, D: All above - -### Response: -Contraindications to laparoscopic cholecystectomy include Coagulopathy Severe chronic obstructive pulmonary disease End-stage liver disease Congestive heart failure Currently, -the major contraindication to completing a laparoscopic cholecystectomy is inability to clearly identify all of the anatomic structures -### End" -7240,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Method of autopsy in which various systems organs are removed en masse -, with the following options: A: Rokitansky, B: Virchow, C: Gasses, D: Lettulle - -### Response: -In Letulles technique cervical, thoraxic, abdominal and pelvic organs are removed en masse and dissected as organ block. Dr. Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27 th edition pg. 57. -### End" -7241,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Time taken for electrical conduct from SA node to AV node in ECG is, with the following options: A: PR interval, B: ST segment, C: QT interval, D: Cannot be determined by ECG - -### Response: -PR interval is the interval between beginning of p wave to the beginning of QRS. It indicates atrial depolarization and AV nodal delay. (REF: GANONG&;S REVIEW OF MEDICAL PHYSIOLOGY) -### End" -7242,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: AB group has following agglutinins:, with the following options: A: Anti - A & anti - B, B: Neither anti-A nor anti-B, C: Anti-A, D: Anti-B - -### Response: -Blood Types with Their Genotypes and Their Constituent Agglutinogens and Agglutinins: -### End" -7243,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pemphigus vulgaris is caused due to which type of hypersensitivity reaction?, with the following options: A: I, B: II, C: III, D: IV - -### Response: -Ans. is 'b' i.e., lllRef: IADVL textbook of dermatology 3'd/e p. 10991Pemphigus is a type 2 hypersensitivity reaction (antibody mediated), with formation of antibodies to pemphigus antigen present rn intercellular substance. -### End" -7244,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice to diagnose congenital hip dislocation in neonates?, with the following options: A: Plain radiographs, B: US, C: CT, D: MRI - -### Response: -Ans BIn neonates the femoral head is cartilaginous and not ossified hence it cannot be identified on radiographs but well demonstrated on USG. Also the Graf's classification using Alpha and Beta angles are very definitive in assessment and can be readily calculated on USG. -### End" -7245,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common neuroendocrine tumour of pancreas is, with the following options: A: Insulinoma, B: Gastrinoma, C: Non-functional tumours, D: VIPoma - -### Response: -TumourIncidence%Insulinoma70-80Gastrinoma20-25Non-functional tumours30-50VIPoma4Glucagonoma4Somatostatinoma<5Carcinoid<1ACTHoma<1GRFoma<1Ref: Bailey and Love 27e pg: 846 -### End" -7246,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An young boy presents to you with history of breathlessness on exertion .You being an intern proceed with auscultation of the patient's chest. Your findings are ejection systolic murmur in the left 2nd intercostal space , S1 is normal and has wide and fixed split S2. You then send the patient for an ECG , what would be the most likely finding in the ECG report?, with the following options: A: Right axis deviation, B: Left axis deviation, C: Large p waves, D: Absent p waves - -### Response: -The history given is typical of ASD . It is characterized by right axis deviation and right bundle branch block pattern.  -Left axis deviation can happen if it is osmium primum ASD -### End" -7247,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Glucogenic amino acid transported to the liver most commonly -, with the following options: A: Alanine, B: Glycine, C: Lysine, D: Leucine - -### Response: -Ans. is 'a' i.e., Alanine o Transport of alanine from muscle to liver (glucose-alanine cycle) has two functions :-Providing substrate for giuconeogenesisTransport of ammonia (NH4+) to liver for urea synthesis.o During the first few days of starvation, there is a rapid breakdown of muscle protein, providing aminoacids for giuconeogenesis. The most important gluconeogenic amino acid is alanineQ (through glucose-alanine cycle). Alanine is released due to increased muscle protein breakdownQ and is transported to liver for giuconeogen-esis (glucose alanine cycle). The other important gluconeogenic amino acid in starvation is glutamine,o After some weeks of starvation, the rate of muscle breakdown decreases due to decreased need of glucose as a fuel for brain which has began using ketone bodies as a source of energy'. However, when the triacylglycerol stores are completely exhaused, muscle proteins once again enter in a stage of rapid depletion due to protein breakdown,o Alanine transport from muscle to liver has an important additional role, beside giuconeogenesis. Because muscle is incapable of synthesizing urea, most of the ammonia formed by protein catabolism is transferred to pyruvate to form alanine by transamination. Alanine is transported to liver where amino group of alanine is removed to form urea and the resulting pyruvate is converted to glucose by giuconeogenesis.o Thus, sources of alanine release from muscle are (i) Degradation of protein (ii) Transamination of pyruvate.o Besides alanine, lactate produced in muscles by anerobic use of glucose, also seves as a substrate for giuconeogenesis - cori cycle or lactic acid cycle -### End" -7248,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following clinical features is not characteristic of giant cell aeritis?, with the following options: A: Headache is usually the first symptom, B: Jaw pain during chewing, C: Palatal paralysis, D: Loss of visual acuity - -### Response: -Giant cell aeritis (GCA) is a granulomatous aeritis that affects any large (including aoa) and medium-sized aeries. It is commonly associated with polymyalgia rheumatica (PMR), which presents with symmetrical, immobility-associated neck and shoulder girdle pain and stiffness. Clinical features The cardinal symptom of GCA is headache, which is often localised to the temporal or occipital region and may be accompanied by scalp tenderness. Jaw pain develops in some patients, brought on by chewing or talking. Visual disturbance can occur (most specifically amaurosis) and a catastrophic presentation is with blindness in one eye due to occlusion of the posterior ciliary aery. On fundoscopy, the optic disc may appear pale and swollen with haemorrhages, but these changes may take 24-36 hours to develop and the fundi may initially appear normal. Rarely, neurological involvement may occur, with transient ischaemic attacks, brainstem infarcts and hemiparesis. In GCA, constitutional symptoms, such as weight loss, fatigue, malaise and night sweats, are common. With PMR, there may be stiffness and painful restriction of active shoulder movements on waking. Muscles are not otherwise tender, and weakness and muscle-wasting are absent . Ref Davidsons 23e p1042 -### End" -7249,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pediatric airway differs from adult by, with the following options: A: Large tongue, B: Sho epiglottis, C: Narrowest pa is glottis, D: Larynx in lower position - -### Response: -Airway: Pediatric Obligate nasal breatherLarge tongueLarynx & trachea are funnel-shapedThe narrowest pa is cricoid (glottis in adults)(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2036 - 2037) -### End" -7250,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a section of lung tissue consisting dominantly of alveoli, a tubule about 2mm in diameter is observed that contains smooth muscle and cailage in its wall. The tubule is which one of the following?, with the following options: A: Alveolar duct, B: Alveolar sac, C: Bronchiole, D: Bronchus - -### Response: -Any tubule with cailage in its wall and contained in the parenchyma of the lung is a bronchus. Alveolar ducts, alveolar sacs, and bronchioles do not contain cailage. The trachea lies outside of the lung. -### End" -7251,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following vaccines can be administered to a patient with known anaphylactic reactions to eggs?, with the following options: A: Haemophilus influenzae type B vaccine, B: Influenza vaccine, C: Measles vaccine, D: Mumps vaccine - -### Response: -Haemophilus influenzae type B vaccine is not an egg-based vaccine and is safe to administer to a patient with a history of anaphylactic reactions to eggs. Influenza, measles, mumps, and yellow fever vaccines are egg-based. Vaccines often contain materials other than the active-immunizing antigens, such as preservatives, antibiotics (e.g., neomycin, streptomycin) to prevent bacterial overgrowth, adjuvants to enhance immunogenicity, and stabilizers. Patients who are allergic to neomycin should not receive the measles-mumps-rubella (MMR) and oral polio vaccines. Patients who are allergic to streptomycin should not receive the live or the killed polio vaccine. -### End" -7252,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A wave in ERG is due to activity of-, with the following options: A: Pigmented epithelium, B: Rods and cones, C: Ganglion cell, D: Bipolar cell - -### Response: -Ans. is 'b' i.e.. Rods and cones Electroretinogramo The changes induced by the stimulation of light in the resting potential of the eye are measured by electroretinography. It is extinguished or absent in complete failure of function of rods and cones, e.g. pigmentary retinal dystrophy, complete occlution of retinal artery, complete retinal detachment, advanced siderosis etc.Negative 'a1 wave represent the activity in rods and cones.Positive 'b' wave arises in inner retinal layers.Positive 'c' wave is associated with the pigmentary epithelium.Uses1) Diagnosis and prognosis of retinal disorders such as retinitis pigmentosa, Leber's congenital amaurosis, retinal ischaemia and other chorioretinal degenerations.2) To assess retinal function when fundus examination is not possible, e.g. in the presence of dense cataract and corneal opacity.3) To assess the retinal function of the babies where possibilities of impaired vision is considered. -### End" -7253,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A middle-aged lady presents with complaints of lower back pain. On examination there is weakness of extension of right great toe with no sensory impairment. An MRI of the lumbosacral spine would most probably reveal a prolapsed intervetebral disc at what level?, with the following options: A: L3 - L4, B: L4 - L5, C: L5 - S1, D: S1 - S2 - -### Response: -LUMBAR DISC PROLAPSE DEFINITION It is condition in which there is outpouching of the disc Nucleus pulposus along with few annular fibres and end plate cailage through the tears in annulus fibrosus into the extradural space * Antalgic gait Affected hip more extended and knee more flexed than normal side * Trendelenberg gait (L5 nerve root) * List abrupt planar shift Axillary disc --same side Shoulder disc- opposite side * Thigh and calf muscle wasting * Loss of lumbar lordosis Paraspinal spasm-central furrow sign ref : maheswari 9thed -### End" -7254,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oral contraceptive Pill (OCP) failure is seen with all except:, with the following options: A: Rifampicin, B: Phenobarbitone, C: Valproate, D: Phenytoin - -### Response: -Drugs leading to OCP failure are: Rifampicin Tetracyclines Phenytoin Phenobarbitone Antifungals Cephalosporin Ritonavir for HIV (interferes with absorptionn of OCP) Ref: online resources (ncb.nlm.nih.gov) -### End" -7255,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following factors are considered as safety measures in X-ray production except:, with the following options: A: Use of low kVp is recommended, B: Use of lead foil is mandatory, C: Use of high kVp is recommended, D: None of the above - -### Response: -The optimal operating potential of dental X-ray units is between 60 and 70 kVp (ADA 2012). Although image diagnosis may be improved slightly with increased image contrast (low kVp) images, the patient dose is reduced with higher kVp exposures. -White and Pharoah's Oral  Radiology Principles and Interpretation 8th edition -### End" -7256,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false regarding neonatal resuscitation?, with the following options: A: T - tube delivers free flow oxygen, B: Self - inflating bag should not be used without reservoir, C: Self - inflating bag can deliver free flow oxygen, D: Flow inflating bag delivers free flow oxygen - -### Response: -1. T - tube delivers free flow oxygen - TRUE 2. Self - inflating bag should not be used without reservoir - FALSE - can be used but FiO2 will be less. 3. Self - inflating bag can deliver free flow oxygen - TRUE 4. Flow inflating bag delivers free flow oxygen - TRUE -### End" -7257,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Specific test for diagnosis of rickettsial infection -, with the following options: A: Weil - felix reaction, B: Agglutination of ricketssial suspension, C: Paul bunnell test, D: Rose waaler test - -### Response: -Ans. is 'b' i.e., Agglutination of ricketssial suspension * Both epidemic typhus and endemic typhus are positive for OX-19 antigen - Thus Weil Fleix reaction cannot differentiate between the two.Serological diagnosis of Rickettsial infection* Serological diagnosis may be made by :-i) Heterophile Weil-Felix reaction.ii) Specific tests using rickettsial antigens.A) Weil-Felix reaction* This reaction is an agglutination test in which sera are tested for agglutinins to O antigens of certain nonmotile proteus strains OX -19, OX - 2 and OX - K.* The basis of the test is the sharing of an alkali - stable carbohydrate antigen by some rickettsiae and by certain strains of proteus, P. vulgaris OX - 19 and OX - 2 and P. mirabilis OX - K.* The test is usually done as a tube agglutination, though rapid slide agglutination methods have been employed for screening.1) Scrub typhus is positive with OXK.2) Epidemic typhus and endemic typhus are positive for OX-19.3) Rocky mountain spoted fever is positive with OX-19 and OX-2.4) Q fever, trench fever and rickettsial pox do not show positive test with any of the three antigen. Thus Weil Felix test is not useful in these disease.DiseaseOX-19OX-2OX-KRocky Mountain spotted fever++-Rickettsial pox---Epidemic typhus+--Bril - Zinsser disease+/---Scrub typhus--+Endemic typhus+--Trench fever---Q fever---B) Specific tests using rickettsial antigens* Following antigens are used:-i) Group specific soluble antigen - More commonly used.ii) Type specific washed rickettsial antigen - Necessary for differentiation between epidemic and endemic typhus.* Tests used to detect these antigens are :-i) Complement fixation test (most commonly used).ii) Agglutination of rickettsial suspensions.iii) Passive agglutination of red cells sensitized by ESS (erythrocyte sensitising substance)iv) Toxin neutralisationv) Immunofluorescensevi) Radioisotope precipitation -### End" -7258,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is the MOST common cause of superficial thrombophlebitis?, with the following options: A: Trauma, B: Infection, C: Varicosities, D: Intravenous infusion - -### Response: -Superficial thrombophlebitis is a disorder of superficial veins characterized by aseptic local inflammation. In the upper extremity it is caused by IV infusion of acidic fluid or prolonged cannulation. Thrombophlebitis migrans or recurrent superficial thrombophlebitis is associated with malignant visceral tumors, systemic collagen vascular disease and blood dyscrasias.The deep veins and visceral veins may be involved. Ref: Essentials of Surgery: Scientific Principles and Practice edited by Lazar J. Greenfield, page 690. -### End" -7259,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pain during injection occurs all except, with the following options: A: Propofol, B: Thiopentone, C: Ketamine, D: Etomidate - -### Response: -Induction of anesthesia with propofol is often associated with pain on injection, apnea, hypotension, and, rarely, thrombophlebitis of the vein into which propofol is injected.Pain on injection is reduced by using a large vein, avoiding veins in the dorsum of the hand, and adding lidocaine to the propofol solution or changing the propofol formulation. Multiple other drugs and distraction techniques have been investigated to reduce the pain on injection of propofol. Pretreatment with a small dose of propofol, opiates, nonsteroidal antiinflammatory drugs, ketamine, esmolol or metoprolol, magnesium, a flash of light, a clonidine-ephedrine combination, dexamethasone, and metoclopramide all have been tested with variable efficacy. Ketamine has been administered by the IV, intramuscular (IM), transcutaneous, oral, nasal, and rectal routes and as a preservative-free solution epidurally or intrathecally. Most clinical use involves the IV and IM routes, by which the drug rapidly achieves therapeutic concentrations. The dose depends on the desired therapeutic effect and on the route of administration. There is no pain on injection. Although etomidate provides stable hemodynamics and minimal respiratory depression, it is associated with several adverse effects when it is used for induction, including nausea and vomiting, pain on injection, myoclonic movement, and hiccups. Etomidate has been associated with PONV. More recently, etomidate in a lipid emulsion was associated with equal or an increased incidence of postoperative nausea compared with propofol. The lipid formulation of etomidate is associated with a much less frequent incidence of pain on injection, thrombophlebitis, and histamine release. Pain on injection may be reduced by injecting IV lidocaine, 20 to 40 mg immediately before injection of etomidate. Ref: Millers anesthesia 8th edition -### End" -7260,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Therapeutic Drug Monitoring (TDM) involves measurement of plasma concentrations of drugs to find whether the drug levels are within the therapeutic range or not. For TDM to be clinically useful the following criteria should be fulfilled:, with the following options: A: There should be good relationship between plasma concentration and drug dosage, B: The relationship between plasma drug concentration and therapeutic response and /or toxicity should be poor, C: When pharmacodynamic tolerance is suspected, D: When the clinical response cannot be easily monitored - -### Response: -Therapeutic drug monitoring (TDM) is useful in the following situations: 1. Drugs with low safety margin-digoxin, anticonvulsants, antiarrhythmics, theophylline, aminoglycosides, lithium, tricyclic antidepressants, vancomycin In case of failure of response without any apparent reason-antimicrobials, To check patient compliance-psychopharmacological agents Monitoring of plasma concentration is of no value for1. Drugs whose response is easily measurable antihypeensives, hypoglycaemics, diuretics, oral anticoagulants(Warfarin), general anesthetics.2. Drugs activated in the body-levodopa.3. 'Hit and run drugs' (whose effect lasts much longer than the drug itself)-reserpine, guanethidine, MAO inhibitors, omeprazole.4. Drugs with irreversible action-organophosphate anticholinesterases, phenoxybenzamine. Ref ; KD Tripathi pharmacology 7th edition (page no; 34) -### End" -7261,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is used to differentiate tumour recurrence and rediation necrosis?, with the following options: A: PET scan, B: MRI, C: 3D CT, D: USG - -### Response: -Ans. is'a'i.e., PET scanPET may be used in therapeutic monitoring after chemotherapy or radiotherapy, with a classic indication being assessment for recurrent tumor versus radiation necrosis.Conventional imaging can not differentiate recurrent tumor from radiation necrosis. -### End" -7262,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with twin pregnancy, USG done at 26 weeks of pregnancy shows a single placenta, first twin with AFI of 5 cm, fetal weight of 700 gms, bladder not visible, second twin with AFI of 16 cm, fetal weight of 1200gms. Diagnosis is?, with the following options: A: IUGR of first twin and normal second twin, B: Twin reverse aerial perfusion syndrome, C: Acardiac second twin, D: Twin to twin transfusion syndrome - -### Response: -Twin to twin transfusion syndrome (TTTS) Occurs in monochorionic twin pregnancy. Cause is unidirectional blood flow through A-V anastomosis in a cotyledon shared by the two twins. Features: Discordant twins (difference in fetal weight > 20 % with larger twins as reference) Donor twin: oliguria, anemia, cardiac failure, IUGR, absent bladder Recipient twin: polyuria, hyperbilirubinemia, polyhydramnios, hydrops Poly-oli ( 'polyhydramnios in recipient -oligohydramnios in donor' sequence) -### End" -7263,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gene mutation in AML with poor prognosis all except:, with the following options: A: FLT3 gene, B: WT-1, C: NPM1, D: MLL - -### Response: -Ans. C. NPM1ExplanationAssociated with worse prognosis:FLT3-ITDKITMLL-PTDWT-1Associated with favorable prognosis:CEBPANPM1 -### End" -7264,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 3-year old child is able to perform all of the following activities, except:, with the following options: A: Climbing stairs with alternate feet, B: Riding a tricycle, C: Cursive writing, D: Copying a circle - -### Response: -Cursive writing is not possible by a 3 year old child. Cursive writing means flowing, not disconnected writing in which the strokes of the letters are joined in each word. At 2 years of age the child can climb stairs by bringing both his feet up on one step before climbing to next step. At 3 years he can climb stairs with alternate feet. A child can pedal a tricycle by 2 to 3 years of age. A child scribbles spontaneously by 12 to 24 months of age, copies and draws a horizontal or veical line at 2 years; a circle by 3 years, a cross sign by 4 years, tilted cross (multiplication sign) by 5 years, rectangle by 4 years and triangle by 5 years of age. -### End" -7265,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What are the vessels in umbilical cord?, with the following options: A: 1 artery, 2 veins, B: 2 arteries, 1 vein, C: 1 artery, 1 vein, D: 2 arteries, 2 veins - -### Response: -Ans. B 2 arteries, 1 veinRef: I.B. Singh, 9th ed. pg. 59""Remember 2AV""* Umbilical cord is the structure which connects mother to fetus and acts as a bridge for transfer of blood and other nutrients from mother to baby.* It contains 2 arteries and one vein. Arteries carry deoxygenated blood from fetus to mother while vein carries oxygenated blood from mother towards fetus.* Cord contains Wharton's jelly and the structures embedded in this are:# 2 arteries and 1 vein# Allantois and# Remains of Vitello intestinal duct -### End" -7266,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spontaneous regression is seen in:, with the following options: A: Po Wine Hemangioma, B: Strawberry Hemangioma, C: Cavernous Hemangioma, D: Aerial angioma - -### Response: -Strawberry Hemangioma :Type of capillary hemangioma Baby is normal at bih Appears at the age of 1-3 weeks Grows with the child upto 1 year of age & then cease to grow. By the age of 9 years , 90% demonstrate complete involution . Emptying sign is demonstrable -### End" -7267,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The process whereby WBC can squeeze through pores in capillary walls is, with the following options: A: Diffusion, B: Diapedesis, C: Osmosis, D: Pinocytosis - -### Response: -(B) Diapedesis# Diapedisis is the passage of red or white blood corpuscles through the walls of the vessels that contain them without damage to the vessels. -### End" -7268,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bilirubin bound inside hepatocyte to ?, with the following options: A: Albumin, B: Ubiquinone, C: Ligandin, D: Globulin - -### Response: -Ans. is 'c' i.e., Ligandin Bilirubin metabolism Bilirubin is the end product of heme degradation. The heme is derived from - i) Senescent erythrocytes by mononuclear phagocytic system in the spleen, liver and bone marrow (major source). ii) Turnover of hemoproteins (e.g. cytochrome p.450). Heme is oxidized to biliverdin by heme oxygenase. Biliverdin is then reduced to bilirubin by biliverdin reductase. Bilirubin is transpoed to liver in bound form with albumin. Bilirubin is transferred to hepatocytes where it is bound to ligandin. There is carrier mediated uptake of bilirubin in the liver. This bilirubin is conjugated with glucuronic acid by UDP glucuronyl transferase (UGT1A1) to from conjugated bilirubin (bilirubin glucronides). Conjugated bilirubin is excreted into bile. Most of the conjugated bilirubin is deconjugated and degraded to urobilinogen. The most of the urobilinogen is excreted in the feces. -### End" -7269,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest presenting symptom of Pott's spine is: March 2007, with the following options: A: Cold abscess, B: Back pain, C: Decreased spinal movements, D: Collapse of spine - -### Response: -Ans. B: Back Pain Tuberculosis (TB) of the spine (Pott's disease) is the most common site of bone infection in TB. The lower thoracic and upper lumbar veebrae are the areas of the spine most often affected. Pott's disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent veebrae into the adjoining disc space. If only one veebra is affected, the disc is normal, but if two are involved the interveebral disc, which is avascular, cannot receive nutrients and collapses (seen as narrowing of interveebral space on X-rays) The disease progresses slowly. Signs and symptoms include: Localised back pain is the earliest and commonest complaint Paraveebral swelling may be seen Neurological signs may occur, leading to paraplegia. Stiffness Deformity Constitutional symptoms Spinal X-ray may not show early disease as 50% of bone mass must be lost for changes to be visible on x-ray. However, plain radiographs can show veebral destruction and narrowed disc space. MRI is useful to demonstrate the extent of spinal compression and can show changes at an earlier stage than plain radiographs. Bone elements visible within the swelling, or abscesses, are strongly indicative of Pott's disease as opposed to malignancy. CT scans and nuclear bone scans can also be used. -### End" -7270,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ACTH level is highest during:, with the following options: A: Early morning, B: Evening, C: Afternoon, D: Night - -### Response: -A i.e. Early morningACTH level is highest during early morningQ. About 75% of daily output occurs between 4 AM and 10 AM.Secretion is least in the evening. The biological clock responsible for diurnal variation of ACTH is located in suprachiasmatic nuclei of hypothalamusQ. -### End" -7271,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trichomycosis axillaris is caused by, with the following options: A: Trichophyton, B: Aspergillus, C: Corynebacterium, D: Staphylococcus - -### Response: -Trichomycosis axillaris is a misnomer, it's not a fungal infection. It is a corynebacterium infection of hair shaft. -### End" -7272,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 0, with the following options: A: 0, B: 0, C: 0, D: 0 - -### Response: -0 -### End" -7273,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Contraindicated in Androgenic Alopecia –, with the following options: A: Testosterone, B: Minoxidil, C: Cyproterone, D: Finasteride - -### Response: -Testosterone (androgens) is the cause of androgenic alopecia. So, antiandrogens are used (not androgens). -### End" -7274,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25 year-old-male presents with sudden painless loss of vision. The ocular and systemic examination is normal. What is probable diagnosis?, with the following options: A: Retinal detachment, B: Eale's disease, C: Glaucoma, D: Optic neuritis - -### Response: -Optic neuritis is an inflammatory, demyelinating condition that causes acute, usually monocular, visual loss. Most cases of acute demyelinating optic neuritis occur in women (two-thirds) and typically develop in patients between the ages of 20 and 40. -### End" -7275,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In an adult male, on per rectal examination, the following structures can be felt anteriorly except-, with the following options: A: Internal iliac lymph nodes, B: Bulb of the penis, C: Prostate, D: Seminal vesicle when enlarged - -### Response: -The following structures can be palpated by the gloved index finger inserted into anal canal and rectum in the normal person:- - -1. Anteriorly -i)   In males - -Opposite terminal phalanx:- Contents of the rectovesical pouch, posterior surface of bladder, seminal vesicle, and ductus deferens. -Opposite middle phalanx :- Rectoprostatic fascia and prostate. -Opposite proximal phalanx:- Perineal body, urogenital diaphragm, and bulb of the penis. - -ii)  In females - -Opposite terminal phalanx:- Rectouterine pouch, vagina, and cervix. -Opposite middle phalanx :- Urogenital diaphragm and vagina. -Opposite proximal phalanx:- Perineal body, and lower part of the vagina. - -2. Posteriorly - -Sacrum, Coccyx, anococcygeal body and anorectal ring. - -3. Laterally - -Ischiorectal fossae and ischial spines. -### End" -7276,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Karyotyping is done in which phase of cell cycle:, with the following options: A: Anaphase, B: Metaphase, C: Telophase, D: S phase - -### Response: -Ans. (b) Metaphase(Ref: Robbins 9th/pg 158; 8th/pg 159)In KaryotypeChromosomes are examined after arresting dividing cells in metaphase with mitotic spindle inhibitors (e.g. N-diacetyl-N-methylcolchicine), followed by stainingResolution of Karyotyping: 2 to 5 million base pairs Q -### End" -7277,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Phantom calyx/ Amputed calyx"" on IVU is feature of, with the following options: A: Tuberculosis, B: Hydronephrosis, C: Bilharziasis, D: UPJ obstruction - -### Response: -. -### End" -7278,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of death in polycystic kidneys is?, with the following options: A: Uraemia, B: Atherosclerosis, C: Azotemia, D: HTN - -### Response: -GFR ||- Renin increases - Hypeension -### End" -7279,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pancytopenia with hypercellular marrow is due all EXCEPT:, with the following options: A: Myelodysplasia, B: Paroxysmal nocturnal hemoglobinuria, C: Sarcoidosis, D: Dyskeratosis congenital - -### Response: -Dyskeratosis congenital REF: Harrison's Internal Medicine 17th ed > Chapter 102, table 102-1 Differential Diagnosis of Pancytopenia Pancytopenia with Hypocellular Bone Marrow Acquired aplastic anemia Constitutional aplastic anemia (Fanconi's anemia, dyskeratosis congenita) Some myelodysplasia Rare aleukemic leukemia (AML) Some acute lymphoid leukemia Some lymphomas of bone marrow Pancytopenia with Cellular Bone Marrow Primary bone marrow diseases Secondary to systemic diseases Myelodysplasia * Systemic lupus erythematosus Paroxysmal nocturnal hemoglobinuria * Hypersplenism Myelofibrosis * B12, folate deficiency Some aleukemic leukemia * Overwhelming infection Myelophthisis * Alcohol Bone marrow lymphoma Hairy cell leukemia * Brucellosis Sarcoidosis Tuberculosi Leishmaniasis Hypocellular Bone Marrow +- Cytopenia Q fever Legionnaires' disease Anorexia nervosa, starvation Mycobacteria -### End" -7280,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for absence seizure:, with the following options: A: Lamotrigine, B: Sodium valproate, C: Trimethadione, D: Ganoxolone - -### Response: -(Ref: KDT 6th ed. pg. 407-408)Uses of Sodium Valproate* Valproic acid is the drug of choice for absence seizures.* It is an alternative/adjuvant drug for GTCS, simple partial seizure and complex partial seizure* Myoclonic and atonic seizures-control is often incomplete, but valproate is the drug of choice.* Mania and bipolar illness: As alternative to lithium.* Valproate has some prophylatic efficacy in migraine.MOA: prolongation of Na+ channel inactivationAugmentation of release of inhibitory transmitter GABA by inhibiting its degradationDrugs which can be used for absence seizure:* Sodium valproate* Ethusuximide* Lamotrigine* ClonazepamDrug of choice for different seizuresSeizure typesDOCAbsence seizures (petit mal) in children (<2 - 3 yr)EthosuximideAbsence seizuresNa+ ValproateGTCS (Grand mal)LAMOTRIGINE > Na+ ValproateFocal onset/Partial seizureCarbamazepineMyoclonic seizuresNa+ Valproate> LamotrigineTonic/Clonic seizuresNa+ ValproateInfantile/salam seizureACTHInfantile spasm associated with tuberous sclerosisVigabatrinFebrile seizuresDiazepam (per rectal)Status epilepticusLorazepam (I.V.)Seizures in eclampsiaMagnesium sulphateSeizure during pregnancyLamotrigineLennox Gastaut syndromeNa+ Valproate -### End" -7281,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The basis of Korotkoff sound is, with the following options: A: Aoic valve closure, B: Production of hea sound, C: Aerial turbulence, D: Aerial valve expansion - -### Response: -The sounds of Korotkoff are produced by turbulent flow in the brachial aery. When the aery is narrowed by the cuff, the velocity of flow through the constriction exceeds the critical velocity and turbulent flow results. -### End" -7282,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 'Spade-like' deformity of the cardiac apex on angiography is pathognomonic of:, with the following options: A: ASD (Atrial septal defect), B: ARVD (Arrythmogenic right ventricular dysplasia), C: Hyperophic cardiomyopathy, D: PTA (persistent truncus aeriosus) - -### Response: -Ace of Spades-like' deformity of the apex demonstrated on Angiography and MRI directed through the long axis of the left ventricle Apical Hyperophic Cardiomyopathy It consists of marked ventricular wall thickening at the apex resulting in cavity narrowing at the apex with a relatively normal appearance of the mid-ventricle. On a longitudinal view of the left ventricle, this results in an appearance resembling a playing card spade. It can be demonstrated on echocardiography, ventriculography, and cardiac MRI. -### End" -7283,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following diseases have a defect in DNA repair mechanism except for, with the following options: A: Xeroderma pigmentosum, B: Huntington’s disease, C: Fanconi syndrome, D: Hereditary non polyposis colon cancer - -### Response: -Inherited autosomal recessive syndromes of defective DNA repair -Ataxia Telangiectasia -Bloom syndrome -Fanconi anaemia -Xeroderma pigmentosum -Hereditary Nonpolyposis cancer -Huntington’s disease is an example of trinucleotide repeat disorders -### End" -7284,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements is true about rabies virus -, with the following options: A: It is double stranded RNA virus, B: Contains a DNA-dependent RNA polymerase, C: RNA has a negative polarity, D: Affects motor neurons - -### Response: -The genome of Rabies virus is an unsegmented linear negative sense RNA. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO-530 -### End" -7285,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient of Mediterranean ancestry was given primaquine to protect against malaria when going on an overseas trip. The patient rapidly developed a hemolytic anemia due to a mostly silent mutation in which one of the following pathways or enzymes?, with the following options: A: Malic enzyme, B: Glycolysis, C: Hexose monophosphate shunt, D: Gluconeogenesis - -### Response: -The patient most likely has glucose-6-phosphate dehydrogenase deficiency, one of the enzymes that produces NADPH. When glucose-6-phosphate dehydrogenase is defective, both it and the subsequent enzyme in the hexose monophosphate shunt pathway (6-phosphogluconate dehydrogenase) do not produce NADPH. The red blood cells have insufficient NADPH; under these conditions, to keep glutathione in its reduced, protective form, and in the presence of a strong oxidizing agent (primaquine), red cell membrane damage occurs, and the cells lyse, producing the hemolytic anemia. Mutations in glycolysis, gluconeogenesis, and fatty acid oxidation do not fit this pattern of damage in the presence of a strong oxidizing agent. Mutations in glycolysis (such as pyruvate kinase) can lead to anemia, but that occurs in the absence of oxidizing agents as well. The red blood cells do not oxidize fatty acids, nor do they carry out gluconeogenesis. -### End" -7286,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most useful investigation of choice for liver abscess is, with the following options: A: Exploratory laparotomy, B: Ultrasound, C: Liver enzymes, D: Parasite in the stool - -### Response: -Ans. (b) UltrasoundRef: Bailey & Love 25th 169* On ultrasound, an abscess cavity in the liver is seen as a hypoechoic or anechoic lesion with ill-defined borders; internal echoes suggest necrotic material or debris. The investigation is very accurate and is used for aspiration, both diagnostic and therapeutic.* Where there is doubt about the diagnosis, a computerized tomography (CT) scan may be helpful.Also KnowDiagnostic pointers for infection with Entamoeba histolytica* Bloody mucoid diarrhoea in a patient from an endemic area or following a recent visit to such a place* Upper abdominal pain, fever, cough, malaise* In chronic cases, a mass in the right iliac fossa = amoeboma* Sigmoidoscopy shows typical ulcers--biopsy and scrapings may be diagnostic* Serological tests are highly sensitive and specific outside endemic areas* Ultrasound and CT scans are the imaging methods of choice. -### End" -7287,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following monoclonal antibody is directed against alpha 4 integrin?, with the following options: A: Efalizumab, B: Natalizumab, C: Ibalizumab, D: Toclizumab - -### Response: -NatalizumabNatalizumab is a humanized IgG4 monoclonal antibody that binds to the a4-subunit of a4b1 and a4b7 integrins expressed on the surfaces of all leukocytes except neutrophils and inhibits the a4-mediated adhesion of leukocytes to their cognate receptor. It is indicated for patients with multiple sclerosis and Crohn's disease who have not tolerated or had inadequate responses to conventional treatments.Ref: Katzung 13th ed.pg 993. -### End" -7288,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true regrading spinal cord and neuraxial blockade, with the following options: A: Spinal cord ends at S1 in adults, B: Spinal anaesthesia is given below L3 level in children, C: Dural sac extends upto S2 in children, D: Spinal cord ends at lower border of L1 in children - -### Response: -Spinal cord ends at upper border of L3 in children , and at lower border of L1 in adults. The dural sac extends upto S3 in children and S2 in adults. -### End" -7289,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of postoperative renal failure:, with the following options: A: Decreased renal perfusion, B: Toxicity of anesthetic drugs, C: Toxicity of antibiotics, D: None of the above - -### Response: -Decreased renal perfusion Postoperative renal failure results from many etiologies how more than 90% cases fo postoperative renal failure are due to hypovolemia and inadequate perfusion. Most common cause of postoperative renal failure is decreased renal perfusion due to hypovolemia. Hypovolemia usually results from inadequate intraoperative fluid replacement, continuing fluid sequestration by tissues (third spacing) or wound drainage or postoperative bleeding -### End" -7290,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Uronic acid pathway is impoant for the formation of?, with the following options: A: GAG (glycosamine glycans), B: Glycoproteins, C: Conjugation of bilirubin, D: All of the above - -### Response: -UDP-glucuronate (a product of uronic acid pathway) is a donar of glucuronate residue for various conjugation and synthetic processes. -### End" -7291,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Daily requirement of Iodine in adults is, with the following options: A: 50 mcg, B: 100 mcg, C: 150 mcg, D: 200 mcg - -### Response: -The daily requirement of iodine is 150 mcg supplied normally by well balanced diets and drinking water. -### End" -7292,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Serological marker of infectivity of Hepatitis is?, with the following options: A: HBeAg, B: HBeAg, C: IgM anti Hbc, D: HBcAg - -### Response: -Ans. is 'b' i.e., HBeAg -### End" -7293,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Young lady comes with mild erosion of cervix & pap smear shows dysplasia, next step is :, with the following options: A: Antibiotics, B: Colposcopy, C: Cryosurgery, D: Conization - -### Response: -Ans. is b i.e. Colposcopy A young lady is presenting with erosion which on cytology shows dysplasia. Now what will be the next step : Friends, here first of all it is impoant to know that erosion (ectopy) : is a condition in which the squamous covering of the vaginal aspect of the cervix is replaced by columnar epithelium lining the ondocervix It appears as a bright red area continuous with the endocervix and with a clearly defined outer edge. It often bleeds on touch and has to distinguished from carcinoma, tuberculosis, syphilitic and other ulcers of the cervix. ""Although a cervical smear may be helpful. the distinction may not be possible except by colposcopy or biopsy"". Jeffcoate 7/e, p 411 Here in the question : Pap smear has already been done and it shows dysplasia which should be confirmed by colposcopy. Extra Edge : Management of cervical erosion : If it is detected during pregnancy treatment should be deferred for atleast 12 weeks postpaum. Management : - Thermal cauterizations - Cryosurgerydeg - Laser vaporisationdeg Aim : To destroy columnar epithelium so that on healing it is replaced by squamous epithelium. -### End" -7294,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Cancrum Oris except :, with the following options: A: Associated with malnutrition and vitamin deficiency, B: Follows chronic infection, C: Involves jaw, D: Treatment is excision and skin grafting with tubed pedicle graft - -### Response: -Cancrum Oris (also k/a Noma and Gangrenous stomatitis) : - -Cancrum Oris is now rarely seen in developed countries but is still not uncommon in many developing countries. -It is a gangrenous process of the mouth, which starts suddenly, rapidly involve the adjacent tissues of the face, quickly becomes well demarcated, and then spreads no further. It most often affects one or both sides of the jaw, and occasionally the front of the face (mouth, lips, nose & chin). The gangrenous process may spread to destroy the bones of the face. -This disease occurs primarily in a severely malnourished child less than 5 yrs of age. Often they have had a preceding illness such as measles, malaria, scarlet fever, tuberculosis, malignancy or immunodeficiency, which has weakened the general health of the child. -The exact cause is not known but may be bacterial. Fusiformis & Borrelia are largely responsible, but the ds. is not contagious. -Untreated Cancrum Oris is almost always quickly fat.: due to associated illness or a complication, such as a septicemia or aspiration pneumonia. - -Management involves : - -correction of the general condition. -antibiotics (Penicillin + Metronidazole). -Excision of the dead tissue. -Plastic surgery. -### End" -7295,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The virus, which spreads by both hermatogenous and neural route is -, with the following options: A: Rabies virus, B: Varicella zoster virus, C: Poliovirus, D: E.B. Virus - -### Response: -The virus multiplies initially in the epithelial cells of the alimentary canal and the lymohatic tissues from tonsil to peyer's patches. It then spreads to the rwgiinal lymoh node and enters blood stream. Direct neural transmission ti the CNS may also occur. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:486 -### End" -7296,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are features of neonatal necrotizing enterocolitis except -, with the following options: A: Abdominal distension, B: Increased bowel sound, C: Metabolic acidosis, D: Pneumoperitoneum - -### Response: -Ans. is 'b' i.e., Increased bowel sound o Bowel sounds are diminished or absent. -### End" -7297,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Erythroblastosis fetalis, the first child is spared because:, with the following options: A: Immune response in second exposure is fast, B: Sensitization of Rh-negative mothers by a Rh-positive fetus generally occurs at bih, C: Small amounts of fetal blood leak into the ma ternal circulation at the time of delivery, D: Mothers develop significant titers of anti-Rh ag glutinins during the postpaum period - -### Response: -Sensitization of Rh-negative mothers by a Rh-positive fetus generally occurs at bih -### End" -7298,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: After trauma, hypovolemic shock can be due to all EXCEPT:, with the following options: A: Pelvic fracture, B: Head injury, C: Blunt trauma to abdominal viscera, D: Hemothorax - -### Response: -Head injury REF: Fluid and Electrolyte Balance by Norma Metheny, Norma Milligan Metheny Page 221 Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock. Intracranial injuries alone do not produce circulatory inadequacy until brain stem and its reticular activating system is profoundly involved. Therefore the presence of shock in a head injury patient indicates a search for another cause. -### End" -7299,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are relevant in compament syndrome except:, with the following options: A: Fasciotomy, B: Splitting of tight pop cast, C: Reexploration, D: Exercise - -### Response: -D i.e. Excercise Excercise may increase intra compamental pressure & muscle edema, so it is avoided in cases of acute compamental syndromeQ. -### End" -7300,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hepatocellular damage of wilson's resembles ?, with the following options: A: Acute hepatitis, B: Chronic hepatitis, C: Cholestasis, D: All - -### Response: -Ans. is 'a' i.e., Acute hepatitis; 'b' i.e., Chronic hepatitis; 'c' i.e., CholestasisWilson diseaseo This autosomal - recessive disorder is marked by the accumulation of toxic levels of copper in many tissues and organs, principally the liver, brain and eye.Clinical features of Wilson's disease?Organs involved Symptoms producedHepatic o The liver often bears the brunt of injury in wilson disease with hepatic changes ranging from relatively minor to massive damage which are - Fatty change, acute hepatitis, chronic hepatitis, cirrhosis, massive liver necrosis (acute fulminant hepatitis).All forms of hepatitis are seen in wilson disease (chronic active hepatitis also seen)C.N.S. o In brain, the toxic injury primarily affects the basal ganglia paicularly the putamen which demonstrates atrophy and cavitation.The involvement of basal ganglia produces extrapyramidal symptoms which are - Dystonia, incoordination, tremor, dysphagia, dysahria, chorea.Memory loss, migraine headaches and seizures too can occur.Patients can have difficulty in concentrating on tasks but cognition is usually not impaired.Remember that Sensory abnormalities and muscular weakness are not seen in this disease.Psychiatric o H/O of behavioral disturbances within five years of the onset of the disease.Features are diverse and include loss of emotional control (temper tantrums, crying bouts) Depression, hyperactivity, loss of sexual inhibition.Occular o Kayser Flescher ring (green to brown deposits in the descment's membrane in the cornea)Sunflower cataractBlood o Hemolytic anemia (in severe hepatic failure hemolytic anemias may occur because large amounts of copper are released. The association of hemolysis and liver disease makes wilson disease likely diagnosis).Others o Urinary excretion of glucose, phosphates, amino acids, urates -### End" -7301,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Folding of nascent polypeptide chains is the function of, with the following options: A: Chaperones, B: Proteosome, C: Heat shock proteins, D: Ribosomes - -### Response: -In molecular biology, molecular chaperones are proteins that assist the covalent folding or unfolding and the assembly or disassembly of other macromolecular structures. Chaperones are present when the macromolecules perform their normal biological functions and have correctly completed the processes of folding and/or assembly. The chaperones are concerned primarily with protein folding. -### End" -7302,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Female patient with injury on her scalp, hair was shaved and sutures were put. On which day sutures should be removed?, with the following options: A: 8-10 days, B: 2 weeks, C: 3 weeks, D: 1 month - -### Response: -Ans. (a) 8-10 daysRef Sabiston 18th ed. 12134Scalp suture should be removed on 6th to 8th day. Given these options, 8-10 days is the best choice.Day of suture removal from different body areasBody areaSuture removal on* Scalp6-8 days* Face3-5 days* Chest, Abdomen8-10 days* Ear10-14 days* Extremities, back12 -14 days -### End" -7303,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nucleotides are, with the following options: A: Heterocyclic Compounds, B: N-Glycosides, C: Phosphorylated Nucleosides, D: O-Glycosides - -### Response: -Purines & Pyrimidines Are Heterocyclic Compounds.Nucleosides Are N-Glycosides.Nucleotides Are Phosphorylated Nucleosides .Ref: Harper&;s Biochemistry; 30th edition; Chapter 32; Nucleotides -### End" -7304,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chromosomal anomalies more than 20% is associated with -, with the following options: A: Gastroschisis, B: Omphalocele, C: Spina Bifida, D: Cleft Palate - -### Response: -Ans. is 'b' i.e., Omphalocele o Chromosomal abnormalities have been repoed in as many as 43% fetuses with omphalocele. The most common being trisomy 13, 18, 21 and Turner syndrome. -### End" -7305,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The sputum specimen of a 70 year old male was cultured on a 5% sheep blood agar. The culture showed the presence of a-haemolytic colonies next day. The further processing of this organism is most likely to yield., with the following options: A: Gram positive cocci in short chains, catalase negative and bile resistant, B: Gram positive cocci in pairs, catalase negative and bile soluble, C: Gram positive cocci in clusters, catalase positive and coagulase positive, D: Gram negative coccobacilli catalase positive and oxidase positive - -### Response: -Ans. is 'b' i.e., Gram positive cocci in pairs, catalase negative and bile solubleStreptococci can be divided into three group based on their specific hemolytic ability.Classification of streptococci based on their ability to hemolyze Red blood cells:Beta hemolytic r They completely lyse the RBC's leaving a clear zone of hemolysis around the colonyAlpha hemolytic - They only partially lyze the RBC's leaving a greenish discoloration of the culture medium surrounding the colony.This discolored area contains analysed RBC's and a green coloured metabolite of hemoglobinGamma hemolytic - These streptococci are unables to hemolyze the RBc's and therefore we should really not use the word hemolytic in this situation (the term non hemolytic streptococci is often used to avoid confusion)In the question the culture of the sputums yields a hemolysis colonies. So we have to look for streptococci causing a hemolysis.Streptococci causing a hemolysis are :Streptococcus pneumoniaViridans streptococciEnterococcus fecalis and other enterococci (group D)Now we move in the reverse direction i.e. we take each options one by one and see whether they fit in any of the above streptococci.Option 'd'It can be easily ruled out as streptococci are gram positive Option 'c'This one also falls one of favour as streptococci are catalase negative (staphylococcic are catalase positive).Now we are left with options 'a' and 'b'The characteristics given in option 'a' matches with those of streptococci viridans and option 'b' matches with those of streptococcus pneumonia. Here is a comparison of Streptococcus pneumonia and Streptococcus viridans Streptococus pneumoniaeStreptococcus viridansMorphologyCapsulated, lanceolate diplococciNon capsulated, oval or round cells in chainsHemolysisa hemolytica hemolyticQuellung testPositiveNegativeColoniesInitially dome, later draughtsman coloniesDome - shapedGrowth in liquid mediaUniform turbidityGranular turbidity, powdery depositBile solubilityInvariably positiveInvariably negativeOptochin sensitivityPositiveNegativeIntraperitoneal inoculation inFatal infectionNonpathogenic in miceBut the point which favours streptococcus pneumonia is, presence of respiratory tract infection (probably pneumonia) in the patient, Streptococcus viridans rarely causes respiratory infection. -### End" -7306,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Needle for thoracocentesis is inserted most commonly at -, with the following options: A: 5th intercostal space in the midaxillary line, B: 3rd intercostal space in the midaxillary line, C: 4th intercostal space in the anterior axillary line, D: 9th intercostal space in the midclavicular line - -### Response: -Ans. is 'a' i.e., 5th intercostal space in the midaxillary line o Lung extends upto 8th intercostal space at midaxillary line.o Pleura extends upto 10th intercostal space in mid-axillary line. Thus thoracocentesis is done at 8th, 9th or 10th intercostal space in midaxillary line to avoid damage to lung.o Chest tube drainage - 4th or 5th intercostal space just anterior to midaxillary lineo Thoracocentesis - 8th, 9,h or 10th intercostal space in midaxillary line. -### End" -7307,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 30 year old primi with 36 weeks of pregnancy with blood pressure 160/110 and urinary albumin is 3+ & platelet count 80000/mm3. What will be the management?, with the following options: A: Betamethasone, B: MgSO4, C: Labetalol, D: Urgent LSCS - -### Response: -Answer is b and c That is MgSO4 and Labetalol Patient has severe pre-eclampsia and gestational age is 36 weeks : If gestational age is above 34 weeks, the best approach is to treat with magnesium sulphate for the prevention of seizures.,give antihypeensive to control the BP and delivery after stabilization. Ref Fernando Arias 4 /e p 210 Betamethasone to hasten lung maturity is not required at 36 weeks as lungs are already mature by this time Ref.. Williams obs 23/e p729 -### End" -7308,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best drug therapy for paranoid schizophrenia in a thin built 21 - years old young male would be, with the following options: A: Chlorpromazine, B: Risperidone, C: Olanzapine, D: Quetiapine - -### Response: -The clue in this question is antipsychotic that can be used in lean patients, antipsychotic olanzapine is a well researched drug that has lesser discontinuation * Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 1053 -### End" -7309,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following physiological change can occur when there is vagal stimulation of hea?, with the following options: A: Increased R-R interval, B: Increased hea rate, C: Increased cardiac output, D: Increased force of contraction - -### Response: -Stimulation of parasympathetic (vagus) fibers causes decrease in the hea rate (increased R-R interval), reduce the force of contraction, and constrict the coronary aeries. Stimulation of sympathetic nerves increases hea rate (decreased RR interval). Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 4. Hea. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy. -### End" -7310,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following parasite infection predispose to malignancies, with the following options: A: Paragonimus westermani, B: Guinea work infection, C: Clonorchiasis, D: Schistosomiasis - -### Response: -Ref Robbins 8/e p880; 9/e p874 The following two parasites have definitive ethilogical association with malignancies: Clonorchis sinensis : cholangiocarcinoma Opisthorchis viveerini: cholangiocarcinoma Schistosoma japonicum: colorectal cancer -### End" -7311,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are among the major criteria to diagnose Marfan syndrome, except, with the following options: A: Ectopia lentis, B: Dilatation of the ascending aoa, C: Dural ectasia, D: Striae over the buttocks - -### Response: -The diagnosis of MFS according to the Ghent standards, the major criteria includes presence of at least four skeletal abnormalities, ectopia lentis, dilation of the ascending aoa with or without dissection, dural ectasia, and a blood relative who meets the same criteria, with or without a DNA diagnosis. Striae is not among the major criteria. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 3213 -### End" -7312,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Histamine blocker in stomach act through, with the following options: A: Decreasing cAMP in stomach, B: Increasing cAMP in stomach, C: Increasing IP3 in stomach, D: Decreasing IP3 in stomach - -### Response: -Histamine H2 blockersinhibit the action of histamine ongastric H2 receptors thereby decreasing gastric acidity. They were considered a breakthrough in the treatment of peptic ulcer disease when first introduced. Refer kDT 6/e 153 -### End" -7313,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for treatment of gastrointestinal stromal tumors is:, with the following options: A: Rituximab, B: Imatinib mesylate, C: Anagrelide, D: Denileukin diftitox - -### Response: -Ans: B (Imatinib mesylate) Ref: Goodman & Gillman, The pharmacological basis of therapeutics, 12th edition, Pg No. 1732-1734.Explanation:Imatinib mesylate is used in the treatment of (Approved indications)Chronic phase of CIVILGIST- Gastrointestinal Stromal tumorChronic Myelomonocytic leukemiaHypereosinophilic syndromeDermatofibrosarconia protruberanceProgressive plexiform neurofibromatosisIt is also tried in (Experimental and Not approved for routine use)Systemic MastocytosisPulmonary hypertensionAlzheimer' s diseaseLowering or reversing opioid toleranceDesmoid tumor -### End" -7314,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Desmoid tumor, treatment is, with the following options: A: Local excision, B: Wide excision, C: Wide excision with radiotherapy, D: Radiotherapy - -### Response: -Desmo means Band/Tendon in Greek. It is a tumour arising from the musculoaponeurotic layer of abdomen, below the level of the umbilicus. It is unencapsulated, hard, fibroma, presently classified under aggressive fibromatosis.80% of cases occur in women, commonly after deliveries, over the abdominal scars, OCP use.It is often associated with Gardner's syndrome. Wide excision of the tumour with a margin of 2.5 cm along with placement of a mesh to the abdominal defect is the treatment of choice . It is moderately radiosensitive. Drugs like sulindac and tamoxifen are also used. Chemotherapeutic agents like doxorubicin, actinomycin D, dacarbazine, carboplatin are used but with significant toxicity. Recurrence rate is high--20-40%.Reference : page 742-43 SRB's manual of surgery 5th edition -### End" -7315,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transformation of one epithelium to other epithelium, with the following options: A: Dysplasia, B: Hyperplasia, C: Neoplasia, D: Metaplasia - -### Response: -Ref Robbins 8/e p10,11; 9/e p37 Metaplasia is a reversible change in which one adult cell type (epithelial or mesenchymal) is replaced by another adult cell type. In this type of cellular adaptation, a cell type sensitive to a paicular stress is replaced by another cell type better able to withstand the adverse environment. Metaplasia is thought to arise by reprogramming of stem cells to differ- entiate along a new pathway rather than a phenotypic change (transdifferentiation) of already differentiated cells. Epithelial metaplasia is exemplified by the squamous change that occurs in the respiratory epithelium of habitual cigarette smokers (Fig. 1-5). The normal ciliated columnar epithelial cells of the trachea and bronchi are focally or widely replaced by stratified squamous epithelial cells. The rugged stratified squamous epithelium may be able to survive the noxious chemicals in cigarette smoke that the more fragile specialized epithelium would not tolerate. Although the metaplastic squamous epithelium has survival advantages, impoant protective mechanisms are lost, such as mucus secretion and ciliary clearance of paiculate matter. Epithelial metaplasia is therefore a double-edged sword. Moreover, the influences that induce metaplastic change, if per- sistent, may predispose to malignant transformation of the epi- thelium. In fact, squamous metaplasia of the respiratory epithelium often coexists with lung cancers composed of malignant squamous cells. It is thought that cigarette smoking initially causes squamous metaplasia, and cancers arise later in some of these altered foci. Since vitamin A is essential for normal epithelial differentiation, its deficiency may also induce squamous metaplasia in the respiratoryepithelium. Metaplasia need not always occur in the direc- tion of columnar to squamous epithelium; in chronic gastric reflux, the normal stratified squamous epithelium of the lower esophagus may undergo metaplastic transformation to gastric or intestinal-type columnar epithelium. Metapla- sia may also occur in mesenchymal cells but in these situ- ations it is generally a reaction to some pathologic alteration and not an adaptive response to stress. For example, bone is occasionally formed in soft tissues, paicularly in foci of injury. -### End" -7316,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pineal gland forms, with the following options: A: Floor of third ventricle, B: Anterior wall of third ventricle, C: Posterior wall of third ventricle, D: Roof of third ventricle - -### Response: -Anterior wall :Anterior column of fornixAnterior commissureLamina terminalisPosterior wall:Pineal glandPosterior commissureCommencement of cerebral aqueduct.Roof: ependymaFloor:Optic chiasmaTuber cinereumMamillary bodiesPosterior perforated substanceTegmentum of midbrainLateral wall:ThalamusHypothalamusRef: Vishram Singh textbook of clinical neuroanatomy second edition pg 137 -### End" -7317,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prenatal diagnosis of Hemophilia is best done by:, with the following options: A: PCR, B: Linkage analysis, C: Cytometry, D: Microarray - -### Response: -PCR is used in prenatal diagnosis of hemophilia. All direct testing methods are dependent on PCR, so it is the best test for the detection of this disease. Ref: Textbook of Hemophilia By Christine A. Lee, Erik E. Berntorp, W. Keith Hoots, Page 39; Molecular Diagnosis of Genetic Diseases By Rob Elles, Roger Mountford, Page 347; Wintrobe's Atlas of Clinical Hematology By Douglas C. Tkachuk, Jan V. Hirschmann, Page 213. -### End" -7318,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The base not present in DNA is:, with the following options: A: Adenine, B: Uracil, C: Guanine, D: Thymine - -### Response: -Uracil -### End" -7319,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest complication of CSOM is:, with the following options: A: Subperiosteal abscess, B: Mastoiditis, C: Brain abscess, D: Meningitis - -### Response: -Ans. C Brain abscess There is no confusion as far as this question is concerned: According to Turner ""Most common complication of CSOM is brain abscess (intracerebral) According to Scotts Brown ""In a large series of 268 patients with complications of COM, he incidence of extracranial complications was 32%, intracranial complications was 56% and combined intracranial and extracranial was 72%"" Relative Incidence of Complications in Active Mucosal and Squamous COM Extracranial % Intracranial % Post auricular abscess Facial palsy Bezold abscess Petrous apicitis Meningitis 75 06 02 0.2 12 Subdural abscess Brain abscess Extradural abscess Lateral sinus thrombosis S1 20 10 20 So from above text of Scotts Brown it is clear that Intracranial complications are more common than extracranial and amongst intracranial as is clear from the table - M/C is Brain abscess Hence there is no doubt regarding this answer. Most common complication of acute otitis media - Acute mastoiditis Most common intracranial complication of acute otitis media - Meningitis Most common extracranial complication of (SOM -Post-auricular abscess Most common intracranial complication of (SOM -Brain (intracerebral abscess) -### End" -7320,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Main function of B HCG:, with the following options: A: Maintain corpus luteum, B: Stimulate decidua, C: Initiate implantation, D: initiate breast growth - -### Response: -Ans: a (Maintain corpus luteum)Ref: William's Obstetrics, 23rd ed., Chapter 3Both alpha- and beta-chain synthesis of hCG are regulated separately. A single gene located on chromo- some 6 encodes the alpha-subunit for hCG, LH, FSH, and TSH. There are seven separate genes on chromosome 19 for the beta-hCG- beta-LH family.The best-known biological function of hCG is the so-called rescue and maintenance of function of the corpus luteum-- that is, continued progesterone production.Progesterone-producing life span of a corpus luteum of menstruation could be prolonged perhaps for 2 weeks by hCG administration.Maximum plasma hCG concentrations are attained well after hCG-stimulated corpus luteum secretion of progesterone has ceased. Specifically, progesterone luteal synthesis begins to decline at about 6 weeks despite continued and increasing hCG production.Before 5 weeks, hCG is expressed in both syncytiotrophoblast and cytotrophoblast. Later, when maternal serum levels peak, hCG is produced almost solely in syncytiotrophoblasts. -### End" -7321,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pulled elbow is, with the following options: A: A sprain of extensor tendons, B: Dislocation of head of radius, C: Fracture of lateral condyle of humerus, D: Dislocation of elbow - -### Response: -B i.e. Dislocation of head -### End" -7322,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: X-ray findings in chronic otitis media-, with the following options: A: Honeycombing of mastoid, B: Sclerosis with cavity in mastoid, C: Clear-cut distinct bony partition between cells, D: None of the above - -### Response: -(Refer: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 73 – 82) -“X-ray in CSOM, especially in atticoantral disease, may show sclerosis with presence of cavity” -### End" -7323,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Feature of metabolic syndrome is-, with the following options: A: Hypoinsulinemia, B: High HDL cholesterol, C: Hyperinsulinemia, D: Type 1 diabets mellitus - -### Response: -Ref -medscape.com -### End" -7324,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In case of Maxillary canine replacement FPD, forces are directed_________on Canine, with the following options: A: Outwards, B: Inwards, C: Upwards, D: Laterally - -### Response: -Fixed partial dentures replacing canines can be difficult, because the canine often lies outside the interabutment axis. The prospective abutments are the lateral incisor, usually the weakest tooth in the entire arch, and the first premolar, the weakest posterior tooth. -A fixed partial denture replacing a maxillary canine is subjected to more stresses, than that replacing a mandibular canine, since forces are transmitted outward (labially) on the maxillary arch, against the inside of the curve (its weakest point) . -On the mandibular canine, the forces are directed inward (lingually), against the outside of the curve (its strongest point) . Any fixed partial denture replacing a canine should be considered a complex fixed partial denture. -No fixed partial denture replacing a canine should replace more than one additional tooth. An edentulous space created by the loss of a canine and any two contiguous teeth is best restored with a removable partial denture. -### End" -7325,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ichthyosis is caused by –, with the following options: A: Hemosiderosis, B: Refsum disease, C: Niacin deficiency, D: Steven johnson syndrome - -### Response: -Syndromal ichthyosis (ichthyosis with additional characteristics) is seen in carvaj al syndrome, CHILD syndrome, Daffier 's disease, Refsum disease, Rud syndrome, Netherton syndrome, Neutral lipid storage disease, Tey syndrome, Senter syndrome. -### End" -7326,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Bacillus anthracis is, with the following options: A: Causes anthrax, B: Toxin is tripartite, C: Capsule made up of polypeptide, D: Most common transmission is by inhalation of spores - -### Response: -Cutaneous mode is most common transmission. -### End" -7327,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Loading dose is given for which of the following drug, with the following options: A: Diazepam, B: Propranolol, C: Chloroquine, D: Aspirin - -### Response: -Chloroquine is a drug having maximum Volume of Distribution (Vd >1300 L). This means it is mostly distributed in the tissues whereas the main site of its pharmacological action is RBCs. Therefore, it is given as a loading dose to attain steady state plasma concentration quickly. Chloroquine is a synthetic 4-aminoquinoline that has been the mainstay of antimalarial therapy, is the drug of choice in the treatment of erythrocytic P. falciparum malaria, except in resistant strains. -### End" -7328,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Predisposing factors of carcinoma endometrium are all EXCEPT, with the following options: A: Obesity, B: Late menopause, C: Multiparity, D: Unopposed administration of estrogen - -### Response: -(Multiparity) (573-74-Shaw's 14th)Multiparity is common in carcinoma cervix, while carcinoma of endometrium women are either nulliparous or of low parityPredisposing Factors in Carcinoma Endometrium* Peak incidence is 55-70 years* An Early menarche and late menopause is characteristic* Unopposed and unsupervised administration of HRT* Chronic non ovulatory cycles as seen in DUB* Familial predisposition - Familial Lynch II syndrome* Tamoxifen given to women with breast cancer increases the risk of endometrial hyperplasia* Combined oral hormonal pills* Obesity hypertension and diabetes* Infertile women and women with polycystic ovarian disease* Feminizing ovarian tumour at the time of diagnosis* The risk of endometrial carcinoma is the highest with the following complex hyperplasia with atypia** histological pattern of endometrial hyperplasia (about 28%)*** -### End" -7329,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bisgaard regimen is used in treatment of?, with the following options: A: Trophic ulcer, B: Malignant ulcer, C: Ischaemic ulcer, D: Varicose ulcer - -### Response: -ANSWER: (D) Varicose ulcerREF: SRB manual of surgery by Bhat 2nd ed page 160, Bailey 23rd ed page 239, 249BISGAARD'S REGIMEN OF VARICOSE ULCER: ( Mnemonic: 5Es)Education: Patient education of ulcer dressing and care, Ulcer care by regular cleaning by with povidone iodine, H2O2, Dressing with EUSOL,Elevation: limb elevation to reduce edema, increase venous drainage, to promote ulcer healingExercise: Massage, active and passive exercisesElastic compression: Pressure bandage (crepe bandage), Four layered high pressure compression bandageEvaluation:Note: Antibiotics depending on culture and sensitivity of discharge -### End" -7330,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best way to sterilize all-glass syringes is: September 2007, with the following options: A: Boiling, B: Autoclave, C: Hot air oven, D: Formaldehyde - -### Response: -Ans. C: Hot air oven Dry heat can be used to sterilize items, but as the heat takes much longer to be transferred to the organism. The standard setting for a hot air oven is at least two hours at 160 degC (320 degF). It is used to sterilise glassware, forceps, scissors, scalpels, all-glass syringes, swabs, liquid paraffin etc. A rapid method heats air to 190 degC (374 degF) for 6 minutes for unwrapped objects and 12 minutes for wrapped objects. Dry heat has the advantage that it can be used on powders and other heat-stable items that are adversely affected by steam. -### End" -7331,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following enzymes does the neutrophil use to initiate the production of toxic oxygen compounds that kill bacteria?, with the following options: A: Hydrogen peroxide, B: Myeloperoxidase, C: NADPH oxidase, D: Superoxide - -### Response: -The first step in killing bacteria is the production of superoxide ion, O2- , by the action of NADPH oxidase on NADPH and O2. The superoxide is then conveed to hydrogen peroxide, either spontaneously or through the action of superoxide dismutase. The hydrogen peroxide can also be conveed to the toxic HOCl. radical by the action of myeloperoxidase. Note: Hydrogen peroxide is not an enzyme. Myeloperoxidase is pa of the killing pathway, but is active later in the sequence, when H2O2 is conveed in the presence of Cl- to the HOCl. radical. Superoxide is not an enzyme. Ref: Gallin J.I. (2012). Chapter 60. Disorders of Granulocytes and Monocytes. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -7332,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Malta"" fever is caused by:, with the following options: A: Treponema, B: Borellia, C: Brucella, D: Pseudomonas - -### Response: -Brucella -### End" -7333,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meniere's disease is characterised by:, with the following options: A: Conductive hearing loss and tinnitus, B: Vertigo, ear discharge, tinnitus and headache, C: Vertigo, tinnitus, hearing loss and headache, D: Vertigo, tinnitus and hearing loss - -### Response: -Meniere's disease is due to raised endolymphatic pressure and clinically presents with vertigo, tinnitus, sensorineural hearing loss and sense of aural fullness. Vertigo can be accompanied by nausea and vomiting. Choice (a) is excluded due to conductive loss, (b) due to headache and ear discharge, and (c) due to headache. Presence of headache with vertigo and tinnitus may be a feature of neurological disorder. -### End" -7334,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When the patient is asked to look upwards with the head fixed, there will be absence of wrinkling on the forehead, this is known as:, with the following options: A: Joffroy's sign, B: Von graffe's sign, C: Moebius sign, D: Dalrymple's sign - -### Response: -Various other eye signs seen in thyrotoxicosis are: -### End" -7335,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 83-year-old man complains that for the last few weeks he has had a bleeding lesion on his chest that seems to be growing rapidly. The lesion is shown below. What is the single most likely diagnosis?, with the following options: A: Basal cell carcinoma, B: Malignant melanoma, C: Seborrheic keratosis, D: Squamous cell carcinoma - -### Response: -This is a Squamous cell carcinoma. Sun-exposed skin in areas such as the head, neck, hands, and arms represent other typical sites of involvement. Bleeding, rapid growth and irregular surface differentiate from a seborrhoeic keratosis or wa. Basal cell carcinoma has a rolled edge, shows central ulceration and a pearly rolled telangiectatic tumor border. -### End" -7336,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug induced myopathy can be caused by all of the following except:, with the following options: A: atrovastaine, B: d-penicillamine, C: ciprofloxacin, D: chloroquine - -### Response: -Ans. is 'c' i.e., ciprofloxacin The long list given on page 436 is not enough, also see the list given on page 2523.Its advised to go through both these lists and try to learn as many drugs as possible because this topic has been asked in two consecutive AIIMS papers (Also see question no. 57 from May 2002)I have picked up some important drugs from both these tables. Let's hope they are sufficient for future questions on this topic * Drugs causing myopathyclofibrate*lovastatin* (all the statins cause myopathy including Atorvastatin)Gemfibrozil*Chloroquine*Cyclosporine*D penicillamine*DanazolCimetidineGoldAmphotericin-BZidovudineGlucocorticoids -### End" -7337,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The feature that differentiates a follicular carcinoma from a follicular adenoma of thyroid is -, with the following options: A: Nuclear pleomorphism, B: Huhle cell change, C: Capsular invasion, D: Absence of colloid - -### Response: -Ans. is 'c' i.e., Capsular invasion Differentiating feature of follicular adenoma from follicular carcinoma. o The hallmark of all follicular adenomas is the presence of on intact ,wall-formed capsule encircling the tumor. o Careful evaluation of the integrity of the capsule is therefore critical in distinguishing follicular adenomas from follicular carcinomas which demonstrate capsular and /or vascular invasion . o Huhle cells are seen both in follicular adenomas and follicular carcinoma (Note -Huhle cells are also seen in hashimoto thyroiditis) Differentiation of follicular adenoma from multinodular goiter Multinodular goiter lacks well formed capsule while follicular adenoma has well formed capsule. o Multinodular goiter produce less compression of the adjacent thyroid parenchyma ,while follicular adenoma comresses the adjacent thyroid. o In multinodular goiter the involved and uninvolved (normal ) thyroid have similar growth pattern , on the other hand growth pattern within the adenoma is distinct from the adjacent non- neoplastic thyroid. -### End" -7338,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Roth's spots are seen in -, with the following options: A: Infective Endocarditis, B: Rheumatic Endocarditis, C: Central Retinal Arterial Occlusion (CRAO), D: Typhoid - -### Response: -Ans. is 'a' i.e., Infective Endocarditis o Roth s spots (lesion) are oval retinal haemorrhages with a clear pale center that are typically seen in patients with subacute bacterial endocarditis. They are believed to be caused by immune complex deposition and are included as a minor criteria amongst Duke s criteria for clinical diagnosis of infective Endocarditis.Major clinical manifestation of infective endocarditis Intravascular lesionsImmunological ReactionsSvstemic Manifestations(occurs due to transmission of microemboli to various organs)(Bacterial infection cause immune complex formation)o Fevero Chillso Rigorso Night sweatso Anorexiao Fatigueo Weakness.o Petechiae (skin, eye, mucosa)o Roth spotso Osier's nodeso Janeway lesionso Splinter hemorrhageso Stroke, myocotic aneurysmo Glomerulonephritiso Arthritiso Finger clubbing -### End" -7339,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Methods to measure error of refraction are all except?, with the following options: A: Retinoscopy, B: Refractometry, C: Keratometry, D: Binocular balancing - -### Response: -Ans. is 'd' i.e., Binocular balancing Refraction The procedure of determining and correcting refractive errors is termed as refraction. The refraction comprises two complementary methods : ? Objective methods These are used to measure the error of refraction. These tests are :- Retinoscopy Keratometry Refractometry Subjective refraction Subjective refraction is meant for finding out the most suitable lenses to be prescribed. The proper subjective refraction includes three steps. Subjective verification of refraction Subjective refining of refraction Subjective binocular balancing -### End" -7340,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recurrent respiratory tract infections may occur in all of the following except –, with the following options: A: Ventricular septal defect, B: Tetrology of Fallot, C: Transposition of great arteries, D: Total anomalous venous return - -### Response: -Chest infections are frequent in the following two groups of congenital cardiac anomalies. -a) Left to right shunts → This group includes - -Atrial septal defect -Ventricular septal defect -Patent ductus arteriosus -This group of CHD's are characterized by frequent chest infections. -There is large flow of blood in the lungs which causes lung infections. -Each attack of cold seems to turn into Bronchopneumonia. -It is not uncommon for these patients to have 6-8 attacks of pneumonia in the first year of life. - -b) Cyanosis with increased pulmonary blood flow. - -A large no. of conditions result in a combination of cyanosis with increased pulmonary blood flow. -Common to these conditions is the presence of abnormal mixing of pulmonary venous blood with the systemic venous blood and absence of obstruction to pulmonary blood flow. -The anomalies included in this group are - - -Transposition of great vessels -Total anomalous pulmonary venous connection -Single ventricle without obstruction to pulmonary blood flow. -Persistent truncus arteriosus -Tricuspid atresia with absence of obstruction to pulmonary blood flow. -Double outlet right ventricle without pulmonary stenosis. - - -Clinically these patients are characterized by - - -Cyanosis -Cardiomegaly -Almost 80% of these patients are lost due to congestive cardiac failure or pulmonary infection. - -Congenital heart diseases which are not predisposed to pulmonary infection -1) Right to left shunts                                                  - -This group includes                                                        -Tetralogy of Fallot                                                      -Ebstein's anamoly             - - 2) Obstructive lesions          - -This group includes          -Aortic stenosis              -Coarctation of Aorta            -Pulmonary stenosis - -Characteristic of this group is                                          - -Presence of cyanosis            -The absence of chest infections           - -Clinical characteristic of this group - -The absence of frequent chest infections and cyanosis -The absence of a precordial bulge -Presence of forcible or heaving cardiac impulse. -### End" -7341,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Structure related to deltopectoral groove is, with the following options: A: Axillary aey, B: Cephalic vein, C: Basilic vein, D: Radial nerve - -### Response: -the deltopectoral groove - The cephalic vein, the deltoid branch of the thoraco-acromial aery, and one or two deltopectoral lymph nodes lie in the deltopectoral groove, under the deep fascia on the medial side of the septum. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 1 , pg. no., 43 -### End" -7342,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trypsin, Chymotrypsin & Elastases -What type of enzymes are they?, with the following options: A: Hydrolases, B: Lyases, C: Synthases, D: Synthetases - -### Response: -Ans. is 'a' i.e., HydrolasesAll digestive enzymes (trypsin, pepsin, elastase, chymotrypsin) are hydratases. -### End" -7343,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transitional cell carcinomas can be caused by ?, with the following options: A: Napthylamine, B: Smoking, C: Bilharziasis, D: All - -### Response: -Ans. is 'a' i.e., Napthylamine; 'b' i.e., Smoking & 'c' i.e., Bilharziasis -### End" -7344,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inclusions in oligodendrogliocytes is a feature of aEUR', with the following options: A: Creutzfeldt-Jakob disease, B: CIDP, C: HSV, D: Progressive multifocal leukoencephalopathy - -### Response: -Progressive multifocal leukoencephalopathy Progressive multifocal leucoencephalopathy :? . Progressive multifocal leucoencephalopathy is a progressive disorder cause by J.C. virusdeg. . The main cells affected in the disease are oligodendrocytesdeg. . Since oligodendrocytes are concerned with myelination, progressive multifocal leucoencephalopathy is characterized by multifocal areas of demyelinationQ of varying size distributed throughout the brain but sparing the spinal cord and optic nerves. Pathology . Besides demyelination there are characteristis cytological alterations in both astrocytes and oligodendrocytes : - AstrocytesQ . Enlarged and contain, hyperchromatic, deformed and bizarre nuclei and frequent mitotic figures. OligodendrocytesQ . These have enlarged densely staining nuclei that contains virus inclusions.formed by crystalline arrays. Symptoms of progressive multifocal leucoencephalopathy :? Visual defects (45%) --> Homonymous hemianopia, Conjugate gaze abnormalities Mental impairment (38%) Dementia, confusion, personality changes Weakness --> Hemi or monoparesis and ataxia Seizures (20%) ---> Speech defect aphasia, hemiparesis, ataxia Focal neurological signs . Progressive multifocal leucoencephalopathy is predominantly seen in patients with immunosuppressive disorders: ? . Most commonly associated conditions are: ? - AIDS (80%)Q - Hematological malignancies (13%) - Transplant recipients (5%) - Chronic inflammatory disease (2%) Prognosis of progressive multifocal leucoencephalopathy . In most cases death occurs in 3-6 months .from onset of neurological symptoms and even more rapidly in patients with AIDS unless aggressive interetrul treatment is undeaken. Diagnosis . MRI is used for the diagnosis of PML. . MRI is better than CT scan in the diagnosis of PML and is frequently used for the diagnosis of PML. . On MRI the lesion appears as multrfocal asymmetric coalescing white matter located periventricularly. . These lesions have increased signals on T2 and FLAIR images and decrease signal on T,-weighted images. . PML lesions are classically nonenhancingQ. . Other impoant diagnostic tool in PML is the PCR amplification of JCV DNA. . The PCR amplification of JCV DNA in association with typical MRI lesion in the appropriate clinical setting is diagnostic of PML. I am not sure of the answer, visual symptoms, aphasia dysahria are commonly seen in PML. -### End" -7345,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following usually differentiates hysterical symptoms from hypochondriacal symptoms -, with the following options: A: Symptoms do not normally reflect understandable physiological or pathological mechanism, B: Physical symptoms are prominent which are not explained by organic factors, C: Personality traits are significant, D: Symptoms run a chronic course - -### Response: -The preoccupation in hypochondriasis is based on a misinterpretation of physical symptom in the presence of normal body function. For example, an occasional change in heart rate will lead a person with hypochondriasis to fear of severe heart disease. -On the other hand, hysterical symptoms are not due to misinterpretation of physiological response. -### End" -7346,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 45-year-old woman is admitted to the outpatient clinic for shoulder pain. During physical examination she presents with weakened shoulder movements. Radiographic examination reveals quadrangular space syndrome, causing weakened shoulder movements. Which of the following nerves is most likely affected?, with the following options: A: Suprascapular, B: Subscapular, C: Axillary, D: Radial - -### Response: -The weakness in shoulder movement results from denervation of the teres minor and deltoid by the axillary nerve, which passes through the quadrangular space. Quadrangular space syndrome happens when there is hypertrophy of the muscles that border the quadrangular space or fibrosis of portions of the muscles that are in contact with the nerve. -### End" -7347,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: With a bihrate of 30 per thousand, in a subcentre of 5000 population, what would be the number of pregnant women -, with the following options: A: 150, B: 155, C: 160, D: 165 - -### Response: -Crude bih rate = Annual number of live bihs per 1000 mid year population Here, live bih =30 per 1000 So for 5000 population = 30/1000 x 5000 = 150 Pregnancy wastage =10% 150x 10/100 = 15 Total pregnant women = 150+15+165 -### End" -7348,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Woodruff's area is located at ?, with the following options: A: Antero-inferior pa of nasal septum, B: Posteroinferior pa of nasal septum, C: Superior pa of nasal septum, D: Posteroinferior pa of lateral nasal wall - -### Response: -Posteriorly on the lateral nasal wall is the area known as Woodruff's area. It is situated under the posterior end of inferior turbinate.Sphenopalatine aery anastomoses with posterior pharyngeal aery, in this area. -### End" -7349,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: EEG waves prominent in occipital lobe is, with the following options: A: Alpha, B: Beta, C: Gamma, D: Theta - -### Response: -Stages of Sleep Electrophysiological Criteria Stage Of Sleep 1)Voltage 2) Frequency 1)EOG 2)EMG Wakefulness (eyes closed) 1)Low-voltage2) mixed, Alpha (8-13 Hz) 1)Eye movements, blinks2)High tonic activity, voluntary movements Non Rapid Eye Movement sleep 75 %* Stage I 5 % 1)Low-voltage, 2) mixed, Theta (3-7 Hz)*, veex sharp waves 1)Slow eye movements2)Tonic activity slightly decreased stage II 45 % 1)Low-voltage2) mixed ,K-complexes* sleep spindles * (12-14 Hz bursts) 1) Low tonic activity 2)EOG None Stage III 12 % 1)High-amplitude (75 uV) 2) Slow(delta) waves * (< 2Hz) occupying 20% to 50 % of epoch Stage IV 13% 1)High-amplitude 2) Slow(delta) waves occupy >50% of epoch Rapid Eye Movements sleep 25%* 1)Low-voltage2) Mixed, Saw-tooth waves, theta activity, slow alpha activity 1)Tonic atonia* with phasic twitches 2)Rapid Eye Movements As we proceed from wakefulness to sleep, we see the EEG waves becoming slower (i.e decreasing in frequency), increasing in amplitude, heterogeneous (mixed activity) to homogenous waves. K complexes (negative sharp wave followed by a positive slow wave) EEG wave Frequency Recorded B A Te D Beta 13-30 Hz Parietally, frontally Activation of various areas of the brain Alpha 8-13 Hz Occipitally Wakefulness(eyes closed) Theta 4-8 Hz All areas Sleeping adults, children Delta 0.5-4Hz All areas Sleeping adults, infants Pneumonic BATeD waves in active brain - deep sleep Reference: P.752 24.1 Normal Sleep Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition) -### End" -7350,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Discarded cytotoxic medicines should he disposed in?, with the following options: A: Blue bag, B: Black bag, C: Red bag, D: Yellow bag - -### Response: -Ans. is 'b' i.e., Black bag -### End" -7351,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best treatment of cystic hygroma is?, with the following options: A: Radiotherapy, B: Sclerotherapy, C: Surgical excision, D: Chemotherapy - -### Response: -Ans. (c) Surgical excisionRef: Schwartz 9th ed ch-39 -### End" -7352,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient present with diarrhoea. Analysis of stool on wet mount shows mobile protozoa without RBCs and pus cells. The diagnosis is:, with the following options: A: Balantidium Coli, B: Giardiasis, C: Trichomonas hominis, D: Entamoeba histolytica - -### Response: -Ans. (b) Giardiasis a. Balantidium coli Live in large intestine causing balantidiasis (zoonosis). Occurs in 2 stages; trophozoite (binucleated) and cyst (= infective form). Clinical disease results only when trophozoites burrow into mucosa causing ulcer and submucosal abscesses resembling lesion of amoebiasis so it 'resembles amoebiasis' causing diarrhoea or frank dysentery, so stool may contains pus cells. Treatment: Tetracyline/metronidazole/nitroimidazole b. Giardia lamblia Intestinal flagellate, the only protozoan parasite found in the lumen of human small intestine (Duodenum and upper jejunum). Infection is acquired by ingestion of cysts in contaminated food and water. It does not invade tissue (so no RBC and pus cells in faeces) but remains attached to epithelial surface by sucking disc which may cause abnormalities of villous architecture and loss of brush border enzymic activities leading to self limited mucus diarrhoea; malabsorption like syndrome; weight loss; abdominal cramps. Occasionally cause biliary colic and jaundice. Piiinkci- p 36 Diagnosis: Detection of cysts (encystation occur in colon) as well as trophozoite (die outside so hot infectious) in stool sample or in duodenal aspiration by enterotest if biliary symptoms predominate. Detection of antigen by ELISA or immunochromatographic strip test. Giardiasis is a cause of traveller's diarrhoea. Treatment: DOC - Metronidazole/tinidazole Alternative - quinacrine hydrochloride and furazolidone. c. Trichomonas vaginalis Not cause diarrhoea. d. Entamoeba histolytica It cause amoebic dysentery so stool contain cellular exudate as well as RBC, charcot leyden crystals, amoeba, etc. -### End" -7353,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anticra% ing drug given in alcohol dependence:, with the following options: A: Buprenorphine, B: Acamprosate, C: Disulfiram, D: Diazepam - -### Response: -Ans. b. AcamprosateAnticraving drug given in alcohol dependence is Acamprosate.Treatment of Alcohol DependenceAversion therapy: ApomorphineQ, sub-threshold electric shockPsychotherapyGroup therapyDeterrent agents: (Alcohol sensitizing drugs)QDisulfiramQCitrated calcium carbimide (CCC)Metronidazole, NitrafezoleQMethyltetrazolethiolSulfonylureas (specially ChlorpropamideQ)Cephalosporins (cefoperazoneQ, moxalactamQ, cefamandoleQ)Anticraving agents: (FAN)FluoxetineQ AcamprosateQNaltrexoneQ -### End" -7354,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following drugs can be used in hypeensive crisis except:-, with the following options: A: Labetalol, B: Pindolol, C: Nitroprusside, D: Nifedipine - -### Response: -Pindolol is non-selective b blocker and not used in hypeensive emergencies. Labetalol is DOC for gestational hypeension as well as hypeensive emergencies in pregnancy. Nitroprusside is DOC for hypeensive emergencies in patients with aoic dissection. Nifedipine can be used rarely for the rapid control of blood pressure but the route of administration is sub-lingual. Nicardipine and Clevidipine are also DOC for hypeensive emergencies. DRUGS USED FOR HYPEENSIVE EMERGENCIES Group Drugs Vasodilators Sodium NitroprussideNitroglycerineHydralazine Calcium channel blockers NicardipineClevidipineNifedipine Alpha blockers PhentolamineTolazolineUrapidil Beta blockers LabetalolEsmolol ACE inhibitor Enalaprilat D1 agonist Fenoldopam Diuretic Furosemide -### End" -7355,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Osteoahritis not seen in ?, with the following options: A: Ankle joints, B: Knee joints, C: Hip joints, D: I stmetacarpophalangeal joint - -### Response: -Ans. is 'a' i.e., Ankle joints OA affects ceain joints, yet spares others. Commonly affected joints include the cervical and lumbosacral spine, hip, knee, and first metatarsal phalangeal joint (MTP). In the hands, the distal and proximal interphalangeal joints and the base of the thumb are often affected. Usually spared are the wrist, elbow, and ankle. Our joints were designed, in an evolutionary sense, for brachiating apes, animals that still walked on four limbs. We thus develop OA in joints that were ill designed for human tasks such as pincer grip (OA in the thumb base) and walking upright (OA in knees and hips). Some joints, like the ankles, may be spared because their aicular cailage may be uniquely resistant to loading stresses. -### End" -7356,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Homogentisate oxidase deficiency causes ?, with the following options: A: Phenylketonuria, B: Alkaptonuria, C: Methylmalonic aciduria, D: Albinism - -### Response: -Ans. is 'b' i.e., Alkaptonuria -### End" -7357,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child presents with lid lag and an enlarged cornea with a diameter of 13mm. Examination of the eye reveals double contoured opacities concentric to the limbus. Which of the following is the most likely diagnosis:, with the following options: A: Superficial keratitis, B: Deep keratitis, C: Thyroid Endocrinopathy, D: Congenital Glaucoma - -### Response: -D i.e. Congenital Glaucoma -### End" -7358,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest complication of mumps is -, with the following options: A: Orchitis and oophritis, B: Encephalitis, C: Pneumonia, D: Myocarditis - -### Response: -Epididymo orchitis is a complication seen in about a third of post pubeal male patients. REF:ANATHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:508 -### End" -7359,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The second heart sound is caused by, with the following options: A: Closure of the aortic and pulmonary valves., B: Vibrations in the ventricular wall during systole., C: Ventricular filling., D: Closure of the mitral and tricuspid valves. - -### Response: -The second is a shorter, high-pitched “dup” (second sound), caused by vibrations associated with closure of the aortic and pulmonary valves just after the end of ventricular systole. -### End" -7360,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nephrotoxic anaesthetic agent is :, with the following options: A: Halothane, B: Isoflurane, C: Methoxyflurane, D: Nitrous Oxide - -### Response: -Ans. is 'c' Methoxyflurane Methoxyflurane has the highest fluoride content so it is highly NephrotoxicThere is high output renal failure and high chances of Oxalate stone. -### End" -7361,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Samuel Hahnemann is referred to as Founding Father of:, with the following options: A: Ayurveda, B: Allopathy, C: Homeopathy, D: Yoga - -### Response: -Ans. (c) Homeopathy* Founding Father of Homeopathy: Samuel Hahnemann (Germany)ALSO REMEMBERHOMEOPATHY:* Principle of Fiomeopathy system of medicine:- First principle -'similia similibus curenter': In healthy persons, produces symptoms similar to those of the disease being treated (known as 'Human drug pathogenicity study').- Second principle: Single medicine at the time of treatment- Third principle: Minimum dose to be used* ISM and H (Indigenous Systems of Medicine and Homeopathy) have been now re-designated as 'AYUSH system' of medicine- Ayurveda- Yoga and Naturopathy- Unani- Siddha- Homeopathy -### End" -7362,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is deposited in band keratopathy, with the following options: A: CaSO4, B: CaPO4, C: MgSO4, D: MgPO4 - -### Response: -Answer- B. CaPO4Band keratopathy is characterized by the deposition ofcalcium and phosphorus salts (especially hydroxyapatite) in a bandlike pattern in the anterior layers of the cornea. The keratopathy is usually limited to the interpalpebral area. Symptoms include irritation, injection, and blurring of vision.Chronic eye diseases (most common cause) -### End" -7363,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Exposure to cotton dust in a textile factory causes, with the following options: A: Bagassosis, B: Byssinosis, C: Anthracosis, D: Silicosis - -### Response: -(B) Byssinosis # Byssinosis is an asthma-like disorder in textile workers caused by inhalation of cotton dust, pathogenesis is obscure> Chest tightness, cough, and dyspnea are characteristically worse on Mondays or the first day back at work, with symptoms subsiding later in the week, repeated exposure leads to chronic bronchitis. Also called as Monday Morning Asthma> Byssinosis is due to inhalation of cotton fibre dust over long period of time.> The symptoms are chronic cough and progressive dyspnoea, ending in chronic bronchitis and emphysema. -### End" -7364,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following drugs are known to cause anterior uveitis except, with the following options: A: Rifabutin, B: Cidofovir, C: Metipranolol, D: Gatifloxacin - -### Response: -1. Rifabutin is used mainly in the management and prophylaxis of mycobacterial infections. It may cause acute anterior uveitis. 2. Cidofovir is used in the management of cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS). AAU with few cells but marked fibrinous exudate may develop following repeated intravenous infusions. 3. Systemic administration of fluoroquinolone antibiotics, paicularly moxifloxacin, has been associated with acute extensive anterior segment pigment dispersal.Gatifloxacin does not cause anterior uveitis. 4. Bisphosphonates, TNF alpha inhibitors, Sulphonamides can also cause uveitis. 5. Metipranolol is an antiglaucoma drug not used now a days commonly.It is also well known to cause anterior uveitis. -### End" -7365,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Total body water differences between male and female is not seen at the age of, with the following options: A: Above 60 years, B: 40-60 years, C: 10-18 years, D: 18-25 years - -### Response: -By weight, the average human adult male is approximately60% water and the average adult female is approximately 55%. ... Most of animal body water is contained in various body fluids. These include intracellular fluid; extracellular fluid; plasma; interstitial fluid; and transcellular fluid 45,46,47 -### End" -7366,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: TRUE statement regarding use of adrenaline in anaphylactic shock is:, with the following options: A: The usual dose is 0.5-1 mg by IM route, B: Cerebral hemorrhage never occurs as an adverse effect to epinephrine when used in treatment of anaphylactic shock, C: It is repeated after every 2-4 hours, D: Same solution can be given for SC as well as IV route - -### Response: -Ans. (A) The usual dose is 0.5-1 mg by IM route(Ref: KDT 8th/e p150)Adrenaline 0.5 ml of 1 :1000 solution (i.e., 0.5 mg) by i.m. route is drug of choice for anaphylactic shock. It can also be used by s.c. routeIf not responding, it can be repeated after 5 minutes (not 2-4 hours). In desperate circumstances i.v. route can be used but it must be diluted 10 times (i.e., 1 : 10000 concentration is used), therefore same solution cannot be utilized, However, in rare circumstances, i.v. adrenaline can result in cerebral hemorrhage due to uncontrolled rise in blood pressure. -### End" -7367,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mutation in the oxidative enzymes (peroxisomes) could lead to:, with the following options: A: Zellweger's syndrome, B: Gaucher's disease, C: Epidermolysis bullosa, D: Leber's neuropathy - -### Response: -Most cases of zellweger syndrome are due to mutations in genes involved in the biogenesis of  peroxisomes. -This condition is apparent at birth and is characterized by profound neurologic impairment, victims  often dying within a year. -The number of peroxisomes can vary from being almost normal to being virtually absent in some  patients. - -Key Concept: -Mutation in peroxisomes can lead to Zellweger’s syndrome. -Ref : Harper’s illustrated biochemistry, 31st edition. -### End" -7368,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are involved in cardiac conduction pathway except:, with the following options: A: SA node, B: Purkinje fibers, C: Bundle of His, D: Sarcomere - -### Response: -Ans: D (Sarcomere) Ref: Ganong's Review of Medical Physiology. 21st ed.Explanation:Cardiac Conduction PathwaySA nodeAV nodeBundle of HisLeft and right bundle branchPurkinje fibres -### End" -7369,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secondary allograft rejection is mediated by?, with the following options: A: Memory cells, B: Antibodies, C: Immune complexes, D: None of the above - -### Response: -Secondary rejection (accelerated rejection) - -After hyperacute rejection, transplantation of a second graft, which shares a significant number of antigenic determinants with the first one, results in a rapid (2-5 days) rejection. It is due to the presence of T lymphocytes sensitized during the first graft rejection memory cells). Accelerated rejection is mediated by immediate production of lymphokines, activation of monocytes and macrophages, and induction of cytotoxic lymphocytes. -### End" -7370,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are TNF-alpha antagonists used in rheumatoid arthritis except:, with the following options: A: Ifosfamide, B: Infliximab, C: Etanercept, D: Adalimumab - -### Response: -SOME IMPORTANTLY USED TNF - ALPHA INHIBITORS ARE AS FOLLOWS: - -Etanercept : Chimeric protein and neutralizes both TNF alpha and TNF beta can be used along with methotrexate in rheumatoid arthritis also used in ankylosing spondylosis, juvenile arthritis and plaque psoriasis. -Infliximab : Monoclonal antibody against TNF alpha.used in refractory rheumatoid arthritis, fistulating Crohn's disease, ulcerative colitis and psoriasis. -Adalimumab : Fully human recombinant antibody anti TNF alpha. It is less antigenic.use same as infliximab. -### End" -7371,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following are features of complete hea block EXCEPT-, with the following options: A: Bradycardia, B: Cannon waves, C: Varying intensity of 1st hea sound, D: Hea rate increase during exercise - -### Response: -Third-degree atrioventricular block (AV block), is a medical condition in which the nerve impulse generated in the sinoatrial node (SA node) in the atrium of the hea can not propagate to the ventricles Because the impulse is blocked, an accessory pacemaker in the lower chambers will typically activate the ventricles. This is known as an escape rhythm. Since this accessory pacemaker also activates independently of the impulse generated at the SA node, two independent rhythms can be noted on the electrocardiogram (ECG). The P waves with a regular P-to-P interval (in other words, a sinus rhythm) represent the first rhythm. The QRS complexes with a regular R-to-R interval represent the second rhythm. The PR interval will be variable, as the hallmark of complete hea block is lack of any apparent relationship between P waves and QRS complexes . Ref Harrison 20th edition pg 1532 -### End" -7372,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hormone for breast milk feeding is:, with the following options: A: Oxytocin, B: Prolactin, C: Galactogen, D: GH - -### Response: -Oxytocin -### End" -7373,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site for putting chest drain in case of pleural effusion -, with the following options: A: 2nd intercostal space midclavicualar line, B: 7th intercostal space midaxillary line, C: 5th I.C. space mid clavicular line., D: 5 - -### Response: -Site for putting chest drain in pleural effusion → 7th ICS mid axillary line -Site for putting needle in spontaneous pneumothorax → 2nd ICS, mid clavicular line. -### End" -7374,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: When is surgery not done in cases of Ulcerative Colitis?, with the following options: A: Toxic megacolon, B: Colonic perforation, C: Colonic obstruction, D: Refractory fistula - -### Response: -Surgical indications for ulcerative colitis: Urgent Non-urgent: Fulminant colitis Toxic megacolon Perforation Massive hemorrhage Acute colonic obstruction Colon cancer Medically refractory disease Unacceptable medication related toxicity Dysplasia Suspected ca Ulcerative colitis Crohn's disease MC pa involved is Rectum(colon) MC is terminal ileum (mouth to anus) Hallmark is pseudo polyp Fistula More prone for malignancy Less prone that ulcerative colitis Mucosa and submucosa involved Transmural involvement Complications: Hemorrhage Toxic megacolon Fistula Abscess Obstruction Perforation Lead pipe colon String of Kantor Surgery can be done DOC is sulphasalazine Surgery is of no use DOC is sulphasalazine -### End" -7375,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ovulation is primarily caused by preovulatory surge of:, with the following options: A: Estradiol, B: Luteinizing hormone, C: Progesterone, D: Follicle stimulating hormone - -### Response: -B i.e. LH A surge in LH secretion triggers ovulation and ovulation normally occurs about 9 hours after the peak of the LH surge at midcycle'Q -### End" -7376,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about boundaries of lesser Sac:, with the following options: A: Posteriorly stomach, B: Crus of diaphragm anterior, C: Spleen anteriorly, D: Greater omentum - -### Response: -D. i.e. Greater omentum -### End" -7377,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: h/o consumption of rice milk, child preseting with protruded abdomen low albumin but no proteinuria what is the probable diagnosis ?, with the following options: A: kwashiorkar, B: marasmus, C: nephrotic syndrome, D: liver failure - -### Response: -Kwashiorkor Clinical Manifestations Diagnostic Signs : Edema , Muscle wasting Psychomotor changes Common Signs : Hair changes , Diffuse depigmentation of skin , Moonface , Anemia Occasional Signs: Flaky-paint , rash , Noma , Hepatomegaly Laboratory: 1. Decreased serum albumin 2. EEG abnomalities 3. Iron & folic acid deficiencies 4. Liver biopsy fatty or fibrosis may occur ref : op ghai 9th ed -### End" -7378,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: the above marked structures are seen in all except ?, with the following options: A: thalasemia, B: sickle cell anemia, C: liver cirrhosis, D: CML - -### Response: -GAMMA GANDY BODIES WERE SEEN IN SICKLE CELL ANEMIA ,CML AND CIRRHOSIS .THEY ARE DEPOSITS IN CONGESTIVE SPLEENOMEGALY WHICH CONTAINS : IRON +CALCIUM + FIBROUS TISSUE OF SPLEEN Sickle Cell Anemia 1) Single nucleotide substitution (""point mutation"") in the gene for the beta chain of hemoglobin. 2) Different amino acid gets placed in the peptide chain.. 3) Beta chain synthesized from the sickle-cell allele does not ""fold"" correctly and hempglobin molecules ""clump"" together forming a red blood cell that resembles a sickle. 4) Sickled cells die early (10-20 days vs. 120 days) producing anemia. 5) Sickled cells clog the fine capillaries, leading to lack of oxygen in target organs. * A blood test can check for hemoglobin S -- the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is pa of routine newborn screening done at the hospital. But older children and adults can be tested, too. * In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, fuher tests will be done to determine whether one or two sickle cell genes are present. Check for a low red blood cell count (anemia) will be done. REF: ROBBINS 10TH ED -### End" -7379,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 75-year-old patient clutches his chest and falls down. A physician arrives on the scene and finds the patient unresponsive with no breathing effos. What is the first thing to be done by the physician?, with the following options: A: Call for help, B: Clear patient airway, C: Check peripheral pulse, D: Chest Compressions - -### Response: -Evaluation and Initiation of CPR -Check for response -Call for help or ask someone to call local emergency number -If aspiration or airway obstruction is suspected then Hemlich maneuver should be performed to dislodge obstructing body. -Check for pulse(no longer than 10 sec) -Assess breathing -Chest compressions should be initiated without delay. Note : Cpr protocol C-A-B -### End" -7380,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antrum of Highmore is another name for:, with the following options: A: Maxillary, B: Ethmoid, C: Sphenoid, D: Frontal - -### Response: -Maxillary sinus is also called as antrum of highmore and is the first to develop in human fetus.It is the largest paranasal sinus (15 ml capacity in adults). -### End" -7381,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hepatotoxic drugs are, with the following options: A: Chloroform, B: Halothane, C: Both are above, D: None - -### Response: -Refer KDT 6/e p372 Massive liver necrosis following Halothane anaesthesia is seen in some cases If chloroform cos given for long period liver damage occurs -### End" -7382,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A newborn baby presented with profuse bleeding from umbilical stump after birth. Probable diagnosis is, with the following options: A: Factor XIII deficiency, B: VWF deficiency, C: Factor XII deficiency, D: Glanzmann thrombosthenia - -### Response: -Ans. is 'a' i.e. Factor XIII deficiency Bleeding from umbilical stump suggests Factor XIII deficiency.Neonates with a positive bleeding history, particularly with features such as delayed bleeding, umbilical stump bleeding or miscarriages and in whom the initial panel of screening test is negative should be tested for factor XIII deficiency.The normal screening tests such as PT and PTT are normal in factor XIII deficiency because factor XIII is needed to stabilize the clot after a fibrin clot has formed, so tests used for evaluating the extrinsic or intrinsic pathways are not affected. (Note, that factor XIII is used, once the clot has formed.)Test used for evaluation of factor XIIITest used in qualitative evaluation of factor XIII is evaluation of clot stability in 5M urea.Clots formed from normal individuals remain stable in 5M urea, while clots from factor XIII deficient patient dissolve in urea.This assay detects only the most severely affected patients with 1% to 2% factor XIII deficiency or tests.A quantitative chromogenic assay has been developed but is not yet readily available.In addition to hemorrhages these patients may have poor wound healing a high incidence of infertility among males and abortion among affected females and a high incidence of intracerebral hemorrhage.About other options:Von Willebrand diseasePatients with Von-Willebrand disease rarely presents in the neonatal period because plasma concentration of Von Willebrand factor is high in neonatal period.Platelet function disordersGenetic disorders that result in deficient platelet function are rare causes of bleeding in infants.Most patients with these platelet disorders do not present in neonatal period but rather later in life. They are not recognized as a problem during the neonatal period.Glanzman's thromboastheniaThis is an extremely rare disorder of the blood in which the platelets lack the glycoprotein IIb/HIa.Hence platelet aggregation cannot occur and bleeding time is significantly prolonged and there is increased bleeding.Bernard Soulier syndromeIt is an autosomal recessive disorder characterized by thrombocytopenia and large platelets (giant platelets)There is absence of the platelet membrane GpIb/IX complex.Symptoms are consistent with low or dysfunctional platelets and include easy bruising, nosebleeds, mucosal bleeding, menorrhagia and occasionally G.I. bleedingFactor XII deficiency * It is not associated with clinical bleeding. -### End" -7383,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Prostaglandin analogues are used in -, with the following options: A: Induction of labor, B: Induction of abortion, C: Management of PPH, D: All of the above - -### Response: -Ans. is 'd' i.e., All of the above o Prostaglandins are autocrine/paracrine hormones as they act locally at the site of productiono PGF2a acts predominantly on the myometrium, while PGE2 acts mainly on the cervix due to its collagenolytic activityo Use in Obstetrics :# Induction of abortion (MTP and missed abortion)# Termination of molar pregnancy# Induction of labor# Cervical ripening prior to induction of abortion or labour# Augmentation (acceleration) of labour# Management of atonic PPH# Medical management of tubal ectopic pregnancyo Contraindications:# Hypersensitivity to the compound# Uterine scar# Active cardiac, pulmonary, renal or hepatic disease# Bronchial asthma (PGF2a) -### End" -7384,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which muscle receives its nerve supply from a direct branch of the ansa cervicalis ?, with the following options: A: Mylohyoid, B: Geniohyoid, C: C Sternohyoid, D: Cricothyroid - -### Response: -The ansa cervicalis is formed by nerve fibers from the anterior rami C It gives rise to nerves that nnervate the infrahyoid strap muscles: sternohyoid, sternothyroid, and omohyoid. The geniohyoid muscle is innervated by cervical nerve fibers that are carried with the hypoglossal nerve. The mylohyoid is innervated by a branch of the mandibular division of the trigeminal nerve. The cricothyroid and cricoarytenoid muscles are intrinsic muscles of the larynx and are innervated by branches of the vagus nerve. -### End" -7385,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bromocriptine is indicated in the following conditions except ?, with the following options: A: Prolactin -secreting adenomas, B: Prolactin deficiency, C: Amenorrhea - Galactorrhea, D: Acromegaly - -### Response: -Ans. is 'b' i.e., Prolactin deficiency Bromocriptine is used in :- Suppression of lactation in galactorrhea Cyclical mastalgia Induction of ovulation in anovulatory infeility caused by hyperprolactinemia Parkinsonism Acromegaly due to small pitutary tumours Hepatic coma Recently, it has been approved for treatment of type 2 DM. -### End" -7386,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Maximum first pass metaboilsm is seen by which route ?, with the following options: A: Intravenous, B: Interaaerial, C: Rectal, D: Oral - -### Response: -Ans. is 'd' i.e., Oral First pass metabolism is seen with oral and rectal routes. Maximum first pass metabolism is seen with oral route. In rectal route, drug absorbed into external hemorrhoidal veins bypasses liver, but not that absorbed into internal haemorrhoidal veins -First pass metabolism occurs, but less than oral route (avoids first pass metabolism to 50%). Most rapid onset of action is seen with I. route. Bioavailability by I. V route is 100%. -### End" -7387,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Interaction involved in primary structure of protein ?, with the following options: A: Hydrogen bond, B: Disulfide bond, C: Peptide bond, D: Electrostatic bond - -### Response: -Ans. is `c' i.e., Peptide bond -### End" -7388,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is not true about adipocere formation -, with the following options: A: It is a modification of putrefaction, B: It is developed in presence of air, C: It occurs in dead bodies lying in water, D: Body has an offensive sweet smell - -### Response: -Warm, moist and anaerobic environment is required for saponification. Dr. Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27 th edition pg. 86. -### End" -7389,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ground glass appearance of maxillary sinus is seen in?, with the following options: A: Maxillary Sinusitis, B: Maxillary Carcinoma, C: Maxillary polyp, D: Maxillary fibrous dysplasia - -### Response: -Ans. (d) Maxillary fibrous dysplasiaRef: Ballenger's Otorhinolaryngology: Head & Neck Surge: by James Byron Snow, Phillip A. Wackym, John Jacob Ballenge centennial ed p-506 -### End" -7390,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presented with Tongue deviation on right side with ipsilateral atrophy. Which cranial nerve is damaged?, with the following options: A: Ipsilateral XII, B: Contralateral XII, C: Ipsilateral X, D: Ipsilateral XI - -### Response: -(A) Ipsilateral XII # CN XII Hypoglossal Nerve:> Origin: Medulla> Innervation: Muscles of the tongue except Palatoglossus> Function: Movement of the tongue> Dysfunction: Unilateral lesions can cause paresis, atrophy, furrowing, fibrillation and fasciculation on the affected half.> On protrusion tongue deviates towards the affected side due to unopposed action of the Contralateral Genioglossus> Flaccid Paralysis: Dysphagia Dysarthria Dyspnea Difficulty chewing food# XII Cranial nerve controls all tongue movements.> Nuclear or intranuclear lesions produce paralysis, atrophy, and fasciculations of the tongue on involved side.> Supranuclear lesions produce mild to moderate contralateral weakness that may be transient.> Bilateral supranuclear lesions, seen in pseudobulbar palsy, produce moderate to severe inability of the tongue to function> The transient nature is usually the clue> Nuclear lesions produce atrophy, weakness, or paralysis and fasciculations. Amyotrophic lateral sclerosis and polio are two causes.> Syringobulbia, infarction, and intraspinal tumors are other etiologies.> Nuclear lesions are often bilateral because of the closeness of the two nuclei in the medulla.> Hypoglossal nerve involvement after the individual fibers exit from the medulla is seen with many of the lesions that affect the spinal accessory nerve.> Tumors can compress the nerve in the hypoglossal canal and in the jugular foramen.> Basilar meningitis, due to granulomatous infection or carcinoma, can produce hypoglossal lesions.> Unilateral twelfth nerve palsy has been reported as one of the more common cranial mononeuropathies due to metastases -### End" -7391,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Brain size achieves 90 % of adult size by the age of:, with the following options: A: 2 years, B: 4 years, C: 6 years, D: Puberty - -### Response: -Ans: aRef: Still searching -### End" -7392,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50 year old lady presented with history of pain upper abdomen, nausea, and decreased appetite for 5 days. She had undergone cholecystectomy 2 years back- Her bilirubin was 10 mg/dl, SGOT 900 lU/L SGPT 700 lU/L and scrum alkaline phosphatase was 280 lU/L. What is the most likely diagnosis, with the following options: A: Acute pancreatitis, B: Acute cholangitis, C: Acute viral hepatitis, D: Posterior penetration of peptic ulcer - -### Response: -Viral hepatitis This must be considered in anyone presenting with hepatitic liver blood tests (high transaminases). All these viruses cause illnesses that have similar clinical and pathological features and are frequently anicteric or even asymptomatic. They differ in their tendency to cause acute and chronic infections. Therapeutic developments for viral hepatitis, in paicular hepatitis C, are evolving veryrapidly, with several new classes of drugs entering clinicalpractice Clinical features of acute infection A non-specific prodromal illness characterised by headache, myalgia, ahralgia, nausea and anorexia usually precedes the development of jaundice by a few days to 2 weeks. Vomiting and diarrhoea may follow and abdominal discomfo is common. Dark urine and pale stools may precede jaundice. There are usually few physical signs. The liver is often tender but only minimally enlarged. Occasionally, mild splenomegaly and cervical lymphadenopathy are seen. These features are more frequent in children or those with Epstein-Barr virus (EBV) infection. Symptoms rarely last longer than 3-6 weeks. Complications may occur but are rare . Investigations A hepatitic pattern of LFTs develops, with serum transaminases typically between 200 and 2000 U/L in an acute infection (usually lower and fluctuating in chronic infections). The plasma bilirubin reflects the degree of liver damage. The ALP rarely exceeds twice the upper limit of normal. Prolongation of the PT indicates the severity of the hepatitis but rarely exceeds 25 seconds, except in rare cases of acute liver failure. The white cell count is usually normal with a relative lymphocytosis. Serological tests confirm the aetiology of the infection. Management Most individuals do not need hospital care. Drugs such as sedatives and narcotics, which are metabolised in the liver, should be avoided. No specific dietary modifications are required. Alcohol should not be taken during the acute illness. Elective surgery should be avoided in cases of acute viral hepatitis, as there is a risk of post-operative liver failure. Liver transplantation is very rarely indicated for acute viral hepatitis complicated by liver failure, but is commonly performed for complications of cirrhosis resulting from chronic hepatitis B and C infection. Ref Davidson edition23rd pg 872 -### End" -7393,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 65-year-old woman is found to have a 1-cm mass in the upper outer quadrant of the left breast. The most likely cause is, with the following options: A: Fibrocystic disease., B: Acute mastitis., C: Fibroadenoma., D: Carcinoma. - -### Response: -The location of the mass in the upper outer quadrant and the patient's age of 65 years suggest that the breast lesion is a carcinoma. A breast mass in a postmenopausal patient is most often a carcinoma. -### End" -7394,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Urease positive organism -, with the following options: A: Proteus, B: Streptococcus, C: Vibrio cholera, D: Pseudomonas - -### Response: -Ans. is 'a' i.e., ProteusUrease positive bacteria* Proteus* Staph aureus* Morganella* Klebseilla* Nocardia* H. Pylori* Y. pseudotuberculosis* Y. enterocolitica* Cryptococcus (fungus)* Diphtheroids* Mycobacteria except MAC -### End" -7395,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MAEL'S sign is seen in NOT RELATED-MEDICINE, with the following options: A: Gout, B: SLE, C: Takayasu, D: Kawasaki disease - -### Response: -. -### End" -7396,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cyclosporine nephrotoxicity aggravated by-, with the following options: A: Amphototerian, B: Itraconazole, C: INH, D: Lovastatin - -### Response: -Ans. is 'a' i.e., Amphotericin B o All nephrotoxic drugs like aminoglycosides, Vancomycin, amphotericin B and NSAIDs enhance toxicity of cyclosporine. -### End" -7397,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IQ level of intelligence 90-109 is: March 2013 (c, g), with the following options: A: Borderline, B: Normal, C: Low normal, D: Superior - -### Response: -Ans. B i.e. Normal -### End" -7398,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is angiotensin receptor antagonist, with the following options: A: Losaan, B: Enalapril, C: Captopril, D: Ramipril - -### Response: -Refer kDT 6/e p 488 Examples of angiotensin II receptor blockers include: Azilsaan (Edarbi) Candesaan (Atacand) Eprosaan. Irbesaan (Avapro) Losaan (Cozaar) Olmesaan (Benicar) Telmisaan (Micardis) Valsaan (Diovan -### End" -7399,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which vitamin is necessary for coA synthesis, with the following options: A: Pantothenic acid, B: Ascorbic acid, C: Biotin, D: Pyridoxine - -### Response: -Synthesis of coenzyme A from pantothenate occurs in a series of  reactions. Pantothenate is  first phosphorylated to  which  cysteine is  added. Decarboxylation, followed by addition of AMP moiety and a phosphate (each from ATP) results in  coenzyme A.  -Ref : Satyanarayana, 3rd ed, pg- 148 -### End" -7400,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In adult polycystic kidney, all are true except -, with the following options: A: Hypertension is rare, B: Hematuria is a common symptom, C: Cysts are seen in liver spleen and pancreas, D: Autosomal dominant transmission is seen. - -### Response: -Hypertension is present in up to 75% of patients over the age of 20 years with polycystic disease. -### End" -7401,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common species of Pseudomonas causing intravascular catheter-related infections is, with the following options: A: P. Cepacia, B: P. Aeruginosa, C: P. Maltiphila, D: P. Mallei - -### Response: -In hospitals, P. Aeruginosa can cause localized or generalized infections. Localized lesions are common in wound and bedsores The pre-eminent role of P. aeruginosa in hospital infection is due to its resistance to common antibiotics and antiseptics, and its ability to establish itself widely in the hospital. Being extremely adaptable organisms, it can survive and multiply even with minimum nutrients, if moisture is available. Equipment such as respiratory and endoscopes, Catheters etc can lead to infections. Ref: Ananthanarayan& Paniker&;s textbook of microbiology, 9th edition. Pg no.315 -### End" -7402,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What are the Cardinal ligaments of uterus ?, with the following options: A: transverse cervical ligament, B: round ligament of ovary, C: pubo cervical ligament, D: round ligament of uterus - -### Response: -Transverse Cervical Ligaments of Mackenrodt - These are also known by various other names like lateral cervical ligaments; cardinal ligaments; paracervical ligaments; retinacula uterine sustentaculum of bonny. These are fan-shaped condensations of the pelvic fascia on each side of the cervix above the levator ani and around the uterine vessels. They connect the lateral aspects of the cervix and of the upper vaginal wall to the lateral pelvic wall, about 2.5 cm ventraJ to the ischial spine. They form a 'hammock' that suppos the uterus. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 2 , pg. no., 425. -### End" -7403,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nasolacrimal duct opens into: (Repeat), with the following options: A: Inferior meatus, B: Superior meatus, C: Middle meatus, D: Sphenoethmoidal recess - -### Response: -Ans: A (Inferior meatus) Ref: Gray's Anatomy, 40th edition. pg. 550Explanation:Lateral wall of the nose has 3 concha 3 meatusThe inferior concha is an independent bone.The space under cover of the inferior concha is known as the inferior meatus- largest meatusDuring postnatal development, the ostium of the nasolacrimal duct moves upwards and is increasingly hidden under the over-arching inferior concha.The middle and superior concha are parts of ethmoidal labyrinthThe space undercover the middle concha and superior concha is called middle meatus and superior meatus respectivelyThe area intervening between the superior concha and nasal roof is called as supreme meatus ContentsSupreme meatusOpening of spenoidal sinusSuperior meatusPosterior ethmoidal sinusMiddle meatusBulla ethmoidalis Hiatus semilunaris Openings of maxillary and ethmoidal sinusInferior meatusNaso lacrimal duct -### End" -7404,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the following is false regarding SPARE RECEPTOR ?, with the following options: A: they are needed for binding drug to achieve the maximum effect, B: they respond to agonists only, C: they do not alter maximal efficacy, D: can be detected by finding that EC 50 < Kd for the agonist - -### Response: -SPARE RECEPTORS they are NOT needed for binding drug to achieve the maximum effect they respond to agonists only they do not alter maximal efficacy can be detected by finding that EC 50 < Kd for the agonist REF : KD TRIPATHI 8TH ED -### End" -7405,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vascular invasion is a prominent feature of, with the following options: A: Cryptococcus, B: Mucor, C: Candida, D: Rhinosporidium - -### Response: -Vascular invasion is a feature of Mucormycosis causing thrombosis, infarction. -### End" -7406,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not an example of epigenetic change?, with the following options: A: Histone acetylation, B: Poly A tailing, C: Si RNA interference, D: Splicing DNA methylation - -### Response: -Epigenetic Modifications - This is a mechanism that results in stable propagation of gene activity states from one generation of cells to the next. The epigenetic modifications include changes in histones and DNA methylation. Epigenetic states can be modified by environmental factors which may result in the expression of abnormal phenotypes. These epigenetic modifications control gene expression and changes are also inherited. The epigenome is represented by methyl groups attached to DNA base cytosine and ceain covalent modifications in histones. Ref: DM VASUDEVAN'S TEXTBOOK OF BIOCHEMISTRY,SIXTH EDITION, PG.NO.,511. -### End" -7407,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During time that the core of the mandible rotates forward an average of 15 degrees, the mandibular plane angle, representing the orientation of the jaw to an outside observer?, with the following options: A: Decrease only by 2-4 degrees on the average, B: Increase only 2-4 degrees on the average, C: Increase only to 6-8 degrees on the average, D: Decrease only to 5-8 degrees on the average - -### Response: -During the time that the core of the mandible rotates forward an average of 15 degrees, the mandibular plane angle, representing the orientation of the jaw to an outside observer, decreases only 2 to 4 degrees on the average. The reason that the internal rotation is not expressed in jaw orientation, of course, is that surface changes (external rotation) tend to compensate. This means that the posterior part of the lower border of the mandible must be an area of resorption, while the anterior aspect of the lower border is unchanged or undergoes slight apposition. Studies of surface changes reveal exactly this as the usual pattern of apposition and resorption. On the average, then, there is about 15 degrees of internal, forward rotation and 11 to 12 degrees of external, backward rotation producing the 3 to 4 degree decrease in mandibular plane angle observed in the average individual during childhood and adolescence. -Ref: Contemporary orthodontics Proffit , 4th ed pg 116 -### End" -7408,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: cove sensitization is used for, with the following options: A: PTSD, B: hysteria, C: brain injury, D: alcohol use - -### Response: -In cove sensitization also called as imagined punishment, the individual who wants to quit alcohol will be asked to think about adverse consequences of taking alcohol like getting arrested for drunken driving or facing a accident underintoxicated state. He would be told to dream as if if he is drunk and lies intoxicated in the road and has to be brought back to the home by family members where he will be given lot of advice from neighbours and there would be a loss of respect. While these imagined exposure the patient feels bad and makes sure thet he should quit alcohol and his thoughts ahgainst alcohol increases. Ref.kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 845 -### End" -7409,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anorectal anomalies are commonly associated with, with the following options: A: Cardiac anomalies, B: Duodenal atresia, C: CNS malformations, D: Abdominal wall defects - -### Response: -Anorectal anomalies are commonly associated with Cardiac anomalies .Early in embryonic life there is a common chamber - the cloaca - into which the hind gut and the allantois open. This endodermlined chamber is separated from the surface ectoderm of the embryo by the cloacal membrane. The cloaca becomes divided into two pas, dorsal (rectum) and ventral (urogenital sinus), by the downgrowth of a septum. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1244 -### End" -7410,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is the most common childhood CNS tumor to metastasize outside brain?, with the following options: A: Ependymoma, B: Glioblastoma multiforme, C: Choroid plexus tumor, D: Medulloblastoma - -### Response: -Glioblastoma, also known as glioblastoma multiforme (GBM), is the most aggressive cancer that begins within the brain. Initially, signs and symptoms of glioblastoma are nonspecific. Uncommon risk factors include genetic disorders, such as neurofibromatosis and Li-Fraumeni syndrome, and previous radiation therapy. Glioblastomas represent 15% of brain tumors. They can either sta from normal brain cells or develop from an existing low-grade astrocytoma. The diagnosis typically is made by a combination of CT scan, MRI scan, and tissue biopsy. No clear way to prevent the disease is known. Typically, treatment involves surgery, after which chemotherapy and radiation therapy are used. The medication temozolomide is used frequently as pa of chemotherapy. High-dose steroids may be used to help reduce swelling and decrease symptoms. Whether trying to remove all or simply most of the cancer is better is unknown. Despite maximum treatment, the cancer usually recurs. The tumor may extend into the meninges or ventricular wall, leading to high protein content in the cerebrospinal fluid (CSF) (> 100 mg/dl), as well as an occasional pleocytosis of 10 to 100 cells, mostly lymphocytes. Malignant cells carried in the CSF may spread (rarely) to the spinal cord or cause meningeal gliomatosis. However, metastasis of GBM beyond the central nervous system is extremely unusual. About 50% of GBMs occupy more than one lobe of a hemisphere or are bilateral. Tumors of this type usually arise from the cerebrum and may exhibit the classic infiltration across the corpus callosum, producing a butterfly (bilateral) glioma. The tumor may take on a variety of appearances, depending on the amount of hemorrhage, necrosis, or its age. A CT scan usually shows an inhomogeneous mass with a hypodense center and a variable ring of enhancement surrounded by edema. Mass effect from the tumor and edema may compress the ventricles and cause hydrocephalus. Ref Harrison20th edition pg 2234 Ref Davidson edition23rd pg 1123 -### End" -7411,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In leprosy nerves commonly involved?, with the following options: A: High ulnar, low median, B: High median, low ulnar, C: Triple nerve palsy, D: High radial, low median - -### Response: -Involvement is high ulnar (at or above elbow) and low median (at wrist). The sensory component is commonly the first and most severely affected, but occasionally there is a pure motor lesion. Autonomic dysfunction is always present in severe nerve damage. MC cranial nerve involved: Facial MC peripheral nerve involved: Ulnar>Posterior Tibial -### End" -7412,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heberden done denotes involvement of, with the following options: A: Distal inetrphalangeal joint, B: Proximal interphalangel joint, C: Metacarpophalangeal joint, D: Metatarsophalangeal joint - -### Response: -In osteoahritis of hand:Distal interphalangeal joint: Heberden's nodeProximal interphalangeal joint: Bouchard's node(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 88, 101, 127) -### End" -7413,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drugs within the following groups react unourably with lithium, with the following options: A: ACE inhibitors, B: Morphine, C: Valproate, D: Antipsychotics - -### Response: -Causes worsening of lithium toxicity and renal damage -### End" -7414,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Impoant adverse effect of nesiritide is, with the following options: A: Dysgusua, B: Hypotension, C: Cough, D: Angioedema - -### Response: -The recommended dose of Natrecor is an IV bolus of 2 mcg/kg followed by a continuous infusion of 0.01 mcg/kg/min....Common side effects may include: headache, mild dizziness; nausea, vomiting; back pain; numbness or tingly feeling; tremors; or. vision changes Refer Goodman and Gilman 11e p696 -### End" -7415,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Stellate ganglion block is useful in:, with the following options: A: Sudeck osteodystrophy, B: Compound palmar ganglion, C: Tenosynovitis, D: Osteoahritis of first CMC joint - -### Response: -A i.e. Sudeck osteodystrophy -### End" -7416,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about delirium is?, with the following options: A: Normal sleep, B: Disorientation, C: Attention is intact, D: Loss of memory - -### Response: -Ans. is 'b' i.e., Disorientation Clinical features of delirium1. Altered consciousness (clouding of consciousness to coma)2. Cognitive impairment:- Impaired attention, poor concentration, disorientation or confusion, altered sensorium, and memory disturbances (Impairment of immediate and recent memory).3. Perceptual anomalies :- Illusion, Hallucinations.4. Emotional disturbances :- fear & anxiety.5. Language disturbances and psychomotor disturbances (hypoactivity or hyperactivity).6. Disturbance of sleep-wake cycle.7. Autonomic disturbances :- Tachycardia, sweating, tremors.8. Neurological disturbances Tremor, seizure, choreiform movements.9. Memory:- There is disturbance of immediate and recent memory which are responsible for registration, retention and recall of new memories. On recovery there is amnesia for the period of delirium, but remote memory is intact. That means there is no memory loss and patient remembers everything before the episode of delirium, there is amnesia only for the period of delirium. -### End" -7417,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Young man whose voice has not broken is called:, with the following options: A: Puberphonia, B: Androphonia, C: Plica ventricularis, D: Functional aphonia - -### Response: -In males at the time of pubey, the voice normally drops by an octave and becomes low pitch. It occurs because vocal cords lengthen Failure of this change leads to persistence of childhood high pitched voice and is called as puberphonia It is seen in boys who are emotionally insecure and show excessive attachment to their mothers. Their physical and sexual development is normal Treatment Training the body to produce low pitched voice. Gutzmann pressure test: In this test, thyroid prominence is pressed backward and downward producing low tone voice. If this test is positive it indicates puberphonia. -### End" -7418,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Phenol coefficient indicates, with the following options: A: Efficacy of a disinfectant, B: Dilution of a disinfectant, C: Quantity of a disinfectant, D: Purity of a disinfectant - -### Response: -On exposure to air, the colorless crystals of phenol become pinkish and on longer exposure, the color deepens to dark blue. Pure phenol is not an effective disinfectant. It is used as an effective disinfectant. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 140 -### End" -7419,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a feature of Hepatorenal syndrome ?, with the following options: A: Low GFR with serum creatinine level >1.5 mg/dL, B: Plasma osmolality > Urine osmolality, C: Urine sodium level <10 mEq/L, D: Urine red blood cell count <50/HPF - -### Response: -Hepatorenal syndrome- pre-renal variety of AKI and blood supply to the glomerulus is compromised. Major criteria (All major criteria are required) Additional criteria (Not necessary for the diagnosis but provide suppoive evidence) Low GFR- serum creatinine level >1.5 mg/dL or 24-hour creatinine clearance <40 mL/min Absence of shock, ongoing bacterial infection and fluid losses, and current treatment with nephrotoxic medications No sustained improvement in renal function after diuretic withdrawal & expansion of plasma volume with 1.5 L of plasma expander Proteinuria <500 mg/d & no USG evidence of obstructive uropathy or intrinsic parenchymal disease Urine volume <500 mL/d Urine sodium level <10 mEq/L Urine osmolality > plasma osmolality Serum sodium concentration <130 mEq/L Urine red blood cell count <50/HPF -### End" -7420,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following glycoprotein transported in plasma in iron metabolism:, with the following options: A: Spectrin, B: Transferrins, C: Ferritin, D: Haemosiderin - -### Response: -(Transferrin): Ref: 644-R, 369-HM) (436- Basic pathology 8th)* Iron in transported in plasma by an iron-binding glycoprotein called transferrin. Which is synthesized in the liver. In normal individuals transferrin is a bout 33% saturated with iron. Yielding serum levels that average 120 mg/dl is man and 100m/dl in woman.INTERNAL IRON CYCLE:* The major function of plasma transferrin is to deliver iron to cells including erythroid precursors, where iron is required for hemoglobin synthesis, Immature red cells posses high affinity receptors for transferring and iron is transported into erythroblasts by receptor mediated endocytosis.* Ferritin and haemosiderin are storage forms of excess iron (30%) -### End" -7421,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding malaria except -, with the following options: A: Infant parasite rate is a poor indicator of malaria occurence in a community, B: ABER is used for operational approach, C: Spleen rate is an impoant indicator of endermicity of malaria, D: Usually caused by Plasmodium vivax - -### Response: -Infant parasite rate is defined as the percentage of infants below the age of 1 year showing malaria parasites in their blood films.It is regarded as most sensitive index of recent transmission of malaria in a locality Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 277 -### End" -7422,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Harlequin skin change is seen due to mutation of which gene?, with the following options: A: ABC A 12, B: FAD, C: Keratin 1, D: ALOXE 3 - -### Response: -Ans. is 'a' i.e., ABCA 12 Harlequin Ichthyosis* Harlequin ichthyosis (HI) is caused by mutations in the ABCA 12 gene.* Mutation in the gene leads to defective lipid transport and ABCA 12 activity is required for the generation of long- chain ceramides that are essential for the development of the normal skin barrier. It is inherited by autosomal recessive mode of inheritance.Clinical Manifestations* At birth, markedly thickened, ridged, and cracked skin forms horny plates over the entire body, disfiguring the facial features and constricting the digits.Treatment* Initial treatment includes high fluid intake to avoid dehydration from transepidermal water loss and use of a humidified heated incubator, emulsifying ointments, careful attention to hygiene, and oral retinoids (1 mg/kg/ day).* Prenatal diagnosis has been accomplished by fetoscopy, fetal skin biopsy, and microscopic examination of cells from amniotic fluid.Extra edge* N.B. The fetus in ichthyosis appears grostesque and the appearance is called harlequin fetus. But, it is different from Harlequin color change.Harlequin color change* This rare but dramatic vascular event occurs in immediate newborn period and is most common in low birth weight infants.* If reflects an imbalance in the autonomic vascular regulatory mechanism.* When the infant is placed on the side, the body is bisected longitudinally into pale upper half and a deep red dependent half. -### End" -7423,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Heparin inhibits Xa by, with the following options: A: Blocking vitamin K mediated activation of Xa, B: Activating Antithrombin III, C: Direct breakdown of Xa, D: Blocking P2 Y12 receptor of ADP - -### Response: -Heparin contains pentasaccharide unit that activates Antithrombin III & inhibits factor Xa (Thus it is a indirect thrombin inhibitor). -Unfractionised heparin also contains a heteropolysaccharide unit that inhibits factor II a. -LMWH lacks this heteropolysacchoride unit and therefore inhibitors factor Xa only. -### End" -7424,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Absolute indication for Cochlear implantation is:, with the following options: A: Outer hair cell, B: Inner hair cell, C: Spiral ganglion cell, D: Auditory nerve - -### Response: -Ans. d. Auditory nerve Cochlear Implants are used in cochlear type of sensorineural hearing loss where nerve fibers remain intact and functional Cochlea and auditory nerve should be presentdeg in the patients of sensorineural hearing loss planned for cochlear Implants Cochlear Implants Electronic devices which conve sound signal to electrical impulses which directly stimulate the fibers of CN VIII Cochlear implants replace the nonfunctional transducer system of hair cells of cochlea. Used in cochlear type of sensorineural hearing loss where nerve fibers remain intact and fenctional Electrode array consists of multiple electrodes and is implanted in the scala tympani of the cochlea. It stimulates the fibers of CN VIII. Cochlear Implants Selection criteria for Adults Age: 18 years or more Bilateral severe to profound hearing loss Limited or no benefit from hearing aids No medical contraindicationdeg to undergo surgery Cochlea and auditory nerve should be present Realistic expectation Good family and social suppo Adequate cognitive function to be able to use the disease Post lingually deafened adults are good candidates. Results are not so good in pre-lingually deaf adults unless they had been receiving aural-oral training for communication. Selection criteria for children Bilateral profound or severe to profound hearing loss Minimal or no benefit from hearing aid No medical contraindication Cochlea and auditory nerve should be present Good family and social suppo Adequate cognitive function to be able to use the disease Auditory deprivation in the early developmental period causes degenerative changes in central auditory pathway. Now implants can be used at an age as early age 12 months Implants can be used in both pre-lingually and post-lingually deafened infants and children Hearing Aids Contralateral routing of signals (CROS) In this type, microphone is fitted on the side of the deaf ear and the sound picked up is passed to the receiver placed in the better ear. Useful for the person with one ear severely impaired and helps in sound localization coming from the side of deaf ear Auditory Brainstem Implant (ABI) This implant is designed to stimulate the cochlear nuclear complex in the brainstem directly by placing the implant in the lateral recess of fouh ventricle Such implants are needed when CN VIII has been severed in surgery of vestibular schwannomadeg. In these cases, cochlear implants are of no use. In unilateral acoustic neuroma, ABI is not necessary as hearing is possible from the contralateral side but in bilateral acoustic neuromas as NF2, rehabilitation is required by ABI -### End" -7425,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Major source of NADPH for fatty acid synthesis is:, with the following options: A: HMP shunt, B: TCA cycle, C: Glycolysis, D: Uronic acid pathway - -### Response: -Reductases in fatty acid synthesis require NADPH as reducing power. Out of all the options, NADPH is produced by HMP shunt only. Insulin is lipogenic. It increases the production of enzymes of HMP shunt. Other minor pathways producing NADPH are:- Malic enzyme (NADP Malate Dehydrogenase) Cytoplasmic Isocitrate dehydrogenase Glutamate dehydrogenase -### End" -7426,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is used in the treatment of hyperprolactinemia?, with the following options: A: Cimetidine, B: Methysergide, C: Bromocriptine, D: Ondansetron - -### Response: -Ans. (C) Bromocriptine(Ref: KDT 8/e p261)It is an ergot alkaloid and is a dopamine agonist. Dopamine acts as prolactin inhibiting hormone in the brain. Agonism of dopamine receptors by bromocriptine is responsible for its use in hyperprolactinemia. -### End" -7427,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Preplacement examination in dye industry includes all of the following except -, with the following options: A: Anemia, B: Asthma, C: Precancenrous, D: Dermatitis - -### Response: -Anemia is the preplacement examination in case of lead or in lead industries.all other are included under dye industry. (Ref.PARK'S textbook of preventive and social medicine 21st edition page no.753) -### End" -7428,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pneumothorax -, with the following options: A: Trachea shifted to opposite side, B: Dull, C: | breath sound, D: | TVF - -### Response: -Ans. is 'a' i.e., Trachea shifted to opposite side Clinical distinguishing features on clinical examination Tracheal deviation (Mediastinal shift)Chest expansionPercussion note | Duller| Hyper-resonantBreath sounds| Louder| SofterAdded soundsVocal resonanceConsolidationNoNormal, or decreaseNormal, or decreaseIncrease (Brochial)Coarse crackles +/- rubIncreaseWhisperingPectoriloquyLobar collapseYes (Towards collapse)DecreaseDecreaseDecreaseNoDecreasePleural effusionNoDecreaseDecrease (Stony dull)DecreaseOccasional rubDecreasePneumothoraxYes (Specially with tensionNormal or decreaseIncreaseDecreaseOccattonal clickDecrease -### End" -7429,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Recurrent epistaxis in a 15 year old female the most common cause is -, with the following options: A: Juvenile nasopharyngeal fibroma, B: Rhinosporidiosis, C: Foreign body, D: Hematological disorder - -### Response: -As such this answer is not given anywhere but we can come to the correct answer by exclusion. -Option “a” is Juvenile nasopharyngeal fibroma. -It is seen in adolescent males and is therefore the most common cause of recurrent epistaxis in males and not in females. -Ref. Dhingra 6/e, p 346 -Option “b” is Rhinosporidiosis is a cause of epistaxis but usually occurs in young males from India. -Ref. Turner 10/e, p 61 -Option “c” is Foreign body which is a cause of epistaxis in children and is not commonly seen in 15 years of age. So we are left with hematopoietic disorder which can be seen in a 15 years old female. -Ref. Dhingra 6/e, p161 -### End" -7430,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are concerned with auditory pathway except-, with the following options: A: Trapezoid body, B: Medial geniculate body, C: Genu of internal capsule, D: Lateral leminiscus - -### Response: -Genu of internal capsule is not a part of auditory pathway. The fibres from medial geniculate body, pass through the posterior limb of internal capsule to reach auditory cortex. -### End" -7431,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A teenager has seen her local physician complaining of persistent and severe headaches. Her physician diagnosed migraine and prescribes sumatriptan, which acts by which of the following mechanisms?, with the following options: A: Dopamine 1 agonist, B: GABAB antagonist, C: Muscarinic 3 antagonist, D: Serotonin 1D agonist - -### Response: -Sumatriptan is a serotonin 1D agonist that is used to abo migraine headaches. It is also effective in the treatment of cluster headaches. Currently, no dopamine 1 (D1) agonists, GABAB antagonists, or muscarinic m3 (M3) antagonists are used clinically. -### End" -7432,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Father of Physiology is?, with the following options: A: Herophilus of Chalcedon, B: Claude Bernard, C: Louis Pasteur, D: Robin Virchow. - -### Response: -Ans. B. Claude BernardFather of AnatomyHerophilus of ChalcedonFather of PhysiologyClaude BernardFather of MicrobiologyLouis PasteurFather of BacteriologySir Robert KochFather of ChemotherapyPaul EhrlichFather of PharmacologyOswald SchmiedebergFather of Modern PathologyRudolf VirchowFather of Forensic MedicineBernard Spills buryFather of Modern EpidemiologyJohn SnowFather of Occupational HealthRamazziniFather of Modern MedicineHippocratesFather of Indian MedicineCharakaFather of American MedicineWilliam OslerFather of Modern SurgeryAmbroise PareFather of Indian SurgerySushrutaFather of Antiseptic SurgeryJoseph ListerFather of Modern Inguinal Hernia SurgeryEdoardoBassiniFather of Thyroid SurgeryEmil KocherFather of GeneticsGregor MendelFather of Modern Human GeneticsDr Victor A. McKusickFather of PsychoanalysisSigmund FreudFather of Porphyrin chemistryHans FischerFather of PTCAAndreas GruentzigFather of Modern PsychiatryJohann WeyersFather of American PsychiatryBenjamin RushFather of BiologyAristotleFather of Diagnostic ImagingRoentgen -### End" -7433,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: High first pass metabolism is seen in:, with the following options: A: Lignocaine, B: Propranolol, C: Salbutamol, D: All of these - -### Response: -- Among given options Lignocaine, Propranolol and Salbutamol has high first pass metabolism. -### End" -7434,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following metabolic anomaly is seen in hemorrhagic shock, with the following options: A: Metabolic Acidosis, B: Respiratory Acidosis, C: Respiratory Alkalosis, D: Metabolic Alkalosis - -### Response: -Answer- A. Metabolic AcidosisHemorrhagic shock is characterized by lactic acid accumulation causing lactic acidosis/metabolic acidosis. -### End" -7435,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ascaris lumbricoides causes deficiency of?, with the following options: A: Iron, B: Vit B 12, C: Folic acid, D: Vitamin A - -### Response: -ANSWER: (D) Vitamin AREF: With text""Ascaris infestation may lead to malnutrition. Apart from anorexia leading to poor intake, studies have shown that lactose indigestion and intolerance also occur, and the absorption of vitamin A is impaired. All these leads to PEM, Iron deficiency anemia and vitamin A deficiency"" (REF: Surgical Diseases in Tropical Countries by Suneet Sood Page 70)Diarrhea may be associated with Giardia and Ascaris, both of which reduce vitamin A absorption, in some instances by as much as 70% (REF: Vitamin A deficiency: health, survival, and vision - Alfred Sommer, Keith P. West Page 197)""Kwashiorkor has long been associated with Ascaris infection and it is known that ascariasis also contributes to vitamin A and possibly vitamin C deficiency"" (REF: Imaging of tropical diseases: with epidemiological, pathological and clinical correlation: Volume 2 -Philip E. S. Palmer, Maurice Merrick Reeder Page 20) -### End" -7436,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Staphylococcal infection causes all disease execept:, with the following options: A: Impetigo, B: Erysipelas, C: Ecthyma, D: Scaldy Skin Syndrome - -### Response: -B i.e. Erysipelas -### End" -7437,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscle spindle function is:, with the following options: A: Length, B: Stretch, C: Touch, D: Temperature - -### Response: -Ans. A. LengthFunctions of Muscle spindlea. Sensing and Maintaining normal muscle length (By Length servo and Follow up servo mechanism)b. Stretch Reflexc. Muscle tone (Due to Gamma efferent discharge)d. Body Posture (Postural reflex at spinal cord level)So both stretch and length are functions of muscle spindle but the primary function is maintenance of length.Pneumonic: Golgi tendon organ is for tension (t for tension, t for tendon) Muscle spindle is for length -### End" -7438,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A female is admitted in the ICU with the symptoms of GBS. She is getting these symptoms for the third time during few weeks. Nerve biopsy reveals onion-bulb appearance. What can be the MOST probable diagnosis?, with the following options: A: Amyloidotic neuropathy, B: Diabetic neuropathy, C: Chronic inflammatory demyelinating polyneuropathy, D: Leprotic neuropathy - -### Response: -Chronic inflammatory demyelinating polyneuropathy (CIDP):An acute-onset form of CIDP should be considered when GBS deteriorates >9 weeks after onset or relapses at least three times.This neuropathy shares many features with the common demyelinating form of GBS, including elevated CSF protein levels and the Edx findings of acquired demyelination.The CSF is usually acellular with an elevated protein level.Biopsy typically reveals little inflammation and onion-bulb changes (imbricated layers of attenuated Schwann cell processes surrounding an axon) that result from recurrent demyelination and remyelination.CIDP responds to glucocoicoids, whereas GBS does not. Ref: Amato A.A., Hauser S.L. (2012). Chapter 385. Guillain-Barre Syndrome and Other Immune-Mediated Neuropathies. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -7439,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are radiological features of Mitral stenosis except –, with the following options: A: Straight left border of heart, B: Oligemia of upper lung fields, C: Pulmonary hemosiderosis, D: Lifting of left bronchus - -### Response: -Radiological signs of mitral stenosis - -Due to left atrial enlargement:- Straightening of left heart border, elevation of left main bronchus with the widening of the carina, double atrial shadow (Double density sign), posterior displacement of the esophagus on barium swallow, Prominent posterosuperior part of the cardiac shadow. -Due to pulmonary venous hypertension :- Diversion of blood flow from the lung bases to the upper zone (cephalization of pulmonary vascularity), pulmonary hemosiderosis, peribronchial cuffing, Kerley B lines and sometimes Kerley 'A' lines, perihilar haze, alveolar edema, small pleural effusion, pulmonary ossicles, fine punctate calcification in lung. -Due to elevated pulmonary hypertension:- Enlargement of central pulmonary vessels with peripheral pruning. - - -There is increased blood flow (plethora) in upper lung fields due to the diversion of blood flow to the upper zone. -### End" -7440,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An 8-month-old child presents with a silver sheen to her hair, seizures, hepatosplenomegaly, lymphadenopathy, pancytopenia, recurrent Staph aureus skin infections, and enlarged granules noted within neutrophils on peripheral smear. Which of the following gene defects is most likely to be identified?, with the following options: A: c-kit, B: LYST, C: PAX3, D: HPS1 - -### Response: -Chediak-Higashi Syndrome Autosomal recessive Lysosomal transpo protein (LYST/CHS1) gene defect, vesicular trafficking defect Incomplete oculocutaneous albinism Decreased chemotaxis of neutrophils, decreased antibody dependent cellular cytotoxicity, presence of giant peroxidase-positive lysosomal granules in peripheral blood granulocytes; results in severe infections Clinical findings;- Childhood CHS: accelerated phase: early onset with fever, anemia, and neutropenia . Adolescent CHS: severe infections in early childhood, no accelerated phase Adult CHS: mild form, develop progressive and fatal neurologic dysfunction in middle age Eyes: ocular hypopigmentation causes photophobia, nystagmus, and strabismus Hair: silvery sheen Skin: pale, deep ulcerations, petechiae, bruising, and gingival bleeding Neurologic: weakness, ataxia, sensory deficits, and progressive neurodegeneration Lymphoma: ""accelerated phase"" precipitated by viruses (e.g., Epstein-Barr virus); widespread infiltration of viscera Other: hepatosplenomegaly, lymphadenopathy, pancytopenia, pseudomembrane, and sloughing of the buccal mucosa . Laboratory findings:- Giant intracellular granules in circulating neutrophils, melanocytes, neurons, and renal tubular cells * Granules form secondary to delayed disorder of lysosomal enzymes from cells. Treatment:- Bone marrow (or stem cell) transplant, acyclovir, interleukin, gamma globulin, vincristine, prednisone, and prophylactic antibiotics. Ref:- Dermatology pictorial review by ASRA ALI; pg num:-170 -### End" -7441,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for treating malignant hypehermia, with the following options: A: Dantrolene, B: Nikethamide, C: Baclofene, D: Propofol - -### Response: -Dantrolene sodiumis thedrug of choicefor malignant hypehermia but it is to be reconstituted withsterile distilled water, not saline as it can precipitate in saline or other salt solutions. It is given at a dose of2.5 mg/ kgintravenously and can be repeated every 5-10 minutes (upto 10mg/kg) till the attack subsides. All anesthetic agents should be cut off and the patient is given 100% oxygen. Bicarbonate at a dose of 1 to 4 mEq/kg IV can be used to treat metabolic acidosis. If the body temperature is high, it should be brought down using cold intravenous fluids, cooling body cavities with sterile iced fluids, surface cooling with ice packs and cooling blankets. -### End" -7442,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug induced pemphigus is most commonly caused by, with the following options: A: Penicillamine, B: Phenytoin sodium, C: Carbamazepine, D: Penicillin - -### Response: -captopril and d- penicillamine are the two most common drugs inducing pemphigus vulgaris . page no.281 . Reference IADVL's concise textbook of dermatology -### End" -7443,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paralysis of opponens muscle leads to loss of following function of thumb?, with the following options: A: Flexion, B: Extension, C: Pinching, D: Abduction - -### Response: -Opponens pollicis muscle attaches to the trapezium, flexor retinaculum, and first metacarpal. It pulls the thumb medially and forward across the palm so that the palmar surface of the tip of the thumb may come into contact with the palmar surface of the tips of the other fingers. It is an impoant muscle and enables the thumb to form a claw in the pincerlike action used for picking up objects. Paralysis of opponens muscle leads to loss of pincer action of thumb. -### End" -7444,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ""Bird beak"" appearance on barium swallow study is seen in:, with the following options: A: Achalasia cardia, B: Carcinoma esophagus, C: Hiatus hernia, D: Diffuse esophageal spasm - -### Response: -Barium study feature of few esophageal diseases Diffuse esophageal spasm: ""Yo-Yo"" motion of barium ""Corkscrew"" appearance (scalloped configuration of barium column) ""Rosary-bead/Shish kebab"" configuration (compamentalization of barium column) Feline esophagus: Gastroesophageal reflux disease Double-barrel esophagus: Mallory-Weiss tear Intramural abscess Intraluminal diveiculum Achalasia cardia: ""Bird beak"" deformity Absence of primary peristalsis below level of cricopharyngeus Candidal esophagitis: Cobble stone mucosa Cytomegalovirus esophagitis: Giant ovoid flat ulcers (vasculitis of submucosal vessels) Herpes esophagitis: Discrete superficial punctate/linear serpentine/stellate/diamond shaped ulcers Hiatus hernia: Epiphrenic bulge > 4 longitudinal coarse thick gastric folds above gastroesophageal junction or in the suprahiatal pouch Distance between B ring and hiatal margin > 2 cm Scleroderma: Esophageal shoening Sliding hiatus hernia Carcinoma oesophagus: Rat-tail esophagus Shouldering sign -### End" -7445,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which pa of the fallopian tube acts as a functional/ anatomical sphincter?, with the following options: A: Isthmus, B: Intramural, C: Ampulla, D: Infundibulum - -### Response: -Ans. a. Isthmus Isthmus of the fallopian tube acts as a functional/anatomical sphincter. The uterine end of the tube, called the isthmus, acts like sphincter, and prevents the embryo from being released into the uterus for 2 days, so that it enters the uterus at the just right time for the implantation.'- How To Have A Baby: Overcoming Infeility By Aniruddha N Malpani/105 'The lumen of the narrow isthmus is relatively simple, with a few longitudinal folds. This poion of its tube is 2 or 3 cm long. There are three layers of musculature: the inner longitudinal, the middle circular layer, and the outer longitudinal layer. There is some evidence that the isthmus may act as a sphincter.'- Clinical Anatomy of the Uterus, Fallopian Tubes, and Ovaries by Eric R Sokol -### End" -7446,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Class II exposure in animal bites includes the following, with the following options: A: Bites from wild animals, B: Licks on a fresh wound, C: Scratch with oozing of blood on palm, D: Scratches without oozing of blood - -### Response: -• Rabies occur due to: Animal bites (dogs, cats, monkeys, cow, goat, sheep, buffalo, horses, bats, foxes, jackals, hyenas Except rat bite and Human bite.) -• Human bites are likely to transmit: Streptococcus viridans, Staphylococcus aureus, Eikenella corrodens, Hemophilus influenzae, Fusobacterium nucleatum, Prevotella, Porphyromonas, Peptostreptococcus, HIV, Hepatitis B/ -• Rat bite can transmit: Streptobacillus monliformis, Spirillum minor. -### End" -7447,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Synthesis of clotting factors needs which vitamin, with the following options: A: A, B: K, C: D, D: E - -### Response: -K group Catalyze g carboxylation of glutamic acid residues on various proteins concerned with blood clottingRef: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:466 -### End" -7448,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Increased sexual desire in males is known as -, with the following options: A: Nymphomania, B: Satyriasis, C: Frigidity, D: Fetishism - -### Response: -Ans. is 'b' i.e. Satyriasis o Satyriasis is excessive sexual desire in male where he enjoys having multiple sexual partners or desires excessive sexual activity.o The female-specific term for the same condition is Nymphomania.o Fetishism means the use of objects for sexual gratification leading to orgasm. For example underclothing, brassiere, petticoat, stocking, shoes, etc.o Frigidity is inability to initiate sexual arousal in female. -### End" -7449,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4-year-old child living in a slum is bitten by a rat while sleeping. Two days later, the child develops a rash characterized by discrete erythematous 1-4 mm macules on the extremities and face, most obvious on the palms and soles. Which of the following organisms is the most likely cause of this child's disease?, with the following options: A: Borrelia burgdorferi, B: Streptobacillus moniliformis, C: Pseudomonas mallei, D: Pseudomonas pseudomallei - -### Response: -The child has ""rat-bite fever."" This occurs in two forms with somewhat similar clinical manifestations. The form this child has is the Haverhill fever form, caused by Streptobacillus moniliformis and characterized by a sho (often 1-3 days) incubation period. One of the problems with diagnosing these diseases is that the victims are usually young children, and the bite site may be inapparent by the time the disease becomes severe enough for the child to be taken to a doctor. Borrelia burgdorferi causes Lyme disease, which is characterized by an expanding erythematous rash, ahralgias, and eventual nervous system involvement. Pseudomonas mallei causes glanders, which generally affects horses or humans in close contact with equines. Pseudomonas pseudomallei causes melioidosis, a rare pulmonary disease found mostly in Southeast Asia. Ref: Brooks G.F. (2013). Chapter 22. Legionellae, Baonella, and Unusual Bacterial Pathogens. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e. -### End" -7450,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Marjolin's ulcer is a, with the following options: A: Malignant ulcer found on the scar of burn, B: Malignant ulcer found on infected foot, C: Trophic ulcer, D: Meleney's gangrene - -### Response: -Marjolin's ulcer is well-differentiated squamous cell carcinoma which occurs in chronic scars like burn scar, scar of venous ulcer. It is slow growing, locally malignant disease. Reference : SRB's Manual of Surgery, 6th Edition, page no = 283. -### End" -7451,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best scale to measure pain in children of 5 years age would be –, with the following options: A: VAS, B: Mc Gill scale, C: Faces scale, D: CHEOPS - -### Response: -For children (1-7 years) CHEOPS scale is used. -### End" -7452,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is considered as an accurate duplicating material?, with the following options: A: Agar, B: Alginate, C: Impression compound, D: None of the above - -### Response: -DUPLICATING MATERIALS -Both types of hydrocolloids are used in the dental laboratory to duplicate dental casts or models for the construction of prosthetic appliances and orthodontic models. Agar hydrocolloid is more popular in the lab because it can be used many times. In addition, with intermittent stirring, agar hydrocolloid can be kept in a liquid form for 1 or 2 weeks at a constant pouring temperature. These factors make the cost of reversible impression materials quite reasonable. -These property requirements are identified in ANSI/ADA Specification No. 20 (ISO 14356; Dentistry—Duplicating material). -NOTE: Both alginate and agar are considered as accurate impression materials. Owing to the extensive use of agar as a duplicating material, agar can be a better choice. -Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 176 -### End" -7453,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin which formed from amino acid -, with the following options: A: Thiamine, B: Riboflavin, C: Niacin, D: Biotin - -### Response: -Ans. is 'c' i.e., Niacin o This question is confusing one (Read text below)o Niacin (Vitamin B3) is synthesized from tryptophan inside the bodo Some vitamins are also formed by bacterial activity in coloni) Vitamin Kii) Vitamin B12Thiamin (Vitamin Bl)iv) Riboflavin (Vitamin B2)v) Biotin (Vitamin B7)o Thus, options a, b & d all are correct here. But best answer among these is niacin as it is the only vitamin which is synthesized by proper anabolic metabolism. -### End" -7454,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Phenylketonuria the main aim of first-line therapy is, with the following options: A: Replacement of the defective enzymes, B: Replacement of the deficient product, C: Limiting the substrate for deficient enzyme, D: Giving the missing amino acid by diet - -### Response: -In PKU Phenylalanine hydroxylase enzyme is deficient.So alternative pathways are opened. Leading to the formation of Phenylketone,Phenyllactate and Phenylacetate. This can be prevented by limiting the substrate for deficient enzyme.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 236 -### End" -7455,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cyclin Dl/Ig H gene is associated with -, with the following options: A: Mantle cell lymphoma, B: Hairly cell leukemia, C: Follicular lymphoma, D: Diffuse large B-cell lymphoma - -### Response: -Answer- A. Mantle cell lymphomaMantle cell lymphoma, a translocation has juxtaposed the llql3 band bearing cycline Dl gene with the IgH locus on chromosome 14 (11-14 translocation). -### End" -7456,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Period of mixed dentition is, with the following options: A: 3-5 years, B: 6-11 years, C: 12-15 years, D: 15-18 years - -### Response: -Period of mixed dentition: stas from the eruption of first molar. It is usually 6-11 years and may extend to 12-13 years. Thus, Number of teeth by 2-6 years: 20 temporary Number of teeth at 7 years is 24 teeth: 4 permanent and 20 temporary teeth At the age of 10 years, 16 permanent teeth and 8 temporary teeth. At 11 years, 20 permanent teeth and 4 temporary teeth. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS PAGE NO 80 -### End" -7457,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Features of multiple myeloma are, with the following options: A: B cell monoclonal proliferation, B: B cell in bone marrow, C: B cell in peripheral blood, D: Plasma cell secretes immunoglobulin - -### Response: -Multiple myeloma is a malignant proliferation of plasma cells. Normal plasma cells are derived from B cells & prodece immunoglobulins which contain heavy & light chains. Normal immunoglobulins are polyclonal,which means that a variety of heavy chains are produced . In myelona,plasma cells produce immunoglobulin of a single hwavy & light chain , a monoclonal protein commonly referred to as a paraprotein.Reference :Davidson's principles &practice of medicine 22nd edition pg no 1046. -### End" -7458,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nerve supply of muscles of soft palate is/are, with the following options: A: Glossopharynegal Nerve, B: Vagus Nerve, C: Trigeminal Nerve, D: Greater palantine nerve - -### Response: -Ref BDC volume 3,6th edition pg 223MOTOR NERVE SUPPLY:All muscles of soft palate except tensor veli palatini are supplied by pharyngeal plexus. The fibers of this plexus are derived from the cranial pa of the accessory nerve through vagus. The tensor veli palatini is supplied by mandibular nerve.GENERAL SENSORY NERVES:The middle and posterior lesser palatine nerves which are branches of maxillary nerve through the pterygopalatine ganglionThe glossopharyngeal nerveSPECIAL SENSORY OR GUSTATORY NERVESThe nerves carrying taste sensations from the oral surface are contained in the lesser palatine nerves.SECRETOMOTOR NERVESThese are also contained in the lesser palatine nerves. -### End" -7459,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congenital passive immunity is NOT found in, with the following options: A: Polio, B: Mumps, C: Rubella, D: Measles - -### Response: -(Rubella) (96, 168-Park 19fh) (97-140-Park 20th)Passive Immunity - when antibodies produced in one body (human or animal) are transferred to another to induce protection against disease* Body does not produce its own antibodies but depends upon ready- made antibodies(a) By administration of an antibody- containing preparation (immune globulin or antiserum)(b) By transfer of maternal antibodies across the placenta Human milk also contains protective antibodies (IgA)(c) By transfer of lymphocytes to induce passive cellular immunity - this procedure is still experimentalPassive immunity differs from active immunity in the following respects1. Immunity is rapidly established2. Immunity produced is only temporary (days to months till the antibody is eliminated from the body3. There is no education of the reticulo endothelial systemPoliomyelitis - The maternal antibodies gradually disappears during the first 6 months of life. Immunity following infection is fairly solid although re infection can occur since infection with one type does not protect completely against the other two types of viruses. Type 2 virus to be most effective antigens* Neutralizing antibody is widely recognized as an important index of immunity to polio after infection * *Mumps - Most infents below the age of 6 months are immune because of maternal antibodies* One attack clinical or subclinical is assumed to induce life -long immunity. Second attack can occure (132-Park 19th)Rubella - Infants of immune mothers are protected from 4 to 6 months**.* One attack gives life long immunity, secondary attack is rare- Transplacental (or vertical) transmission - TORCH agents (Toxoplasm, gondii, rubella virus, CMV and herpes virus) Varicella virus, syphilis, hepatitis, Coxsackie- B and AIDSActive immunity may be acquired1. Following clinical infection eg. Chickenpox, rubella, measles2. Following sub clinical or in apparent infections eg polio, Diptheria3. Following immunization with antigen which may be a killed, live attenevnted or toxoidMeasles (Rubeola) - Infant are protected by maternal antibodies upto 6 months of age or may persists 9 months. (127-P) -### End" -7460,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sweating as a result of exertion is mediated through, with the following options: A: Adrenal hormones, B: Sympathetic cholinergic, C: Sympathetic adrenergic, D: Parasympathetic cholinergic - -### Response: -Sweat glands have a sympathetic but cholinergic nerve supply. -### End" -7461,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following anaesthetic produces best uterine relaxation?, with the following options: A: Nitrous oxide, B: Halothane, C: Chloroform, D: Ether - -### Response: -Halothane is the anaesthesia of choice for internal version and manual removal of placenta. -Halothane  -Pharyngeal and laryngeal reflexes are abolished early and coughing is suppressed, while bronchi dilate. As such, halothane is the preferred anaesthetic for asthmatics. It inhibits intestinal and uterine contractions. This property is utilized for facilitating external or internal version during late pregnancy. However, its use during labour can prolong delivery and increase postpartum blood loss.  -Reference: Essentials of Medical Pharmacology Eighth Edition KD  TRIPATHI  page no 406 -### End" -7462,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following contribute in polypeptide synthesis?, with the following options: A: Leader sequence, B: Enhancer, C: tRNA, D: ncRNA - -### Response: -Enhancer is the cis-acting DNA sequence that increases the rate of initiation of transcription of eukaryotic genes by RNA polymerase. Leader sequence is the untranslated segment of mRNA before the sta codon. Ref: Harper, 28th Edition, Page 343. -### End" -7463,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common acute complication of dialysis is -, with the following options: A: Hypotension, B: Bleeding, C: Dementia, D: Muscle cramps - -### Response: -Hypotension is the most common acute complication of hemodialysis particularly among patients with diabetes mellitus. -Factors involved are -ÿ. Excessive ultrafiltration, with inadequate compensatory -vascular filling, impaired vasoactive or autonomic response, osmolar shis, overzealous use of anhypertensives. -### End" -7464,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a tumor marker for hepatocellular carcinoma, with the following options: A: AFP, B: PIVKA II, C: CEA, D: Glycipin 3 - -### Response: -CEA is raised in colon ca. -### End" -7465,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following events happens when a nerve impulse arrives at the Neuromuscular Junction:, with the following options: A: Release of Calcium from the Sarcoplasmic Reticulum, B: Acetylcholine binds to receptors on the postsynaptic sarcolemmal membrane, C: Acetylcholine binds to receptors on the postsynaptic sarcolemmal membrane, D: Efflux of calcium through synaptic vesicles into the synaptic cleft - -### Response: -B i.e. Acetylcholine binds to receptors on the postsynaptic sarcolemmal membrane- Action potential conducted along the nerve fiber enhances the endocytic release of ACh (acetyl choline) from vesicles (packets) into the neuromuscular cleft by enhancing the permeability of presynaptic membrane to Ca++ ions (lit Ca++ influx not efflux through voltage gated channels).- Sequence of events when a nerve impulse arrives at neuromuscular junction is: Calcium influx in presynaptic neural membrane though voltage gated Ca++ channels -> Exocytosis of ACh from synaptic vesicles into synaptic cleft -> ACh binds to Nm receptors on post synaptic sarcolemmal membrane which are ligand gated Na+ channels -+ Na+ influx; development of EPP & current sink -> AP conducted in both directions and enter muscle fiber T-tubules -> Ca++ released (efflux) from sarcoplasmic reticulum (ryanodine receptor channels) in response to voltage change sensed by DHPR on T tubules Binding of Ca++ to troponin C, uncovering myosin binding sites of actin l/t formation of cross linkage (bridging) that allows muscle contraction.Nerve impulse reach NM junction -+ Increased Ca++ permeability of presynaptic neural membrane d/t opening of voltage gated Ca++ channels --> Influx of calcium from synaptic space to interior of presynaptic nerve ending --> Calcium ion attracts acetyl choline (ACh) vesicles and draws/ fuse them to neural membrane adjacent to dense bars leading to a marked increase in exocytosis/ release of ACh in synaptic cleft?ACh diffuses through synaptic space and binds to nicotinic cholinergic (Nm) receptors in the post synaptic motor end plate. (ACh receptors are concentrated at the top of subneural clefts = junctional folds) --> Binding of ACh to ACh receptors (which are ligand gated sodium channel) increases Na+ and K+ conductance of muscle cell membrane.Influx of positively charged Na+ ions into the muscle fibre creates a local positive potential change inside the muscle fiber i.e. end plate potential (EPP) -4 Current sink created between depolarized end plate (with EPP) and adjacent muscle plasma membrane on (both sides) initiates an action potential (ie depolarizes the adjacent muscle membrane to its firing level) --> Action potentials are generated on either side of end plate and are conducted away from end plate in both directions along the muscle fiber -+ AP (depolarization) spreads to all pas & to interior of muscle fibers by way of T (transverse) tubules (communicate externally with ECF, contain ECF and are actually internal extension of cell membrane) -4 As AP reaches T-tubules, the voltage change is sensed by DHPR (dihydro pyridine receptors) on T tubule -+ DHPRs are physically linked to calcium release (ryanodine receptor) channels in the adjacent sarcoplasmic reticular (SR) cisternae. AP in T-tubule cause conformational change in voltage sensing DHP receptors, which unlocks (opens) the Ca'+ release channels in terminal cistern of SR and permitting Ca"" to rapidly diffuse into the sarcoplasm (thick & thin filament). The calcium induced Ca"" release quickly amplifies the release of Ca"" -4 Binding of Ca-- to troponin C, uncovering myosin binding sites on actin -4 Formation of cross linkage between actin and myosin and sliding of thick on thin filaments producing movement. -### End" -7466,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cholesterol is a predominant lipid in, with the following options: A: LDL and HDL, B: HDL and VLDL, C: Chylomicron and VLDL, D: IDL and HDL - -### Response: -LDL and HDL lipoproteins are the major carrier of cholesterol . Reference: Harpers illustrated biochemistry 31st edition page 248 -### End" -7467,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In TNM staging, N= ?, with the following options: A: Nature of tumor, B: Number of tumors, C: Number of lymph nodes, D: Metastasis - -### Response: -Ans. (c) Number of lymph nodes -### End" -7468,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cat is an agent for transmission of the following disease of man -, with the following options: A: Isospora hominis, B: Fasciola hepatica, C: Toxoplasma gondii, D: Chilomastrix mensili - -### Response: -Cat and other felines- definitive host Human - intermediate host (Refer pgno:64 baveja 3 rd edition) -### End" -7469,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: M.C. site of CA oesophagus is -, with the following options: A: Middle 1/3rd, B: Upper 1/3rd, C: Lower 1/3rd, D: Lower end of esophagus - -### Response: -Esophageal Carcinoma is of two common histological types - - -Squamous cell Ca - the MC type in the world (-95% according to Sabiston) -Adenocarcinoma - where incidence is increasing at a rapid rate and is now the MC type in the USA (Ref:• Harrison, Schwartz) - - -Distribution of Squamous Cell Ca. - -Upper 1/3 → 10% -Middle 1/3 → 60% -Lower 1/3 → 30%      - -Adenocarcinoma is mainly located in lower 1/3. -Nowhere, I could get the MC site of esophageal carcinoma overall (including both squamous and adeno variety). -But one thing is sure - squamous cell Ca is the MC type of esophageal cancer in the world - - -So I presume that the overall MC site would be the MC site involved by the MC type of esophageal cancer i.e. → Middle 1/3 - -So remember -MC type of esophageal Ca in world → Squamous Cell Ca (-95%) MC site → Middle 1/3 -### End" -7470,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about endotracheal intubation is -, with the following options: A: It reduces normal anatomical dead space, B: It produces decrease in resistance to respiration, C: Subglottic edema is most common complication, D: All of the above - -### Response: -Ans- A It reduces normal anatomical dead space 1. Endotracheal intubation decreases the normal anatomical dead space (150 ml) to as less as 25 ml, thus decreases the work of breathing (WOB). 2. It increases the resistance during respiration. To keep this resistance at a minimum, WIDEST INTERNAL DIAMETER ENDOTRACHEAL TUBE that will fill in the larynx is recommended. 3. The most common complication of endotracheal intubation is apnoea . -### End" -7471,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nagler reaction is type of -, with the following options: A: Neutrilization reaction is type of -, B: CFT, C: Precipitation, D: Agglutination - -### Response: -Its a neutralization test. Lecithinase test or Nagler's reaction is a biochemical test used to identify organisms which liberate phospholipases (lecithinases) e.g. Clostridium perfringens. The alpha (a) toxin of C. perfringens has phospholipase activity and hence, helps in differentiation of C. perfringens from other Clostridium spp that also produce lecithinase (C.baratti, C.absonum, C.bifermantans, C.sordelli and C.novyi) by neutralization of lecithin c activity by an antitoxin. Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:112 -### End" -7472,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding indirect inguinal hernia are all except:March 2008, with the following options: A: Most common type of hernia, B: Always unilateral, C: Inguinal herniotomy is the basic operation, D: Transillumination distinguishes it from hydrocele - -### Response: -Ans. B: Always unilateralIndirect inguinal hernia is the most common type of hernia and occurs commonly in the youngIn the first decade it is more common on the right side.The hernia is bilateral in 12% of cases.In boys, differentiating between a hernia and a hydrocele is not always easy.Transillumination has been advocated as a means of distinguishing between the presence of a sac filled with fluid in the scrotum (hydrocele) and the presence of bowel in the scrotal sac.However, in cases of inguinal hernia incarceration, transillumination may not be beneficial because any viscera that is distended and fluid-filled in the scrotum of a young infant may also transilluminate.A rectal examination may be helpful if intestine can be felt descending through the internal ring.* Silk sign: When the hernia sac is palpated over the cord structures, the sensation may be similar to that of rubbing 2 layers of silk together. This finding is known as the silk sign and is highly suggestive of an inguinal hernia. The silk sign is paicularly impoant in young children and infants, in whom palpation of the external inguinal ring and inguinal canal is difficult because the patients' small size.Operation is the treatment of choice.The basic operation is inguinal herniotomy, which entails dissecting out and opening the hernia sac, reducing any contents and then transfixing the neck of the sac and removing the remainder. -### End" -7473,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surfactant accelerated by, with the following options: A: Thyroxine, B: Glucocorticoids, C: Carbamazepine, D: Iodine - -### Response: -(Glucocorticoids) (657-Ganong 22nd) (442-A.K. Jain 3rd) (598-Ganong 23rd)* Maturation of surfactant in the lungs is accelerated by glucocorticoid hormones. Fetal and maternal cortisol increases near term and the lungs are rich in glucocorticoid receptors* Nomally after birth, the infant makes several strong inspiratory movements and the lung expand. Surfactant keeps them from collapsing again. But due to deficiency of surfactant in this disease, surface tension in the lungs of these infants is very high, and there are many areas in which alveoli are collapsed (At electasis) also pulmonary oedema occurs and infants dies of pulmonary insufficiency. Infants with RDS show low thyroid hormone and cortisol levels in their plasma. -### End" -7474,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following comprise classical triad for congenital rubella syndrome, EXCEPT:, with the following options: A: Sensory neural deafness, B: Cataract, C: Patent ductus aeriosus, D: Micrognathia - -### Response: -Congenital Rubella Syndrome - Risk of congenital defects is maximum before 11 weeks of gestation, C/F (Mnemonic: 'C D C') - Cataract - Deafness - Congenital hea disease (Most common is PDA) - IUGR - Microcephaly - Blue berry muffin lesions - Retinopathy - Most common manifestation of CRS: Sensineural deafness Late onset manifestations of CRS - Diabetes mellitus Thyroid dysfunction -### End" -7475,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements regarding pyrazinamide is FALSE?, with the following options: A: One should discontinue treatment if hyperuricemia occurs, B: There is minimal cross resistance with INH, C: Polyahralgia is a common side effect, D: It can cause hepatotoxicity - -### Response: -(Ref: Katzung 10/e p775) Pyrazinamide is a first line antitubercular drug that can cause hyperuricemia and hepatotoxicity. Non gouty rhthralgia is vey common adverse effect of this drug. Hyperuricemia per se is not the indication for discontinuation of pyrazinamide. -### End" -7476,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Centchroman is a?, with the following options: A: Female oral contraceptive, B: Male contraceptive, C: Tocolytic, D: Oxytocic - -### Response: -ANSWER: (A) Female oral contraceptiveREF: Dutta 6th ed p. 558CENTCHROMAN_(saheli)Product of CDRI LucknowNon steroidal potent anti estrogenic effectsOral OCPContains ormeloxifene -### End" -7477,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Left common cardinal vein is reduced to, with the following options: A: Great cardiac vein, B: Azygos vein, C: SVC, D: Coronary sinus - -### Response: -Left common cardinal vein is reduced to coronary sinus Ref Human embryology Inderbir singh Tenth edition Page 232 -### End" -7478,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During surgical staging of ovarian tumor, there is a surgical spill during intra-op. What is the FIGO stage of this patient?, with the following options: A: Stage 1C1, B: Stage 1C2, C: Stage 1C3, D: Stage II - -### Response: -STAGE ITumor limited to ovary or ovariesaStage 1AOne ovary without malignant ascites, positive peritoneal washings, surface involvement or ruptureStage 1BBoth ovaries, without malignant ascites, positive peritoneal washings, surface involvement or rupture Stage 1CMalignant ascites, positive peritoneal washings, surface involvement or rupture present1C1Surgical spill1C2Capsule rupture before surgery, or tumor on ovarian or fallopian tubal surface1C3Malignant cells in ascites or peritoneal washings STAGE IIOvarian tumor with pelvic extensionaStage IIAInvolvement of the uterus or fallopian tubesStage IIBInvolvement of the pelvic organs STAGE IIITumor involving upper abdomen or lymph nodes Stage IIIAPositive retro-peritoneal nodes only or microscopic peritoneal disease outside the pelvisStage IIIA1Positive retro-peritoneal nodes as the only site of extra-pelvic spreadIIIA1Metastasis up to 10mm in greatest dimensionIIIA1Metastasis > 10mm in greatest dimensionStage IIIA2Microscopic extra-pelvic peritoneal involvement Stage IIIBMacroscopic peritoneal metastasis <= 2cm in diameter bStage IIICMacroscopic peritoneal metastasis > 2cm in diameter b STAGE IVDistant organ involvement, including Pleural spacec or Hepatic/Splenic ParenchymaStage IVAPleural effusion with positive cytologyStage IVBParenchymal metastasis or metastasis to extra-abdominal sites such as inguinal lymph nodesa Patients with disease that appears to be confined to the ovaries or pelvis require nodal biopy for complete staging in order to rule out occult nodal involvementb Disease measurements for staging purposes are made before debulking has been attemptedc Pleural effusion must be cytologically proven to be malignant if used to define stage IV disease -### End" -7479,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Policeman's tip hand is seen in?, with the following options: A: Erb's palsy, B: Klumpke's paralysis, C: Axillary nerve injury, D: None of the above - -### Response: -ERB'S PARALYSIS:- Caused by a forceful widening of the angle between the head and shoulder which may occur by traction of the arm during the bih of a child or by fall on the shoulder.Involves upper trunk - C5, C6 roots. Leads to typical deformity in the limb- policeman's tip hand/ poer's tip hand. The arm hangs by the side, adducted and medially rotated, the forearm is extended and pronated. DISABILITY: The following measures are lost. Abduction and lateral rotation of the arm at the shoulder joint. Flexion and supination of the forearm. Biceps and supinator jerks are lost. Sensations are lost over a small area over the lower pa of the deltoid. {Reference: BD Chaurasia page no. 59}. -### End" -7480,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following is a stupefying agent, with the following options: A: Atropine, B: Aconite, C: Datura, D: Nerium - -### Response: -Examples of stupefying poisons : Alcohol dhatura cannabis chloral hydrate -### End" -7481,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First change of improvement noted after iron therapy is initiated, with the following options: A: Decreased irritability, B: Reticulcytosis, C: Increase in serum iron levels, D: Replenishment of iron stores - -### Response: -First change of improvement noted after iron therapy is decreased irritability followed by increased reticulocyte count. Reference: GHAI Essential pediatrics, 8th edition -### End" -7482,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 5HT, antagonist is:, with the following options: A: Levocetrizine, B: Metoclopromide, C: Domperidone, D: Ondansetron - -### Response: -(D) Ondansetron # 5-HT3 antagonists are a class of medications which act as receptor antagonists at the 5-hydroxytryptamine-3 receptor (5-HT3 receptor), a subtype of serotonin receptor found in terminals of the vagus nerve and in certain areas of the brain. With the notable exception of alosetron and cilansetron, which are used in the treatment of irritable bowel syndrome, all 5-HT3 antagonists are antiemetics, used in the prevention and treatment of nausea and vomiting. They are particularly effective in controlling the nausea and vomiting produced by cancer chemotherapy, and are considered the gold standard for this purpose.> Therapeutic uses:1. In the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV), especially that caused by highly emetogenic drugs such as cisplatin2. In the prevention and treatment of radiation-induced nausea and vomiting (RINV), when needed, and postoperative nausea and vomiting (PONV).3. 5-HT3 antagonists are ineffective in controlling motion sickness.4. Investigational useful in treating antipsychotic-induced tardive dyskinesia in people with schizophrenia.> Available agents:1. Ondansetron2. Tropisetron3. Granisetron4. Dolasetron5. Palonosetron6. Ramosetron7. Alosetron and8. cilansetron> Certain medications such as cisapride, renzapride and metoclopramide, although not 5-HT3 antagonists proper, possess some weak antagonist effect at the 5-HT3 receptor. Galanolactone, a diterpenoid found in ginger, is a 5-HT3 antagonist and is believed to at least partially mediate the anti-emetic activity of this plant. -### End" -7483,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First case that comes to notice of physician is ?, with the following options: A: Primary case, B: Secondary case, C: Index case, D: Refer case - -### Response: -Ans. is 'c' i.e., Index case o Primary case --> First case of communicable disease introduced into the population. o Index case --> First case to come to attention of the investigator. -### End" -7484,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 60-year-old man presents with acute renal insufficiency. He treated his garden last week with a number of herbicides and insecticides, some of which may have contained heavy metals. Laboratory studies confirm oliguria and increased levels of BUN (54 mg/dL) and creatinine (3.7 mg/dL). A renal biopsy is shown. What is the most likely diagnosis?, with the following options: A: Acute tubular necrosis (ATN), B: Bilateral cortical necrosis, C: Papillary necrosis, D: Rapidly progressive glomerulonephritis - -### Response: -Nephrotoxic ATN is caused by chemically induced injury to epithelial cells. Because they absorb and concentrate the chemicals, tubular epithelial cells are preferred targets for certain toxins, including some antibiotics, radiographic contrast agents, heavy metals (e.g., mercury), and organic solvents. The photomicrograph shows widespread necrosis of proximal tubular epithelial cells with sparing of distal and collecting tubules. Tubulointerstitial nephritis (choice E) may be a response to certain drugs but features interstitial inflammation.Diagnosis: Acute tubular necrosis -### End" -7485,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best IOL is:, with the following options: A: Ant chamber, B: Post chamber, C: Iris suppoed, D: Angle suppoed - -### Response: -B i.e. Posterior chamber Classical signs of aphakia are - a deep anterior chamber, iridodonesis (tremulousness of iris), only 2 images on Purkinje's test, dark (jet black) papillary reflexQ and highly hypermetropic small disc on fundus examination with markedly defective vision for both far and near d/t high hypermetropia and absence of accommodationQ. A scar mark around limbusQ is found in surgical aphakia. Because of high hypermetropia, an aphakic eye requires the correcting spectacle lens of about 10-11 D worn in the usual position if the eye were previously emmetropic. The retinal image of aphakic eye wearing spectacles is about 25% (quaer) magnified/ larger than the emmetropic image. Hence vision of even 6/6 with 10-11 D glasses is not quite as good as it seems. Because of the disparity of images, correcting unilateral aphakia with spectacles when there is good vision in other eye 1/ t an intolerable diplopia. With contact lenses, a comfoable binocular vision may be attained in aphakia. However, posterior chamber intraocular (in bag) lens implantation is the best available method of correcting aphakiaQ - The optical rehabilitation of aphakia is best done by IOL implants and best site for intraocular lens implants is posterior chamber or within capsular bag Q and this is the normal anatomical position. Whereas anterior chamber lens has more complications like corneal endothelial damage, secondary glucoma, uveitis etc. - With incision in upper pa of cornea, the sutureless phacoemulsification produces 0.5-1D 'against the rule' astigmatism (since cornea is flattened in veical meridian) whereas, extra capsular cataract extraction (ECCE) performed with sutures produces 1 D to 3 D 'with the rule' astigmatism (which gradually reduces after suture removal & thee after). Aphakia Aphakia means absence of crystalline lens from eye. However from optical point of view, it may be considered a condition in which the lens is absent from the pupillary area. Causes of aphakia are - congenital absence of lens, surgical aphakia (most common), traumatic absorption or extrusion of lens and posterior dislocation of lens Optical changes of aphakia eye are: - Total power of eye is reduced to +44 D from + 60 D Q - Eye becomes highly hypermetropic (10-11 D) Q - All accommodation is lost Q - The anterior focal point becomes 24 mm (15 nun for normal eye) in front of the cornea - The posterior focal point becomes 31 mm (24 mm for normal eye) behind the cornea i.e. about 7 mm behind the eye ball (anteroposterior length of eye ball is 24 mm) Signs of aphakia are - deep anterior chamber, jet black pupil, iridodonesis (i.e. tremulousness of iris) and purkinje's image test shows only two images (normally four images are seen). Main symptoms of aphakia is marked defective vision for both far and near d/t high hypermetropia and loss of accommodationQ. Erythropsia and cynopsia (seeing red & blue images) occurs d/t excessive entry of UV and infrared rays in absence of lens Features Aphakia Pseudoaphakia (Ae-phakia) Definition Absence of It is correction of crystalline lens aphakia with an from it normal aificial intraocular position (pupillary lens (i.e. presence of area) in eye. an IOL implant). Surgical scar Limbal scar may be Mostly seen (unless seen in surgical but very small) near absent in congenital absence of lens limbus Anterior Deep (>4 mm) and Normal or slightly chamber wide deep ( Iridodonesis Tremulousness of Usually absent or very iris characteristically present & is inarkedQ mild Purkinje Only 2 images are All 4 images (just like image test seen with absence of 3rd & 4f5 images normal are seen) Pupil Jet black papillary Black in color but reflexQ when light is thrown shining reflexes are observed in pupillary area and presence of IOL is confirmed Fundus Hypermetropic Relatively normal examination small discQ sized disc Retinoscopy High Refractive status is & Refraction hypermetropiaQ variable and may be and astigmatism. 1. Emmetropia (ideal) Roughly + 10 to + occurs if exact 11D cylindericalQ power IOL glasses are required implanted; patient in previously needs plus (+) emmetropic eyes. glasses for near An addition +3 to vision only +4 D is required for 2. Consecutive near vision to myopia occurs compensate for when implanted IOL accommodation over corrects the refraction of eye; patient require glasses for distant vision/ myopia and may or may not need glasses for near vision. 3. Consecutive hypermetropia occurs when under power IOL is implanted; patient requires plus (+) glasses for distance vision & additional + 2D to + 3D for near vision. -### End" -7486,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug of choice for post menopausal osteoporosis is, with the following options: A: Estrogen, B: Bisphosphonates, C: Teriparatide, D: Thyroxine - -### Response: -Drug used in osteoporosis Inhibit resorption:Bisphosphonates (drug of choice), Denosumab, calcitonin, estrogen, SERMS, gallium nitrate. Stimulate formation: Teriparatide (PTH analogue), calcium, calcitriol, fluorides. Both actions: Strontium ranelate. -### End" -7487,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Water hammer pulse is seen in -, with the following options: A: Aortic regurgitation, B: Anemia, C: Pregnancy, D: All the above - -### Response: -Ans. is 'd' i.e., All the above Water Hammer Pulse or Corrigans pulse* It is a large bounding pulse, associated with increased stroke volume of the left ventricle and decrease in the peripheral resistance, leading to a wide pulse pressure.* The pulse strikes the palpating finger with a rapid, forceful jerk and quickly disappears.* It is best felt in the radial artery with the patients arm elevated.* It is seen in Aortic regurgitation. It is also seen in anemia, pregnancy and mitral regurgitation.Pathophysiology of water hammer pulse* In Aortic regurgitation the stroke volume is high, so the systolic pressure is high and this is responsible for sharp rise in the pulse.* The stroke volume is high because the left ventricle gets blood from two sources during the diastole i.e. blood leaking from the Aorta and the blood it receives from left atria.The collapse occurs because* Diastolic leak of blood into the left ventricle from the Aorta* Rapid run off to the periphery as a result of low systemic vascular resistance (the increased cardiac output stimulates the baroreceptors in the aortic arch and the result is reflex vasodilatation of the peripheral vessels into which the blood flows rapidly). -### End" -7488,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 month old child presents with two weeks history of fever, vomiting and alteration of sensorium Cranial CT scan reveals basal exudates and hydrocephalus, the most likely etiological agent is ?, with the following options: A: Mycobacterium tuberculosis, B: Cryptococcus neoformans, C: Listera monocytogenes, D: Streptococcus pneumoniae - -### Response: -Ans. is 'a' i.e., Mycobacterium Tuberculosis lnsiduous /gradual onset of fever over a duration of two weeks, with features of raised intracranial tension in the form of vomiting and altered sensorium with characteristic basal exudates and hydrocephalus on cranial CT scan are almost characteristic of tuberculous meningitis. TUBERCULOUS MENINGITIS J Tuberculous meningitis usually arises from the formation of metastatic caseous lesions in the cerebral coex or meningitis that develops during the lymphohaematogenous spread of primary infection. This initial lesion increases in size and discharges tubercle bacilli in the subarachnoid space. o This results in gelatinous basal exudate which interferes in the normal flow of CSF, in and out of the ventricular system at the level of basal cisterns leading to a communicating hydrocephalus. Clinical manifestations of tuberculous meningitis o The clinical course of TB meningitis has three stages ? Prodromal stage or stage of invasion Insidious onset Headache and vomiting Low grade fever, loss of appetite Photophobia Disturbed sleep Constipation Stage of meningitis Signs of meningeal irritation develops - Neck rigidity, Kernig's sign Stage of coma Loss of consiousness Bradycardia Pupils arc dilated & fixed Chyne-strokes or Biot type of respiration Episodic decerebration CT findings in TBM : Basal cisterns are obliterated by isodense / hyperdense exudate Post contrast there is a avid enhancement of the basal meninges extending into the ambient, syln, pontine and chiasmatic cisterns. Meningeal enhancement may continue over the cerebral and cerebellar hemispheres. Hydrocephalus is present in 45-87% of patients at time of diagnosis. -### End" -7489,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: IgM is:, with the following options: A: Monomer, B: Dimer, C: Pentamer, D: Tetramer - -### Response: -Ans. (c) PentamerRef: Anatnayayan 9/ e page 98AntibodyEffective valency* IgM5* IgG2* IgD2* IgE2* IgA2,4Also Know* Ig having maximum molecular weight: IgM* First antibody produced by newborn: IgM* All immuniglobulin are heat stable EXCEPT: IgE* Ig present in breast milk: IgA* Ig with maximum half life: IgG* Ig with minimum half life: IgE* Ig having maxilum serum concentration: IgG * Ig having least serum concentration: IgE -### End" -7490,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Girl is suffering from:, with the following options: A: Treacher Collins syndrome, B: Pierre Robin syndrome, C: Craniofacial dysostosis, D: Sainton's disease - -### Response: -Clinical Features. Wide variations in the clinical expression of this syndrome are recognized, ranging from a complete, typical form manifesting all abnormalities listed below through incomplete, abortive, and atypical forms. The important clinical manifestations of the disease are:  - -Antimongoloid palpebral fissures with a coloboma of the outer portion of the lower lids, and deficiency of the eye-lashes (and sometimes the upper lids). -Hypoplasia of the facial bones, especially of the malar bones and mandible. -Malformation of the external ear, and occasionally of the middle and internal ears. -Macrostomia, high palate (sometimes cleft) and abnormal position and malocclusion of the teeth. -Blind fistulas between the angles of the ears and the angles of the mouth. -Atypical hair growth in the form of a tongue-shaped process of the hairline extending towards the cheeks. -Other anomalies such as facial clefts and skeletal deformities. - -The characteristic faces of the patients have often been described as being bird like or fish like in nature. -The syndrome is thought to result from a retardation or failure of differentiation of maxillary mesoderm at and after the 50 mm stage of the embryo. The fact that the teeth of the upper jaw are usually unaffected, and ordinarily are present by the sixth week, is further evidence of retardation or arrest of differentiation at or after the second month of fetal life. The first visceral arch of the visceral mesoderm also advances secondarily to form the mandible, and again retardation occurs on the same basis. -A disease that has sometimes been confused with mandibulofacial dysostosis, because of certain clinical features in common is hemifacial microsomia (also known as oculoauriculovertebral dysplasia or Goldenhar syndrome). However, hemifacial microsomia is sporadic in the vast majority of cases, although familial cases have been reported. In addition as the name implies, this disease is unilateral and has been suggested to be related to an abnormality in the vascular supply of the head. It has been discussed in detail by Gorlin and his associates.  -Ref: Shafer’s Ed 7th pg 721 -### End" -7491,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Causes of diffuse hyperpigmentation include all of the following except?, with the following options: A: Busulfan administration, B: Nelsons syndrome, C: Addison disease, D: Hermansky-Pudlak Syndrome - -### Response: -Busulfan administration Busulfan, cyclophosphamide, 5-fluorouracil, and inorganic arsenic induce pigment production and cause diffuse hyperpigmentation Nelson's syndrome Increased ACTH (Which has paial MSH activity) due to bilateral adrenalectomy Addison's disease Increased ACTH (Which has paial MSH activity) due to destruction of adrenal coex and low coisol Hermanksy- Pudlak syndrome Autosomal recessive disorder which results in oculo-cutaneous albinism (decreased pigmentation), and bleeding problems due to a platelet abnormality (platelet storage pool defect) -### End" -7492,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 21-year-old woman presents with a 3-month history of malaise, joint pain, weight loss, and sporadic fever. The patient appears agitated. Her temperature is 38degC (101degF). Other physical findings include malar rash, erythematous pink plaques with telangiectatic vessels, oral ulcers, and non blanching purpuric papules on her legs. Laboratory studies show elevated levels of blood urea nitrogen and creatinine. Antibodies directed to which of the following antigens would be expected in the serum of this patient?, with the following options: A: C-ANCA (anti-proteinase-3), B: Double-stranded DNA, C: P-ANCA (anti-myeloperoxidase), D: Rheumatoid factor - -### Response: -Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory disease that may involve almost any organ but characteristically affects the kidneys, joints, serous membranes, and skin. Autoantibodies are formed against a variety of self-antigens. The most impoant diagnostic autoantibodies are those against nuclear antigens:-- Antibody to double-stranded DNA A soluble nuclear antigen complex that is pa of the spliceosome and is termed Sm (Smith) antigen. High titers of these two autoantibodies (termed antinuclear antibodies) are nearly pathognomonic for SLE. -Antibodies to rheumatoid factor (choice D) are seen in patients with rheumatoid ahritis. -Antineutrophil cytoplasmic antibodies (choices A and C) are seen in patients with small vessel vasculitis (e.g., Wegener granulomatosis). Diagnosis: Systemic lupus erythematosus -### End" -7493,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sure sign of malignancy is, with the following options: A: Mitosis, B: Polychromasia, C: Nuclear pleomorphism, D: Metastasis - -### Response: -Ref Robbins 8/e p269; 9/e p272 CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS Nothing is more impoant to the patient with a tumor than being told: ""It is benign."" In general, benign tumors appear to be genetically ""simple,"" harboring fewer muta- tions than cancers, and genetically stable, changing little in genotype over time. The latter feature probably explains why benign tumors such as lipomas and leiomyomas transform to malignancies rarely, if at all. In practice, the determination of benign versus malignant is made with remarkable accuracy using long-established clinical and anatomic criteria, but some neoplasms defy easy character- ization. Ceain features may indicate innocence, and others may indicate malignancy. Such problems are not the rule, however, and there are four fundamental features by which benign and malignant tumors can be distinguished: dif- ferentiation and anaplasia, rate of growth, local invasion, and metastasis. Differentiation and Anaplasia Differentiation and anaplasia are characteristics seen only in the parenchymal cells that constitute the transformed elements of neoplasms. The differentiation of parenchymal tumor cells refers to the extent to which they resemble their normal forebears morphologically and functionally. * Benign neoplasms are composed of well-differentiated cells that closely resemble their normal counterpas. A lipoma is made up of mature fat cells laden with cytoplasmic lipid vacuoles, and a chondroma is made up of mature cailage cells that synthesize their usual cailaginous matrix--evidence of morphologic and functional differentiation. In well-differentiated benign tumors, mitoses are usually rare and are of normal configuration. * Malignant neoplasms are characterized by a wide range of parenchymal cell differentiation, from sur- prisingly well differentiated (Fig. 5-3) to completely in sheets, with total loss of communal structures, such as glands or stratified squamous architecture. The more differentiated the tumor cell, the more com- pletely it retains the functional capabilities of its normal counterpas. Benign neoplasms and even well-differenti- ated cancers of endocrine glands frequently elaborate the hormones characteristic of their origin. Well-differentiated squamous cell carcinomas produce keratin (Fig. 5-3), just as well-differentiated hepatocellular carcinomas secrete bile. In other instances, unanticipated functions emerge. Some cancers may elaborate fetal proteins not produced by comparable cells in the adult. Cancers of nonendocrine origin may produce so-called ectopic hormones. For example, ceain lung carcinomas may produce adrenocor- ticotropic hormone (ACTH), parathyroid hormone-like hormone, insulin, glucagon, and others. More is said about these phenomena later. Despite exceptions, the more rapidly growing and the more anaplastic a tumor, the less likely it is to have specialized functional activity. Of relevance in the discussion of differentiation and ana- plasia is dysplasia, referring to disorderly but non-neoplastic undifferentiated. For example, well-differentiated ade- nocarcinomas of the thyroid may contain normal- appearing follicles. Such tumors sometimes may be difficult to distinguish from benign proliferations. Between the two extremes lie tumors loosely referred to as moderately well differentiated. The stroma carrying the blood supply is crucial to the growth of tumors but does not aid in the separation of benign from malignant ones. The amount of stromal connective tissue does deter- mine, however, the consistency of a neoplasm. Ceain cancers induce a dense, abundant fibrous stroma (des- moplasia), making them hard, so-called scirrhous tumors. * Malignant neoplasms that are composed of undiffer- entiated cells are said to be anaplastic. Lack of differen- tiation, or anaplasia, is considered a hallmark of malignancy. The term anaplasia literally means ""back- ward formation""--implying dedifferentiation, or loss of the structural and functional differentiation of normal cells. It is now known, however, that at least some cancers arise from stem cells in tissues; in these tumors, failure of differentiation, rather than dedifferentiation of specialized cells, accounts for their undifferentiated appearance. Recent studies also indicate that in some cases, dedifferentiation of apparently mature cells does occur during carcinogenesis. Anaplastic cells display marked pleomorphism (i.e., variation in size and shape) (Fig. 5-4). Often the nuclei are extremely hyperchromatic (dark-staining) and large resulting in an increased nuclear-to-cytoplasmic ratio that may approach 1: 1 instead of the normal 1: 4 or 1 :6. Giant cells that are considerably larger than their neighbors may be formed and possess either one enormous nucleus or several nuclei. Anaplastic nuclei are variable and bizarre in size and shape. The chromatin is coarse and clumped, and nucle- oli may be of astounding size. More impoant, mitoses often are numerous and distinctly atypical; anarchic multi- ple spindles may produce tripolar or quadripolar mitotic figures (Fig. 5-5). Also, anaplastic cells usually fail to develop recognizable patterns of orientation to one another (i.e., they lose normal polarity). They may grow proliferation. Dysplasia is encountered principally in epi- thelial lesions. It is a loss in the uniformity of individual cells and in their architectural orientation. Dysplastic cells exhibit considerable pleomorphism and often possess hyperchro- matic nuclei that are abnormally large for the size of the cell. Mitotic figures are more abundant than usual and frequently appear in abnormal locations within the epithe- lium. In dysplastic stratified squamous epithelium, mitoses are not confined to the basal layers, where they normally occur, but may be seen at all levels and even in surface cells. There is considerable architectural anarchy. For example, the usual progressive maturation of tall cells in the basal layer to flattened squames on the surface may be lost and replaced by a disordered scrambling of dark basal- appearing cells (Fig. 5-6). When dysplastic changes are marked and involve the entire thickness of the epithelium, the lesion is referred to as carcinoma in situ, a preinvasive stage of cancer (Chapter 18). Although dysplastic changes often are found adjacent to foci of malignant transforma- tion, and long-term studies of cigarette smokers show that epithelial dysplasia almost invariably antedates the appear- ance of cancer, the term dysplasia is not synonymous with cancer; mild to moderate dysplasias that do not involve the entire thickness of the epithelium sometimes regress completely, par- ticularly if inciting causes are removed. -### End" -7494,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about pendred syndrome is?, with the following options: A: 7q mutation, B: Goitre, C: Associated with thyroglossal cyst, D: Congenital sensorineural loss - -### Response: -Pendred syndrome is Congenital sensorineural loss + goitre. -### End" -7495,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following condition is most likely seen in which of the following condition:, with the following options: A: Vitamin D Intoxication, B: Acromegaly, C: Hyper parathyroid, D: None of the above - -### Response: -Ans. C. Hyper parathyroida. The image shows subperiosteal bone resorption of radial aspects of proximal & middle phalanges of 2nd, 3rd, 4th fingersb. This is characteristic radiological feature of hyperparathyroidism. -### End" -7496,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The earliest finding in Diabetic nephropathy is?, with the following options: A: Shrunken kidney is hallmark, B: Fibrin Caps, C: Elevated Creatinine Clearance, D: Urine albumin > 30 mg/dl - -### Response: -For early diagnosis of Diabetic Nephropathy, Quantification of 24-h urinary excretion of albumin is the best screening test. Initiation of ACE inhibitors will prevent progression to ove proteinuria and decline in GFR. Macroalbuminuria(Urinary protein > 550 mg/day) in 3 consecutive samples- A reliable indicator of Diabetic nephropathy. Earliest manifestation of diabetic nephropathy is increased GFR -### End" -7497,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bidextrous approach at what age?, with the following options: A: 4 months, B: 5 months, C: 6 months, D: 3rd year - -### Response: -3 months - Holds an object when placed in hands 4 months - Tries to reach for an object, but overshoots 5 months - Bidextrous grasp 6 months - Unidextrous/palmar grasp -### End" -7498,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child with erythematous non-blanching bosselated lesion on right side of the face, Rx is –, with the following options: A: Erbium laser, B: Nd–YAG laser, C: Flash light pumped dye laser, D: Q ruby laser - -### Response: -""Non blanching bosselated lesion on right side of the face suggests port wine stain"" -Treatment of choice for port-wine stain is a yellow-pulsed dye laser often along with cryogen spray cooling. -### End" -7499,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Leukoreduced blood products have lower WBC&;s than normal by what fold, with the following options: A: 1 log reduction, B: 2 log reduction, C: 3 log reduction, D: 4 log reduction - -### Response: -Leukoreduction is the removal of white blood cells (or leukocytes) from the bloodor blood components supplied for blood transfusion. After the removal of the leukocytes, the blood product is said to be leukoreduced. Reference: GHAI Essential pediatrics, 8th edition -### End" -7500,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Modifications of bur design does not include which of the following?, with the following options: A: Increased use of crosscuts, B: Extended heads on fissure burs, C: Rounding of sharp tip angles, D: Small diameter sizes - -### Response: -As the effectiveness of small burs has increased, they have replaced larger burs in many procedures. -Three other major trends in bur design are discernible: - -Reduced use of crosscuts -Extended heads on fissure burs -Rounding of sharp tip angles.  - -Crosscuts are needed on fissure burs to obtain adequate cutting effectiveness at low speeds, but they are not needed at high speeds. Because crosscut burs used at high speeds tend to produce unduly rough surfaces, many of the crosscut sizes originally developed for lowspeed use have been replaced by noncrosscut instruments of the same dimension for high-speed use. -Ref: Sturdevant's art and science of operative dentistry. 4th edition page 333 -### End" -7501,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 35-year old female presented with a swelling in the neck for the past 2 months, she had the treatment for Hodgkin’s lymphoma when she was 22 years with irradiation. On examination, her vitals were normal, there was a single, firm, irregular nodule, moving with deglutition in the left side of midline. Clinical examination also revealed a single node in the left side of the neck. The most likely clinical diagnosis of this condition is:, with the following options: A: Recurrence of lymphoma, B: Malignant goiter, C: Benign multinodular goiter, D: Toxic nodular goiter - -### Response: -Papillary Carcinoma of Thyroid: - -Accounts for 80% of all thyroid malignancies in iodine-sufficient areas. -MC thyroid cancer in children and individuals exposed to external radiation. -More often in women, 30-40 years. - -Pathology: - -Grossly: Hard and whitish and remain flat on sectioning with a blade with macroscopic calcification, necrosis, or cystic changes. -Multifocality is common (up to 85% of cases) on microscopic examination. -Multifocality is associated with an increased risk of cervical nodal metastases. -Rarely invade adjacent structures such as the trachea, esophagus, and RLN. -Rarely encapsulated (PCT are seldom encapsulated). -Other variants: Tall cell, insular, columnar, diffuse sclerosing, clear cell, trabecular, and poorly differentiated types; account for about 1%; associated with a worse prognosis. - -Histological characteristics of Papillary Carcinoma Thyroid: - -Papillary projections: PTC contains branching papillae of cuboidal epithelial cells -Orphan Annie eyed nuclei: The nuclei contain finely dispersed chromatin, which imparts an optically clear or empty appearance, giving rise to term ground glass or Orphan Annie eyed nuclei. -Invaginations of cytoplasm in cross-sections: Intranuclear inclusions (pseudo-inclusion) or intranuclear grooves. -Diagnosis of PTC is based on these nuclear characteristics even in the absence of papillary structures. -Psammoma bodies: Microscopic, calcified deposits representing clumps of sloughed cells. - -Clinical Features: - -Most patients are euthyroid and present with a slow-growing painless mass in the neck. -Dysphagia, dyspnea and dysphonia are associated with locally advanced invasive disease. -Lymph node metastases are common, especially in children and young adults, and may be the presenting complaint. -“Lateral aberrant thyroid” almost always denotes a cervical lymph node that has been invaded by metastatic cancer. -Distant metastases are uncommon at initial presentation, but may ultimately develop in up to 20% of patients. -The MC sites of metastasis: Lungs >bone >liver >brain. - -Diagnosis: - -Diagnosis is established by FNAC of the thyroid mass or lymph node. -Once thyroid cancer is diagnosed on FNAC, a complete neck ultrasound to evaluate the contralateral lobe and for LN metastases in the central and lateral neck compartments. - -Treatment: Total or near-total thyroidectomy - -During thyroidectomy, enlarged central neck nodes should be removed. -Biopsy-proven lymph node metastases detected clinically or by imaging in the lateral neck in patients with papillary carcinoma are managed with modified radical neck dissection.  - -Prognosis: - -PTC have an excellent prognosis with a >95% 10-year survival rate -### End" -7502,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The length of a muscle at which tension is maximum is called:, with the following options: A: Active length, B: Resting length, C: Optimal length, D: Maximal length - -### Response: -When a muscle at rest is stretched, its sarcomere length is changed. When this muscle is made to contract from the various lengths at rest, contractile force developed varies according to the actin-myosin interaction possible within the sarcomere. Resting length of sarcomere = 2 m. This is Li or length initial. Contractile force increases as muscle length is increased up to a point. Sarcomere length of 2.2 m obtains maximum force of contraction. (Starling's law: Greater the fiber length, stronger will be the contractile force). This is Lo or length optimum. At this length, there is optimum interdigitation between actin and myosin. -### End" -7503,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the surgery of choice for diffuse type of choledochal cyst, with the following options: A: Resection and repair, B: Rouxeny hepaticojejunostomy, C: Liver transplant, D: Observation - -### Response: -Diffuse dilatation of the CBD is treated with resection and roux en y hepaticojejunostomy -### End" -7504,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Superfecundation is, with the following options: A: Fertilisation of two ova discharged within same menstrual cycle, by two different acts of coitus, B: Fertilisation of two ova discharged from ovary at different periods of ovulation, C: Both of the above, D: None of the above - -### Response: -Optios b is superfetation. -### End" -7505,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PQLI includes -, with the following options: A: IMR, B: Life expectancy at birth, C: MMR, D: Per capita income - -### Response: -Subjective component of well being → Quality of life -While ""level of living"" is an objective component, ""quality of life"" comprises the individual's own subjective evaluation. -The index for quality of life is ""Physical quality of life index (PQLI) 99. -The PQLI is an attemt to measure quality of life or well-being of a country, -Physical quality of life index consolidates three indicators :- -Literacy rate -Infant mortality rate -Life expectancy at age 1 year (LE) -PQLI ranges from 0 to 100 -PQLI in India is 65. -### End" -7506,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cupola sign –, with the following options: A: Radiological finding in supine posture for pneumoperitoneum, B: Radiological finding in supine posture for pneumothorax, C: Air in Morrison pouch, D: Both wall of bowel is seen - -### Response: -Cupola sign is seen in supine film of pneumoperitoneum -### End" -7507,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which portion of MHC 1 complex forms the component of antigen presenting part :, with the following options: A: Between alpha 1 – beta 2 microglobulin, B: Distal part of alpha chain, C: Proximal part of alpha chain, D: Between aS and b2 microglobulin - -### Response: -Antigen Presenting part of MHC -MHC I/HLAI : -Class 1 molecule consists of a three domains of heavy alpha peptide chain (a1 ; a2; a3) which are non-covalently linked to smaller -β2 microglobulin peptide. -The distal domain (alpha 1 and alpha 2) of MCH 1 have highly variable amino acid sequences and are folded to form a cavity or groove. -Protein antigens are bound to this groove for presentation to CD8 T cells. MHC II/HLA II : -MHC II antigens are heterodimer consisting of an alpha and beta chain. Each chain has two domain proximal one is constant and distal one is variable. -The two distal domain (alpha 1, beta 1) constitute the antigen binding site, for recognition by CD4 T cells. -Both class 1 and class 2 are members of immunoglobulin gene super family. -MHC III /HLA III -§ MHC III are heterogenous they include complement components involved in the formation of C3 convertase, heat shock protein and tumor necrosis factor. -### End" -7508,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Epinephrine action in liver, with the following options: A: Glycolysis, B: Lipolysis, C: Glycogenolysis, D: Gluconeogenesis - -### Response: -Epinephrine markedly stimulates glycogen breakdown in muscle and, to a lesser extent, in the liver. The liver is more responsive to glucagon, a polypeptide hormone that is secreted by the a cells of the pancreas when the blood-sugar level is low Ref: guyton and hall textbook of medical physiology 12 edition page number:419,420,421 -### End" -7509,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 19-year-old boy was posted for emergency repair of the ruptured globe .The patient had last meal 5 hr ago. Which among the following is anesthetic technique of choice in this patient ?, with the following options: A: Retrobulbar block, B: Subtenon block, C: General anesthesia, D: Peribulbar block - -### Response: -Anesthetic technique of choice for emergency repair of the ruptured globe in full stomach patients is General anesthesia--despite the increased risk of aspiration pneumonia . The patient is considered to have a full stomach if the injury occurred within 8 hr after the last meal, even if the patient did not eat for several hours after the injury Although Retrobulbar block, Subtenon block and Peribulbar block minimizes the risk of aspiration pneumonia, it is still C/I in patients with penetrating eye injuries Because injecting local anesthetic behind the globe increases intraocular pressure and may lead to expulsion of intraocular contents. -### End" -7510,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 58-year-old man with no prior cardiac history presents to the emergency department with symptoms of retrosternal chest pain starting at rest and lasting 30 minutes. The pain radiates to the left arm and is associated with diaphoresis and dyspnea.On physical examination, his blood pressure is 150/90 mm Hg, pulse is 100/min, the heart sounds are normal, and the lungs are clear to auscultation. Which of the following is the next most appropriate investigation?, with the following options: A: CT scan - chest, B: CXR, C: cardiac troponin, D: ECG - -### Response: -This man has acute coronary syndrome (ACS) until proven otherwise. The ECG is the most useful initial investigation since it identifies individuals with ST-segment elevation who maybe candidates for either thrombolysis or primary angioplasty (PCI). The troponins are important in diagnosing myocardial necrosis. The other investigations may be important in looking for alternate causes of chest pain once ST-elevation MI has been ruled out. -### End" -7511,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False about Borderline personality disorder?, with the following options: A: Self image, B: Impulsivity, C: Self mutilation behavior, D: Attention seeking behavior - -### Response: -Ans is 'd' i.e. Attention seeking behavior Borderline personality disorder* The central feature of borderline personality disorder is a pervasive pattern of unstable and intense interpersonal relationship, self perception and mood.* The patient make recurrent suicidal threats and gesture and a small proportion of patients carry out the act or self mutilation like cutting or burning.* The patients have difficulty in controlling their anger and impulsitivity.* There is uncertainty about personal identity.About other options* Violation of the rules - Antisocial (Dissocial) personality disorder* Grandiose - Narcissistic personality disorder* Attention seeking behavior - Histrionic personality disorder -### End" -7512,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An Example of a tumour suppressor gene is:, with the following options: A: myc, B: fos, C: ras, D: RB - -### Response: -RB -### End" -7513,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Placido disc is used for measuring?, with the following options: A: Corneal thickness, B: Corneal surface, C: Corneal staining, D: Corneal curvature - -### Response: -Ans. (b) Corneal surface -### End" -7514,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nocardia can be differentiated from other Actinomyces by, with the following options: A: ZN staining, B: Fontana stain, C: Gram staining, D: Oxygen requirement - -### Response: -Actinomyces - on ZN staining- central pa as non-acid fast surrounded by acid-fast clubs( antigen-antibody complex ). Nocardia- on ZN staining - acid-fast. Nocardia species are aerobic. Reference: Textbook of Microbiology; Ananthanarayan and paniker's; 10th edition; Pg: 398 -### End" -7515,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: While giving incision for third molar trans-alveolar extraction, if the posterior extension of the incision is given in straight line, it would damage the lingual nerve, because?, with the following options: A: The blade has tendency to cut nerve before muscle, B: Mandible ramus diverges laterally, C: Temporalis fibers are resistant to cut, D: Non of the above - -### Response: -Due to the lateral diversion of the mandibular ramus, posterior extent of the incision must extend laterally to the anterior ramus, to prevent damage to the lingual nerve. -### End" -7516,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following cause inhibition of CYP3A except:, with the following options: A: Saquinavir, B: Ritonavir, C: Itraconazole, D: Erythromycin - -### Response: -Five protease inhibitors-Indinavir (IDV), Nelfinavir (NFV), Saquinavir (SQV), Ritonavir (V) and Lopinavir. This protease acts at a late step in HIV replication, i.e. maturation of the new virus paicles when the RNA genome acquires the core proteins and enzymes,They bind to the protease molecule, interfere with its cleaving function, and are more effective viral inhibitors than AZT. Because they act at a late step of viral cycle, they are effective in both newly and chronically infected cells. Under their influence, HIV-infected cells produce immature noninfectious viral progeny-hence prevent fuher rounds of infection. Ritonavir:It is a potent PI; also a potent CYP3A4 inhibitor. Saquinavir :Two types of formulations (hard gel and soft gel capsules) with differing, but low oral bioavailability have been produced. The tablet load is large and side effects are frequent; photosensitivity can occur. It is a weak inhibitor of CYP3A4. ltraconazole: This newer orally active triazole antifungal has a broader spectrum of activity than KTZ or fluconazole;It is largely metabolized in liver by CYP3A4; an active metabolite is produced which is excreted in faeces ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:764,773 -### End" -7517,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Complications of benign ovarian tumors are ail except :, with the following options: A: Torsion, B: Bleeding, C: Pseudomyxoma, D: Metastasis - -### Response: -Metastasis -### End" -7518,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young girl presented with swelling of right thigh, with history of trauma 2 months back. Now she presents with swelling at mid-shaft of femur & low grade fever. ESR is mildly raised. X-ray shows a laminated periosteal reaction. Next line of investigation would be -, with the following options: A: MRI, B: Biopsy, C: Bone scan, D: Blood count & CRP - -### Response: -OSTEOSARCOMA : Classification * PRIMARY or SECONDARY * PRIMARY OSTEOSARCOMAS (15 - 25 yrs) Conventional /classic osteosarcoma (high grade, intra medullar y) Low-grade intramedullary osteosarcoma Paraosteal osteosarcoma Periosteal osteosarcoma High-grade surface osteosarcoma Telangiectatic osteosarcoma, and Small cell osteosarcoma. * SECONDARY OSTEOSARCOMAS * Osteosarcoma occurring at the site of another disease process. * more common in >50 years of age most commonly a/w premalignant condition like - Paget disease - Previous radiation treatment - endochondromatosis - Fibrous dysplasia - Osteochondromas - Osteogenesis imperfecta Clinical Presentation * Pain- progressive pain paicularly with activity. * Swelling - Palpable mass in the region of metaphysis. - skin over the swelling shiny with prominent veins. - swelling may be warm & tender. * Decreased range of motion of the involved joint. * Lymphadenopathy - unusual focal & regional lymph node involvement. * Respiratory finding - late stage with lung metastasis. * Fever & night sweats are rare. Treatment Radioloical staging Biopsy to confirm diagnosis Preo perat ivhemotherapy Repeat radiological staging (access chemo response, finalize surgical treatmeni Ian) Surgical resecting with wide margin Reconstruction using one of many techniques Post op chemo based on preop response ref : maheswari 9th ed -### End" -7519,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The term schizophrenia was coined by, with the following options: A: Erich muir, B: Sigmund freud, C: Bluelar, D: Emil kraeplin - -### Response: -Emil Kraepelin: Manic-Depressive Psychosis and Dementia Praecox (dementia of the young). Eugen Bleuler - schizophrenia-""splitting"" of psychic functions*. His four primary symptoms (four As) were Abnormal associations, Autistic behavior, and thinking, Abnormal affect, Ambivalence. Ku Schneider First Rank Symptoms Second-Rank Symptoms Audible thoughts Voices arguing or discussing(commanding voices) Voices commenting on patient's actions (commenting voices) Made feelings Made impulses or drives Made volitional acts Thought withdrawal Thought inseion Thought broadcasting Delusional perception Somatic Passivity Other disorders of perception Sudden delusional ideas Perplexity Depressive and euphoric mood changes Feelings of emotional impoverishment and several others as well . pneumonic 3HMT-DP Reference: Page No.1434 chap 12.2 Phenomenology of Schizophrenia (Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition) -### End" -7520,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Psammoma bodies seen in all except:, with the following options: A: Follicular Ca of thyroid, B: Papillary Ca of thyroid, C: Serous cystadenocarcinoma of ovary, D: Meningioma - -### Response: -. Follicular Ca of thyroid -### End" -7521,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The trochlear nerve innervates:, with the following options: A: Superior oblique, B: Inferior oblique, C: Lateral rectus, D: Superior rectus - -### Response: -(Superior oblique): Ref: 108-109-BDC-3NERVE SUPPLY OF EXTRAOCULAR MUSCLES ISO-4, LR-6, AO-31* Superior oblique - Trochlear nerve (SO-4)* Lateral rectus - Abducent nerve (LR - 6)* Superior, inferior and medial reacti, inferior - Oculomotor nerve (AO i.e. all others - 3)In fourth nerve paralysis: The patient complaints of double vision on looking straight downward, this is because the superior oblique is paralyzed and the eye turns medially as the inferior rectus pulls the eye downward (910- Snell 7th)The trochlear nerve is a motor nerve, the most slender of the cranial nerves leaves the posterior surface of the mid brain and immediately decussates with the nerve of the opposite side. -### End" -7522,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Insal-Salvati index is used for, with the following options: A: Olecranon, B: Patella, C: Talus, D: Scaphoid - -### Response: -a-length of patellar ligament b-length of patella INSAL-SALVATI index=a/b Normal range is 0.8 -1.2 If ratio increases it suggests patella is at a higher level-PATELLA ALTA If ratio decreases it suggests patella is at a lower level -PATELLA BAHA ref:apley's 9th edition pg no.565 -### End" -7523,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Natural stiffening of muscles after death is known as?, with the following options: A: Algor mortis, B: Rigor mortis, C: Postmortemlividity, D: Cadaveric spasm - -### Response: -Ans. is 'b' i.e. Rigor mortis Rigor mortiso It is defined as contraction, stiffening, shortenig and opacity of muscles after death.o It occurs after molecular (cellular) death. In tropical countries (e.g. india), it begins 1-2 hours after death, takes further 2 hours to develop, and lasts for 18-36 hours in summer and 24-48 hours in winter.o In temperate countries, it begins in 3-6 hours, takes further 2-3 hours to develop and lasts for 2-3 days.o All muscles of body are involved, i .e. voluntary or involuntary.o However, it does not start in all muscles simultaneously (nysten's rule).o Involuntary muscles (heart) are involved first than voluntary muscles.o Sequence of muscles involvement is as follows : Heart > upper eyelid > neck > jaw > face > chest > upper limb > abdomen > lower limb > finger and toes.o It passes off in the same order in which it has appeared.Note:o Cadaveric spasm is not natural stiffening. It is defined as the condition wherein a group of muscles, which were in contraction or spasm at the time of death, continue to be in spasm even after death, without the stage of primary relaxation. It does not occur in all deaths (unlike rigor mortis, which occurs in all deaths). -### End" -7524,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acquired extra – cranial infection that causes aqueductal Stenosis is –, with the following options: A: Bacterial endocarditis, B: Mumps, C: Measles, D: Staphylococcal septicemia - -### Response: -Aqueductal stenosis - -Causes of acquired aqueductal stenosis - -Neonatal meningitis                       o Intrauterine viral infections -Subarachnoid hemorrhage              o Mumps meningoencephalitis -### End" -7525,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Basophilic stippling is seen with, with the following options: A: Thalassaemia, B: Sickle cell anemia, C: Megaloblastic anemia, D: Splenectomy - -### Response: -i.e. (Thalassaemia) : (292-Harsh mohan 6th) (658-H17th/6th)Punctate basophilia or basophilic stippling is diffuse and uniform basophilic granularity in the cell which does not stain positively with Perl's reaction (in contrast to pappenhamer bodies which stain positively)Examples -* Aplastic anaemia* Thalassaemia* Myelodysplasia* Infections* Lead poisoning* Howell -Jolly bodies - present in Megaloblastic anemia and after splenectomy* Basophilic leucocytosis indicative of CML**PYRIMIDINE 5' - NUCLEOTIDASE (PSN) DEFICIENCY - Highly distinctive feature of this condition is a morphological abnormality of the red cells known as basophilic stippling. This condition is rare but it probably ranks third in frequency among red cell enzyme defects (after G6PD deficiency and pyruvate Kinase deficiency) (658-H17th) -### End" -7526,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Karsakoff's Psychosis is diagnosed by, with the following options: A: Peripheral neuropathy, B: Visual hallucination, C: Impairment of long term memory, D: Seizures - -### Response: -C i.e. Impairment of long term memory -### End" -7527,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Substance with same atomic number but different mass number, with the following options: A: Isotope, B: Isobar, C: Atom, D: Mineral - -### Response: -Ans. a (Isotope). (Ref. Radioactive isotope in medicine and biology by Quimby, 2nd ed., 26)TermDefinitionIsotopesAtoms having same atomic numbers, different mass numbers (hence different neutron number) e.g., 17CI35, 17CI37 (same no.of protons and electrons)IsobarsAtoms having same mass numbers, different atomic number (hence different neutron number) e.g., 28Ni64, 30Zn64IsotonesAtoms have same neutron number, different atomic mass number e.g., 18A40IsomersAtoms having same atomic and mass numbers but different energy states in nucleus. -### End" -7528,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Maltese cross is seen on polarizing microscopy in -, with the following options: A: Cryptococcus neoformans, B: Penicillium marneffei, C: Blastomyces, D: Candida albicans - -### Response: -Maltese cross pattern under polarized light is seen in:- Babesia, Cryptococcus, Aspergillus nidulans, starch granules and lipid (cholesterol) droplets. - -""Fungal ball due to Aspergillus nidulans have a propensity to produce pale staining thick walled non-viable null cells that show maltese cross birefringence when examined under the polarized light"". -""On the polarized light, the spores in cryptococcus give maltese cross appearance"". -""Babesia microti is associated with maltese cross forms and ring forms"". -""Starch granules and fat (cholesterol) droplets produce a maltese cross pattern in the polarized light"". -### End" -7529,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Punishment for culpable homicide not amounting to murder is covered under, with the following options: A: Sec 269 IPC, B: Sec 304 IPC, C: Sec 300 IPC, D: Sec 302 IPC - -### Response: -Refer the byte ""Legal sections"". -### End" -7530,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Paget-Schroetter syndrome is, with the following options: A: Primary lower limb DVT, B: Primary upper limb DVT, C: Femoral vein compression, D: Pelvic vein compression - -### Response: -Primary upper limb deep vein thrombosis is Paget Schroetter syndrome is due to subclavian vein compression that occurs in thoracic outlet syndrome. -### End" -7531,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Exclamation mark hair pattern is seen in, with the following options: A: Alopecia areata, B: Androgenic alopecia, C: Anagen effluvium, D: Telogen effluvium - -### Response: -Alopecia areata - autoimmune condition Exclamation mark - These are broken hair follicles with broad distal and thin proximal shaft It is pathognomonic of alopecia areata but not always found. -### End" -7532,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 28 years old lady is suspected to have polycystic ovarian disease. Sample for testing LH & FSH are best taken on the following days of menstrual cycle:, with the following options: A: 4-Jan, B: 10-Aug, C: 13-15, D: 24-26 - -### Response: -In PCOS, determination of FSH and LH levels may help to confirm the diagnosis of polycystic ovaries.These are assayed on 2nd or 3rd day of the cycle. -### End" -7533,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anatomic dead space in a non smoker under normal conditions is:, with the following options: A: 2.2 cc/kg, B: 5.1 cc/kg, C: 3.1 cc/kg, D: 1.5 cc/kg - -### Response: -Approximately 30% of each breath does not paicipate in alveolar gas exchange and is thus called dead space ventilation (VDS). Dead space ventilation is made up of anatomic dead space and alveolar dead space. Anatomic dead space is the volume of air that fills the conducting airways (trachea, bronchi, and bronchioles) and is estimated at approximately 2.2 cc/kg. The combination of alveolar and anatomic dead space is called the physiologic dead space. Ref: Slesinger T.L. (2011). Chapter 20. Blood Gases. In R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. -### End" -7534,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Bullous myringitis is caused by?, with the following options: A: Pseudomonas, B: Mycoplasma, C: Pneumococcus, D: Candida - -### Response: -It is a painful condition characterised by the formation of hemorrhagic blebs on the tympanic membrane and deep meatus. It is probably caused by a virus or Mycoplasma pneumonia. ( Ref: Textbook of diseases of ENT, 7TH edition, PL Dhingra, pg no. 58) -### End" -7535,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following muscles of the pectoral girdle are innervated by branches from the brachial plexus: except:, with the following options: A: Subclavius, B: Serratus anterior, C: Rhomboid major, D: Trapezius - -### Response: -Trapezius is supplied by spinal pa of cranial nerve XI -### End" -7536,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Components of epithalamus include all except, with the following options: A: Habenula, B: Striae medullaris, C: Striae terminalis, D: Pineal gland - -### Response: -Epithalamus consists of  - -Dorsal segment of diencephalon -Habenula -Striae medullaris -Pineal gland -### End" -7537,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Superotemporal dislocation of the lens is seen in, with the following options: A: Marfan's syndrome, B: Homocystinuria, C: Weil Marchesani syndrome, D: Alpo's Syndrome - -### Response: -(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 215 - 216)Types of lens dislocations in various disease:Marfan syndrome-superotemporalHomocystinuria-InferonasalWeil-Marchesani syndrome-forward -### End" -7538,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The term &;Id&; was coined by-, with the following options: A: Freud, B: Skinner, C: Wayker, D: BlueIer - -### Response: -Ans. is 'a' i.e., Freud o Structural theory of mind (the id, ego and superego) was given by sigmund freud.Structural theory of mindo Freud coined the term ""The Ego and The Id"", and divided the mental apparatus (Personality) into three dynamic structures : -The Id :- The id is the only component of personality that is present from birth. This aspect of personality is entirely unconscious and includes the instinctive and primitive reflexive behavior. The Id is the source of all psychic energy, making it the primary component of personality. The id is driven by the pleasure principle, which strives for immediate gratification of all desires, wants, and needs. If these needs are not satisfied immediately, the result is a state anxiety or tension. For example, an increase in hunger or thirst should produce an immediate attempt to eat or drink. The id is very important early in life, because it ensures that an infant's needs are met. If the infant is hungry, he or she will cry until the demands of id are met.The Ego :- The ego is the component of personality that is responsible for dealing with reality. The ego develops from the id and ensures that the impulses of the id can be expressed in manner acceptable in the real world. The ego functions in conscious, preconscious and unconscious mind. The ego operates based on the reality principle, which strives to satisfy1 the Id's desires in realistic and socially appropriate ways. The superego :- The last component of personality to develop is the superego. The superego is the aspect of personality that holds all of our internalized moral standards and ideals that we acquire from both parents and societyOur sense of right and wrong. The superego based on idealism principle and acts to perfect and civilize our behavior. It works to supress all unacceptable urge of id, i.e.. It tries to prove or disprove the urge of Id, and struggles to make the ego act upon idealistic standards rather than upon realistic principles. The activities of superego occur largely unconscious. There are two components of superego : -The ego ideal: - Includes rules and standard for good behaviors. These behaviors include those which approved of by parental and other authority figures. Obeying these rules leads to feeling pride, value and accomplishment.The conscience : - Include information about things that are viewed as bad by parents and society. These behaviours are often forbidden and lead to bad consequences, punishments or feeling of guilt or remorse. -### End" -7539,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following differentiates Hodgkin's lymphoma from non Hodgkins lymphoma?, with the following options: A: Fever, night sweat, weight loss, B: Generalized lymphadenopathy, C: Elderly, D: Reed stem berg cells - -### Response: -ANSWER: (D) Reed stern berg cellsREF: Robbing 7th ed p. 669The differentiation between Hodgkin and non Hodgkin can be reliably done by histopathological examination and Reed Sternberg cells Is very characterstic of hodgkins lymphoma.* The clinical features of both the diseases can be very similar and distinction is difficult to be made on clinical grounds alone at times. Both types of lymphoma may also be associated with general symptoms of weight loss, fevers, and night sweatsDIFFERENCES BETWEEN HODGKIN'S AND NON HODGKIN'S DISEASE:Hodgkin'sNon hodgkin s* Less common* Bimodal distribution , more common in young* More often localised to single group of axial lymph nodes ( cervical , mediastinal , para aortic )* Orderly spread by contiguity * Mesentric and waldeyer's nodes rarely involved* Extranodal involvement uncommon* Reed stern berg cell seen* More common* Occurs in elderly only* Multiple periferal nodes* Non contigous spread* Commonly Involved* Extranodal involvement common* Reed stemberg cell not seen -### End" -7540,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Raised intracranial pressure should be suspected when there is, with the following options: A: Neck stiffness, B: Sixth cranial nerve palsy, C: Episodic unilateral headache, D: Unilateral ptosis - -### Response: -Manifestations of raised intracranial pressure Loss of consciousness 6th nerve palsyAnisocoriaCheyne- Stokes breathingHeadacheDecreased vision Seizures Enlarged blind spot Bilateral ptosis Back pain PapilledemaCushing's triad - increased systolic blood pressure, a widened pulse pressure, bradycardia, and an abnormal respiratory patternPersonality or behavioral changesCranial nerve palsies(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 238-239) -### End" -7541,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Fungi without sexual cycle are classified as:, with the following options: A: Fungi imperfecti, B: Phycomycetes, C: Ascomytcetes, D: Basidiomycetes - -### Response: -Fungi have classified into phylums according to the three types of sexual spores formed by them. Basidiomycetes form sexual spores called basidiospores. Ascomycetes form sexual spores called ascospores. Phycomycetes or zygomycetes form sexual spores called zygospores. Fungi imperfecta or deuteromycetes are those fungi where the sexual spores have not been identified yet. -### End" -7542,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Local anaesthesia acts by -, with the following options: A: Na+ channel inhibition, B: Ca++ channel inhibition, C: Mg++ channel inhibition, D: K- channel inhibition - -### Response: -Ans. is 'a' i.e., Na+ channel Mechanism of action of LAo Local anaesthetics block generation and conduction of nerve impulse at all part of neuron where they come in contact, without causing structural damage.o Thus not only sensoiy but motor impulses and autonomic control is also interrupted.o Mechanism of action# Normally Na+ channel in axonal membrane has following phases: RecoveryResting (close)-Active (open)-Inactive (open)LAs prolong the inactive state channel takes longer to recover - refractory period of the fiber is increased.LAs first penetrate the axonol membrane to come inside and then their active species (cationic form) bind to Na+ channel from inside.Cationic form (active form) is able to approach its receptor only when the channel is open at the inner face - So resting nerve is resistant to block as Na+ channels are not activated and cationic form is not able to approach its receptor.So blockade develops rapidly when the nerve is stimulated repeatedly.Degree of blockade is frequency dependent - greater blockade at higher frequency of stimulation.Exposure to higher concentration of Ca+2 reduces inactivation of Na+ channels and lessens the block.o Order of blockade of fibres B > C > Ad > Aa, b& g (Autonomic > Sensory > Motor). Order of recovery is in reverse order.o Among sensory afferent order of block is : Temperature (cold before heat) > Pain > touch > deep pressure,o When applied to tongue, bitter taste is lost first followed by sw'eet and sour, and salty taste last of all.o Myelinated nerves are blocked earlier than nonmyelinated,o Smaller fibres are more sensitive than larger fibres. -### End" -7543,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Modified BPP consists of:, with the following options: A: NST with AFI, B: NST with fetal breathing, C: NST with fetal movement, D: NST with fetal tone - -### Response: -Ans. a. NST with amniotic fluid index (Ref: Williams Obstetrics 24/e p342. 343)Modified Biophysical profile consists of NST with amniotic fluid index.Modified Biophysical Profile: Because the biophysical profile is labor intensive and requires a person trained in sonography, Clark and coworkers (1989) used an abbreviated biophysical profile as a first-line screening test in 2628 singleton pregnancies. Specifically, a vibroacoustic nonstress test was performed twice weekly and combined with amnionic fluid index determination for which < 5 cm was considered abnormal. This abbreviated biophysical profile required approximately 10 minutes to perform, and they concluded that it was a superb antepartum surveillance method because there were no unexpected fetal deaths. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics (2012) have concluded that the modified biophysical profile test is as predictive of fetal well-being as other approaches to biophysical fetal surveillance. ''-- Williams Obstetrics 24/e 343Biophysical ProfileManning proposed combined use of 5 fetal biophysical variables as a more accurate means of assessing fetal health than a single elementQ.Typically, these tests require 30 to 60 minutes of examiner tuneQ.5 fetal biophysical components assessed: (1) heart rate acceleration, (2) breathing, (3) movements, (4) tone, and (5) amniotic fluid volumeQ.Normal variables were assigned a score of 2 each, and abnormal variables were given a score of 0Q.Highest score possible for a normal fetus is 10Q.Components and Scores for the Biophysical ProfileComponentScore 2Score 0Non stresstest> 2 acceleration of > 15 beats/min for > 15 sec within 20-40 min0 or 1 acceleration within 20- 40 minutesFetal breathing> 1 episode of rhythmic breathing lasting > 30 sec within 30 min< 30 sec of breathing within 30Fetal movement> 3 discrete body or limb movements within 30 min< 3 discrete movementsFetal tone> 1 episode of extremity extension and subsequent return to flexion0 exiension/flextion eventsAmniotic fluid volumeA pocket of amniotic fluid that measure at least 2 cm in two planes perpendicular to each other (2 x 2 cm pocket)Largest single vertical pocket < 2 Interpretation of Biophysical Profile ScoreBiophysical profile ScoreInterpretationRecommended Management10Normal, non-asphyxiated fetus* No fetal indication for intervention, repeat test weekly except in diabetic patients & Post-term pregnancy (twice weekly)8/10 (Normal AFV) 8/8 (NST not done)Normal, non-asphyxiated fetus* No fetal indication for intervention; repeat testing as per protocol8/10 (Decreased AFV)Chronic fetal asphyxiasuspected* Deliver6Possible fetal asphyxia* If amniotic fluid volume abnormal, deliver* If normal fluid at > 36 weeks with favourable Cervix, deliver* If repeat test > 6, deliver* If repeat test > 6, observe, and repeat as per protocol4Probable fetal asphyxia* Repeat testing same day; if biophysical profile score < 6, deliver0 to 2Almost certain fetal asphyxia* Deliver -### End" -7544,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are neurologic channelopathies except:, with the following options: A: Episodic ataxia type 1, B: Spinocerebellar ataxia 1, C: Familial hemiplegic migraine, D: Hypokalemic periodic paralysis - -### Response: -Spinocerebellar ataxia (SCA) type 1 is not a neurological channelopathy. But SCA type 6 is a neurological channelopathy. Channelopathies refers to a wide variety of neurologic diseases caused by dysfunction of ion channels in the excitable membranes. These are due to inherited mutations of genes encoding ion channels in muscle, neurons and glia. Severe myoclonic epilepsy of infancy, episodic ataxia type 1, 2, familial hemiplegic migraine, spinocerebellar ataxia type 6 are examples of neurologic channelopathy. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 373; A-Z of Neurological Practice: A Guide to Clinical Neurology By Andrew J. Larner, 2nd Edition, Page 122 -### End" -7545,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the most common microorganism found in pediatric subacute infec ve endocarditis?, with the following options: A: Staph aureus, B: Strep viridans, C: E. coli, D: Pneumococci - -### Response: -. -### End" -7546,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cerebral salt wasting occurs due to which of the following?, with the following options: A: SIADH, B: Hyper secretion of ANP, C: Low coisol secretion, D: Low aldosterone secretion - -### Response: -. -### End" -7547,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cicatrising alopecia with perifollicular blue-gray patches hyperpigmentation is most commonly associated with:, with the following options: A: Pitting of nails, B: Whitish lesions in the buccal mucosa, C: Ahritis, D: Discoid plaques in the face - -### Response: -B i.e. Whitish lesions in the buccal mucosa Cicatrising alopecia with perifollicular erythema / hyperpigmentation/ hyperkeratosis & scaleQ are seen in lichen planus (lichen planopilaris or spinosus et folliculitis decalvans). Whereas, Ciratrising alopecia with follicular accentuation/ widening/ dilation and keratotic plugging (i.e dilated hyperpigtnented follicular orifices)Q. are seen in DLE. -### End" -7548,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Proteus isolated from a patient of UTI will show which biochemical reaction-, with the following options: A: Phenyl-pyruvic acid reaction, B: Bile esculine reaction, C: Colchicin sensitivity, D: Bacitracin sensitivity - -### Response: -Ans. is 'a' i.e., Phenyl-pyruvic acid reaction Proteuso They are gram negative, non capsulated, pleomorphic, motile bacilli.o Proteus bacilli are divided in to three genera.# Proteus-Proteus vulgaris, Proteus mirabilis# Morganella-Morganella morganii# Providencia-Prov. alcalifaciens, Prov stuartii, Prov. rettgerio Most of them except providencia strains, produce powerful ureaseo Acharacterstic feature of proteus bacilli is ""PPA reaction""o It is due to presence of enzyme phenylalanine deaminase which converts phenylalanine to phenyl pyruvic acid,o Culture of proteus bacilli have a characteristic putrefactive odour described as ""fishy or seminar.o They produce swarming growth over the surface of agar, except for morganella morganni which does not swarmo Dienes phenomenon is used to detect swarming growth (Note: Dienes method is used to study mycoplasma colony)o Some non motile proteus strains (OX-2, OX-19 and OX-K) are used in weil-felix agglutination reaction for the diagnosis of rickettsiae infections.o Proteus mirabilis is an important cause of urinary and septic infections, often nosocomialo Proteus bacilli are resistant to many of common antibiotics. An exception is Pr. mirabilis which is senstive to ampicillin and cephalosporins.o Their ability to generate histamine form contaminated fish has implicated in the pathogenesis of scombroid poisoning.o Proteus produces phosphate stanes in kidney as it produces ammonia and contributes to alkalinity which leads to necrosis of renal tubular epithelium with precipitation of phosphate stones. -### End" -7549,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding symmetric IUGR except, with the following options: A: Obstretic cause like utero - placental in sufficiency, B: Ponderal index >2, C: Problem occuring in first trimerter, D: Brain growth (head circum ference) spared - -### Response: -IUGR: Evidence of wasting + - - - -  -Symmetric IUGR -Asymmetric IUGR - - -Timing of problem -Problem in first and - early second trimester -Problem in last second and - third trimester - - -Cause  -TORCH infection - Chromosomal anamoly -Maternal problems: - Maternal hypertension - Placental insufficiency - - -  -Head to foot are - equally affected -Brain growth (head - circumference) spared - - - -Ponderal index (PI) - PI = Weight (gm) X 100 -        Length (cm3) - ->2 -<2 -### End" -7550,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following muscle is not inseed into the dorsal digital expansion of ring finger ?, with the following options: A: Fouh dorsal interossei, B: Third palmar interossei, C: Fouh lumbricals, D: Extensor digitorum - -### Response: -The dorsal digital expansion (extensor expansion) is a small triangular aponeurosis (related to each tendon of the extensor digitorum) covering the dorsum of the proximal phalanx. Its base, which is proximal, covers the metacarpophalangeal (MP)joint. The main tendon of the extensor digitorum occupies the central pa of the extension, and is separated from the MP joint by a bursa The muscles inseed into the dorsal digital expansions of Ring finger: Fouh dorsal interosseous, third palmar interosseous, third lumbrical and extensor digitorum slip. REF - BDC 6th e p135 -### End" -7551,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hollow ground bevel is?, with the following options: A: Knife edge, B: Exaggerated chamfer, C: Shoulder, D: Shoulder with bevel - -### Response: -Hollow ground (concave) bevel: - -Used when  cusp required to cover with cast metal -Prepared with 12 fluted round ended bur -Provide sufficient bulk of restoration at cavosurface margin -It is an exaggerated chamfer basically -Also known as concave bevel -In posterior ceramic restorations at cavosurface angle hollow-ground chamfer confined to the marginal enamel will aid in developing a more effective seal -### End" -7552,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Drug given for metoclopramide induced dystonic reaction is:, with the following options: A: Pheniramine, B: Promethazine, C: Chlorpromazine, D: Prochlorperazine - -### Response: -Ans. (B) Promethazine(Ref: KDT 8th/e p180)""Acute muscle dystonia caused by antiemetic-antipsychotic drugs is promptly relieved by parenteral promethazine or hydroxyzine"" This is based on central anti-cholinergic action of the drugs.Promethazine is a first generation anti-histaminic which has maximum penetration of blood brain barrier and maximum anticholinergic activity. -### End" -7553,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a patient with blood pressure of 90/60 mm of Hg, blood drawn was chocolate colored, lips and peripheries were cyanosed. The condition is due to?, with the following options: A: Methaemoglobinemia, B: Hypovolumic shock, C: Cardiogenic shock, D: Hemorrhagic shock - -### Response: -ANSWER: (A) MethaemoglobinemiaREF: Harrisons Internal Medicine 17th edition Chapter 99. Disorders of Hemoglobin Methemoglobinemia:Methemoglobin is generated by oxidation of the heme iron moieties to the ferric state, causing a characteristic bluish-brown muddy color resembling cyanosis. Methemoglobin has such high oxygen affinity that virtually no oxygen is delivered.Hypotension is seen in methemoglobinemia due to hemolysisMethemoglobin should be suspected in patients with hypoxic symptoms who appear cyanotic but have a Pa02 sufficiently high that hemoglobin should be fully saturated with oxygen.A history of nitrite or other oxidant ingestions may not always be available; some exposures may be unapparent to the patient, and others may result from suicide attempts.The characteristic muddy appearance of freshly drawn blood can be a critical clue.The best diagnostic test is methemoglobin assay, which is usually available on an emergency basis.Methemoglobinemia often causes symptoms of cerebral ischemia at levels >15%; levels >60% are usually lethal.Intravenous injection of 1 mg/kg of methylene blue is effective emergency therapy. Milder cases and follow-up of severe cases can be treated orally with methylene blue (60 mg three to four times each day) or ascorbic acid (300-600 mg/d).(Same features can be seen in hypovolemic shock, hemorrhagic and cardiogenic shock but what catches the answer is presence of central cyanosis and presence of chocolate color blood) -### End" -7554,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pancreatitis is an ADR of which antidiabetic?, with the following options: A: Vildagliptin, B: Metformin, C: Glibenclamide, D: Insulin - -### Response: -Pancreatitis can be seen with DPP4 inhibitors like vildagliptin. Other drugs in this group are sitagliptin, saxagliptin. They inhibit the DPP4 enzyme and increse the t half of incretins to increase the insulin production. Ref: KD Tripathi 8th ed. -### End" -7555,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antigen presented along with HLA-ll stimulates, with the following options: A: CD8 cells, B: CD4cells, C: CD2 cells, D: CD19 cells - -### Response: -Ref Robbins 9/e p195 Class II MHC molecules are encoded by genes in the HLA-D region, which contains at least three subregions: DP, DQ, and DR. Class II MHC molecules are heterodi- mers of noncovalently linked polymorphic a and b sub- units (Fig. 4-3). The extracellular poion of the class II MHC heterodimer contains a cleft for the binding of antigenic peptides and a region that binds CD4. Class II MHC expression is restricted to a few types of cells, mainly APCs (notably, dendritic cells ), macro- phages, and B cells. In general, class II MHC molecules bind to peptides derived from proteins synthesized outside the cell (e.g., those derived from extracellular bacteria) and ingested into the cell. This propey allows CD4+ T cells to recognize the presence of extracellular pathogens and to orchestrate a protective response. -### End" -7556,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood supply of sigmoid colon is by -a) Middle colic arteryb) Marginal arteryc) Left colic arteryd) Sigmoid artery, with the following options: A: c, B: d, C: ab, D: bd - -### Response: -Blood supply of sigmoid colon comes from the sigmoid artery and marginal artery of sudeck . -The marginal artery is an arterial cascade formed by anastomosis of -ileocolic, rt. colic, middle colic, left colic, and sigmoid arteries. And blood supply of colon (Large intestine) is derived from the marginal artery. -### End" -7557,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with diarrhoea. analysis of stool on wet mount shows mobile protozoa without RBCs and pus cells. The diagnosis is -, with the following options: A: Balantidium coil, B: Giardiasis, C: Trichomonas hominis, D: Entamoeba histolytica - -### Response: -Ans. is 'b' i.e., Giardiasis . Mobile protozoa with absence of RBC's and pus cells in stools in a patient with diarrhoea suggests giardiasis. . In balantidum cob and entomoeba histolytica infections, pus cells and RBC's will be present in stools. Trichomonas hominis is considered as non-pathogenic -### End" -7558,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Impetigo contageosa most commonly due to :, with the following options: A: Group B Streptococcous, B: Staphylococcus, C: Moniliasis, D: Streptococcus Viridans - -### Response: -B i.e. Staphylococcus -### End" -7559,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Socially acquired behavior is known as: March 2005, September 2010, with the following options: A: Culture, B: Socialization, C: Internalization, D: Custom - -### Response: -Ans. A: Culture Culture is defined as ""learned behaviour which has been socially acquired"". It is the central concept around which cultural anthropology has grown. Socialization refers to the process of inheriting norms, customs and ideologies. It may provide the individual with the skills and habits necessary for paicipating within their own society; a society itself is formed through a plurality of shared norms, customs, values, traditions, social roles, symbols and languages. Socialization is thus 'the means by which social and cultural continuity are attained' Acculturation means culture contact. -### End" -7560,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about Neisseria gonorrhoeae except, with the following options: A: Gram positive cocci, B: Cause stricture of urethra, C: Involves seminal vesicles and spreads to epididymis, D: Drug of choice is ceftriaxone - -### Response: -Gonococci is a gram-negative coccus. Chronic urethritis due to gonococci can lead to stricture formation. In men, the disease caused by gonococci stas as an acute urethritis with a mucopurulent discharge containing gonococci in large numbers. Infection extends along the urethra to prostrate, seminal vesicles and epididymis. Treatment involves ceftriaxone 125 mg single IM dose or ciprofloxacin 500 mg oral single dose. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 230 -### End" -7561,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: During the surgical repair of femoral hernia.the structure most vulnerable to major injury lies, with the following options: A: Anterioly, B: Posteriorly, C: Medially, D: Laterally - -### Response: -The fermol vein lies lateral of the femoral conal. -### End" -7562,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Basanti, a 28 yrs aged female with a history of 6 weeks of amenorrhoea presents with pain in abdomen; USG shows fluid in pouch of douglas. Aspiration yields dark color blood that fails to clot.Most probable diagnosis is:, with the following options: A: Ruptured ovarian cyst, B: Ruptured ectopic pregnancy, C: Red degeneration of fibroid, D: Pelvic abscess - -### Response: -The picture given in the question classically represents a case of ruptured ectopics pregnancy. -Symptoms – In Ectopic pregnancy triad of: - -Amenorrhea (seen in 75% cases) followed by: -Abdominal pain (seen in 100% cases, it is the most consistent symptom of ectopic pregnancy). -Appearance of vaginal bleeding are seen: -The above triad may be accompanied by nausea, vomiting, fainting attacks or syncope. -Patient may present in shock with pallor, tachycardia, hypotension and cold clammy extremities, if ectopic pregnancy has ruptured - -Examination: -General examination: In case of rupture— - -P/R ↑ -Pallor +nt -BP ↓ -Slight intermittent pyrexia due to absorption of products of degeneration. - -Per Abdomen - Abdomen is tense, tender and distended. - -Shifting dullness may be present (depending on the amount of hemorrhage in ruptured ectopic). -Rigidity/muscle guarding +/–, -Cullen’s sign - bluish discolouration around the umbilicus may be present. - -On Bimanual examination - -Vaginal mucosa appears blanched. -Uterus: normal size/slightly bulky. -Extreme tenderness on cervical movement -Fornices-tender (Remember - tenderness in pelvis is the most constant sign of Ectopic pregnancy). -U/L adnexal mass: is palpable in one third to half of patient. - -Culdocentesis: - -It is a simple technique used to identify hemoperitoneum. -Fluid is aspirated from cul-de-sac via posterior fornix with the help of a needle. -If non clotting blood is obtained, it is indicative of an intraperitoneal bleed and probably a ruptured ectopic. -### End" -7563,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Back pressure porosity can be avoided by:, with the following options: A: Using asbestos liners, B: Placing the sprue at least one quarter inch away from the end of casting ring, C: Preventing rapid heating of the investment in burnout oven, D: Using a short and wide sprue - -### Response: -Backpressure porosity  -This is caused by inadequate venting of the mold. Air is trapped in the mold and is unable to escape. The sprue pattern length should be adjusted so that there is not more than 1/4"" thickness of the investment between the bottom of the casting ring and the wax pattern. When the molten metal enters the mold, the air inside is pushed out through the porous investment at the bottom. If the bulk of the investment is too great, the escape of air becomes difficult causing increased pressure in the mold. The gold will then solidify before the mold is completely filled resulting in a porous casting with rounded short margins.  -Avoided by: - -Using adequate casting force.  -Use investment of adequate porosity.  -Place pattern not more than 6 to 8 mm away from the end of the ring. -Providing vents in large castings.  - -Manapallil 3rd P:370 -### End" -7564,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anemia is caused by deficiency of which micronutrient?, with the following options: A: Iron, B: Potassium, C: Phosphorus, D: Nickel - -### Response: -ANSWER: (A) IronREF: Ganong 24th ed page 560, Guyton 12th ed pg 420Anemia is the deficiency of hemoglobin in the blood which can be caused by either too few red blood cells or too little hemoglobin in the cells. 30% of the world suffers from iron deficiency anemia, due to inadequate intake or absorption of iron from the diet. Iron is needed for the synthesis of hemoglobin. Deficiency caused due to inadequate intake or blood loss causes iron deficiency' anemia. -### End" -7565,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not seen in human body?, with the following options: A: L-fucose, B: L-fructose, C: D-Glucose, D: D- Fructose - -### Response: -L-fructose is not seen in human body All sugars in our body are D-sugars. All amino acids in the human protein are L-amino acids. But there are exceptions. (L-sugar found in the human body, i.e. L-fucose.) L-Fucose : Methyl pentose Found in glycoproteins e.g. Blood group antigen. -### End" -7566,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The validity period of &;valid ceificate of yellow fever vaccination&; is -, with the following options: A: 10 days after date of vaccination up to 7 years, B: 10 days after date of vaccination up to 7 years, C: 10 days after date of vaccination up to 10 years, D: 7 days after date of vaccination up to 7 years - -### Response: -

international ceificate for vaccination:- India and most other cute require a valid ceificate of vaccination against yellow fever from travellers coming from infected areas. A few countries like india require thus even when the traveller has been in transit. It rests with the each country to decide whether a ceificate of vaccination is needed for infants under 1 year. The validity of ceificate begins 10 days after the date of vaccination and extends upto 10 years. Revaccination performed before the end of validity renders the ceificate valid for another 10 years staing on the day of revaccination. For the purpose of international travel , the vaccination must be given at an officially designated centre and the ceificate must be validated with the official stamp of ministry of health. The ceificate valid only if it conforms with the model prescribed under the international health regulations. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.284}

Prolonged . PTdeg --> Normal . BTQ ---> Normal . Fibrinogendeg --> Normal -### End" -7591,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CAMP reaction is shown by which streptococci?, with the following options: A: Group A, B: Group B, C: Group C, D: Group D - -### Response: -Ans. b (Group B). (Ref. Textbook of microbiology by Ananthanarayan 6th ed. 187).Serological or Lancefield classification system for streptococci1Group A streptococciCatalase -,Beta-hemolysis,Bacitracin sensitive,PYR test +,Ribose not fermented.Includes Streptococcus pyogenes.2Group B streptococciCAMP + and Beta-hemolysis +.CAMP reaction (Christie, Atkins and Munch Peterson reaction) due to their ability to hydrolyze hippurate, which can be demonstrated as accentuated zone of hemolysis when streptococcus agalactiae is inoculated perpendicular to streak of staph aureus grown on blood agar.Includes only one bacterium, S. agalactiae.Currently, it has been found to be a cause of sexually transmitted urogenital infections in females.3Group C streptococciRibose and trehalose fermentation4Group D streptococciGrow in 6.5% NaCI and are optochin sensitive.Hydrolysis of bile esculin (dark brown medium)-this indicates the ability of the bacteria to tolerate bile from the liver and growth in high salt cone.Includes Enterococcus and non-Enterococcus.The Enterococci include E. faecalis, a cause of urinary tract infections, and E. faecium, a bacterium resistant to many common antibiotics. Diseases such as septicemia, endocarditis, and appendicitis have also been attributed to group D Strep. Once identified, Group D Strep can be treated with ampicillin alone or in combination with gentamicin. Viridans GroupThe Viridans Streptococci, consisting of S. mutans and S. mitis, are alpha-hemolytic bacteria.These bacteria inhabit the mouth.In fact, a large percentage of tooth decay can be attributed to S. mutans.5Group F streptococciMinute streptococci;streptococcus MG. -### End" -7592,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Spider leg appearance is found in :, with the following options: A: Polycystic kidney, B: Pyelonephritis, C: Hydronephrosis, D: Renal aery stenosis - -### Response: -A i.e. Ploycystic Kidney Chronic hydronephrosis is most common cause of abdominal mass in first 6 months of life.Q On IVP it shows: - Early = Rim SignQ (thin band of radiodensity surrounding clyces) - Delayed = Opacification & dialation collecting system Polycystic or Congenital cystic kidney presents with abdominal mass, loin pain, heamaturia, infection, hypeension & uremia; but usually not before age of 30 years. On excretory urography it has B/L spiders' leg apearanceQ. Decapping surgery (Rovsing's operation) is rarely indicated, as it only relives pain (no prognostic change) Radiological Feature Disease Rim / Cresent SignQ d/ t ureteric Hydronephrosis & pelvic dialatation lit coex compression Soap Bubble appearanceQ Hydronephrosis Flower vase appearance of ureterQ Horse shoe kidney Drooping flower appearanceQ Ectopic ureter Cobra (Adder) head appearanceQ Ureterocoel Thimble bladderQ Tubercular cystic (chronic) Sandy patchesQ Schistosomiasis of bladder Fish hook bladderQ BPH B/L Spider leg appearanceQ Polycystic kidney Swiss-cheese nephrogram Sub burst nephrogram Egg in cup appearance, ring Papillary necrosis shadows/ ring sign, lobster claw (analgesic sign or calyceal horns and diminished density of contrast in nephrogramQ nephropathy) Tree barking or Corduroy Squamous appearance (in IVU or RGU) i.e. metaplasia of multiple linear radiolucencies in ureter lit mucosal ureter thickening -### End" -7593,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Claviceps fusiformis is responsible for, with the following options: A: Neurolatyrism, B: Ergotism, C: Epidemic dropsy, D: Endemic ascites - -### Response: -Ergot Unlike Aspergillus, ergot is not a storage fungus, but a field fungus. Foodgrains such as bajra, rye, sorghum, and wheat have a tendency to get infested during the flowering stages by the ergot fungus (Claviceps purpurea). Fungus grows as a blackish mass and the seeds become black and irregular and are harvested along with food grains. Consumption of ergot infested grain leads to ergotism. Sporadic outbreaks of ergot poisoning in human population have been repoed from time to time in areas where bajra is consumed as a staple. The symptoms are acute but rarelyfatal and include nausea, repeated vomiting, giddiness and drowsiness extending sometimes for periods upto 24 to 48 hours after the ingestion of ergoty grain. In chronic cases, painful cramps in limbs and peripheral gangrene due to vasoconstriction of capillaries have been repoed. However, the long-term effects of consuming small amounts of the Toxin are not known. A disquieting feature is that the recently introduced high-yielding varieties of bajra are more susceptible to infestation. Ergot-infested grains can be easily removed by floating them in 20 per cent salt water. They can also be removed by hand-picking or air floatation. The upper safe limit for the ergot alkaloids has been estimated to be 0.05 mg per 100 grams of the food material. Ref: Park 25th edition Pgno : 694 -### End" -7594,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Who is the chairman of district blindness control society?, with the following options: A: District collector, B: Programme manager, C: District health officer, D: District eye surgeon - -### Response: -Ans. a. District collector (Ref: Park 23/e p439, 22/e p406; www.nrhmtn.gov.in/dbcs.html)District collector is the chairman of district blindness control society.District Blindness Control Society has been established under the chairmanship of District Collector/Deputy Commissioner. Park 23/e p439District Blindness Control SocietyChairmanDistrict CollectorVice-ChairmanDeputy Director of Health ServicesMember SecretaryChief Ophthalmic Surgeon andDistrict Programme ManagerTechnical AdviserDistrict Ophthalmic Surgeon -### End" -7595,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: First sign in sympathetic ophthamilis is :, with the following options: A: Presence of aquous flare, B: Presence of precipitates, C: Constriction of pupil, D: Retrolental flare - -### Response: -D i.e. Retrolental flare -### End" -7596,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which position is the X rays for minimal right sided pleural effusion done?, with the following options: A: Left lateral decubitus, B: Right lateral decubitus, C: Erect chest xray AP view, D: PA view - -### Response: -ANSWER: (B) Right lateral decubitusREF: Wofgang 5th ed p. 428-430Ipsilateral lateral decubitus leads to collection of even minimal fluid in lateral pleural recess; hence it is the view of choice -### End" -7597,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following trigger onset of labour?, with the following options: A: ACTH in mother, B: ACTH in fetus, C: Prostaglandin, D: Oxytocin - -### Response: -Fetal ACTH acts on fetal adrenal gland causing release of DHEA and DHEA sulphate which are used by the placenta along with the other enzymes like Sulfatase ,Aromatase, 3 B hydroxysteroid dehydrogenase, 17 B hydroxysteroid dehydrogenase -Conveing into Estriol and Estardiol that help in triggering the labour. Ref: Williams Obs 24e pg 108-109. -### End" -7598,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antitussive opioid is ?, with the following options: A: Ethylmorphin, B: Pethidine, C: Methadone, D: Buprenorphine - -### Response: -Ans. is 'a' i.e., Ethylmorphine Antitussives (cough center suppressants) Opioids : Codeine, ethylmorphine, pholcodeine. Non-opioids : Noscapine, dextro methorphan, chlophedianol. Antihistaminics : Chlorpheniramine, diphenhydromine, promethazine. Peripherally active : Prenoxdiazine. -### End" -7599,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about communicability of Malaria, except -, with the following options: A: The number of gametocytes in blood increases with time, B: Gametocytes appear in blood 4-5 days after the appearance of the asexual parasite, in vivax infection., C: Gametocytes appear in blood 10-12 days after the appearance of asexual parasite, in falciparum infection, D: In the early stage of infection, their density may exceed 1000 per cmm of blood. - -### Response: -Ans. is 'a' i.e. The number of gametocytes in blood increases with time A malarial parasite (Plasmodium) has got 2 hostsMan is the intermediate hostMosquito is the definitive hostPlasmodium undergoes 2 cycles of development -the asexual or human cyclethe sexual or mosquito cycleThe mosquito cycle begins when a mosquito feeds on an infected mass and ingests gametocytesMalaria is communicable as long as mature, viable gametocytes exist in the human circulating blood in sufficient density to infect vector mosquitoes.In P. vivax infections, gametocytes appear in blood 4-5 days after the appearance of the asexual parasites.In P. falciparum infections gametocytes appear 10-12 days after the first appearance of asexual parasites.Gametocytes are the most numerous during the early stage of infection when their density may exceed 1000 per cubic mm of blood.They also tend to occur in waves in blood. -### End" -7600,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trisomy 13 is seen in -, with the following options: A: Edward syndrome, B: Patau syndrome, C: Down syndrome, D: Tumer syndrome - -### Response: -Ans. is 'b' i.e., Patau syndrome Trisomy 13- Patau syndromeTrisomy 18- Edward syndromeTrisomy 21- Down syndromeXO- Turner syndromeXXY- Klinefelter syndrome -### End" -7601,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Time taken for any project is estimated by ?, with the following options: A: Work sampling, B: Input/output analysis, C: Network analysis, D: System analysis - -### Response: -Ans. is 'c' i.e., Network analysis o PE is a type of network analysis which can estimate the time needed to complete the project. Programme Evaluation and Review technique (PER'] PER I is a management technique which makes possible more detailed planing and more comprehensive supervision. PE is method to analyze the involved tasks in completing a given project, especially the time needed to complete each task, and identifying the minimum time needed to complete the total project. The essence of PE is to construct an arrow diagram. which represents the logical sequence in which events must take place. o It is possible with such a diagram to calculate the time by which each activity must be completed, and to identify those activities that are critical. -### End" -7602,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication after lens extraction persistent hyperplastic primary vitreous is:, with the following options: A: Orbital cellulitis, B: Retinal detachment, C: Vitreous hemorrhage, D: Keratitis - -### Response: -Ans. c. Vitreous hemorrhage In Kanski, Yanoffs, Parsons and Khurana, both vitreous hemorrhage and retinal detachment are mentioned as complications of surgery in persistent hyperplastic primary vitreous. Incidence of these two complcations is not mentioned clearly Persistent Hyperplastic Primary Vitreous (PHPV) Persistent hyperplastic primary vitreous (PHPV) also known as persistent fetal vasculature (PFV). PHPV is a pathologic entity resulting from abnormal persistence of the fetal fibrovascular primitive stroma (hyaloid system) of the eye which should disappear by the time of bih. The primary vitreous forms around the seventh week of life and begins involuting by 20 weeks. Persistence and hyperophy of these vessels can result in PHPV in the anterior and/or posterior chambers The typical imaging findings of posterior PHPV include the demonstration of Cloquet's canal and a small eye. -### End" -7603,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Parietal cells in the stomach secrete a protein crucial for the absorp on of vitamin B12 by the ileum. What is this protein?, with the following options: A: Intrinsic factor, B: Gastrin, C: Somatostatin, D: Cholecystokinin (CCK) - -### Response: -. -### End" -7604,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is TRUE regarding tumorigenesis during aging?, with the following options: A: Telomerase reactivation, B: Telomerase inactivation, C: Increased apoptosis, D: Suppression of proto-oncogenes - -### Response: -Telomerase is a ribonucleoprotein that is expressed in stem cells and most cancer cells, but not in somatic cells. More than 90% of human cancers express high levels of telomerase that prevent telomere shoening to critical levels and allow indefinite cell proliferation. Ref: Longo D.L. (2012). Chapter 84. Cancer Cell Biology and Angiogenesis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -7605,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cytochrome P450 is identified to 11-ss hydroxylase is known as, with the following options: A: CYMA-IB, B: CYPA-2B, C: CYPA-3B, D: CYPA-4B - -### Response: -Cytochromes P450 (CYPs) are a family of enzymes containing heme as a cofactor that function as monooxygenases. In mammals, these proteins oxidize steroids, fatty acids, and xenobiotics, and are impoant for the clearance of various compounds, as well as for hormone synthesis and breakdown Ref: guyton and hall textbook of medical physiology 12 edition page number:20,21,22 -### End" -7606,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Interstitial keratitis may be associated with:, with the following options: A: Congenital syphilis, B: Malaria, C: Sarcoidosis, D: All of the above - -### Response: -Ans. All of the above -### End" -7607,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ziemann dots are seen in, with the following options: A: P. Vivax, B: P. Falciparum, C: P. Malariae, D: P. Ovale - -### Response: -Ziemann dots are small red dots stippling seen in P. Malariae. -### End" -7608,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gamma camera is used for: September 2007, with the following options: A: Measuring the radioactivity, B: Radionuclide scans, C: Both of the above, D: None of the above - -### Response: -Ans. C: Both of the above A gamma camera/scintillation camera/ Anger camera is a device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy. The applications of scintigraphy include early drug development and nuclear medical imaging to view and analyse images of the human body or the distribution of medically injected, inhaled, or ingested radionuclides emitting gamma rays. Scintigraphy is the use of gamma cameras to capture emitted radiation from internal radioisotopes to create twodimensional images. SPECT (single photon emission computed tomography) imaging, as used in nuclear cardiac stress testing, is performed using gamma cameras, usually one, two or three detectors or heads, are slowly rotated around the patient's torso. Multiheaded gamma cameras can also be used for Positron emission tomography scanning. Gamma camera PET is markedly inferior to PET imaging with a purpose designed PET scanner, as the scintillator crystal has poor sensitivity for the high-energy annihilation photons, and the detector area is significantly smaller. However, given the low cost of a gamma camera and its additional flexibility compared to a dedicated PET scanner, this technique is useful where the expense and resource implications of a PET scanner cannot be justified. -### End" -7609,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False regarding childhood autism is:, with the following options: A: Isolated area of talent may be remarkable developed', B: Parental attitude and behavior do not attribute to it, C: Emergence of speech and social smile is often delayed, D: It represents a type of childhood neurotic disorder - -### Response: -AUTISM includes mental retardation, learning disability, communication disorder and attention deficit disorders. Autism is not a disease. It is one of the developmental disorders of the brain function. Its cause is not known in majority of cases but unlike other developmental disabilities, prenatal and perinatal factors do not playa major role in its etiology. Clinical features are speech and language delay, impairment of comprehension of language, fluent but unintelligible jargon, impairment of social interaction, hyperactivity, unusual interest in TV commercials, repetitive compulsive play activity, etc. Seizures are more common in autistic children than in general population. Some autistic children have islands of brilliance. -### End" -7610,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true about coho study?, with the following options: A: Disease to risk factor study, B: Effect to cause study, C: Not associated with attributable risk, D: Associated with antecedent causation - -### Response: -A coho study is a paicular form of longitudinal study that samples a coho (a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as bih or graduation), performing a cross-section at intervals through time. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 83 -### End" -7611,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mechanism of action of Fluoroquinolones is, with the following options: A: Inhibit cell wall synthesis, B: Inhibit protein synthesis, C: Inhibit DNA gyrase, D: Interfere with DNA synthesis - -### Response: -(Inhibit DNA gyrase) (628, 647-KDT) (688-KDT 6th)Fluoroquinolones (FQs)* First generation FQs - Norfloxacin, Ciprofloxacin, Ofloxacin, Pefloxacin* Second generation FQs - Lomefloxacin, Sparfloxacin, Levofloxacin, Gatifloxacin, Moxifloxacin.* FQs inhibits the enzyme bacterial DNA gyrase, which nicks double stranded DNA, introduces negative super coils and then reseals the nicked ends.* FQ action is similar enzyme topo isomerase IV, which nicks and separates daughter DNA strands after DNAreplication. -### End" -7612,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chronic pancreatitis is seen in all except, with the following options: A: Chronic renal failure, B: Intraductal mucinous carcinoma, C: Alcohol, D: None of the above - -### Response: -Etiology of Chronic Pancreatitis Heavy alcohol consumption is MC cause of CP (70-80%) Smoking increases the risk of alcohol induced CP Other causes: Chronic duct obstruction, trauma, pancreas divisum, cystic dystrophy of the duodenal wall, Hyperparathyroidism, hyperiglyceridemia, autoimmune pancreatitis, tropical pancreatitis & hereditary pancreatitis (accounts for <10% of all cases Ref: Harrison's 19th edition Pgno :2098 -### End" -7613,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Characteristic radiological finding in Frontal mucocoele is:, with the following options: A: Loss of scalloping, B: Thickening of wall of sinus, C: Heterogenous opacification, D: Patchy osteolysis - -### Response: -Ans: D (Patchy osteolysis) Ref: Aggarwai SK et al. Frontal sinus mucocele with orbital complications: Management by varied surgical approaches. Asian J Neurosurg. 2012 Jul-Sep; 7(3): 135-140.Explanation:There are three criteria for CT diagnosis of a mucocoele:Homogeneous isodense massClearly defined marginPatchy osteolysis around the massErosion of the sinus wall with marginal sclerosis is also an indicative findingIn MRI, mucocoeles tend to be fairly bright on TIW images compared to the brain and isohyperintense on T2W images (Pathognomonic MRI finding) -### End" -7614,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Millard repair is used for treatment of:, with the following options: A: Cleft lip, B: Cleft palate, C: Meningocele, D: Saddle nose - -### Response: -The rotation advancement cleft lip repair, also referred to as a Millard repair, is probably the most commonly performed repair today. Almost no tissue is discarded; the medial lip element is rotated downward, even with a back cut, if necessary, and the lateral lip element is advanced into the defect under the nasal sill. Mucosal flaps are used to line the nose and the vestibule of the lip -### End" -7615,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mad cow disease is due to?, with the following options: A: Protein mis-folding, B: Bacterial, C: Viral, D: Spirochete - -### Response: -Ans. (a) Protein MisfoldingRef: Harrison 19th ed. / 444e-9* When a prion enters a healthy organism, it induces existing, properly folded proteins to convert into the misfolded prion form. In this way, the prion acts as a template to guide the misfolding of more proteins into prion form.* All known mammalian prion diseases are caused by the prion protein, PrP. The endogenous, properly folded form is denoted PrPc (for Common or Cellular), whereas the disease-linked, misfolded form is denoted as PrPSc (for Scrapie, after one of the diseases first linked to prions and neurodegeneration.)* The precise structure of the prion is not known, though they can be formed by combining PrPc, polyadenylic acid, and lipids in a Protein Misfolding Cyclic Amplification (PMCA) reaction -### End" -7616,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of Herpes Zoster complications are all EXCEPT:, with the following options: A: Acyclovir, B: Amitryptyline, C: Gabapentin, D: Prednisone - -### Response: -(Acyclovir): Ref 1044-45-H, 853-CMDT-09 (1093, 1104-H17th)TREATMENTS OF COMPLICATIONS* Postherpetic neuralgia - NSAIDs, Gabapentin, amitriptyline hydrochloride, lidocaine patches, and fluphenazine hydrochloride - beneficial for pain relief.* In one study glucocorticoids (prednisone) therapy administered early in the course of localized herpes-zoster significantly accelerate such quality of the life improvements as a return to usual activity and termination of analgesia* Secondary bacterial infection of lesions are treated with antibiotics providing coverage for staphylococci* Initial treatment with antivirals and corticosteroids does not clearly reduce the incidence or severity of postherpetic neuralgia (1358 - CMDT-06) -### End" -7617,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of them are true about the 4th nerve EXCEPT, with the following options: A: The only nerve to emerge from the dorsal aspect of brain, B: The only nerve to cross over to opposite side, C: It is the thickest cranial nerve, D: It has the fewest axons of any cranial nerve - -### Response: -The trochlear nerve has several features that make it unique from the other cranial nerves: Thinnest cranial nerve. Is the only nerve to exit from the dorsal surface of the brain. Is the only nerve in which all the lower motor neuron fibers decussate. Has the longest intracranial course. Has the smallest number of axons. -### End" -7618,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Complex polysaccharides are conveed to glucose and absorbed by the help of-, with the following options: A: a) Na+K+ATPase, B: b) Sucrase, C: c) Enterokinase, D: d) Carboxypeptidase - -### Response: -The cells of brush border of intestine contain the enzyme, Sucrase, Maltase, Iso-maltase, lactase hydrolyse corresponding diasaccharides to monosaccharides which are absorbed. -### End" -7619,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All form part of portal triad except -, with the following options: A: Hepatic artery, B: Hepatic vein, C: Bile duct, D: Portal vein - -### Response: -Ans. is 'b' i.e., Hepatic vein o Glissons's capsule extend into the liver around branches of hepatic artery, portal vein and bile ducts as branching trabeculae called as portal tracts (portal canals).o The combination of a bile ductule, branch of hepatic artery, and branch of portal vein is referred to as portal triad. -### End" -7620,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is the best for management of methanol poisoning?, with the following options: A: Acamprosate, B: Fomepizole, C: Disulfiram, D: Naltrexone - -### Response: -Acamprosate + Naltrexone use for Alcohol Deaddiction Fomepizole - DOC = Methanol poisoning Fomepizole -DOC for ethylene glycol poisoning DOC for Ethylene glycol poisoning & for Anti-freeze agent ingestion Disulfiram = Alcohol craving -### End" -7621,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If you are in PHC, which anticoagulant is used to sent the blood sample for blood glucose estimation?, with the following options: A: EDTA, B: Heparin, C: Potassium oxalate, D: Potassium oxalate + sodium fluoride - -### Response: -Sodium fluoride- potassium oxalate mixture is used for glucose determination. -NaF inhibits the glycolytic enzymes responsible for the breakdown of glucose in the blood ( At room temperature, about 10% of the glucose is lost per hour from an untreated sample). -The potassium oxalate is the primary anticoagulant, as NaF has a poor anticoagulant effect. -### End" -7622,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are used to treat influenza B except, with the following options: A: Oseltamivir, B: Zanamivir, C: Premavir, D: Ribavarin - -### Response: -Neuraminidase inhibitors such as Oseltamivir, Zanamivir and Peramivir, which inhibit the viral enzyme neuraminidase in both influenza virus A and B, are effective for treatment and prophylaxis of influenza Amantadine and Rimantadine are active only against Influenza A Ref: Mason's Tropical Disease, 24th edition Pgno : 168-169 -### End" -7623,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The following are live attenuated vaccine, except-, with the following options: A: Oral poilio, B: Yellow fever, C: Measles, D: Influenza - -### Response: -oral polio vaccines were first introduced by Sabin in 1957.it contains live attenuated strains of virus type 1,2, and 3.grown in primary monkey kidney or h7man diploid cell cultureref;parks tectbook,ed22,pg 187 -### End" -7624,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Among the following options Truncus arteriosus is most -commonly associated with, with the following options: A: Turner's syndrome, B: Digeorge Syndrome, C: Klinefilter's syndrome, D: Down's syndrome - -### Response: -Truncus arteriosus is commonly associated with Digeorge Syndrome. -### End" -7625,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a characteristic of poliomyelitis -, with the following options: A: Initial febrile illness followed by development of asymmetrical paralysis, B: Symmetrical muscle wekaness with frequent paraesthesia but normal reflexes, C: Ascending motor paralysis with presevation of reflexes and sensation, D: Pain in the affected limb with sensorimotor deficit - -### Response: -

A history of fever at the time of onset of paralysis is suggestive of polio. The paralysis is characterised as descending.i.e.staing at the hip then moving down to the distal pas. It is asymmetrical paralysis.. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:205-206. <\p> -### End" -7626,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is a DNA virus ?, with the following options: A: Hepatitis A, B: Hepatitis B, C: Hepatitis C, D: Hepatitis D - -### Response: -Ans. is 'b' i.e., Hepatitis B -### End" -7627,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Popliteal aery is difficult to palpate because, with the following options: A: It is not superficial, B: Does not pass over prominent bony structure, C: Superficial but does not pass over prominent bony structure, D: Not superficial & does not pass over prominent bony structure - -### Response: -D i.e. Not superficial & does not pass over prominent bony structure -### End" -7628,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Directly acting cholinergic drug is/are:, with the following options: A: Pilocarpine., B: Bethanechol., C: Methacholine., D: All of the above. - -### Response: -Directly acting - -Ach -Pilocarpine -Bethanechol -Methacholine -Carbachol -### End" -7629,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In which case Anterior resection is the method of tit ?, with the following options: A: Ca sigmoid colon, B: Ca rectum, C: Ca colon, D: Ca anal canal - -### Response: -Ans 'b' ie Ca Rectum Anterior resection is the general term used to describe operations in which rectosigmoid pa is resected from an abdominal approach with no need for perineal, sacral or other incision. Resection of the rectosigmoid colon performed above the pelvic peritoneum is called high anterior resection. whereas an operation in which it is necessary to open the pelvic peritoneum to approach the lesion in upper 2/3 of rectum is called as Low anterior resection. -### End" -7630,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Calculate Sensitivity and Specificity of ELISA in a population screened for HIV. Data is given below HIV Present HIV Absent ELISA +ve 80 40 ELISA -ve 20 60, with the following options: A: 60%, 80%, B: 80%, 60%, C: 66.6%, 75%, D: 75%, 66.6% - -### Response: -HIV Present HIV Absent ELISA + ve 80 = a 40 =b ELISA -ve 20 = c 60 =d Sensitivity = a/a+c x 100 = 80/100 X 100 = 80% Specificity = d/ b+d x 100 = 60/100 X 100 = 60% PPV 80/120 X 100 = 66% NPV 60/80 X 100 = 75% -### End" -7631,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According to WHO all are B cell lymphomas except?, with the following options: A: Burkitt's lymphoma, B: Follicular lymphoma, C: Mantle cell lymphoma, D: Anaplastic large cell lymphoma - -### Response: -Answer-D. Anaplastic large cell lymphomaPeripheral T - Cell and NK - Cell NeoplasmsT-cell prolymphocytic leukemiaLarge granular lymphocytic leukemialylycosis fungoides/Sezary syndromePeripheral large cell lymphoma, unspecifiedAnaplastic large cell lymphomaEnteropathy - associated T - cell lymphomaHepatosplenic gamma delta T - cell lymphomaAdult T . cell leukemia / lymphomaNK I T - cell lymphoma, nasal typeNK cell leukemia -### End" -7632,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cholemicnephrosis seen in -, with the following options: A: Malaria, B: Addison's disease, C: Hemochromatosis, D: Obstructive jaundice - -### Response: -Ans. is 'd' i.e., Obstructive jaundice Choiemic Nephrosis o Cholemicnephrosis is used to describe the renal failure in patients with obstructive jaundice, particularly after renal transplantation.o Diagnosis is made on light microscopy by presence of typical bilirubin casts.o Altered hemodynamics and bile toxicity to tubular epithelial cells is the probable cause for renal failure in such patients.o Patients usually have hepatorenal syndrome, reduced glomerular filtration rate and increased concentration of bile salts and bilirubin in urine. -### End" -7633,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Progressive loss of hearing, tinnitus and ataxia are commonly seen in a case of:, with the following options: A: Otitis media, B: Cerebral glioma, C: Acoustic neuroma, D: Ependymoma - -### Response: -Ans. C. Acoustic neuroma -### End" -7634,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cerebellar cortex contains:, with the following options: A: Pyramidal cells, B: Purkinje cells, C: Stromal cells, D: Kupffer cells - -### Response: -Ans. B Purkinje cellsRef. Gray's, 4Vted.pg. 335-336* The cerebellar cortex contains five types of neurons: Purkinje, Granule, Basket, Stellate and Golgi Cells. -### End" -7635,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Compared to conventional amalgams, spherical amalgams:, with the following options: A: Require more mercury, B: Require heavy compaction forces, C: Have longer setting times, D: None of the above - -### Response: -Amalgams made from lathe-cut powders or admixed powders tend to resist condensation better than amalgams made entirely from spherical powders. Since freshly triturated amalgams from spherical powders are very plastic, one cannot rely on the pressure of condensation to establish a proximal contour for a class II restoration. Spherical alloys require less mercury than typical lathe-cut alloys because spherical alloy powder has a smaller surface area per volume ratio than does the lathe-cut powder. Amalgams with low mercury content generally have better properties. Spherical alloys also require less compaction forces and have lower setting times. -Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 343 -### End" -7636,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which antihypeensive is a prodrug and is coveed to its active form in brain?, with the following options: A: Clonidine, B: Methyldopa, C: Minoxidil, D: Nitroprusside - -### Response: -(Ref: KDT 6/e p547) Although both methyldopa and minoxidil are produrgs, conversion of methyldopa to a-methylnorepinephrine takes place in the brain whereas minoxidil is activated to minoxidil sulphate (by phase II reaction) in the periphery. -### End" -7637,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HHH syndrome results from the defect in the enzyme is, with the following options: A: Ornithine Permease, B: Ornithine Transcarbamoylase, C: Argininosuccinate Synthase, D: Argininosuccinate Lyase - -### Response: -Ornithine PermeaseThe hyperornithinemia, hyperammonemia, and homocitrullinuria syndrome (HHH syndrome) result from mutation of the ORNT1 gene that encodes the mitochondrial membrane ornithine permease. The failure to impo cytosolic ornithine into the mitochondrial matrix renders the urea cycle inoperable, with consequent hyperammonemia, and hyperornithinemia due to the accompanying accumulation of cytosolic ornithine. In the absence of its normal acceptor (ornithine), mitochondrial carbamoyl phosphate carbamoylates lysine to homocitrulline, resulting in homocitrullinuria.Ref: Harper&;s Biochemistry; 30th edition; Chapter 28; Catabolism of Proteins & of Amino Acid Nitrogen -### End" -7638,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acetyl choline decreases heart rate by:, with the following options: A: Acting on specific K+ channels and increasing efflux, B: Acting on Ca2+ channels and increasing efflux, C: Acting on specific K+ channels and increasing influx, D: Acting on specific Ca2+ channels and increasing influx - -### Response: -Ans: a (Acting on specific K+ channels and increasing efflux)Ref: KD Tripathi 6th ed Pg. 95; Ganong 21st ed Pg. 550 -551Ach acts via muscarinic M2 receptors opening a special set ++ of K channels increasing efflux of K.Muscarnic receptorsM1Mainly a neuronal receptor located on ganglion cells and central neurons, especially in cortex, hippocampus and corpus striatum It plays a major role in mediating gastric secretion, relaxation of lower oesophageal sphincter on vagal stimulation.It acts via G-protein coupled receptor.IP3 /DAG - increase in Ca which leads to increase in prostaglandin synthesis.m2They are called cardiac muscarnic receptors. They decrease heart rate and contractility.It acts via G protein coupled receptor.It causes opening of K+ channels increasing efflux of K\ This results in decrease in cAMP and so heart rate and contractility is decreasedm3Mainly on visceral smooth muscle contraction and glandular secretions.It acts via G-protein coupled receptor.IP3/DAG - increase in Ca2+ which leads to increase in prostaglandin synthesis. -### End" -7639,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Peripheral chemoreceptors are stimulated maximally by:, with the following options: A: Cyanide, B: Anemia, C: Hypocapnia, D: Alkalosis - -### Response: -Ans. A. Cyanidea. ""Carotid and aortic bodies can also be strongly stimulated by certain chemicals,b. particularly cyanide ion and other poisons of the metabolic respiratory chain."" Cyanide produces histotoxic hypoxia of glomus cell. Hypoxia leads to closure of O2 sensitive K+ channel of glomus cell and stimulation. -### End" -7640,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An Rh-ve woman became pregnant with a Rh+ve fetus. Within a few days after birth, the infant developed jaundice, ascites, hepatomegaly and edema. The likely substance (s) deposited in skin and sclera in jaundice is/are given below. Which is the best possible answer-, with the following options: A: Biliverdin, B: Conjugated and unconjugated bilirubin, C: Unconjugated bilirubin, D: Conjugated bilirubin - -### Response: -It is a case of erythroblastosis fetalis. -In erythroblastosis fetalis there is excessive breakdown of RBC's. Leading to increased production of bilirubin in the blood. This increased bilirubin is predominantly unconjugated but there is some increase in conjugated bilirubin too. ""The canalicular mechanisms responsible for bilirubin excretion are also immature at birth, and their maturation may lag behind that of UGT1A1, this can lead to transient conjugated neonatal hyperbilirubinemia, especially in infants with hemolysis"". ---Harrison 17th/e 1928 -You should also know this important fact. -Hemolysis in otherwise normal individual results in purely unconjugated hyperbilirubinemia. —Harrison 1928 -### End" -7641,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hypothyroidism is caused by which of the following anti-tubercular drug?, with the following options: A: Streptomycin, B: Ethionamide, C: Thioacetazone, D: Ethambutol - -### Response: -Ethionamide (Etm): It is a tuberculostatic drug of moderate efficacy introduced in 1956. It acts on both extra- and intracellular organisms. Atypical mycobacteria are sensitive. Resistance to Etm develops rapidly and some cross resistance with Tzn is seen. It is absorbed orally, distributes all over, including CSF, completely metabolized and has a sho duration of action (t&;h 2-3 hr). Anorexia, nausea, vomiting and abdominal upset are common, especially in Indian patients. Though the recommended dose of Etm is 1 g/day, more than 0.5 g is generally not tolerated. Other side effects are aches and pains, rashes, hepatitis, peripheral or optic neuritis, mental disturbances and impotence. It is seldom used; only in case of resistance to better tolerated drugs. Ethionamide is not considered as 1st line therapy because of its significant gastrointestinal side effects. Ethionamide is thought to prevent organification of iodine in thyroid hormone synthesis as it is structurally related to other thionamides (propylthiouracil and methimazole) . Other MDR TB therapy drug that can cause hypothyroidism is Para-amino salicylic acid (PAS) ESSENTIALS OF MEDICAL PHARMACOLOGY AND WWW.ncbi.nlm.nih.gov/pmc/aicles/PMC4576583/ AUTHOR:K.D.TRIPATHI SIXTH EDITION PAGE NO:743 -### End" -7642,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50 year old electrician repos pain in his left upper extremity and tingling and numbness in his 4th and 5th digits of his left hand. There is mild swelling of the left hand. The man repos most of his pain and numbness occurs when he is doing electrical work with his arms overhead. X-ray reveals the presence of a cervical rib. Which of the following structures is most likely being compressed?, with the following options: A: Axillary aery, B: Brachial aery, C: Brachiocephalic aery, D: Subclan aery - -### Response: -The subclan aery passes laterally over the upper surface of the first rib and lies posterior to the scalenus anterior. In the case of thoracic outlet syndrome, this aery is usually compressed between the scalenus anterior and a cervical rib. Thoracic outlet syndrome is a broad term for a group of disorders in which there is compression of ceain neurovascular bundles. The presence of a cervical rib adds to the compression, and repetitive motion and poor posture are other predisposing factors. When the neurovascular bundle is entrapped, the patient presents with neurological and/or circulatory changes in the upper extremity on the involved side.The axillary aery is the continuation of the subclan aery. This aery begins at the outer border of the first rib and continues through the axilla to the lower border of the teres major.The brachial aery is the continuation of the axillary aery in the upper extremity and can not be compressed by a cervical rib.The brachiocephalic aery arises from the arch of the aoa. At the level of the right sternoclavicular joint, it separates into the right common carotid aery and the right subclan aery. -### End" -7643,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The dicrotic notch on the aortic pressure curve is caused by, with the following options: A: Closure of the mitral valve., B: Closure of the tricuspid valve., C: Closure of the aortic valve., D: Closure of the pulmonary valve. - -### Response: -The dicrotic notch, a small oscillation on the falling phase of the pulse wave caused by vibrations set up when the aortic valve snaps shut, is visible if the pressure wave is recorded but is not palpable at the wrist. The pulmonary artery pressure curve also has a dicrotic notch produced by the closure of the pulmonary valves. -### End" -7644,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient with limited systemic sclerosis for the past 10 years complaints of shoness of breath for the past one year. His pulmonary function tests are as follows - PFT OBSERVED PREDICTED FVC 2.63 2.82 FEV 1 88% 80% DLCO 5.2 16.3 Which among the following is the probable diagnosis, with the following options: A: Interstitial lung disease, B: Pulmonary hypeension, C: Pnuemothorax, D: Diaphragmatic weakness - -### Response: -Pulmonary aery hypeension The forced vital capacity (FVC) is not decreased in this case. The forced vital capacity in the question is FVC 93% is normal. - (Any pulmonary. function test which is 80-100% of the predicted value is considered normal) The FEV I is also mentioned as normal. So, the only pulmonary function abnormality is decrease in DLCO. This strongly suggests pulmonary aery hypeension. - Systemic sclerosis is associated with both pulmonary aery hypeension and interstitial lung disease. - They are quite difficult to distinguish clinically because pulmonary, function test are almost similar. - Both presents with restrictive pattern of disease and decrease in DLCO. Features of pulmonary function test which ours pulmonary aery hypeension are : -- Decrease in DLCO in the absence of any other abnormality on pulmonary. test i.e., isolated decrease in DLCO. - Decrease in DLCO is out of propoion to the decrease in FVC. If FVC/DLCO ratio > 1.5 ---> Pulmonary aery hypeension < 1.5 --> Interstitial lung disease. The definitive diagnosis of : ? Pulmonary aery hypeension --> Pulmonary aery catheterization. Interstitial lung disease --> Helical CT scan In the question the patient shows decrease in DLCO in the absence of any other abnormality. This strongly suggests pulmonary aery hypeension. -### End" -7645,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following Conjunctivitis can also involve intact cornea?, with the following options: A: Acute mucopurulent conjunctivitis, B: Acute membranous conjunctivitis, C: Acute purulent conjunctivitis, D: Angular conjunctivitis - -### Response: -Acute purulent conjunctivitis caused by Gonococci. Gonococus can penetrate intact cornea. -### End" -7646,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acute leukemia in children is associated with - all except, with the following options: A: Down's syndrome, B: Klinefelter's syndrome, C: Marfan's syndrome, D: Turner's syndrome - -### Response: -Marfan syndrome is an inherited disorder that affects connective tissue -- the fibers that suppo and anchor your organs and other structures in your body. Marfan syndrome most commonly affects the hea, eyes, blood vessels and skeleton. People with Marfan syndrome are usually tall and thin with dispropoionately long arms, legs, fingers and toes. The damage caused by Marfan syndrome can be mild or severe. If your aoa -- the large blood vessel that carries blood from your hea to the rest of your body -- is affected, the condition can become life-threatening. Reference: GHAI Essential pediatrics, 8th edition -### End" -7647,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscae volitantes are seen in -, with the following options: A: Vitreous detachment, B: Vitreous hemorrhage, C: Remains of primitive hyaloid vasculature, D: Eale's disease - -### Response: -Muscae volitantes: These are physiological opacities and represent the residues of primitive hyaloid vasculature. Patient perceives them as fine dots and filaments, which often drift in and out of the visual field, against a bright background (e.g., clear blue sky). Ref:comprehensive ophthalmology AK Khurana page no 245 REF IMG -### End" -7648,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Terminal stage of pneumonia is ?, with the following options: A: Congestion, B: Red hepatization, C: Gray hepatization, D: Resolution - -### Response: -Ans. is 'd' i.e., Resolution -### End" -7649,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common aneuploidy compatible with life is, with the following options: A: Down syndrome, B: Turner syndrome, C: Klinefelter's syndrome, D: Patau syndrome - -### Response: -Answer- A, Down syndromeMost common aneuploidy in which infant can survive is trisomy-21 (Down syndrome) -### End" -7650,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following decreases in nephrotic syndrome except, with the following options: A: Albumin, B: Transferrin, C: Ceruloplasmin, D: Fibrinogen - -### Response: -Fibrinogen is increased in nephrotic syndrome. -### End" -7651,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Latent phase of Labour is said to be prolonged when the duration in a primigravida is more than..., with the following options: A: 3 hours, B: 8 hours, C: 12 hours, D: 20 hours - -### Response: -Latent phase in a Primigravida is prolonged if its more than 20 hours, multigravida if its more than 14 hours Labour Pattern Primigravida Multigravida Prolonged latent phase > 20hours >14 hr -### End" -7652,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Surest sign of identification, with the following options: A: Mummification, B: Maceration, C: Hanging, D: Drowning - -### Response: -Maceration -### End" -7653,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cardiac myxoma most common seen in?, with the following options: A: Right Atrium, B: Right Ventricle, C: Left Atrium, D: Left Ventricle - -### Response: -Ans. is 'c' i.e., Left AtriumCardiac myxomaThis is the most common primary tumor of hea.It is more common in females. The most common location is left atrium, with left to right ratio (4:1).The region of fossa ovalis in the atrial septum is the oured site of origin.These are gelatinous structures consisting of myxoma cells (lepidic) cells, endothelial cells, and smooth muscle cells embedded in a stroma rich in glycosaminoglycans (mucopolysaccharide). -### End" -7654,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Method for waste disposal in small camps -, with the following options: A: Burial, B: Tipping, C: Compositing, D: Manure pits - -### Response: -Ans. is 'a' i.e., Burial ""Burial is suitable for small camps""__________ Park -### End" -7655,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Systemic absorption of local anaesthetic is better with, with the following options: A: Subcutaneous route, B: Epidural route, C: Tracheal route, D: Intercostal route - -### Response: -Intravenous > tracheal > intercostal is order of systemic absorption of local anaesthetic drug. -### End" -7656,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Howel-Jolly bodies may be seen after ?, with the following options: A: Hepatectomy, B: Splenectomy, C: Pancreatectomy, D: Cholecystectomy - -### Response: -Ans:B.) Splenectomy Howell-Jolly bodies They are histopathological findings of basophilic nuclear remnants (clusters of DNA) in circulating erythrocytes. Howell-Jolly bodies are seen with markedly decreased splenic function. Common causes include asplenia (post-splenectomy)or congenital absence of spleen. Other causes are radiation therapy involving the spleen, such as that used to treat Hodgkin lymphoma. Howell-Jolly bodies are also seen in: amyloidosis, severe hemolytic anemia, megaloblastic anemia, hereditary spherocytosis, heterotaxy with asplenia and myelodysplastic syndrome. -### End" -7657,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The common presentation of duct papilloma of the breast is, with the following options: A: Bloody nipple discharge, B: Mass in breast, C: Breast eczema, D: Pagets disease - -### Response: -True polyps of epithelium lined breast ducts Benign and not precancerous Solitary and located under areola Less than 1 cm in size and can grow up to 4-5 cms Most common presentation is bloody nipple discharge -Treatment - excision of duct along with tumor known as duct excision -### End" -7658,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a derived lipid?, with the following options: A: Fatty acids, B: Glycolipid, C: Phospholipid, D: Triglyceride - -### Response: -Classification of lipids Type Examples Simple lipids Fats (Triacylglycerols), Waxes Complex lipids Phospholipids, Aminolipids, Glycolipids, Sulfolipids Precursor & Derived lipids Fatty acids, glycerol, steroids, fatty aldehydes, ketone bodies hydrocarbons, lipid-soluble vitamins, hormones -### End" -7659,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 1 month old boy is refereed for failure to thrive. On examination, he shows feature of congestive failure. The femoral pulses are feeble as compared to branchial pulses. The most likely clinical diagnosis is, with the following options: A: Congenital aoic stenosis, B: Coarctation of aoa, C: Patent ductus aeriosus, D: Congenital aooiliac disease - -### Response: -In coarctation of aoa there will be radiofemoral delay. Ref : Ghai essential of pediatrics, eighth edition, p.no:432 -### End" -7660,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is false regarding dimorphic fungi -, with the following options: A: Occurs in two growth forms, B: Can cause systemic infection, C: Cryptococcus is an example, D: Coccidioides is an example - -### Response: -Dimorphic fungi: They exist as molds (hyphal form) in the environment at ambient temperature (25degC) and as yeasts in human tissues at body temperature (37degC). Examples include: Histoplasma capsulatum, Blastomyces dermatitidis, Coccidioides, Paracoccidioides,Penicillium marneffei and Sporothrix schenckii. Systemic mycoses are caused by fungi of soil, which are inherently virulent and cause disease in healthy humans. The systemic mycoses include coccidioidomycosis, paracoccidioidomycosis, histoplasmosis, blastomycosis, and cryptococcosis. Most fungi causing systemic infections are dimorphic fungi. Cryptococcus is a true yeast. -### End" -7661,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: X-ray chest showing globular cardiomegaly with oligemic lung fields in a child is suggestive of, with the following options: A: Tetralogy of fallot, B: TAPVC, C: Ebstein's, D: PDA - -### Response: -Ans. Ebstein's -### End" -7662,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which type of malaria is associated with renal failure -, with the following options: A: Falciparum, B: Vivax, C: Malariae, D: Ovale - -### Response: -P.falciparum - The trophozoites usually disappear from peripheral circulation after about 24 hours. By then, a strain-specific high molecular weight antigen appears on the surface of the infected red cells, associated with knob-like projections on the erythrocyte membrane. Such red cells disappear from peripheral circulation and adhere to the walls of venules and capillaries in internal organs--brain, hea, kidney, lungs, spleen, intestine, bone marrow, placenta. This cytoadherence causes sequestration of infected red cells in, these sites and is responsible for many of the serious complications of falciparum malaria, such as cerebral malaria. -### End" -7663,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a VEGF inhibitor?, with the following options: A: Bevacizumab, B: Omalizumab, C: Adalizumab, D: Abciximab - -### Response: -Cetuximab, Bevacizumab, Sunitinib, Sorafenib acts as VEGF inhibitors inhibiting angiogenesis.Ref: Sharma and Sharma 3rd ed/pg 875 -### End" -7664,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Addison's disease drug to be given is -, with the following options: A: Hydrocoisone, B: Betamethasone, C: Prednisolone, D: DOCA - -### Response: -Ans. is 'a' i.e., Hydrocoisone o In Addison's disease, there is chronic insufficiency of adrenal hormones. o Both glucocoicoids and mineralocoicoids are deficient, therefore treatment includes combination of glucocoicoids and mineralocoicoid to replace the adrenal insufficiency. o Hydrocoisone along with fludrocoisone is prescribed most commonly. -### End" -7665,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Longest extraocular muscle is, with the following options: A: Superior Rectus, B: Inferior rectus, C: Superior Oblique, D: Inferior oblique - -### Response: -Superior oblique is the longest extraocular muscle Extraocular muscles: Shoest tendon among rectus- MR Muscle having least distance from limbus - MR Superior oblique is longest muscle Inferior oblique is smallest muscle -### End" -7666,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Example of type 4 hypersensitivity is, with the following options: A: Farmer's lung, B: Contact hypersensitivity, C: Immediate hypersensitivity, D: Myasthenia gravis - -### Response: -Ref Robbins 9/e p209 Delayed-type hypersensitivity (DTH), described next, is an illustrative model of T cell-mediated inflammation and tissue injury. The same reactions are the underlying basis for several diseases. Contact dermatitis is an example of tissue injury resulting from T cell-mediated inflammation. It is evoked by contact with pentadecylcatechol (also known as urushiol, the active component of poison ivy and poison oak, which probably becomes antigenic by binding to a host protein). On reexposure of a previously exposed person to the plants, sensitized TH1 CD4+ cells accumulate in the dermis and migrate toward the antigen within the epidermis. Here they release cytokines that damage kera- tinocytes, causing separation of these cells and formation of an intraepidermal vesicle, and inflammation manifested as a vesicular dermatitis. It has long been thought that several systemic diseases, such as type 1 diabetes and mul- tiple sclerosis, are caused by TH1 and TH17 reactions against self antigens, and Crohn disease may be caused by uncon- trolled reactions involving the same T cells but directed against intestinal bacteria. T cell-mediated inflammation also plays a role in the rejection of transplants, described later in the chapter. Delayed-Type Hypersensitivity DTH is a T cell-mediated reaction that develops in response to antigen challenge in a previously sensitized individual. In contrast with immediate hypersensitivity, the DTH reac- tion is delayed for 12 to 48 hours, which is the time it takes for effector T cells to be recruited to the site of antigen chal- lenge and to be activated to secrete cytokines. The classic example of DTH is the tuberculin reaction, elicited by chal- lenge with a protein extract of M. tuberculosis (tuberculin) in a person who has previously been exposed to the tuber- cle bacillus. Between 8 and 12 hours after intracutaneous injection of tuberculin, a local area of erythema and indura- tion appears, reaching a peak (typically 1 to 2 cm in diam- eter) in 24 to 72 hours and thereafter slowly subsiding. On histologic examination, the DTH reaction is characterized by perivascular accumulation (""cuffing"") of CD4+ helper T cells and macrophages (Fig. 4-13). Local secretion of cyto- kines by these cells leads to increased microvascular per- meability, giving rise to dermal edema and fibrin deposition; the latter is the main cause of the tissue induration in these responses. DTH reactions are mediated primarily by TH1 cells; the contribution of TH17 cells is unclear. The tubercu- lin response is used to screen populations for people who have had previous exposure to tuberculosis and therefore have circulating memory T cells specific for mycobacterial proteins. Notably, immunosuppression or loss of CD4+ T cells (e.g., resulting from HIV infection) may lead to a nega- tive tuberculin response even in the presence of a severe infection. Prolonged DTH reactions against persistent microbes or other stimuli may result in a special morphologic pattern of reaction called granulomatous inflammation. The initial perivascular CD4+ T cell infiltrate is progressively replaced by macrophages over a period of 2 to 3 weeks. These accumulated macrophages typically exhibit morphologic evidence of activation; that is, they become large, flat, and eosinophilic, and are called epithelioid cells. The epitheli- oid cells occasionally fuse under the influence of cytokines (e.g., IFN-g) to form multinucleate giant cells. A micro- scopic aggregate of epithelioid cells, typically surrounded by a collar of lymphocytes, is called a granuloma (Fig. 4-14, A). The process is essentially a chronic form of TH1-mediated inflammation and macrophage activation (Fig. 4-14, B). Older granulomas develop an enclosing rim of fibroblasts and connective tissue. Recognition of a granuloma is of diagnostic impoance because of the limited number of conditions that can cause it (Chapter 2). -### End" -7667,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Absence of tear film is seen in, with the following options: A: Conjunctivitis, B: Lacrimal gland removal, C: Herpes keratitis, D: Kerato conjunctivitis sicca - -### Response: -Ans. is 'd' i.e. Keratoconjunctivitis sicca. Keratoconjunctivitis sicca: A condition in which there is deficiency of the aqueous tears.Causes are:Sjogren's syndromeCongenital alacrimaParalytic hyposecretionIdiopathic hyposecretionAbsence of tear film is not seen in lacrimal gland removal because :""It must be remembered that xerosis or dryness of the conjunctiva does not result from extirpation of the superior and inferior lacrimal glands, the moistening of the conjunctiva by Krause's glands and its own mucous cells being sufficient to prevent it."" -### End" -7668,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lynch Howah surgery is for:, with the following options: A: Nasal septal perforation, B: Sinonasal tumours, C: Acoustic neuroma, D: Otosclerosis - -### Response: -Frontal osteomas can be excised by Lynch Howah surgery -### End" -7669,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All the following factors affect APGAR score except, with the following options: A: Prematurity, B: Maternal retardation, C: Neurological condition of the new born, D: Mode of delivery - -### Response: -This scoring system provided a standardized assessment for infants after delivery. The Apgar score comprises fivecomponents: 1) color, 2) hea rate, 3) reflexes, 4) muscle tone, and 5) respiration, each of which is given a score of 0, 1, or 2. Reference: GHAI Essential pediatrics, 8th edition -### End" -7670,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following is a feature of concomitant squint -, with the following options: A: Constant amount of detion in all directions of gaze, B: Associated limitation of ocular movements, C: Different amount of detion in different directions of gaze, D: Develops in the patients at 15 - 20 years of age - -### Response: -Concomitant squint is characterised by Amount of detion remains constant in all directions of gaze. There is no associated limitation of ocular movements. Process stas by the age of 3-6 months and is completed upto 5-6 years. Ref : A.K.Khurana; 6th edition; Page no: 347 -### End" -7671,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Optic nerve is: September 2009, with the following options: A: 1st order neuron, B: 2nd order neuron, C: 3rd order neuroon, D: 4th order neuron - -### Response: -Ans. B: 2nd order neuron In the case of the optic nerve and tracts there are three separate neurons linked together, extending from the retina to the occipital coex. The sensory end-organ consists of the rods and cones. The first neuron begins in the outer plexiform or granular layer, and ends in the inner plexiform or granular layer. The cell-body governing the nutrition of this fiber is the bipolar cell, which cells forms the inner nuclear layer. This neuron, although extremely sho is the true optic nerve in the physiological sense, and corresponds to the long fiber which runs from the sole of the foot up into the spinal cord. The second neuron in the retina begins in the inner nuclear layer and runs from here up to the primary optic ganglia, i.e., chiefly the external geniculate body. This is the anatomical optic nerve. The cell governing the nutrition of this fiber is the ganglion cell. -### End" -7672,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication of scaphoid fracture-, with the following options: A: Malunion, B: Avascular necrosis of proximal part, C: Wriststiffners, D: Arthritis - -### Response: -Ans. is 'b' i.e., Avascular necrosis Complication of scaphoid fracture o Fractures of the scaphoid bone, even when undisplaced, are potentially troublesome and the incidence of complications is high, o The most important complications are :- Delayed union Non-union Avascular necrosis Osteoarthritis of wrist ""AVN is the most common complication of a scaphoid fracture, occuring in 15% to 30% of cases"". o Risk of AVN depends on the location of the fracture :- Fracture of the proximal segment (proximal 1/3) has the highest risk Fracture of middle segment (waist) has moderate risk Fracture of distal segment rarely causes AVN o The proximal part is more susceptible for AVN because of retrograde vascular supply. Most of the blood supply to the scaphoid enters distally, and proximal part has precarious supply after fracture through waist or proximal part of the bone. o Therefore, AVN occurs in proximal part. -### End" -7673,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: CCF is associated with increase in all of the following, except:, with the following options: A: Right atrial mean pressure, B: Serum sodium, C: Serum urea, D: Serum norepinephrine - -### Response: -Congestive cardiac failure (CCF) is associated with decreased sodium levels or hyponatremia. CCF is associated with increased right atrial mean pressure, increased serum urea and increased serum nor-epinephrine. Ref: Harrison's Principles of Internal Medicine, 17th Edition, Page 1447 & 1448; 16th Edition, Page 255, 1366; CMDT2006 Edition, Page 870, 389 -### End" -7674,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ca cervix with involvement of upper l/3rd vagina but not the parametrium is: (Repeat), with the following options: A: Stage IIA, B: Stage IIIA, C: Stage IIB, D: Stage IIIB - -### Response: -Ans: A (Stage IIA) Ref: Shows Textbook of Gynecolgy pg 412Explanation:CARCINOMA CERVIX STAGINGStage IStage I is carcinoma strictly confined to the cervix;The diagnosis of both Stages IA1 and IA2 should be based on microscopic examination of removed tissue, preferably a cone, which must include the entire lesson.Stage IA: Invasive cancer identified only microscopically. Invasion is limited to measured stromal invasion with a maximum depth of 5 mm and no wider than 7 mm.o Stage I At: Stage IAI: Measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm diameter.o Stage IA2: Stage IA2; Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 7 mm in diameter.Stage IB: Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than Stage la. All gross lesions even with superficial invasion are Stage IB cancers.o Stage IB1: Stage IB 1: Clinical lesions no greater than 4 cm in size.o Stage IB2: Stage IB2: Clinical lesions greater than 4 cm in size.Stage IIStage II is carcinoma that extends beyond the cervix, but does not extend into the pelvic wall.The carcinoma involves the vagina, hut not as far as the lower third.Stage IIA: No obvious parametria] involvement. Involvement of up to the upper two-thirds of the vagina.Stage IAB: Obvious parametria! involvement, but not into the pelvic sidewall.Stage IIIStage III is carcinoma that has extended into the pelvic sidewall.On rectal examination, there is no cancer-free space between the tumour and the pelvic sidewall.The tumour involves the lower third of the vagina.All cases with hydronephrosis or a nonfunctioning kidney are Stage III cancers.Stage III A: No extension into the pelvic sidewall but involvement of the lower third of the vagina.Stage II IB: Extension into the pelvic sidewall or hydronephrosis or nonfunctioning kidney.Stage IVStage IV is carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.Stage IVA: Spread of the tumour into adjacent pelvic organs.Stage IVB: Spread to distant organs. -### End" -7675,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The incidence of the mucocele is lowest in, with the following options: A: Frontal sinus, B: Sphenoid sinus, C: Maxillary sinus, D: Ethmoid sinus - -### Response: -Paranasal sinus mucoceles most commonly occur in the third or fouh decades of life with a slight male predilection. The frontal sinus is most commonly affected followed by the ethmoid sinuses, with repos suggesting 70-90 % of mucoceles occur in these locations.Ten percent of mucoceles occur in the maxillary sinus and the sphenoid sinus is involved rarely. -### End" -7676,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which drug is used in treatment of veigo, with the following options: A: Cinnarizine, B: Metoclopramide, C: Cisapride, D: None - -### Response: -Ans. is 'a' i.e., Cinnarizine Veigo is due to labyrinthine disorder and the impulse utilizes cholinergic muscarinic and H1 histamic receptors (similar to motion sickness). So, the drugs used are antimuscarinic, phenothiazines (phenothiazines have anticholinergic propey) and antihistaminics. Cinnarizine (act by inhibiting influx of Ca"" into endolymph) and betahistine. (a histamine) analogue improve blood circulation to the inner ear can be used in Meniere's disease. -### End" -7677,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement about diazoxide is false, with the following options: A: It acts by causing prolonged opening of ATP dependent potassium channels in beta cells, B: It can cause severe hypoglycemia, C: It can be used to treat patients with insulinaemia, D: It is used as an antihypeensive agent - -### Response: -Diazoxide cause hyperglycemia and not hypoglycemia Diazoxide is a potassium channel activator, which causes local relaxation in smooth muscle by increasing membrane permeability to potassium ions. This switches off voltage-gated calcium ion channels, preventing calcium flux across the sarcolemma and activation of the contractile apparatus Refer katzung 11e p180 -### End" -7678,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dissecting haematoma is a clinical complication occurring in, with the following options: A: Turner's syndrome, B: Klinefelter's syndrome, C: Down syndrome, D: Marfan syndrome - -### Response: -Ans. (d) Marfan syndrome(Ref: Robbins 9th/pg 491-492; 8th/pg 496-497, Harrison 18th ed 2063)Dissecting aneurysmWall of an artery rips (dissects) longitudinallyThis occurs because bleeding into the weakened wall splits the wall.Common in Marfan syndrome QThoracic aorta more affected Q -### End" -7679,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Typical field defect observed in anterior ischaemic optic neuropathy is:, with the following options: A: Altitudinal hemianopia, B: Paracentral scotoma, C: Homonymous hemianopia, D: Baring of the blind spot - -### Response: -Ans. Altitudinal hemianopia -### End" -7680,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All except one is true regarding minimum alveolar concentration, with the following options: A: Lower the MAC, higher the potency, B: Rate of induction depends on MAC, C: Nitrous oxide has MAC value of 104 and thus is least potent, D: Methoxy flurane has lowest MAC value - -### Response: -Rate of induction depends on Blood gas partition coefficient. -### End" -7681,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young child presented with history of passage of dark colored with urine with reduced urine output. He has a past history of abdominal pain, fever, and bloody diarrhea for 4 days which resolved on its own. There is absence of peripheral edema or rashes. Investigations show anemia, thrombocytopenia, and elevated blood urea nitrogen and serum creatinine. Which of the following findings is most expected finding in this patient?, with the following options: A: Elevated haptoglobin level, B: Elevated serum indirect bilirubin, C: Elevated thrombin and prothrombin time, D: Low fibrinogen and elevated D-dimer level - -### Response: -- Child given is presenting with classical history of hemolytic uremic syndrome In HUS, there is initial history of diarrhea caused d/t E-coli which causes damage to endothelial cells resulting in thrombotic microangiopathy affecting kidney. Typical Causative agent: Escherichia coli strain O157:H7 infection; Endothelial damage by Shiga-like toxin Characterized by triad of Renal failure, Anemia, Thrombocytopenia Peripheral findings - Presence of Schistocytes. As it causes hemolytic anemia, | in haptoglobin level & | in serum indirect bilirubin is seen Low fibrinogen and elevated D-dimer level is usually seen in DIC -### End" -7682,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Humming bird sign on MRI is seen in, with the following options: A: Progressive supra nuclear palsy, B: Multiple sclerosis, C: Developmental venous malformation, D: All of the above - -### Response: -Humming bird sign - PSP. -Dawson's finger sign - Multiple sclerosis. -### End" -7683,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In splenic injury conservative management is done in, with the following options: A: Hemodynamically unstable, B: Young patients, C: Shattered spleen, D: Extreme pallor and hypotension b - -### Response: -Most serious complications after splenectomy are OPSI (Oppounistic Post Splenectomy Infections) it is most common in young children and immunocompromised adults. ""Therefore it is essential to save the spleen in children."" Now spleen salvage methods are the management of choice even in adults. Splenectomy is usually indicated under the following circumstances (Ref: Sabiston 18/e pi639 (17/e} p 1694) 1. the pt. is unstable 2. the spleen is extensively injured with continuous bleeding 3. bleeding is associated with hilar injury 4. other injuries require prompt attention SRB 5th edition page no. 672 & 671 -### End" -7684,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pseudoarterial aneurysm in drug abuser's seen in, with the following options: A: Radial, B: Brachial, C: Femoral, D: Carotid - -### Response: -Pseudoaneurysm is a rare condition arising from disruption in the arterial wall with blood dissecting into the tissues around the damaged artery creating a perfused sac that communicates with the arterial lumen. Its incidence is on rising due to the increase in endovascular procedures, hemodialysis and intravenous drug abuse. -Here we report a young male who was found by an NGO worker, lying on the roadside near a Mandir with a pulsatile inguinal swelling and blood oozing out from it. He was taken immediately to the emergency department of LN Hospital. He was a rickshaw puller and known drug addict. -The swelling was diagnosed as pseudo-aneurysm of common femoral artery on clinical examination and by Doppler ultrasonography. He was referred to CTVS department and admitted there for surgery. -In the meanwhile, he collapsed in the hospital toilet and died due to hemorrhagic shock consequent upon rupture of pseudoaneurysm of the femoral artery. -### End" -7685,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is the mode of inheritance of APKD?, with the following options: A: Autosomal dominant, B: Autosomal recessive, C: X-linked recessive, D: Mitochondrial inheritance - -### Response: -Ans is 'a' i.e., Autosomal dominant Summary of Renal cystic disease InheritancePathologic featuresClinical features of ComplicationsAdult polycystic kidney diseaseAutosomal dominantLarge multicystic kidneys, liver cysts, berry aneurysmsHematuria, flank, pain, urinary tract infection, renal stones, hypertensionChildhood polycystic kidney diseaseAutosomal recessiveEnlarged cystic kidneys at birthHepatic fibrosisMedullary sponge kidneyNoneMedullary cysts on excretory urographyHematuria, urinary tract infection, recurrent renal stonesFamilial juvenile nephronophthisisAutosomal recessiveCorticomedullary cysts, shrunken kidneysSalt wasting, polyuria, growth retardation, anemiaAdult-onset meduallry cystic diseaseAutosomal dominantCorticomedullary cysts, shrunken kidneysSalt wasting, polyuriaSimple cystsNoneSingle or multiple cysts in normal-sized kidneysMicroscopic hematuria -### End" -7686,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement (s) is/are true about dengue fever -, with the following options: A: | Hematocrit, B: Increase in Platelet, C: Negative tourniquet test, D: Vector (Aedes aegypticus) usually bites in night time - -### Response: -

In dengue fever , hematicrit increases, platelet decreases, positive tourniquet test ,vector usually bite in day time. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:236-255. <\p> -### End" -7687,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: As compared to unfractionated heparin, low molecular weight heparin -, with the following options: A: Are absorbed more uniformly when given subcutaneously, B: Require more frequent lab monitoring, C: Can be given to patients with heparin induced thrombocytopenia, D: A higher risk of osteopenia - -### Response: -Ans. is 'a' i.e., Are absorbed more uniformly when given subcutaneously o Unfractionated heparin binds to several plasma proteins, therefore it has less predictable dose-response profile when administered sc or iv. o On the other hand, LMW heparins are less protein bound and have a predictable dose response profile when administered sc or iv. About other options o Since aPTT/clotting time are not prolonged (much) with LMW heparins, laboratory monitoring is not needed. o LMW heparins are unsuitable for HIT as antibody may be cross-reactive. Agent of choice in HIT are direct thrombin inhibitors like hirudin, lepirudin, bivalirudin. o Osteoporosis (osteopenia) occurs as a dose related side effect of unfractionated heparin. The relative risk with LMW heparin is not yet estabilished. -### End" -7688,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Salt and pepper dyschromatosis is seen in: September 2009, with the following options: A: Dermatofibrositis, B: Scleroderma, C: SLE, D: Psoriasis - -### Response: -Ans. B: Scleroderma Skin changes in scleroderma: Skin pigmentary changes include a salt-and-pepper appearance, with areas of hyperpigmentation alternating with hypopigmentation, or an overall appearance of tanned skin that persists long after sun exposure Telangiectasias are dilated vessels located just beneath the dermis on any skin area, but they are most obvious in the face (perioral area), hands, and anterior chest. The skin of the hands may be edematous or swollen early in the disease, and the patient may initially repo this as puffy changes. This edematous stage precedes the indurated sclerotic stage; longer time to progression to the sclerotic phase indicates a better prognosis. In the sclerotic phase, the skin may appear tight and shiny, with a characteristic loss of hair, decreased sweating, and loss of the ability to make a skin fold. Calcinosis may develop on the fingers and extremities, usually the extensor side of the forearms and the prepatellar areas -### End" -7689,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common complication of mumps in children is, with the following options: A: Orchitis, B: Aseptic meningitis, C: Pancreatitis, D: Myocarditis - -### Response: -(B) Aseptic meningitis > In adult males, mumps can cause bilateral orchitis and sterility, Meningitis usually follow parotitis and acute pancreatitis occurs in 2nd week, may result in diabetes mellitus.> Meningo encephalitis results 3-10 days after onset of glandular swelling.> Incubation period of mumps is 12-21 days (Mean 17 days)> COMPLICATIONS OF MUMPS: Epididymo-orchitis is a complication seen in about a third of postpubertal male patients. The testis becomes swollen and acutely painful, with accompanying fever and chills. Orchitis is usually unilateral but when it is bilateral and followed by testicular atrophy, sterility or low sperm counts may result. The central nervous system is involved in about 60 per cent of cases, as indicated by pleocytosis in the CSF but only about 10 per cent show symptoms of meningitis.> Mumps has been reported to cause about 10-15 per cent of cases of aseptic meningitis'. Mumps meningitis and meningoencephalitis usually resolve without sequelae but deafness may sometimes result. Munps meningitis may occasionally occur in the absence of parotitis, when diagnosis rests solely on laboratory evidence. The virus can be grown readily from the CSF in the early phase of meningitis.> Other less common complications are arthritis, oophoritis, nephritis, pancreatitis, thyroiditis and myocarditis. Most common complication of mumps in children is aseptic meningitis. -### End" -7690,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common benign tumor of larynx in a child between 2-5 years is, with the following options: A: Chondroma, B: Infantile hemangioma, C: Scleroma, D: Juvenile laryngeal papilloma - -### Response: -SQUAMOUS PAPILLOMAS They can be divided into (i) juvenile and (ii) adult-onset types. 1. JUVENILE PAPILLOMATOSIS (SYN. RESPIRATORY PAPILLOMATOSIS) Juvenile papillomatosis is the most common benign neoplasm of the larynx in children. It is viral in origin and is caused by human papilloma DNA virus type 6 and 11. It is presumed that affected children got the disease at bih from their mothers who had vaginal human papilloma virus disease. Papillomas mostly affect supraglottic and glottic regions of larynx but can also involve subglottis, trachea and bronchi. Clinical features:- Patient, often a child, between the age of 3 and 5 years presents with hoarseness or aphonia with respiratory difficulty or even stridor. Diagnosis:- Diagnosis is made by flexible fibreoptic laryngoscopy and later confirmed by direct laryngoscopy and biopsy. Papillomas are known for recurrence but rarely undergo malignant change. Ref:- Dhingra; pg num:-305 -### End" -7691,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is true regarding random error:, with the following options: A: Systematic differences in characteristic between cases and control, B: Cases and controls are asked questions about their past history, C: Error in sampling, D: Different rates of admission in hospital - -### Response: -sampling error Berkesonian bias is a special example of bias. It is named after Dr. Joseph Berkson who recognized this problem. The bias arises because of the different rates of admission to hospitals for people with different diseases (hospital cases and controls). Recal bias: differential recall ability between the cases and the controls Neyman bias: differential moality between groups, which is not accounted for. -### End" -7692,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which layer of epidermis is underdeveloped in the VLBW infants in the initial 7 days?, with the following options: A: Stratum germinativum., B: Stratum granulosum, C: Stratum lucidum, D: Stratum corneum - -### Response: -Ans. is 'd' ie., stratum corneum ""Stratum corneum is permeable in preterm infants and becomes similar to the adults and in infants after two to three weeks of post natal maturation"" - page 109, Physical diagnosis in neonatology: -### End" -7693,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gamma - Carboxylation of what requires vitamin k?, with the following options: A: Glutamine, B: Glutamic Acid, C: Glycine, D: Aspartate - -### Response: -Vitamin K -Function -1.   Catalyzes gamma-carboxylation of glutamic acid residues on various proteins concerned with blood clotting. -2.   Catalyzes gamma carboxylaton of glutamic acid to GABA. -Deficiency -1.   Neonatal haemorrhage with increased PT and aPTT, but normal bleeding time. -2.   Synthesized by intestinal flora, so vitamin-K deficiency can occur after the prelonged use of broad-spectrum antibiotics. -      (Note: Vitamin-K dependent clotting factors are II, VII, IX, X and protein C and S. Warfarin is a vitamin-K antagonist) -      A specific protein known as PIVKA (Protein induced in vitamin K absence) is important in diagnosing vitamin K deficiency. -### End" -7694,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is responsible for ligament laxity during pregnancy?, with the following options: A: Estrogen, B: Prolactin, C: Progestrone, D: B hcg - -### Response: -Ans c (progestrone) Ref: Sheila Balakrishnan pg 91Progestrone induced relaxation of joints contributes to the changes in posture in pregnancy- Progressive lordosis and waddling gait. -### End" -7695,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Treatment of genuine stress incontinence:a) Anterior colporrhaphyb) Posterior colporrhaphyc) Colposuspensiond) Pelvic floor exercisee) Sling operation, with the following options: A: bce, B: bde, C: acde, D: abde - -### Response: -Pelvic floor exercises -Sling operation -Colposuspension (Burch) are all done for management of SUI. -As far as anterior colporrhaphy is concerned - Kelly's plication is anterior colporrhaphy along with bladder neck repair, so -### End" -7696,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Excess of avidin causes deficiency of:, with the following options: A: Folate, B: Choline, C: Vitamin B12, D: Biotin - -### Response: -Excess consumption of raw eggs, which contains a protein 'avidin' - a biotin binding protein leads to biotin deficiency When cooked, avidin is paially denatured and its binding to biotin is reduced. So cooked egg whites are safe to consume. -### End" -7697,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Odds ratio is related to:, with the following options: A: Incidence, B: Relative risk, C: Attributable risk, D: Prevalence - -### Response: -Relative risk -### End" -7698,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best sample taken for identification from burnt Body:, with the following options: A: Hair, B: Bone, C: Teeth, D: Blood - -### Response: -Identification of burnt bodies Hair: singed Blood: burned Bone: difficult to extract DNA from charred bones Teeth: DNA can be extracted from pulp of the teeth even in a burnt body. -### End" -7699,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Classic sign of lead induced peripheral neurotoxicity is:, with the following options: A: Loss of vibration sense, B: Paraesthesia, C: Anaesthesia, D: Foot drop - -### Response: -Lead-induced pathological changes in these fibres include segmental demyelination and axonal degeneration. Extensor muscle palsy with wrist and ankle drop has been recognized since the time of Hippocrates as the classic clinical sign of the peripheral neurological toxicity of lead; however, this generally only occurs with chronic lead poisoning and is rare in acute exposure to lead. Ref : -### End" -7700,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Middle superior alveolar nerve is a branch of which of the following nerve?, with the following options: A: Facial Nerve, B: Lingual nerve, C: Maxillary nerve, D: Mandibular nerve - -### Response: -Middle superior alveolar nerve arise from infra orbital branch of maxillary nerve in the infra orbital groove and canal.Course of superior alveolar nerve:It is given off from the maxillary nerve just before its exit from the infra orbital foramen. It descends in a canal in the anterior wall of the maxillary sinus, and divides into branches which supply the incisor and canine teeth. It communicates with the middle superior alveolar branch, and gives off a nasal branch and supplies the mucous membrane of the anterior pa of the inferior meatus and the floor of the nasal cavity. Ref: Essentials of Anatomy By I. B. Singh, 2nd Edition, Page 391 -### End" -7701,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The given pedigree chart most appropriately resembles which of the following disease, with the following options: A: Rett syndrome, B: Duchenne's muscular dystrophy, C: Albinism, D: Marfans syndrome - -### Response: -The pedigree chart depicts X-linked recessive inheritance. -Among the options, Duchenne's muscular dystrophy only shows X-linked recessive inheritance. -### End" -7702,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minimal pleural effusion is best viewed in which position, with the following options: A: Lateral decubitus, B: Full inspiration erect, C: Supine, D: Full expiration erect - -### Response: -Ans. Lateral decubitus -### End" -7703,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The usefulness of the long bones in stature estimation is, with the following options: A: Femur > tibia > humerus > radius, B: Tibia > femur > humerus > radius, C: Femur > Humerus > tibia > radius, D: Tibia > humerus > femur > radius - -### Response: -For height estimation : (of the individual's height in life ) Humerus is 20% Tibia 22% Femur 27% Spine 35% -### End" -7704,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Microscope was invented by ?, with the following options: A: Ronald ross, B: Robert koch, C: Antonie van Leeuwenhoek, D: Louis pasteur - -### Response: -Microscope was invented by Antonie Van Leeuwenhoek. -### End" -7705,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Steroids hormones exe their effects by binding to, with the following options: A: Cell surface receptors, B: G proteins, C: Transcription factors, D: Cyclic adenosine monophophate (AMP) - -### Response: -Steroid hormones cross the cell membrane and bind to specific receptors within the cell. These receptors are transcription factors that are active only in the presence of paicular hormones. The hormone-transcription factor complex binds to steroid hormone responsive elements in DNA to influence transcription from steroid-sensitive genes. Thyroid hormone, retinoic acid, and 1,25-dihydroxycholecalciferol exe their effects in a similar way. -### End" -7706,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 2-week old neonate with a history of stridor that improves when the baby assumes the prone position - what is treatment -, with the following options: A: Oral calcium, B: Nebulisation, C: Wait & watch, D: Antibiotic - -### Response: -Ans. is 'c' i.e., Wait & watch Laryngomalaciao The most common congenital laryngeal anomaly and the most frequent cause of stridor in infants and children.o Typically, stridor is inspiratory: low pitched, and exacerbated by any exertion (crying, agitation, feeding), supine position, and viral infections of the upper airway.o Stridor results from the collapse of supraglottic structures inward during inspiration.o Symptoms usually appear in the first 2 wk of life and increase in severity for up to 6 mo, although gradual improvement can begin at any time,o The diagnosis is confirmed by flexible laryngoscopyo Expectant observation is suitable for most infants because most symptoms resolve spontaneously. -### End" -7707,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sensory fibres from the taste buds in the bard and soft palate travel along:, with the following options: A: Trigeminal nerve, B: Facial nerve, C: Glossopharynegeal nerve, D: Vagus nerve - -### Response: -B i.e. Facial nerve -### End" -7708,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hormones is responsible for inhibiting lactation during pregnancy?, with the following options: A: Progesterone, B: Human placental lactogen, C: Oxytocin, D: Prolactin - -### Response: -Lactation is d/t Prolactin so it cannot inhibit lactation Progestrone: Maintain pregnancy & during pregnancy inhibits Lactation. Post delivery its effect is gone so doesn't inhibit Lactation. Oxytocin: has no role in lactation, its function is milk production. -### End" -7709,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carbamoyl phosphate is used in, with the following options: A: Urea, B: Uric acid, C: Pyruvic acid, D: Stearic acid - -### Response: -One molecule of ammonia and co2 condenses to form Carbomy phoshate in presence of 2 molecules of ATP and carbomyl phosphate synthetase II enzyme. this carbomyl phoshate is transferred to NH2 group of ornitine to form Citrulline in urea cycle.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 203 -### End" -7710,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Civatte bodies are a feature of ?, with the following options: A: Lichen simplex chronicus, B: Lichen planus, C: Lichen sclerosus, D: All of the above - -### Response: -Ans. is 'b' i.e., Lichen planus Civatte bodies (cytoid bodies/ colloid bodies/ hyaline bodies)* A characteristic histopathological feature of lichen planus* They are apoptotic basal cells present at dermo-epidermal junction and papillary dermis. Formed my macrophages engulfing the melanin.Other histopathological features of lichen planus* Hydropic degeneration of basal cells (Pathognomic feature)* Hypergranulosis (thickening of the granular layer) (focal hypergranulosis clinically creates Wickham striae)* Hyperkeratosis (thickening of stratum corneum)* Acanthosis (thickening of stratum Malpighi)* Sub-epidermal lichenoid band (deposition of lymphocytes 8c histiocytes in the upper dermis)* Pigment incontinence (dropping of melanin from damaged Keratinocytes of epidermis into dermis)* Max Joseph space /cleft (separation of the epidermis in small clefts)* Sawtooth appearance (flattened rete ridges) -### End" -7711,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Holstein lewis sign is related to which nerve ?, with the following options: A: Median nerve, B: Radial nerve, C: Ulnar nerve, D: Axillary nerve - -### Response: -A Holstein-Lewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve. * Most commonly caused by fracture of the humerus, v at the junction of the middle and distal thirds. (Holstein-Lewis fracture) * Radial nerve in paicular jeopardy * The proximal spike of this radial breaks through the lateral coex at a point where the nerve is most closely apposed to the bone . ref : maheswari 9th ed -### End" -7712,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Catatonia is most commonly seen with, with the following options: A: Schizophrenia, B: dissociation, C: Anxiety disorder, D: Obsessive compulsive disorder - -### Response: -Catatonic schizophrenia (Cata: disturbed, tonic: tone) is characterised by a marked disturbance of motor behaviour the charecterstic feuture of catatonia is mutism and stupour catatonia can be rated by a rating scale called as Bush Francis Catatonia Rating Scale.It can present in three clinical forms: excited catatonia, stuporous catatonia, and catatonia alternating between excitement and stupor. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 59 -### End" -7713,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Activated protein C is used therapeutically in:, with the following options: A: Abnormal PT\/PTT, B: Ml, C: Fungal infection, D: Sepsis - -### Response: -Answer is option4, sepsis Human recombinant activated protein C for severe sepsis. Mai-Carvajal AJ1, Sola I, Lathyris D, Cardona AF. Author information Update in Human recombinant protein C for severe sepsis and septic shock in adult and paediatric patients. Abstract BACKGROUND: Sepsis is a common and frequently fatal condition. Human recombinant activated protein C (APC) has been used to reduce the high rate of death by severe sepsis or septic shock. This is an update of a Cochrane review (originally published in 2007 and updated in 2008). -### End" -7714,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 13 years old boy often argue with parent and teachers. However he is not physical aggressive and there is no history of drug abuse, theft, lying or bullying. Most likely diagnosis is-, with the following options: A: Conduct disorder, B: Oppositional defiant disorder, C: Autism, D: Pervasive developmental disorder - -### Response: -Ans: B. Oppositional defiant disorder(Ref: Kaplan & saddock's th/e p. 11391)This boy is showing a pattern of defiance of authority (arguing with parents and teachers).There are no features of conduct disorder (drug abuse, theft' lying).Thus, the diagnosis is oppositional defiant disorder. -### End" -7715,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common site of Brain metastasis is?, with the following options: A: Lung cancer, B: Head and neck cancer, C: Prostate cancer, D: Breast cancer - -### Response: -Ref: Bailey and Love 26th edition, P 614The leading cause of brain metastasis is lungs > Breast>MelanomaTissue of origin for brain metastases (approximate).OriginPercentageLung40Breast15Melanoma10Renal/GU10Other Unknown25 -### End" -7716,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with recurrent swelling of the lips as shown. He has no itching. Family history is positive. Which of the following is deficient in this patient?, with the following options: A: C1,C2,C4, B: C1 inhibitor, C: C3b inactivator, D: C5-C8 - -### Response: -This boy presents with features of hereditary angioneurotic edema, which is due to deficiency of C1 inhibitor. C1 inhibitor deficiency - Hereditary angioedema. C1, C2, C4 deficiency - Collagen vascular disorders C5-C8 deficiency - Recurrent bacteremia with Neisseria. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition -### End" -7717,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are the Intranatal causes of Perinatal moality except:-, with the following options: A: Bih injuries, B: Bih asphyxia, C: Antepaum hemorrhage, D: Obstructed labor - -### Response: -Causes of perinatal moality: Antenatal cause Intranatal cause Maternal disease -HTN,DM,TB,Anemia,Cardiovascular disease Bih injuries Pelvic disease Bih asphyxia Anatomical defects Prolonged effo time; obstructed labour Endocrine imbalance Other Obstetric complications Malnutrition Postnatal causes Toxemias Prematurity Antepaum hemorrhage Respiratory distress syndrome Congenital defects Respiratory and alimentary infections Advanced maternal age Congenital anomalies Blood incompatibilities -### End" -7718,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acquired nasolacrimal duct obstruction is caused by:, with the following options: A: Brimonidine, B: Dorzolamide, C: Timolol, D: Pilocarpine - -### Response: -Drugs such as epinephrine, echothiopate and pilocarpine can produce lacrimal duct obstruction. Secondary causes of nasolacrimal duct obstruction includes: Traumatic nasal injury with bony fractures, iatrogenic causes such as complications from sinus surgery or orbital decompression, migration of punctual and lacrimal plugs, Sarcoidosis, Wegners granulomatosis, Steven Johnson syndrome and severe nasal polyposis. -### End" -7719,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about corneal opacity are all except: March 2008, with the following options: A: Anterior staphyloma has iris tissue incorporated within the scar tissue, B: Healing of a perforated corneal ulcer may lead to formation of adherent leucoma, C: A strictly localized dense leucoma interferes more than a thin,diffuse nebula covering the papillary area., D: Some opacities may persists despite destruction of Bowman's membrane - -### Response: -Ans. C: A strictly localized dense leucoma interferes more than a thin,diffuse nebula covering the papillary area Nebular corneal opacity-If the details of the iris can be seen through the opacity. Macular corneal opacity-Details of the iris cannot be seen but the margins of the iris and the pupil can be marked out Leucomatous corneal opacity-if the opacity is very dense and totally opaque obscuring the view of pupil. Anterior staphyloma has iris tissue incorporated and incarcerated within the scar tissue, as seen in healing of a large sloughed corneal ulcer. Healing of a perforated corneal ulcer, so that iris is adherent to the back of the leucoma may lead to formation of adherent leucoma. A strictly localized dense leucoma interferes more less than a thin, diffuse nebula covering the papillary area because leucoma stops all the light falling on it, whereas nebula refracts it irregularly, allowing many of the rays to fall upon retina where they blur the image formed by the regularly refracted rays. Some opacities may persists despite destruction of Bowman's membrane but many clears considerably paicularly in younger patients. -### End" -7720,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drugs has maximum chances of absorption from gastric mucosa, with the following options: A: Diclofenac sodium, B: Morphine sulfate, C: Hyoscine hydrobromide, D: Quinine dihydrochloride - -### Response: -Ref-Katzung 10/e p7,8 Diclofenac is an acidic drug and is non-ionized in the acidic medium of stomach.therefore,it has the maximum chances of absorption from the stomach.other drugs in the options are basic drugs that are ionized at gastric pH -### End" -7721,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hea block is seen in:, with the following options: A: Hypermagnesemia, B: Hypomagnesemia, C: Hypernatremia, D: Hypocalcemia - -### Response: -Hypermagnesemia slows the hea and leads to hea block Hypomagesemia leads to cardiac arrhythmias like SVT and VT -### End" -7722,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Superior colliculus is concerned cells, with the following options: A: Olfaction, B: Hearing, C: Vision, D: Pain sensation - -### Response: -The superior colliculus (SC) is a midbrain area where visual, auditory and somatosensory information are integrated to initiate motor commands. The SC plays a central role in visual information processing in the mouse; it receives projections from 85% to 90% of the retinal ganglion cells (RGCs). Ref Harrison20th edition pg 2345 -### End" -7723,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Carcinoma in which surgery is rarely indicated, with the following options: A: Osteosarcoma, B: Wilm's tumor, C: Neuroblastoma, D: Rhabdomyosarcoma - -### Response: -Osteosarcoma An osteosarcoma (OS) or osteogenic sarcoma (OGS) (or simply bone cancer) is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma) and that exhibits osteoblastic differentiation and produces malignant osteoid. Treatment A complete radical, surgical, en bloc resection of the cancer, is the treatment of choice in osteosarcoma. Although about 90% of patients are able to have limb-salvage surgery, complications, paicularly infection, prosthetic loosening and non-union, or local tumor recurrence may cause the need for fuher surgery or amputation. Mifamuide is used after a patient has had surgery to remove the tumor and together with chemotherapy to kill remaining cancer cells to reduce the risk of cancer recurrence. Also, the option to have rotationplasty after the tumor is taken out exists. Patients with osteosarcoma are best managed by a medical oncologist and an ohopedic oncologist experienced in managing sarcomas. Current standard treatment is to use neoadjuvant chemotherapy (chemotherapy given before surgery) followed by surgical resection. The percentage of tumor cell necrosis (cell death) seen in the tumor after surgery gives an idea of the prognosis and also lets the oncologist know if the chemotherapy regimen should be altered after surgery. Standard therapy is a combination of limb-salvage ohopedic surgery when possible (or amputation in some cases) and a combination of high-dose methotrexate with leucovorin rescue, intra-aerial cisplatin, adriamycin, ifosfamide with mesna, BCD (bleomycin, cyclophosphamide, dactinomycin), etoposide, and muramyl tripeptide. Rotationplasty may be used. Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low. Despite the success of chemotherapy for osteosarcoma, it has one of the lowest survival rates for pediatric cancer. The best repoed 10-year survival rate is 92%; the protocol used is an aggressive intra-aerial regimen that individualizes therapy based on aeriographic response. Three-year event-free survival ranges from 50% to 75%, and five-year survival ranges from 60% to 85+% in some studies. Overall, 65-70% patients treated five years ago will be alive today. These survival rates are overall averages and vary greatly depending on the individual necrosis rate. Filgrastim or pegfilgrastim help with white blood cell counts and neutrophil counts. Blood transfusions and epoetin alfa help with anemia. Computational analysis on a panel of Osteosarcoma cell lines identified new shared and specific therapeutic targets (proteomic and genetic) in Osteosarcoma, while phenotypes showed an increased role of tumor microenvironments Ref : Internet sources -### End" -7724,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about endometriosis is all except, with the following options: A: Chronic inflammatory disease, B: Estrogen independent, C: Ectopic endometrial tissue, D: Frequently seen in ovaries - -### Response: -Endometriosis is estrogen-dependent condition. -### End" -7725,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: OCT (Optical coherence tomography) is based on?, with the following options: A: High coherence interferometry, B: Low coherence interferometry, C: Non-coherence interferometry, D: Polariztion - -### Response: -Optical Coherence Tomography(OCT) is a new imaging modality that produces high resolution, cross-sectional images of ocular structures in vivo. OCT produces detailed two-dimensional images of the retina and measures retinal thickness with a longitudinal image resolution of approximately 10 microns. The principles of OCT are similar to B-mode ultrasound, however OCT utilizes the reflection of Light waves from different structures in the eye rather than sound. Low coherent light, produced by a continuous wave superluminescent diode source, is directed into the eye and is reflected at the boundaries of tissues with different optical propeies. Optical coherence tomography (OCT) is an imaging technique that uses low-coherence light to capture micrometer-resolution, two- and three-dimensional images from within optical scattering media (e.g., biological tissue). It is used for medical imaging and industrial nondestructive testing (NDT). ref khurana 6th edition pg 456 -### End" -7726,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: One of the following is not a characteristic of casual association-, with the following options: A: Coherence, B: Specificity, C: Sensitivity, D: Biological plausibility - -### Response: -Assosciations can be broadly grouped under 3 headings: Spurious association Indirect association Direct association, which consists of a) one to one causal association and b) multifactorial causation Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 95 -### End" -7727,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Young male Kallu is brought to the hospital with Severe asthama. PharmacoKinetics of theophylline include the following parameters:Vd=35L ;CL=48ml/min;half life is 8hrs.if an intravenous infusion of theophylline is staed at a rate of 0.48mg/min,how long will it take to reach 93.75% of the final steady stare, with the following options: A: Approximately 48min, B: Approximately 5.8hrs, C: Approximately 8hrs, D: Approximately 32hrs - -### Response: -Ref-Katzung 10/e p52 For a drug following first order kinetics,rise in plasma concentration as well as fall in plasma concentraton is similar.when the steady state is attained and the drug administration is stopped.it will be eliminated from the body.50% will be eliminated in one half life 75% in second half life and 87.5%(50+25+12.5%) in third half life and 93.75% (50+25+12.6+6.5%) in four half lives. When constant i.v. is administered, plasma concentration increases in the same manner.in one half life,it is 50% of the steady state and to reach 93.75% of steady state ,4half loves will be required As the half life of this drug is 8hrs, approximately 32hrs will be taken -### End" -7728,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Hyoid bone is closely associated to: September 2012, with the following options: A: Bronchogenic cyst, B: Cystic hygroma, C: Thyroglossal cyst, D: Ranula - -### Response: -Ans. C i.e. Thyroglossal cystThyroglossal cystMC site:- Beneath the hyoid,Occupies the midline usually (except in the region of thyroid cailage),Swelling moves upwards on protrusion of the tongue as well as on swallowing (attachment with foramen caecum),Painless -### End" -7729,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eustachian valve is seen in -, with the following options: A: Eustachian tube opening at nasopharyngeal end, B: Eustachian tube opening in tympanic cavity, C: IVC opening in right atrium, D: Coronary sinus opening in right atrium - -### Response: -Ans. is 'c' i.e., IVC opening in right atrium o Opening of IVC in right atrium is guarded by - Eustachian valve (rudimentary valve). o Opening of coronary sinus in right atrium is guarded by - Semilunar valve/Thebesian valve (functional valve) -### End" -7730,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anti - LKM 2 antibodies are seen in, with the following options: A: Type I Autoimmune hepatitis, B: Type II Autoimmune hepatitis, C: Drug induced hepatitis, D: Chronic hepatitis D - -### Response: -Anti LKM 1 antibodies - Type II AIH -Anti LKM 2 - Drug induced hepatitis -Anti LKM 3 - Chronic hepatitis D. -### End" -7731,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Postpaum tubectomy in a hea disease patient is done at, with the following options: A: 48 hours, B: 1 week, C: 2 weeks, D: Immediately - -### Response: -Sterilization should be considered with the completion of the family at the end of first week in the puerperium under local anaesthesia throught abdominal route by minilap technique. If the hea is not well compensated the husband advised for vasectomy. -### End" -7732,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Anthracosis is caused by;, with the following options: A: Silica, B: Asbestos, C: Coal dust, D: Sugar cane waste - -### Response: -Anthracosis is caused by Coal dust. There are two general phases in Anthracosis The first phase is simple pneumoconiosis which is associated with little ventilatory impairment. The second phase is characterised by progressive massive fibrosis (PMF); this causes severe respiratory disability and frequently results in premature death. -### End" -7733,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A disease which only affects the formation and eruption of the tooth but does not cause -hypoplasia is?, with the following options: A: Hyperthyroidism, B: Hypothyroidism, C: Vitamin A deficiency, D: All of the above - -### Response: -Hyperthyroidism does not cause hypoplasia. -In children, shedding of the deciduous teeth occurs earlier than normal, and eruption of the permanent teeth is greatly accelerated. -Ref: Shafer's textbook of oral pathology 7th edition page 652 -### End" -7734,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following should be considered as the cause6 of generalised convulsions 20 minutes post operatively, with the following options: A: Halothane, B: Enflurane, C: Isoflurane, D: Sevoflurane - -### Response: -Refer anaesthesiology by Longnecker /761 KDT 6/e p372 Enflurane Enflurane is known to produce seizures -### End" -7735,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Adenocarcinoma of esophagus is commonly found in, with the following options: A: Achlasia acardia, B: Barret's oesophagus, C: Plummer vinson syndrome, D: Chronic smoking - -### Response: -Answer is B (Barret's esophagus) Adenocarcinoma is seen in Barret's esophagus Barret's esophagus is a metaplastic change in the lining mucosa of oesophagus in response to chronic gastroesophagus reflex. In Barret's esophagus the junction between oesophageal mucosa (squammous) and gastric mucosa (columnar) moves proximally such that the lower pa of esophagus now becomes lined with different types of gastric mucosa. This pa of oesophagus has an increased risk for adenocarcinoma i.e. Adenocarcinoma is seen in Barrets esophagus. -### End" -7736,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A neonate presents with recurrent seizures with hypocalcemia, recurrent infections. What is the diagnosis?, with the following options: A: Di George syndrome, B: Baer syndrome, C: Gitelman syndrome, D: Idiopathic hypercalciuria - -### Response: -Mnemonic: CATCH-22 is used to describe DiGeorge syndrome, with the 22 to remind one that the chromosomal abnormality is found on the 22 chromosomes: Cardiac Abnormality (especially Tetralogy of Fallot) Abnormal facies Thymic aplasia= explains the recurrent infections Cleft palate Hypocalcemia/Hypoparathyroidism: explains recurrent seizures and tetany Gitelman syndrome occurs in older children and features episodes of muscle weakness and tetany associated with severe hypokalemia, and hypomagnesemia. These children have hypocalciuria. Bater syndrome is thought to result from mutations in two genes (NKCC2, ROMK) affecting nephron Na+-K+or K+transpo. These patients typically have a history of polyhydramnios and following bih have recurrent life-threatening episodes of fever and dehydration with the aforementioned electrolyte and acid-base disturbances, hypercalciuria, and early-onset nephrocalcinosis. -### End" -7737,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following physiological changes occur during fever?, with the following options: A: Thermoregulatory centre to shift to new level, B: Resetting of skin temperature, C: Both of the above, D: None of the above - -### Response: -Fever is an elevation of body temperature that exceeds the normal daily variation and occurs in conjunction with an increase in the hypothalamic set point . The processes of heat conservation (vasoconstriction) and heat production (shivering and increased nonshivering thermogenesis) develops until the temperature of the blood bathing the hypothalamic neurons matches the new thermostat setting. Once that point is reached, the hypothalamus maintains the temperature at the febrile level. Ref: Dinarello C.A., Porat R. (2012). Chapter 16. Fever and Hypehermia. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. -### End" -7738,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Microscopic examination of a specimen shows organisms with characters of both corynebacteria and streptococci and resemble diphtheroids in stained smears. The organism is:, with the following options: A: Proteus vulgaris, B: Proteus mirabilis, C: Vibno, D: Listeria - -### Response: -Listeria monocytogenes is a Gram-positive rod with some bacteriologic features that resemble those of both corynebacteria and streptococci. In stained smears of clinical and laboratory material, the organisms resemble diphtheroids. Listeria produces small, b-hemolytic colonies on blood agar. Listeria species are catalase-positive, which distinguishes them from streptococci, and they produce a characteristic tumbling motility in fluid media at temperatures below 30degC, which distinguishes them from corynebacteria. Ref: (2010). Chapter 26. Corynebacterium, Listeria, and Bacillus. In Ryan K.J., Ray C(Eds), Sherris Medical Microbiology, 5e. -### End" -7739,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True regarding Wolfes graft is, with the following options: A: Uptake of graft is easy, B: Donor site left open to granulate and contract, C: Large grafts could be taken, D: Not useful for cosmetic surgeries - -### Response: -Wolfes graft is full thickness skin graft. In this donor site will have to be closed primarily or left open to granulate and contract. -### End" -7740,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Therapeutic drug development which is the newest agent ?, with the following options: A: Ribozyme, B: Micro RNA, C: SnRNA, D: Retro RNA - -### Response: -Ans. is 'b' i.e., Micro RNA Mi RNAs regulate gene expression by pairing to target mRNAs, thus inducing translational repression. Novel findings indicate an orchestrated coregulation with long noncoding RNAs. Since its discovery, this small RNA species has opened new frontiers in cardiovascular diseases. -### End" -7741,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: An appearance in culture given below is seen due to which organism ?, with the following options: A: Sporothrix schenckii, B: Paracoccidioides brasiliensis, C: Histoplasma capsulatum, D: Blastomyces dermatidis - -### Response: -The appearance is known as Pilot wheel or Mariner's wheel . Pilot wheel Seen in Paracoccidioides brasiliensis on culture growth at temperature of 37 degC Occurs due to multiple budding yeast cells in culture attached to large mother cell . =Sporotrichosis or Rose Gardner's diseaseis chronic subcutaneous pyogranulomatous disease caused by a thermally dimorphic fungus Sporothrix schenckii. =Blastomyces dermatitidis causes Gilchrist's disease, Chicago disease =HistoplasmosisorDarling's diseaseis caused by dimorphic fungus - Histoplasma capsulatum -### End" -7742,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A young man presented with hyper parathyroidism. Which of the following radionuclide scan is done for parathyroid adenoma?, with the following options: A: Sesta MIBI scan, B: Iodine-123 scan, C: 99mTc-sulphur colloid, D: Gallium scan - -### Response: -The localization ability of Technetium 99m sestamibi scintigraphy is based on its preferential uptake by parathyroid cells, due to their high mitochondrial activity. Delayed images taken 2 to 3 h after injection are sensitive in up to 90% of single adenoma cases, with over 90% specificity. Sestamibi imaging is also effective in cases of double adenoma. However, it has significantly reduced accuracy in cases of four-gland hyperplasia. Ref: Singer M.C., Terris D.J. (2012). Chapter 43. Parathyroid Disorders. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology--Head & Neck Surgery, 3e. -### End" -7743,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acantholytic cell in pemphigus is derived from :, with the following options: A: Stratum granulosum, B: Stratum basale, C: Stratum spinosum, D: Langerhan's cell - -### Response: -C i.e. Stratum spinostunPemphigus (vulgarisQ, vegetans, foliaceus, erythematous, endemic, paraneoplasticQ) causes intra epidermalQ and PemphigoidQ (bullous, cicatricial, gestations, linear IgA disease) causes sub epidermal bullae formation(2. Blisters (vesicles, bullae or split) are intra epidermal in pemphigus and subepidermal in pemphigoid and dermatitis herpetiformisQ -### End" -7744,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The synthesis of one peptide bond involves hydrolysis of, with the following options: A: 1 ATP & 3 GTP, B: 2 ATP & 2 GTP, C: 3 ATP & 1 GTP, D: 4 ATP - -### Response: -During the translation process, the formation of one peptide bond (adding one amino acid) consumes 4 high energy phosphates (2 from ATP & 2 from GTP). Eukaryotes will add 6 amino acids and prokaryotes will add 18 amino acids per second. (Refer: Harper's Illustrated Biochemistry, 26th edition, pg no: 370) -### End" -7745,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rokitansky protuberances are seen in -, with the following options: A: Mucinous carcinoma, B: Teratoma, C: Epidermal cystoids adenoma, D: Papillary carcinoma - -### Response: -Teratoma - -Teratomas are divided into three categories: - -(1) Mature (benign) - -Most benign teratomas are cystic and are known as dermoid cysts. -These neoplasms are presumably derived from the ectodermal differentiation of totipotential cells. -They are bilateral in 10% to 15% of cases. -Characteristically, they are unilocular cysts containing hair and cheesy sebaceous material. On section, they reveal a thin wall lined by an opaque, grey-white, wrinkled, apparent epidermis. -Generally, in one area of the cyst wall, a solid prominence is seen known as Rokitansky's protuberance where tissue elements such as tooth, bone, cartilage & various other odd tissues are present. -On histologic examination, the cyst wall is composed of stratified squamous epithelium with underlying sebaceous glands, hair shafts, and other skin adnexal structures. In most cases, structures from other germ layers can be identified, such as cartilage, bone, thyroid tissue, and other organoid formations. -Dermoid cysts are sometimes incorporated within the wall of a mucinous cystadenoma. -About 1% of the dermoids undergo malignant transformation of any one of the component elements ( but most commonly, squamous cell carcinoma). - -(2) Monodermal or Specialized Teratomas - -The rare group of tumors, the most common of which are struma ovarii and carcinoid. -They are always unilateral, although a contralateral teratoma may be present. -Struma ovarii is composed entirely of mature thyroid tissue. Interestingly, these thyroidal neoplasms may hyperfunction, causing hyperthyroidism. -The ovarian carcinoid, which presumably arises from intestinal epithelium in a teratoma, might, in fact, be functioning, particularly in large tumors, producing 5-hydroxytryptamine and the carcinoid syndrome. - -(3) Immature Malignant Teratomas - -These are rare tumors that differ from benign teratomas in that the component tissue resembles that observed in the fetus or embryo rather than in the adult. -The tumor is found chiefly in prepubertal adolescents and young women. -These grow rapidly and frequently penetrate the capsule with local spread or metastases. -On microscopy, there are varying amounts of immature tissue differentiating toward cartilage, glands, bone, muscle, nerve, and others. -An important risk for the subsequent extraovarian spread is the histologic grade of tumor, which is based on the proportion of tissue containing immature neuroepithelium. -### End" -7746,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cause of post-menopausal bleeding is :, with the following options: A: Arrhenoblastoma, B: Cystadenoma, C: Granulosa cell tumour, D: Hilus cell tumour - -### Response: -Granulosa cell tumour -### End" -7747,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pathognomic of measls -, with the following options: A: Koplik spot, B: Rash, C: Fever, D: Conjuctivitis - -### Response: -Ans. is 'a' i.e., Koplik spot Measleo Caused by RN A virus.o Highly contagious droplet spread from secretion of nose and throat 4 day before and 5 days after rash,o Secondary attack rate >90% in contact.o Prodromal phase - characterized by fever, rhinorrhea, conjuctival congestion and dry hackig cough,o Koplik spots bluish-gray specks or ''grains of sand"" on a red base-develop on the buccal mucosa opposite the second molarsGenerally appear 1 -2 days before the rash and fast 3-5 daysPathognomonic for measles, but not always presento Rash appears on D4 first behind pinna on neck the spread of face, thrunk and abdomen,o SSPE is long term complication seen in measls. -### End" -7748,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pathogenesis of all of the following is granulomatous inflammation, except:, with the following options: A: Wegener's granulomatosis, B: Churg-Strauss syndrome, C: Takayasu's aeritis, D: Microscopic polyangitis - -### Response: -Microscopic polyangitis is characterized by segmental fibrinoid necrosis of the media with focal transmural necrotizing lesions; granulomatous inflammation is absent. -### End" -7749,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: High priority in triage is for -, with the following options: A: Red color, B: Yellow color, C: Green color, D: Black color - -### Response: -Ans. is 'a' i.e., Red colour o The most common triage classification system used international is four colour code system.1. Red- High priority treatment or transfer2. Yellow- Medium priority3. Green- Ambulatory patients4. Black- Dead or moribund patients -### End" -7750,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most accurate method to diagnose Hemangioma of liver, with the following options: A: USG, B: MRI, C: Hepatic Scintigraphy, D: CECT - -### Response: -Most accurate method - MRI > hepatic scintigraphy. -### End" -7751,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Structures passing through obturator foramen are all EXCEPT:, with the following options: A: Internal Pudendal vessels, B: Obturator Nerve, C: Obturator Aery, D: Obturator Vein - -### Response: -Internal Pudendal Vessels pass through greater and lesser sciatic foramina(not through obturator foramen). The obturator aery,obturator vein, and obturator nerve all travel through the canal. fig :-structure passing through sciatic foramina -### End" -7752,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Schilling test is used for -, with the following options: A: Fat absorption, B: Vit K absorption, C: Vitamin B12 absorption, D: Vitamin D absorption - -### Response: -Ans. is 'c' i.e., Vitamin B12 absorption [Ref: Clinical diagnosis and management by the laboratory method""Schilling test is used for l it B12 absorption ""Schilling test Step 1o Administer an intramuscular injection of Vitamin Bl2This will saturate the vitamin B12 receptors because otherwise, the body would be hungry for the oral dose of vitamin B12 and radiolabelled vitamin B12 will not appear in urine even if there is no abnormality in vitamin B12 absorption.Step 2o Give a radiolabeled oral dose of vitamin BI2If the vitamin B 12 absorption is normal the radiolabelled vitamin B 12 would appear in the urine. In that case, Vitamin B12 deficiency is believed to be due to dietary deficiency.If the vitamin B 12 does not appear in the urine malabsorption of Vitamin B12 is suspected. It has to find out whether its due to pernicious anemia or some other cause.Step 3o Sow, administer intrinsic factor along with radiolabelled Vitamin BI2If vitamin B12 appears in the urine then the diagnosis is pernicious anemia.If the Vitamin Bl 2 still does not appear in the urine then it is a case of malabsorption but not due to pernicious anemia and most commonly due to ileal resection or small bowel infection and bacterial overgrowth. -### End" -7753,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cranial nerve related to apex of petrous temoporal bone, with the following options: A: VIII, B: VII, C: VI, D: IX - -### Response: -Cranial nerve 5 & 6 are related to apex of petrous bone. -Only 1st & 2nd cranial nerves do not arise from brain stem and so do not pass through posterior-cranial fossa. And all other C.N (i.e. 3rd to 12th) pass through posterior cranial fossa. -Trochlear (4th) nerve is the only cranial nerve to emerge dorsally from the brain stem & has longest infra cranial course and most slender cranial nerve (in terms of axons it contains) -### End" -7754,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is/are not the features of henoch-Schonlein purpura (HSP) -, with the following options: A: Abdominal pain, B: Splinter hemorrhage, C: Thrombocytopenia, D: Epistaxis - -### Response: -Ans. is 'c' i.e., Thrombocytopenia o HSP is characterized by tetrad of palpable purpura, ahritis, glomerulonephritis and abdominal pain. o Less common skin lesions are : nonpalpable macules & patches, uicaria, bullous lesions, vesicles, splinter hemorrhage and ulcerations. o Rarely epistaxis may occur. -### End" -7755,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Lymphoid tissue is the site of latent infection for which of the following herpes viruses?, with the following options: A: Cytomegalovirus, B: Epstein barr virus, C: Herpes simplex virus type 1, D: Herpes simplex virus type 2 - -### Response: -Epstein barr virus is a human herpes virus type 4, belonging to the gamma family. Its latent infection is in the lymphoid tissues. While that of Herpes simplex virus type 1 and 2 is in neurons and that of cytomegalovirus is in secretary glands and kidneys. Ref: Textbook of Microbiology, Anathanaraya and panicker's, 8th Edition, Page 468 -### End" -7756,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40 -- years -- old woman presented to the gynecologist with complaints of profuse vaginal discharge. There was no discharge from the cervix on the speculum examination. The diagnosis of bacterial vaginosis was made based upon all of the following findings on microscopy except :, with the following options: A: Abundance of gram variable coccobacilli, B: Absence of Lactobacilli, C: Abundance of polymorphs, D: Present of clue cells - -### Response: -Ans. is c i.e. Abundance of polymorphs In Bacterial vaginosis, polymorphs are either absent or there is only a slight increase. -### End" -7757,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ulnar collateral nerve is, with the following options: A: Branch of ulnar nerve, B: Branch of radial nerve supplying medial head of triceps, C: Branch of radial nerve supplying long head of biceps, D: Branch of radial nerve supplying lateral head of triceps - -### Response: -In the arm, the radial nerve is posterior to the brachial aery. Here it gives muscular branches to long and medial heads of triceps brachii. The branch for medial head lies very close to the ulnar nerve and hence is called the ulnar collateral nerve. ReferenceClinicall Anatomy for students, a problem-solving approach, Neeta v Kulkarni, 2nd edition, page no.179 -### End" -7758,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements concerning immunoglobulins is wrong -, with the following options: A: Igm does not cross placenta, B: IgE is | ed in parasitic infection, C: IgM increased in primary response, D: Fetal infection is characterised by increased in IgG - -### Response: -IgM antibodies do not pass across the human placenta. Demonstrating IgM antibodies in a patient's serum indicates recent infection, or in a neonate's serum indicates intrauterine infection Reff: Ananthanarayan & Parkers textbook of microbiology 9th edition pg:98 -### End" -7759,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are seen in Behchets syndrome except -, with the following options: A: Genital ulcers, B: Uveitis, C: Oral ulcers, D: Pyoderma gangrenosum - -### Response: -Ans. is 'd' i.e., Pyoderma gangrenosum Behcet's diseaseo Behcet's disease is a multisystem disease that is defined by the presence of oral aphthosis with at least two of the following: genital aphthae, synovitis, posterior uveitis, cutaneous pustular vasculitis or meningoencephalitis, in the absence of IBD or autoimmune Diseases .o Children sometimes develop Behcet's disease, but it typically affects young adults.o Its association with HLA-B51Diagnostic criteria:Recurrent oral ulceration - Minor aphthous, major aphthous, or herpetiform ulceration observed by physician orpatient that recurred at least 3 times in one 12-month periodPlus two of the following criteria :Recurrent genital ulceration Aphthous ulceration or scarring observed by physician or patientEye lesions : Anterior uveitis, posterior uveitis, or cells in vitreous on slit-lamp examination; or retinal vasculitis observed by ophthalmologistSkin lesions : Erythema nodosum observed by physician or patient, pseudofolliculitis or papulopustular lesions; or acneiform nodules observed by physician in post-adolescent patients not receiving corticosteroid treatmentPositive pathergy test: Read by physician at 24-48 h. -### End" -7760,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 5 yr/M presented with fever for 10 days, for which child was given some medication. He has developed anorexia & vomiting for last 3 days, altered sensorium for 1 day. The child also had 2 episodes of seizures 1 day before presentation. O/e the child was hemodynamically stable, had no pallor or icterus, no meningeal signs. Liver was palpable-2cm below right costal margin, blood glucose 40 mg%, Hb 11 g/dl, TLC 8300, Platelet count 2.8 lac/mm3, PT was 58/12 sec. What is the diagnostic possibility?, with the following options: A: Tyrosinemia, B: Reye syndrome, C: Alagille syndrome, D: Acute Viral Hepatitis - -### Response: -Given scenario suggests diagnosis of: Reye syndrome Alagille Syndrome- Triangular faces, conjugated jaundice Tyrosinemia- hepatorenal involvement, peripheral neuropathy -### End" -7761,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: S100 is a marker used in the diagnosis of, with the following options: A: Melanoma, B: Schwannoma, C: LCH, D: All of the above - -### Response: -S100 proteins are normally present in cells derived from the neural crest (Schwann cells, and melanocytes), chondrocytes, adipocytes, myoepithelial cells, macrophages, Langerhans cells, dendritic cells, and keratinocytes.S100 protein family are useful as markers for ceain tumors and epidermal differentiation. It can be found in melanomas, schwannomas, neurofibromas, 50% of malignant peripheral nerve sheath tumors, paraganglioma stromal cells, histiocytoma and clear cell sarcomas. -### End" -7762,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: This is a specimen of stalk resection of pedunculated bony swelling. Diagnosis is, with the following options: A: Osteochondroma, B: Chondroma, C: Osteoid osteoma, D: Osteoclastoma - -### Response: -Osteochondroma, also known as an exostosis, is the most common benign bone tumor; about 85% are solitary.It is a benign cailage-capped tumor that is attached to the underlying skeleton by a bony stalk. The cap is composed of benign hyaline cailage varying in thickness and is covered peripherally by perichondrium. The coex of the stalk merges with the coex of the host boneRef: Robbins Pathology; 9th edition; Page no: 1200 -### End" -7763,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: False negative hydrostatic test in live fetus is for, with the following options: A: Atelectasis, B: Aicial respiration, C: Emphysema, D: Putrefaction - -### Response: -False negative hydrostatic test can be seen in :- 1. Diseases e.g. : acute edema, pneumonia, Congenital syphilis. 2. Atelectasis False positive hydrostatic test can be seen in :- 1. Presence of putrified gases. 2. Aificial inflation. -### End" -7764,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A new born baby had normal APGAR score at bih and developed excessive frothing and choking on attempted feeds. The investigation of choice is ?, with the following options: A: Esophagoscopy, B: Bronchoscopy, C: MRI chest, D: X-ray chest and abdomen with the red rubber catheter passed per orally into esophagus - -### Response: -Ans. is 'd' i.e., X-ray chest and abdomen with the red rubber catheter passed per orally into esophagus o This is a case of tracheo esophageal fistula. C/F of tracheo esophageal fistula a) The newborn regurgitates all of its first and subsequent feeds. b) Saliva pours almost continuously from the mouth of the infant (This is 'the sign' of tracheoesophageal atresia. It does not occur in any other condition) c) Attacks of coughing and cyanosis occurs on feeding. Clinical confirmation of diagnoses q If a nasogastric tube is tried to pass into the infant it will come against an obstruction within 10 cm. If this occurs the diagnosis is viually ceain. o Radiological confirmation of diagnosis a) A lateral chest X-ray --> It shows a lucent proximal pouch that may displace trachea anteriorly. b) X-ray abdomen --> Gas in the stomach is seen if there is communication between the lower pa of the esophagus and trachea which occurs in the commonest variety of tracheo-esophageal fistula. -### End" -7765,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A girl at 16 years of age, presents with primary amenorrhea. On examination, breast development is normal, axillary and pubic hair are sparse, vagina is normal. USG revealed absent uterus and solid nodular structures in B/L inguinal regions. Diagnosis is?, with the following options: A: Androgen insensitivity syndrome, B: MRKH, C: Turners syndrome, D: Pure gonadal dysgenesis - -### Response: -MRKH Androgen insensitivity syndrome Genotype XX XY sex of rearing Female Female Breast development Normal (estrogen effect) Normal Pubic and axillary hair Normal Absent (insensitivity to testosterone) Gonad Normal ovary Testis Uterus Absent Absent Risk of gonadal malignancy None Increased Gonadectomy Not required Recommended after attaining pubey LEARNING TIP: MRKH (MULLERIAN AGENESIS) IS XX BUT DOESN'T HAVE MULLERIAN COMPONENT (UTERUS AND VAGINA). NORMAL OVARY (IT IS NOT MULLERIAN) - ESTROGEN - NORMAL SECONDARY SEXUAL CHARACTERS - FEMALE PHENOTYPE ANDROGEN INSENSITIVITY IS XY, TESTES ARE PRESENT, BUT BODY IS RESISTANT TO TESTOSTERONE (NO AXILLARY N PUBIC HAIR) - NORMAL SECONDARY SEXUAL CHARACTERS - FEMALE PHENOTYPE TURNERS IS XO - STREAK GONADS - ABNORMAL FEMALE PHENOTYPE -### End" -7766,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sun ray appearance is seen in – a) Osteosarcomab) Ewing sarcomac) Osteoclastomad) Multiple myeloma, with the following options: A: ac, B: ab, C: ad, D: bc - -### Response: -Sunray appearance is classically seen in osteosarcoma. It may also occur in metastases, Ewings sarcoma, Haemangioma, Meningioma and tuberculosis. -### End" -7767,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The prostatic urethra is characterized by all of the following features, except, with the following options: A: Is the widest and most dilatable pa, B: Presents a concavity posteriorly, C: Lies closer to anterior surface of prostate, D: Receives prostatic ductules along its posterior wall - -### Response: -The prostatic urethra, the widest and most dilatable pa of the urethra canal, is about 3 cm. long The transverse section of this canal is shaped like a horse-shoe. Its convex pa is directed towards the front. -### End" -7768,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dohle bodies -, with the following options: A: Dilated Endoplasmic Reticulum in Neutrophils, B: Mitochondria, C: Golgi apparatus, D: Lysosomes - -### Response: -Dohle bodies are patches of dilated endoplasmic reticulum that appear as sky blue cytoplasmic puddles. Ref :Robbins pathologic basis of disease ; south east asia edition ;pg:583 -### End" -7769,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Respiratory minute volume of lung is -, with the following options: A: 6L, B: 4L, C: 500mL, D: 125L - -### Response: -Ans. is 'a' i.e., 6L o The minute respiratory' volume averages about 6 L/min.o Minute volume (Pulmonary ventilation or respiratory minute volume) : - It is the amount of air breathed in (inspired) or out (expired) by the lungs in one minute. So, minute volume = Tidal volume x Respiratory rate. It is at about 6LQ (500 ml tidal volume x 12 breath per minute respiratory rate). Minute volume is considered as a measure of pulmonary ventilation.Respiratory Volumes and Capacities for an Average Young Adult MaleMeasurementTypical valueDefinitionRespiratory volumes1. Tidal volume (TV)500 mlAmount of air inhaled or exhaled in one breath during relaxed, quiet breathing2. Inspiratory reserve volume (IRV)3000 mlAmount of air in excess of tidal inspiration that can be inhaled with maximum effort3. Expiratory reserve volume (ERV)1200 mlAmount of air in excess of tidal expiration that can be exhaled with maximum effort4. Residual volume (RV)1200 mlAmount of air remaining in the lungs after maximum expiration, keeps alveoli inflated between breaths and mixes with fresh air on next inspirationRespiratory Capacities5. Vital capacity (VC)4700 mlAmount of air that can be exhaled with maximum effort after maximum inspiration (ERV+TV+IRV); used to assess strength of thoracic muscles as well as pulmonary function6. Inspiratory' capacity (IC)3500 mlMaximum amount of air that can be inhaled after a normal tidal expiration (TV + IRV)7. Functional residual capacity (FRC)2400 mlAmount of air remaining in the lungs after a normal tidal expiration (RV + ERV)8. Total lung capacity (TLC)5900 mlMaximum amount of air the lungs can contain (RV + VC) -### End" -7770,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Why is Clopidogrel preferred over Ticlodipine?, with the following options: A: Cost, B: Drug interaction, C: Side effect, D: Efficacy - -### Response: -(C) Side effect# TICLOPIDINE like clopidogrel, it is an adenosine diphosphate (ADP) receptor inhibitor.> Clopidogrel due to simpler dosing regimen, the absence of neutropenia, bone marrow aplasia and the lower frequency of other side effects make it a safe alternative to ticlopidinel. -### End" -7771,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mutation seen in Hartnup's disease:, with the following options: A: SLC6A 18, B: SLC6A 19, C: SLC6A 17, D: SLC6A 16 - -### Response: -b. SLC6A 19(Ref: Nelson 20/e p 3160)Hartnup's disease is due to mutation of SLC6A 19 gene encoding the neutral amino acid transporter, resulting in deficiency of nicotinamide synthesis -### End" -7772,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: According couinaud's classification of functional segments of liver, which of the following is segment IV of liver?, with the following options: A: Left lobe, B: Right lobe, C: Caudate lobe, D: Quadrate lobe - -### Response: -Segment I     →  Caudate lobe -Segment IV   → Quadrate lobe -### End" -7773,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following enzyme uses citrate in fatty acid synthesis?, with the following options: A: Aconitase, B: Citrate synthase, C: Malic enzyme, D: ATP citrate lyase - -### Response: -Reference: Harpers illustrated biochemistry 30th edition -### End" -7774,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old woman complains of intermittent vague right upper quadrant (RUQ) pain. She has been on oral contraceptive tablets for 6 years. A CT scan of her abdomen shows multiple low-density solid masses occupying the entire right lobe of her liver as well as most of the left lobe. What is the best treatment for this patient?, with the following options: A: Hepatic embolization, B: Discontinuation of oral contraceptives and a repeated CT scan of her abdomen in 3-6 months, C: CT-guided percutaneous needle biopsy of several liver masses, D: Laparoscopic biopsy of the liver masses and cholecystectomy - -### Response: -The CT scan findings of this patient plus the history of prolonged use of oral contraceptives are characteristic in hepatocellular adenoma. Because the tumor extensively involves both the right and left lobes of the liver, oral contraceptive use must be discontinued, and the patient must be observed for 3-6 months. Significant reduction in size of the adenoma has been noted in many cases after cessation of oral contraceptive use. If there is no regression of lesions, then liver transplantation should be recommended. -### End" -7775,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Satiety center is located at, with the following options: A: Ventromedial nucleus of hypothalamus, B: Dorsomedial nucleus of hypothalamus, C: Peritrigonal area, D: Lateral nuclei - -### Response: -Ans. (a) Ventromedial nucleus of hypothalamus(Ref: Ganong, 25th ed/p.308)Feeding center - lateral nucleus of hypothalamusSatiety center - ventromedial nucleus of hypothalamus -### End" -7776,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Patients suffering from multidrug resistant tuberculosis can be treated with all the following drugs EXCEPT:, with the following options: A: Tobramycin, B: Amikacin, C: Ciprofloxacin, D: Clarithromycin - -### Response: -Multidrug-resistant (MDR) TB: is defined as resistance to both H and R and may be any number of other(1ST LINE) anti-TB drugs. MDR-TB has a more rapid course (some die in 4-16 weeks). Treatment of these cases is difficult, because one or more second line drugs are to be given for 12-24 months. If sensitivity of the TB bacilli is known, the drug/ drugs to which they are resistant is /are excluded and other first line drugs are prescribed along with 1-3 second line drugs. A total of 5-6 drugs are given. One of the FQs is generally included. ln case streptomycin is not being given, one out of kanamycin/ amikacin/ capreomycin should be added, because they are tuberculocidal. TOBRAMYCIN It was obtained from S. tenebrarius in the 1970s. The antibacterial and pharmacokinetic propeies, as well as dosage are almost identical to gentamicin, but it is 2-4 times more active against Pseudomonas and Proteus, including those resistant to gentamicin. However, it is not useful for combining with penicillin in the treatment oi enterococcal endocarditis. It should be used only as a reserve alternative to gentamicin. Serious infections caused by Pseudomonas and Proteus are its major indications. Ototoxicity and nephro toxicity is probably lower than gentamicin. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:724,748 -### End" -7777,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following can be conveed to an intermediate of either the citric acid cycle or the urea cycle?, with the following options: A: Tyrosine, B: Lysine, C: Leucine, D: Aspaate - -### Response: -. -### End" -7778,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents with cough with expectoration. Diagnosis of farmers lung is suspected. True statement regarding this condition:, with the following options: A: May to June seasonal, B: Persistent cough with expectoration, C: X-ray features upper lobe predominant in chronic HP, D: Pleural effusions are common - -### Response: -Ans: (c) X-ray features upper lobe predominant in chronic HPRef: Fishman's Pulmonary Disease and Disorders, 5th edition, Chapter 58Farmer's LungResults from exposure to moldy hay containing spores of Thermophilic Actinomycetes that produce a hypersensitivity pneumonitisMost cases of farmer's lung disease occur in cold, damp climates in late winter and early spring, when farmers (usually male) use stored hay to feed their livestockManifestations of the disease may be acute, subacute or chronicAcute clinical presentation includes transient fever, hypoxemia, myalgias, arthralgias, dyspnea, and cough that occur 2 to 9 hours after exposure and resolve in 12 to 72 hours without specific treatmentIn acute HP, chest radiographs-diffuse poorly defined nodular radiodensities, often with areas of ground-glass radiodensities or occasionally even consolidation, tend to occur in the lower lobes and spare the apicesChronic form is clinically more insidious, and patients may lack a history of acute episodes, but present with a gradual onset of cough, dyspnea, fatigue, and weight loss. Symptoms are usually present for months to years.In chronic HP, chest radiographs - diffuse linear and nodular radiodensities, with sparing of the bases and upper-lobe predominance, and volume loss. Pleural effusions and thickening are very unusual -### End" -7779,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following women is most likely to have a successful induction of labor, with the following options: A: G1P0 with BMI = 32 and neonatal birth weight of 2500g., B: G2 P1 with BMI = 27 and neonatal birth weight of 3100g., C: G1 P0 with BMI of 24 and neonatal birth weight of 4000g., D: G2 P1 with BMI of 32 and neonatal birth weight of 3200g. - -### Response: -Favorable factors for successful induction - -BMI < 30 -Favorable cervix -Birth weight < 3500g. -### End" -7780,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Abdominal pain, fever and jaundice. This triad is known as;, with the following options: A: Charcot's triad, B: Saint's triad, C: Virchow triad, D: Renault's triad - -### Response: -- Charcot's triad - abdominal pain + jaundice + fever. - Seen in Cholangitis. - For cholangitis to occur, the 2 essential factors are obstruction & infection. Predisposing factors for cholangitis: CBD stones (M.C) Stricture Cholangiocarcinoma Choledochal cyst Worms M.C organism responsible for CBD is E. coli > Klebsiella. M.C symptom - fever + chills. Inadequate treatment causes Reynold's pentad - Charcot's triad + shock + mental status changes. -### End" -7781,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Basic amino acid (s) is/are, with the following options: A: Arginine, B: Lysine, C: Histidine, D: All of these - -### Response: -Basic amino acids → Histidine, arginine, lysine (Memonics HAL). -Acidic amino acids → Aspartic acid (aspartate), glutamic acid (glutamate). -All other 15 standard amino acids are neutral. -### End" -7782,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If stage lb cervical cancer is diagnosed in a young woman, while performing radical hysterectomy which structure would you not remove, with the following options: A: Uterosacral and uterovesical ligament, B: Pelvic Lymph nodes, C: periureteral tissues, D: Upper third of vagina - -### Response: -Ovaries are not removed in radical hysterectomy if not diseased Types of Hysterectomy Type I : Extrafascial Hysterectomy Simple total abdominal hysterectomy with or without bilateral salpingo-oophorectomy Type II: Modified Radical Hysterectomy Removes the medial half of cardinal and uterosacral ligaments Type II differs From Type III by Uterine aery is transected at the level of ureter; Preserving the ureteral branch to the ureter Cardinal ligament is divided close to the midpoion near the ureteral dissection Anterior vesicouterine ligament is divided but posterior vesicouterine ligament is conserved Smaller margin of vagina is removed Type III Removal of most of the uterosacral, cardinal ligaments and upper one-third of the vagina Associated with Pelvic lymphadenectomy Extended Radical Hysterectomy Type IV: Additional structures removed Periureteral tissue Superior vesicle aery Three fouhs of vagina Type V: Poions of distal ureter and bladder are resected Reference: Berek and Novak's Gynecology; 15th edition; Chapter 36 -### End" -7783,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 25-year-old man presents with 3 months of polyuria and increased thirst. The patient suffered trauma to the base of the skull in a motorcycle accident 4 months ago. A 24-hoururine collection shows polyuria but no evidence of hematuria, glucosuria, or proteinuria. The pathogenesis of polyuria in this patient is most likely caused by a lesion in which of the following areas of the brain?, with the following options: A: Adenohypophysis, B: Brain stem, C: Mammillothalamic tract, D: Neurohypophysis - -### Response: -Central diabetes insipidus may be caused by head trauma that damages the posterior lobe of the pituitary (neurohypophysis) and interrupts the secretion of ADH. One fourth of cases of central diabetes insipidus are associated with brain tumors, particularly craniopharyngioma. The other choices do not involve areas of the brain that secrete ADH. The anterior pituitary (adenohypophysis, choice A) does not secrete ADH.Diagnosis: Diabetes insipidus -### End" -7784,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Niacin is derived from which amino acid -, with the following options: A: Tyrosine, B: Phenylalanine, C: Tryptophan, D: Methionine - -### Response: -Ans. is 'c' i.e., TryptophanAmino acidsBiological important compoundTyrosineCatecholamines (epinephrine, norepinephrine, dopamine), thyroxine,triiodothryonine, melanin(Note : - Phenylalanine is the precursor of tyrosine, thus it can also give rise to all these compounds through tyrosinejJ-lipotropic hormone (b-LPH) (phenylalanine - Tyrosine - Catecholamines, thyroxine T., melanin).TryptophanVitamin niacin, melatonin. SerotoninGlycine,Arginine, methionineCreatineGlycine, cysteineBile saltsGlycineHemeAspartic acid and glutaminePyrimidine basesGlycine, aspartic acid, glutaminePurine basesb-alanineCoenzyme-AArginineNitric oxideHistidine, Arginine, lysineKeratinMethionine, lysineCarnitineGABAGlutamateGlutamate, cysteine, glycineGlutathione -### End" -7785,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Organophosphates bind to, with the following options: A: Anionic site of AChEs, B: Esteratic site of AChEs, C: Ach, D: None - -### Response: -(Ref: KDT 6/e p99-100) The active region of Acetylcholinesterase (AChE) has two sites i.e. an anionic site and an esteratic site. Anticholinesterase poisoning like Organophosphate compounds binds to esteratic site of AChE. -### End" -7786,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is TRUE about trigger finger?, with the following options: A: Injury to fingers while operating a gun., B: Stenosis tenovaginitis of flexor tendon of affected finger, C: A feature of carpal tunnel syndrome, D: Any of the above - -### Response: -Stenosing flexor tenosynovitis or trigger thumb or trigger finger is characterized by local tenderness over the proximal tendon pulley at the MP joint, with pain referred to the PIP joint and a snapping when the finger or thumb goes through an active range of motion. Usually a history of repetitive strain is involved. Ref: Ewen B, Ha R.G. (2011). Chapter 29. Hand Trauma. In Stone C, Humphries R.L. (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e. -### End" -7787,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary site of infection in Cryptococcosis is, with the following options: A: Adrenal glands, B: Bone, C: Central nervous system, D: Lungs - -### Response: -Infection is acquired by inhalation causing pulmonary cryptococcosis leading to mild pneumonitis. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition -### End" -7788,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nitrates in drinking water indicate:-, with the following options: A: Recent pollution, B: Remote pollution, C: Radioactivity, D: Coliforms - -### Response: -Nitrates in drinking water indicates: Remote contamination. Nitrites in drinking water indicates: Recent contamination. Guidelines of drinking water quality in India: Colour = < 15 TCU Turbidity = < 1 NTU Hardness = < 100-300 mg/L pH = 6.5- 8.5 TDS = < 500 mg/L Fluorides = < 1ppm Nitrates = < 45 mg/d Nitrites = < 3 mg/ d Radio-activity: alpha= <0.5 Bcq/L ; Beta= < 1.0 Bcq/L. Extra edge: - Turbidity of water is visible to naked eye when its > 4 NTU. -### End" -7789,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Decrease number of melanocyte is seen in:, with the following options: A: Albinism, B: Piebaldism, C: Ichthyosis, D: Chemical leucoderma - -### Response: -Piebaldism is a Autosomal dominant disease characterized by patches of skin that lack melanin as a result of defect in migration of melanoblast from neural crest to skin. -Skin biopsy: Hypo melanotic area-few to no melanocytes. Vitiligo: is an acquired disease and similar patch of loss ofmelanin, but the loss develops after birth and progressive. Albinism: Congenital inability to synthesize melanin. -### End" -7790,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Congenital Dislocation of Hip (CDH) occurs classically due to, with the following options: A: Small femoral head epiphysis, B: Abnormal angle of femoral neck, C: Hypertrophied ligamentum teres, D: Developmental Acetabular dysplasia - -### Response: -Ans. d (Developmental Acetabular dysplasia) (Ref. Baily and Love 24th ed., Fig. 27.34)DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)# This term is more accurate than the older congenital dislocation of the hip (CDH) because it includes dislocation along with other less severe forms, all of which have in common a dysplasia or natural shallowness of the acetabulum. The femoral neck is usually anteverted.Aetiology# A family history of DDH increases the risk up to 30 times.# The condition is five times more common in girls.# The left side is affected more commonly than the right.# Breech presentation, especially the extended position, firstborn children and caesarean section are associated with increased neonatal instability, possibly through restricted foetal movement.# Finally, it may be association with neuromuscular disease conditions and skeletal dysplasia.Diagnosis# Neonate- Clinical Barlow and Ortolani tests: The baby should be relaxed and the hips flexed to 90 degree. It is possible to reduce a dislocated hip by abduction and gentle forward pressure (Ortolani) or dislocate an unstable hip by adduction and gentle backward pressure (Barlow). In both cases a soft clunk is felt as the hip reduces or dislocates.The specificity of clinical neonatal examination is 100% (no false positives). However, its sensitivity is much lower.- Ultrasonography is most valuable test. It can detect not only displacement of the femoral head but also varying degrees of dysplasia.- X-rays are not generally reliable until approximately the age of 3 months.# Adult- Pain is again the usual complaint and X-rays may now show degenerative change as well as dysplasia.# Rx:Infant.Traction and surgery are not indicated. The hips can usually be reduced (Ortolani) and should then be held in a harness or splint for about 8 weeks.A baby, for example, aged 6 monthsWould usually require preliminary traction followed by closed reduction augmented by soft-tissue release (psoas and/or adductor).Toddler and young childwith age, open reduction along with femoral or innominate osteotomy will be required.Adolescent or young adultThose presenting with a painful dysplastic hip may require surgery. A realignment of the joint through pelvic or femoral osteotomy is only appropriate if there is a congruous hip joint. Otherwise (i.e., subluxation) the acetabulum has to be augmented by other means, for example shelf arthroplasty. -### End" -7791,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A person having CD-4 count of 200 presents with the difficulty of breathing. Most probable diagnosis is?, with the following options: A: Tuberculosis, B: Histoplasmisis, C: Candidiasis, D: Pneumocystis carinii - -### Response: -The host factors that predispose to the development of Pneumocystis pneumonia (PcP) include defects in cellular and humoral immunity. -The risk of PcP among HIV-infected patients rises markedly when circulating CD4+ T cell counts fall below 200/µL. Pneumocystis pneumonia is the most common opportunistic infection associated with AIDS. -Pneumocystis pneumonia may be difficult to diagnose because the symptoms—fever, cough, and shortness of breath— are nonspecific. -Other persons at risk for PcP are patients receiving immunosuppressive agents (particularly glucocorticoids) for cancer and organ transplantation; those receiving biologic agents such as infliximab and etanercept for rheumatoid arthritis and inflammatory bowel disease; children with primary immunodeficiency diseases; and premature malnourished infants. -### End" -7792,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: If a chromosome divides in an axis perpendicular to usual axis of division it is going to form:, with the following options: A: Ring chromosome, B: Isochromosome, C: Acrocentric chromosome, D: Subtelocentric chromosome - -### Response: -Isochromosome Chromosome dividing in an axis perpendicular to usual axis of division Results when one arm of a chromosome is lost and the remaining arm is duplicated, resulting in a chromosome consisting of two sho arms only or of two long arms. Morphologically identical genetic information in both arms. The most common present in live bihs involves the long arm of the X and is designated as i(X)(q10). The Xq isochromosome is associated with monosomy for genes on the sho arm of X and trisomy for genes on the long arm of X. Associated with tumors - 17q. High chance of development of testicular cancer- 12p. -### End" -7793,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The periphery of the retina is visualized with, with the following options: A: Indirect binocular ophthalmoscopy, B: Direct ophthalmoscopy, C: Contact lens, D: Goldman's three mirror contact lens - -### Response: -The technique of examining the fundus of the eye is called ophthalmoscopy. In indirect ophthalmoscopy, a real and inveed image is formed between the condensing lens and the observer. The advantage of stereopsis (depth perception) and a larger field of view makes indirect ophthalmoscope (IDO) more useful both in retina clinics and during posterior segment surgeries. Reference : A K KHURANA Comprehensive Ophthalmology; edition 4; page-567 -### End" -7794,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 2-year-old boy is brought to the physician by his parents, who complain that their son continually loses his balance. They also report that his speech seems more slurred. Physical examination confirms the truncal ataxia and wide-based gait. The child appears lethargic, and there is bobbing of the head while he is sitting. Muscle tone is normal. This patient may have a midline tumor in which anatomic portion of the brain?, with the following options: A: Cerebellum, B: Corpus callosum, C: Frontal lobes, D: Hypothalamus - -### Response: -The neuroectoderm may (albeit infrequently) give rise to a neoplasm of neuronal heritage. These tumors occur most often in childhood, and their cellular composition is usually primitive. An example is medulloblastoma, which arises in the cerebellum, generally in the first decade of life. This entity is usually situated in the vermis. Its growth is rapid and regional infiltration is extensive. Children with medulloblastoma are first seen with cerebellar dysfunction or hydrocephalus. Tumors in the other areas do not ordinarily produce the symptoms described.Diagnosis: Medulloblastoma -### End" -7795,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Propanolol is useful for all of the following except ?, with the following options: A: Angina, B: Familial tremor, C: Hypeension, D: Paial AV block - -### Response: -Ans. is 'd' i.e., Paial AV block -### End" -7796,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which hormone increases with age?, with the following options: A: GH, B: Prolactin, C: Parathormone, D: Insiilfn - -### Response: -Parathyroid hormone (PTH), also called parathormone or parathyrin, is a hormone secreted by the parathyroid glands that are impoant in bone remodeling, which is an ongoing process in which bone tissue is alternately resorbed and rebuilt over time.Ref: Ganong&;s review of medical physiology: 24th -### End" -7797,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statement is true about Pinna except:, with the following options: A: In Treacher-Collins syndrome malformed pinna may be present, B: Made up of elastic cailage, C: Develop from lst pharyngeal cleft only, D: Helps in localization of sound - -### Response: -Ans. c. Develop from lst pharyngeal cleft onlyFirst branchial cleft is the precursor of external auditory canal.Around the sixth week of embryonic life, a series of six tubercles appear around the first branchial cleftBranchial clefts are ectodermal in origin.Pinna develops from 1st and 2nd pharyngeal arch -### End" -7798,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are signs of successful stellate ganglion block, except:, with the following options: A: Flushing of face, B: Conjunctival congestion, C: Mydriasis, D: Nasal stuffiness - -### Response: -The stellate ganglion is pa of the sympathetic network formed by the inferior cervical and first thoracic ganglia. It receives input from the paraveebral sympathetic chain and provides sympathetic efferents to the upper extremities, head, neck, and hea. The infiltration of local anesthetic has been used to treat a variety of disorders, but it is primarily performed in the setting of reflex sympathetic dystrophy. Stellate ganglion blocks have traditionally been performed blindly by palpating the anterior tubercle of the transverse process of C6 (Chassaignac tubercle) and infiltrating a large volume (as much as 20 mL) of local anesthetic followed by the patient sitting up immediately afterwards so that the gravitational effect allows enough volume to reach the stellate ganglion to result in an effective block. This method has a relatively high failure rate, with numerous significant and even potentially fatal adverse effects signs of successful stellate ganglion block 1. Horner syndrome 2. conjunctival congestion 3. ipsilateral nasal stuffiness 4. tympanic membrane congestion 5. flushing -### End" -7799,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Shift of O2 - Hb dissociation curve to the left due to, with the following options: A: Exercise, B: Acidosis, C: Hypothermia, D: Adult hemoglobin - -### Response: -O2Dissociation Curve (Odc)Graphical representation between PO2& percentage saturation of Hb. Normal is S-shaped/sigmoid shapedShift to the Right (Release/tissues) (increased P50 decreased affinity)Shift to the Left (Lungs/binding) (decreased P50 increased affinity)Increased PCO2, Increased temperatureIncreased 2, 3-DPG as in Growth hormone, Exercise, Hypoxia, High altitude, AnemiaAcidosis (decreased pH)Sickle cell anemia & Adult HbDecreased PCO2, Decreased temperatureDecreased 2, 3-DPG as inAlkalosis (increased pH)Fetal Bb, Stored blood(Refer: Ganong&;s Review of Medical physiology 24th edition,pg no: 642-643) -### End" -7800,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The test used to diagnose Dubin .lohnson syndrome is-, with the following options: A: Scrum transaminases, B: Bromsulphalein test (BSP), C: Hippuratc test, D: Gamma glutamyl transferase level - -### Response: -A prolonged BSP dye excretion test is diagnostic of Dubin Johnson syndrome BSP is a dye which is removed from circulation by the same mechanism as bilirubin. Reference Harsh mohan page no.593 -### End" -7801,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cottage Loaf sign in Chest x-ray is seen in, with the following options: A: TGA, B: TAPVC, C: ASD, D: VSD - -### Response: -Snowman or Figure of 8 or Cottage Loaf sign is seen in TAPVC. -### End" -7802,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of these is FALSE for laparoscopic hysterectomy?, with the following options: A: In case of a previous midline scar, a minilap incision may be taken at the umbilicus for primary canula, B: While placing lateral pos , inferior epigastric vessels are to be avoided, C: After opening retroperitoneal space, ureter is identified over medial leaf of broad ligament, D: In LAVH uterine vessels are ligated laparoscopically after skeletonisation - -### Response: -The umbilical site typically is used in patients without a previous history of surgery or intra-abdominal infection. In cases of previous surgery where there was a midline incision or a history of a pelvic-abdominal incision, an open laparoscopy (mini lap at umbilicus) is recommended or an alternate site can be chosen to introduce the primary cannula. The most impoant step when placing lateral pos is to avoid the inferior epigastric vessels, which are branches of the external iliac aery and vein. The retroperitoneal space is opened after ligation of utero-ovarian ligament and the ureter identified on the medial leaf of the broad ligament. -### End" -7803,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Oesophagus crosses the diaphragm at the level of:, with the following options: A: T8, B: T10, C: T12, D: T2 - -### Response: -T10 -### End" -7804,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In Baden Walker Halfway system of classification of prolapse, the reference point is:, with the following options: A: Hymen, B: Introitus, C: Internal OS, D: External os - -### Response: -Baden walker halfway system STAGE DESCRIPTION 0 No descent of pelvis 1 leading edge of the prolapse remains 1cm or more above the hymenal ring II leading edge of the prolapse extends from 1 cm above to 1cm below the hymenal ring III From 1cm beyond the hymenal ring but without complete vaginal eversion IV Essentially complete eversion of vagina D.C.DUTTA&;S TEXTBOOK OF GYNAECOLOGY,Pg no:206,6th edition -### End" -7805,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 55-year-old female presents with abdominal pain, distension, ascites and dyspnea. Her CA 125 levels are elevated. The most likely diagnosis is:, with the following options: A: Ca ovary, B: Ca cervix, C: Ca lung, D: Symphoma - -### Response: -Ans. is a, i.e. Ca ovaryRef: Jeffcoates 7th/ed, p543; Novaks 15th/ed, p1366* M/c age incidence for primary ovarian neoplasms is 40-60 years, peak age incidence being 55-60 years. Ovarian malignancies generally present with vague symptoms like abdominal pain, dyspepsia, and patient may also experience irregular menses and if pelvic mass compresses the bladder or rectum she may have urinary frequency or constipation.In advanced stages patients have symptoms related to presence of ascites, omental metastasis or bowel metastasis like abdominal distension, dyspnea, bloating, nausea, anorexia or early satiety.In the patient given in the question all these symptoms are present (which could be seen in other cancers as well) plus her Ca 125 levels are raised, which favors the diagnosis of ovarian cancer in her.RememberThe most important sign of epithelial ovarian cancer is the presence of a pelvic mass on physical examination. -### End" -7806,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Young women suffering from 2-1 & 3rd degree uterovaginal prolapse, choice of operation is :, with the following options: A: Purandare and Mnatre sling operation, B: Virkud's sling operation, C: Mangeshkar's Laparoscopic technique, D: Neeta Way's Laparoscopic modification of shirodkar's operation - -### Response: -Purandare and Mnatre sling operation -### End" -7807,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary action of inferior oblique ?, with the following options: A: Abduction, B: Adduction, C: Extorsion, D: Elevation - -### Response: -Ans. is 'c' i.e., Extorsion -### End" -7808,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is most diagnostic investigation for acute pancreatitis, with the following options: A: Serum amylase, B: Serum lipase, C: Serum P-isoamylase, D: Serum LDH - -### Response: -Diagnosis of Acute pancreatitis Corner Stone of the diagnosis of AP: Clinical findings +elevation of pancreatic enzyme level in the plasma Pancreatic enzymes A threefold or higher elevation of amylase & lipase levels confirms the diagnosis Amylase's serum half - life is shoer as compared with lipase Lipase is also a more specific marker of AP because serum amylase levels can be elevated in a number of conditions, such as peptic ulcer disease, mesentric ischaemia, salpingitis and microamylasemia Patients with AP are typically hyperglycemic; they can also have leukocytosis and abnormal elevation of liver enzyme levels Elevation of ALT levels in the serum in the context of AP has a positive predictive value of 95% in the diagnosis of acute biliary pancreatitis X-Ray abdomen Localized ileus of duodenum and proximal jejunum (sentinel loop) or that of transverse colon up to its mid point (colon cut off sign) IOC for acute pancreatitis : CECT Ref: Sabiston 20th edition Pgno :1524-1528 -### End" -7809,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Gottron's papules Seen in?, with the following options: A: SLE, B: MTCD, C: Dermatomyositis, D: Rheumatoid arthritis - -### Response: -ANSWER: (C) DermatomyositisREF: Harrison's 17th ed ch: 388DERM ATOM YOSITIS:DM is a distinctive entity identified by a characteristic rash accompanying, or more often preceding, muscle weakness.[?] Heliotrope rash: The rash may consist of a blue-purple discoloration on the upper eyelids with edema[?] Gottron's sign: A flat red rash on the face and upper trunk and erythema of the knuckles with a raised violaceous scaly eruption.[?] Gottron's papules: Discrete erythematous papules overlying the metacarpal and interphalangeal joint[?] The erythematous rash can also occur on other body surfaces, including the knees, elbows, malleoli, neck and anterior chest (often in a V sign), or back and shoulders (shawl sign), and may worsen after sun exposure.[?] In some patients, the rash is pruritic, especially on the scalp, chest, and back.[?] Dilated capillary loops at the base of the fingernails are also characteristic. The cuticles may be irregular, thickened, and distorted, and the lateral and palmar areas of the fingers may become rough and cracked, with irregular, ""dirty"" horizontal lines, resembling mechanics hands. -### End" -7810,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The mechanism of hearing and memory, include all, EXCEPT:, with the following options: A: Changes in level of neurotransmitter at synapse, B: Increasing protein synthesis, C: Recruitment by multiplication of neurons, D: Spatial Reorganization of synapse - -### Response: -Neurons are 'permanent cells' that do not undergo mitotic division in post natal life. The production of neurons stop sholy after bih. Ref: Neurons and Networks: An Introduction to Behavioral Neuroscience By John E. Dowling; Ganong's Review of Medical Physiology, 22nd Edition, Page 259, 270; Robbins Pathologic Basis of Disease, 7th Edition, Page 91 -### End" -7811,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arachidonic acid metabolites are all except:, with the following options: A: Prostaglandin G2, B: Leukotriene C4, C: Thromboxanes, D: Phospholipase - -### Response: -The lipid mediators prostaglandins and leukotrienes are produced from arachidonic acid (AA) present in membrane phospholipids, and stimulate vascular and cellular reactions in acute inflammation. AA derived mediators, also called eicosanoids (because they are derived from 20 carbon fatty acids; Greek eicosa = 20) These are synthesized by two major classes of enzymes: cyclooxygenases (which generate prostaglandins and thromboxanes) lipoxygenases (which produce leukotrienes and lipoxins) Principal actions of Arachidonic acid metabolites in inflammation Action Eicosanoid Vasodilation Prostaglandins PGI2 (prostacyclin), PGE1, PGE2, PGD2 Vasoconstriction Thromboxane A2, leukotrienes C4, D4, E4 Increased vascular permeability Leukotrienes C4, D4, E4 Chemotaxis, leukocyte adhesion Leukotrienes B4, HETE (hydroxyeicosatetraenoic acid.) -### End" -7812,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following changes may be observed in a normal pregnancy, EXCEPT:, with the following options: A: Increase in blood viscosity, B: Fall in serum iron concentration, C: Increase in serum iron binding capacity, D: Increase in blood oxygen carrying capacity - -### Response: -During pregnancy there is a dispropoionate increase in plasma and RBC volume which produces a state of hemodilution during pregnancy. During pregnancy plasma volume increases upto 50%. RBC volume increases to the extend of 20-30%. The advantages of hemodilution are: Diminished blood viscosity ensures optimum gaseous exchange between the maternal and fetal circulation. Protection of mother against the adverse effects of blood loss during delivery. Ref: Textbook of Obstetrics By D.C. Dutta, 6th edition, Pages 51-55 -### End" -7813,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Megaloblastic anemia should be treated with both folic acid and vitamin B12 because:, with the following options: A: Folic acid alone causes improvement of hematologic symptoms but worsening of neurological symptoms, B: It is a co factor, C: It is enzyme, D: None of the above - -### Response: -Megaloblastic anemia may be caused by a deficiency of vitamin B12 (cobalamine) or deficiency of folate. Unless it is clearly established, which of the two deficiencies (folate or cobalamine) is the cause anemia, treatment should include administration of both folic acid and vitamin B12. If only folic acid is administered in a patient with megaloblastic anemia due to vitamin B12 deficiency, worsening of neurological symptoms (cobalamine neuropathy) is seen despite an improvement in the hematological symptoms (anemia). So ""Folic acid alone causes improvement of hematologic symptoms but worsening of neurological symptoms"" is the single best answer of choice. Ref: Harrison's Principles of Internal Medicine, 17th Edition, Page 651 -### End" -7814,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: With the use of DMPA contraceptive, the side effects are all of the following EXCEPT:, with the following options: A: Change in quantity and quality of breast milk, B: Weight gain, C: Irregular bleeding, D: Increased reproductive tract inflection - -### Response: -Ans. is 'a' ie change in quantity and quality of breast milk. Change in quantity and quality of breast milk is seen with the use of estrogen contraceptives not progesterone.Infact is a plus point of DMPA that it does not affect lactation. It can be therefore used in the post-partum period, without affecting the lactation.Side effects of Depot Medroxy Progesterone Acetate (DMPA)Weight gain*Irregular menstrual bleeding*Increased incidence of ectopic pregnancy *Increased risk of ovarian cystsProlonged anovulation and infertility after its use is discontinuedOsteoporosis.I could not get any information on the option 'd' (ie increased reproductive tract infection) despite exhaustive search in Williams, Dutta, Shaw's and Park.The only information which I have is that, the risk of vaginitis or vulvovaginitis (Candida) is increased by use of combined pills. Which component of the pill (estrogen or progesterone) is responsible for this is not known. -### End" -7815,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Doc for Listeria Monocytogenes is, with the following options: A: Amoxycillin, B: Ampicillin, C: Amikacin, D: Ceftriaxone - -### Response: -Doc - Ampicillin -Cotrimoxazole in case of penicillin allergy. -### End" -7816,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: MC cause of anovulation is?, with the following options: A: PCOS, B: Hyperprolactinemia, C: Premature ovarian failure, D: Low ovarian reserves - -### Response: -Ans. is 'a' i.e.,PCOSAnovulation and ovulatory dysfunction can be caused by a number of factors.The most common cause of ovulatory dysfunction is polycystic ovarian syndrome, or PCOS.Other potential causes of irregular or absent ovulation:Obesity Underweight Extreme exerciseHyperprolactinemia Premature ovarian failure Perimenopause, or low ovarian reservesThyroid dysfunction Extremely high levels of stress -### End" -7817,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which bacteria acts by inhibiting protein synthesis?, with the following options: A: Pseudomonas, B: Staphylococcus, C: Streptococcus, D: Klebsiella - -### Response: -Ans. is 'a' i.e., Pseudomonas -### End" -7818,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The superficial external pudendal aery is a branch of which of the following aery?, with the following options: A: Aoa, B: Femoral aery, C: External iliac aery, D: Internal iliac aery - -### Response: -Superficial external pudendal aery is a branch of femoral aery. It runs medially to supply skin of the scrotum (or labium majus). -### End" -7819,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest immediate complication after dilatation and evacuation for MTP is: September 2011, with the following options: A: Haemorrhage, B: Injury, C: Retained products of conception, D: Sepsis - -### Response: -Ans. A: Haemorrhage Immediate complications of D and E operation includes 1) haemorrhage, 2) injury, 3) shock, 4) perforation of vessels/ viscera, 5) sepsis, 6) haematometra and 7) increased morbidity. -### End" -7820,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following describes humoral hypercalcemia of malignancy (HHM)?, with the following options: A: The rise in calcium levels due to PTH-rP, B: Paraneoplastic Calcitonin Production, C: Vitamin D Hypervitaminosis, D: Parafollicular C-cell proliferation of Thyroid Gland - -### Response: -The rise in calcium levels due to PTH-rP is termed humoral hypercalcemia of malignancy (HHM). A common consequence of some cancers can be increased levels of calcium (hypercalcemia) with secretion of PTH-related peptide (PTH-rP). PTH-rP has significant homology with PTH, but only in the amino-terminal 13 amino acids, which make up the receptor-binding region. Because PTH-rP is not secreted by the parathyroid glands, hypercalcemia produces no feedback regulation of its production. Cancers usually associated with HHM include breast and lung cancers and multiple myeloma. Ref: Kerr J. (2012). Chapter 13. Connective Tissue and Bone. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry. -### End" -7821,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Moist burn refers to?, with the following options: A: Simple bums, B: Scalds, C: Electric bums, D: Thermal bums - -### Response: -Ans. is 'b' i.e., Moist heat o Dry heat (e.g. flame) - Simple burns (or burns).o Moist heat - Scalds. -### End" -7822,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following statements are true for episiotomies except:, with the following options: A: Allows widening of bih canal, B: Can be either mid-line or medio -lateral, C: Involvement of anal sphincter is classified 3rd degree perineal tear., D: Mid-line episiotomies bleed less, are easier to repair and heal more quickly - -### Response: -The bih canal is the path made by the pelvic curve through the planes of inlet mid pelvis and outlet, to be taken by the baby, while the vulva is the opening of the bih canal on which the episiotomy is given. An episiotomy will therefore not increase the size of the bih canal per se, but only widen the perineal outlet to facilitate delivery of the baby in conditions like a tight perineum, shoulder dystocia, breech delivery, and prior to application of forceps etc. Involvement of the anal spincter is seen in third degree tear. Type III and IV constitute the Complete Perineal tear. Mid-line episiotomies bleed lesser and heals better but can extend into anal sphincter easily. There are 2 main types- mid-line and medio-lateral episiotomy -### End" -7823,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: BCG is used for:, with the following options: A: Treatment of tuberculosis, B: Treatment of superficial bladder cancer, C: Treatment of anthrax, D: All of the above - -### Response: -(Ref: Goodman & Gliman 11/e p1422) BCG is used for immunization against TB. It is also used for the treatment of superficial bladder cancers. It is directly instilled in the urinary bladder for this purpose. -### End" -7824,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a multilayered wound, the deep layer is sutured by chromic gut. This is done because chromic gut sutures have:, with the following options: A: Increased strength, B: Increased ease of use, C: Delayed resorption, D: Less tissue irritation - -### Response: -This is a direct pick from one of the question banks and hence the answer given there must be followed. -### End" -7825,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Peripheral level health workers are all except?, with the following options: A: Anganwadi workers, B: DAIS, C: Gram Sevak, D: VHNS - -### Response: -Ans. is 'c' i.e., Gram Sevak -### End" -7826,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following statements about erythropoietin is FALSE ?, with the following options: A: It is used for the treatment of anemia due to chronic renal failure, B: It results in decrease in reticulocyte count, C: It decrease the requirement of blood transfusions, D: It can cause hypeension - -### Response: -Ans. is 'b' i.e., It results in decrease in reticulocyte count The primary use of epoetin (recombinant human erythropoietin) is anemia of chronic renal failure. o Other uses --> anemia in AIDS patients treated with zidovudin, cancer chemotherapy induced anemia, and preoperative increased blood production for autologous transfusion during surgery. ""The most common adverse effects of erythropoietin are hypeension and thrombotic complications"". o It acts on erythroid marrow and ? Stimulates proliferation of colony forming cells of the erythroid series. Induces hemoglobin formation and erythroblast maturation. Releases reticulocytes in circulation --> increased reticulocyte count. -### End" -7827,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient presents to the emergency room with vomiting, diarrhea, high fever, and delirium. Upon physical examination, you notice large buboes, which are painful on palpation, and purpura and ecchymoses suggestive of disseminated intravascular coagulation. Gram stain on aspirate of a bubo reveals gram-negative rods with bipolar staining. Which of the following antibiotics is the drug of choice for empiric therapy?, with the following options: A: Ceftazidime, B: Chloramphenicol, C: Penicillin, D: Streptomycin - -### Response: -The patient is infected with Yersiniapestis and has bubonic plague. The drug of choice for plague is streptomycin (d). Gentamicin or another aminoglycoside can be substituted. Ceftazidime, chloramphenicol, penicillin, and vancomycin are not used to treat plague. -### End" -7828,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about genetic code except: (PGI June 2009), with the following options: A: Degenerate, B: Overlapping, C: Ambiguous, D: Universal - -### Response: -Ans: B (Overlapping) & C (Ambiguous) The genetic code is specific (unambiguous), universal, degenerate, nonoverlapping & commaless.Charactemtlc-of Genetic Codespecificity: The genetic code is specificQ (unambiguous) i,e. a particular codon always codes for the same amino acid.universality: The genetic code is virtually universal i.e. the specificity of the genetic code has been conserved from very early stages of evolution with only slight differences in the manner in which the code is translated.degeneracy: The genetic code is degenerate (sometimes called redundant) Although each codon corresponds to a single amino acid, a given amino acid may have more than one triplet coding for it.Nonoverlapping & commaless: The genetic code is nonoverlapping & commutes, i.e. the code is read from a fixed starting point as a continuous sequence of bases, taken three at a time.Not punctuated -### End" -7829,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30 years old male comes to oho emergency with his 3 years old daughter who is crying. The father gives the history of child being swung by forearm. The most probable diagnosis is:, with the following options: A: Supracondylar humerus fracture, B: Elbow dislocation, C: Stress fracture, D: Pulled elbow - -### Response: -D i.e. Pulled elbow -### End" -7830,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are a differential diagnosis in hypochromic microcytic anaemia Except, with the following options: A: Thalassemia, B: Iron deficiency, C: Sideroblastic anemia, D: Recent blood loss - -### Response: -Differential diagnosis of a hypochromic microcytic anaemia: iron deficiency, thalassemia, anaemia of chronic disease, sideroblastic anaemia.In recent blood loss, the blood smear shows macrocytosis and polychromasia, which results from an increased reticulocyte count.Harrison 19e pg: 628 -### End" -7831,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Low levels of dopamine produced by the hypothalamus is a pathologic condition associated with which of the blood hormone levels., with the following options: A: High prolactin (PRL), B: High TSH, C: High cortisol, D: Low growth hormone (GH) - -### Response: -Tyrosine, produced by the hydroxylation of the essential amino acid phenylalanine, is further hydroxylated to form dihydroxyphenylalanine (dopa), which is subsequently decarboxylated to form dopamine.Dopamine is an inhibitor of prolactin production and secretion. Thus, if dopamine is low, more prolactin will be produced and secreted by the anterior pituitary. -### End" -7832,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause ofAbdominal aneurysm is -, with the following options: A: Atherosclerosis, B: Trauma, C: Marfan's syndrome, D: Congenital - -### Response: -Ans. is 'a' i.e., AtherosclerosisAbdominal aoic aneurysm o The most common etiology for abdominal aoic aneurysm is atherosclerosis.o Atherosclerosis causes aerial wall thining through medial destruction secondary to plaque that originates in the intima.o Besides abdominal aoa, atherosclerotic aneurysm also occur in common iliac aeries, arch and descending pa of thoracic aoa.o The usual site of abdominal aoic aneurism is below the origin of renal aery and above the bifurcation of the aoa.Remembero Most common cause of aoic aneurysm (overall) = Atherosclerosis.o Most common cause of ascending aoic aneurysm = Cystic medial necrosis.o Most common cause of descending aoic aneurysm = Atherosclerosis.o Most common cause of aneurysm of aoic arch = Atherosclerosis.o Syphilitic aneurysm affect = Ascending aoa.o Aneurysm of Takayasu aeritis affects = Aoic arch.o Most common cause of mycotic abdominal aneurysm = salmonella gastroenteritis. -### End" -7833,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Role of 2, 3 DPG in hemoglobin -, with the following options: A: Unloading oxygen to tissues, B: Increased affinity for oxygen, C: Buffering capacity, D: Osmotic fraglity - -### Response: -A i.e. Unloading oxygen to tissues -### End" -7834,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Rupa Devi age 65 year old female with ovarian cancer is being treated with cisplatin based chemotherapy. All of the following are used to limit the toxicity of cisplatin except, with the following options: A: N-acetylcycteine, B: Slow rate of infusion, C: Chloride diuresis, D: Amifostine - -### Response: -Ref-harrison 18/e p697 N-acetylcycteine used for Paracetamol poisoning whereas slow intravenous infusion and chloride diersis with amifostine can limit cisplatin induced nephrotoxicity -### End" -7835,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In a coho study conducted, out of those exposed to risk factor 10 are diseased and out of those non - exposed to risk factor only 5 are diseased. What is the Relative risk?, with the following options: A: 1.33, B: 2, C: 0.5, D: 50 - -### Response: -Relative risk = Incidence among exposed / incidence among non - exposed Incidence among exposed is 10, Incidence among non - exposed is 5 Thus, relative risk is 10/5 = 2 Relative risk 2 implies that association is present; and risk of development of disease among exposed is twice as common as compared to non - exposed. -### End" -7836,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 38 year old female complaining of decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork, the rinne's test without masking is negative on the right ear and positive on the left ear. With the weber's test, the tone is perceived as louder in the left ear. The most likely problem the patient has is, with the following options: A: Right conductive hearing loss, B: Right sensorineural hearing loss, C: Left sensorineural hearing loss, D: Left conductive hearing loss - -### Response: -Patient is presenting with right sided deafness.Interpretation of Rinne's test in this patientRight side negative means : -i) Right sided conductive deafness.orii) Right sided severe sensorineural hearing loss which gives false negative results.Left side positive test means : -Normal left earLeft sided sensorineural hearing loss (However this is not the case in this patient as the patient is presenting with right sided hearing loss).Interpretation of Weber test in this patientWeber is lateralized to left ear. That means : -Right sided sensorineural hearing loss.Left sided conductive deafness (However, this is not the case as patient is presenting with right sided hearing loss).Thus , this patient is suffering from severe right side sensorineural hearing loss in which the Rinne's test is false negative and weber is lateralized to left ear. -### End" -7837,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Best screening test for pheochromocytoma?, with the following options: A: Urinary VMA estimation, B: Serum catecholamine estimation, C: Clonidine suppression test, D: Urinarymetanephrine - -### Response: -Ans: a (Urinary VMA estimation)Ref: Vasudevan & Sreekumari, 6th edi., Pg. 207Vanillyl mandelic acid (VMA) in urineVMA is the main urinary metabolite of the norepinephrine pathway. Metanephrine is acted upon by mono amine oxidase to form(VMA). Normal level of excretion of VMA is 2-6 mg/24 hr.lt is increased in pheochromocytoma and in neuroblastoma.Patient is asked to refrain from intake of chocolate, coffee, banana, vanilla ice creams, citrus fruits (lime & orange). These items contain vanillin, which produces very high value of VMA in urine. Patient should not take aspirin or drugs containing phenol ring.Homovanillic acid (HVA) in urine: HVA is the main urinary metabolite of dopa and dopamine pathway It is increased in neuroblastoma, malignant pheochromocytoma and ganglioneuroma.It is useful to predict prognosis of neuroblastoma. Drugs increasing the value are -L-dopa, disulfiram and reserpine. -### End" -7838,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non-shivering thermogenesis is mediated bya) α1 receptorb) β2 receptorc) β3 receptord) UCP-2e) UCP-1, with the following options: A: a, B: ce, C: ac, D: ae - -### Response: -Brown fat is generally where the non-shivering thermogenesis occur. UCP-1 & β3 receptors are involved in the process. -### End" -7839,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Chlamydia can cause infertilty due to?, with the following options: A: Slaphingitis, B: Endometritis, C: Oophritis, D: Cervicitis - -### Response: -ANSWER: (A) SlaphingitisREF: Shaw 13th ed p. 209Salphingitis due to chlamydia and gonnorrea are common causes of tubal block resulting in infertility -### End" -7840,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Essential health care made universally accessible to individuals and acceptable to them is called: September 2009, with the following options: A: Essential health care, B: Primary health care, C: Community health care, D: Social medicine - -### Response: -Ans. B: Primary health care Primary health care/ PHC is essential health care based on practical, scientifically sound and socially acceptable methods and technology that are universally accessible to individuals and families in the community through their full paicipation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination. -### End" -7841,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is the most common adverse effect of omeprazole, with the following options: A: Nausea, B: Constipation, C: Jaundice, D: Black stools - -### Response: -PROTON PUMP INHIBITORS (PPIs) Omeprazole Adverse effects:- Nausea, loose stools, headache, abdominal pain, muscle and joint pain, dizziness, Rashes. Leucopenia and hepatic dysfunction are infrequent. On prolonged treatment atrophic gastritis has been repoed. Ref:- kd tripathi; pg num:- 653 -### End" -7842,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 17-year-old boy is diagnosed with schizophrenia. What is the risk that one of his siblings will develop the disease?, with the following options: A: 2%, B: 5%, C: 9%, D: 20% - -### Response: -The risk of developing schizophrenia in first degree relatives of schizophrenic patients is elevated compared to the risk of the general population (0.9%). Parents of schizophrenic patients have a lifetime prevalence of 11%, and siblings have a prevalence of 9%. Identical twins have a 50% chance of suffering from schizophrenia if their sibling has it. Children of schizophrenics have a lifetime prevalence of 12.8%. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 310 -### End" -7843,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A male infant presented with distension of abdomen sholy after bih with passing of less meconium. Subsequently a full-thickness biopsy of the rectum was performed. The rectal biopsy is likely to show ?, with the following options: A: Fibrosis of submucosa, B: Lack of ganglion cells, C: Thickened muscularis propria, D: Hyalinisation of the muscular coat - -### Response: -Ans. is 'b' i.e., Lack of ganglion cells ""Whenever neonate presents with delayed passage of stool, Hirschsprung's disease should be suspected-. Diagnosis of Hirschsprung's disease The diagnosis of Hirschsprung's disease is confirmed by rectal suction biopsies Rectal suction biopsies demonstrate -- i) Hyperophied nerve bundles ii) Absence of ganglion cells Other diagnostic procedures in Hirschsprung's disease Rectal manometry Anorectal manometry measures the pressure of internal anal sphincter while a balloon is distended in the rectum. The results are interpreted as Normal individual --> Reflex decline in internal sphincter pressure. Hirschsprung's disease ---> Pressure fails to drop, Paradoxical rise in pressure with rectal distention. o Radiography (Barium enema) It demonstrates the presence of transition zone between normal dilated proximal colon and a smaller caliber obstructed distal colon caused by non relaxation of aganglionic bowel. Delayed passage of stool (meconium) and abdominal distension suggests low intestinal obstruction. -### End" -7844,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Thin filament consists of all except, with the following options: A: Actin, B: Troponin, C: Myosin, D: Tropomyosin - -### Response: -The thin filaments are made up of actin, tropomyosin, and troponin. Thick filaments are made up ofmyosin.(REF: GANONG'S REVIEW OF MEDICAL PHYSIOLOGY -23rd EDITION. Page No-95) -### End" -7845,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nikolsky's sign is positive in following conditions except:, with the following options: A: Pemphigus vulgaris, B: Toxic epidermal necrolysis, C: Epidermolysis bullosa, D: Pemphigoid - -### Response: -Nikolsky's Sign is seen in: Pemphigus (vulgaris and foliaceous). Porphyria Sjogren's syndrome SSSS TEN (Lyell's disease) Epidermolysis bullosa congenita It occurs due to separation of epidermis from underlying dermis due to intraepidermal cleaving -### End" -7846,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Antipyschotic drug-induced Parkinsonism is treated by -, with the following options: A: Anticholinergics, B: Levodopa, C: Selegiline, D: Amantadine - -### Response: -Ans. is 'a' i.e., Anticholinergics Parkisonism o Rigidity, tremor, hypokinesia, mask like facies, shuffling gate. o Between 1-4 weeks of therapy. o Treatment --> central anticholinergic (levodopa is ineffective). -### End" -7847,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Golden S sign is seen in:, with the following options: A: Bronchogenic carcinoma with collapse of lung, B: Traction Bronchiectasis with apical scarring, C: Emphysema with increased lucency and flattened diagphragm, D: Pulmonary edema - -### Response: -Ans. (a) Bronchogenic carcinoma with collapse of lung* The Golden S sign (reverse S sign of Golden.) is seen in PA chest radiographs with right upper lobe collapse.* It is caused by a central mass obstructing the upper lobe bronchus and should raise suspicion of a primary bronchogenic carcinoma.* The right upper lobe appears dense and shifts medially and upwards with a central mass expanding the hilum. The combination of two changes together form a reverse S shane. -### End" -7848,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Condition required for autoclave is?, with the following options: A: 121°C temperature for 20 min, B: 121°C temperature for 15 min, C: 100°C temperature for 60 min, D: 100°C temperature for 90 min - -### Response: -Autoclave: Recommended condition- 121–124°C temperature for 15 min at 1.1 bar pressure -Alternate: 134–138°C temperature for 3 min at 2.2 bar pressure -Hot air oven: 160°C temperature for 120 min or 180°C temperature for 30 min -### End" -7849,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Meckel&;s diverticulum is situated at a maximum distance of about____ cm from the ileocecal valve -, with the following options: A: 25, B: 60, C: 75, D: 100 - -### Response: -Meckel diverticulum, caused by persistence of the vitelline duct and, on the antimesenteric ileal border, 60 to 100 cm from the ileocecal valve in adults. It is the most common and the most clinically significant congenital anomaly of the small intestine. Two thirds of patients are younger than 2 years. The omphalomesenteric duct (omphaloenteric duct, vitelline duct or yolk stalk) normally connects the embryonic midgut to the yolk sac ventrally, providing nutrients to the midgut during embryonic development. The vitelline duct narrows progressively and disappears between the 5th and 8th weeks gestation. In Meckel's diverticulum, the proximal part of vitelline duct fails to regress and involute, which remains as a remnant of variable length and location. The solitary diverticulum lies on the antimesenteric border of the ileum (opposite to the mesenteric attachment) and extends into the umbilical cord of the embryo. The left and right vitelline arteries originate from the primitive dorsal aorta, and travel with the vitelline duct. The right becomes the superior mesenteric artery that supplies a terminal branch to the diverticulum, while the left involutes. Having its own blood supply, Meckel's diverticulum is susceptible to obstruction or infection. Meckel's diverticulum is located in the distal ileum, usually within 2-3 feet (60-100 cm) of the ileocecal valve. This blind segment or small pouch is about 3-6 cm long and may have a greater lumen diameter than that of the ileum. It runs antimesenterically and has its own blood supply. It is a remnant of the connection from the yolk sac to the small intestine present during embryonic development. It is a true diverticulum, consisting of all 3 layers of the bowel wall which are mucosa, submucosa and muscularis propria. As the vitelline duct is made up of pluripotent cell lining, Meckel's diverticulum may harbor abnormal tissues, containing embryonic remnants of other tissue types. Jejunal, duodenal mucosa or Brunner's tissue were each found in 2% of ectopic cases. Heterotopic rests of gastric mucosa and pancreatic tissue are seen in 60% and 6% of cases respectively. Heterotopic means the displacement of an organ from its normal anatomic location. Inflammation of this Meckel's diverticulum may mimic appendicitis. Therefore, during appendectomy, ileum should be checked for the presence of Meckel's diverticulum, if it is found to be present it should be removed along with appendix. A memory aid is the rule of 2s: 2% (of the population) 2 feet (proximal to the ileocecal valve) 2 inches (in length) 2 types of common ectopic tissue (gastric and pancreatic) 2 years is the most common age at clinical presentation 2:1 male:female ratio However, the exact values for the above criteria range from 0.2-5 (for example, prevalence is probably 0.2-4%). It can also be present as an indirect hernia, typically on the right side, where it is known as a ""Hernia of Littre"". A case report of strangulated umbilical hernia with Meckel's diverticulum has also been published in the literature. Furthermore, it can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline fistula when the umbilical cord is cut. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction, ischemia, and necrosis. -### End" -7850,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vertebrate reservoir of Japanese encephalitis is:, with the following options: A: Rat, B: Pig, C: Horse, D: Monkey - -### Response: -(B) Pig > Pigs are vertebrate reservoirs as well as amplifier hosts for Japanese encephalitis virus. -### End" -7851,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Selenium deficiency causes, with the following options: A: Cardiomyopathy, B: Neuropathy, C: Growth retardation, D: Rhabdomyolysis - -### Response: -(A) Cardiomyopathy DEFICIENCIES OF METALSElementDeficiencyBoronNo biologic function determinedCalciumReduced bone mass, osteoporosisCopperAnemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deteriorationChromiumImpaired glucose toleranceFluorideDental cariesIodineThyroid enlargement, T4, cretinismIronMuscle abnormalities, kilonychia, pica, anemia, work performance, impaired cognitive development, premature labor, perinatal maternal mortalityManganeseImpaired growth and skeletal development, reproduction, lipid and carbohydrate metabolism; upper body rashMolybdenumSevere neurologic abnormalitiesSeleniumCardiomyopathy, heart failure, striated muscle degenerationPhosphorousRickets (osteomalacia), proximal muscle weakness, rhabdomyolysis, paresthesia, ataxia, seizure, confusion, heart failure, hemolysis, acidosisZincGrowth retardation, taste and smell, alopecia, dermatitis, diarrhea, immune dysfunction, failure to thrive, gonadal atrophy, congenital malformations -### End" -7852,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following drug DOES NOT cause megaloblastic anemia?, with the following options: A: Phenytoin, B: Chloroquine, C: Sulfasalazine, D: Metformin - -### Response: -Agents implicated in drug induced macrocytic anemia are: Phenytoin Azathioprine Metformin Leflunomide Sulfisoxazole Sulfasalazine Mesalamine Zidovudine Trimethoprim Sulfamethoxazole -### End" -7853,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Calcium initiates a skeletal muscle contraction by, with the following options: A: Binding to tropomyosin, B: Being released primarily from the sarcolemma during an action potential, C: Binding to troponin, D: Covering action binding sites - -### Response: -During excitation-contraction coupling in a skeletal muscle fiber, calcium is released from the sarcoplasmic reticulum (not the sarcolemma) and binds to troponin (not tropomyosin or myosin). The binding of calcium to the troponin causes the troponin to shift the position of the tropomyosin to which it is attached, thus uncovering the actin binding sites for binding with myosin. -### End" -7854,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The best possible intervention for acute myocardial infarction is:, with the following options: A: Streptokinase, B: Streptokinase and aspirin, C: Early primary coronary intervention, D: Streptokinase and heparin - -### Response: -Answer is C (Early Primary coronary intervention) Streptokinose (Thrombolysis) is a form of Reperfusion therapy that is indicated for only ST Elevation MI (STEM). Its use is contraindicated in cases of Non ST Elevation MI (NSTEMI) Early Primary Coronary Intervention (Early PCI) can be used as a form of Reperfusion therapy for both STEM! and NSTEMI. Early Primary Caronary Intervention is therefore the single best answer of choice amongst the options provided. -### End" -7855,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 73-year-old man with history of hypertension and osteoarthritis is evaluated for gradually increasing dyspnea over the preceding 6 weeks. He takes metoprolol for hypertension and naproxen for the arthritis. He has occasionally awakened in the night with mild dyspnea relieved by sitting up but has not noticed edema. Physical examination shows BP of 148/94, HR 96, and RR 16. O2 saturation is 92%. Neck veins show the jugular column 7 cm above the sternal angle. Lung examination reveals mild basilar crackles but no wheezing. Cardiac examination shows sustained apex impulse, S4 gallop, and no murmur. There is no peripheral edema. ECG shows stable left ventricular hypertrophy; no Q waves are seen. Chest x-ray shows increased interstitial markings and some cephalization of flow to the upper lobe vessels. The cardiac silhouette is boot-shaped, but there is no definite cardiomegaly. Echocardiogram shows left ventricular hypertrophy and LV ejection fraction of 55% (normal 50%-70%). What is the likely pathogenesis of this patient's dyspnea?, with the following options: A: Increased metabolic demands leading to high-output heart failure (HF), B: Occult coronary artery disease with dyspnea as an angina equivalent, C: Impaired diastolic relaxation and filling, D: Interstitial lung disease (ILD) mimicking pulmonary vascular congestion - -### Response: -The most likely explanation for this patient's presentation is heart failure with preserved ejection fraction (HFPEF), also known as diastolic dysfunction. As many as 50% of patients presenting with definite HF (Heart failure) will have an ejection fraction above 50%. HFPEF is more common in the elderly, in women, and those with conditions (especially hypertension) that lead to LV hypertrophy. Often the echocardiogram will show evidence of impaired relaxation or increased stiffness of the LV (the latter often suggested by decreased flow across the MV during atrial systole, giving the so-called reversed e/a flow ratio). Tachycardia, by decreasing diastolic filling time, will often worsen HF symptoms in diastolic dysfunction. As opposed to systolic HF, beta-blockers and ACE inhibitors have not demonstrated long-term survival benefit. Management focuses on controlling BP, preventing tachycardia, and treating pulmonary and peripheral fluid overload with diuretics; so many of the modalities used in systolic HF are also employed in HFPEF, just without proof of survival benefit.High output HF due to an AV fistula, Paget disease, or hyperthyroidism can mimic diastolic HF, but the patient usually has evidence of a hyperdynamic circulation (tachycardia, wide pulse pressure, hyperdynamic precordium). Occult CAD should be considered in patients with exertional dyspnea (which can be an angina equivalent), but this patient's rest symptoms and pulmonary vascular congestion would be unusual. In HF due to coronary artery disease, there is almost always evidence of prior MI or ischemic change on ECG. Nevertheless, a stress test is often obtained in patients with unexplained HF to rule out this possibility. Interstitial lung disease can cause rales and interstitial changes on CXR but would not explain the cephalization of flow nor the elevated venous pressure. Measuring B-type natriuretic peptide (BNP) will resolve the issue in equivocal cases; BNP will be elevated in HF and normal or minimally elevated in ILD. Anemia can cause fatigue and exertional dyspnea and, rarely, even overt HF, but to cause HF the anemia would have to be very severe (usually Hb 7 g/dL or below) and should be apparent from the physical examination. In addition, severe anemia would usually cause evidence of hyperdynamic circulation as seen in high-output HF. -### End" -7856,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is NOT pyrogenic Interleukin, with the following options: A: IL-1, B: TNF-a, C: IL-4, D: IL-6 - -### Response: -(C) IL-4 # Pyrogenic cytokines: Known pyrogenic cytokines include IL-1, IL-6, TNF, ciliary neurotropic factor (CNTF), and interferon (INF)a. Others probably exist; although IL-18 - a membrane of the IL-1 family - does not appear to be pyrogenic cytokine. Each cytokine is encoded by a separate gene, and each pyrogenic cytokine has been shown to cause fever in laboratory animals and in humans. When injected into humans, IL-1, IL-6 and TNF produce fever at low doses (10 to 100 ng/kg).> Fever, characterized by an elevation of body temperature, usually by 1deg to 4degC, is one of the most prominent manifestations of the acute-phase response, especially when inflammation is caused by infection. Fever is produced in response to substances called pyrogens that act by stimulating prostaglandin (PG) synthesis in the vascular and perivascular cells of the hypothalamus. Bacterial products, such as lipopolysaccharide (LPS; called exogenous pyrogens), stimulate leukocytes to release cytokines such as IL-1 & TNF (called endogenous pyrogens) that increase the levels of cyclooxygenases that convert AA into prostaglandins. In the hypothalamus the PGs, especially PGE2, stimulate the production of neurotransmitters, which function to reset the temperature set point at a higher level. IL-4 is involved in immediate hypersensitivity reactions. -### End" -7857,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most impoant factor which decides the results of a randomized controlled trial is: March 2005, with the following options: A: Inclusion of all age groups, B: 50% treated with placebo and 50% with drugs, C: 100% follow up, D: Effective randomization - -### Response: -Ans. D: Effective randomization It is a procedure by which the paicipants are allocated into groups usually called 'study' and 'control' groups. Randomization is the hea of control trials. It eliminates selection bias -### End" -7858,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Catalase positive, coagulase negative beta hemolytic bacteria, with the following options: A: Strep pyogens, B: Staph aureus, C: CONS, D: Enterococci - -### Response: -All staphylococci are catalase positive. Amongst staphylococci, Staph. aureus and Staph haemolyticus (CONS) are beta hemolytic. Most species of coagulase negative staphylococcus species are non-hemolytic except Staph. haemolyticus. -### End" -7859,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a test for diabetes mellitus -, with the following options: A: Fasting blood sampling, B: Random blood sampling, C: D-xylose, D: Oral glucose tolerance test - -### Response: -D-xylose absorption is a laboratory test to determine how well the intestines absorb a simple sugar (D-xylose). The test helps determine if nutrients are being properly absorbed. It is done in : persistent diarrhea, signs of malnutrition, unexplained weight loss. Rest of the options are the tests done in diabetes mellitus. Ref - Harrisons internal medicine 20e topic diabetes -### End" -7860,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muscles have which efferent nerve fibers for regulating tone?, with the following options: A: a-neuron, B: Gamma neuron, C: Beta neuron, D: Delta neuron - -### Response: -Ans. is 'b' i.e., Gamma neuron(Ref: Ganong 23'd/e p.158-162; Guyton 12n/e p. 657)Muscle tone is maintained by stretch reflex through muscle spindles (intrafusal fibers). -### End" -7861,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A most common mode of treatment of a 1-year-old child with asthma is –, with the following options: A: Inhaled short acting beta 2 agonist, B: Oral short acting theophylline, C: Oral ketotifen, D: Leukotriene agonist - -### Response: -Treatment of asthma -Treatment of asthma can be divided into - -A) Treatment of chronic asthma -B) Treatment of acute exacerbation - - -Treatment of mild, moderate or severe exacerbation -Treatment of life-threatening exacerbation (status asthmaticus) - -Treatment of chronic asthma - -Treatment of chronic asthma is given to control asthma and to prevent acute exacerbation. -Severity of asthma is classified on the basis of - - - -The frequency of daytime symptoms      -The frequency of nighttime symptoms  -The degree of airflow obstruction (FEV1) -Peak expiratory flow (PEF) variability - - -For children less than 5 years of age, severity is classified on the basis of (1) and (2) only because young children cannot perform the manoeuvre required for lung function measurement ((3) & (4)). - -I) Mild intermittent                                   - -Symptoms for ≤ 2 days/week                            -Symptoms for 5 ≤ 2 night/month                   -FEV1 80%                                                  -PEF variability < 20%            - -2) Mild persistent     - -Symptoms > 2days / week   -PEF variability 20-30%      -Symptoms >2 night / months     -FEV1 80%         - -3) Moderate persistent                                 - -Day symptoms daily                                     -Symptoms > I night/week                             -FEV1 > 60% - < 80%                                  -PEF variability >30%                                   -A stepwise pharmacological therapy is indicated. - -  4) Severe persistent - -Continuous day symptoms -Frequent night symptoms -FEVi 60% -PEF variability >30% -### End" -7862,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Nucleus intercalatus is seen in, with the following options: A: Frontal lobe, B: Medulla, C: Temporal lobe, D: Midbrain - -### Response: -Nucleus intercalates is present in the medulla at the level of olives between the dorsal nucleus of the vagus nerve (lateral to the intercalated nucleus) and the nucleus of the hypoglossal nerve. Probably involved in the control of the vestibuloocular reflex and may contribute to the veical neural integrator. (Ref: vishram Singh textbook of clinical neuroanatomy second edition pg 77) -### End" -7863,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Metastasis of ca buccal mucosa goes to ?, with the following options: A: Regional lymph node, B: Liver, C: Hea, D: Brain - -### Response: -Ans is 'a' ie Regional lymph nodes ""Tumors in this area have a propensity to spread locally and to metastasize to regional lymphatics.""- Schwaz Also know Lymphatic metastasis of Buccal ca go to submandibular and later upper jugular nodes. - Dhingra 4/e MC type of Buccal ca Squamous cell ca Commonest site of origin --> angle of mouth or the line of occlusion of upper and lower teeth (Dhingra) -### End" -7864,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are true regarding about Arachidonic acid (AA) pathway, except:, with the following options: A: Aspirin inhibits arachidonic acid pathway, B: Cytosolic Ca2+ leads to activation of membrane phospholipase A2, C: Action of phospholipase A2 causes synthesis of arachidonic acid, D: Leukotrienes C4, D4 cause vasodilation - -### Response: -Cellular phospholipases, mainly phospholipase A2, release arachidonic acid (AA) from membrane phospholipids. Activation of phospholipase A2 is triggered by increase in cytosolic Ca2+ and activation of various kinases in response to external stimuli. Cyclo-oxygenase inhibitors such as aspirin, indomethacin inhibit activity of cyclo-oxygenase involved in conversion of AA into prostaglandins. Leukotriene A4, B4 cause chemotaxis. Leukotrienes C4 and D4 cause vasoconstriction and increase vascular permeability. Leukotrienes C4, D4, E4 are SLOW REACTING SUBSTANCE OF ANAPHYLAXIS (SRS-A). Action Examples Vasodilation PGI2, PGE1, PGE2, PGD2 Vasoconstriction Thromboxane A2, leukotriene C4, D4, E4 Increase vascular permeability Leukotriene C4, D4, E4 Chemotaxis, leukocyte adhesion Leukotriene B4 Smooth muscle contraction PGC4, PGD4, PGE4 -### End" -7865,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following transmit a nerve branch to the meninges?, with the following options: A: Foramen spinosum, B: Mastoid foramen, C: Jugular foramen, D: Foramen magnum - -### Response: -The foramen spinosum transmits the middle meningeal aery, the meningeal branch of the mandibular nerve or nervus spinosus, and the posterior trunk of the middle meningeal vein. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition. -### End" -7866,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: which of the following antidepressent is used in atypical depression, with the following options: A: imipramine, B: phenelezine, C: paroxetine, D: amitriptilline - -### Response: -MAOI * IMPOANCE First class of antidepressant drugs that were introduced * MECHANISM There are three monoamines namely dopamine, adrenaline and serotonin. These mon amines are degraded by monoamine oxidase. MAOI inhibit this enzyme and acts increasing monoamines * DRUGS Phenelezine Tranylcipromine * USE ATYPICAL DEPRESSION, depression with reverse vegetative symptoms * SIDE EFFECTS Hypeensive crisis Cheese reaction When a patient on MAOI takes tyramine rich food like tyramine there will be increased release of monoamines. These excess monoamines cannot be degraded by MAO as it is blocked by MAOI. Thus, this may result in hypeensive crisis. Paresthesia's due to pyridoxine deficiency LIKE IPRONIAZID WEIGHT gain SEXUAL dysfunction ref. Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955 -### End" -7867,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The tidal volume is, with the following options: A: The amount of air that normally moves into (or out of) the lung with each respiration., B: The amount of air that enters the lung but does not participate in gas exchange., C: The largest amount of air expired after maximal expiratory effort., D: The largest amount of gas that can be moved into and out of the lungs in 1 min. - -### Response: -The amount of air that moves into the lungs with each inspiration (or the amount that moves out with each expiration) is called the tidal volume. -### End" -7868,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Concentrated alcohol-based antiseptic for skin preparation of the operative site leads to, with the following options: A: >95% reduction in bacterial count, B: >50% reduction in bacterial count, C: <50% reduction in bacterial count, D: Contraindicated for operative site - -### Response: -One application of a more concentrated alcohol-based antiseptic is adequate for skin preparation of the operative site.This leads to a >95% reduction in bacterial countCaution should be taken not to leave a pool of alcohol-based fluid on the skin which could ignite with diathermy and burn the patient.Ref: Bailey and Love 27e pg: 52 -### End" -7869,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Woods lamp used in diagnosis of – a) P. versicolorb) Vitiligoc) Porphyriad) Psoriasise) Lichen planus, with the following options: A: abc, B: bc, C: acd, D: bcd - -### Response: -Wood's lamp is used in Tinea capitis, Erythrasma, vitiligo, albinism, Leprosy, Tuberous sclerosis, Pseudomonas infection, Porphyria, Tinea versicolor. -### End" -7870,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Diazepam poisoning is treated by:, with the following options: A: Flumazenil, B: Hemofiltration, C: Charcoal, D: Resins - -### Response: -ANSWER: (A) FlumazenilREF: Harrison's 17th ed Table e 35-4See APPENDIX-42 below for list of ""Antidotes""""Specific antidote for benzodiazepine poisoning is flumazenii"" APPENDIX - 42AntidotesAntidotePoison/drug/toxinN-AcetylcysteineAcetaminophenCarbon tetrachlorideOther hepatotoxinsAmyl nitrite, sodium nitrite and sodium thiosulfate (Cyanide antidote kit)NitrilesBromatesChloratesCyanide (e.g., HCN, KCX and NaCN)Mustard agentsNitroprussideSmoke inhalation (combustion of synthetic materials)Antivenin, Crotalidae Polyvalent (Equine Origin)Pit viper envenomation (e.g. rattlesnakes, cottonmouths, timber rattlers and copperheads)Antivenin, Crotalidae Polyvalent Immune Fab - Ovine (CroFab)Pit viper envenomation (e.g.. rattlesnakes, cottonmouths, timber rattlers and copperheads)Atropine sulfateAlpba2 agonists (e.g., clonidine)Alzheimer drugs (e.g., donepezil, galantamine, rivastigmine, tacrine)Antimyesthenk agents (e.g., pyridostigmine)Bradyarrhythmia-producing agents (e.g., beta blockers, calcium channel blockers and digitalis glycosides)Cholinergic agonists (e.g., bethanechol) .Muscarine-containing mushrooms Nerve agents (sarin, soman, tabun and VX)Organophosphate and carbamate insecticidesDigoxin immune FabCardiac glycoside-containing plants (foxglove and oleander)Digitoxin, DigoxinEthanolEthylene glycolMethanolFlumazenilBenzodiazepinesZaleplonZolpidemFolic acid and Folinic acid (Leucovorin)Formaldehyde/Formie AcidMethanolMethotrexate, trimetrexatePyrimethamineTrimethoprimFomepizoleEthylene glycolMethanolGlucagonBeta blockersCalcium channel blockersHypoglycemiaHypoglycemic agentsHydroxocobalaminNitrilesBromatesChloratesCyanide (e.g., HCN, KCN and NaCN)Mustard agents NitroprussideSmoke inhalation (combustion of synthetic materials)Hyperbaric oxygen (HBO)Carbon monoxideCarbon tetrachlorideCyanideHydrogen sulfideMethemoglobinemiaMethylene blueMethemoglobin-inducing agents including;Aniline dyesDapsoneLocal anesthetics (e.g., benzocaine)MetoclopramideNaphthaleneNitrates and nitritesNitrobenzenePhenazopyridineNalmefene and NaloxoneACE inhibitorsAlpha2 agonists (e.g., clonidine)Imidazoline decongestants (e.g., oxymetazoline and tetrahydrozoline) LoperamideOpioids (e.g., codeine, fentanyl, heroin, meperidine, morphine)Physostigmine salicylateAntihistaminesAtropine and other anticholinergic agentsDhatura poisoningIntrathecal baclofenPhytonadione (Vitamin Kl)Long-acting anticoagulant rodenticides (e.g., brodifacoum and bromadiolone) WarfarinPralidoxime chloride (2-PAM)Antimyesthenic agents (e.g., pyridostigmine)Nerve agents (sarin, soman, tabun and VX)Organophosphate insecticidesTacrineProtamine sulfateEnoxaparinHeparinPyridoxine hydrochloride (Vitamin B6)Acrylamide Ethylene glycol Hydrazine Isoniazid (INH)Sodium bicarbonateChlorine gasHyperkalemiaSerum Alkalinization:Agents producing a quinidine-like effect as noted by widened QRS complex on EKG (e.g., amantadine, carbamazepine, chloroquine,cocaine, diphenhydramine, flecainide,tricyclic antidepressants, quinidine)Urine Alkalinization:Weakly acidic agents (chlorpropamide, methotrexate, phenobarbital and salicylates)Deferoxamine and DeferasiroxAcute iron poisoningDimercaprol (BAL in oil)Hydrofluoric acid (HF)Hyperkalemia (not digoxin-induced)HypermagnesemiaCalcium disodium EDTA (Versenate)Acute arsenic poisoning,Acute mercury poisoning,Lead poisoning (in addition to EDTA)Dicobalt EDTACyanide poisoningSucdmer/ Dimercaptosuccinic acid (DMSA)Lead poisoning,Arsenic poisoning,Mercury poisoningDimercapto-propane sulfonate (DMPS)Severe acute arsenic poisoning,Severe acute mercury poisoningD-Penicillamine (Cuprimine)Mainly in: copper toxicityOccasionally adjunctive therapy in: Gold toxicity, Arsenic poisoning, Lead poisoning, Rheumatoid arthritisBotulinum antitoxin * Bivalent (types AB)<< Trivalent (types ABE)Food-borne botulismWound botulismBotulism as a biological weaponNote: Not currently recommended for infant botulismL-CarnitineValproic acidCyproheptadine HCLMedications causing serotonin symdromeDantrolene sodiumMedications causing neuroleptic malignant symdrome (NMS)Medications causing malignant hyperthermiaInsulin and dextroseBeta blockersCalcium channel blockers (diltiazem, nifedipine, verapamil)Octreotide acetateSulfonylurea hypoglycemic agents (e.g., glipizide, glyburide)Sodium thiosulfateBromatesChloratesMustard agentsNitroprussideThiamineEthanolEthylene glycolPrussian blue, ferric hexacyan ofer rateRadioactive cesium (Cs-137), radioactive thallium (Tl-201), and nonradioactive thallium -### End" -7871,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In collapsing glomerulopathy which of the following is seen -, with the following options: A: Hyperophy and necrosis of the visceral epithelium, B: Proliferation of the parietal epithelium, C: Tuft necrosis, D: Mesangiolysis - -### Response: -A morphologic variant called collapsing glomerulopathy is characterized by the collapse of the glomerular tuft and epithelial cell hyperplasia. This more severe manifestation of FSGS may be idiopathic or may be associated with HIV infection, drug-induced toxicities, and some microvascular injuries. It carries a paicularly poor prognosis Ref: ROBBINS BASIC PATHOLOGY 10th ed Pg no: 557 -### End" -7872,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Secondary retrosternal goitre derives its blood supply from :, with the following options: A: Mediastinal vessels, B: Thyroid vessels, C: Arch of aorta, D: Bronchial vessels - -### Response: -Secondary retrrosternal goitre : Is the extension of thyroid tissue to mediastinum from thyroid in the neck. and it derives blood supply from thyroid vessels. -Primary retrrosternal goitre : Is the ectopic thyroid tissue in the mediastinum and it derives blood supply from mediastinal vessels. -### End" -7873,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In the lymph node showing non nercrotizing and non caseating granuloma which of the following is suspected, with the following options: A: Toxoplasmosis, B: Lumphogranuloma venereum, C: Cat scratch disease, D: Kikuchis lymphadenitis - -### Response: -Toxoplasmosis is transmitted by cat ( definitive host) man is the intermediate host It is diagnosed by Sabin Feldman dye test Ref Robbins 9/e chapter : environment and infectious diseases pg no.320 -### End" -7874,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A child with three days history of upper respiratory tract infection presents with stridor, which decreases on lying down postion. What is the most probable diagnosis -, with the following options: A: Acute Epiglottitis, B: Laryngotracheobronchitis, C: Foreign body aspiration, D: Retropharyngeal abscess - -### Response: -Ans. is 'b' i.e., Laryngotracheobronchitis This child has : - i) 3 days history of upper respiratory tract infection. ii) Followed by stridor These features suggest the diagnosis of croup. Clinical manifestations of Croup Most patients have an upper respiratory tract infection with some combination of - Rhinorrhea Pharyngitis Mild cough Low grade fever o After 1-3 days signs and symptoms of upper respiratory tract obstruction become apparent - Barking cough Hoarseness Inspiratory stridor -### End" -7875,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Transketolase activity is seen with which vitamin, with the following options: A: Vit B1, B: Vit B2, C: Vit B3, D: Vit B4 - -### Response: -Transketolase activity is seen in Vit B1. In thiamine deficiency, blood thiamine is reduced, but pyruvate, alpha-ketoglutarate and lactate are increased. Erythrocyte transketolase activity is reduced; this is the earliest manifestation seen even before clinical disturbances. Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 392 -### End" -7876,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common feature indicative of Antemortem drowing:, with the following options: A: Washerwomen feet, B: Pugilistic attitude, C: Clenched fist, D: Cyanosis - -### Response: -Ans. (c) Clenched fistRef: The essentials of FSM by KS Narayan Reddy 31st ed. P344* Presence of gravel, grass, etc firmly grasped in hand due to cadaveric spasm strongly suggest that person was alive when drowned as it indicates the struggle of person for life.Postmortem signs of drowningPathognomic Signs: indicates antemortem drowningNon Specific signsExternal* Fine copious white leathery froth from mouth, nose & air passage which increases on chest pressure.* Weeds, grass, mud etc in tightly clenched hand: a very definite sign.Internal* Water in stomach & intestine and middle ear* Diatoms in brain & bone marrow of long bones.* Cutis anserine or goose skin* Washer woman hand & feet* Paltauf (subpleural, pectechial) haemorrhage* Emphysema aqousum -### End" -7877,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 40-year-old HIV positive male, presented with complaints of a characteristic rash over his back and buttocks. The rash was painful and has worsened over the past 3 days. Physical examination is unremarkable. Rest of the skin examination is normal. A smear was prepared from the lesions. All of the following drugs are approved for the above condition except: -, with the following options: A: Acyclovir, B: Valcyclovir, C: Ganciclovir, D: Famciclovir - -### Response: -This is a case of Herpes zoster/ Shingles. The image shows hemorrhagic vesicles and pustules on an erythematous base in a dermatomal distribution. 2nd image shows a Tzanck smear with classical multinucleate giant cells seen in varicella. Drugs approved are: - Valcyclovir Famciclovir Acyclovir Ganciclovir is approved for CMV infection. -### End" -7878,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is a wrong association ?, with the following options: A: HPV - CaCx, B: EBV - Burkitt's lymphoma, C: HHV 8 - Kaposi sarcoma, D: CMV - Nasopharyngeal carcinoma - -### Response: -Ans. is 'd' i.e., CMV-Nasopharyngeal carcinoma -### End" -7879,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The peak level of chorionic gonadotropin in normal pregnancy occurs, with the following options: A: 30-40 days, B: 60-70 days, C: 10-20 days, D: 100-110 days - -### Response: -Peak maternal levels of chorionic gonadotropin in normal pregnancy occurs between 60th and 80th days after menses and is around 100,000 mIU/mL. Before 5 weeks of gestation, hCG is expressed in both cytotrophoblast and syncytiotrophoblast. Later during gestation, when maternal serum levels peak, hCG is produced almost solely in syncytiotrophoblasts. Plasma levels of hCG begin to decline at 10 to 12 weeks and a nadir is reached about 16 weeks. Plasma levels are maintained at this lower level for the remainder of pregnancy. Human Chorionic Gonadotropin is a glycoprotein with biological activity similar to luteinizing hormone. It has a molecular weight of 36,000 to 40,000 Da. It is structurally related to LH, FSH and TSH. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 3. Implantation, Embryogenesis, and Placental Development. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e. -### End" -7880,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not True about IMNCI, with the following options: A: Includes early Neonatal care, B: Pink color code refers to urgent referral, C: Includes Home based care, D: Dedication of 75% training staff to Infants - -### Response: -Under IMNCI, the proportion of training time devoted to sick infant and other sick children is almost same. -### End" -7881,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which is not a complication of PUVA therapy, with the following options: A: Skin cancers, B: Premature aging of skin, C: Cataracts, D: Exfoliation - -### Response: -Complications of PUVA therapy Sho-term side effects Nausea and vomiting Erythema, pruritus and xerosis Skin pain Pigmentation Central nervous system (CNS) side effects such as headache, dizziness, depression, insomnia and hyperactivity Reactivation of herpes Photo-onycholysis, melanonychia, friction blisters and ankle edema. Long-term side effects Photo aging Eye toxicity: This occurs as psoralens accumulate in the lens with an increased potential for cataract. Cutaneous malignancies: nonmelanoma skin cancer, paicularly squamous cell carcinoma (SCC). Men exposed to PUVA have an increased risk of genital skin cancer. -### End" -7882,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Eiosinophilic meningoencephalitis is caused by -a) Gnathostoma spinigerumb) Naegleriac) Toxocara canisd) Angiostrongylus cantonensis, with the following options: A: b, B: c, C: ad, D: ab - -### Response: -Eosinophilic meningoencephalitis - - -Meningoencephalitis, in which there is > 20% eosinophilic pleocytosis in C.S.F. - - -Eosinophilic meningoencephilitis is caused by - - -Angiostrongylus cantonensis (most common) -Gnathostoma spinigerum - - -Naegleria causes primary amoebic meningoencephilitis but it is not an eosinophilic meningoencephalitis. -### End" -7883,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Umbilical cord separation takes, with the following options: A: First 1 week, B: First 2 weeks, C: First 3 weeks, D: First 4 weeks - -### Response: -Umbilical cord separation usually takes place within first 2 weeks. -### End" -7884,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The Electron Microscopy is viually diagnostic in renal biopsy study of -, with the following options: A: Goodpasture's syndrome, B: Churg-Strauss syndrome, C: Alpo syndrome, D: Wegner's granulomatosis - -### Response: -Ans. is 'c' i.e., Alpo syndromeo Alpo's syndrome presents with characteristic histological features on electron microscopy. Such changes may present in other diseases, but are most pronounced and widespread in Alpo's syndrome.Features of Alpo's syndrome on electron microscopy :o Alpo's patients early in their disease typically have diffuse thinning of the basement membrane which thickens over time into multilamellous surrounding lucent areas that often contain granules of varying density.o The characteristic electron electron microscopic finding of fully developed disease is that glomerular basement membrane shows irregular foci of thickening alternating with attenuation (thinning) with pronounced splitting and lamination of lamina densa often with distinctive basket weave appearance. -### End" -7885,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arsenic compounds are used for the treatment of which of the following cancer?, with the following options: A: APML, B: CLL, C: ALL, D: CML - -### Response: -ARSENIC TRIOXIDE It is used for the treatment of Acute Promyelocytic Leukemia (APML). It may cause hyperglycemia and prolonged QT interval. Like tretinoin, it also acts as a differentiating agent. -### End" -7886,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Compared to hepatic bile, gallbladder bile contains a reduced concentration of which of the following?, with the following options: A: Bile acids, B: Chloride Ions, C: Protons, D: Cholesterol - -### Response: -Composition of Bile Substance Liver Bile Gallbladder Bile Water 97.5 g/dl 92 g/dl Bile salts 1.1 g/dl 6 g/dl Bilirubin 0.04 g/dl 0.3 g/dl Cholesterol 0.1 g/dl 0.3 to 0.9 g/dl Fatty acids 0.12 g/dl 0.3 to 1.2 g/dl Lecithin 0.04 g/dl 0.3 g/dl Na+ 5 mEq/L 130 mEq/L K+ 5mEq/L 12 mEq/L Ca++ 5 mEq/L 23 mEq/L Cl- 100 mEq/L 25 mEq/L HCO3 28 mEq/L 10 mEq/L -### End" -7887,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Finding the most cost effcetive way doing a project -, with the following options: A: Network analysis, B: System analysis, C: Cost analysis, D: Field analaysis - -### Response: -The purpose of system analysis is to help the decision maker to choose an appropriate course action by investigating his problem,searching out objectives,finding out alternative solution,evaluation of the alternatives in terms of cost effectiveness,re-examination of the objectives if necessary and finding the most cost effective alternative (refer pgno:872 park 23 rd edition) -### End" -7888,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Papain cleaves the immunoglobin molecule into:, with the following options: A: 1 Fc and 1 Fab, B: 1 Fc and 2 Fab, C: 2 Fc and 1 Fab, D: 2 Fc and 2 Fab - -### Response: -Ans. (b) 1 Fc and 2 Fab Antibody Fragmentation The performances of ceain immunoassay procedures are enhanced by using antibody fragments, such as Fab and F(a13'),. Antibody fragmentation is accomplished using reducing agents and proteases that digest or cleave ceain poions of the immunoglobulin protein structure. Antibody fragments of primary interest are: Antigen-binding fragments such as Fab and b. Class-defining fragments such as Fc that do not bind antigen. Technique of antibody fragmentation Papain digestion: A nonspecific, thiol-endopeptidase defragment IgG molecules into three fragments of similar size: two Fab fragment and one Fc fragment. Pepsin digestion: A nonspecific endopeptidase produces one F(ab')2 fragment and numerous small peptides of the Fc poion. The resulting F(ab')2 fragment is composed of two disulfide-connected Fab units. Ficin digestion A thiol protease that can digest mouse monoclonal IgG1 into either F(ab')2 or Fab fragments, depending on the concentration of cysteine included. Types of antibody fragments F(ab')2 fragments: F(ab')2 (110,000 daltons) fragments contain two antigen-binding regions joined at the hinge through disulfides. This fragment is void of most, but not all, of the Fc region. Fab' fragments: Fab' (55,000 daltons) fragments can be formed by the reduction of F(ab')2 fragments. The Fab' fragment contains a free sulfhydryl group that may be alkylated or utilized in conjugation with an enzyme, toxin or other protein of interest. Fab' is derived from F(ab')2. Fab fragments: Fab (50,000 daltons) is a monovalent fragment that is produced from IgG and IgM, consisting of the VH, CH1 and VL, CL regions, linked by an intramolecular disulfide bond. Fv fragments: Fv (25,000 daltons) is the smallest fragment produced from IgG and IgM that contains a complete antigen-binding site. Fv fragments have the same binding propeies and similar three-dimensional binding characteristics as Fab. Fc fragments: Fc (50,000 daltons) fragments contain the CH2 and CH3 region and pa of the hinge region held together by one or more disulfides and noncovalent interactions. Fc and Fc5jt fragments are produced from fragmentation of IgG and IgM, respectively. The term Fc is derived from the ability of these antibody fragments to crystallize. The Fc fragment cannot bind antigen, but it is responsible for the effector functions of antibodies, such as complement fixation. -### End" -7889,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Excessive eating of non-nutritive substances is known as?, with the following options: A: PICA, B: Anorexia nervosa, C: Bulimia, D: Trichoteliomania - -### Response: -Ans. a (PICA). (Ref. O.P Ghai, 6th/pg.p 58)PICA# PICA is a disorder involving repeated or chronic ingestion of non-nutritive substances including plaster, charcoal, clay, wood, ashes and earth.# PICA after 2nd year of life needs to be investigated.# MR, lack of parental nurturing, autism, and behavior disorders like Kleine-Terin syndrome, family disorganization, low socioecomy.# Geophagia (earth eating) is seen with pregnancy.# Here patient develops craving for substance such as- Starch (amylophagia),- Ice (pagophagia) &- Clay (geophagia) these symptoms are peculiar i.e. Characteristic of iron deficiency.# Some of these materials such as starch & clay bind iron in the gastrointestinal tract, worsening the deficiency.# The basis of this bizarre behavior is unknown.# A particularly invidious consequence of iron deficiency, is increased by intestinal absorption of lead.# Children from impoverished families who often have both iron deficiency & pica are at greatest risk of developing lead poisoning.# The toxicity of lead is at least in part due to a disruption of hemesynthesis in neural tissue, a process abetted by iron deficiency.# Thus, these children are at increased risk of lead poisoning, iron deficiency anemia and parasitic infection. -### End" -7890,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Endothelium derived relaxation factor is supposed to be: (Repeat), with the following options: A: Nitric oxide, B: Angiotensin, C: Serotonin, D: Norepinephrine - -### Response: -Ans: A (Nitric oxide) Ref: Pal GK. Synaptic transmission in CNS: ami Neurotransmitters. In: Textbook of medical physiology. 2nd ed. Ahuja publishing house. 2011; 100: 794.Explanation:Nitric oxide is also called as EDRF (Endothelial derived relaxation factor)Formed from arginine by NO synthase which needs NADPHIt mediates the action of many other vasodilators - Histamine, Ach, hradykinin. VIP, substance P -### End" -7891,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: DOC for smoking cessation?, with the following options: A: Acamprosate, B: Varenicline, C: Thalidomide, D: Tryptophan - -### Response: -Ans. B. Varenicline (If Bupropion is not an option)Anti-smoking drugs:Bupropion (along with Varenicline & Nicotine replacement therapy) is a USFDA approved first-line agent for pharmacotherapy in smoking cessation.Varenicline:Effective agent for smoking cessation.Synthetic drug with paial agonist action at a4ss2 nicotinic receptors.Has antagonist propeies persisting due to long half-life & high receptor affinity.Hence, prevents stimulant effect of nicotine at presynaptic a4ss2 receptors a results in dopamine release. -### End" -7892,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Albe's stain is used for ?, with the following options: A: Staphylococcus, B: Corynebacterium diphtheriae, C: C. perfringens, D: C. tetani - -### Response: -Ans. is 'b' i.e., Corynebacterium diphtheriae Albe's stain is used for metachromatic granules, mostly found in corynebacterium diphtheriae. -### End" -7893,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Intestinal biopsy is not diagnostic in, with the following options: A: Abetalipoprotienemina, B: Tropical sprue, C: Intestinal lymphagienctaisis, D: Agammaaglobinemia - -### Response: -Refer Robbins page no 9/e 784 Small bowel biopsy is viually always abnormal when the tTG IgA antibody level is very high (more than five-fold the normal range), and EMA is positive. This is done in a procedure called a biopsy. The physician eases a long, thin tube called an endoscope through the mouth andstomach into the small intestine, and then takes samples of the tissue using small instruments passed through the endoscope.Biopsy remains the most accurate way to diagnose celiac disease -### End" -7894,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A patient complains of muscle weakness. It was reversed on administration of neostigmine,because ?, with the following options: A: It blocks action of acetylcholine, B: It interferes with the action of amine oxidase, C: It interferes with the action of carbonic anhydrase, D: It interferes with the action of acetylcholine esterase - -### Response: -Ans. is 'd' i.e., It interferes with the action of acetyl cholinesterase o Neostigmine acts by inhibiting the enzyme acetylcholinesterase. This enzyme is involved in degradation of ACh, consequently neostigmine increases the synaptic level of ACh. Muscle weakness can be improved by stimulation of NM receptor at muscle end plate due to increased ACh. -### End" -7895,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Multiple epidermoid cysts are seen in ?, with the following options: A: Turcot's syndrome, B: Gardner's syndrome, C: Peutz-Jegher syndrome, D: Familial polyposis coli - -### Response: -Ans. is 'b' i.e., Gardener's syndrome -### End" -7896,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Arrange vascular events in acute inflammation: A. Increased blood viscosity B. Vasodilatation C. Stasis D. Vasoconstriction E. Increased vascular permeability, with the following options: A: D,B,E,A,C, B: B,A,E,C,D, C: B,C,E,A,D, D: E,C,A,D,B - -### Response: -The vascular reactions of acute inflammation consist of changes in the flow of blood and the permeability of vessels, both designed to maximize the movement of plasma proteins and leukocytes out of the circulation and into the site of infection or injury. The sequence of vascular changes in acute inflammation are as follows: Immediate transient vasoconstriction Vasodilation Increased vascular permeability Increased blood viscosity and stasis -### End" -7897,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Burst suppression of EEG is sees in, with the following options: A: Herpes, B: SSPE, C: Prions disease, D: Epilepsy - -### Response: -. * In SSPE ,EEG demonstrates characteristic periodic bursts of triphasic waves. Ref Harrison20th edition pg 2567 -### End" -7898,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Blood supply of liver-, with the following options: A: 80% hepatic artery, 20% portal vein, B: 20% hepatic artery, 80% portal vein, C: 50% hepatic artery, 50% portal vein, D: 100% hepatic artery - -### Response: -The liver has dual blood supply :- - - -20% of blood supply is through the hepatic artery. -80% of blood supply is through the portal vein. -### End" -7899,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Acquired blue blindness is a feature of:, with the following options: A: Increased sclerosis of the crystalline lens, B: Disease of optic nerve, C: Disease of macula, D: All of the above - -### Response: -Ans. Increased sclerosis of the crystalline lens -### End" -7900,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Direct action of radiation is the dominant process for, with the following options: A: X-rays, B: Neutrons and alpha paicles, C: Electrons, D: Gamma rays - -### Response: -Ionizing radiation acts by two methods: Direct and IndirectDirect action is radiation directly causing DNA damage; example: neutrons and alpha paiclesIndirect action is radiation causing free radical production which acts on DNA; example: photons and gamma raysReference: Khan Physics of Radiation therapy; 5th edition -### End" -7901,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following factors is labelled as cytokine in the pathogenesis of systemic inflammatory response syndrome (SIRS) ?, with the following options: A: Nitric oxide, B: Complements, C: Leukotrienes, D: Tumor Necrosis factor - -### Response: -Ans. is 'd' i.e., Tumor Necrosis factor -### End" -7902,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin E deficiency causes all EXCEPT:, with the following options: A: Ataxia, B: Neuropathy, C: Megaloblastic anemia, D: Ophthalmoplegia - -### Response: -Deficiency of vitamin E can lead to:- Neurological problems Difficulty coordinating movements (ataxia) Speech (dysahria) Loss of reflexes in the legs (lower limb areflexia) Loss of sensation in the extremities (peripheral neuropathy). Ophthalmoplegia in susceptible persons. Megaloblastic anaemia is caused by deficiency of vitamin B12 and folic acid -### End" -7903,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Immediate treatment of hypercalcemia of malignancy is, with the following options: A: IV Fluids, B: Bisphosphonates, C: Calcitonin, D: Glucocorticoids - -### Response: -Drug of choice for hypercalcemia of malignancy is Bisphosphanates but immediate treatment involves administration of IV fluids. -### End" -7904,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Coho study is a type of, with the following options: A: Clinical trial, B: Analytic study, C: Descriptive study, D: Experimental study - -### Response: -Coho or follow up is a type of analytical study with individuals as a unit of the study. (refer pg no: 62, park 23 rd edition ) -### End" -7905,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: As a pa of space-research program , a physiologist was asked to investigate the effect of flight-induced stress on blood pressure. Accordingly, the blood pressure of the cosmonauts were to be measured twice: once before the take-off and once after the spacecraft entered the designated orbit around the eah. For a proper comparison, the preflight blood pressure should be recorded in which position?, with the following options: A: The sitting position, B: The standing position, C: The lying down position, D: Any position, as long as the post-flight recording is made in the same position - -### Response: -In the space there is no gravity. In order to compare the blood pressure taken preflight and the one in the space, BP should be taken in a position where gravity is nullified. In lying position the gravitational force is nullified, so preflight BP measurement should be done in the lying down position. In supine position, legs are at the same level as the hea so that the gravitational forces that come into play in the upright position are diminished. When a person is lying on his back, the tricuspid valve is located at almost exactly 60% of the chest thickness in front of the back. This the zero pressure reference level. Ref: High-Yield Physiology, Pa 845, Volume 2008 By Ronald W. Dudek, Page 51; Essentials Of Medical Physiology By Khurana, Page 185. -### End" -7906,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In human genome project, scientist notices that one strand of the DNA molecule contains 20 thymine (T), 25 cytosine (C), 30 guanine (C) and 22 adenine (A) residues. How many of each of the bases are found in the complete double-stranded molecule?, with the following options: A: T-44, C=60, G=50, A=40, B: T-22, C=30, G=25, A=20, C: T-40, C=50, G=60, A=44, D: T-42, C=55, G=55, A=42 - -### Response: -Question repeated -### End" -7907,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: ESI act is under which minstry -, with the following options: A: Ministry of human resources developments, B: Ministry of social welfare, C: Ministry of labour and employment, D: Ministry of health 8c education - -### Response: -Ans. is 'c' i.e., Ministry of labour and employment* Employees' state insurance (abbreviated as ESI) is a self-financing social security and health insurance scheme for indian workers. This fund is managed by the employees' state insurance corporation (ESIC) according to rules and regulations stipulated there in the ESI Act 1948. ESIC is an autonomous corporation by a statutory creation under ministry of labour and employment government of India. -### End" -7908,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Use of magnesium sulfate in pregnancy are ssociated with all of the following side-effects except: March 2010, with the following options: A: Muscular paralysis, B: Bradycardia, C: Cardiac arryhthmias, D: Respiratory depression - -### Response: -Ans. B: Bradycardia Magnesium sulfate (MgSO4) is commonly used as an anticonvulsant for toxemia and as a tocolytic agent for premature labor during the last half of pregnancy. Toxicity of I/V magnesium sulfate includes cardiac arrhythmias, muscular paralysis, respiratory depression and CNS depression in mother as well as the neonate. -### End" -7909,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Aplastic crisis in sickle cell anemia as compared to haemolytic crisis leads to, with the following options: A: Increased blood volume, B: Total leucocyte count decreased, C: Decrease in reticulocytes, D: Same findings - -### Response: -Aplastic crisis is an acute event caused by sudden decrease in red cell production. This is usually triggered by infection of erythroblasts by parvovirus B-19. -Hemolytic crisis is associated with hyperbilirubinemia and compensatory reticulocytosis. -### End" -7910,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: In N-linked glycosylation, a core oligosaccharide is transferred to the polypeptide chain after first being attached to a molecule of, with the following options: A: Serine, B: Phosphatidyl choline, C: Cholesterol, D: Dolichol - -### Response: -N-linked glycosylation begins in the endoplasmic reticulum. A core oligosaccharide is synthesized attached to a molecule of the lipid dolichol. The oligosaccharide is transferred from dolichol to an asparagine residue of the polypeptide chain. The oligosaccharide is first trimmed and then modified by the addition of monosaccharide units as the protein molecule is processed through the endoplasmic reticulum and the Golgi apparatus. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 562 -### End" -7911,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Minimum quantity of blood required to be preserved for chemical analysis is -, with the following options: A: 2 ml, B: 10 ml, C: 50 ml, D: 100 ml - -### Response: -Blood → 30 ml (minimum 10 ml) -Urine →  30 ml -### End" -7912,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Typical coloboma of iris occurs:, with the following options: A: Inferonasally, B: Superonasally, C: Inferotemporally, D: Superotemporally - -### Response: -Ans. Inferonasally -### End" -7913,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Herpes zoster most commonly involves:, with the following options: A: Facial nerve, B: Ophthalmic division of Trigeminal, C: Mandibular division of Trigeminal, D: Maxillary ivision of Trigeminal nerve - -### Response: -Ref: Harrison's l8th editionExplanation:The clinical syndrome caused by the reactivation of VZV from sensory ganglia is herpes zoster.The commonly involved dermatomes are:The thoracic dermatomes, especially T4 to T12. are involved in about 50% of casesThe lumbosacral dermatomes in about 16%The cranial nerves in 14 to 20% ot patientso Opthalmic division of trigeminal in 10 to 15 percent ando Other cranial nerves causing 4 to 5 percentThere are two rather characteristic cranial herpetic syndromes are ophthalmic herpes and geniculate herpes.In ophthalmic herpes, which accounts for 10 to 15 percent of all cases of zoster, the pain and rash are in the distribution of the first division of the trigeminal nerve, and the pathologic changes are centered in the gasserian ganglion. The main hazard in this form of the disease is herpetic involvement of the cornea and conjunctiva, resulting in corneal anesthesia and residual scarring. Palsies of extraocular muscles, ptosis, and mydriasis are frequently associated, indicating that the third, fourth, and sixth crania] nerves are affected in addition to the gasserian ganglion.The less common but also characteristic cranial nerve syndrome called Ramsay Hunt syndrome - consists of a facial palsy in combination with a herpetic eruption of the external auditory meatus, sometimes with tinnitus, vertigo, and deafness. This is due to the reactivation of herpes from the geniculate ganglion. -### End" -7914,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Exocytosis is by, with the following options: A: Engulfment, B: Cell destruction, C: Multiplication of cell organelles, D: Expulsion - -### Response: -Ans: d (Expulsion) Ref: Ganong 22nd ed/p. 28-30Exocvtosis:-Vesicles containing the material for export are targeted to the cell mem-brane, where they bond via the vsnare/ t-snare arrangement.The area of fusion then breaks down, leaving the contents of the vesicle outside and the cell membrane intact.This is a Ca2+ dependant process.Thus, there is a net increase in the surface area of the cell as the cytoplas-mic sides of two membranes fuse.Endocvtosis:-The process by which cells take up large molecules. In endocytosis, two non cytoplasmic sides of membranes fuse. Endocytotic vesicles are generated when segments of the plasma membrane invaginate, enclosing a minute volume of extracellular fluid and is contents. The vesicle then pinches off as the fusion of plasma membranes seal the neck of the vesicle at the original site of invagination.There are two general types of endocytosis:-a) Phagocytosisb) PinocytosisPhagocvtosis:-Involves ingestion of large particles such as viruses, bacteria, cells or debris.Occurs only in specialized cells such as macrophages and granulocytes.Pinocvtosis:-Property of all cellsIt is a cellular uptake of fluid and fluid contents.It is of two types:-Fluid phase pinocytosis is a non selective process in which the uptake of a solute is simply proportionate to its concentration in the surrounding extracellular fluid.Absoipti ve pinocytosis is a receptor mediated selective process primarily responsible for the uptake of mac- romolecules. The vesicles formed dur-ing absorptive pinocytosis are derived from invagination (pits) that are coated on the cytoplasmic side with a Filamentous material.In many systems, Clathrin is the filamentous material. For e.g., LDL is internalised by means of coated pits containing the LDL receptors. -### End" -7915,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Primary hyperparathyroidism, phaeochromocytoma may be associated with which type of thyroid cancer?, with the following options: A: Medullary carcinoma of the thyroid, B: Papillary carcinoma of the thyroid, C: Anaplastic carcinoma of the thyroid, D: Follicular carcinoma of the thyroid - -### Response: -Ref : Bailey and love surgery text book 27th Ed. It is characterized clinically by medullary thyroid carcinoma (MTC), pheochromocytoma, and hyperparathyroidism. Approximately 70-95% of individuals with MEN 2A develop MTC, 50% develop pheochromocytoma, and 15-30% develop hyperparathyroidism. -### End" -7916,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Endosalpingitis is best diagnosed by, with the following options: A: laparoscopy, B: X-Ray abdomen, C: Hysterosalpingography, D: Hystero-laparoscopy - -### Response: -Clinical Triad for Diagnosis of PID Pelvic organ tenderness, Adnexal tenderness, Cervical motion tenderness (Suggests the presence of peritoneal inflammation, which causes pain when the peritoneum is stretched by moving the cervix and causing traction of the adnexa on the pelvic peritoneum) Direct or rebound abdominal tenderness may be present. Evaluation of both vaginal and endocervical secretions is a crucial pa of the workup of a patient with PID. Increased number of polymorphonuclear leukocytes may be detected in a wet mount of the vaginal secretions or in the mucopurulent discharge. More elaborate tests include Endometrial biopsy to confirm the presence of endometritis, Ultrasound or radiologic tests to characterize a tubo-ovarian abscess laparoscopy to confirm salpingitis visually A laparoscopy, if asked in the Questions, is indeed the best test to diagnose PID. Its not a practical option always since this is a common presentation in the OPD and will be impossible to do on every one . Regular OPD diagnosis is made by the clinical triad If a Laparoscopy is being done for some indication & the surgeon notices inflamed tubes, then it is diagnostic of a PID Also: Please note that for diagnosis of PID , any uterine procedure like hysteroscopy, HSG, sonosalpingography ,will all push in fluids through the Uterus and this can in fact increase the PID. -### End" -7917,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The preferred treatment of verrucouse carcinoma of the larynx is, with the following options: A: Endoscopic removal, B: Electron beam therapy, C: Pulmonary surgery, D: Total laryngectomy - -### Response: -Verrucous Carcinoma 1) Verrcous carcinoma makes up only 1-2% of laryngeal carcinomas. 2) The larynx is the second most common site of occurence in the head and neck after the oral cavity. 3) Most common site of involvement is vocal cord. 4) Grossly, verrucous carcinoma appears as a fungating, papillomatous, grayish white neoplasm. 5) Microscopically, it is well differentiated squamous cell carcinoma with minimal cytological atypia. 6) It has low metastatic potential . 7) Hoarseness is the most common presented symptom. Pain and dysphagia may occur but are less common. 8) Treatment of most verrucous tumors is primary surgery. Endoscopic laser surgery is appropriate as the tumor is less aggressive than usual squamous cell carcinoma. Ref:- Current otolaryngology; pg num:- 444 -### End" -7918,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest malignancy in renal transplant recipient is, with the following options: A: Skin cancer, B: Renal cell carcinoma, C: Non hodgkins lymphoma, D: Hodgkins lymphoma - -### Response: -Cancers seen in renal transplant recipients in decreasing order are: - -Skin cancer > Lymphoma > Kaposi's Sarcoma > Ca Cervix > Renal tumors > Ca Vulva & perineum. -### End" -7919,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common intraocular foreign body retained is, with the following options: A: Airgun pellets, B: Iron, C: Glass, D: Chisel - -### Response: -Common foreign bodies responsible for such injuries include: chips of iron and steel (90%), paicles of glass, stone, lead pellets, copper percussion caps, aluminium, plastic and wood. It is impoant to note that during chopping a stone with an iron chisel, it is commonly a chip of the chisel and not of the stone which enters the eye. Ref khurana 6/e p433 -### End" -7920,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following hormones are increased due to stress during surgery, especially in DM:, with the following options: A: Epinephrine, B: GH, C: Glucocoicoids, D: All - -### Response: -A i.e. Epinephrine; B i.e. GH; C i.e. Glucocoicoid Glucagon, catecholamines (epinephrine & norepinephrine), coisol, ACTH, GH (growth hormone) are increased in stress (infection, surgery, hypoglycemia) whereas, insulin is suppressed (decreased)Q. In maintenance of internal homeostasis (ie avoiding stress) and reproduction processes, multiple hormones cooperate to bring about organized biochemical & physiological responses. Stress Syndrome: CRH - ACTH - Coisol Axis The primitive signal of glucose (substrate) lack is expanded to a broder signal of fright or stress and evokes a coordinated neural and endocrine response. Any stressful event eg. surgery, infection, burn triggers a hypermetabolic state in which a resting energy expenditure is increased alongwith body temperature. CRH-ACTH - coisol axis is central to this integrated response to stress. Features of Stress Syndrome - Coicotropin releasing hormone (CRH) is increased in response to noxious environmental stimuli like pain, trauma, hypoglycemia, infection, surgery, hypovolemia. Various nervous impulses using several neuro transmitters (NTs) like norepinephrine, serotonin, acetylcholine, dopamine, and GABA reach CRH neurosecretory cells and cause release of CRH - In response to CRH, both ACTH and p endorphins (secreted 13-LPH & mature p-endorphin) are released in equimolar quantities 13-endorphin produce central analgesic response. - Glucagon & catecholamines (epinephrine & norepinephrine) are increased, stimulating glycogenolysis (glucose production in liver) for immediate use by critical organs such as the brain. - Coisol production is increased in adrenal coex which induces gluconeogenesis (glucose production from noncarbohydrate source like muscles & other body proteins) - Glucogon, epinephrine, ACTH and growth hormone (GH) stimulate lipolysis and free fatty acids (FFA) & ketones are released into the circulation to be used as an alternative metabolic fuel. - Insulin is suppressedQ that results in decrease in glucose utilization. - One form of stress that is cold, specially in neonate causes increased TRH secretion due to depressed metabolism of neurons in pre- optic area by cooling which release inhibitory discharge, permitting TRH secretion. - ADH (vasopressin), angiotensin & aldosterone synthesis is increased enhancing salt water retention - So increased glucose production (by glycogenolysis & gluconeogenesis) and decreased utilization of glucose results in hyperglycemia. There is marked increase in release of aminoacids from tissue protein, paicularly from skeletal muscle for gluconeogenesis. However, synthesis of specific proteins may increase - These metabolic changes are coordinated with increased sympathetic nervous system activity causing peripheral vasoconstriction and increased blood pressure. -### End" -7921,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trichophyton infects:, with the following options: A: Skin + nail, B: Skin + hair, C: Hair + nail, D: Skin +hair+ nail - -### Response: -Ans: (d) Skin + Hair + NailRef: Roxburg 17th ed. / 39* Trichophyton Infects skin, hair & nail.* Infecting species include:# Trichophyton rubrum, Memtangrophyte, Violaceum, Verrucosum and Schoenleinii. -### End" -7922,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The order of sensory blockade of local anesthesia is:, with the following options: A: Temperature - pain - touch - pressure, B: Pain - pressure - touch - temperature, C: Touch - pressure - temperature - pain, D: Touch - pain - pressure - temperature - -### Response: -Individual type of nerve differs in their minimal blocking concentration. Not all sensory and motor modalities are blocked equally by local anesthetics. This is termed differential blockade. For different fibers order of blockade b > AS = C > AU > A b > Aa autonomic > sensory> motor is the sequence of block. for sensory blockade the sequence is Temperature - pain - touch - pressure -### End" -7923,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 4-year-old girl developed clumsiness and difficulty ambulating over 6 months. On physical examination, she showed difficulty with balance while walking, dysarthria, poor hand coordination, absent deep tendon reflexes, and a bilateral Babinski sign. Light touch and vibratory sensation were greatly diminished. There was no muscular weakness. Over the next 5 years, she developed congestive heart failure from hypertrophic cardiomyopathy. She also had hyperglycemia. At autopsy, there was increased perinuclear iron deposition within cardiac myocytes. Which of the following genetic abnormalities with trinucleotide repeat expansions was most likely present in this patient?, with the following options: A: CAG repeats in the huntingtin gene, B: CGG repeats in the FMR1 gene, C: CTG repeats in the dystrophila myotonia-protein kinase gene, D: GAA repeats in the frataxin gene - -### Response: -She had Friedreich ataxia, an autosomal recessive progressive illness that most often has an onset in the first decade of life. The frataxin gene encodes for a protein involved in iron regulation in cells, and a GAA trinucleotide repeats expansion results in decreased protein and decreased mitochondrial oxidative phosphorylation. The other options listed have no cardiac involvement. Mutations of the huntingtin gene are seen with Huntington disease marked by choreoathetosis beginning in young to middle-aged adults. Increased tandem repeats in the FMR1 gene account for cases of fragile X syndrome characterized by mental retardation. The dystrophila myotonia-protein kinase gene is abnormal in cases of myotonic dystrophy with muscular weakness and dementia. -### End" -7924,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is NOT affected in Rh isoimmunization?, with the following options: A: Anti C, B: Anti E, C: Anti-Lewis, D: Anti D - -### Response: -Anti-Lewis and anti-I antibodies are not associated with fetal hemolytic disease. It differs from all other antigens in that they are not synthesized in RBC membrane, but absorbed into it. Ref: Obstetrics and Gynecology By Charles R. B. Beckmann, American College of Obstetricians and Gynecologists, 2010, Page 197. -### End" -7925,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Juxtaglomerular apparatus lies in relation to :, with the following options: A: Proximal convoluted tubule, B: Ascending loop of Henle, C: Descending loop of Henle, D: Glomerulus - -### Response: -Glomerulus As the name implies ju.aglomerulus apparatus (JGA) lies at hilum of glomerulus Juxtaglornerulus apparatusThe juxtaglomerular apparatus is a microscopic structure in the kidney, which regulates the function of Lech nephron. The juxtaglomerular apparatus is named for its proximity to the glomerulus: it is found between the vascular pole of the renal corpuscle and the returning distal convoluted tubule of the same nephron. This location is critical to its function in regulating renal blood flow and glomerular.filtration rate.The three microscopic components of the apparatus are the macula densa, extraglomerular mesangial cells (lacis cells), and juxtaglomerular cells.Juxtaglomerular cellJuxtaglomerular cells (JG cells, also known as granular cells) are the site of renin secretion.The JG cells are found in the media of afferent aerioles of the glomerulus and act as an intro-renal pressure sensor Lowered pressure leads to decreased pressure on the JG cells stimulating renin secretion. Renin then acts to increase systemic blood pressure (while maintaining GFR) the resi angiotensin systemMacula densaAt the point where the afferent aeriole enters the glomerulus and the efferent leaves it, the tubule of the nephron touches the aeriole of the glomerulus from which it arose.At this location, which marks the sta of the distal convulation, there is the modified region of tubular epithelium called the macula densaThe macula densa senses sodium chloride concentration in the distal tubule of the kidney and secretes a locally active (paracrine) vasopressor which acts on the adjacent afferent aeriole to decrease glomerular filtration rate (GFR), as pa of the tubuloglomerular feedback loop. Specifically, excessive filtration at the glomerulus or inadequate sodium uptake in the proximal tubule / thick ascending loop of Henle brings fluid to the distal convoluted tubule that has an abnormally high concentration of sodium. Na/K/2C1 cotranspoers move sodium into the cells of the macula densa. The increased Na+ conc. triggers a signal that causes constriction of the afferent aeriole thus reducing the GFRLacis cells or extraglomerular mesangial cellsThe function of the extraglomerular mesangial cells remains somewhat mysterious. They contain actin and myosin, allowing them to contract when stimulated by renal sympathetic nerves, which may provide a way for the sympathetic nervous system to modulate the actions of the juxtaglomerular apparatus. In addition, extraglomerular mesangial cells are strategically positioned between the macula densa and the afferent aeriole, and may mediate signalling between these two structures -### End" -7926,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Type of collagen seen in dermo-epidermal junctions?, with the following options: A: Type IV, B: Type VII, C: Type XV, D: Type XXII - -### Response: -Type VII collagen is seen in dermo-epidermal junctions. Reference: Harper; 30th edition; Page no: 628 Table no: 50-1 -### End" -7927,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true regarding Sample Registration System (SRS) EXCEPT:, with the following options: A: Initiated in the 1960, B: Estimates of birth and death rates, C: Dual-record system, D: Survey should be done every year - -### Response: -(Survey should be done every year) (743-Park 20th)Sample Registration System (SRS) - civil registration is deficient in India.* SRS was initiated in the mid-1960 to provide reliable estimates of birth and death rates at the National and state levels.* SRS is a dual-record system consisting of continuous enumeration of births and deaths by an enumerator and an independent survey every 6 months by an investigator-supervisor* It is major source of health information. -### End" -7928,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Low serum haptoglobin in hemolysis is masked by -, with the following options: A: Pregnancy, B: Liver disease, C: Bile duct obstruction, D: Malnutriotion - -### Response: -Haptoglobin is an acute phase protein and its level increased in case of any inflammation. In hemolytic anemias there is fall in serum haptoglobin levels. If there is any inflammation along with it there will be rise in haptoglobin levels as it is an a/c phase protein (eg biliary obstruction causes inflammation) Ref:Postgraduate Hematology by Victor Hoffbrand pg 127 Ref Robbins 9/e pg 419 -### End" -7929,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Kuttner Tumour is a lesion of following gland, with the following options: A: Lymph gland, B: Salivary gland, C: Sebaceous gland, D: Thymus gland - -### Response: -• Kuttner tumor is also called as Chronic sclerosing sialadenitis -• Benign inflammatory lesion (fibro inflammatory) -• Associated with submandibular glands in most of the cases. -• Is basically a chronic inflammatory disease of salivary glands. -• Positive for cytokeratin CK 7, 8, 13, 19. -### End" -7930,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: 70 year old man has abdominal pain with mass inabdomen. Angiography reveals aneurysm of aoa. Mostlikely cause is:, with the following options: A: Trauma, B: Atherosclerosis, C: Syphilis, D: Congenital - -### Response: -. Atherosclerosis -### End" -7931,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A children presents with running nose, breathlessness, family history positive, Most likely diagnosis is -, with the following options: A: Bronchiolitis, B: Viral pneumonia, C: Bronchial asthma, D: None - -### Response: -Ans. is 'c' i.e., Bronchial asthma o Except for bronchial asthma, no other option will have family history (+) ye. -### End" -7932,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 50 year old male presented with history of hematemesis - 500ml of blood and on examination shows BP- 90/60, PR-110bpm and splenomegaly 5cm below lower costal margin. Most probable diagnosis is, with the following options: A: Malory-weiss tear, B: Duodenal ulcer, C: Gastritis, D: Poal hypeension - -### Response: -Splenomegaly and massive bleeding leading to hypotension are in our of poal hypeension. Common causes of upper Gastrointestinal Hemorrhage Non-variceal bleeding (80%) Poal Hypeensive Bleeding (20%) Peptic ulcer disease (MC) 30-40% Gastroesophageal varices >90% Malory-weiss tear 15-20% Hypeensive poal gastropathy <5% Gastritis or duodenitis 10-15% Isolated gastric varices <5% Esophagitis 5-10% Aeriovenous malformations 5% Tumors 2% Others 5% Ref: Sabiston 20th edition Pgno : 1142 -### End" -7933,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Superior oblique muscle is supplied by :, with the following options: A: Occulomotor nerve, B: Trochlear nerve, C: Abducent nerve, D: Trigeminal nerve - -### Response: -B i.e. Trochlear -### End" -7934,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not a renal vasoconstrictor?, with the following options: A: Norepinephrine, B: Acetylcholine, C: Angiotensin II, D: None of the above - -### Response: -Norepinephrine (noradrenaline) constricts the renal vessels, with the greatest effect of injected norepinephrine being exeed on the interlobular aeries and the afferent aerioles. Dopamine is made in the kidney and causes renal vasodilation and natriuresis. Angiotensin II exes a constrictor effect on both the afferent and efferent aerioles. Prostaglandins increase blood flow in the renal coex and decrease blood flow in the renal medulla. Acetylcholine also produces renal vasodilation. A high-protein diet raises glomerular capillary pressure and increases renal blood flow. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 38. -### End" -7935,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Von-Rosen's sign is positive in -, with the following options: A: Perthe'sdisease, B: SCFE, C: DDH, D: CTEV - -### Response: -Ans. is 'c' i.e., DDHRadiological features of DDH/CPHo In Von Rosen's view following parameters should be notedPerkin's line : Vertical line drawn at the outer border of acetabulumHilgenreiner's line : Horizontal line drawn at the level of tri-radiate cartilageShenton's line : Smooth curve formed by inferior border of neck of femur with superior margin of obturator foramen.Acetabular index: Normally is < 30degCE angle of Wiberg: Normal value is 15-30dego Normally the head lies in the lower and inner quadrant formed by two lines (Perkin's & Hilgenreiner's). In DDH the head lies in outer & upper quadranto Shenton's line is brokeno Delayed appearance & retarded development of ossification of head of femuro Sloping acetabulumo Superior & lateral displacement of femoral headVon-Rosen's lineo This is a line, which helps in the diagnosis of DDH in infants less than 6 months.o For this AP view of pelvis is taken with both lower limb in 45deg abduction and full internal rotation,o Upward prolongation of long axis of shaft of the femur points towards the lateral margin of the acetabulum and crosses the pelvis in the region of sacroiliac joint.o In CDH, upward prolongation of this line points towards anterior superior iliac spine and crosses the midline in the lower lumber region - Positive Von-Rosen's sign. -### End" -7936,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The most common anomaly of the upper urogenital tract is, with the following options: A: Ureteropelvic junction stenosis, B: Ectopic uretheral opening, C: Ureterocele, D: Ectopic ureter - -### Response: -UPJ stenosis is the most common abnormality in childhood and is more frequent in male children, characterized by narrowing usually on the left sideOverall, position & shape of the kidney being most common oneHorseshoe kidney is the most common and most frequently found renal abnormality among men.(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 470) -### End" -7937,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is NOT a feature of HIV infection in childhood –, with the following options: A: Failure to thrive, B: Hepatomegaly, C: Lymphoid interstitial pneumonitis, D: Kaposi sarcoma - -### Response: -""Kaposi sarcoma, commonly seen in men with advanced HIV disease, has been reported only rarely in children"". -Clinical manifestations of HIV infection in children - -Failure to thrive is universal                                                                    -P. carinii pneumonia → M.C. AIDS-defining illness in children       -Recurrent and chronic bacterial infections (first sign).                         -Otitis, Sinusitis, Pneumonia                                                                   -Hepatosplenomegaly                                                                                -Anemia / Thrombocytopenia / Neutropenia     -Lymphadenopathy         -Dermatological complications    -Candidiasis     -Hepatitis -Lymphoid interstitial pneumonia    -Cardiomyopathy -### End" -7938,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not true about clozapine is:, with the following options: A: Should be discontinued, if WBC counts < 3500/dl, B: Has no anti suicide propey, C: Should not be used along with carbamazepine, D: The action is more on D4 receptors than D2 receptors - -### Response: -Clozapine: It is a DOC for treatment resistant schizophrenia(TRS) TRS is defined as lack of response to 2 antipsychotics (atleast 1 atypical) at adequate dose for atleast 4-6 weeks It has more affinity for D4 receptors , less affinity for D2- [?] minimum EPS. It has anti- suicide propey It is an antipsychotic agent with maximum weight gain propey. Side effects: most common- sedation (due to H1 blocking propey) Sialorrhea Syncope, hypotension, tachycardia, nausea and vomiting Anticholinergic side effects like constipation Three life threatening side effects: Agranulocytosis(Idiosyncratic) Myocarditis Seizures(Dose dependent) Monitoring: TLC and ANC Once a week for first 6 months Once in two weeks for next 6 months Once a month till patient is on clozapine If WBC count falls below 3000/dL or ANC falls below 1500/dL, STOP the clozapine. Contraindications: WBC <3500/dL History of agranulocytosis on clozapine Use of bone marrow suppressants such as carbamazepine. -### End" -7939,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The minimum age at which an individual is responsible for his criminal act is: COMEDK 07; Bihar 11; NEET 14, with the following options: A: 7 years, B: 12 years, C: 16 years, D: 21 years - -### Response: -Ans. 7 years -### End" -7940,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 30 year old lady do sudden onset breathlessness, anxiety, palpitation & feeling of impending doom. Physical examination is normal. What is the diagnosis, with the following options: A: Panic attack, B: Anxiety disorder, C: Conversion disorder, D: Acute psychosis - -### Response: -Panic attack DSM-IV Criteria for a Panic Attack A panic attack is a period of intense fear or discomfo, developing abruptly and peaking within 10 minutes, and requiring at least four of the following :-Chest pain or discomfoChills or hot .fushesDerealization (feeling of unreality) or depersonalization (being detached from oneself)Fear of losing controlFeeling of chokingNausea or abdominal distressPalpitations or tachycardiadegParesthesiasSensations of shoness of breathdeg or smotheringSense of impending doomdeg.SweatingTrembling or shaking -### End" -7941,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which cervical veebra that does not have a body or spinous process?, with the following options: A: C1, B: C2, C: C3, D: C4 - -### Response: -First cervical veebra is ring-shaped. It has neither a body nor a spine.Features of typical cervical, thoracic and lumbar veebra are given belowFeaturesCervical veebraThoracic veebraLumbar veebraBodySmall and broad from side to sideMedium size and hea-shapedLarge and kidney-shapedVeebral foramenLarge than the body and triangularSmall and circularTriangularSpinous processSmall and bifidLong and directed downwardsSho, flat and projected backwardInferior aicular facetDirected forward and downwardsDirected forwards, slightly downwards and mediallyDirected laterallyTransverse processHave foramen transversariumHas costal facets Long and slender -### End" -7942,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is the most common tumor to produce metastasis to cervical lymph nodes?, with the following options: A: Glottic carcinoma, B: Nasopharyngeal carcinoma, C: Carcinoma base of tongue, D: Carcinoma lip - -### Response: -Ans. is 'b' i.e. Nasopharyngeal carcinoma -### End" -7943,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: You have diagnosed a patient clinically as having SLE and ordered 6 tests. Out of which 4 tests have come positive and 2 are negative. To determine the probability of SLE at this point, you need to know-, with the following options: A: Prior probability of SLE; sensitivity and specificity of each test, B: Incidence of SLE and predictive value of each test, C: Incidence and prevalence of SLE, D: Relative risk of SLE in this patient - -### Response: -Ans. is 'a' i.e. Prior probability of SLE; sensitivity and specificity of each test o Probability allows for an accurate method of calculating how much the likelihood of changes as new information (i.e., a test result) becomes available. o Probability of disease after a given test (post-term probability) can be calculated by (Bayes' theorem) Post test probability = Pretest probability x Likelihood ratio Pre test probability o It is the probability of disease before getting a test. o There is a principal ""The interpretation of new information depends on old information"". o That means the interpretation of a test result (post-test probability) depends on the probability of disease before test (pre-test probability). o Pre-test probability depends on prevalence, infact prevalence rate is described as pre-test probability of having a disease. Likelihood ratio o The likelihood ratio provides a direct estimate of how much a test result will change the probability of having the disease. o Tests results are often expressed as either positive or negative. o So, there is A likelihood ratio for a positive test result (LR +), and A likelihood ratio for a negative test result (LR-) o The positive likelihood ratio (LR +) tells us how much to increased the probability of a disease if the test is positive. It is calculated by following formula. The likelihood ratio is generally a better descriptor than sensitivity or specificity because it more directly describes the effect of a test result on the probability of disease and it incorporates both the sensitivity and specificity. So, in sho o To know the probability of a disease after a test (post test probability) depends upon : i) Pretest probability --> Prevalence ii) Likelihood ratio --> Specificity & sensitivity -### End" -7944,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: % of children with simple febrile seizures developing epilepsy is-, with the following options: A: 1-2%, B: 2-5%, C: 5-10%, D: 10-20% - -### Response: -Ans. is 'a' i.e., 1-2% o Children with febrile seizures have an increased risk of developing epilepsy. o Between 2% to 7% of all children with febrile seizures develop epilepsy if followed upto the age of 25 years. Risk depends on type of febrile seizure :- i) Simple febrile seizures --) 2% of all children with simple febrile seizures. ii) Complex febrile seizures --) 6-8% of all children with complex febrile seizures. o Three major risk factors increase the risk of epilepsy :? i) Complex febrile seizures. ii) Pre-existing neurodevelopmental abnormality. iii) Epilepsy in first degree relatives. -### End" -7945,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the most common type of fingerprint ?, with the following options: A: Arch, B: Composite, C: Loops, D: Whorls - -### Response: -About 60 - 70% people have loop pattern in their fingerprints. -The order of Frequency is  - -Loops (60 - 70%) -Whorls -Arch -Composite -### End" -7946,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Claw hand is seen in all except:, with the following options: A: Scleroderma, B: Sarcoidosis, C: Leprosy, D: Hurler’s syndrome - -### Response: -Claw hand is seen with: - -Scleroderma  -Leprosy​ -Mucopolysaccharidosis or Hurler's syndrome or Gorgolism​. -### End" -7947,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: “Smack” is the “common” name for, with the following options: A: Heroin, B: Cocaine, C: Opium, D: None - -### Response: -Heroin or di-acetyl-morphine is about two times more potent than morphine in injectable form. Apart from the parenteral mode of administration, -heroin can also be smoked or ‘chased’ ( chasing the dragon), often in an impure form (called ‘ smack’ or ‘ brown sugar’ in India). -Heroin is more addicting than morphine and can cause dependence even after a short period of exposure. -### End" -7948,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Multiple punched out lesion in skull is characteristically seen in, with the following options: A: Thalassemia, B: Multiple Myeloma, C: Rickets, D: Osteoporosis - -### Response: -(Multiple myeloma): (1041 -Davidson 21st edition)MULTIPLE MYELOMA - presents as multifocal destructive bone tumours composed of plasma cells throughout the skeletal system* The bone lesions appears radiographically as punched out defects usually 1-4 cm in diameter and grossly consists of gelatinous soft red tumour masses* Hyperparathyroidism - ""pepper pot skull"", The mandible a common site for 'brown ' tumours* Moth - eaten appearance - syphilis* Rugor Jersy spine - Osteopetrosis* Beheaded scortish terrior sign - Spondylolisthesis -### End" -7949,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Following shown condition is least common in:, with the following options: A: Frank breech, B: Transverse lie, C: Footling presentation, D: Brow presentation - -### Response: -Abnormal Labour patterns diagnostic criteria and potential it. -### End" -7950,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Pyometra commonly occurs following :, with the following options: A: Carcinoma endometrium, B: Carcinoma cervix, C: Carcinoma urethra, D: Senile endometritis - -### Response: -Ans. is a i.e. Carcinoma Endometrium Pyometra is collection of pus or mixture of pus and blood within the uterus Causes : Most common cause 2""d most common cause : Other causes : Congenital atresia of the vagina/cervix. Stenosis of cervix / vagina following : - Operations - Burns Radiotherapy Endometritis : Senile Tuberculous Puerperal Carcinoma : - Ca endometrium (most common)deg Ca cervix - Ca corporis -### End" -7951,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Dermatome supplying the middle finger is-, with the following options: A: C6, B: C7, C: C8, D: T1 - -### Response: -Ans. is 'b' i.e., C7 * Sensory distribution of upper limb is as followThe cutaneous nervesRegion suppliedNerve(s)Root valueDerived fromUpper part of pectoral region, and skin over upper part of deltoidSupraclavicularC3,C4Cervical plexusArm 1. Upper medial partIntercostobrachialT22nd intercostal2. Lower medial partMedial cutaneous nerve of armT1,T2Medial cord3. Upper lateral part (including skin over lower part of deltoid)Upper lateral cutaneous nerve of armC5, C6Axillary nerve4. Lower lateral partLower lateral cutaneous nerve of armC5, C6Radial nerve5. Posterior aspectPosterior cutaneous nerve of armC5Radial nerveForearm 1. Medial sideMedial cutaneous nerve of forearmC8,T1Medial cord2. Lateral sideLateral cutaneous nerve of forearmC5> C6Musculocutaneous3. Posterior sidePosterior cutaneous nerve of forearmC6, C7, C8Radial nervePalm 1. Lateral two-thirdsPalmar cutaneous branch of medianC6, C7Median2. Medial one-thirdPalmar cutaneous branch of ulnarC8UlnarDorsum of hand 1. Medial half including proximal phalanges of medial 2 1/2 digitsDorsal branch of ulnarC8Ulnar2. Lateral half including proximal phalanges of medial 2 1/2 digitsSuperficial terminal branch of radialC6, C7RadialDigits Palmar aspect, and dorsal aspect of middle and distal phalanges 1. Lateral 3V6 digitsPalmar digital branch of medianC7Median2. Medial 1 Vi digitsPalmar digital branch of ulnarC8Ulnar -### End" -7952,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following increases the prevalence of the disease-, with the following options: A: Immigration of healthy people, B: Increase in cure rates, C: Decrease in the number of new cases, D: Increase in duration of disease - -### Response: -Ans. is 'd' i.e. Increase in duration of disease Prevalence refers ""to all current cases (old + new) existing at a given point in time (point prevalence) or over a period of time (period prevalence) in a given population""It thus includes all the new cases, as well as those old persisting cases. -### End" -7953,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following disappear in umbilical cord, with the following options: A: Left aery, B: Left vein, C: Right aery, D: Right aery - -### Response: -D. i.e. Right vein -### End" -7954,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 7 year old boy presented with generalized edema.Urine examination revealed marked albuminuria.Serum biochemical examinations showedhypoalbuminaernia with hyperlipidaemia. Kidneybiopsy was undeaken. On light microscopicexamination, the kidney appeared normal. Electronmicroscopic examination is most likely to reveal:, with the following options: A: Fusion of foot processes of the glomerular epithelial cells, B: Rarefaction of glomerular basement membrane, C: Deposition of electron dense material in the basement membrane, D: Thin basement membrane - -### Response: -Thin basement membrane -### End" -7955,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All of the following are differential diagnosis for constricted pupils except, with the following options: A: Horner's syndrome, B: Pontine myelinosis, C: Opioid withdrawl, D: Organophosphaste poisoning - -### Response: -Opioid poisoning: Pin point pupils. -Opioid withdrawl: dilated pupils. -### End" -7956,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 26yr old female presented with complaints of coloured -halos, matted and sticky eyelids since 3 days. On examination, -visual acuity was normal. Most common organism causing -this condition is, with the following options: A: Gonococcus, B: Pneumococcus, C: Staphylococcus aureus, D: Streptococcus hemolyticus - -### Response: -The Clinical scenario gives the diagnosis of Acute mucoopurulent conjunctivitis which is most commonly caused by Staphylococcus aureus. -### End" -7957,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Normal Poal venous pressure is:, with the following options: A: 5-10 mm Hg, B: 10-15 mm Hg, C: 15-20 mm Hg, D: 20-255 mm Hg - -### Response: -Normal poal pressure is 5-10 mm Hg (Schwaz) Normal Poal pressure is 5-8 mm Hg (Kumar and Clark)Poal systemThe poal vein drains blood from the small and large intestines, stomach, spleen, pancreas, and gallbladder.The superior mesenteric vein and the splenic vein unite behind the neck of the pancreas to form the poal vein.The poal trunk divides into 2 lobar veins.The right branch drains the cystic vein, and the left branch receives the umbilical and paraumbilical veins that enlarge to form umbilical varices in poal hypeension.The coronary vein, which runs along the lesser curvature of the stomach, receives distal esophageal veins, which also enlarge in poal hypeension. -### End" -7958,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Trethowan sign is used in radiological diagnosis of?, with the following options: A: TB Hip, B: Pehes Disease, C: Slipped Capital Femoral Epiphysis, D: Avascular Necrosis of head of femur - -### Response: -TRETHOWAN'S SIGN In normal hip a line drawn tangential to superior femoral neck (Klein's line) intersects small poion of lateral capital epiphyseal. In posterior displacement of epiphyses the line doesn't intersect. -### End" -7959,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which one of the following is not a feature of liver histology in Non cirrhotic poal fibrosis (NCPF) ?, with the following options: A: Fibrosis in and around the poal tracts, B: Thrombosis of the medium and small poal vein branches, C: Non specific inflammatory cell infiltrates in the poal tracts, D: Bridging fibrosis - -### Response: -Ans. is 'd' i.e., Bridging fibrosisFibrosis bridging one poal tract to another (bridging fibrosis) is not seen.Pathology : o Non cirrhotic poal fibrosis is primarily a vascular disorder of the liver characterized by fibrous intimal thichening of the poal vein or its branches in patients with non cirrhotic protal hypeension.Vascular changesHallmark of the disease is thrombosis/sclerosis of the poal vein branches.The poal vein is dilated with sclerosis of the walls and in autopsy thrombin in medium or small poal vein branches with accompanying areas of ischaemic necrosis have been repoed.Aberrant Intrahepatic vessels may be present in the peripoal area, which correspond to dilated terminal poal vein branches or venules. These are often termed as ""megasinusuoids"" or peripoal angiomatosis. FibrosisVascular changes are accompanied by poal and peripoal fibrosis of varying extent. -### End" -7960,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is not associated with DIC, with the following options: A: Thrombocytopenia, B: Increased PT, C: Hyperfibrinogenemia, D: Increased FDP - -### Response: -Ans. is 'c' i.e., Hyperfibrinogenemia o DIC is associated with decreased plasma fibrinogen level. -### End" -7961,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Not used for intravascular volume maintainence is, with the following options: A: Hydroxy ethyl starch, B: Dextran, C: Erythropoetin, D: Gelatin - -### Response: -Answer- C. ErythropoetinErytheropoetin InjectionsErythropoietins available for use as therapeutic agents are produced by recombinant DNA technology in cell culture, They are used in treating anemia resulting from chronic kidney disease, chemotherapy induced anemia in patients with cancer, inflammatory bowel disease (Crohn's disease and ulcerative colitis). -### End" -7962,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Non depolarizing neuromuscular blocker is, with the following options: A: Non competitive neuromuscular blocker, B: Reversed by neostigmine, C: Persistent stimulator of nicotinic cholinergic receptors, D: Induces fasciculations - -### Response: -Non depolarising neuromuscular blocker is competitive antagonist at nicotinic cholinergic receptor. It doesn’t cause fasciculations . it is reversed by neostigmine. -### End" -7963,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vasopressor of choice in hypotension produced during sub-arachnoidblock, with the following options: A: Ephedrine, B: Mephenteramine, C: Adrenaline, D: Dopamine - -### Response: -A i.e. Ephedrine Most common complication of spinal anesthesia is hypotensionQ, which can be prevented by preloading with crystalloid. In spinal anesthesia autonomic preganglionic sympathetic fibresQ are the earliest blocked fibres. Block of sympathetic nerves causes vasodialation of venous capacitance vessels, pooling of blood and HypotensionQ (most common complication of spinal anesthesiaQ). It is prevented by preloading with crystalloid. Following spinal subarachnoid block most common complication is hypotensionQ. During sub-arachnoid block, there is sympathetic blockade producing decreased venous return & hence, cardiac output and BP falls. So the patient can be managed by all the four means but the least effective & most controversial mean is lowering head end. The specific gravity (baricity) of CSF is 1.003 - 1.008Q at 37degC. A hyper baric solution of LA is denser than CSF & hypobaric solution of LA is Lighter than CSF. A LA solution can be made hyperbaric by adding glucose & hypobaric by addition of sterile water. Most impoant factors affecting level of spinal anesthesia are: BaricityQ, Position of patient - during & immediately after injection,Q drug dose & site of injection. Thus with a head down position a hyperbaric solution spreads cephald & hypobaric solution moves caudad and vice versa. And in this Q baricity of LA & time passed after injecting spinal anesthesia is not mentioned, so lowering the head end is weakest option. -### End" -7964,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Meckel's cailage develops from, with the following options: A: I branchial arch, B: II branchial arch, C: III branchial arch, D: IV branchial arch - -### Response: -The cailage of the first arch is called Meckel's cailage. the incus and malleus are derived from its dorsal end. the ventral pa of the mandible is surrounded by the developing mandible and is absorbed Ref: Human Embryology, Inderbir Singh, 10th edition, page no: 131 -### End" -7965,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 32 year old female patient wants to get her missing tooth replaced but does not want to get dental implants placed. Intra-oral examination reveals a missing 46. 45 and 47 were prepared to receive a 3 unit fixed dental prosthesis. What type of stress will be experienced on the occlusal surface of this prosthesis?, with the following options: A: Tensile, B: Compressive, C: Shear, D: No stress is expressed - -### Response: -Subjecting a structure such as an FDP to three-point loading, whereby the endpoints are fixed and a force is applied between these endpoints, tensile stress develops on the tissue side of the FDP, and compressive stress develops on the occlusal side. Between these two areas is the neutral axis that represents a state with no tensile stress and no compressive stress. -### End" -7966,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: What is trench fever:, with the following options: A: Q-fever, B: 5-days fever, C: Boutonneuse fever, D: Indian tick typhus - -### Response: -Ans. is. 'b' i. e., 5-days fever -### End" -7967,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: PQLI is measured by all except?, with the following options: A: Infant moality, B: Life expectancy at age 1, C: Literacy, D: Per capita income - -### Response: -Ans. is 'd' i.e., Per capita income Physical quality of life index consolidates three indicators :- Literacy rate Infant moality rate Life expectancy at age I year (LEI -### End" -7968,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: The risk of endometrial cancer is highest with the following histological pattern of endometrial hyperplasia :, with the following options: A: Simple hyperplasia without atypia, B: Simple hyperplasia with atypia, C: Complex hyperplasia without atypia, D: Complex hyperplasia with atypia - -### Response: -Risk of endometrial cancer Simple hyperplasia without atypia: 1% Complex hyperplasia without atypia: 3% Simple hyperplasia with atypia: 8% Complex hyperplasia with atypia: 29% -### End" -7969,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following is not done before ABG?, with the following options: A: Allen test, B: Heparin to rinse the syring, C: Flexion of wrist, D: Poking the aery at 45 degrees angle - -### Response: -Done Before ABG Allen test: integrity of palmer arch. Heparin: to rinse the syringe Poking the aery at 45-degree angle. Extend wrist joint: Radial Aery tent. -### End" -7970,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Early deceleration pattern on cardiotocography indicates :, with the following options: A: Head compression, B: Fetal distress, C: Cord prolapse, D: Hypoxia - -### Response: -Head compression -### End" -7971,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Ovulation is associated most commonly with?, with the following options: A: LH surge, B: Increase in progesterone, C: Increase in FSH, D: Increase in basal body temperature - -### Response: -LH surge REF: Ganong WF: Review of Medical Physiology, 22nd ed (chapter 23) Figure 6-10, William's obstetrics 22""d edition Figure 3-1. ""The onset of the gonadotropin surge resulting from increasing secretion of estrogen by preovulatory follicles is a relatively precise predictor of the time of ovulation, occurring some 34 to 36 hours before the release of the ovum from the follicle. The peak of LH secretion occurs 10 to 12 hours before ovulation and stimulates the resumption of the meiosis process in the ovum with the release of the first polar body"" -### End" -7972,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which of the following best describes the permeability to sodium and potassium in rod cells in response to the light?, with the following options: A: Decreased sodium permeability, decreased potassium permeability, B: Decreased sodium permeability, increased potassium permeability, C: Decreased sodium permeability, no change in potassium permeability, D: Increased sodium permeability, decreased potassium permeability - -### Response: -Activated rhodopsin (metarhodopsin II) closes cGMP-gated sodium channels by lowering levels of cGMP; this action decreases sodium permeability. Potassium permeability is not affected. -### End" -7973,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Candida is most often implicated in causation -(, with the following options: A: Conjunctivitis, B: Tinea capitis, C: Dese rheumatism, D: Thrush - -### Response: -Ans. is 'd' i.e., Thrush -### End" -7974,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Which among the following is the origin of the uterine aery?, with the following options: A: External iliac aery, B: Inferior rectal aery, C: Internal iliac aery, D: Ovarian aery - -### Response: -The blood supply to the uterine corpus arises from the ascending branch of the uterine aery and from the medial or uterine branch of the ovarian aery. The uterine aery may originate directly from the internal iliac aery as an independent branch or it may have a common origin with the internal pudendal or with the vaginal aery. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 38. Anatomy. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e. -### End" -7975,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HIAA is a metabolite of:, with the following options: A: Serotonin, B: Dopamine, C: Epinophrine, D: Histamine - -### Response: -Ans is 'a' i.e. SerotoninSerotonin or 5 hydroxytryptamine is catabolized to 5 Hydroxy indole acetic acid (5HIAA).The enzyme which catalyzes this reaction is - Monoamine oxidase.5 HIAA is excreted normally in urine. Normal adult excretes about 7 mg of HIAA per day. -### End" -7976,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Commonest site of Ca breast is:, with the following options: A: Upper outer quadrant, B: Upper inner quadrant, C: Lower outer quadrant, D: Lower inner quadrant - -### Response: -Ans: a (Upper outer quadrant) Ref: Bailey & Love, 24th ed, p. 837Note:Breast carcinoma with good prognosis evenwith axillary lymph nodes-Medullary CaBull's eye appearance is seen in- Invasive lobularDesmoplastic reaction is shown by- Ductal invasiveComedo carcinoma is- Ductal carcinoma in situ (DCIS)Most common variant of breast carcinoma- Ductal invasiveLobular carcinoma - Multicentnc and bilateralThe underlying lobular architecture can still be recognized on microscopic examination ""Indian file pattern"" is seen. -### End" -7977,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: How is endotoxin shock initiated?, with the following options: A: Endothelial injury, B: Peripheral vasodilation, C: Increased vascular permeability, D: Cytokines action - -### Response: -. Endothelial injury -### End" -7978,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 24 year old male presents to a STD clinic with a single painless ulcer on external genitalia. The choice of laboratory test to look for the etiological agent would be:, with the following options: A: Scrappings from ulcer for culture on chocolate agar with antibiotic supplement., B: Serology for detection of specific IgM antibodies., C: Scrappings from ulcer for dark field microscopy., D: Scrappings from ulcer for tissue culture. - -### Response: -Ans. is 'c' i.e. Scrapings from ulcer for dark field microscopy [Ref.: Harrison 16/e p 981 (15 /e p. 1046, 1047)Single painless ulcer on external genitalia in young male is suggestive of syphilis the patient is in the first stage of syphilis. The single painless ulcer is primary chancre.Diagnosis of syphilisAbsolute diagnosis during the first and second stages can be made by direct examination under dark field microscopy of a specimen from infective lesions which arePrimary chancreMaculopapular rashCondyloma lataDarkfield microscopy reveals tiny helically shaped organisms moving in a corkscrew like fashion.Since direct visualization of spirochetes effective only during the active stages primary and secondary syphilis, serological tests were developed for diagnosis. These serologic tests detect antibodies IgM or IgA type against antigen.Let's seeApproach to diagnosis of Genital ulcers (also see the table from Q. No. 74 of May 2001)Painful ulcers* -Chancroid, HerpesPainless ulcers* -Syphilis, lymphogranulomaVenarum, DonovanosisUlcer with Necrotic base -Hemophilus DucreyiIndurated ulcers* -SyphilisVesicular lesions -HerpesMultiple ulcers -ChancroidHerpes (B/L symmetrical)Donovanosis (can be single or multiple)Single lesions* -Syphilis, LGVLymphadenopathy* -Present in all exceptDonovanosis (pseudobuboes* are seen)Painful lymphadenopathy* -Cancroid's LGVSinuses in lymphadenopathy* - Lymphadenopathy present after theLGVlesion has healed* -LGV -### End" -7979,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True about generator potential:, with the following options: A: Graded, B: Follows all or none law, C: Propagated, D: Does not show summation - -### Response: -Generator potentialare graded potentials whose magnitude is propotional to ghe intensity of the stimulus . Graded potentials have different names depending on which type of stimulus causes them and where they occur. For eg, when a graded potential occurs in the dendrites or cell body of a neuron in response to a neurotransmitter, it is called a postsynaptic potential. On the other hand, the graded potentials that occur in sensory receptors are termed receptor or generator potentials. Other examples: end-plate potentials, pacemaker potentials, and slow wave potentials. PROPEIES OF GRADED POTENTIAL -### End" -7980,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Sandfly can fly upto -, with the following options: A: 50 yards, B: 100 yards, C: 200 yards, D: 300 yards - -### Response: -Sandflies Sansflies are troublesome nocturnal pests. They are incapable of flying over long distances. They merely hop about from one place to another. Sandflies are generally confined to within 50 yards. REFERENCE: PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE, 25TH EDITION, PG NO. 835 -### End" -7981,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Wolffian duct give rise to, with the following options: A: Vas deference, B: Appendix testis, C: Testis, D: Prostate - -### Response: -(Vas deference) (1403-LB) (1377-B &L 25,h)* The testis develops from the genital fold medial to the mesonephros (Wolffian body)* The Wolffian duct becomes the epididymis and vas deferensDevelopment of genitourinary System:Embryonic structureStructure developing in MALEStructure developing in FEMALEGenital tuberclePenis (C. cavernosa)ClitorisUrethral foldsPenile urethra (C. spongiosa)Labia minoraGenital swellingScrotumLabia majoraGubemaculumGubemaculums testisLigament of ovaryRound ligament of uterus Genital glandsTestisOvary (genital ridge)Germinal cordsSeminiferous tubulesPfluger's tubeMesonephric duct (Wolffian duct)Epididymis, Vas deferens and seminal vesicles Ejaculatory ductsAppendix epididymidisDuct of epoophoron Gartner's duct vesicular appendageUreter, renal pelvis etc Trigonal structure**Ureter, renal pelvis, et^ Trigonal structuresMullerian duct (Paramesonephric duct)Appendix testisProstatic utricleUterine tubes, Uterus, Vagina (upper four- fifths)Muller's tubercleVeromontanumSite of hymenSinovaginal bulb from urogenital sinusPart of prostatic utricleLower one-fifth of vaginaJunction of sinovaginal bulb and urogenital sinusDisappears normally (remnants probably from posterior urethral valves)HymenUrogenital sinusVentral and pelvic partUrinary bladder (except the trigone)Supramontanel part of prostatic urethraUrinary bladder (except the trigone) whole urethraPhallic or urethral portionInframontanal part of prostatic urethra Membranous urethraVaginal vestibules -### End" -7982,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Russell’s body is found in:, with the following options: A: Metastatic calcification, B: Plasma cells, C: RBC, D: Mast cells - -### Response: -Russell bodies are large homogenous eosinophilic inclusions formed by hugely distended endoplasmic reticulum of plasma cell. -Their formation is triggered by synthesis of excessive amount of normal secretory proteins in plasma cells. -### End" -7983,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: All are true about aspirin sensitive asthma excpet -, with the following options: A: Nasal polyposis, B: Treatment with inhaled corticosteroids, C: Rhinosinusitis, D: Increased prostaglandins - -### Response: -Ans. is 'd' i.e., Increased prostaglandins o Aspirin-sensitive asthma is associated with severe rhinosinusitis and recurrent nasal polyposis.o The complex pathogenesis of aspirin-sensitive asthma involves chronic eosinophilic inflammatory changes, with evidence of increased mast cell activation.o Aspirin-sensitive asthma is an underdiagnosed condition affecting up to 20% of the adult asthmatic population.o It is associated with more severe asthma, requires increased use of inhaled and oral corticosteroids, more presentations to hospital and a risk of life - threatening reactions with aspirin,o The cyclo-oxygenase pathways play a major role in the respiratory reactions that develop after aspirin ingestion.Aspirin sensitive respiratory syndrome primarily affects adults and is characterized by:Perennial vasomotor rhinitis|Hyperplastic rhino-sinusitis with Nasal Polyps|Aspirin exposure|Block cycloxygenase without affecting lipoxygenase|Increased leukotriene|Progressive AsthmaOn exposure to even very small quantities of aspirin, affected individuals typically develop ocular and nasal congestion with acute, often severe, episodes of airway obstruction. -### End" -7984,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Cerebral infarction is caused by, with the following options: A: Toxoplasma, B: Mucor, C: Aspergillosis, D: All of the above - -### Response: -Refer Robbins page no 1363 Causes of cerebral infarction. Syphilis Tuberculosis Toxoplasmosis Aspergillosis Mucormycosis CMV encephalitis -### End" -7985,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Husband having suspicion that his wife is having affair with another man, diagnosis is -, with the following options: A: Illusion, B: Delusion, C: Hallucination, D: Delirium - -### Response: -Ans. is 'b' i.e. Delusion o A delusion is false, firm (unshakeable) belief that is not accepted by other members of patient's culture and society.o Above is an example of delusion of infedility (morbid jealousy, othello syndrome) i.e. False belief that one's lover has been unfaithful.o Persecutory delusions (paranoid):- The patient feels that he is being persecuted against. There is false belief that one is being harmed, threatened, cheated, poisoned, harassed or spied on or is a victim of conspiracy to damage his reputation. The supposed persecutor of the patient may be people in the environment (e.g., members of family, neighbours, former friend) or may be political or religious groups. These delusions occur in schizophrenia (especially paranoid), severe affective disorders (sever mania or severe depression)> and organic brain syndrome. This is the most common type of delusion. Delusion of persecution may occur in the context of primary delusional experiences, auditory hallucinations, bodily hallucinations or experiences of passivityo Grandiose delusion (expansive delusions) : - False belief that one is exceptionally powerful, talented or important. These delusions seen most commonly in mania, However, can also occur in schizophrenia and organic stateso Delusions of reference:- False belief that certain objects, people or events have intense personal significance and refer specifically to one self, e.g., believing that a television news reader is talking directly about oneself, or people walking on the road are talking about him. These delusions are seen in schizophrenia, mania and organic states.o Religious delusions:- False belief pertaining to a religious theme, often grandiose in nature, e.g., believing that one is a special messenger from God. These delusions are seen in schizophreniao Delusions of love (erotomania):- False belief that another person is in love with one (commoner in woman). In one form, termed de clerambault sydrome, a woman (usually) believes that a man, frequently older and of higher status, is in love with her.o Delusion of infldility (morbid jealousy, othello syndrome): - False belief that one's lover has been unfaithful. These are seen in schizophrenia, alcohol related psychosis, organic states.o Delusion of misidentification:- a) Capgras syndrome (Delusion of double):- Belief that a familiar person has been replaced by an exact double i.e. an impostor, b) Fregoli syndrome:- Belief that a complete stranger is actually a familiar person already known to one.o Delusion of self accusation or guilt:- False feeling of remorse of guilt. It occur in Depressiono Nihilistic delusions:- False belief that oneself, others or the world is non-existent or about to end. There are pessimistic ideas that the patient's career is finished, he is about to die, world is doomed. These occurs in severe depression. If nihilistic delusions are accompanied by ideas concerning bodily function failure, e.g., putrefaction of intestines, etc., the syndrome is called COTARD's SYNDROMEo Hypochondriacal delusions:- False belief about one's health, patient wrongly believes that he has severe medical illness, contrary to the all medical evidences. It is seen in depression.o Delusion of infestations: - False belief that one is infested with small but visible organisms. As a monosymptomatic delusional disorder this is called EKBOM SYNDROME. It is seen in acute confusional state (due to drugs or alcohol withdrawal), in schizophrenia, in dementing illness, and as delusional elaboration of tactile hallucinatory experiences (secondary to formication).o Delusion of control:- Belief that his actions, impulses or thoughts are controlled by an outside agency and accordingly called as made action, made impulse or made affect. Also called somatic passivity experiences (passivity phenomenon). Commonly seen in schizophrenia.o Delusions concerning possession of thoughts - Patients with delusions about possession of thoughts may lose the conviction that their thoughts are their own. Most commonly seen in schizophrenia. -### End" -7986,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Earliest symptoms in acute appendicitis is -, with the following options: A: Pain, B: Fever, C: Vomiting, D: Rise of pulse rate - -### Response: -Schwartz writes - In more than 95% of patients with acute appendicitis, anorexia is the first symptom, followed by abdominal pain, which is followed in turn, by vomiting (if vomiting occurs). If vomiting precedes the onset of pain, the diagnosis of appendicitis should be questioned"". -### End" -7987,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: True statements about neostigmine are, with the following options: A: It is a quaternary ammonium compounds, B: It is metabolized by the liver, C: It can cross the blood brain barrier, D: Prominent effect on cardiac muscle - -### Response: -(Ref. KDT6/e p101-102; Lee 12/ep217) Neostigmine is a reversible cholinesterase inhibitor.It is a quaernary ammonium compound. (lipid insolube agent), so it does not cross blood-brain-barrie. It is paly hydrolyzed by serum cholinesterase and paly excreted unchanged by the kidneys. It possesses some agonistic action on NM receptors. -### End" -7988,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Constricted pupil is seen in all poisoning, except: UPSC 13, with the following options: A: Paracetamol, B: Opium, C: Phenol, D: OPC - -### Response: -Ans. Paracetamol -### End" -7989,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Muller&;s muscle is found in, with the following options: A: Pharynx, B: Middle ear, C: Eye lid, D: Tongue - -### Response: -Mullers muscle or involuntary pa of levator palpebrae superioris is supplied by sympathetic fibres from the superior cervical ganglion. Paralysis of mullers muscle leads to paial ptosis. This is a pa of horners syndrome. Ref BDC volume 3,Sixth edition pg 74 -### End" -7990,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Consider the following 1* Malnutrition deficiency 2. Lithostatin (pancreatic stone protein 3. Cassava tuber Oxidant stress (heightened cytochrome P-450 activity) Which of the above produce tropical calcific pancreatitis (fibrocalculous pancreatic diabetes) ?, with the following options: A: 1, 2 and 3 only, B: 2, 3 and 4 only, C: 1 and 4 only, D: 1, 2, 3 and 4 - -### Response: -Calcification, which is another sign of chronic inflammation, can develop throughout the pancreas. These calcifications are like stones that are within the tissue itself, or within the pancreatic duct Ref Davidson 23rd edition pg 765 -### End" -7991,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Investigation of choice for SCIWORA is, with the following options: A: CT, B: X-ray, C: MRI, D: All of the above - -### Response: -'SCIWORA' is the abbretion of 'spinal cord injury without radiographic abnormality'. MRI is the Investigation of Choice and has normal plain film and CT findings. It tends to occur in the paediatric population and involves upper cervical spinal cord. MRI cervical-dorsal spine Sagitta view of a paediatric patient showing hyper intensity in spinal cord at C7-D1 level s/o spinal cord contusion. -### End" -7992,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Vitamin K leads to?, with the following options: A: g-carboxylation of aspaic acid residues to clotting factor 2,7,9 and 10, B: b-carboxylation of glutamic acid residues to clotting factor 2,7,9 and 10, C: alpha - carboxylation of asparatic acid residues to clotting factor 2,7,9 and 10, D: g-carboxylation of glutamic acid residues to clotting factor 2,7,9 and 10 - -### Response: -Vitamin K leads to g-carboxylation of glutamic acid residues to clotting factor 2,7,9 and 10 Vitamin K is essential for adding carboxyl group to glutamic acid residues on 5 impoant clotting factors 1. Prothrombin (II) 2. Factor VII 3. Factor IX 4. Factor X 5. Protein C -### End" -7993,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Mycosis fungoides is best described as, with the following options: A: Cutaneous fungal infection, B: Exematous reaction, C: skin, D: Cutaneous Lymphoma - -### Response: -Ans d: (Cutaneous Lymphoma) Ref: Harrison 17th edition pg 697 Mycosis fungoides is a lymphoid neoplasm of mature T cell * Median age of presentation - mid fifties * Males > females * Indolent lymphoma with patient often having several years of eczematous or dermatitic skin lesions before diagnosis is established * Skin lesions progress from patch- plaque & cutaneous tumours * Advanced stage lymphoma spread to lymph node and viscera * Patient with this may develop generalised erythroderma and circulates tumour cells- Sezary syndrome Rx Localised early stage- radiotherapy often total skin electron beam radiation More advanced- Topical gluco- corticoid Topical N2 mustard Phototherapy Psoralen with UV A(PUVA) Interferon, antibodies etc -### End" -7994,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: HDI includes all except -, with the following options: A: Income, B: Knowledge, C: Life duration and well being, D: Standard of living - -### Response: -Ans. is 'd' i.e., Standard of living o Life expectancy at birth is a dimension of HDI (not life expectancy at one year).HUMAN DEVELOPMENT INDEX (HDDo HDI is a composite index combining indicators representing three dimensions.Components of HDIRecent (23""Ve & 22nAle of Park)Old (Previous editions)1. Longevity: - Life expectancy at birth2. Knowledey Mean years of schoolingy Expected years of schooling3. Income:-GNI per capita1. Longevity: - Life expectancy at birth2. Knowledgey Mean years of schooling (gross enrolment ratio)y Adult literacy rate3. Income: - GDP per capita -### End" -7995,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Inracellular concentration of K+ is, with the following options: A: 5.5meq/L, B: 15meq/L, C: 28meq/L, D: 150meq/L - -### Response: -Ans. is 'd' i.e., 150 meq/L o Intracellular K+ concentration - 150 meq/Lo Extracellular K+ concentration - 4.5 - 5 meq/LComponentExtracellular fluid (ECF) (meq/1)Intracellular fluid (ICF) (meq/l)Na+K+C1-HCO3-Mg+2Ca+2PO4-21425.5103281[?]22[?]5414150410580 0001 75Protein (organic anion)5 (2g%)40 (16g %) -### End" -7996,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Most common cause of arrhythmia is -, with the following options: A: Ischemic injury, B: Automatism, C: Trigered activity, D: heafailure - -### Response: -Ischemic injury is the most common cause of rhythm disorders, because of direct damage or due to the dilation of hea chambers with consequent alteration in conduction system firing. Far less common are inherited causes of arrhythmias. These are caused by mutations in genes that regulate various ion channels that regulate depolarization and repolarization of myocardial cells. Such channelopathies are impoant (but founately uncommon) substrates for fatal arrhythmias. They underlie some cases of sudden cardiac death. Ref : Harrisons 20th edition pg 1443 -### End" -7997,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: Froment signs is positive in injury of which nerve?, with the following options: A: Median, B: Ulnar, C: Radial, D: None of the above - -### Response: -Ans. is 'b' i.e.,Ulnar -### End" -7998,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 64 year old hypeensive obsese female was undergoing surgery for fracture femur under general anaesthesia. Intra-operatively her end-tidal carbon dioxide decreased to 20 from 40 mm of Hg, followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?, with the following options: A: Fat embolism, B: Hypovolemia, C: Bronchospasm, D: Myocardial infarction - -### Response: -A i.e. Fat embolism -### End" -7999,"Below is an instruction that describes a task. Write a response that appropriately completes the request. - -### Instruction: - -Answer the following medical question: A 10 year old child develops hematuria after 2 days of diarhoea. Blood film shows fragmented RBCs & thrombocytopenia. Ultrasound shows marked enlargement of both kidneys. The likely diagnosis is:, with the following options: A: Acute pyelonephritis, B: Disseminated intravascular coagulopathy, C: Haemolytic uremic syndrome, D: Renal vein thrombosis - -### Response: -Answer is D (Renal vein thrombosis): Although presentation of patient is similar to that of hemolytic uremic syndrome the presence of marked enlargement of both kidneys takes the whole diagnosis in our of renal vein thrombosis. Note : Patient in question has marked enlargement of both kidneys which takes the whole diagnosis in our of renal vein thrombosis. Patients who have bilateral renal vein thrombosis may be difficult to distinguish from those with the hemolytic uraemic syndrome. - Both disorders may be preceded by gastroenteritis and in both children may present with dehydration, pallor and evidence of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. - The marked enlargement of kidneys of a child with renal vein thrombosis helps to distinguish the disorder. - Doppler flow study or angiography of IVC may be necessary to confirm the diagnosis. -### End" +version https://git-lfs.github.com/spec/v1 +oid sha256:ab7afa78489da63a8648fe2895f30bc0bf5cad49b30a10ebacf729bf7e4ca6f2 +size 14662308